Acupuncture, a form of alternative medicine is the stimulation of specific acupuncture points along the skin of the body using thin needles. It is commonly used for pain relief, though it is also used to treat a wide range of conditions. Acupuncture is rarely used alone but rather as an adjunct to other treatment modalities. In Western settings acupuncture is used as a primary intervention for fertility problems. Acupuncture is increasingly used as an adjunct to assisted reproductive technologies and more widely in the complementary health care system.
The Western medical acupuncture approach involves using acupuncture after a medical diagnosis. In traditional acupuncture, the acupuncturist decides which points to treat by observing and questioning the patient to make a diagnosis according to the tradition used.
This method has always been applied to reproductive treatment in China. Western medicine may exert influence on neuroendocrine system, immunological functions and even signal pathway in consideration when discussing the efficacy of acupuncture and these still continue to be studied. The Chinese medicine evaluates the effect of acupuncture from an overall perspective. In Chinese medicine, reproductive function relates not only to reproductive organs, but also to the kidney, the liver, and the heart.
Acupuncture can be used as an adjuvant treatment for unexplained infertility. Although acupuncture did not increase the cumulative pregnancy rate, it decreased the number of control ovarian hyperstimulation (COH) cycles and more patients got pregnant in natural cycles after receiving acupuncture (Tab. 1).
Acupuncture treatment procedures should happen once or twice a week, and will continue for anywhere from a few weeks to a few months. Remember the process may take more time than just twice a week if you are combining it with medical infertility treatments, like IVF. In general, the acupuncture treatment can be completed in 12 appointments. At each appointment, your acupuncturist will most likely take additional time to discuss your current condition and answer any questions that you may have.
Traditional Chinese medicine (TCM) is a style of traditional Asian medicine informed by modern medicine but built on a foundation of more than 2,500 years of Chinese medical practice that includes various forms of herbal medicine, acupuncture, massage (tui na), exercise (qigong), and dietary therapy. It is primarily used as a complementary alternative medicine approach. TCM is widely used in China and is becoming increasingly prevalent in Europe and North America.
One of the basic tenets of TCM "holds that the body's vital energy (chi or qi) circulates through channels, called meridians, that have branches connected to bodily organs and functions." Concepts of the body and of disease used in TCM reflect its ancient origins and its emphasis on dynamic processes over material structure, similar to European humoral theory. Scientific investigation has found nohistological or physiological evidence for traditional Chinese concepts such as qi, meridians, and acupuncture points. The TCM theory and practice are not based upon scientific knowledge, and its own practitioners disagree widely on what diagnosis and treatments should be used for any given patient. The effectiveness of Chinese herbal medicine remains poorly researched and documented. There are concerns over a number of potentially toxic plants, animal parts, and mineral Chinese medicinals. A review of cost-effectiveness research for TCM found that studies had low levels of evidence, but so far have not shown benefit outcomes. Pharmaceutical research has explored the potential for creating new drugs from traditional remedies, with few successful results. A Nature editorial described TCM as "fraught withpseudoscience", and said that the most obvious reason why it hasn't delivered many cures is that the majority of its treatments have no logical mechanism of action. Proponents propose that research has so far missed key features of the art of TCM, such as unknown interactions between various ingredients and complex interactive biological systems.
TCM's view of the body places little emphasis on anatomical structures, but is mainly concerned with the identification of functional entities (which regulate digestion, breathing, aging etc.). While health is perceived as harmonious interaction of these entities and the outside world, disease is interpreted as a disharmony in interaction. TCM diagnosis aims to trace symptoms to patterns of an underlying disharmony, by measuring the pulse, inspecting the tongue, skin, and eyes, and looking at the eating and sleeping habits of the person as well as many other things.
The fundamental principles of TCM are based on the Yin-Yang doctrine, the symbolic way of designating opposing forces, and the five element theory that everything in the Universe is dominated and balanced by the five elements, wood, fire, earth, metal and water. The therapeutic mechanism of TCM focuses on enhancing human body's resistance to diseases by improving the inter-connections among self-controlled systems and integrating the human body with the environment. The practice of TCM involves physical therapy such as acupuncture and chemical therapy using materials originating from plants, minerals and animals, while TCM natural products may comprise one or more herbs in the form of decoctions.
In Chinese philosophy, the concept of yin yang sometimes referred to in the west as yin and yang) is used to describe how polar or seemingly contrary forces are interconnected and interdependent in the natural world, and how they give rise to each other in turn. Many natural dualities — e.g. dark and light, female and male, low and high, cold and hot — are thought of as manifestations of yin and yang (respectively).
Yin yang are complementary opposites within a greater whole. Everything has both yin and yang aspects, although yin or yang elements may manifest more strongly in different objects or at different times. Yin yang constantly interacts, never existing in absolute stasis. The concept of yin and yang is often symbolized by various forms of the Taijitu symbol, for which it is probably best known in western cultures. There is a perception (especially in the West) that yin and yang correspond to good and evil. However, Taoist philosophy generally discounts good/bad distinctions as superficial labels, preferring to focus on the idea of balance.
In TCM, there are five diagnostic methods: inspection, auscultation, olfaction, inquiry, and palpation.
Inspection focuses on the face and particularly on the tongue, including analysis of the tongue size, shape, tension, color and coating, and the absence or presence of teeth marks around the edge.
Auscultation refers to listening for particular sounds (such as wheezing). Olfaction refers to attending to body odor. Inquiry focuses on the "seven inquiries", which involve asking the person about the regularity, severity, or other characteristics of: chills, fever, perspiration, appetite, thirst, taste, defecation, urination, pain, sleep, menses, leukorrhea. Palpation which includes feeling the body for tender A-shi points, and the palpation of the wrist pulses as well as various other pulses, and palpation of the abdomen. Examination of the tongue and the pulse are among the principal diagnostic methods in TCM.Certain sectors of the tongue's surface are believed to correspond to the zàng-fŭ. For example, teeth marks on one part of the tongue might indicate aproblem with the Heart, while teeth marks on another part of the tongue might indicate a problem with the Liver. Pulse palpation involves measuring the pulse both at a superficial and at a deep level at three different locations on the radial artery (Cun, Guan, Chi, located two fingerbreadths from the wrist crease, one fingerbreadth from the wrist crease, and right at the wrist crease, respectively, usually palpated with the index, middle and ring finger) of each, for a total of twelve pulses, all of which are thought to correspond with certain zàng-fŭ. The pulse is examined for several characteristics including rhythm, strength and volume, and described with qualities like "floating, slippery, bolstering-like, feeble, thready and quick"; each of these qualities indicate certain disease patterns. Learning TCM pulse diagnosis can take several years.
Chinese medicine therapies
Anorexia nervosa (AN) is a complex and frequently intractable illness of unknown etiology that is often chronic and disabling. It is characterized by aberrant feeding behaviors, an extreme pursuit of thinness and emaciation, and body image distortions. Onset tends to occur during adolescence.
AN is often associated with denial of illness and resistance to treatment. Consequently it is difficult to engage individuals with AN in treatment, including nutritional restoration, and weight normalization. The continuous restrictive eating and malnutrition result in pervasive disturbances of most organ systems including cardiovascular and gastrointestinal complications, endocrine disorders (i.e. osteopenia (bone weakening) and amenorrhea), and other metabolic alterations.
It is well known that patients with AN, compared to healthy controls, tend to eat significantly fewer calories by restricting caloric intake and avoiding calorie dense foods. Individuals with AN show many unusual eating behaviors like slow and irregular eating, vegetarianism, and choosing a narrow range of foods.
Without weight restoration, patients may face serious or even fatal medical complications of severe starvation. However, the process of nutritional rehabilitation can also be risky to the patient. The refeeding syndrome, a problem of electrolyte and fluid shifts, can cause permanent disability or even death. It is essential to identify at-risk patients, to monitor them carefully, and to initiate a nutritional rehabilitation program that aims to avoid the refeeding syndrome. A judicious, slow initiation of caloric intake, requires daily management to respond to entities such as liver inflammation and hypoglycemia that can complicate the body's conversion from a catabolic to an anabolic state.
Administration of nutrients (Tab. 1) should be done slowly, starting with no more than 500 kcal/day in the form of a complete liquid diet for several days, then gradually increasing the caloric load in a step-wise mater. People at high risk are those with BMI < 12, those who vomit, abuse laxatives and binge and those with physical comorbidity. In such severe cases, strict monitoring is required, and it may take a month or more to restore body weight, not necessarily to normal weight, but to an acceptable level (usually a 10% gain in weight) that can be followed by oral feeding on an outpatient basis.
Caloric requirements in AN patients are high and vary between 30–40 kcal/kg/day (up to 70–100 kcal/kg/day) for inpatients, and 20 kcal/kg/day for outpatients; after the first phase of treatment it is possible to achieve a weight gain of 1–1.5 kg/week in the inpatient setting and of 0.5 kg/week in the outpatient setting. Also, for maintenance, AN patients need higher caloric amounts - around 50–60 kcal/kg/day - than the general population. This increased caloric requirement may be due both to exercise – often a hallmark of this illness - and metabolism.
It has been suggested that the AN patient should be eating calorie dense food to replenish the necessary nutrients. Daily intake of foods containing protein of high biological value, such as whey and casein, and egg whites, that contain a high concentration of essential amino acids per gram and calorie density, should be recommended. Consuming small amounts of protein of high biological value, in conjunction with the protein source foods that are perceived as less challenging by AN patients (usually of a vegetable source), can help assure a faster restoration of nutrient status even in a continued state of reduced body weight. Additionally, a variety of protein food sources including fleshy fish and poultry should be encouraged.
Recommended Daily Allowances (RDA’s) for vitamins and minerals vary by age and gender, but can be met by intake of a multivitamin/multimineral tablet or liquid. Placing the emphasis on nutrient requirements, achieved through food intake, as opposed to caloric intake, may help to lessen the anxiety and resistance to refeeding observed in AN patients.
Nutrition restoration is a core element in treatment because of the need to restore weight in order to avoid severe physical complications and to improve cognitive function to make psychological interventions useful and effective.
Weight loss or anorexia can also cause hormonal imbalance. Sex hormones are affected in both male and female patients with anorexia nervosa. These patients have low levels of hypothalamic gonadotropin releasing hormone (GnRH) and low levels of pituitary luteinizing (LH) and follicle stimulating hormone (FSH), estrogen and testosterone. These abnormalities affect potency, fertility. It is possible that this mechanism evolved to protect the mother’s health. A pregnancy where the mother is weak could pose a risk to the baby’s and mother’s health.
Hallmark of anorexia nervosa is secondary amenorrhea too and weight restoration is the mainstay of treatment for amenorrhea in the setting of anorexia nervosa. However lack of menses, it is possible for women with anorexia nervosa to become pregnant.
In contrast to the occurrence of amenorrhea in females, males have changes in sexual functioning, including a decrease in sexual drive. With decreasing weight is also reduced testosterone levels.
Given the lack of clear correlation between features of anorexia nervosa and subsequent pregnancy complications, there is no clear treatment or preventative measure for this issue, other than treatment of the underlying eating disorder and nutritional deficiencies.
Yoga is a mind-body exercise that combines spiritual traditions with physical movements. It was first practiced by Hindus in India more than 5,000 years ago. These movements, known as "postures," involve deep stretching and meditation (Pic. 1). The word yoga means "union" in the ancient Indian language of Sanskrit (ancient Indian language).
Yoga in Indian traditions, however, is more than physical exercise, it has a meditative and spiritual core. One of the six major orthodox schools of Hinduism is also called Yoga, which has its own epistemology (branch of philosophy concerned with the theory of knowledge) and metaphysics, and is closely related to Hindu Samkhya philosophy (one of the six orthodox schools of Hindu philosophy).
Many studies have tried to determine the effectiveness of yoga as a complementary intervention for cancer, schizophrenia, asthma, heart disease and infertility. The results of these studies have been mixed and inconclusive, with cancer studies suggesting none to unclear effectiveness, and others suggesting yoga may reduce risk factors and aid in a patient's psychological healing process.
It appears that there is a burgeoning number of women who struggle to get pregnant naturally. As a result of infertility problem, many mothers experience chronic stress. It can wreck havoc on body, change mood and depress the immune system. In this case, yoga not only increases blood flow and strengthens pelvic region but also addresses the root cause of stress.
Some major ways in which yoga can effect and treat infertility:
As mentioned before, stress plays a major role in slowing down your fertility. Yoga is a great way to beat stress and achieve peace of mind. Yoga is not just about the body it is also about breathing. The breathing techniques associated with yoga can help lower the stress hormone cortisol in the body. This in turn can increase chances of conceiving.
Detoxifies the body
Certain yoga poses can help detoxify the body and help boost fertility. Yoga can also help relax tight muscles and connective tissues.
Many infertility issues arise due to blockages. With yoga, it is possible to increase blood circulation and ensure that it reaches the reproductive organs. This can help create a positive environment for a pregnancy.
Works on immune system
Yoga is great way to boost immunity. Practicing yoga helps find inner calm, which in turn can help raise the number of white blood cells in the body. This not just helps keeping common diseases at bay but can also help beat infertility.
Helps keep the ovaries healthy
Certain yoga poses reroute the blood flow to reach the ovaries. This helps to provide these specific organs with more oxygen, making them healthier. It is important to note that ovarian dysfunction is a common cause of infertility in women. So, yoga can be a great tool for women with ovary related issues.
Helps deal with hormonal treatment better
With all those hormones in the body, it is easy to fall into the depths of physical and mental distress. This negative energy in the body can reduce chances of conceiving. With yoga, it is possible to minimize these side effects and increase chances of becoming pregnant.
Yoga involves a lot of stretching poses and exercises, thus strengthening reproductive muscles and organs which play a major role both in pregnancy and delivery. Fertility yoga is gentle and not demanding. An example of fertility yoga is Hatha which is slow-pacing.
These simple yet powerful fertility yoga poses should be practiced on a routine basis. Learning from a good yoga teacher is advised to get the pose right. These are some of the poses advisable for increasing fertility.(Pic.2)
• Cobra pose
• Lotus pose
• Legs up the wall pose
• Bridge pose
• Cobbler´s pose
• Supported head stand
• Supported shoulder stand
There is no need to be experienced in these practices to try fertility yoga. Doing these special poses can help women to gain more confidence about themselves and help towards parenthood. It can also help through reproductive difficulties.
Women are unique individuals and the desire to reproduce can be over-whelming. Never is that yearning more magnified then when they are unable to accomplish getting pregnant. Yoga can get women to the place they need to be so that they can free their hearts and prepare for a baby.
The term meditation refers to a broad variety of practices that includes techniques designed to promote relaxation, build internal energy or life force (qi, ki, prana, etc.) and develop compassion, love, patience, generosity, and forgiveness. A particularly ambitious form of meditation aims at effortlessly sustained single-pointed concentration meant to enable its practitioner to enjoy an indestructible sense of well-being while engaging in any life activity.
The word meditation carries different meanings in different contexts. Meditation has been practiced since antiquity as a component of numerous religious traditions and beliefs. Meditation often involves an internal effort to self-regulate the mind in some way. Meditation is often used to clear the mind and ease many health concerns, such as high blood pressure, depression, and anxiety. It may be done sitting, or in an active way—for instance, Buddhist monks involve awareness in their day-to-day activities as a form of mind-training. Prayer beads or other ritual objects are commonly used during meditation in order to keep track of or remind the practitioner about some aspect of that training.
Both physical and psychological or emotional stress affect the body in all kinds of ways, not the least of which is fertility. Stress decreases women’s fertility in part because it can stop ovulation and menstruation altogether. Short of that, women under stress are less likely to get pregnant in any given cycle than are women not experiencing any particular psychological distress. Stressed women also face a higher risk of very early miscarriage.
Studies have clearly demonstrated the fertility effects of stress in men as well. Researchers collected semen samples from their volunteers at a time of stress and again at a time of no extraordinary stress. The first (stressed) samples showed lower sperm counts, lower motility, lower semen quality, and a higher percentage of abnormal sperm compared to those taken later (not under stress). Fortunately, full fertility was restored when the stress disappeared. It may means that reducing stress can reverse fertility problems.
Spending a few minutes a day centering yourself and focusing positively on your body, your health, your cycle, and your fertility may be a great way to tap into.
Medical nutrition therapy (MNT) is a therapeutic approach to treating medical conditions and their associated symptoms via the use of a specifically tailored diet devised and monitored by a medical doctor, registered dietitian or professional nutritionist. The diet is based upon the patient's medical record, physical examination, functional examination and dietary history.
The role of MNT when administered by an MD or DO physician, dietitian or professional nutritionist is to reduce the risk of developing complications in pre-existing conditions such as type 2 diabetes as well as ameliorate the effects any existing conditions such as high cholesterol.
It works to solve current problems and change unhelpful thinking and behavior. The name refers to behavior therapy, cognitive therapy, and therapy based upon a combination of basic behavioral and cognitive principles. Most therapists working with patients dealing with anxiety and depression use a blend of cognitive and behavioral therapy. This technique acknowledges that there may be behaviors that cannot be controlled through rational thought, but rather emerge based on prior conditioning from the environment and other external and/or internal stimuli. CBT is "problem focused" (undertaken for specific problems) and "action oriented" (therapist tries to assist the client in selecting specific strategies to help address those problems), or directive in its therapeutic approach. It is different from the more traditional, psychoanalytical approach, where therapists look for the unconscious meaning behind the behaviors and then diagnose the patient. Instead, behaviorists believe that disorders, such as depression, have to do with the relationship between a feared stimulus and an avoidance response, resulting in a conditioned fear, much like Ivan Pavlov. Cognitive therapists believed that conscious thoughts could influence a person’s behavior all on its own. Ultimately, the two theories were combined to create what is now known as cognitive behavioral therapy.
Assisted reproduction therapy does not exist.
For women, being underweight and having extremely low amounts of body fat are associated with ovarian dysfunction and infertility. Underweight women (BMI < 19 kg/m2) have a four-fold longer time to pregnancy than women with a normal BMI. Specifically, underweight women required an average of 29 months to conceive as compared to 6.8 months in women with a normal weight profile.
Indeed, as for the initiation of menses, a minimum of fat mass is necessary, for maintaining ovulatory function, and therefore, fertility. Conditions of energy deficit, such as eating disorders (ED), malnutrition and strenuous physical activity, are associated with subfecundity and infertility.
In developed nations, conditions that produce malnutrition are eating disorders, a spectrum of psychiatric disturbances that affects childbearing age women. EDs are associated with hypothalamic amenorrhea, oligomenorrhea, anovulatory cycles, and luteal phase deficiency. At the level of the CNS (central nervous system), food deprivation was demonstrated to inhibit the hypothalamic-pituitary-gonads axis, affecting GnRH (Gonadotropin-releasing hormone, a hypothalamic hormone inducing the release of the gonadotropins, specifically Luteinizing hormone and Follicle-stimulating hormone) pulse generator. Inhibition of GnRH secretion leads to a cascade of inhibitory effects, including decreased gonadotropin secretion, retarded follicle development, and inhibited synthesis of gonadal steroids.
It has been reported that 20.7% of infertile women seeking intrauterine insemination (IUI) had been diagnosed with an eating disorder, suggesting that women with history of eating disorders may be at a higher risk for infertility.
Men who are underweight are also at risk of infertility. Men who are underweight tend to have lower sperm concentrations than those who are at a normal BMI. As the majority of the available literature focuses on the impact of obesity, more research is needed into the effects that being underweight may have on male fertility.