Complementary Medicine & Fertile Wellness

A Power Point Presentation on The Berkley Center For Reproductive Wellnes & Women's Health

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A Lesson For Acupuncturists Treating Infertility

15% of Americans are afflicted with infertility. Certainly this is a disorder that can be effectively treated with Chinese medicine.  But our success can be greater with a shift in attitude.

As practitioners of Chinese medicine we must be able to understand not only  pathological factors but etiologies too. For example, a pathology leading to male factor infertility is low sperm count. Many TCM practitioners will automatically render treatment based upon the TCM diagnosis arrived at through the four examinations. This is all well and good and appropriate according the context of our training. There is, however, an inherent problem with this type of diagnosis.

Let’s use a case history for illustrative purposes: A forty-five year old male presents with the main complaint of low sperm count. His constellation of signs and symptoms include mild erectile dysfunction, dribbling urination status-post voiding, he craves salty foods and has tinnitus and has a chronic sore knee secondary to unresolved childhood Osgood-Schlatter disease.  We may conclude perhaps that there is a dual vacuity of kidney qi and essence, and treat accordingly. 

Many practitioners of Chinese medicine would be happy to diagnose this case as I have illustrated above yet their treatments would not yield the desired outcome. Why? Because the etiology of this pathology is manifest as a result of a varicocele of long standing. As a result of this varicocele, qi has stagnated, blood has become static and heat has become trapped in the liver channel locally at the level of the affected testicle. It is important to note that there are no signs or symptoms in this patient of blood stasis or heat. Not in the tongue and not in the pulse and not in other presenting signs and/or symptoms.    This type of presentation is not uncommon. I refer to it as a ‘hidden pathology’.

It is a standard method of operation that one must arrive at a differential diagnosis not matter how confusing the case may be and treat accordingly and if the treatment is ineffective, dig deeper, look more closely, reanalyze and alter the diagnosis and try another approach.  This is a clumsy approach and with greater knowledge our system of diagnosis can become more economic and more accurate.

In China, one hundred or five hundred or three thousand years ago, the doctors did not have the distinct advantage that we, as modern day practitioners have. That is, Western medical science. If for example, the modern day TCM doctor did his or her full intake on the above patient and then simply inquired “have you been evaluated by a urologist?” the answer to the riddle would have been instantly revealed if the patient had and come back to your office with a Western diagnosis of vericocele. Thus, as a result of a urological examination we are able to state with certainty that the TCM diagnosis is stagnation and binding of liver qi and stasis of liver blood transforming heat; not kidney vacuity!  If the patient had not been worked-up by a urologist we would be treating uselessly.  Greater knowledge affords greater treatment options. As the Spanish saying goes: “Saber es poder”, knowledge is power!  What we have at our finger tips today that Chinese practitioners of even fifty years ago were deprived of is the availability of a knowledge-base that can positively affect our diagnoses and our treatment outcomes.

I am not suggesting that there is a direct clinical analogue from a Western medical diagnosis to a TCM pattern differentiation in every case, but frequently, in internal medicine there is.

Let’s say that we have a patient whose main complain is azoospermia. Once again, we treat according to the probable diagnosis of jing-essence vacuity.  But if the patient was diagnosed as having Klinefelter's syndrome one could say with confidence that the diagnosis is pre heaven jing-essence vacuity and detriment which, in my opinion, in this case, is untreatable as the pathomechanism is genetically derived. So, now we have treated this patient with herbs and acupuncture for six months to no avail. If you treated him for six years, results would not differ.  We have taken his money, raised his hopes and proceeded in a way which could negatively impact the reputation of Chinese medicine.

Here is another all too familiar classic story: A thirty-three year old female patient presents at the clinic with the main complaint of primary infertility. She is afraid of Western doctors and really believes in alternative medicine and has heard wonderful things about your skills. In fact, you helped a good friend of hers to become pregnant. So, you treat the patient; and treat her, and treat her some more. You use many point protocols and many herbal formulas. You supplement the kidneys and boost the spleen. You sooth the liver and nourish the blood. You fail. Why? Because this patient has severe bilateral adhesions on the salpinges secondary to pelvic inflammatory disease. You cannot help this patient and your advice at the first interview should have been to visit a Reproductive Endocrinologist and have a full work-up. 

Dan Inosanto who was one of Bruce Lee’s martial arts teachers wrote: “Absorb what is useful and discard the rest”  I highly recommend that we, as healthcare providers absorb the useful diagnostic data which is presently available to us from the Western side. Until we do, we will not truly be practitioners of integrated medicine.

Having an understanding of Western medical science will improve our analytic and diagnostic skills and as a result will improve the results of our treatments and as important, help us determine who is treatable and who isn’t.

Mike Berkley, L.Ac.

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mikeberkley@berkleycenter.com

Welcome from Cynthia Stadd, Integrative Nutrition Specialist

Hello!  I am Cynthia Stadd, HHC, Director of Nutrition Services for the Berkley Center for Reproductive Wellness.  My passion is to help others lead naturally healthy lives with a healing whole foods diet, stress reduction and finding a wonderful balance between work and play.

After suffering from past binge/emotional eating patterns, chronic sinus problems, and menstrual imbalances, I slowly but surely explored the world of holistic healing and found great success in healing my own physical and emotional health concerns.  This experience led me to become a women’s and men’s reproductive health specialist, with an emphasis on using nutrition therapy, stress-reduction techniques and life-transforming counseling modalities for improving reproductive wellness and fertility quotients.  I also work extensively with weight loss coaching and improving chronic digestive disorders and sinus conditions.  In addition, I work with many clients who are generally healthy, yet overwhelmed with how to eat well on a busy schedule.

My counseling style is strong yet compassionate. I hold my clients accountable for action steps that we BOTH agree upon, based on my client’s goals and lifestyle.  Plenty of time is allotted for feedback, progress discussions and obstacle clearing.  While some sessions focus on the particulars of meal plans and healing foods, others center on techniques for stress reduction, lifestyle balance, and clearing “mental gymnastics.”  Laughing, of course, is non-negotiable.

If you have any questions, or wish to speak with me to see if I may be of help to you, don't hesitate to set up a complementary chat with me at 212.685.0985.

www.berkleycenter.com

mikeberkley@berkleycenter.com

Starla's Journey

My entire life I have wanted to have children so when I married later in life at age 39 I was ready to start trying to have a child. This "trying" was supposed to be the fun part and I thought I got lucky when I got pregnant the first month. Soon after I miscarried with what was a blighted ovum(a bad egg with no heart beat) I thought "No big deal it will happen next month"

My journey took me through at least 20 artificial inseminations and 2 failed IVF's. My struggle hasn't been as long as others but when you have a personality like mine, you want everything yesterday. This seemed like eternity. I have gone through close to 2 years of hell. It has effected my relationship with my husband-he feels I only wanted him for his sperm(and I guess he was right at the time) I have gained so much weight- And I was starting to feel defeated. Month after month, waiting, hoping, was making me crazy. Was I ever going to get pregnant?

I began speaking to anyone who would listen and took advise from anyone willing to give it...I went from Raspberry leaf teas to wheat grass juicing. I tried pineapple at the beginning of my cycle and yams added to my diet. I did acupuncture twice a week. I went macrobiotic. My father in law prescribed me every such herbal supplement he could think of. I cut out caffeine, my point is I did it all and each month- my periods were the same, and no double lines showed up on the numerous pregnancy tests I purchased.

I found Dr. Berkley by chance after reading a book about infertility and thought I had nothing to lose. We had a phone consultation and he reviewed my history and asked me numerous questions. I was eventually given a prognosis and prescribed an herbal formula. Dr. Berkley said he promised I would get pregnant. He said that most likely I had some sort of blockage or my system was not balanced and he would help. I was skeptical but thought, "I really had nothing to lose but some money and with all I had spent already it was worth a try." Dr. Berkley said it takes 60 to 90 days for the herbs to start working.

I started the herbs sometime in November 2004 and noticed severe cramping just prior to me getting my period. I continued through December and was unable to do my 3rd IVF cycle due to the fact that the office was closed through the holidays and it interfered with my cycle days. Instead I decided the last minute with alittle coaxing from the nurses at my fertility office to do an IUI. I wasn't even sure why I was spending any more money on IUI's since I had had about 20 and not one resulted in a pregnancy.

45 days after following Dr. Berkeley's protocol I was 2 weeks pregnant. I never would have believed it. After everything we tried month after month Dr. Berkley's approach worked.

Fast forward- On Sept 8th 2005 I delivered a magnificent healthy baby girl named Addison Layne Smith who amazes us everyday. I feel so lucky to have her and don't take a day for granted.

It has been the most difficult experience I have had to handle in my life and I hope this will help someone try alittle harder, seek alittle more advice, and not give up. There are no words to express my gratitude

Starla www.berkleycenter.com mikeberkley@berkleycenter.com

Smoking & Infertility

There are many known causes of infertility. Some are more absolute than others. For example, if a woman has blocked fallopian tubes, or a man has a very low sperm count or motility, then we know the cause of the couples infertility problem (or at least one of the causes). However, there are other fertility issues that are difficult to characterize as "the problem" - but we know that often they are at least factors contributing to the infertility.

	Over 20 published studies in the medical literature have detailed the adverse effects of tobacco smoking on fertility.
	Tobacco smoke contains several hundred substances, many of which are toxic.
	A study done in mice showed that nicotine had disruptive effects on egg maturation, ovulation rates, and fertilization rates. The study also showed more chromosomal abnormalities in the eggs exposed to nicotine.
	Ovarian reserve and egg quantity and quality are reduced in women who smoke.
	Smokers have lower numbers of follicles when stimulated for in vitro fertilization.
	Smokers have lower numbers of eggs retrieved with in vitro fertilization.
	Smokers have lower rates of fertilization of the eggs with in vitro fertilization.
	Smokers have increased rates of miscarriage with in vitro fertilization pregnancies.
	One study showed that the chance for an IVF pregnancy was 2.7 times higher for women who have never smoked as compared to women that do (or have previously). The same study showed that if the woman smoked for over 5 years, the risk was increased to 4.8.
	There is also some evidence that male smoking decreases success rates with IVF. It is not known whether this effect would be caused directly by the sperm, or whether it represents a negative effect on the egg and embryo quality through passive exposure (second hand exposure).

If you smoke - quit. If you are having trouble getting pregnant or particularly if you are planning to go through in vitro fertilization - quit even sooner.

Fertility can improve after quitting, and IVF success rates are higher in women that used to smoke than in women that smoked during the ovarian stimulation, egg retrieval, embryo transfer time frame.

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mikeberkley@berkleycenter.com

Your Blood

Blood and Fertility

One of the most important desired outcomes of acupuncture and herbal medicine treatment from the perspective of treating the individual seeking assistance in conceiving is to enhance blood circulation.

Blood delivers nutrients from the digestive system to all parts of the body. As a result of inhibited blood flow, one may feel lethargic and weak. Acupuncture and herbal medicine increase blood circulation, increase- digestive function and enhance energy.

Blood transports oxygen from the lungs to all parts of the body including the fallopian tubes, ovaries and uterus. Acupuncture and herbal medicine facilitate this transport. This action will immediately improve the health of these organs and increase the reproductive function.

Blood transports carbon dioxide from all parts of the body to the lungs for excretion. Since acupuncture and herbal medicine assist in this 'house-cleaning' function, circulation is enhanced, the removal of toxic-waste from your body is increased and your general health and well-being is improved.

Blood transports waste products from cells to the external environment mainly via the kidneys. These waste products are found everywhere in the body including the fallopian tubes, ovaries and uterus. Acupuncture and herbal medicine often seek the 'strengthen' the energy of the kidneys. This action can greatly improve your reproductive health.

Blood transports hormones from the endocrine system to target cells or organs within the body including the hypothalamus, anterior pituitary and ovaries; the three essential organs necessary to achieve pregnancy. If your FSH is elevated or you have excessive androgens, the first thing on the agenda should be to increase and enhance blood flow so that proper hormonal distribution is facilitated. By including acupuncture and herbal medicine in your fertility-enhancement-protocol we see amazing improvement in the ovarian function, the lowering of FSH levels and thickening of the uterine lining.

Through continuous exchange of it's components with tissue and fluids, blood maintains fluid and electrolyte balance. Including the modalities of acupuncture and herbal medicine in your fertility-enhancing-treatment- protocol frequently increases and enhances mid-cycle cervical mucous and reduces vaginal dryness, night-sweats and dry skin; all signs of fluid deficiency.

Blood defends the body against attack from foreign organisms via the white blood cells and antibodies. If you are frequently sick and weak, your fertility quotient is severely diminished. By enhancing blood circulation throughout the body, white blood cells and antibodies are sent out to ward off infections which can be contributing to difficulties in conceiving. Acupuncture and herbal medicine have been shown to improve immune function and increase the fertility quotient.

Blood defends the body against injury or infection via the inflammatory response. As a result of the immune boosting action and properties of acupuncture and herbal medicine, injuries and infections heal more rapidly.

Blood prevents serious hemorrhage by the clotting process. But, occasionally as a result of inhibited blood circulation, clotting may in fact present. This can cause clotting in the menstruate and severe premenstrual and/or menstrual pain. As a result of improved circulation from regular acupuncture and herbal medicine treatment, this clotting can be successfully reduced or even eliminated with the result being a normalization of blood flow and a healthier reproductive environment.

Blood maintains the body's temperature by circulating heat. Do you have cold hands and feet? Do you feel cold frequently? This may be a sign of inhibited or decreased blood circulation, which, in and of itself, may compromise the effort to conceive. It is important to understand, that though one may 'feel' their coldness in their hands, feet and body, one cannot feel the result of inhibited blood flow to the reproductive organs. It is safe to assume however, that when one has poor circulation to the extremities, one too will have poor circulation everywhere in the body, including the fallopian tubes, ovaries and the uterus. Acupuncture and herbal medicine increase blood flow to these important reproductive organs, improving their function, and significantly increasing your chances of conceiving.

Acupuncture and herbal medicine are a very complex medical modality but just from the one step of increasing blood flow, significant improvement is made in the journey to conception.

The Berkley Center Team is made up of State Licensed and Nationally Board Certified Acupuncturists and Herbalists trained in the Berkley Method.

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mikeberkley@berkleycenter.com

Elevated FSH

Women are born with all the eggs that they will ever have, and they lose them constantly throughout life until menopause, when none remain.

The term "ovarian reserve" is useful in the field of reproductive medicine. It is an estimate of the reserve of the woman's ovaries - remaining egg supply - to be able to make babies in the (near) future. In other words, a woman's ovarian reserve is her remaining fertility potential.

There are several ways to attempt to predict egg quantity and quality as well as trying to estimate chances for conception with various forms of fertility treatment. Female age and "day 3 FSH levels are two very important variables. The response of the ovaries to ovarian stimulation with injectable gonadotropins (FSH) is another very important variable that affects the overall chance for conception when in vitro fertilization is attempted.

We have seen different ovarian responses to injectable gonadotropins depending on the overall health of the woman which includes the health and patency of her ovarian blood flow.

Blood transports hormones from the endocrine system to target cells or organs within the body including the hypothalamus, anterior pituitary and ovaries; the three essential organs necessary to achieve pregnancy.

If FSH is elevated the first order of business should be to increase and enhance blood flow so that proper hormonal distribution is distributed to the ovaries. At the Berkley Center for Reproductive Wellness & Women’s Health, by employing acupuncture, and our proprietary herbal formulas, we have successfully increased blood circulation to the ovaries, and lowered FSH levels while simultaneously keeping E2 between 25 and 80pg/ml. In other words, our treatments don’t falsely repress FSH levels, but rather, regulates them.

Further, we have repeatedly seen reduction in the uterine artery pulsatility index after treatment with acupuncture and herbs. The pulsatility index is a method of determining the patency of blood flow to the uterus via the uterine arteries. The pulsatility index should be < 3 and can be ascertained through a transvaginal Doppler examination. Women whose pulsatility index is >3 rarely achieve conception.

Via the release of beta-endorphins from the brain, the sympathetic nervous system is affected and causes vascular modulation with dilation of the uterine arteries, thereby reducing uterine artery impedance and increasing blood flow to the ovaries.

Antral Follicles

Antral follicles are small follicles (about 2-8 mm in diameter) that can be seen - and measured and counted - with ultrasound. Antral follicles are also referred to as resting follicles. Vaginal ultrasound is the best way to accurately assess and count these small structures. In my opinion, the antral follicle counts (in conjunction with female age) are by far the best tool that is currently available for estimating ovarian reserve and/or chances for pregnancy with in vitro fertilization.

Presumably, the number of antral follicles visible on ultrasound is indicative of the relative number of microscopic (and sound asleep) primordial follicles remaining in the ovary. Each primordial follicle contains an immature egg that can potentially develop in the future. By stimulating blood flow to these follicles with acupuncture, their health can be improved and their maturation can be facilitated.

As mentioned above, we now have proof that blood flow to the entire pelvic environment is increased through the utilization of acupuncture and herbal medicine. The consensus of Western physicians is that when there are only a few antral follicles visible, there are less eggs remaining as compared to when there are more antral follicles visible. Our view, based on clinical experience is that even though there may be a ‘few’ antral follicles present, only one ‘good’ one is required for conception and that the clinical presentation of poor ovarian reserve (few antral follicles) often coexists with diminished egg-quality. By enhancing blood flow to the ovaries we have repeatedly seen improved egg quality, even in women with low ovarian reserve. Only one good egg is necessary for conception to occur.

	FSH Significance
Less than 9	Reassuring level. Expect a good response to ovarian stimulation.
9 - 10	Fair.  Response is between completely normal and somewhat reduced (response varies widely). Overall, a somewhat reduced live birth rate.
10 - 12	Reduced ovarian reserve. Usually show a reduced response to stimulation and some reduction in egg and embryo quality with IVF. Reduced live birth rates on the average.
12 - 17	Generally show a more marked reduction in response to stimulation and usually a further reduction in egg and embryo quality with IVF. Low live birth rates.
Over 17	"No go" level in most clinics. Very poor (or no)  response to stimulation. No live births. "No go" levels must be individualized for the particular lab assay and IVF center.

Many women who visit us present with FSH levels > 17 and after three to six months of treatment see their FSH levels reduced to between 6 and 9 with normal E2 levels.

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mikeberkley@berkleycenter.com

Commitment

Commitment

Until one is committed,
There is hesitancy,
The chance to draw back,
Always ineffectiveness.

Concerning all acts of initiative (and creation),
There is one elemental truth,
The ignorance of which kills countless ideas and splendid plans:
That the moment one definitely commits oneself,
Then providence moves too.

All sorts of things occur to help one
That would never otherwise have occurred.
A whole stream of events
Issues from the decision,
Raising in one's favor,
All manner of unforeseen incidents and meetings and material assistance,
Which no man could have dreamed would have come his way.

Whatever you can do or dream you can
Begin it
Boldness has genius, magic and power in it
Begin it now

Goethe

www.berkleycenter.com

mikeberkley@berkleycenter.com

Article on Traditional Chinese Medicine & Infertility

Traditional Chinese Medicine and Infertility

Written by Mike Berkley, L.Ac., DA(RI)

Although health and healing are the common goals of Traditional Chinese Medicine (TCM) and allopathic medicine, their ideas on the etiology of disease, disease itself and the process used to regain health are decidedly different. The allopathic physician learns that disease must be cured by prescribing medicine, which kills bacteria or renders a virus ineffective; at times surgical intervention is a necessity.

There is nothing inherently wrong with this approach. It often works. The question worth exploring is why TCM succeeds where allopathic medicine fails? What is the mechanism of action of acupuncture and herbal medicine, which results in palliation or cure that is not manifest in biomedicine?

Though the goal of TCM is to cure a patient, the doctor of TCM attempts to do this not by treating the disease but rather by treating the whole person, taking into account the various attributes of an individual which, when combined, account for an individual being sick or healthy. A person, according to the tenets of TCM is more than their pathology. While treating the pathology may yield impressive results, they are commonly temporary.

A person is not, according to TCM, represented solely by his or her illness, but by the accumulation of every human interaction engaged in from the moment of birth, including the values of and the culture from which the individual develops. The emotional experiences, eating habits, work habits, work and living environment, personal habits and the social milieu are factors that contribute to disease and are factors which, when modified appropriately may lead to regained health.

Though the Western scientific community has not, to date, arrived at a methodology to use in research of Chinese medicine, the veracity and efficaciousness of this medical modality is nonetheless proved by its long history of continued success. More than a quarter of the world's population regularly uses TCM as part of their health care regimen. Chinese medicine is the only form of classical medicine, which is regularly and continuously used outside of its country of origin.

The Four Examinations

The 'Four Examinations' is a method of diagnosis which dates back over three thousand years. Observing, Listening and Smelling (Listening and Smelling are counted as one of the Four Examinations), Questioning and Palpating make up the 'Four Examinations'. This method of diagnosis is far from simplistic, allowing the practitioner to arrive at a differential diagnosis.

Each of the "Four Examinations" can take years to master, and while these diagnostic tools are not replacements for that which Western medicine can provide in analyzing and treating disease, they have the ability to offer information which, when understood in the context of TCM, provides additional opportunities in mapping out patterns of disease and arriving at greater treatment success.
The doctor of TCM must approach a patient with a clear and calm mind, without a preconceived diagnosis and etiology. This mind-set will enable the practitioner to yield clinical gems which are clues about the individual who sits before us! This is the stuff of TCM.

The subjective, interpretive and objective evidence of an individual obtained via the 'Four Examinations' leads to the discovery of the etiology of disease while concomitantly opening a window to the 'Whole Person", thus revealing where in the individual's life the pathogenesis started and what initiated it. The practitioner of TCM must utilize his own interpretive skills, which takes into consideration what is verbalized by the patient and what is observed, while considering what the patient does not verbalize as well. Often, that which is not said can be as clinically enlightening as the information which is freely provided. The tone of the voice, the complexion, the condition of the eyes (in TCM, the Shen or spirt of an individual is said to be revealed through their eyes. Who can deny the clinical efficacy of this? Is there a different expression revealed through the eyes of a clinically depressed individual than from those of a happy, well adjusted one?), the facial expression, the overall demeanor, how one walks, sits, and stands are all observed and utilized by the doctor of Chinese medicine as part of the information required to arrive at a differential diagnosis. The doctor must be able to note and sense inconsistencies in an individual that are expressed by the patient even without the patient being cognizant of the chasms which exist between what they verbally express and what their spiritual presentation divulges. The sensitivity to and awareness of these human idiosyncrasies enables the TCM doctor to develop an understanding of who the patient is even before the 'main complaint' is discussed.

Proper treatment in TCM is more than the elimination of pathological processes. In addition to attacking a pathological factor(s), it is the responsibility of the TCM doctor to support the individual in his or her goal of achieving overall health which includes aspects of physical-psycho-emotional and spiritual health. This paradigmatic approach is an inexorable part of the process of healing. Without it, we are merely chasing the sickness and forgetting about the patient. With this approach, the patient is seen as a whole person, representing the sum of a lifetime of experiences if you will, not just an embodiment of pathology.

Pathologies are guests (and we hope temporary ones!) in a home which serves as a gracious host - our physical, emotional and spiritual selves. TCM first is concerned with strengthening the immune function which includes homeostasis of the physical, emotional and spiritual attributes of the patient, so as to be able to assist the patient in his or her endeavor to do battle and destroy the enemy at the gates (or inside them). When people are chronically exhausted from lack of sleep resulting from anxiety or depression, they can become chronically sick as a result of a lowered immune system.
In TCM the point of departure from Western medicine is not to view the acute presentation (called "the branch" in TCM) as primary, but to treat the etiology (called "the root" in TCM) which is the anxiety and depression which causes the insomnia then facilitating exhaustion and lowering the immune function which can lead to chronic illness.

So, rather than prescribing antibiotics repeatedly, we might address the patient's anxiety/depression syndrome or refer them out to a psychotherapist for appropriate intervention while simultaneously providing treatment.

Infertility and TCM - Mechanisms of Action
It was shown in a study done at Harvard that stress reduces the hypothalamic-anterior pituitary-ovarian axis function, thus being a factor to be considered in the infertility work-up. Acupuncture releases endorphins which mitigate ones response to stressful stimuli thus enhancing the possibility for conception.

"Historically, infertility, particularly "functional" infertility, was attributed to abnormal psychological functioning on the part of one or both members of the couple. Preliminary works in the 1940s and 1950s considered "psychogenic infertility" as the major cause of failure to conceive in as many as 50% of cases. As recently as the late 1960s, it was commonly believed that reproductive failure was the result of psychological and emotional factors. Psychogenic infertility was supposed to occur because of unconscious anxiety about sexual feelings, ambivalence toward motherhood, unresolved oedipal conflict, or conflicts of gender identity. Fortunately, advances in reproductive endocrinology and medical technology as well as in psychological research have de-emphasized the significance of psychopathology as the basis of infertility, and modern research shows that there is little evidence to support a role for personality factors or conflicts as a cause of infertility. This perspective unburdens the couple by relieving them of the additional guilt of thinking that it is their mental stress that may be responsible for their infertility.

Biologically, since the hypothalamus regulates both stress responses as well as the sex hormones, it's easy to see how stress could cause infertility in some women. Excessive stress may even lead to complete suppression of the menstrual cycle, and this is often seen in female marathon runners, who develop "runner's amenorrhea". In less severe cases, it could cause anovulation or irregular menstrual cycles. When activated by stress, the pituitary gland also produces increased amounts of prolactin, and elevated levels of prolactin could cause irregular ovulation. Since the female reproductive tract contains catecholamine receptors catecholamines produced in response to stress may potentially affect fertility, for example, by interfering with the transport of gametes through the Fallopian tube or by altering uterine blood flow. However, more complex mechanisms may be at play, and researchers still don't completely understand how stress interacts with the reproductive system. This is a story, which is still unfolding, and during the last 20 years, the new field of psychoneuroimmunology has emerged, which focuses on how your mind can affect your body.

Research has shown that the brain produces special molecules called neuropeptides, in response to emotions, and these peptides can interact with every cell of the body, including those of the immune system. In this view, the mind and the body are not only connected, but also inseparable, so that it is hardly surprising that stress can have a negative influence on fertility.

Stress can reduce sperm counts as well. Thus, testicular biopsies obtained from prisoners awaiting execution, who were obviously under extreme stress, revealed complete spermatogenetic arrest in all cases. Researchers have also showed significantly lower semen volume and sperm concentration in a group of chronically stressed marmoset monkey, and these changes were attributed to lower concentrations of LH and testosterone (which were reduced in the stressed group). However, how relevant these research findings are in clinical practice is still to be determined.(i) "

The stress factors that acupuncture addresses stems from both psycho-emotional factors as well as physical etiologies. For example, extremely painful pre-menstruum or mid cycle pain can be debilitating. This type of physical stress, no doubt produces emotional stress as a result of missed work, manifest pain and other life-style factors resulting from such extreme pain; all can mitigate the function of the reproductive system.

Aceto corticotropic hormone is released as a response to acupuncture needle stimuli. ACTH has an antiinflammatory mechanism which may for example, help with tubal factor based infertility as a response to pelvic inflammatory disease.

The insertion of acupuncture needles has been shown to effectively increase blood circulation. Acupuncture is very effective in treating, for example, Reynaud's Syndrome. Enhanced microcirculatory patency to the uterine lining does, undoubtedly contribute to a healthier and more growth oriented endometrium, especially when utilizing electrical stimulation on inserted acupuncture needles on points known as zigongxue which reside superior to the ovaries. The points zigongxue are located 3 inches inferior to the umbilicus and three inches bilateral to the anterior midline.

"They reviewed existing evidence regarding the role of acupuncture in the treatment of infertility, and identified a number of studies indicating that acupuncture can be beneficial as an adjunct to other infertility treatments, including IVF. Only one randomized controlled study examined the independent effect of acupuncture on IVF outcomes, but this indicated a positive effect.

The reviewed authors also highlight evidence that shows the effects of acupuncture may be mediated through neuropeptides that influence gonadotropin secretion, which could in turn affect the menstrual cycle. The technique can also reduce stress, which is known to adversely affect fertility, and has been implicated in the regulation of uterine blood flow." (ii)

"Using acupuncture during assisted reproduction may improve pregnancy rates, say researchers. However, they acknowledge that the mechanism behind this effect is unclear, and the team plans to carry out further studies to confirm, and further investigate, their findings.

Noting that acupuncture has been shown to affect the autonomic nervous system, Dr. Wolfgang Paulus (Christian-Lauritzen-Institut, Ulm, Germany) and colleagues postulated that the therapy could increase endometrial receptivity via control of related muscles and glands.

The researchers randomly assigned 160 women receiving assisted reproductive therapy to undergo IVF with or without acupuncture, before and after embryo transfer. In acupuncture subjects, the needles were placed at points believed to influence reproductive factors, for example by improving blood flow to the uterus.
Paulus et al report that the acupuncture group had a higher rate of pregnancy compared with those not given acupuncture (43 percent versus 26 percent). They conclude, therefore, that acupuncture could be "a useful tool" for improving pregnancy rates during certain infertility treatments." (iii)

A Diagnostic Window - East Meets West

One TCM diagnosis which exists and which may be etiologic for male or female infertility is called Liver qi stagnation. One of the key identifiers of an individual with the pattern differentiation of Liver qi stagnation is anger, rage, frustration, depression and anxiety.

"Symptoms of depression, anxiety, and anger may help in determining the nature of infertility experienced by some couples, and identify those who would benefit most from psychological counseling, suggest researchers.

Dr. Secondo Fassino (University School of Medicine, Turin, Italy) and colleagues recorded the personal characteristics of 156 infertile and 80 fertile couples, and measured their degree of psychopathology. When the researchers divided the couples according to the nature of the infertility-organic, functional, or undetermined-they found that the triad of anxiety, depression, and a tendency toward anger suppression successfully predicted the diagnosis of organic or functional infertility in women, with 97 percent accuracy.

For infertile men, anxiety was also an important independent predictor of functional infertility, increasing the likelihood of having this form of infertility five-fold, while depression was more predictive of organic infertility. However, with men - unlike women - anger did not appear to influence infertility in men.

The results suggest the possibility of identifying a subgroup of infertile subjects where, beyond the distress that is consequent to the failure of repeated attempts to conceive a baby, there is also a poorly adaptive psychological functioning, which is likely to play an important role in the onset and course of functional infertility," the team concludes."(iv)

It is becoming more and more prevalent that research conducted by Western scientists and physicians are highlighting the veracity and effectiveness of Traditional Chinese Medicine.

Herbal Medicine

The efficacy of herbal medicine in treating infertility is indisputable to the patient community although the mechanism of action is not completely understood at this time. Similarly the mechanism of action of tricyclic antidepressants is not fully understood in its effect on chronic pain (i.e., in the case of fibromyalgia), but its efficacy has been maintained.

Practitioners of Chinese herbal medicine rarely use a single herb in treatment. Chinese herbs are formula based; many herbs are mixed together to create the perfect 'decoction' specifically designed for the individual patient.

Some formulae contain two herbs and some thirty or more herbs. Each herb has many functions. Each herb has its own flavor, nature, temperature and trophism. Prescribing the correct herbal medicinals requires extensive training and clinical experience.
Self-medicating with herbal medicine presents a dual dilemma. At best the herbs will be useless, as the key to correct formula prescription is an accurate differential diagnosis which can only be rendered by a licensed, board certified, experienced practitioner. At the worst case, self-prescribing of herbal medicine may prove harmful or fatal.

A good example of this is Ma Huang/Ephedra. Ma Huang is an herb prescribed on a daily basis by hundreds of TCM practitioners to thousands of patients safely.
That several people have died as a result of taking Ma Huang has nothing to do with the dangerous properties of the herb, rather with the fact that in all cases of fatalities the individuals were self-medicating, without directions from a doctor required for appropriate applications and contraindications. Aspirin can also prove fatal if taken by a hemophiliac. This is not an indication that aspirin should be banned or that it is a dangerous drug, but that it is unsafe if used inappropriately and safe if used appropriately.

Not only is herbal medicine safe, it is highly effective in treating much pathology without the concomitant adverse effects which often accompany pharmaceutical drugs. There are many hospitalizations and fatalities which occur yearly as a result of adverse reactions to biomedicine. The occurrence of adverse reactions to herbal medicine is far less.(v)

I have used herbal formulae repeatedly to lower elevated FSH levels, to regulate irregular menstrual cycles, to mitigate pain in the endometriosis patient; to mitigate pain in the patient who presents with ovulation and/or menstruation related migraines; to thicken an unresponsive endometrium; to treat the amenorrheic; the oligomenorrheic patient; to treat patients with partial tubal occlusion; and the patient who presents with idiopathic infertility. Additionally, I have successfully treated male factor infertility, which includes presentations such as low sperm count and poor motility.

Clearly, further research is needed to fully understand the mechanisms of action of acupuncture and herbal medicine in treating the infertile patient. Nevertheless, it is my opinion that the best-case scenario for most patients is to offer them every reasonable option which may serve to successfully address their presentation. Based upon the empirical evidence of my practice in which I specialize in the treatment of the infertility, the integration of acupuncture and herbal medicine into the treatment protocol from a clinical perspective makes sense.

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ⁱ Domar, Alice (back)
ⁱⁱ Fertility and Sterility 2002: 78: 1149-53 (back)
ⁱⁱⁱ Fertility and Sterility 2002: 77: 721-724 (back)
^iv Human Reproduction 2002; 17: 2986-94 (back)
^v Adverse reactions to drugs are very common in everyday medical practice. A French study of 2067 adults aged 20-67 years attending a health centre for a check up reported that 14.7% gave reliable histories of systemic adverse reactions to one or more drugs. In a Swiss study of 5568 hospital inpatients, 17% had adverse reactions to drugs. Fatal drug reactions occur in 0.1% medical inpatients and 0.01% of surgical inpatients. The main drugs implicated are antibiotics and non-steroidal anti-inflammatory drugs. Adverse reactions to drugs occurring during anesthesia (muscle relaxants, general anesthetics, and opiates), although less common (1 in 6000 patients receiving anesthesia), are life threatening, with a mortality of about 6%.
BMJ 1998;316:1511-1514 ( 16 May )(back)

www.berkleycenter.com

mikeberkley@berkleycenter.com

My First Post!

Who I Am

Mike Berkley, the founder and director ofThe Berkley Center for Reproductive Wellness & Women’s Health, in New York, is licensed and Board Certified in Acupuncture in the states of New York and Connecticut, and licensed as a Doctor of Acupuncture in the State of Rhode Island. Dr. Berkley is also Board Certified in Clinical Herbal Medicine by the National Certification Commission for Acupuncture and Oriental Medicine.

Dr. Berkley is a Member in good standing of the American Society for Reproductive Medicine (ASRM); Resolve, New York, American Infertility Association, the National Certification Commission for Acupuncture and Oriental Medicine; the Acupuncture Society of New York; and the American Association of Oriental Medicine. In addition, he is an Advisory Board member of The InterNational Council on Infertility Information Dissemination, Inc. (INCIID)

Dr. Berkley graduated from The Pacific College of Oriental Medicine in New York in 1996.

Dr. Berkley is the first acupuncturist/herbalist in the United States to work exclusively in the field of Reproductive Pathology. He has developed unique acupuncture protocols and herbal formulae which have been shown to increase success rates by 30 to 35%.

He works exclusively in the area of reproductive medicine and enjoys working in conjunction with some of New York’s most prestigious reproductive endocrinologists.

My Personal Story

I developed an interest in acupuncture and herbal medicine due to a very personal and difficult reason. Infertility.

My wife and I decided that we wanted to start a family a soon after we got married.

We tried and tried for 2 years and then sought the help of a reproductive endocrinologist here in New York City. My wife was diagnosed as having a bacterial infection and an autoimmune marker. We were both given doxycycline and she was given a short course of prednisone. At our follow-up examinations we were 'cleared' of all obstacles to conception and told to go home and 'try'. Try and try we did for another 6 months without success.

At this point my wife sought out the help of an acupuncturist/herbalist who had some basic knowledge of reproductive issues. We were lucky to find one.

After treating with acupuncture and herbal medicine for six months my wife got nothing more than a regulated period. We were disappointed. Then, the very next month, the miracle manifested: she was pregnant and, she carried to term; without a hitch! We had a beautiful 7.5 pound little tiger who is now a big boy.

I was amazed, humbled and enormously excited and gratified by the result which was yielded by what seemed like some hocus-pocus newfangled type of medicine; but it really worked (my son can attest to this!).

It was then that I started to explore acupuncture and herbal medicine on my own.

I had this urgent curiosity to learn more. I couldn't believe it when I found out that this type of medicine had existed for 3000 years and that there are literally hundreds of medical 'classics' dating back centuries on the subject of reproductive disorders and how to treat them. Incredible!

Then, this really strange thing happens: I'm reading the Village Voice and I spot an advertisement from Pacific College of Oriental Medicine in San Diego. The ad reads something like this: "PACIFIC COLLEGE OF ORIENTAL MEDICINE IS PLEASED TO ANNOUNCE THE OPENING OF OUR NEW YORK CAMPUS. ALL ARE INVITED TO AN OPEN HOUSE." And, to the Open House I went. I left almost six years later with a degree in acupuncture and a National Board Certification in herbal medicine.

With license(s) in hand, I devoted every free moment to studying Western medical and Chinese medical approaches to treating infertility. After years of study and clinical experience, I have been fortunate in that I have been able to develop my own unique acupuncture-points-protocols and proprietary herbal formulas which (I am constantly amazed and in awe) work wonders. Just ask all of our new mommies and daddies!

The fact that I am able to help so many couples achieve their dream of starting a family is the focal point of my life. Every single patient that comes to The Berkley Center for Reproductive Wellness & Women's Health is a great gift to us. It's another opportunity to add joy to the world!

Mike Berkley, Licensed Acupuncturist; Doctor of Acupuncture (RI)
Director, The Berkley Center for Reproductive Wellness & Women's Health

www.berkleycenter.com

mikeberkley@berkleycenter.com