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41 questions

Q:  I was diagnosed with premature ovarian failure over a year ago and have been considering acupuncture as a treatment to perhaps improve my chances of conception. I am aware there are a few private clinics in my area, but do not have the funds to attend regularly. Firstly, I am wondering whether it would help me in any way, and secondly I am wondering whether there are any funded or trainees in my local area who may be able to treat me at a reduced rate?

A:  It would be fair to say that we have had a large number of enquiries about reduced rate treatment since the Channel 4 programme 'Something for Nothing' last week.  All we can say on this front is that there are a number of teaching institutions in a formal relationship with our sister body, the British Acupuncture Accreditation Board, which have teaching clinics which may be able to offer treatment at less than the market rate, and as we have said many times before, under the direct supervision of some of the most experienced practitioners in the country, so in no way a reflection on the standard of treatment.
However, it is also true to say that a great many BAcC members are willing to negotiate if treatment really is beyond someone's means. This is not often an advertising point in leaflets and on websites - we'd spend all of our time bartering, and we're professionals who warrant the fees which we charge - but many members are not in it just for the money and have a genuine desire to help people come what may.
The issue of POF, however, is a more tricky one. As our factsheet on fertility shows:
there are a number of studies which seem to offer some encouragement that acupuncture treatment may enhance fertility. However, the treatment of infertility has become something of a growth area over the last decade, and we are troubled by the fact that there are a number of acupuncturists who are claiming expertise where there are no agreed standards. As far as Chinese medicine is concerned there is very little specialist treatment for gynaecological problems which is not a part of someone's core training as a practitioner. It is true that there are practitioners, many of whom are BAcC members, who have chosen to work almost exclusively with this group of patients, and where they do have a distinct advantage is often in their very thorough knowledge of conventional medicine in this area, more than the average practitioner.
From a Chinese medicine perspective, though, the failure to conceive and the disruption to the menstrual cycle would be seen against the backdrop of broader symptoms which a patient may have together with diagnostic signs unique to Chinese medicine, taking the pulse at the wrist and looking at the tongue. If these show functional disturbances there is a possibility that correcting them may have an impact on someone's fertility.
However, to give this kind of informed view is more than we can do online. We recommend that you pop along to a BAcC member near you, perhaps one who advertises on their website that they focus on working with fertility issues and seek face to face advice on whether acupuncture treatment may be worthwhile in your specific case.   

Q:  My daughter-in-law is looking for a Acupuncturist that specialises in IVF in the North East, where do we start looking ?

A:  We do not really have a category of 'specialists' as such, because from our perspective all of our members are competent, safe and well-trained in Chinese medicine, and are all equally wel-equipped to treat appropriately whatever people bring to their practices.
We have recognised, however, that there are members who focus their work on specific patient groups, one of which is the treatment of women in all stages of the reproductive process, from trying to get pregnant through to childbirth and beyond. We are still working on the standards which will enable someone to claim expertise and advertise themselves as such, but in the interim it is a relatively straightforward process of entering 'acupuncture' and 'fertility' with your town name in Google, and we are confident that you will find someone who works with women with fertility issues and who is a BAcC member.
If this fails, then the best option is to use the BAcC 'find a practitioner' search facility to locate someone based near you and ask them who is the best qualified to help in your area. We all know those people local to us who focus on obstetrics or paediatrics, and are more than happy to see a prospective patient find the optimal treatment for them with the most suitable practitioner. 

Q:  I am doing a presentation on infertility and acupuncture what research journals/articles and books do you suggest I can read to help me with my presenttion?

A:  Our factsheet on fertility gives a number of references to journals and papers but these are probably not the sort of thing you would find most useful. We are also not sure how academic or informal your presentation is going to be.
Our own choices for presenting a paper on this topic would be:
1) We would check out what articles have appeared in our 'house' journal. the European Journal of Oriental Medicine. Our whole archive is now online, and these two items, found by using the search facility, would be handy,
They contain a number of references to the main books and journals which you can track down, and the wider search will also give you a number of references to articles about the ethics of IVF and acupuncture and some interesting case studies
2) There is also a useful research resource in America, NCBI, whose website contains many of the main free databases for research. Typing 'ncbi acupuncture' and whatever you want to research into google will generate a number of hits such as this one which we have not cited on our factsheet
3) There are always magazine articles and opinion pieces, especially in the United States, and the article below is one of several of a kind which we are sometimes asked to provide on topics like anxiety, stress and so on.
4) Finally there are first hand accounts which often personalise the process and offer a user's perspective. Rowan Pelling's piece in the Guardian a few years ago is a good example.

Q:  I currently have no periods and am keen for my cycle to return so I can start a family. Is this something accupunture could help with?

A:  There is no short answer to this problem. There are a number of reasons why a woman's periods might not be happening, and before we could give a reasonable assessment we would have to know whether your hormone levels had been checked carefully, whether you had been on the pill for any length of time before your periods stopped, whether you were underweight or anaemic - all the sorts of questions which your GP would ask and the results of the tests to which he or she would refer you.
Of course, Chinese medicine works on an entirely different theoretical basis to western medicine, and amenorrhea has been a health issue for the whole duration of its two thousand year history, so there are obviously explananations for why someone's periods have stopped which can co-exist with a western diagnosis. It is, after all, the same body, just two separate ways of looking at it. However, the importance of having undertaken all of the conventional medical tests is that there are some reasons for the lack of periods which no amount of acupuncture treatment will affect, and western methods may be more assured and more effective.
That said, there are often functional disturbances and blockages in the flow of energy, understood in Chinese medicine as a pattern of flow and balance which maintains health bodily function, and the correction of these may, if there are no underlying problems which make it impossible, get the system moving again.
There is very little research into amenorrhea, because as the books will always say, this is a symptom, not a problem itself, and such research as does exist will be into the specific causes as identified in western medicine. The best advice we can give you is to visit a BAcC member local to you for a brief face to face assessment of your signs and symptoms, and also more importantly for a brief discussion of how the problem developed - were the periods sporadic and then stop, did they stop suddenly, and so on. Once they have had this brief chat with you they will be able to offer you an informed view of whether acupuncture treatment can help you.  

Q:  I am a 32 year old female trying to conceive. I have a history of endometriosis and ovarian cysts. I have had two laparoscopic surgeries to drain the cysts and remove some adhesions as well.  The last laparoscopy was in Oct 2012.  Fertility investigations show that I am ovulating spontaneously but one of my fallopian tubes is blocked. I have been actively trying to conceive for 14 months now.  Would acupuncture help in conceiving?  Secondly, would acupuncture help in improving the symptoms of endometriosis such as painful periods?

A: As far as research into the  acupuncture treatment of fertility is concerned there is very little of sufficient quality to be able to make any encouraging noises about what acupuncture might achieve.

Our factsheet please click here

is very clear on this point. However, there are so many different reasons why someone may not be fertile or may have their fertility compromised that research in conventional terms, which reduces variables to the absolute minimum may be difficult to set up, given that it would have to find a significant number of women with exactly the same fertility issue.
The difference, and to an extent, advantage of Chinese medicine, however, is that it has an entirely different picture of the way that the body mind and spirit function based on an understanding that everything consists of an energy which the Chinese call 'qi'. As long as this energy flows freely and is in balance, all of the natural functions of the body perform as they are intended to. Once there are weaknesses or blockages in the system, then ill health or failure of function occurs. Sometimes there are specific causal relationships between blockages and functional failures/symptoms, and sometimes the symptoms are just an indicator that the whole system is not working well. The skill of the practitioner is to identify and correct patterns of imbalance, and because there is a Chinese medicine understanding of the mechanism of pregnancy a practitioner may be able to establish a direct causal link which explains why a woman is not getting pregnant. More usually the practitioner simply has to put the system in as good a working order as possible to enable conception to take place normally.
Our understanding, though, is that 14 months is still well within the limit at which conventional medicine starts to show concern, and it could simply be a matter of luck. In this case there would be no problem with having acupuncture anyway to prepare the system as well as possible, even though the practitiioner might find you in good balance (although the blocked tube and endometriosis suggest otherwise). 
The caution in modern times is that the fertility industry has become a big business, and there are now many people offering acupuncture treatment as a part of their package for helping women with problems who are not necessarily using the sophisticated system of Chinese medicine as it was intended. Formula treatments are rarely going to be enough to deal with complex issues, and the strength of Chinese medicine lies in the skill and artistry of the practitioner in discerning the unique patterns of the individual's disease.

The endometriosis you mention could be having an impact on your fertility, as our factsheet shows:
The evidence for the use of acupuncture in the treatment of endometriosis is a bit thin. One Cochrane review concluded that there were insufficient trials which met the standard criteria to be able to draw a conclusion
although two studies seemed to us to be relatively positive.
Our clinical experience, however, is that while acupuncture treatment can reduce the severity of the pains and to an extent regularise the menstrual cycle, it is not a condition which responds rapidly to treatment, so it would be unwise to have too many expectations about what can be achieved with treatment.

Our advice is always to visit a BAcC member local to you for a face to face assessment of whether they think acupuncture can help. We are in the process of developing systems for accrediting postgraduate training in the field of obstetrics so that members can make it known that they experts in the field, but since this work is still being finalised we cannot give referrals to individual practitioners with special expertise in this field. Most BAcC members who spend a great deal of their time working with fertility issues are very clear about this on their websites, and it should be relatively simple to identify a BAcC member near you with this particular focus in their practice.  

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