BOOK
Acupuncture for IVF and Assisted Reproduction - E-Book
Irina Szmelskyj | Lianne Aquilina | Alan Szmelskyj
(2014)
Additional Information
Book Details
Abstract
The management of infertility using acupuncture is an expanding area of practice and one which is frequently rewarding for TCM acupuncture practitioners.
Acupuncture for IVF and Assisted Reproduction has been specially prepared to meet the growing demand for information in this area and draws upon 20 years combined experience of the authors together with the latest evidence from both orthodox medicine and TCM.
Richly illustrated and clearly written throughout, the book takes the reader through the anatomy and physiology of reproductive medicine (from both an orthodox and TCM perspective) and explains the underlying basis of orthodox medical fertility tests and investigations. The volume then explores the pathology and aetiology of TCM syndromes and shows how common fertility-related conditions, such as endometriosis and male factor infertility, affect Assisted Reproductive Technology (ART) success rates. It explains in great detail how to take a reproductive medical history and successfully diagnose TCM syndromes. Acupuncture for IVF and Assisted Reproduction also provides guidelines on how to regulate the menstrual cycle in preparation for IVF treatment and shows how lifestyle can affect fertility and ART success rates.
Placing a strong emphasis on the practical aspects of patient care, Acupuncture for IVF and Assisted Reproduction contains an abundance of case history templates, algorithmic acupuncture treatment pathways and patient fact sheets and will be ideal for all acupuncture practitioners working in this field.
"A must have for the bookshelf of any acupuncturist who is ever called upon to treat fertility issues - if you have room for one book this surely must be it." Reviewed by The Acupuncture Fertility Centre March 2015
"Practitioners of all levels of experience and TCM students should find it compelling reading and an invaluable companion to their learning." Reviewed by Stephen Clarke, Journal of the Australian Traditional Medicine Society May 2015
"This book is extremely well re-searched and referenced." Reviewed by Danny Maxwell on behalf of Journal of Chinese Medicine, February 2015
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Dedication | ii | ||
| Acupuncture for IVF and Assisted Reproduction: An Integrated Approach to Treatment and Management | iii | ||
| Copyright | iv | ||
| Contents | v | ||
| Biographies | ix | ||
| IRINA SZMELSKYJ | ix | ||
| LIANNE AQUILINA | ix | ||
| ALAN SZMELSKYJ | x | ||
| Foreword | xi | ||
| Preface | xv | ||
| Acknowledgements | xvii | ||
| Chapter 1: Subfertility overview | 1 | ||
| Introduction | 1 | ||
| Definition of Infertility Disorder | 2 | ||
| Definition of pregnancy | 2 | ||
| Definition of regular intercourse | 2 | ||
| Length of time to achieve pregnancy | 2 | ||
| Implications | 2 | ||
| Prevalence of Infertility | 3 | ||
| Infertility trends | 3 | ||
| Infertility treatment seeking | 3 | ||
| Major Causes of Subfertility from an Orthodox Medical Point of View | 3 | ||
| Common medical causes of subfertility presenting in acupuncture practice | 4 | ||
| Importance of treating both male and female partners | 4 | ||
| Contributory Subfertility Factors: The Orthodox Medical Perspective | 5 | ||
| Socioeconomic factors | 5 | ||
| Delayed parenthood | 5 | ||
| Education and financial status | 6 | ||
| Political policies | 6 | ||
| Healthcare spending | 6 | ||
| Traditions, culture, and family values | 6 | ||
| Environmental factors | 6 | ||
| Occupational factors | 6 | ||
| Overview of other factors | 7 | ||
| Increased stress levels | 7 | ||
| Nutrition, weight, and exercise | 7 | ||
| Early puberty | 7 | ||
| Sexual intercourse | 7 | ||
| Reproductive tract infections | 7 | ||
| Negative lifestyle habits | 7 | ||
| Causes of Subfertility from the TCM Point of View | 7 | ||
| Internal causes of disease/injury through emotion | 7 | ||
| Anger | 8 | ||
| Contemplation or worry | 8 | ||
| Anxiety | 8 | ||
| Fear | 8 | ||
| Sadness and grief | 8 | ||
| Guilt | 8 | ||
| Interrelationship between the emotions, the body, and the Spirit | 9 | ||
| External causes of disease | 9 | ||
| Cold EPF | 10 | ||
| Heat/Fire EPF | 10 | ||
| Damp EPF | 10 | ||
| Miscellaneous causes of disease | 10 | ||
| Constitution | 10 | ||
| Inappropriate diet | 11 | ||
| Surgery | 11 | ||
| Social, recreational, and physical overexertion | 11 | ||
| Work and rest | 11 | ||
| Previous fertility treatment | 11 | ||
| Miscarriages | 11 | ||
| Coitus and family planning | 12 | ||
| Contraception | 12 | ||
| Summary of the causes of diseases in subfertility | 12 | ||
| Reproductive History and Development from an Orthodox Medical Perspective | 12 | ||
| Reproductive History and Development from a TCM Perspective | 13 | ||
| View and worship of fertility | 13 | ||
| Works of classical Chinese medicine physicians | 13 | ||
| Recognition by Chinese medicine of some of the fundamental concepts of fertility | 16 | ||
| Fertile window and intercourse timing | 16 | ||
| The effect of age on fertility | 16 | ||
| Importance of optimizing natural fertility | 17 | ||
| Integrated approach | 17 | ||
| Summary | 17 | ||
| References | 17 | ||
| Chapter 2: Anatomy and physiology of the reproductive system: Prerequirements for conception | 23 | ||
| Functional Anatomy of the Reproductive System from an Orthodox Medical Perspective | 23 | ||
| Female reproductive anatomy | 23 | ||
| The ovaries and follicles | 23 | ||
| The fallopian tubes | 23 | ||
| Uterus | 25 | ||
| Vagina | 25 | ||
| Abnormalities of the female reproductive anatomy | 25 | ||
| Ovarian factors | 25 | ||
| Tubal factors | 25 | ||
| Uterine factors | 25 | ||
| Male reproductive anatomy | 27 | ||
| Testes | 27 | ||
| Epididymides | 27 | ||
| Vas deferens | 28 | ||
| Seminal vesicles | 28 | ||
| Ejaculatory ducts, prostate gland, and prostatic urethra | 28 | ||
| Urethra | 28 | ||
| Penis | 28 | ||
| Abnormalities of the male reproductive anatomy | 28 | ||
| Sperm and Egg Production | 28 | ||
| Spermatogenesis and spermiogenesis | 28 | ||
| Structure of sperm | 28 | ||
| Oogenesis | 30 | ||
| Structure of the egg | 30 | ||
| Folliculogenesis | 32 | ||
| Initial recruitment and development of primordial follicles up to class 5 antral follicles | 32 | ||
| Cyclical recruitment (selection) and development of antral into preovulatory follicles | 32 | ||
| TCM integrated perspective on follicular and egg development | 33 | ||
| Influence of acupuncture on primordial, primary, and early secondary follicles (approximately 360 and 190 days before ovula... | 33 | ||
| Influence of acupuncture on late secondary to preovulatory follicles (approximately 190-0 days before ovulation) | 33 | ||
| Reproductive Physiology from an Orthodox Medical Perspective | 33 | ||
| The Hypothalamic-Pituitary-Gonadal Axis | 33 | ||
| Key reproductive hormones | 34 | ||
| Gonadotrophin-Releasing Hormone | 34 | ||
| Follicle-Stimulating Hormone | 34 | ||
| Luteinizing Hormone | 34 | ||
| Oestrogens | 35 | ||
| Progesterone | 35 | ||
| Human Chorionic Gonadotrophin | 35 | ||
| Testosterone | 35 | ||
| Inhibin | 35 | ||
| Relaxin | 35 | ||
| Other hormones | 35 | ||
| Menstrual cycle | 35 | ||
| Follicular phase | 36 | ||
| Ovulation | 36 | ||
| Luteal phase | 36 | ||
| Reproductive Physiology from a TCM Perspective | 37 | ||
| TCM and Orthodox medical paradigms | 37 | ||
| TCM view of the human body | 37 | ||
| The reproductive lifespan in TCM: The yearly cycles | 37 | ||
| Qi, Blood, and Jing (Essence) | 38 | ||
| Qi | 38 | ||
| Blood | 39 | ||
| Jing (Essence) | 39 | ||
| Egg | 41 | ||
| Sperm | 41 | ||
| The menstrual cycle | 42 | ||
| Menarche | 42 | ||
| Menstrual discharge | 42 | ||
| Menstrual cycle | 42 | ||
| The four phases of the menstrual cycle and Yin Yang | 43 | ||
| Key Zangfu organs in fertility and early pregnancy | 45 | ||
| The Kidney | 45 | ||
| The Liver | 47 | ||
| The Heart | 48 | ||
| The Stomach | 49 | ||
| The Spleen | 49 | ||
| The Lung | 49 | ||
| The Uterus | 50 | ||
| Zangfu organ interactions and IVF | 50 | ||
| The key Extraordinary Vessels in reproduction | 50 | ||
| The Chong Mai (Penetrating Vessel) | 51 | ||
| The Du Mai (Governing Vessel) | 51 | ||
| The Ren Mai (Conception Vessel) | 51 | ||
| The Dai Mai (Girdling Vessel) | 52 | ||
| Summary | 52 | ||
| Reproductive anatomy and physiology | 52 | ||
| Reproductive ageing | 52 | ||
| Egg maturation | 53 | ||
| Reproductive system physiology | 53 | ||
| References | 53 | ||
| Chapter 3: The magic of conception | 59 | ||
| Sexual Intercourse | 59 | ||
| Sperm Transportation up the Female Reproductive Tract | 60 | ||
| Prefertilization Sperm Changes | 60 | ||
| Egg Maturation and Ovulation | 61 | ||
| Egg Fertilization | 61 | ||
| Transportation of the Embryo Down the Female Reproductive Tract | 62 | ||
| Comparison of Natural Fertilization (In Vivo) with ART Fertilization (In Vitro) | 62 | ||
| Embryogenesis | 62 | ||
| Implantation: The First Communication Between the Mother and Her Embryo | 66 | ||
| Implantation window | 66 | ||
| Process of implantation | 66 | ||
| Embryo-maternal interaction | 66 | ||
| Factors affecting implantation | 66 | ||
| Conception from the TCM Point of View | 67 | ||
| Natural conception | 67 | ||
| Classical Chinese literature | 67 | ||
| Traditional Chinese Medicine | 68 | ||
| Conception in IVF or by ICSI from the TCM point of view | 68 | ||
| The embryo's energy (Pre-Natal Qi) | 68 | ||
| Yuan (Original) Qi | 68 | ||
| Pre-Natal Jing (Essence) | 69 | ||
| Zhen (True) Qi | 69 | ||
| Shen (Spirit) | 69 | ||
| Summary | 69 | ||
| Acknowledgement | 69 | ||
| References | 69 | ||
| Chapter 4: Orthodox medical tests and investigations: Optimizing patient care | 73 | ||
| The Initial Consultation | 73 | ||
| Medical history | 73 | ||
| Initial physical examination | 74 | ||
| Tests and Investigations Overview | 75 | ||
| Tests and Investigations: Female | 76 | ||
| Ovulation assessment | 76 | ||
| Ovarian reserve screen | 78 | ||
| FSH, E2 (and LH) | 78 | ||
| AMH | 78 | ||
| AFC | 80 | ||
| CCCT | 80 | ||
| Inhibin B | 80 | ||
| Other blood tests | 80 | ||
| Cervical assessment | 80 | ||
| Uterine anomalies, tubal patency, and other peritoneal factors | 80 | ||
| Ultrasound | 80 | ||
| Hysterosalpingography | 81 | ||
| Hysterosalpingo-contrast-ultrasonography | 81 | ||
| Sonohysterography (saline infusion sonography (SIS)) | 81 | ||
| Laparoscopy | 81 | ||
| Fluoroscopic/hysteroscopic selective tubal cannulation | 82 | ||
| Hysteroscopy | 82 | ||
| MRI | 82 | ||
| Endometrial biopsy | 82 | ||
| Chlamydia Antibody Test | 82 | ||
| Genetic screening | 82 | ||
| Thrombophilia investigations | 83 | ||
| Overview | 83 | ||
| Types of thrombophilia | 83 | ||
| Diagnostic tests for acquired or secondary thrombophilia | 83 | ||
| Diagnostic tests for genetic or inherited thrombophilia | 84 | ||
| Treatment | 84 | ||
| TCM associations | 85 | ||
| Infection screening | 85 | ||
| Immunological investigations | 85 | ||
| Tests and Investigations: Male | 85 | ||
| Semen analysis | 86 | ||
| Endocrine investigations | 87 | ||
| Postejaculatory urinalysis | 88 | ||
| Ultrasound scan | 88 | ||
| Test of leukocytes in semen | 88 | ||
| Antisperm antibodies tests | 89 | ||
| MSOME | 89 | ||
| Sperm DNA fragmentation tests | 89 | ||
| Genetic screening | 90 | ||
| Cystic fibrosis gene mutation | 90 | ||
| Karyotyping | 90 | ||
| Y-chromosome analysis | 90 | ||
| Infection screening | 91 | ||
| Other tests | 91 | ||
| Sperm Penetration Assay/Hamster Egg Penetration Test | 91 | ||
| Hemizona Assay | 91 | ||
| Acrosome Reaction assay | 92 | ||
| Hyposmotic Swelling test | 92 | ||
| Summary | 92 | ||
| References | 92 | ||
| Chapter 5: Investigations from a TCM perspective | 97 | ||
| Medical and Fertility History Taking | 97 | ||
| Personal information | 97 | ||
| Presenting complaint | 97 | ||
| General health | 98 | ||
| Menstrual cycle | 98 | ||
| Past medical history | 99 | ||
| Medical tests and investigations | 99 | ||
| Family medical history | 99 | ||
| Previous pregnancies and obstetric history | 99 | ||
| Modifiable lifestyle factors | 100 | ||
| Assisted Reproductive Technology treatment (ART) history | 100 | ||
| Previous ART treatment cycles: Basic information | 100 | ||
| Preparation phase | 100 | ||
| Acupuncture treatment (if it was done) | 100 | ||
| Orthodox medical treatment (if relevant) | 100 | ||
| Lifestyle factors | 100 | ||
| RIF prevention steps | 100 | ||
| Pretreatment stage (usually downregulation stage) | 101 | ||
| Chapter 6: The fundamentals of ART | 143 | ||
| Introduction | 143 | ||
| Types of ART Treatment | 143 | ||
| Ovulation induction | 143 | ||
| IUI | 144 | ||
| Overview | 144 | ||
| IVF | 144 | ||
| Frozen Embryo Transfer | 146 | ||
| IVM | 147 | ||
| GIFT | 148 | ||
| ZIFT | 148 | ||
| Third-party ART | 148 | ||
| Donor ART | 148 | ||
| Surrogacy/gestational carrier | 148 | ||
| Pharmacological Drugs Used in ART | 149 | ||
| Ovulation induction medication | 149 | ||
| CC therapy | 149 | ||
| Aromatase inhibitors | 149 | ||
| Insulin-sensitizing drugs (commonly used in patients with PCOS) | 149 | ||
| Gonadotrophins | 149 | ||
| hCG | 149 | ||
| Dopamine agonists | 149 | ||
| GnRH | 149 | ||
| GnRH analogues (agonists and antagonists) | 149 | ||
| Luteal/endometrial support medication | 150 | ||
| Other medications | 150 | ||
| Embryo Grading | 150 | ||
| Importance of embryo grading | 150 | ||
| Embryo-grading principles | 150 | ||
| Cleavage-stage embryo scoring systems | 150 | ||
| Blastocyst scoring systems | 151 | ||
| Implications for acupuncturists | 151 | ||
| Advanced ART Techniques | 151 | ||
| Assisted hatching | 153 | ||
| Specialist sperm retrieval methods | 153 | ||
| ICSI | 153 | ||
| IMSI | 153 | ||
| The Role of Acupuncture in ART | 154 | ||
| Physiological effects of acupuncture in reproductive medicine and fertility | 154 | ||
| Role of acupuncture at key stages of ART | 155 | ||
| Preparation phase (3-6 months before the ART/IVF treatment cycle begins) | 155 | ||
| Pretreatment phase (up to 3 weeks before the ART/IVF treatment cycle) | 155 | ||
| The ART/IVF treatment cycle: Ovarian stimulation phase | 155 | ||
| The ART/IVF treatment cycle: Ovulation trigger and final egg maturation | 155 | ||
| The ART/IVF treatment cycle: Egg retrieval | 155 | ||
| The ART/IVF treatment cycle: Embryo transfer | 155 | ||
| The ART/IVF treatment cycle: Luteal phase and early pregnancy | 155 | ||
| The role of fertility acupuncturists | 155 | ||
| Advisory role | 155 | ||
| Emotional support | 155 | ||
| Referral | 156 | ||
| Prevention | 156 | ||
| Future Advances in ART: A Potential Role for Acupuncture? | 156 | ||
| Reproductive ageing and fertility preservation | 156 | ||
| Mitochondria replacement techniques | 156 | ||
| Summary | 157 | ||
| References | 157 | ||
| Chapter 7: Preconception care in preparation for ART | 161 | ||
| Weight | 161 | ||
| Maternal weight | 161 | ||
| Maternal weight and infertility | 161 | ||
| Maternal weight and comorbidities | 161 | ||
| Maternal weight and ART | 161 | ||
| Maternal weight and miscarriages | 162 | ||
| Paternal weight | 162 | ||
| Paternal weight and infertility | 162 | ||
| Paternal weight and ART | 162 | ||
| Paternal weight and miscarriages | 162 | ||
| Recommendation | 162 | ||
| Smoking | 162 | ||
| The effects of smoking on reproductive health | 162 | ||
| The TCM view of smoking | 163 | ||
| Recommendation | 163 | ||
| Alcohol | 163 | ||
| The effects of alcohol on reproductive health | 163 | ||
| Effects of alcohol on IVF outcome | 163 | ||
| The effect of alcohol on the risk of miscarriages | 163 | ||
| The TCM view of alcohol | 163 | ||
| Recommendations | 164 | ||
| Caffeine | 164 | ||
| Effect on female fertility | 164 | ||
| Effect on male fertility | 164 | ||
| Recreational Drugs | 164 | ||
| Orthodox medicine | 164 | ||
| TCM | 164 | ||
| Recommendation | 164 | ||
| Medication | 164 | ||
| Female fertility | 164 | ||
| Male fertility | 164 | ||
| Recommendation | 165 | ||
| Environmental and Occupational Factors | 165 | ||
| Environmental factors | 165 | ||
| Occupational factors | 165 | ||
| Recommendation | 166 | ||
| Nutrition and Supplementation | 166 | ||
| Micronutrients and female fertility | 166 | ||
| Folic acid and vitamin B | 166 | ||
| Vitamin D | 166 | ||
| Iodine | 167 | ||
| Vitamin A | 167 | ||
| Vitamin E | 167 | ||
| Omega 3 | 167 | ||
| Selenium | 167 | ||
| Iron | 167 | ||
| Micronutrients and male fertility | 168 | ||
| Antioxidants that help with DNA sperm damage (vitamin C, vitamin E, vitamin A, omega 3) | 168 | ||
| Omega 3 | 168 | ||
| Zinc | 168 | ||
| Vitamin D | 168 | ||
| Vitamin B12 | 168 | ||
| Other | 168 | ||
| Diet | 168 | ||
| Female fertility | 168 | ||
| Male fertility | 168 | ||
| TCM | 169 | ||
| General dietary advice | 169 | ||
| Foods beneficial in Qi Deficiency syndromes | 169 | ||
| Foods beneficial in Blood Deficiency syndromes | 169 | ||
| Foods beneficial in Yin Deficiency syndromes | 169 | ||
| Foods beneficial in Yang Deficiency syndromes | 169 | ||
| Foods beneficial in Jing (Essence) Deficiency syndromes | 169 | ||
| Foods beneficial in Qi Stagnation syndromes | 170 | ||
| Foods beneficial in Blood Stasis syndromes | 170 | ||
| Foods beneficial in Heat/Fire syndromes | 170 | ||
| Foods beneficial in Phlegm-Dampness syndromes | 170 | ||
| Foods beneficial in Cold syndromes | 170 | ||
| Exercise and Rest | 170 | ||
| Orthodox medical perspective | 170 | ||
| Exercise and female fertility | 170 | ||
| Exercise and male fertility | 170 | ||
| Activity levels after the embryo transfer | 170 | ||
| Sleep and fertility | 170 | ||
| TCM perspective | 171 | ||
| Exercise | 171 | ||
| Rest | 171 | ||
| Sleep | 171 | ||
| Recommendation | 171 | ||
| Stress | 171 | ||
| Stress as a cause of infertility | 171 | ||
| Effects of stress on the reproductive system | 172 | ||
| Prevalence of stress in ART patients | 172 | ||
| Practical tips to reduce stress | 172 | ||
| The TCM view of stress, mind, and emotion | 172 | ||
| Research on acupuncture and stress and/or anxiety in fertility patients | 173 | ||
| Relationship and Sexual Issues | 173 | ||
| Sexual intercourse | 173 | ||
| Fertile window and timing of intercourse | 173 | ||
| Frequency of intercourse | 173 | ||
| Coital practices | 174 | ||
| Ovulation detection methods | 175 | ||
| Cervical mucus | 176 | ||
| Ovulation predictor kits | 176 | ||
| Basal body temperature (BBT) charting | 176 | ||
| Other methods | 177 | ||
| The TCM view of sexual intercourse | 177 | ||
| Recommendation | 177 | ||
| Summary | 177 | ||
| References | 178 | ||
| Chapter 8: Identification and management of conditions detrimental to IVF outcome | 185 | ||
| Tubal Pathology | 185 | ||
| Overview | 185 | ||
| Prevalence | 185 | ||
| Aetiology | 185 | ||
| Diagnosis | 185 | ||
| Orthodox medical treatment | 185 | ||
| Impact on ART treatment | 186 | ||
| Blocked fallopian tubes | 186 | ||
| Hydrosalpinges | 186 | ||
| The role of the acupuncturist | 186 | ||
| Acupuncture treatment | 186 | ||
| Referral for hydrosalpinges surgery | 186 | ||
| Referral for IVF | 187 | ||
| Ovulatory Disorders | 188 | ||
| Overview | 188 | ||
| WHO grade I ovulation disorders | 188 | ||
| WHO grade II ovulation disorders and clomiphene citrate treatment | 188 | ||
| WHO grade III ovulation disorder | 189 | ||
| Polycystic Ovary Syndrome | 190 | ||
| Overview and diagnosis | 190 | ||
| Prevalence | 191 | ||
| Pathology | 191 | ||
| Effect on reproduction | 191 | ||
| Ovarian reserve | 191 | ||
| Miscarriages | 191 | ||
| Pregnancy | 191 | ||
| Mental-emotional health | 191 | ||
| Orthodox medical management of PCOS | 191 | ||
| Lifestyle and dietary modifications | 192 | ||
| Ovulation induction | 192 | ||
| Metformin | 192 | ||
| Surgery | 192 | ||
| IVF | 192 | ||
| In Vitro Maturation | 192 | ||
| Vitamin D supplementation | 193 | ||
| Acupuncture treatment of PCOS | 193 | ||
| Research on acupuncture and PCOS | 193 | ||
| Acupuncture treatment | 193 | ||
| Thyroid Disease | 196 | ||
| Overview | 196 | ||
| Aetiology | 196 | ||
| Orthodox medical management of thyroid disease | 197 | ||
| Indications for biochemical tests | 197 | ||
| Thyroid function tests | 197 | ||
| Management of patients with hypothyroidism | 197 | ||
| Management of patients with hyperthyroidism | 198 | ||
| Effect of thyroid disease on fertility and pregnancy | 198 | ||
| Effect on ovarian reserve | 198 | ||
| Effect on the menstrual cycle | 198 | ||
| Effect on ART | 199 | ||
| Effect on pregnancy and the foetus | 199 | ||
| Effect on male fertility and reproductive health | 199 | ||
| Lifestyle factors | 200 | ||
| The role of acupuncture | 200 | ||
| Referral for investigations | 200 | ||
| Treatment with acupuncture | 200 | ||
| Management during pregnancy | 202 | ||
| Endometriosis | 203 | ||
| Overview | 203 | ||
| Risk factors | 204 | ||
| Signs and symptoms | 204 | ||
| Diagnosis and staging | 204 | ||
| Effect on fertility and reproductive health | 204 | ||
| Orthodox medical treatment | 205 | ||
| Expectant management | 205 | ||
| Medical treatment | 205 | ||
| Surgical treatment | 205 | ||
| ART treatment | 206 | ||
| The role of acupuncture | 206 | ||
| Referral | 206 | ||
| Treatment with acupuncture | 206 | ||
| Unexplained Subfertility | 207 | ||
| Chapter 9: Acupuncture during ART | 237 | ||
| Treatment During IVF | 237 | ||
| Pretreatment phase (suppression or downregulation) | 237 | ||
| Orthodox medical protocol | 237 | ||
| GnRH agonist | 237 | ||
| GnRH antagonist | 237 | ||
| Baseline evaluation | 238 | ||
| TCM protocol | 238 | ||
| Ovarian stimulation phase | 239 | ||
| Orthodox medical protocol | 239 | ||
| Patient monitoring | 241 | ||
| Follicular growth | 241 | ||
| Oestrogen levels | 241 | ||
| Endometrial development | 241 | ||
| TCM protocol | 242 | ||
| Final egg maturation and ovulation induction | 244 | ||
| Chapter 10: Clinical issues during ART | 275 | ||
| Poor Follicular Development | 275 | ||
| Orthodox medical therapeutic options in the affected cycle | 276 | ||
| Longer gonadotrophin stimulation | 276 | ||
| Increasing the dose of stimulation medication | 276 | ||
| Conversion to Intrauterine Insemination | 276 | ||
| Orthodox medical preventative options | 276 | ||
| Androgen pretreatment (DHEA or testosterone) | 276 | ||
| Treatment protocol | 276 | ||
| Higher stimulation dose | 277 | ||
| Minimal stimulation dose or natural IVF | 277 | ||
| Weight loss | 277 | ||
| Acupuncture: Rescue treatment | 277 | ||
| Follicles develop too quickly | 277 | ||
| Follicles develop too slowly | 277 | ||
| Combination of very large and small follicles | 277 | ||
| Acupuncture: Preventative treatment | 277 | ||
| Immature or No Eggs | 277 | ||
| Overview | 277 | ||
| Empty follicle syndrome | 277 | ||
| Follicular flushing | 278 | ||
| Higher dose or different `trigger medication | 278 | ||
| Timing of hCG trigger | 278 | ||
| > 36 h between the trigger injection and egg retrieval | 279 | ||
| Rescue hCG | 279 | ||
| Donor eggs | 279 | ||
| Immature eggs | 279 | ||
| The role of the acupuncturist | 279 | ||
| Suboptimal Endometrial Lining | 279 | ||
| Overview | 279 | ||
| Causes and therapeutic options | 280 | ||
| Lifestyle advice | 280 | ||
| Role of the acupuncturist | 280 | ||
| No Sperm | 281 | ||
| The role of the acupuncturist | 281 | ||
| Fertilization Failure | 281 | ||
| Fertilization failure incidence and implications | 281 | ||
| Fertilization failure in IVF | 282 | ||
| Fertilization failure in ICSI | 282 | ||
| Other causes of fertilization failure | 282 | ||
| The role of the acupuncturist | 282 | ||
| Poor Embryo Growth or Growth Arrest | 283 | ||
| Causes of poor embryo development | 283 | ||
| Maternal influences | 283 | ||
| Paternal influences | 284 | ||
| Other factors | 284 | ||
| Role of the acupuncturist | 284 | ||
| Difficult Embryo Transfer | 284 | ||
| What can go wrong and the consequences | 284 | ||
| Therapeutic options | 284 | ||
| The role of the acupuncturist | 285 | ||
| Summary | 285 | ||
| References | 285 | ||
| Chapter 11: ART complications | 291 | ||
| Ovarian Hyper-Stimulation Syndrome | 291 | ||
| Introduction | 291 | ||
| Orthodox medical management of OHSS | 291 | ||
| Acupuncture management of OHSS | 294 | ||
| TCM view of OHSS | 294 | ||
| OHSS patient management | 294 | ||
| Multiple Gestation | 296 | ||
| Introduction | 296 | ||
| Risks associated with multiple pregnancy following ART | 296 | ||
| How to minimize the risks of ART while maximizing the chances of pregnancy | 296 | ||
| Implications for fertility acupuncturists | 297 | ||
| Summary | 299 | ||
| References | 299 | ||
| Chapter 12: Managing the patient with a complex medical history | 301 | ||
| Repeated Implantation Failure | 301 | ||
| Overview | 301 | ||
| Definition | 301 | ||
| Implantation failure versus preclinical pregnancy failure | 301 | ||
| Causes of RIF | 301 | ||
| Uterine and maternal factors | 302 | ||
| Anatomical abnormalities and hysteroscopy | 302 | ||
| Endometrial injury (biopsy or `scratch) | 302 | ||
| Interval (sequential) embryo transfer | 302 | ||
| Frozen Embryo Transfer | 303 | ||
| `Embryo glue | 303 | ||
| Endometriosis | 304 | ||
| Hydrosalpinges | 304 | ||
| Endometrial thickness | 304 | ||
| Infections | 304 | ||
| Immune disease | 304 | ||
| Thrombophilia | 304 | ||
| Maternal age | 304 | ||
| Male factor | 305 | ||
| Embryo factors | 305 | ||
| Zona hardening and assisted hatching | 305 | ||
| Inadequate culture conditions | 305 | ||
| Blastocysts versus day 2 versus day 3 transfer | 305 | ||
| Zygote Intra Fallopian Transfer | 305 | ||
| Number of embryos transferred | 305 | ||
| Genetic causes: Parental | 305 | ||
| Genetic abnormalities: Embryo | 306 | ||
| Non-invasive embryo assessment (morphokinetic analysis) | 306 | ||
| Other causes | 306 | ||
| Treatment protocol | 306 | ||
| Poor embryo transfer techniques | 307 | ||
| Lifestyle factors | 307 | ||
| Psychological | 307 | ||
| Clinical perspective | 307 | ||
| RIF from a TCM point of view | 307 | ||
| Introduction | 307 | ||
| Common syndromes causing RIF | 307 | ||
| TCM pathophysiology of RIF | 307 | ||
| Kidney pathology | 307 | ||
| Liver pathology | 308 | ||
| Heart pathology | 308 | ||
| Spleen pathology | 308 | ||
| Blood Stasis | 308 | ||
| Cold | 308 | ||
| Phlegm-Damp | 308 | ||
| Blood-Heat | 310 | ||
| The acupuncturists role in the management of RIF | 310 | ||
| Miscarriages and Pregnancy Loss | 310 | ||
| Background and terminology | 310 | ||
| Causes of miscarriages | 312 | ||
| Embryo genetic abnormalities and parental age | 312 | ||
| Parental genetic abnormalities | 312 | ||
| Anatomical factors | 312 | ||
| Infections | 313 | ||
| Acquired and inherited thrombophilia | 314 | ||
| Endocrine factors | 314 | ||
| Polycystic Ovary Syndrome | 314 | ||
| Hypothyroidism and thyroid autoimmunity | 314 | ||
| Luteal phase insufficiency | 314 | ||
| Immunological factors | 315 | ||
| Male factor | 315 | ||
| Environmental, lifestyle, and nutritional factors | 315 | ||
| Unexplained miscarriages | 315 | ||
| Orthodox conventional medical management of patients presenting with suspected miscarriage | 315 | ||
| Presenting signs and symptoms | 315 | ||
| Pregnancy viability assessment | 315 | ||
| TCM management of patients presenting with threatened miscarriage | 316 | ||
| Pathophysiology of miscarriages | 316 | ||
| TCM management of inevitable or missed miscarriages | 317 | ||
| TCM management of patients with a history of RMs | 317 | ||
| When to refer for miscarriage investigations | 317 | ||
| TCM lifestyle advice in prevention of miscarriages | 321 | ||
| Physical activity | 321 | ||
| Intercourse | 321 | ||
| Emotions | 321 | ||
| Diet | 321 | ||
| When to start trying for a baby again | 321 | ||
| Management of patients experiencing anxiety about miscarrying | 322 | ||
| Ectopic pregnancy | 322 | ||
| Preterm birth and cervical insufficiency | 323 | ||
| Reproductive Immunology | 325 | ||
| Introduction | 325 | ||
| Reproductive immune pathology and tests | 325 | ||
| CD56+ natural killer | 325 | ||
| Reproductive immunophenotype | 325 | ||
| Th1:Th2 assay | 325 | ||
| Leukocyte Antibody Detection test | 326 | ||
| Human leukocyte antigen HLA-DQ alpha test | 326 | ||
| Immunotherapy | 326 | ||
| Intravenous Immune Globulin | 326 | ||
| Intralipid therapy | 326 | ||
| Glucocorticoids | 327 | ||
| Lymphocyte Immunization Therapy | 327 | ||
| TNF-alpha inhibitors (Th1:Th2) | 327 | ||
| Peripheral blood mononuclear cells | 327 | ||
| Granulocyte colony stimulating factor | 327 | ||
| Reproductive Immunology from a TCM Point of View | 327 | ||
| Research on the effect of acupuncture on the immune system | 327 | ||
| Acupuncture and Th1:Th2 (TNF-alpha) cells | 327 | ||
| Acupuncture and NK cells | 328 | ||
| Acupuncture points that modulate the immune system | 328 | ||
| Associations of reproductive immunology and TCM | 328 | ||
| Implications for Acupuncturists: To Refer or not to Refer? | 328 | ||
| Summary | 331 | ||
| References | 331 | ||
| Chapter 13: The therapeutic relationship in acupuncture practice | 339 | ||
| Mutuality | 339 | ||
| Trust | 340 | ||
| Care | 340 | ||
| Challenge and Performance | 341 | ||
| Return to Mutuality | 341 | ||
| Measuring the Success of Acupuncture Treatment | 342 | ||
| The Effect of Subfertility on Patients | 342 | ||
| Legal and Ethical Considerations | 342 | ||
| Assisted reproduction ethics | 342 | ||
| Is fertility treatment ethical? | 342 | ||
| Health of babies born as a result of ART | 342 | ||
| Treatment of much older patients | 343 | ||
| Third-party reproduction | 343 | ||
| Regulation of ART treatments | 343 | ||
| Ethical fertility acupuncture practice | 343 | ||
| Fees structure | 343 | ||
| Professional boundaries | 344 | ||
| Continuity of care | 344 | ||
| Confidentiality | 344 | ||
| Limit of competence | 344 | ||
| Treating patients when the prognosis is very poor or futile | 344 | ||
| Refusing to treat a patient | 345 | ||
| Summary | 345 | ||
| References | 345 | ||
| Chapter 14: Aftercare | 347 | ||
| Negative Outcome | 347 | ||
| Immediate aftermath of a negative test | 347 | ||
| Guiding patients in their possible future steps | 347 | ||
| When is the right time to stop the treatment? | 347 | ||
| Positive Outcome: Healthy Transition from Subfertility to Pregnancy | 348 | ||
| Pregnancy following ART and the risk of complications | 348 | ||
| Transition from subfertility to pregnancy | 349 | ||
| Acupuncture treatment during early pregnancy | 349 | ||
| When to discharge pregnant patients | 351 | ||
| Acupuncturists Self-Care: Saying Goodbye to Patients | 351 | ||
| Summary | 352 | ||
| References | 352 | ||
| Appendix I: Templates | 355 | ||
| Appendix II: Basal body temperature (BBT) chart template and instructions | 379 | ||
| Basal Body Temperature (BBT) Template | 379 | ||
| Basal Body Temperature (BBT) Charting Instructions | 379 | ||
| Taking the Temperature | 379 | ||
| Recording the Temperature | 379 | ||
| Intercourse | 379 | ||
| Cervical Fluid | 379 | ||
| Ovulation Test Results | 379 | ||
| Other Notes | 379 | ||
| Appendix III: Investigation reference ranges at a glance | 383 | ||
| References | 392 | ||
| Appendix IV: Fertility factsheets | 395 | ||
| Optimizing Female Fertility | 395 | ||
| Patients factsheet | 395 | ||
| Weight | 395 | ||
| Smoking | 395 | ||
| Alcohol | 395 | ||
| Caffeine | 395 | ||
| Recreational drugs | 395 | ||
| Prescription or over-the-counter medication | 395 | ||
| Environmental toxins | 396 | ||
| Nutrition | 396 | ||
| Supplements | 396 | ||
| Exercise | 397 | ||
| Stress | 397 | ||
| Sexual intercourse | 397 | ||
| Optimizing Male Fertility | 397 | ||
| Patients factsheet | 397 | ||
| Weight | 397 | ||
| Smoking | 397 | ||
| Alcohol | 397 | ||
| Caffeine | 397 | ||
| Recreational drugs | 397 | ||
| Prescription or over-the-counter medication | 397 | ||
| Environmental toxins | 397 | ||
| Nutrition | 398 | ||
| Supplements | 398 | ||
| Exercise | 398 | ||
| Stress | 398 | ||
| Sexual intercourse | 398 | ||
| Appendix V: Commonly used medications in ART | 401 | ||
| Appendix VI: Medications known to adversely affect fertility | 405 | ||
| Index | 415 |