Doctor who is passionate about acupuncture

Doctor who is passionate about acupuncture

Welcome to my blog

Leading acupuncture specialist for facial rejuvenation, pain relief, stress, anxiety, emotion, depression relief, fertility and miscarriage
Based at Kensington and Chelsea at Central London. Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences. This blog is for information only.

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My Guest blog articles and Reviews

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Reviews and articles

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

Monday, 5 October 2015

Acupuncture helps with PCOS associated infertility and other PCOS symptoms.

We all know women have period cycles, which are normally a month (28 days) with ovulation. Women have two ovaries containing about 1 millions eggs at birth. These are the eggs they ever have and there are no more eggs produced after birth. The existing eggs are lost constantly. By the time at puberty, there are only about 400,000 eggs left. Only 400 to 500 eggs are ovulated in life time. Each month, 15-20 eggs develop and normally only one of them becomes mature (the size of a mature egg is ready to ovulate is about 18-28 mm in diameter) and is released. About 14 days after ovulation the woman would get a period if she is not pregnant. If the eggs in ovaries don’t develop and mature properly, there is no ovulation. This will cause problems in women. Polycystic ovary syndrome (PCOS) is such a condition with ovulation problem. The ovaries in women with PCOS contain many small cysts which are fluid-filled sacs. This is because eggs stop growing and form many cysts; they don’t mature and are not released. Women with PCOS don’t ovulate regularly and they don’t get regular periods either.

If you are diagnosed with PCOS, you are not alone. PCOS is a common ovary disorder affecting 8-10% of women in reproductive age. The symptoms include 1) many small cysts on the ovaries found in the ovary ultrasound scan; 2) irregular period cycles or no periods because of irregular ovulation or no ovulation; infertility and miscarriage; 3) excess body air or thinning hair on the head together with acne because of high levels of testosterone produced by the ovaries. 4) insulin resistance and overweight are common presentation for PCOS.

The infertility rate with PCOS is very high. Although patients with PCOS produce high number of eggs, they are often poor quality, leading to lower fertilization and implantation and higher miscarriage rate. These women have difficulty to conceive and need treatment to improve chances to get pregnant. The reduced fertility is attributed to anovulation, poor egg quality resulting from poor egg development as well as to endometrial abnormalities in women with PCOS. Contribution of endometrial abnormalities and low quality of embryos could explain the higher rate of implantation failure after induction of ovulation or higher risk of spontaneous miscarriage after pregnancy in women with PCOS.

The causes of PCOS are not fully understood. Genetic factor contributes to PCOS. Hormonal imbalance affecting follicle development and maturation is associated with PCOS. hypothalamic pituitary ovarian axis has been disturbed. Pituitary gland is more sensitive to Gonadotropin releasing hormone (GnRH) produced in hypothalamus. The hormone imbalance includes follicle stimulating hormone (FSH) deficiency, hypersecretion of luteinizing hormone (LH), high level of androgen and high blood level of insulin with insulin resistance. Women with PCOS have lower FSH compared with women without PCOS. FSH deficiency results in accumulation of smaller follicles which have undergone premature arrest and failed to become dominant follicle. Women with PCOS produce more LH during the follicular phase in their cycles. Luteinizing hormone (LH) pulse is increased in frequency and amplitude together with low follicle stimulating hormone (FSH) production. Increased LH stimulates androgen production and decreased FSH impairs follicle development, maturation and ovulation. androgen level is elevated which results in the clinical symptoms: hair overgrowth and acne. High level of androgens, are found in the blood circulation. These excessive androgens mainly produced in ovaries. A part of these androgens are produced in adrenal gland. High level of androgen is associated with increase LH level which may block dominant follicle development and cause follicular arrest and degeneration. Insulin may be involved in follicle recruitment and it may be an important mediator in follicle development. Insulin resistance may impair follicle development resulting in compromised fertility and miscarriage.

Recent research suggested that increased sympathetic nerve activity may be involved in the pathology of this condition. The greater density of sympathetic nerve fibres in polycystic ovaries has been seen and this increased ovarian sympathetic nerve activity might contribute to PCOS by stimulating androgen secretion. Women with PCOS have increased nerve growth factor (NGF) which is a strong marker for sympathetic nerve activity. Women with PCOS have increased muscle sympathetic nerve activity (MSNA), altered heart rate variability and attenuated heart rate recovery post exercises, compared with age and BMI matched controls. This suggests that there is an increased sympathetic nerve activity in women with PCOS. High testosterone was related to high sympathetic nerve activity in women with PCOS and the degree of androgen concentration can reflect the severity of PCOS which indicates that the degree of increased sympathetic activity is related to the degree of PCOS severity. Physical exercise and low frequency electroacupuncture decrease high level of sex steroid precursors, estrogen, adrgens and androgen metabolites. Physical exercises and acupuncture decreased high sympathetic activity in women with PCOS. Renal sympathetic denervation reduced MSNA and blood pressure and improved insulin sensitivity in some patients with PCOS and hypertension. Reduction of sympathetic nerve activity could be new treatment target of PCOS. Also inflammatory substances in blood increased in women with PCOS indicating the involvement of inflammation to PCOS. Stress is a risk factor of PCOS. Changing of follicular fluid microenvironment could impair egg development. Research showed that higher emotional distress was consistently found for women with PCOS compared with control populations.

There is no gold standard long term treatment for women with PCOS. For many years oral contraceptive pills played an important role in treating PCOS which normalises menstrual cycles and reduces excessive hair growth and acne. Antiadrogens also used to treat excessive hair growth. With the increasing understanding the role of insulin resistance associated with PCOS new agents-the insulin sensitizers such as metformin are introduced in the treatment of PCOS. There are other therapeutic options are emerging such as statins are a promising therapies. Vitamin D, B12 and folate may improve insulin resistance which is beneficial for women with PCOS, though this needs more research to confirm. Pharmacological treatment is effective but associated with unwanted side effects. The use of acupuncture for women’s fertility treatment becomes very common. Up to 22% of women use acupuncture for their infertility treatment in the US and about 8% in the UK. Recent research showed that acupuncture improves period cycles and ovulation as well as excessive hair and acne in women with PCOS.

Acupuncture had effect on excessive androgen and period change in women with PCOS. Polycystic ovarian syndrome (PCOS) presents hyperandrogenism which is a medical condition that is characterised by excessive production of androgen. The symptoms include high acne, excessive hair growth and high testosterone level. Less frequent or absent period and polycystic ovaries. Oral contraceptives, metformin and lifestyle change are recommended for the treatment for women who don’t want to improve fertility. Side effect could be the problems for long term treatment. People tend to seek alternative treatment for the condition. Jedel E et al studied the effect of acupuncture in women with PCOS. They allocated 84 women with PCOS aged 18-37 to three groups: acupuncture group, physical exercise group and no intervention group. 16 weeks treatment was carried out for these patients. After 16 weeks treatment, blood testosterone level and acne score were decreased, whereas menstrual frequency increased in the acupuncture group and exercise group compared to no intervention group; acupuncture group improved significantly greater than that for exercise group. Their conclusion was that both acupuncture and physical exercise had effect to treat excessive androgen and less frequent period or absent period and acupuncture had better effect than physical exercise intervention.

Polycystic ovary syndrome (PCOS) is the most common cause of anovulatory infertility. The first-line medical treatment for women with PCOS to improve fertility outcomes is clomiphene citrate. The second-line medical treatment is donadotrophins, laparoscopic ovarian surgery or metformin, if clomiphene citrate becomes resistant in women with PCOS. Because women with PCOS need prolonged treatments and these medical treatments often accompany numerous side effects. Seeking alternative treatments with less side effects could help ovulation and other symptoms. For example, lifestyle change could help infertile anovulatory PCOS in women who are overweight or obese. Clinical and experimental evidence indicates that acupuncture may be a safe alternative or complement in the treatment in women with PCOS.

A study summarized the clinical researches for PCOS treatment with acupuncture from recent years in China. The study showed that ovulation rate with acupuncture treatment was improved about 80% and pregnancy rate achieved was about 60%. Other symptoms were also improved. Stener-Victorin et al studied effect of acupuncture on ovulation in 24 women with PCOS. The result showed that 10-14 acupuncture treatments in 3 months significantly increased ovulation and period cycles in women with PCOS. There were some published randomized controlled trials which studied effectiveness of acupuncture on women with PCOS associated infertility. The results showed significantly higher pregnancy rate in the acupuncture groups compared to the control groups.

There are physiological bases that could explain why acupuncture treatment is effective on PCOS. Acupuncture stimulates autonomic nerve activities. Stimulation of peripheral nerve terminals causes release of neuropeptides which increase blood flow. Stimulation of nerves on abdomen and legs reduced sympathetic nerve activities in ovaries resulting in increasing ovary blood flow. Acupuncture stimulates peripheral nerve and the signals transmit to central nervous system. This improves function of hypothalamic-pituitary-ovarian axis, regulates blood hormone levels, increases antiinflammatory substances and improves ovary ovulation. Also acupuncture could reduce ovarian cyst size and number. Acupuncture helps reduce stress in women with PCOS.

There was study that investigated effect of acupuncture on egg quality and pregnancy rate for patients with PCOS undergoing IVF. They found that egg quality, fertilisation rate and quality of embryo were all higher in acupuncture group than that for control group with no intervention. Higher pregnant rate was achieved in acupuncture group. Acupuncture improved egg quality as well as local environment of ovaries.

PCOS increases risk of depression and anxiety and negatively affects health-related quality of life. Life style change on diet and exercise is essential and proved that this decreased depression and improved quality of life. E Stener-Victorin et al studied the effect of acupuncture and exercises on depression, anxiety and impaired quality of life in women with PCOS. 72 women with PCOS were recruited in the study. 28 women were offered acupuncture and 29 women were offered physical exercise and 15 women were assigned with no intervention. The treatments were lasted for 16 weeks for different interventions. Total 14 acupuncture treatments over 16 weeks were offered. Physical exercise program included regular exercise, such as walking, cycling or any other aerobic exercise at a self-selected pace. The frequency of exercise was at least 30 min and at least 3 times a week. This lasted 16 weeks. The assessment was at the end of 16 week treatment and 16 week follow-up after the last treatment. The results showed that depression and anxiety scores were reduced at the end of the treatment and the follow-up in the acupuncture group; the quality of life such as physical, energy/vitality, general health perception and the mental component was also improved in the acupuncture group. The quality of life such as general health perception, physical functioning and emotion was improved in exercises group.

Acupuncture is beneficial for patients with PCOS and obesity

Obesity is also associated with infertility with anovulation. It also causes pregnancy loss and late pregnancy complications. There is a link between PCOS and obesity. Women with PCOS have increased the chances of obesity and up to 66% of them are obese. Women with obesity are more likely to develop and express PCOS. PCO is present in about 20% women and many of them do not have other symptoms, such as abnormal period, acne, excessive hair growth, insulin resistance, impaired glucose tolerance, type 2 diabetes, cardiovascular diseases. These symptoms are likely to appear if the women become obese or over weight. Obesity could worsen these symptoms increasing the risk of type 2 diabetes and cardiovascular diseases. Weight loss can improve those symptoms. Preventing obesity can reduce the chances of developing PCOS. Abdominal obesity in particular is associated with anovulation and infertility. Obesity in PCOS is related to failure or delayed response to many infertility treatments. Obese women with PCOS were associated with an increased risk of miscarriage. Obese women with PCOS undergoing IVF had fewer eggs collected and lower fertilised eggs resulting in lower pregnancy rate. Study showed that after losing 5% of initial body weight obese women with PCOS improved spontaneous ovulation and spontaneous pregnancy rate. Reducing abdominal obesity is very effective to restore ovulation. Weight loss before conception also improved live birth rate in those women. Weight loss prior to start of infertility treatment can be a good option.

Research studies have shown that acupuncture can help reduce weight and improve ovulation and menstrual frequency. For example Zheng et al studied abdominal acupuncture for patients with obesity-type PCOS. They compared the effect of acupuncture with that metformin. After 6 month of treatment body mass index (BMI), waist to hip ratio (WHR), Ferriman-Gallwey score, ovarian volume, LH hormone, ratio of lLH and FSH, testosterone, LDL-C, triglycerides, total cholesterol, fasting blood glucose, 2-hour postprandial blood glucose, fasting insulin, 2-hour postprandial blood insulin, and HOMA-IR were reduced significantly in both groups. Acupuncture had better effect on reducing BMI, WHR and increasing menstrual frequency and had fewer side effects compared with those with metformin.

Lai et al studied the effect of acupuncture on polycystic ovarian syndrome (PCOS). There were 86 patients with PCOS and obesity involved in the study. These patients were divided into two groups: acupuncture group and metformin group. In acupuncture group the patients received abdominal acupuncture for 6 months. Body mass index (BMI), waist-hip ratio (WHR), Ferriman-Galleey score (FGS) which is the method to assess overgrowth hair, menstrual frequency (MF), ovarian volume (OV) were measure and compared before and after the treatments. Hormonal levels including follicle stimulating hormone (FS), luteinizing hormone (LH), testosterone hormone were tested as well. In addition fasting blood glucose and insulin, insulin resistance and blood lipid levels (LDL and HDL) were tested. As a result, they found that BMI, WHR, FGS and OV were significantly reduced after treatment in both groups (acupuncture group and metformin group). Menstrual frequency was significantly increased after treatment in both groups. Hormone levels including LH, LH/FSH and testosterone were decreased after treatment in both groups. Fasting blood sugar and insulin, insulin resistance and LDL were decreased, while HDL was increased in both groups. They concluded that acupuncture was beneficial for patients with PCOS and obesity.

Acupuncture could increase insulin sensitivity and reducing blood sugar levels; it also reduces cortisol levels and helps weight loss and eating disorders. Insulin resistance is closely linked to obesity, type 2 diabetes, hypertension, PCOS etc. Liang F and Koya D analysed 234 publications in English from 1979 to 2009 on the effect of acupuncture for the treatment of insulin resistance. These literatures provided evidence to support the effectiveness of acupuncture for treating insulin resistance.

Current opinions on effect of acupuncture to treat PCOS

Recently Lim CE and Wong WS did a review to investigate the effect of acupuncture on polycystic ovary syndrome (PCOS). They obtained and assessed all available acupuncture studies on women with PCOS from June 1970 to June 2009. From this review they found that acupuncture is effective for PCOS treatment. Several studies showed that acupuncture increased beta-endorphin levels which last up to 24 hours; acupuncture may affect hormone levels including follicle stimulating hormone (FSH), luteinizing hormone (LH) and androgen. Acupuncture affects the hypothalamic-pituitary-adrenal axis to contribute to reducing stress. They concluded that acupuncture is a safe and effective treatment for PCOS and no side effects were found. The possible mechanism of the acupuncture treatment of PCOS includes increasing ovarian blood supply, reducing ovarian volume and ovarian cyst numbers. Acupuncture could increase insulin sensitivity and reducing blood sugar levels; it also reduces cortisol levels and helps weight loss and eating disorders. Insulin resistance is closely linked to obesity, type 2 diabetes, hypertension, PCOS etc. Liang F and Koya D analysed 234 publications in English from 1979 to 2009 on the effect of acupuncture for the treatment of insulin resistance. These literatures provided evidence to support the effectiveness of acupuncture for treating insulin resistance.

Stress is a risk factor for PCOS and acupuncture helps to reduce stress

Polycystic ovary syndrome (PCOS) is a common cause of anovulation leading to infertility. A research analysis showed that emotional distress is a common risk in women with PCOS. This conclusion was drawn from meta-analysis of 28 studies from Veltman-Verhulst SM et al in University Medical Center Utrecht, The Netherlands. They examined emotional distress and its association in women with PCOS. The data was obtained up to November 2011. 28 studies included 2384 patients with PCOS and 2705 women in control population. Higher emotional distress was consistently found for women with PCOS compared with control populations, though distress scores mostly remain within the normal range. More recently Murri M et al analysed data up to June 20120 to study oxidative stress and PCOS. Their results were from 1633 studies including 4933 patients with PCOS and 3671 controls. They found that patients with PCOS have higher circulating markers of oxidative stress compared with controls. Oxidative stress may contribute to the pathophysiology of PCOS.

Acupuncture was effective to treat PCOS and acupuncture was also effective to reduce stress. Research showed that 8 weeks acupuncture intervention could help reduce infertility related stress. Acupuncture treatments help change social and relationship concern and reduce anxiety. They felt more relaxed than those without acupuncture treatment.

Recently there is another study on acupuncture for PCOS. In this study, 101 women with PCOS participated. The main acupuncture points used were Zhibian (BL54) and Shuidao (ST28) together with other acupuncture points which chosen individually. After 5 courses of acupuncture treatments basal body temperature was improved and the follicle-stimulating hormone (FSH), luteinizing hormone (LH), LH/FSH and testosterone (T) were significantly reduced.

New research shows acupuncture increases ovulation frequency in women with PCOS

Am J Physiol Endocrinol Metab 2013 published a paper titled Acupuncture for ovulation induction in polycystic ovary syndrome (PCOS): A randomized controlled trial. This research has been done by Stener-Victorin E group. They investigated the effects of acupuncture on ovulation frequency and the mechanism. 32 women with PCOS participated the research. Acupuncture performed twice a week for 10-13 weeks. Previously acupuncture has already been proven to improve menstrual frequency and decrease circulating testosterone in women with PCOS. After 13 weeks of intervention, luteinizing hormone (LH) secretion patterns were changed. Ovulation frequency was higher in acupuncture group compared with control group. Ovarian and adrenal sex hormones Levels decreased significantly in acupuncture group compared with control group.

PCOS takes place when the normal cycle is disrupted due to anovulation. This creates hormonal imbalance with increased oestrogen and androgen in the circulation and without progesterone. Acupuncture increases ovulation frequency and restore hormonal balance.

There are about 10-20% of women have PCOS. The conventional treatments include using birth control pills to inhibit hormone production and using new drugs like metformin a type II diabetes agent to lower insulin resistance. However these treatments are not particularly successful with many side effects. Acupuncture is a promising approach to treat PCOS.

Raja-Khan N et al Am J Physiol Endocrinol Metab (2011) 301:E1-E10.
Jedel E et al Am J Physiol Endocrinol Metab (2011)
Stener-Victorin E et al Ata Obstet Gynecol Scand (2000) 79:180-8
Cui W Zhongguo Zhen Jiu (2011) 31:687-91
E Stener-Victorin et al BMC Complement Altern Med (2013) 13:131
Alexandra Bargiota and Evanthia Diamanti-Kandarakis Ther Adv Endocrimol Metab (2012) 3:27-47
Lai MH et al Zhen Ci Yan Jiu (2010) 35:298-302
Lim CE and Wong WS Gynecol Endocrinol (2010) 26:473-8
Liang F and Koya D Diabetes Obes Metab (2010) 12:555-69
Veltman-Verhulst SM et al Hum Reprod Update (2012) 18:638-51
Murri M et al Hum Reprod Update (2013) Jan 16
Zheng YH et al J Altern Complement Med (2013) 19:740-5

Tuesday, 18 August 2015

Acupuncture is popular therapy in Norway

Acupuncture is a popular therapy in Norway

Recent years the use of complementary and alternative medicine (CAM) is increasing. A recent Norwegian survey shows that 45 % of the respondents had used CAM within the last 12 months. Massage was the most commonly used CAM method, followed by acupuncture. Acupuncture has been an integrated part of the clinical practice of Norwegian general practitioners (GPs). Many GPs have undergone acupuncture training. A survey involved in 111 GPs has shown that 60 % used acupuncture to treat patients. Fifty-two per cent used acupuncture in more than 5 % of their consultations. Acupuncture was most often used to treat musculoskeletal pain, migraine and tension headache, but was also used in nausea, indigestion, allergies, asthma and sleeping disorders. For the most common disease groups, positive effect was reported in 3 out of 4 patients. From 2001 to 2008 the proportion of Norwegian hospitals offering CAM increased from 25 % to 50.5 % and acupuncture was the therapy most frequently offered.

Who is likely to use acupuncture?

There was a report about characteristics of acupuncture users among internal medicine patients in Germany. 2486 patients were participated the study. The results have shown that 51.49% reported acupuncture use and 39.22% reported no prior use. The use of acupuncture was associated with higher age, i.e. those aged 50-64 were more likely to have used acupuncture, while those younger than 30 were less likely. Patients with spinal pain, fibromyalgia, or headache were more likely to be acupuncture users; while IBS patients were less likely. Patients with good to excellent health status, high external-social health locus of control and current smokers were less likely to have used acupuncture. Among those who had used acupuncture, 42.34% perceived the treatment as helpful, while 35.94% did not. Rated helpfulness was associated with female gender, full-time employment, high health satisfaction, and high internal health locus of control. Those with a diagnosis of osteoarthritis or inflammatory bowel disease were more likely to find acupuncture helpful; those with headache or other types of chronic pain were less likely to find acupuncture helpful. The conclusion was that Acupuncture was used by more than half of internal medicine patients. Prevalence and rated helpfulness of acupuncture use was associated with the patients' medical condition, sociodemography, and health locus of control.

Why patients use acupuncture

Acupuncture is used to treat many conditions in china for thousands years. Acupuncture is now used by many people in Western world for some reasons. Why people use acupuncture? Studies in New Zealand have shown that patients' reasons for using acupuncture are diverse and include dissatisfaction with conventional medicine and attraction to holistic and empowering models of healthcare. Patients mostly accessed acupuncture for musculoskeletal and pain-related conditions. Treatment is thought to relieve symptoms of the presenting concern and a range of other effects that improve well-being. Acupuncture was viewed to be appropriate for treating chronic and quality of life health issues. The barrier to access acupuncture was treatment-associated cost.

Jacobsen R et al BMC Complement Altern Med (2015) 15:275
Cramer H et al Complement Ther Med (2015) 23:423-9
Jakes and Kirk (2015) J Prim Helath Care 7:124-9
Jakes et al (2014) J Altern Complement Med 20:663-71

Sunday, 12 July 2015

Unexplained infertility? acupuncture can help

What is infertility? Infertility is defined as inability to conceive after 1 year of regular unprotected intercourse. It is 6 months with women older than 35 years. If you were told that you had unexplained infertility, what does that mean? If you have difficulty to conceive for some time, you would be put on some tests to evaluate the underlying causes for the infertility. There is some standard infertility evaluation. It includes a semen analysis, assessment of ovulation, and a hysterosalpingogram (to detect uterine and fallopian tube pathology); ovarian reserve and laparoscopy are further tests that could be done to examine function of reproductive system. When these results are normal, you would be diagnosed unexplained infertility which means that there are no underlying causes for your infertility found. Are there many people suffer from this condition? Yes. 1 in 6 couples are seeking specialist help in trying for a baby. There are about 30% of infertility is unexplained which means the causes for the infertility are unknown. This diagnosis will be based on a series of fertility tests without revealing any abnormality. The frustrating thing is that there is no reason for the infertility, how can you improve the fertility? Change life style? Many people have already had a very healthy life style, good nutritious diet. They do exercises regularly. General health is good. Nothing on this aspect needs to be improved. What causes their reproductive system problems?

Research showed that subclinical pelvic inflammatory disease (PID) is very common in women. Women with undetected subclinical PID have no symptoms, but the pathological mechanisms are similar to those of acute PID. Wiesenfeld et al studied whether women with subclinical PID are at an increased risk for infertility. They found that women with subclinical diagnosed at enrolment had a 40% reduced incidence of pregnancy compared with women without PID. Undetected subclinical PID could be one of the unfound causes for infertility. Subclinical conditions do not cause symptoms but they make reproductive system not functioning properly causing infertility. Embryos are so delicate and they cannot survive in any unfavourable environment.

Genetic reasons, there are many inflammation events going on in women’s reproductive system. Women’s body has an ability to clear this inflammation very quickly, but some women have difficulty to clear the inflammation in their reproductive system. This may affect their ovarian function including egg quality and poor microenvironment. As a result, they present difficult to get pregnant.

Stress, having been trying to conceive for a long time without success makes those couples stressed. Furthermore they are told that the reasons for the difficulty of conceiving are not clear and the diagnosis of the infertility is unexplained. This makes them more stressed. At least some unexplained infertility is caused by stress and all of this stress mentally and physically also makes the condition worse. Stress makes hormone unbalanced and this affects egg development in female and sperm development in male resulting poor quality of eggs and sperms. This makes low fertilization rate and low quality of embryo.

Do you need to be treated to get pregnant, if you were diagnosed unexplained infertility? Is there a chance to get pregnant on your own without any treatment? What treatments are available for unexplained infertility? Yes, you do need treatment. Many studies showed that the pregnant rate was 1.3 to 4.1% in the untreated group with unexplained infertility. This was lower than most treatment intervention. You have more chances to get pregnant with less than two years duration of unexplained infertility and fewer chances when the duration of infertility exceeds three years and greater than 35 years of age. The duration of infertility is important. The longer the infertility, the less likely the couple is to conceive on their own. With infertility 1 year duration, the couple have 20% chances to get pregnant after a year on their own. After 5 year infertility, the chances dropped to less than 10% without any treatments.

What treatments are available for couples with unexplained infertility? There are some treatment approaches available for unexplained infertility, but they are empiric. The standard protocol is to start from low technology to high technology treatment options. There is no evidence showing that any one treatment is better than the other. The treatment of unexplained infertility is dependent on availability of resources and patients’ age and duration of infertility.

Here are some treatment options:

Controlled ovarian hyperstimulation (COH) and Intrauterine insemination (IUI): To maximize the chance of fertilization, COH and IUI have been used. COH involves medications stimulating the development of multiple eggs of the ovaries in one single cycle, resulting in multiple ovulations. Both clomiphene citrate and gonadotropins have been used for COH. This expects more eggs available for fertilisation. IUI involves placement of washed sperms into uterine cavity around the time of ovulation. IUI may increase the density of motile sperm available to ovulated eggs. There has been a marked increase in the use of COH with or without IUI in the treatment of unexplained infertility over the past decades.

In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI): IVF is most expensive, but also most successful treatment of unexplained infertility; it could be done with or without ICSI. IVF involves stimulating multiple eggs to develop; egg collection to get eggs; fertilising the eggs in the laboratory; and embryo transfer to the uterus. ICSI involves picking up individual sperm and injecting the sperm into the cytoplasm (the inner part) of the egg. The same procedure as IVF in women is also involved.

About ten years ago Guzick DS et al from University of Rochester New York analysed the efficacy of alternative treatments for unexplained infertility from 45 published reports. They found that combined pregnancy rates per initiated cycle were IUI 3.8%, clomiphene citrate (CC) 5.6%, CC + IUI 8.3%, gonadotropins (hCG) 7.7%, hCG + IUI 17.1%, IVF 20.7%. More recently research also showed that IVF is more effective technique for unexplained infertility treatment.

Is acupuncture effective for unexplained infertility? Yes, acupuncture is effective and it is one option for couples with unexplained infertility. Acupuncture is playing an important role in infertility treatment. The treatment for infertility with acupuncture increased fivefold in 10 years time. Currently there are many researches show that acupuncture stimulates brain to improve hormone balance. Acupuncture is well known to produce endorphins in brain releasing pain and also affect the levels of pituitary and ovarian hormones which regulate ovulation. Acupuncture stimulates nerve ending, as a result it improves reproductive system blood flow. Subsequently egg quality and ovulation are improved, fallopian tube spam is released, intrauterine environment is more suitable for embryo implantation and growth. Acupuncture regulates immune function to benefit fertilized eggs survival. Acupuncture also increases in sperm count and improves sperm quality in men suffering from infertility. Acupuncture can help reduce stress both in women and men. After a few month acupuncture treatment, women have better quality of eggs and men have better quality of sperms. Better fertilization and good quality of embryos will be obtained.

Acupuncture is also a useful tool for IVF support to increase IVF success rate because of high quality of eggs and sperms. Acupuncture increases two fold of the pregnancy rate of IVF, if acupuncture is performed during IVF treatment. A study has shown that when combining IUI with acupuncture treatments, 65.5 per cent of the test group pregnancy rate was achieved, compared with 39.4 per cent of the control group, who received no acupuncture therapy. These are major benefits of acupuncture

Here are some case studies showing the effectiveness of acupuncture for unexplained infertility.

There is a report in Chinese for effectiveness of acupuncture on unexplained infertility. 58 patients with unexplained infertility were included in acupuncture group. The age was from 26-38 and trying to conceive from 2-5 years. 41 patients had primary infertility and 17 patients had secondary infertility. All patients had normal fertility evaluation. After 3-5 period cycles of acupuncture treatment, 42 patients achieved pregnancy. Following is a typical case. A 26 year old woman was trying to conceive for 4 year without success. Her period was normal but she had a severe period pain. All fertility tests were normal and the diagnosis was unexplained infertility. After 4 month acupuncture treatment, she was pregnant and gave birth to a lovely girl.

There was a study using acupuncture to treat explained infertility.104 women with unexplained infertility were involved in this study. The age of participants was from 26 to 41 and the average age was 32. The length of history of infertility was from 20.8 to 50.3 weeks with average 33.5 weeks. 41 participants (39.4%) had undergone an assisted reproductive technology (ART) treatment before joining the study. The average number of the ART treatments was 1.4 cycles. Acupuncture were offered for 6 month. At the end of the study, 60% of the patients achieved pregnancy.

Wiesenfeld H et al Obstet Gynecol (2012) 120:37-43
Ray A et al Reprod Biomed Online (2012) 24:591-602
Hopton AK et al Acupuncture in practice: mapping the providers, the patients and the settings in a national cross-sectional survey. BMJ Open. (2012)11:2-9
Yu Ng et al Fertility and Sterility 2008, 90: 1-13
Gnoth C et al Hum Reprod (2005) 20:1144-7
Guzick DS et al Fertil Steril (1998) 70:207-13
Pandian Z et al Cochrane Database Syst Rev (2012) 4:CD003357
Park JJ et al J Altern Complement Med (2010) 16:193-8

Tuesday, 31 March 2015

Acupuncture helps with chronic fatigue syndrome

I am very tired. It is not a rare complaint. Everyone must ever feel tired sometimes, but the tiredness would go away after rest or sleep. If it does not go away, it is a problem. Constant fatigue is the main symptom of chronic fatigue syndrome (CFS). CFS refers to severe exhaustion during and after daily activities or to a lack of energy which is prolonged for 6 or more months and resting and sleeping cannot make fatigue go. CFS affects about 1 in 300 people in the UK. It is about three times as common in women as in men. Most common age group developing CFS is 20-45 and it occurs more in women than in men. Apart from constant fatigue feeling, there are also other symptoms associated with severe fatigue, such as muscle and joint pain, headache, insomnia and poor short term memory etc.

The cause is not clear but there are a few theories including: a viral infection, immune system problems, neuroendocrine dysfunction causing hormones imbalance and psychiatric problems, such as stress and emotional trauma, various inflammatory conditions, central nervous system impairments, and stress. Recently a reduced blood flow in some brain region is found. Some biochemical changes were found in the brain. The purpose of the treatment is to improve the symptoms. Treatments include cognitive behavioural therapy, a structured exercise programme called graded exercise therapy, medication to control pain, nausea and sleeping problems. Acupuncture helps improves symptoms such as reducing pain, stress and improving sleep. This will help improve quality of life in patients with CFS.

Effectiveness of acupuncture on chronic fatigue syndrome

There is no known cure for this condition although treatment may help to ease symptoms. Recently much research has been done to show acupuncture is helpful for chronic fatigue syndrome. For example, one study compared the effects of acupuncture, warm needle and non acupoint groups. They have shown that in comparison with pre-treatment, the scores of Chalder Fatigue Scale including physical and mental fatigue and total score were significantly decreased in both acupuncture and warm-needling groups but not in the non-acupoint group. The physical, mental and total scores of the acupuncture and warm-needling groups were significantly lower than those of the non-acupoint group. Another study compared the effect of acupuncture and prednisone. They have shown that after one course of treatment, the BELL's scores of both groups were obviously improved, but there was no significant difference between groups; after two courses of treatment, the BELL's score in acupunctureand cupping group improved more obviously than that in Prednisone group, and the total effective rate of 91.9% (34/37) in acupuncture and cupping group was superior to that of 71.4% (25/35) in Prednisone group. There was a study compared the effect of acupuncture on chronic fatigue syndrome with herb injection. They found that acupuncture had better effect than herb injected on fatigue scores and symptoms improved.

Recently Zhang W et al studied the effect of acupuncture of Back-shu acupoints in patients with CFS. This was a randomised controlled trial involved in 120 patients with CFS. These patients were equally divided into two groups: acupuncture group and control group. General health was measured and fatigue was measured using Chalder fatigue scale. At the end of the treatment and follow up survey at 4 weeks and 3 months after the treatment, mental and physical function, pain sensation as well as Chalder fatigue scale was improved significantly in acupuncture group compared with those control group. They concluded that acupuncture is effective on chronic fatigue syndrome both on immediate and mid- term basis.

Ng SM &Yiu YM studied the effect of acupuncture on chronic fatigue syndrome (CFS). The participants were 99 patients with chronic fatigue syndrome. This study was well designed with randomized, controlled and single blinded methods. These participants were divided into two groups: acupuncture group and control group with sham acupuncture. The interventions were given twice a week for 4 weeks. They found that physical and mental fatigue was significantly decreased after the treatments. Health related quality of life was improved significantly. Surprisingly there was therapeutic effect with sham acupuncture which was considered due to pressure on the acupuncture points from the sham needles in addition to normal placebo effects. However acupuncture has significantly greater effects than that for sham acupuncture.

When is the best time for acupuncture treatment for chronic fatigue syndrome?

Acupuncture is use to treat chronic fatigue syndrome effectively. In modern era, people are busy at work and they usually go to acupuncture treatment in the evening after finish a day’s work. For chronic fatigue syndrome treatment with acupuncture, is there different effect when acupuncture is received during different time of the day? Ling JY et al investigated this aspect using acupuncture in selective time 9:00 am to 11:00 am in the morning and compared the effect with acupuncture at any time apart from the selective time. 80 patients with chronic syndrome are participated the study. The results have shown that the improvements in the scores of the selective-time-acupuncture group were superior to the anytime acupuncture group. More specifically in the anytime acupuncture group, the total score of fatigue and the score of physical fatigue were reduced after treatment as compared with those before treatment. In the selective-time -acupuncture group, the total score of fatigue, the score of physical fatigue and the score of mental fatigue after treatment were reduced obviously as compared with those before treatment. The ratio of CD3+ and CD8+ T cells was increased obviously after treatment in both groups and the ratio of CD4+ and CD8+ T cells was reduced obviously in the selective-time-acupuncture group, which was better than that in the anytime acupuncture group. The total effective rate was 95.0% (38/40) in the selective-time-acupuncture group, which was better than 80.0% (32/40) in the anytime acupuncture group. They concluded that the acupuncture therapy at selective time is effective in the treatment of chronic fatigue syndrome, which is especially better at relieving mental fatigue. The effect of this therapy is achieved probably by improving the immune function via the regulation of the ratios among CD3+, CD4+ and CD8+ T cells.

Recently a clinical trial studied the effect of acupuncture on CFS. The Fatigue Severity Scale (FSS) score, the Stress Response Inventory (SRI), the Beck Depression Inventory (BDI) and the Numeric Rating Scale (NRS) were used to assess the effect. After 5 weeks of acupuncture treatment, FSS score, SRI and NRS were significantly lower in the treatment group compared to the control group. After 13 weeks of treatment BDI score was significantly lower in acupuncture group. Body acupuncture in addition to usual care may help improve fatigue in CFS patients.

Ling JY et al Zhongguo Zhen Jiu (2013) 33:1061-4
Zhang W et al Zhen Ci Yan Jiu (2011) 36:437-41
Ng SM & Yiu YM Altern Ter Health Med 2013 19:21-6
Couilliot MF et al J Integr Med (2013) 11:26-31
Lu C et al Zhen Ci Yan Jiu (2014) 39:313-317
Kim JE et al Trials (2015)16:314

Sunday, 8 February 2015

Differences between Chinese acupuncture, western medical acupuncture and dry needling

Acupuncture is a treatment derived from ancient Chinese medicine. Fine needles are inserted at certain sites in the body for therapeutic or preventative purposes.

Acupuncture is originated from China thousands years ago known as Chinese acupuncture or TCM acupuncture. It is a complementary medicine as a part of Chinese medicine. It is based on qi, meridian theory or Yin Yang theory. In this theory, there is qi which is energy force flowing through meridians or channels freely. There are 14 channels on the body with 361 classic acupuncture points. Apart from these acupuncture points there are many extra points developed or to be developed. If these channels are blocked, qi cannot run through, this will cause disharmony of the body and unbalanced Yin and Yan. Diseases may occur. Chinese acupuncture is involved insertion of needles to certain acupuncture points along certain meridians to unblock the channels and restore body harmony and Yin and Yan balance. As a consequence, it cures illness.

Differences between Chinese acupuncture and western medical acupuncture

Chinese acupuncture was introduced into Western countries for some time and adapted into western medical acupuncture using current knowledge of anatomy, physiology, pathology and principles based on modern medicine. This term of western medical acupuncture is used to distinguish it from traditional Chinese acupuncture. Since 1970s the concept of traditional Chinese medicine such as qi, Yin and Yang is no longer used in western medical acupuncture (WMA). According to British Medical Journal (BMJ), WMA is the form of acupuncture that is practiced predominantly by conventionally trained healthcare practitioners in western countries. It is mainly practiced by conventional doctors, physiotherapists, nurses and other healthcare practitioners working within the Western health service, mostly in primary care but also in rheumatology, orthopaedic and pain clinics. It is a part of conventional medicine rather than a complete “alternative medical system”. Western medical acupuncture is used to distinguish it from acupuncture used as a part of Chinese traditional medicine. Two important distinctions between WMA and Chinese acupuncture are that WMA does not involve the traditional concepts such as Yin/Yang and circulation of “qi”, and that WMA does not claim to be an “alternative” medical system.

Patients are benefit from these needling. The effectiveness of these needles is explained by stimulating nervous system. Acupuncture needling has local effects through local antidromic axon reflexes, releasing neuropeptides such as calcitonin gene related peptide and increasing local nutritive blood flow, improving, for example, the function of salivary glands.In the spinal cord and brain, there is well established evidence that acupuncture causes the release of opioid peptides and serotonin. The clinical effects on musculoskeletal pain are best explained by inhibition of the nociceptive pathway at the dorsal horn (segmental effects) by activation of the descending inhibitory pathways,and possibly by local or segmental effects on myofascial trigger points.

There are fewer differences between traditional Chinese acupuncture and western medical acupuncture in terms of treatment techniques. Both use manual and electrical needles. Classical acupuncture points are still applied because they are proved to be the optimal points to stimulate the nervous system. Duration of the acupuncture sessions vary from very brief to up to 20 min or 30 min.

Dry needling and acupuncture

Dry needling is a special type of acupuncture---a technique using acupuncture for the treatment of muscle pain. It is also an adaption of Chinese acupuncture. The points that dry needling used are so called trigger points which are comparable to the Ashi points in Chinese acupuncture theory. Trigger points in skeletal muscles are the most painful points on deep palpation. They also can trigger referred pain and motor dysfunction. The difference of dry needling from acupuncture is that it is not based on meridian theory; needles are not on the acupuncture points on the meridians, but on the Ashi points. Dry needlings are practiced by many physiotherapists and chiropractors in many countries.


A White

Monday, 5 January 2015

Had miscarriage? acupuncture can help

A miscarriage is the loss of a pregnancy during the first 23 weeks. About 1 in 5 of all recognised pregnancies is miscarried usually before the 13th week of pregnancy. Because of more sensitive techniques developed for detecting early pregnancy, research showed that about up to 70% of all pregnancies are lost. The most common cause of early pregnancy loss is chromosomal abnormalities. Collagen vascular disease is one of the causes. Collagen vascular diseases are conditions in which a person’s own immune system attacks their own organs, such as systemic lupus erythematosus and antiphospholipid antibody syndrome. Uncontrolled diabetes could cause miscarriage. Hormonal problems are also the cause of miscarriage, such as thyroid disease and polycystic ovary syndrome (PCOS). Infection increases the risk of miscarriage. Abnormal anatomy of the uterus could cause miscarriage, such as uterine septum, fibroids. Some life style factors could increase the risk of miscarriage, such as smoking, alcohol, caffeine. Nonsteroidal anti inflammatory drugs are also a risk factor.

Recurrent miscarriage

Recurrent miscarriage is the spontaneous loss of three or more consecutive pregnancies in the first trimester. It affects 1-2% of women, half of whom have no identifiable cause. The causes of recurrent pregnancy loss (RPL) are classified as genetic, anatomic, endocrinological, immunological, microbiological and environmental. Anatomic abnormalities account for 10% to 15% of cases of RPL and are generally thought to cause miscarriage by interrupting the vasculature of the endometrium. There is an association between RPL and heritable thrombophilias which is a condition where the blood has an increased tendency to form clots. Blood clot impairing placental development and function could lead to miscarriage. Imbalanced hormones such as abnormal LH surge, low progesterone and high androgen result in premature egg aging and impaired endometrial development.

Uterine blood flow changes can be seen in the uterus and ovaries during the menstrual cycle and uterine blood flow affects uterine receptivity and an important factor in achieving a normal pregnancy. Differences in uterine blood flow impedance between fertile and infertile women and reduced uterine blood flow may be one cause of unexplained infertility. Recent research also has suggested that impaired uterine blood flow is associated with recurrent pregnancy loss. In women with recurrent miscarriage their blood flow resistance in uterine artery was elevated which means the blood flow was reduced. As we can see that reduced blood circulation in endometrium and placenta is the reason for many miscarriages.

The treatments for recurrent miscarriage are limited. There is a systematic review that evaluated the effectiveness of current treatment methods. Their finding is as follows:

Bed rest: they found no systematic reviews or control trials to show the effectiveness of bed rest in women with recurrent miscarriage.

Early scanning in subsequent pregnancies: There were no systematic review and control trials for this method. Early scanning might reduce anxiety of women with recurrent miscarriage which may be beneficial.

Human chorionic gonadotrophin (HCG) treatment: There were four control trials showing that HCG reduced the miscarriage rate though the standard of the trials were not high.

Progesterone treatment: One systematic review showed that progesterone reduced miscarriage rate.

Intravenous immunoglobulin treatment, trophoblastic membrane infusion, paternal white cell immunisation: There were high standard control trials showing that these treatments did not increase live birth rate in women with recurrent miscarriage.

Lifestyle adaptation (stop smoking, reduce alcohol consumption, Loss weight): There was no systematic review or control trial to show the effectiveness of this methods on recurrent miscarriage.

Low dose aspirin, oestrogen, corticosterioids, vitamin supplementation: There was no systematic review or control trial showing effectiveness of these treatments in women with recurrent miscarriage.

Acupuncture was applied to treat miscarriage in China. There was a case report by Zhang in Tianjin gynecology hospital showing effectiveness of acupuncture in women with recurrent miscarriage. This report is involved 558 cases with recurrent miscarriage. 86.6-93% cases were successful.

In early pregnancy your body starts to change because of the hormonal changes in the body. For example, the uterine and vaginal lining becomes ticker and breast becomes tender. When miscarriage occurred, your body has to go back to normal from the pregnancy loss, physically and emotionally.

Acupuncture can help you recover from miscarriage and get your body ready for next pregnancy. Acupuncture stimulates nerve endings to helps hormone balance; improves ovarian and uterine blood flow; reduces inflammation and reduces stress. All of these could help prevent miscarriage from happening again and have a successful pregnancy.

Here is a case report. Sophia had two miscarriges in 6 weeks and 12 weeks before. After this, she had been trying to get pregnant for a year without success. She started acupuncture treatment, after three cycles, she got pregnant and this time the pregnancy stayed to full term and she had a lovely girl.


Duckitt K and Qureshi A Clin Evid (Online) 2008 pii:1409
Alexandros Sotiriadis BMJ 2004

NICE recommends acupuncture for chronic primary pain April 2021

NICE guidelines for chronic primary pain The National Institute for Health and Care Excellence (NICE) provides national guidance and advice ...