Ask an expert - body - fertility

39 questions

Q: I am having an IVF embryo transplant this afternoon followed by another acupuncture session. If I have one more session tomorrow is that safe or is it too much?

A:There is nothing to worry about, as far as we can see. Many of the protocols which have been devised for assisting in IVF are focused on the point of implantation, and the most well known of these, the Paulus Protocol, involves using acupuncture within twenty minutes of the implantation. It would not be at all surprising if someone had developed a protocol which extended this to a slightly longer time frame and to involve multiple sessions. The evidence base for the success of these protocols, especially the Paulus, is good, and even though the treatment is a formula and not the traditional acupuncture which we practise it is a good baseline from which to move forward. You can read the about Paulus here https://www.ncbi.nlm.nih.gov/pubmed/11937123.

As far as frequency of treatment is concerned it is not uncommon in China for someone to receive treatment daily for ten days, and because the treatment is offered in the outpatient departments of hospitals within the national health scheme it is accepted as a viable process for short term acute problems. There is no suggestion that over-treatment can be a problem. Acupuncture is a very safe treatment, and if the body has had enough it simply fails to respond any further. Excessive treatment might make someone very tired or a little whoozy, possibly even a little nauseous, but these effects would be very short lived.

In short it sounds as though you are in safe hands with someone who knows what they are doing, and we very much hope that it has the desired result.

Q: I've had three acupuncture sessions to try and improve my chances of conceiving. My acupuncturist said this was 'laying the foundations' for improving my fertility. She  recommended fortnightly treatments after that. Could you advise what she might have meant by 'laying the foundations'?

A: It is always a little difficult to be entirely sure what a practitioner was intending, but we think it is highly likely that she is simply describing the way that many of us work with conditions or patients where it would be unrealistic to expect quick fixes for their problems. In the treatment of migraines, for example, we might often treat someone for four or five sessions once a week, and then step back, depending on progress, to a number of monthly sessions and eventually maintenance treatment a few times a year.

 This reflects our overall view of what we are trying to achieve. Traditional acupuncture treats the person rather than the condition, so although each patient comes to us with presenting signs and symptoms our job is to make sense of these within the overall context of their energies and try to restore an overall balance. The challenge is that many of the patterns which people have in their energy systems have become deeply entrenched, so it is as much a matter of encouraging and retaining a change in the face of some resistance as it is of immediately reversing a pattern. In order to do this we often speak of using the first few sessions as a kind of foundation for what follows on which we can then build. One of our old teachers used to talk about watering plants - when you rescue a plant you might have to douse it two or three times but after that you would water less frequently to let nature take its course. Once the tide has turned, so to speak, then you can guide the changes as much as looking for major reversals.

 Fertility problems are particularly challenging in terms of treatment planning because the desired outcome, a pregnancy, is going to be possible only for a few days each month. Many practitioners undertake special postgraduate training to work with these issues, and great care is taken to address the different energetic needs at times of the cycle to encourage the best overall pattern. Early sessions would establish the overall pattern, and involve any major changes which a practitioner might want to encourage, and after that it would it building on this by carefully targeting what the following sessions aimed to do.

 We hope that this makes sense, and also that it reflects what the practitioner intended. We think it may have been to our detriment over the last decade or so to have become more focused on named conditions in our PR and marketing because this inevitably invites comparison with Western medicine which usually has set protocols involving specific numbers of treatments for many problems. In Chinese medicine each patient is unique and different, and the treatment of the same named condition in a dozen patients may be different in every case. Our aim is to restore balance to the whole system in the belief that this enables the body to put right whatever symptoms might have appeared as a consequence. Once you look at treatment in this way the notion of laying foundations makes a great deal more sense.

 

Q:I have recently started acupuncture to aid fertility (my husband and I have been trying to conceive for 18 months with no luck). I am currently receiving acupuncture every fortnight and have been doing so for the past three months. Since starting the treatment I have been experiencing irregular spotting for about a week before my period is due. Is this normal? I am starting to think it is doing more harm than good.

A: We are sorry to hear of your problem. We would probably need a great deal more detail before we could offer a more specific view - what kind of bleeding, how long, any triggers and the background context of your normal cycle and problems with conceiving. Even then we would be cautious; there are several reasons why someone can start spotting, and it would be incautious to be offering too definitive a view at long range.

 What we can say with certainty, though, is that it is highly unlikely that acupuncture treatment has caused anything in the body to malfunction. The only harm that acupuncture treatment can ever do is physical damage to the body by putting a needle into internal organs by needling incorrectly, or by the simple act of insertion itself - nerve damage, minor bruising. We all train for a minimum of three years to ensure that these sorts of accidents don't happen, and the safety record of acupuncture treatment is exemplary. Research studies published in the BMJ a decade ago reveal how few even minor adverse events there are, only about 14 in 66,000 treatments.

 There are occasionally reactions like this when the body starts to return to normal function, and sometimes energetic reasons why a patient might be losing blood in the later part of the cycle. However, were this to happen to any of our patients our first action would be to refer them to their GP or consultant for further testing and investigation. The majority of reasons for spotting at this stage of the cycle are benign but some aren't, and these need to be checked out immediately. It may be that the acupuncture treatment and the advent of spotting are purely coincidental, and we have had to deal with a number of cases in the past where arguments have kicked off about what caused a problem while the problem itself has gone uninvestigated. Finding out what is happening should always be the first step; what caused it usually emerges from getting the answer.

 The other thing we would do is to seek the advice of experts within the acupuncture profession in the treatment of fertility issues. Although we have yet to formally recognised specialisms there are two or three areas like paediatrics and obstetrics/fertility where practitioners have undertaken significant postgraduate study and where leading practitioners have dedicated their practice solely to these areas. Many BAcC members undertake training with them, and have access to their advice and expertise. We would hope that any member who did not fully understand why a specific symptom was happening to ask for specialist advice to set a patient's mind at rest.

 We hope that this isn't too woolly, but without greater detail we would be unhappy to be more specific. We think the best advice is to talk the matter through with your practitioner, and if they cannot offer a satisfactory explanation then they should be talking to someone who can. In any event, we would advise you to get the symptom checked anyway just to eliminate some of the more rare reasons why spotting can start to happen.

 

Q:  My husband and I have just started our first IUI (intra uterine insemination) treatment. I began injections to stimulate ovulation and have a second scan planned for 24th next week. I wondered if I should have an acupuncture treatment to hopefully help the process? And at which point in the cycle do you think would be best?

A:  There are no hard and fast rules about the use of acupuncture during IVF and IUI, although over the years a kind of consensus has emerged that weekly treatment as an overall constitutional benefit is a solid foundation for preparation for IUI, and then specific treatments just before and just after the IUI to maximise the chances of success.

There are a number of practitioners out there in what has become something of a growth industry who offer the treatments at the time of the IUI without any other treatments, i.e. are not qualified acupuncturists but have trained in a few limited techniques. This can have benefits, just as the more well-known Paulus Protocol has been shown to increase the success rate of IVF. However, much as we like to see evidence for the success of acupuncture treatment we are committed as generalists to treating people, and the use of formula points for specific issues not only goes against our collective grain but also seems to us to short change the patient. We believe that marrying some of these specific interventions to a more all-embracing constitutional approach is far better, and for that you really need to be seeing a professionally trained and qualified practitioner.

We are in the process of drawing up guidelines for areas of expert practice like obstetrics and paediatrics because we have an increasingly large number of members who spend the majority of their time working with pregnant or infertile women, or children. We intend to set standards through which they can claim to be expert practitioners and by which we can identify them from our membership when asked questions like this. At the moment, though, we cannot point you to individual practitioners, but we are absolutely certain that if you enter 'acupuncture fertility BAcC' and the area where you live you are pretty much guaranteed to find a member with a special interest in fertility issues who will be able to offer you the very best advice about what to do, and will almost certainly be able to gear that advice to your specific situation better than the sort of generic advice we offer here.

Q: I currently receive acupuncture treatment for fertility. I experience headaches after some sessions, is this common and what is it due to?

A:  There are a number of short term adverse effects after treatment which happen frequently enough that we warn patients of their possibility. Headaches, a feeling of slight dizziness and occasionally a slightly nauseous feeling are common enough to warn patients of, and much more commonly a deep tiredness after the first one or two sessions is not uncommon.

There are a number of possible reasons for the effect, although we could never say with absolute certainty why things happen because each patient is unique and different. The energy system is a closed system, and so any treatment which improves the flow of energy can occasionally uncover slight blockages in the system which were not an issue when the flow was impaired. It's a rotten analogy, but sometimes central heating systems will function fine when used occasionally in the summer but then develop major problems when cranked up full in the winter. An experienced practitioner may well be able to tell from the tongue and pulse that there are blockages and deal with them.

It is also possible that the treatment is causing functional disturbances whose outcome is to generate a headache. There has been some very lively discussion over the years between those practitioners who argue that treating the person as a whole in a traditional fashion is enough to kickstart the system into operating normally, and those who use a much more formulaic syndrome-based approach to treatment which addresses the reproductive function. This latter approach can sometimes generate unwelcome consequences elsewhere because the internal connections within the system make other parts react and sometimes over-perform. Again, an experienced practitioner should be able to make sense of either of these situations, because if a symptom develops there is always going to be some evidence in the diagnostic signs that we use.

We have answered a similar question before and there we cautioned the person not to make the assumption that the headache was caused by the treatment even though it happened immediately after it. Sometimes there are coincidences, and we are always keen to ensure that if an unusual system kicks off that people don't waste time arguing about whether the acupuncture caused it or not while it goes untreated. In your case, however, the chances are that since it has happened a few times after sessions and then subsides it is treatment related.

The best advice that we can give is to talk to your practitioner and see what can be done to make these less intrusive and hopefully stop happening altogether.

And good luck with the fertility treatment!

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