The Fertility Maze
Acupuncture and IVF
Influencing nervous system – hypothalamus
Stimulate the endocrine system – pituitary glad, ovaries , and/or testis
Regulate menstruation in females
Control stress, anxiety and depression
Normalise the immune system
New Leaf Clinic
Fertility
Acupuncture has been used for supporting fertility for at least 2000 years. Acupuncture is still used extensively for:
- influencing the nervous system—hypothalamus
- stimulating the endocrine system—pituitary gland, ovaries and/or testes
- regulating menstruation in females
- controlling stress, anxiety and depression
- normalising the immune system.
As an acupuncturist, I can assist men and women in preparing their bodies for conception—to give you the best possible chance of conceiving. Navigation medical knowledge about fertility can be difficult, the following is an outline of Western fertility medicine and fertility terminology.
Fertility
Fertility is the ability to conceive a child after a year of regular, unprotected intercourse or therapeutic donor insemination.
Infertility
Infertility is a spectrum of issues ranging from severe, whereby one or both partners are completely sterile and do not have the ability to reproduce, through to mild, whereby simple changes result in conception of a child.
Male and female factors affecting fertility
Interestingly, infertility is just as likely to be due to a male factor as to a female factor. Often it is due to a combination of male and female issues. As well, for some couples, no cause for infertility can be found. Proportionally, infertility is due to:
- 20–30% male factors
- 20–35% female factors
- 25–40% complicated by both male and female factors
- 8–20% no cause identified.
Male factors
The most common male factor is the quality and production of semen. There are some relatively common male factors that can be readily diagnosed by a general practitioner, such as cryptorchidism where the testes do not descend from the abdomen or Varicocele where the veins around the scrotum are enlarged affecting the temperature and thereby the quality of semen.
There are also less common hormone issues or congenital issues that can interfere with semen production, and these may need to be resolved by consultation with an endocrinologist or urologist.
However, the reason for most cases of absence, or low number, of semen is unknown. Stress, diet, and environmental factors are likely to be the root cause.
- 13% cryptorchidism
- 10% varicocele
- 4% congenital abnormality of the vas deferens
- 2% endocrine abnormality (hormone issue)
- 10% other
- 57% no cause found
Female factors
Female factors are often an issue with ovulation or the uterus. Ovulatory disorders are either a problem with regulation of reproductive hormones by the hypothalamus or the pituitary gland. These disorders are readily diagnosed by a general practitioner.
Uterus disorders can be from the fallopian tubes, such as bacterial infection, or from the uterus wall lining, such as endometriosis. These disorders can also be diagnosed by a general practitioner.
Female factors can be difficult to diagnoses and may require specialist involvement. As with male fertility factors, the majority of female fertility factors go unexplained:
- 21 % ovulatory disorders
- 14 % fallopian tube disorders
- 6 % endometriosis
- 59% other or unexplained
Despite all these factors contributing to sub-fertility, couples will go on to conceive a child without treatment. After trying to get pregnant for two years, about 95% of couples successfully conceive.
Female reproductive system
Menstruation or period is the synchronising of two female body cycles. The ovarian cycle matures a single egg for potential fertilisation. The uterine cycle prepares the uterus for a potential pregnancy. The two synchronising cycles, known collectively as a period, start at an average age of 12 years (menarche). The cycles end at an average age of 51 years (menopause).
Unlike men, who produce sperm every day from puberty onwards, a women is born with all her reproductive cells. At birth, a woman has approximately 2 million immature egg cells (oocytes). This finite supply of eggs naturally depletes down to 500 thousand immature eggs cells at puberty.
From puberty, approximately 1000 immature eggs (oocytes) are involved in menstruation every month (about every 25–35 days); although, only 1 out of the 1000 will mature to ovulation stage and be capable of being fertilised—the rest will be shed.
Even though the rate of immature eggs cells (oocytes or follicle) shedding is a natural process, the rate can be influenced by genetic and environmental factors, such as smoking, that are known to increase the rate of immature egg cells shedding. The supply of immature eggs continues for approximately 40 years.
Menstruation cycle timeline
Intercourse outside the ovulation window, when the fertile egg is not in the fallopian tube, is unlikely to result in pregnancy. The ovulation window is 4 days before ovulation plus the day of ovulation. Ovulation occurs 14 days into the menstrual cycle when one of the chosen immature eggs is matured and travels to the fallopian tube ready for potential fertilisation.
Ovulation is governed by the nervous system via the hypothalamus and by the endocrine system via the pituitary gland, which releases gonadotropins hormones that stimulate ovaries to release sex hormones. Regulation is achieved by the spiking of four main sex hormones at specific times: FSH (follicle stimulating hormone) matures the immature egg, estrogen and LH (luteinizing hormone) are involved in the triggering of ovulation, and progesterone, which also plays a part in triggering ovulation as well as preparing the uterus for potential pregnancy.
Successful fertilisation during the ovulation window may result in pregnancy. Pregnancy signs include absence of menstruation, nausea, and swollen tender breasts. Approximately 60% of pregnancies fail within 2 weeks of fertilisation—before a pregnancy test is capable of detecting the pregnancy.
Among healthy couples, 25% conceive within the first month of trying; however, 5-–15% of couples experience difficulties conceiving. By far the majority of couples (95%) will conceive within the first 2 years without treatment.
Factors affecting fertility
- Delayed parthood can be a contributing factor to infertility. Although older couples are often more financially and emotional stable, delayed parenthood can be a contributing factor to infertility. The female egg reserve rapidly declines after women reach 35 years of age, with 66% of women aged 35–40 years conceiving within 12 months and only 44% of women aged over 40 years conceiving within 12 months. Moreover, older men have higher rates of sperm with DNA damage, resulting in complications for their offspring, such as birth defects and chronic and mental health disease.
- Being diagnosed as infertile and over investigation or treatment may have psychological consequences relating to fears and emotions of being unable to conceive. Stress is a controversial cause of infertility.
- Exposure to environmental pollutants may interfere with the pituitary gland, in turn affecting a woman’s ability to ovulate (ovulatory disorder) and affecting a man’s ability to produce healthy sperm.
- Occupational hazards that increase intra-scrotal temperatures may result in men having poor quality sperm or a low number of healthy sperm.
- Nutrition, weight, and exercise are believed to indirectly contribute to infertility—to what degree is controversial.
- Intercourse lubricants, even saliva, can damage sperm; and intercourse outside the ovulation window is unlikely to result in pregnancy.
- Infections in the reproductive tract can be a cause of infertility. Sexually transmitted diseases, such as human papilloma virus and herpes simplex virus, are common causes of reproductive tract infections and, consequently, infertility in men and women.
- Smoking, alcohol, and recreational drug use may affect fertility in both men and women.
Infertility is a spectrum of issues rather than being black or white. By far the majority of couples will conceive within 2 years without treatment. To optimise success, acupuncture is a drug-free treatment option. For those that choose the IVF path, acupuncture works well in conjunction with IVF treatments and many of the major clinics have their own acupuncturist.
Ozyigit, A., Female Infertility-Diagnosis and Management.
Szmelskyj, Irina & Aquilina, Lianne. (2014). Acupuncture for IVF and Assisted Reproduction: An integrated approach to treatment and management.