Acupuncture and Unexplained Infertility

by Cathy
(Marin, CA)

Hi Amelia,
I have had unexplained infertility since a miscarriage at 12 weeks in 2006. I hemorrhaged a great deal and very nearly needed a transfusion. I had elevated FSH after a Clomid challenge test last year.

I started seeing a RE last June. We did 3 IVF cycles and 1 IUI. We had low egg retrieval numbers except for the last IVF, in which we had 3 embryos transferred with no success.

Throughout all IVFs I did acupuncture and took some herbs. I cut out caffeine and limited alcohol. I got pregnant naturally in April of this year, only to miscarry at 7 weeks.

I am now 40 and would like to be more aggressive about TCM. Can you suggest any changes? I am primarily also vegetarian, though I eat eggs and fish. I try to limit dairy. I have been diagnosed as spleen deficient. I look forward to hearing your advice.

Thoughtfully...
Cathy

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Acupuncture and Unexplained Infertility
by: Amelia Hirota

Hi Cathy,
Did you do the 3 IVF and 1 IUI cycles in June 2007 and then get pregnant naturally in April 2008? What do you charts look like? Length of your entire cycle, average temps during follicular phase, average temps during luteal phase and length of luteal phase?

What was your FSH off Clomid and on the Clomid challenge? How long is your period, what is the color of the blood, what is the flow like, do you have cramps and are there any clots? What about your progesterone 6 days past ovulation? Have you had a hysteroscopy or sono-hystogram to check the lining of your uterus for fibroids or polyps?

Have you had your thyroid thoroughly tested and if so, what were the numbers? What were your hCG and progesterone numbers like during your pregnancies? I'm interested in the levels and the speed at which they doubled. Lastly, what are the numbers for your partner's sperm count, motility, forward progression and morphology?

On the surface, it seems to me that you are not a candidate for IVF. The fact that you've been pregnant naturally twice indicates that
your partner's sperm is decent (although poor sperm quality has been shown to lead to miscarriage), your fallopian tubes are open and
you're ovulating. I believe that more examination needs to be done in the area of your thyroid, luteal phase and sperm quality. Please respond to the above questions, and I'd be happy to further explore this with you.

Warm regards,
Amelia

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Acupuncture and Unexplained Infertility
by: Cathy

Hi Amelia,
Here are my answers to your questions. My first IVF was in August 2007 with traditional lupron protocol, low estrogen levels, 4 eggs retrieved, 1 embryo fertilized and transferred, no pregnancy.
Second IVF October 2007 micro dose protocol, 2 eggs retrieved, 2 embryos fertilized with ICSI, only survived 2 days.

IUI December 2007 estrogen priming, estrogen levels ideal, no pregnancy. Third IVF February 2008 with estrogen priming, 5 eggs retrieved, 4 embryos fertilized with ICSI, 3 surviving transferred on day 2, no pregnancy.

Typical cycle 28-30 days, average temp during follicular phase is 97.2. I have not charted my luteal phase. I do not know my FSH levels off Clomid, on the Clomid challenge (done Jan.
2007) it was 14. My period is usually 3 days, blood is red, heavy bleeding the first two days, only spotting on third day. Flow has a lot of clots. Not much cramping though I have a history of endometriosis causing bad cramps. I have had laparoscopy twice for removal of endometrial adhesions.

I do not know my progesterone levels post ovulation. For the IUI and IVF cycles, when I was on progesterone, I had hot flashes at night.
HSG and HCG were normal, no blockages, fibroids, or polyps. I had my thyroid tested, all levels were in normal range. I do not know any
numbers. I do not know any of my hormone levels from pregnancies.

My husband's sperm count, motility, and progression were all good. I have been pregnant naturally 3 times. I have a 4 yr. old daughter. I got pregnant in 2006 very easily, within a few weeks of trying. I have had problems since the miscarriage of that pregnancy in 2006. I hemorrhaged a great deal with that loss. I was anemic for two months. I believe that the blood loss has caused damage to my ovaries and has led to the infertility.

I look forward to hearing your thoughts...
Cathy

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Acupuncture and Unexplained Infertility
by: Amelia Hirota

Hi Cathy,
Thank you for the details. I agree with you that the miscarriage in 2006 was very hard on your body and may be a major contributor to you not getting pregnant. In order to understand your overall fertility, I would encourage you to check your Day 3 FSH, 6 DPO (days past ovulation) progesterone, the actual thyroid numbers and the various sperm numbers. When I meet with patients in the clinic, it's important to see the actual numbers, not just hear that a doctor said that the test was "fine."

Eighty percent of my patients were told that the sperm was fine and we come to find out that it wasn't. Generally, healthy sperm does not need ICSI to penetrate the egg and the fertilization rate would be above 75%. It's also very important to really delve into the thyroid. It's a major contributor to miscarriage and it's definitely not examined closely enough.

I would strongly encourage you to chart your cycle. It's only through charting your cycle that you will see if you're ovulating on your own and if your luteal phase is sufficient to allow for implantation to take place. Since you are working with an acupuncturist, I would encourage you to get weekly acupuncture treatments, request personalized herbal formulas that are tailored to your cycle and take 4-6 (bare minimum) months to properly prepare your body for conception.

To learn more about understanding your various hormone tests and how traditional Chinese medicine can help you conceive and have a healthy pregnancy, sign up for one of my courses. The groups are wonderful and very supportive. Also, many of my past patients have gotten pregnant, once they figured out their own challenges. It's so beautiful to work with empowered women. Good luck to you!

Warm regards,
Amelia

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