Endometriosis

Endometriosis is something that can creep up on us.  You can go through years of painful cramps and irregular cycles not realizing that what you are experiencing is not normal.  Many women find out about their condition when going to the doctor's after months or years of difficulty conceiving.  You are not alone!  According to the Cleveland Clinic at least 5.5 million women in North America alone have endometriosis.  And of those women 30-40 percent have difficulty conceiving.



To read about endometriosis, go to these links;

1. http://my.clevelandclinic.org/disorders/Endometriosis/hic_Endometriosis.aspx 
2.  http://www.mayoclinic.com/health/endometriosis/DS00289

According to Jane Lyttleton, a well respected fertility specialist, the following are what may hinder conception:

• "If there is a significant amount of endometriosis in a very inconvenient place such as the fallopian tubes or ovaries, it is not difficult to see how the distortions it causes could prevent conceptions.  But this is the reason for difficulty in conceiving in only 5% of cases.
• Endometriosis tissue may affect fertility by attracting or activating more macrophages to the area.  Macrophages are large cells which mop up cellular debris and bacteria and other foreign material.  The peritoneal cavity of a woman has quite a large number of macrophages and one of their jobs is to finish off sperm that swim all the way out of the tubes and into the abdomen.  When there is endometriosis present, the macrophages seem to become more activated and go on seek and destroy missions with great vigor.  Unfortunately these vigilantes can enter the fallopian tubes and pick off sperm before they have had a chance to meet the egg.  In women with partners with poor sperm counts this can be quite disastrous leaving no sperm at all to fertilize the egg.  
• These same macrophages have also been shown to produce cytokines, which are chemicals which are toxic to sperm and to embryos, providing another damaging blow to fertility.
• The type of endometriosis that sits superficially on the membrane surrounding the pelvic structures has been shown to have glands similar to that found in the endometrium.  These glands secrete mucus. This mucus can coat the fimbriae or the ovary, preventing the transfer of the egg to the tube.  Such a phenomenon has been observed in animal studies.
• Endometriosis is associated with increased levels of prostaglandins (PGE2 and PGF), which appear to have a deleterious effect on the potency and flexibility of the fallopian tubes.
• Endometriosis is associated with a higher incidence of the ovulatory disturbance luteinised unruptured follicle syndrome (LUFS) and lower progesterone levels in the luteal phase. "

The following information was taken from:


http://www.acupuncturetoday.com/mpacms/at/article.php?id=27820

Chinese Herbs from a Western Perspective 
 
Many herbs have remarkable pain-relieving properties. Of these herbs, corydalis (yan hu suo) offers the most potent and consistent relief of pain. It works on the central nervous system and is effective in relieving both external and internal pain. With appropriate dosage levels, the analgesic effect of corydalis has been measured to the effect of morphine. Corydalis has many fewer side effects and complications (such as development of tolerance and dependence) than morphine, but morphine has a proportionately stronger analgesic effect and faster onset of action.¹ The analgesic effect of corydalis can be further enhanced when combined with electroacupuncture.²
 
In addition to corydalis, there are many other herbs with strong analgesic effects. Mastic (ru xiang) and myrrh (mo yao) are effective against pain of skeletal muscles;³ cnidium (chuan xiong) is effective against neurogenic pain;⁴ and bupleurum (chai hu), angelica (bai zhi) and licorice (gan cao) have generalized analgesic effects.^5,6,7
 
Tang kuei (dang gui) has long demonstrated effectiveness in treating disorders of the uterus. Administration of tang kuei is associated with both stimulating and inhibiting effects on uterine tissues. Laboratory studies have shown that water and alcohol extracts of tang kuei tend to stimulate the uterus, while the essential oil tends to inhibit the uterus.⁸ Furthermore, clinical studies have shown that when the uterus is in a state of relaxation, tang kuei can induce contraction. On the other hand, if the uterus is in a state of contraction, then tang kuei can induce relaxation.⁹ This dual action of the herb explains its therapeutic effect of relieving spasms and stopping pain.

Other herbs with marked effectiveness in treatment of gynecological disorders include bulrush (pu huang) and perilla (zi su ye). In a clinical study, 31 women with abnormal uterine contractions and continuous bleeding with blood clots were treated with three grams of bulrush three times daily for three consecutive days. Most women reported satisfactory result with a gradual decrease in both bleeding and clots.¹⁰ In another clinical study, patients with bleeding from the uterus or the cervix were treated with perilla topically. Of 108 patients treated, 86 (79.63%) reported satisfactory results.¹¹
 
Chinese Herbs from an Eastern Perspective 
 
In addition to the herbs discussed above, many herbs have shown excellent results in treating endometriosis but without laboratory or clinical studies to support their effect. Nonetheless, they are quite effective according to historical and traditional uses and applications. Below is a list of herbs with excellent effects according to traditional Chinese medicine explanations.

Corydalis, the strongest analgesic herb in the materia medica, is the king herb for pain relief in this formula. Bulrush, a blood regulator, and pteropus (wu ling zhi), a blood invigorator, are commonly used to ease painful menstruation. To treat the root of endometriosis, blood stagnation must be resolved. Mastic and myrrh are often paired together, as are scirpus (san leng) and zedoaria (e zhu). In this formula, both pairs are used synergistically to remove blood stasis in both the organs and channels. They are used in this formula to break up blood stasis in the lower burner (jiao) in the chong and ren channels. The chong channel is the point of emergence of all 12 regular channels, and is also considered to be the "sea of blood." Cnidium is commonly used to treat gynecological disorders, in part because its descending function is to enter the chong channel to regulate qi and blood circulation and normalize menstruation. Red peony (chi shao) enters the blood (xue) level to break up blood stagnation. It also assists the heat-clearing herbs in this formula to relieve inflammation of the pelvic cavity.

Pangolin scales (chuan shan jia) and cinnamon twigs (gui zhi) are strong herbs used to break up blood stagnation and open the channels and collaterals. Qi-regulating herbs such as lindera (wu yao), saussurea (mu xiang), magnolia bark (hou po) and fennel seed (xiao hui xiang) are used to address symptoms such as bloating and colicky pain associated with endometriosis. Besides relieving pain, these qi-regulating herbs assist the blood-invigorating herbs in dispersing stagnation. Aurantium (zhi ke) relieves distention; areca seed (bing lang) disperses stagnation and promotes the movement of qi. Bupleurum enters the liver and helps regulate menstruation.

http://www.acupuncturetoday.com/mpacms/at/article.php?id=27820


Lifestyle Instructions

• Adequate intake of vitamins and minerals on a daily basis is important. Vitamin E helps with hormone balance, while vitamin K is essential for normal blood clotting. Both are readily available in a balanced and diverse healthy diet, with vitamin K enhanced by moderate skin exposure to moderate sunlight. Iron is also needed, as heavy monthly bleeding contributes to iron deficiency.
• Advise the patient to avoid alcohol; caffeine; animal fats; butter; dairy products; fried foods; all hardened (hydrogenated) fats; junk food; fast foods; red meats; salt; shellfish; and sugar.¹³ If you eat poultry, select products from birds raised on organic food, without the administration of antibiotics or hormone supplements. 

http://www.acupuncturetoday.com/mpacms/at/article.php?id=27820


This study was done on endometriosis and Chinese medicine.  If you click on the link below you can view the abstract.  On the right of the page is a column listing the full text of the study in HTML or PDF form.  To view the study in it's complete form you can download it from those two options.

Evolution of medical treatment form endometriosis: back to the roots?

Studies and Articles vol. 1

Some of you have asked me to post some studies and articles to read.  I have a long list of them but thought that this would be a good place to start.  Please check in for more! To go to the website click on to the title. 


1. ABCs of Fertility: Acupuncture, Babies, Chinese Medicine - Part 1 
By: Jennifer Dubowsky, L.Ac., M.S.O.M., Dipl.Ac

"Many women get pregnant easily, but it is unlikely that they are reading this article. For other couples, having a baby may be more difficult and therefore frustrating. If you are having difficulty, undoubtedly you want to optimize the likelihood of a pregnancy by practicing informed, healthy, fertile choices."



This article is published in the acufinder website.  It is a good general article to familiarize yourself with some of the basic principles of Chinese medicine and how it works with fertility.


2.  In April 2002, German researchers reported that they had increased the success rate by nearly 50% in women undergoing in vitro fertilization (IVF) using acupuncture.

This study is a landmark that was published in Fertility & Sterility Journal that pretty much launched acupuncture and Chinese medicine into the spotlight.  I have linked the abstract report and not the full text.  To read more about the study you can google the Journal issue and there are numerous stories about it.


3. Acupuncture Shows Promise in Improving Rates of Pregnancy Following IVF
 
"A review of seven clinical trials of acupuncture given with embryo transfer in women undergoing in vitro fertilization (IVF) suggests that acupuncture may improve rates of pregnancy. An estimated 10 to 15 percent of couples experience reproductive difficulty and seek specialist fertility treatments, such as IVF. IVF, which involves retrieving a woman's egg, fertilizing it in the laboratory, and then transferring the embryo back into the woman's womb is an expensive, lengthy, and stressful process. Identifying a complementary approach that can improve success would be welcome to patients and providers."

This article can be found on the NIH (National Institute of Health) website.

Some Help For the Men, Please...

I wanted to post here some foods that men can eat to help with their sperm.  Motility, morphology and sperm count are all important. As we all know, it takes two to make a baby....


Foods that are rich in zinc are included in the list.

Nuts are especially good for motility and morphology problems.

Almonds
Artichoke
Avocado
Bananas
Blackberries
Cashew
Cauliflower
Chicken (dark meat)
Chickpeas (including hummus and falafel)
Crab, Dungeness
Cucumber
Eggs
Fish
Kidney beans
Kiwi fruit
Lima beans
Liver
Olives
Onion
Oysters
Peaches
Pecan Nuts
Pine Nuts
Pumpkin seeds
Radish
Shellfish
Spinach
Squash
Strawberries
Sunflower seeds
Sweet potatoes
Turkey (dark meat)
Walnuts

OV-Watch, New ovulation predictor kit

I know what you are thinking, "another gadget!".  Some of you may already be using the pee stick and/or the Basal Body Temperature charts to determine when you ovulate.  However they may not work as the pee stick tells when you are ovulating and by then it may be too late.  Or if you are an early riser for work your body temperature may always register on the cold side, without any of the peaks that are indicative of ovulation.  My patient told me about the the OV Watch last week and I was thrilled to learn about something new.  From what I gather with this product is that it tells you the four days prior to ovulating that is so essential for the most fertile times.  I copied from the Amazon.com website the product description so that you could read about it.  Of course if you go on the Amazon site you can read all the reviews and decide for yourself if this is something that you would like to try.

"OV-Watch is a clinically proven, patented fertility predictor that is cleared by the FDA. It is a wrist-mounted, bio-sensing medical device that tracks a woman's individual body chemistry to find the 4 crucial days before ovulation-her most fertile days of the month. OV-Watch has a special processor and biosensor that takes readings from your skin every 30 minutes while you sleep. This advanced technology works differently from other ovulation prediction devices in that it tracks chloride ion levels as opposed to LH or estrogen surges. It allows you to be able to fully utilize all 6 days of fertility- the four most crucial fertile days of a woman's cycle before ovulation and the time during ovulation. With OV-Watch, there are no messy, urine strips and no complicated charts. Just wear the watch at night while you sleep knowing that you will be alerted 4 days before ovulation, giving you plenty of time to plan multiple romantic interludes if desired. If women use a LH urine kit that only detects hours before ovulation, they may miss their most fertile time since by the time ovulation occurs, the egg, which only has a life span of approximately 12-17 hours, is already beginning to die. Sandra Ann Carson, President of the American Society for Reproductive Medicine states, "Although LH peaks accurately detect ovulation, they do not identify the pre-ovulatory fertile period. Up to two thirds of pregnancies are conceived at or prior to ovulation."..."

Infertility and Traditional Chinese Medicine

I was talking with one of my patients the other day.  We were discussing how we figured that once we got all our ducks lined up, mainly careers, then we would just magically start having children.  Not once did it cross our minds that becoming pregnant would be reduced to a science that seems more like shooting rubber bands at the stars.  Every year, millions of women wait month by month and are disappointed yet again.  There is not much to be offered out there aside from the plethora of fertility drugs and procedures that are at best reduce women to feeling like just another number in a clinic. 

After years of working with women who are seeking to get pregnant, I am struck time and time again the uniqueness of each individual and the beauty of Chinese medicine.  Through the lenses of this medicine we can really focus on what is happening with a woman’s body and every woman has walked away if not pregnant at least of better body, mind and spirit.  Women are no longer reduced to just fibroids or hormonal imbalances but a whole being that is supported in every way possible to allow a natural process to occur. 

The most common question that I am asked is how does Chinese medicine work?  This is such a complex question that six and a half years of schooling and 15 years of practice still has me stopped in my tracks to contemplate a moment how best to answer.  Everything in the body can be reduced to Qi and truly not much can happen without it.  Blood cannot move, the spirit cannot be tended to and cycles cannot be maintained without Qi and all of those things are essential for fertility to occur.  I like to think of the practice of Chinese medicine as the supporting of Qi, through the work of channels and organs.   Every point that we insert a needle directly effects the delicate balance in the body’s energetics, helping to nudge the flow one way or another.  Of course this is a very much simplified answer and open to much larger discussions.

Welcome

There have been many years that I have been working with women and infertility.  As things have changed and new information being made available I wanted to be able to share this information with everyone.  Somehow, I am hoping that this will provide the place that can be easily referenced.  I will do my best to include all the latest studies, stories, personal reflections and anything related to infertility and Chinese medicine.