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Maggie Ju (2014) Current opinion in acupuncture on stroke rehabilitation
The Journal of Chinese Medicine And Acupuncture Volume 21 Issue 2 September 2014 P9
Maggie Ju. (2015) What Part Does Acupuncture Play in IVF?
The Journal of Chinese Medicine And Acupuncture Volume 22 Issue 1 March 2015 P21
Maggie Ju (2020) The Potentiality of COVID-19 Treatment with Chinese Herbal Medicine in the UK
The Journal of Chinese Medicine And Acupuncture Volume 27 Issue 2 November 2020 P9
Wednesday, 27 February 2013
Pelvic pain and period pain are the most common symptoms for endometriosis. The pain depends on where the misplaced tissues are located. Deeper implants and implanted area with many pain sensing nerves may be more likely to produce pain. Implanted tissues may produce substances causing pain. Scars formed by implanted tissues could cause pain. Heavy and irregular period is also common symptom of endometriosis. Infertility is another common symptom resulted from endometriosis. The reason for decreased fertility caused by endometriosis is not completely understood. This could be anatomical or hormonal reasons. Misplace tissues cause adhesion and distort normal reproductive system anatomy. For example, it blocks tube affecting egg transportation. It may also affect hormone production causing imbalanced hormone affecting fertility. Misplaced tissue causes local inflammation altering environment of reproductive system.
Surgical treatment focuses on removal of endometrial tissues; medications using birth control pills focuses on regain hormonal balance. Apart from conventional treatment, acupuncture is a new trend to treat endometriosis. Acupuncture reduces pain by its analgesic effect. Acupuncture improves heavy bleeding. Acupuncture also improves fertility for women with endometriosis by reducing local inflammation and restoring hormone balance. Dietary changes by avoiding caffeine, sugar and alcohol consumptions may be recommended. Borage oil or evening primrose oil, vitamine Bs, and vitamin E may be helpful. Regular exercises increase the general well-being in women with endometriosis.
Tuesday, 26 February 2013
Recently researches showed that poor sleep altered gene activities which instruct protein productions in the body. Also natural body clock is disturbed by poor sleep. Preovulatory LH surge is disturbed by lack of sleep causing anovulation. Immune function in the body is disturbed by poor sleep causing many disorders such as diabetes.
Good sleep is essential for those women who want to conceive. Good sleep improves reproductive function, improves ovulation and conceiving and sustains a pregnancy.
Acupuncture can help sleep by altering brain activities.
Apart from lack of sleep can affects ovulation, your other daily activities can affect ovulation too. Excessive exercise, being under weight or overweight, being stressed all of these affect ovulation. These changes reduce gonadotrophin releasing hormone production in hypothalamus resulting in reduction in luteinising hormone (LH) and follicle stimulating hormone (FSH). Changing your life style could improve ovulation.
Alcohol affects fertility in both men and women
It became common knowledge that alcohol affects health. If a couple are trying to conceive, their fertility could be affected by alcohol. There are studies that show the link between alcohol and infertility. Alcohol has negative impact on men’s fertility, such as testicular atrophy, decreased libido, and decreased sperm count, sperm morphology, sperm motility and semen volume. Alcohol has also negative impact on women’s fertility. Though the amount of alcohol is linked to fertility is not clear yet. Study showed that amounts of alcohol ranging one drink a week to 5 units a day can have various effects on fertility, for example, anovulation, luteal phase dysfunction, increased time to pregnancy, decreased probability of conception rate by over 50% and decreased implantation rate, abnormal blastocyst development, increased both the risk of spontaneous abortion and of fetal death.
Caffeine, infertility and miscarriage
The widely known source of caffeine is coffee and tea. Caffeine became a part of the daily life and an integral part of society. Moderate amounts of daily caffeine about 300 milligrams or three cups of coffee cause no harm in most healthy adults. Increased amount of caffeine intakes cause many health problems, such as addiction, insomnia etc. Caffeine has been reported to have negative effects on female fertility. Caffeine increases the time to pregnancy of over 9.5 months, especially if the amount is over 500 mg per day. There is no link between infertility and consuming less than 100 mg or a cup of coffee. Recent research showed negative effects of caffeine on spontaneous abortion, fetal death and still birth. Women who consumed more than 100 mg of caffeine a day were more likely to have a miscarriage. Research showed that after adjusting for smoking and drinking, women who drank four to seven cups of coffee had nearly an 80% increase in chance of still birth and those who consumed more than 8 cups of coffee a day had nearly a 300% increase.
Vegetable protein promotes fertility
High proteins foods are important for our health. Protein helps to lose weight and make you feeling full. But too much proteins increase burdens to your kidney. Eating right kind of proteins appears more important when you are trying to conceive. A recent study showed that meat intake was positively linked to ovulatory infertility. Adding one serving of meat (red meats, chiken, turkey, processed meats and fish) per day had 32% increased risk of ovulatory infertility. Eating chicken and turkey was mostly related; eating red meats was related to a lesser degree; eating processed meats, fish and eggs were unrelated ovulatory infertility; eating foods with high vegetable proteins decreased the risk of ovulatory infertility in some degree. So it is a good idea to replace chicken and red meats with vegetable proteins if you are trying to conceive.
Is exercise good for your fertility?
In men moderate amount of exercise can be good for their fertility. Study has shown that all sperm parameters are higher in men who did an hour exercise three times a week compared with those who did more frequent and rigorous exercise. Riding bicycle for over five hours per week has negative impact on sperm. In women excessive exercise can have negative effect on their fertility too. Increased frequency, intensity and duration of exercise were significantly related with infertility in women who exercised every day.
Blood flow is reduced in your reproductive system when you exercise
Blood flow (BF) increases with increasing exercise intensity in skeletal, respiratory, and cardiac muscle. In humans during maximal exercise intensities, 85% to 90% of total cardiac output is distributed to skeletal and cardiac muscle. During exercise BF increases modestly and heterogeneously to brain and decreases in gastrointestinal, reproductive, and renal tissues and shows little to no change in skin. If the duration of exercise is sufficient to increase body/core temperature, skin BF is also increased in humans. Because blood pressure changes little during exercise, changes in distribution of BF with incremental exercise are essential approach the body used to supply adequate oxygen to the active skeletal muscles.
Acupuncture increased blood flow in reproductive system and boosts fertility
Study has shown that after 8 sessions of acupuncture treatment blood flow in uterine artery is improved.
Where are steroids hormones produced?
Hormones are fundamental for fertility. There are three types of hormones from the chemical point of view: proteins such as FSH and LH, peptides such as GnRH and ACTH, and steroids such as progesterone, estradiol, androgen and corticosteroids. Proteins are large molecules and water soluble, while steroids are small and fat soluble. Peptides are somewhere between the two.
Steroids hormones are produced mainly in endocrine glands which are the adrenals and ovaries in women and the adrenals and testes in men. Small amount of steroids hormones are also produced in peripheral tissues which are nonendocrine tissues such as the liver, intestine, fat, kidney and brain, though this is main source of oestrogen production in menopausal women. Steroids are inactivated in the liver, and to a lesser degree, the kidney.
Hormones and fertility
Hormones are the driving force of your fertility. If you want to understand your fertility, you really need to understand hormones that are involved in fertility. There are mainly five hormones that are involved in fertility: gonadotropin-releasing hormone (GnRH), follicle-stimulating hormone, luteinizing hormone (LH), estrogen and progesterone. These hormones are produced by hypothalamic-pituitary-ovarian axis which refers to the complex interaction between hypothalamus, pituitary, and ovaries. This axis regulates reproductive cycles and fertility by producing those hormones. These hormones directly and indirectly stimulate egg development and ovulation, endometrial development for embryo implantation and menstruation. Disruption of any parts of this axis could lead to loss of hormone balance. As a result menstrual cycles and the fertility can be affected.
Acupuncture helps to balance your hormones
Acupuncture is used for fertility treatment in China and recognised to improve fertility by modern medicine research. One of the mechanisms is acupuncture normalises dysfunction of hypothalamic-pituitary-ovarian axis. This helps to correct hormone balance. Research suggested that acupuncture affects gene expression of brain, as a result it normalizes production of hormones such as GnRH, LH E2. This is of course specific on acupuncture points. Chen et al studied the effect of acupuncture on gene expression and they found acupuncture at some effective points may activate the production of body estrogen, resulting in a long term increase or suppression at the level of gene expression and normalization on the hypothalamus-pituitary-ovarian axis.
How does Traditional Chinese Medicine (TCM) view infertility?
In TCM healthy kidney essence and Qi are essential for fertility. If there is kidney qi deficiency, it causes loss of qi and blood balance, therefore it causes infertility. So anything damage kidney qi could cause infertility, such as genetic causes, heavy menstrual bleeding, too much sexual intercourse, stress, contraceptive pills etc.
In TCM infertility was divided into four types:
1. Kidney deficiency: this was divided into kidney yang deficiency and kidney yin deficiency.
Kidney yang deficiency symptoms include infertility, light period, dizziness, fast heart rate lower back pain, feeling cold, low libido, diarrhea, light tongue with light white coat, sink and week pulse.
Kidney yin deficiency symptoms include infertility, red menstrual blood, thirsty, feeling hot, dizziness, fast heart rate, lower back pain, red tongue with light coating, weak fast pulse.
2. Dampness and phlegm blockage symptoms include infertility, light period, sticky discharge, overweight, red tongue with thick white coating, slippery pulse.
3. Liver stagnation symptoms include infertility, irregular period with irregular menstrual bleeding, dark red with clot, depression, breast pain, lower tummy pain, dark tongue with light coating, floating pulse.
4. Blood stasis symptoms include infertility, light periods, dark blood with clot, lower tummy pain, dark tongue with light coating, floating pulse.
Monitoring your menstrual cycles to get pregnant
Uterine endometrium lies on the inner side of uterus. It has cyclic changes each month in response to ovarian hormones estrogen and progesterone. The endometrium is shed off every month and new one grows in a new cycle. This is a menstrual cycle which reflects the health of reproductive system including hypothalamic pituitary and ovarian axis, and uterus. If you want to get pregnant, monitoring your menstrual cycles is very important to evaluate your reproductive function. The typical cycles are 28 days and periods are 3-7 days. You should have ovulation in the mid cycle day 14. If you have difficult to conceive, and all fertility tests are normal, doing basal body temperature chart to monitor your menstrual cycle is a good way to find what is wrong. It takes lots of efforts, but it is worth doing it. This is because general fertility test is only check at one point of your cycles; in order to get pregnant your menstrual cycles are need to be good all the time. You need to ovulate every cycle, not occasionally. If you have difficult to conceive, and all fertility tests are normal, it is a good idea to get help from acupuncture which could help you to improve your menstrual cycles and your fertility.
If you think your fertility is compromised, you need to take some basic tests to evaluate your fertility. Egg quantity and quality could be checked. This is so called ovarian reserve test. There are three tests:
First, day 3 FSH (follicle stimulating hormone) and estradiol (E2) test. FSH is produced in the brain and it is the main hormone involved in producing mature eggs in the ovaries. FSH level keeps changing and day 3 is the lowest level. If you are running out of egg, the brain has to work hard to produce more FSH to stimulate ovaries for egg maturation. Your FSH level will be high. E2 is mainly produced in ovaries. E2 level in day 3 is also low. High level of E2 will indicate a problem ovarian reserve and suppress brain producing FSH which could mask high FSH.
Second, AMH (anti-mullerian hormone) test. AMH is produced by small follicles in ovaries. The levels are constant and the test can be done at any day of a woman’s cycle. Low level of AMH indicates that the remaining microscopic follicles decreases.
Third, antral (resting follicle) follicle count. Antral follicles are small follicle that can be seen, measured and counted under ultrasound. Low number of antral follicles indicates poor egg quantity.
Ovulation could be tested. This is to know if there is egg released from your ovary in the middle of your cycle.
Ovulation test does not increase stress in women trying to conceive
There are some opinions that ovulation test and timing intercourse could increase stress in women trying to conceive. To solve the problem, intercourse every 2-3 days without checking ovulation was recommended. Does home ovulation test have any impact on stress in women trying to conceive? Toplady S et al from Bedford UK studied home ovulation test and stress in women trying to conceive using a randomized controlled trial. 210 women who were seeking to conceive were participated. 115 women were allocated to the test group which was given digital ovulation tests to time intercourse to the most fertile time of the cycle. 95 women were in the control group which was provided with the current National Institute for Health and Clinical Excellence guidelines for increasing the chances of conception (intercourse every 2-3 days) and asked not to use any additional methods to check ovulation. The study was performed for two menstrual cycles. They found that there was no evidence for a difference in stress level between two groups at any point during the study. They concluded that checking ovulation does not affect stress level in women trying to conceive.
There are four methods to test ovulation.
The first is using ovulation prediction kit. The commonly used kit is the kit to test urine LH level. Before ovulation LH level in the urine is increased. This is something that you can do it yourself.
The second is using BBT (basal body temperature) chart. Charting your body temperature could find out if ovulation occurred. After ovulation, your basal body temperature raised about 0.5 degree. Also you can do this at home.
The third is to use ultrasound scan. Emptied follicle after mid cycle indicates ovulation.
The fourth is day 21 progesterone test. Progesterone is produced by copus luteum which is the remaining part of follicle after the egg is released from ovary. Low level of progesterone indicates no ovulation.
Test your tubes and uterus
Hysterosalpingogram-HSG, this is the test to check your tubes and uterus.
Why prevalence of infertility is increasing?
Infertility issue is increasing, what is the reason for this? The main reasons are lifestyle and nutritional factors, epidemic infections and sexually transmitted diseases. Apart from these reasons, other reasons contribute to the factors. First because of widespread use of contraception, delaying the first pregnancy to their thirties in women, women are at high risk for uterine fibroids, endometriosis, polycystic ovary syndrome (PCOS), and chronic anovulation; Second, prolonged exposure to chronic stress and environmental pollutants are also contribute to decreasing fertility; Third, many patients survive cancer because of successful cancer treatments but their fertility is compromised.
What is your chance to get pregnant with diminished ovarian reserve?
There were many studies about IVF success rate in women with difficulty to conceive, but there were relatively less studies on comparisons of pregnancy rate in natural cycles between women with low ovarian reserve and with normal ovarian reserve. There was a new research about pregnancy rate in non IVF cycles. The participants were younger women (age< or =37 years) with diminished ovarian reserve day 3 FSH greater than 15 mIU/ml. The pregnancy rate was compared with women with normal ovarian reserve day 3 FSH less than 8 mIU/ml. These women were given luteal support with progesterone or at most mild FSH stimulation or intrauterine insemination for mild male factor or cervical factor. Success rate was halved with 33.3% with increased day 3FSH compared with normal day 3 FSH with 62.5%.
What do you need to know about seeking acupuncture treatment for infertility?
Though acupuncture is very popular for infertility treatment, there are different opinions in medical fields about if acupuncture helps infertility. If you want to have acupuncture, follow the advice experts offered:
If you decide to try on acupuncture, look for a practitioner who is trained and licensed in acupuncture, and who has a background in treating infertility.
If you are undergoing fertility treatment with a fertility specialist, make sure that he or she knows you are considering acupuncture.
If you are undergoing IVF or any traditional fertility treatment, don’t take any herbs without first discussing this with your doctor.
If you are undergoing an IVF protocol and acupuncture at the same time, once you reach the implantation stage it’s imperative to take a pregnancy test before proceeding with more acupuncture treatments.
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Petraglia F et al Int J Gynaecol Obstet 2013 Sep 7
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