Interview with Ellice Yang by Sarah Clark
If you are like me the thought of having needles jabbed into your skin can make you feel a little squeamish or downright scared. However, when I tried acupuncture I was pleased to experience only a little prick (and guess what – no pain!). After the needles were inserted I was left alone for about 20 minutes to relax. I listened to calming music and slowly fell into a deep state of relaxation.
I know when I was going through infertility I would have benefited from this type of relaxation.
You may have heard about how acupuncture can help increase the success rate of IVF and IUI, especially on the day of embryo transfer. Check out this article for details: http://www.sciencedirect.com/science/article/pii/S0015028206002123
I was curious to know how Traditional Chinese Medicine and acupuncture could help with specific infertility types such as PCOS, endometriosis, low ovarian reserve and male factor infertility.
I contacted local Toronto TCM practitioner and acupuncturist Ellice Yang to learn more.
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Can you share a little bit about yourself and your background?
I am a Registered Practitioner with the College of Traditional Chinese Medicine and Acupuncturists of Ontario and a graduate from the University of Toronto with an Honours Bachelor of Science degree in biology.
I am classically trained in Traditional Chinese Medicine, but bridge that knowledge with modern science and evidence-based research. Over the years I have had the privilege of being a part of my patient’s journey to conceive and to support them during their pregnancy and labour.
My colleagues Jasmine Sufi, Fay Meling von Moltke Pao and I co-founded Acutoronto 10 years ago – an integrative health & wellness centre focusing on women’s health to address fertility issues, pregnancy and labour support.
Describe how acupuncture and herbal remedies can help to improve fertility
There is a lot of research that shows support and evidence that acupuncture and TCM improves fertility and helps to support someone going through infertility treatments. Acupuncture and TCM addresses the person as a whole and brings balance and harmony to the body. It improves uterine blood flow. It also helps with ovulation, regulating menses, stress management and hormonal balance.
It is beneficial during IVF and IUI treatments. An acupuncturist and TCM practitioner can be onsite at the fertility clinic to provide treatment before and after the transfer.
Acupuncture and TCM can also help to maintain a healthy pregnancy and prevent miscarriage. The treatments prevent miscarriage by relaxing the uterus and preventing premature contractions. It also helps to ensure the lining is strengthened and nourished for the baby.
What type of lifestyle and diet changes do you recommend to your patients to enhance fertility?
There are many things you can do on your own.
- One very easy way is to increase your water intake. This helps with the cervical mucus.
- Get at least 7 hours of uninterrupted sleep. This is very important for fertility health.
- Stress is another factor that affects fertility, it can be related to the fertility process, but often it is more related to occupational stress.
- Moderate exercise can help with stress, we also recommend mindfulness for fertility. We work with Amira Posner who runs a 6 week Mind Body Fertility support groups. For more information on the mind body fertility group visit: http://www.acutoronto.com/about-us/. Yoga for fertility is also another good option.
- Diet is another big factor that affects fertility. The first step is to eat mostly whole foods, eliminate processed foods, eliminate sugar (which causes inflammation), reduce red meat, and consume adequate protein from vegetables, white meat and fish. Sometimes there is not enough protein in the diet and protein is essential for egg health. An easy way to incorporate protein (brown rice, pea protein or whey protein (grass fed whey)) is with a protein power. I recommend Sun Warrior. You can mix it with some berries or if you prefer, although it doesn’t need it, you could add stevia (which is a natural sweetener)
Which types of infertility will benefit the most from acupuncture?
Typically acupuncture and TCM can address all kinds of fertility issues and works best for functional fertility conditions.
However, if there is structural fertility issues, such as blocked fallopian tubes or endometriosis(structural, physical and scar tissue) micro- surgery will be needed, before acupuncture or TCM is considered. When the blockage is cleared acupuncture and TCM can be used.
There is research that finds that endometriosis can be helped with acupuncture and TCM. http://www.pacificcollege.edu/acupuncture-massage-news/articles/1047-tcm-to-treat-endometriosis-symptoms.html
For men there are a lot of studies that show that acupuncture is quite effective to help improve sperm quality, motility and morphology. It can help to improve the success rate of ICSI. http://www.pacificcollege.edu/acupuncture-massage-news/articles/590-sp-1849429939.html
Many fertility clinics recommend against the use of herbal remedies. What is your experience with integrating TCM with western medicine?
There is not enough research to show how Chinese herbs interact with western medication. When our patients are going through a medicated cycle, usually during their luteal phase when they are being stimulated, we do not prescribe Chinese herbs. We always encourage patients to keep open communication with their doctors or we will do so for them with their permission. After the transfer, usually patients are just on progesterone and so we may recommend Chinese medicine especially if there is a history of miscarriage.
How does acupuncture and herbal remedies help with low sperm count, low motility, morphology and reduce sperm DNA fragmentation?
For sperm health and egg quality to change it takes about 3 months. It takes approximately 90 days for the sperm to develop. During this time we can make the most impact on the quality of the sperm. Acupuncture and TCM can help to increase blood flow to decrease inflammation and help manage stress. We also go over patient’s diet and lifestyle, as this can be helpful for sperm health.
Sometimes men are turned away from acupuncture because they may fear it is done near the reproductive organs. However, acupuncture is done on the legs, lower back, abdomen and hands. Each person is individually assessed to see what will work best.
Low sperm count protocol – acupuncture and TCM is very effective (especially when combined with Chinese herbs). We see the patient once per week, they can take the herbs in a tea format once per day. It’s best to wait for a few months before trying to conceive, since there may be a higher chance of miscarriage due to the poor sperm quality. Often it very difficult for couples to wait and we always tell them it is their choice.
The herbs are in a tea format. Some patients say the tea tastes like a very bitter coffee. If they are not able to tolerate the tea there is a pill format. About 15% of patients are not able to take the tea (due to a gag reflex).
What is the protocol for other infertility types?
In Chinese medicine, regardless of the disease we have to treat the person as a whole and not just the disease. There is a saying: “different diseases, one treatment; same disease, different treatments”. What this means is that even though 3 patients with the chief complaint of migraines come in to the clinic, it is quite possible that they may all be presenting very different symptoms although western diagnosis is migraines. The location, quality and frequency of the migraines may be very different and so the Chinese medicine treatment protocols will be different for each person. On the other, 1 person with PCOS and another person with endometriosis may be given the same Chinese medicine treatment protocols even though different conditions.
With conditions related to women’s fertility acupuncture and Chinese herbal treatment protocols are designed to work with each phase of their menstrual cycle in addition to their constitutional diagnosis. Treatments vary from 1-2 times per week and the course of treatments are usually at least 3 months and on average up to 6-9 months.
Low ovarian reserve protocol – we work with the patient for at least 3 months and we work to increase the quality of the eggs, we include acupuncture one to two times per week, as well as diet and lifestyle factors, we may refer to naturopath (for specific supplements that can boost egg quality). We also prescribe Chinese herbal medicine which helps to improve uterine blood flow and tonify the woman’s essence and qi during the course of treatment. With this protocol we recommend that our patients hold off from trying to conceive for at least a few months, while we allow the treatments to begin to heal the body.
Many women with low AMH levels have been told that their only option is a donor egg. Upon hearing this news many patients take a break to try naturally or they may seek a second opinion. Unfortunately, although your FSH levels can fluctuate from cycle to cycle, your AMH levels will either remain or continue to decline. We can’t change egg quantity but we can certainly impact egg health . There are many factors that impact egg quality such as, environmental toxins, age, food and diet, stress, inflammation, genetics etc. Having said that, these ovarian reserve tests such day 3 FSH levels and AMH levels are tools to help decide which fertility treatments or natural therapies would be best for the patient. It doesn’t necessarily mean you cannot get pregnant and carry to full term. I have seen patients who have been told they need egg donors to conceive become pregnant naturally!….it’s not a cure by all means but it can be helpful enough to improve your egg health for conception.
Endometriosis/PCOS protocol – acupuncture once per week for at least 3 months, acupuncture can be used on the lower back, wrist and hands. Chinese herbs are recommended too. Our goal is to help remove blood stagnation and to tonify the kidney and spleen organ system to resolve and dampness to break up the lesions. Acupuncture and Chinese herbal medicine is effective especially for mild endometriosis. Normally, laproscopy is needed for women with endometriosis to remove these lesions.
Patient with PCOS is also treated in a similar manner, usually there is an accumulation of phlem-dampness and acupuncture and chinese herbal medicine is focused on tonify the kidney organ system to resolve this accumulation and regulate ovulation.
Luteal Phase Defect/Thin Uterine Lining/PCOS – we recommend to take at least 2 months to follow the treatment protocol and build up the body before trying to conceive as there is an increased chance of miscarriage with these infertility types.
Miscarriage – we recommend waiting 3 months before trying again. We work with you to give the body a chance to heal with a customized treatment protocol and prepare for a healthy pregnancy. There are many emotions that come up after a miscarriage such as grief and loss and many people are not able to deal with these emotions. There is a lot of support available and we can help to connect people with the right support system to help them heal. Talia Singer a psychotherapist and nurse facilitates an 8 week pregnancy loss support groups at Acutoronto. It’s a great way for women to speak with other women and feel supported and find ways to cope with the loss.
Hypothyroidism –For women trying to conceive naturally or through fertility treatments, hypothyroidism can be a huge factor. High TSH levels (even if its high normal) can be associated with anovulation, miscarriage and PCOS. Usually if women are being seen by a fertility specialist blood work will be done to determine their TSH levels and if too high will be prescribed medication. Naturopathic Doctors can also be helpful and regulating thyroid function. We would like to see the thyroid regulated before you start trying to conceive, as there is an increased chance of miscarriage.
How long is each acupuncture session?
The first session we review your health history, ultra sounds, blood work, tongue and pulse diagnosis (an important diagnostic tool for chinese medicine). This takes about 30 minutes, we then recommend a treatment protocol followed by acupuncture treatment.
The appointments are typically once per week as follows:
- Day 3
- Day 10
- Around Day 14 and or day 17 (Ovulation and pre-implanation)
- Continue acupuncture weekly and if pregnancy test is positive continue until second trimester.
- If patient has negative pregnancy test, we see them again on day 3 and repeat.
The acupuncture needles are in for about 25 minutes. Many patients fall asleep during the session. We find that there is stress about trying to conceive, but primarily we find that the stress is a result of occupational stress. Acupuncture helps them to relax during the session.
If you are going through an IVF and IUI
If you are going through fertility treatments such as IVF, IUI or ICSI, acupuncture is very beneficial in encouraging embryo implanation, stimulating uterine blood flow, relax the uterus and help patient to relax. Studies such as http://www.ncbi.nlm.nih.gov/pubmed/11937123from Germany, have concluded when pre and post embryo transfer acupuncture is combined with fertility treatments, it increase success rates of pregnancy and lie births from 40%-91%. That’s pretty incredible.
What is pre and post embryo transfer acupuncture? These acupuncture treatments are done just prior to embryo transfer and immediately afterwards. Not only for embryo transfers but also same protocol for patients undergoing IUI. The idea is to help stimulate uterine blood flow and to relax the uterus to encourage proper implantation of the embryo. Also another important focus of the acupuncture treatments are to help patients relax as much as possible. Hair-fine sterile needles are gently inserted on legs, abdomen and arms for about 25 minutes. Most patients will even fall asleep during their acupuncture sessions which is fantastic.
If onsite acupuncture cannot be done (due to scheduling or finances), we see patients in our clinic before and after their procedure. Fortunately we are closely located to most of the Toronto fertility clinics. We continue with acupuncture 3-5 days post transfer and continue weekly until beta test is done to determine pregnancy. If positive we continue for the first trimester.
Electro stimulation is when we place clips on the needles, which sends a gentle stimulation to the needles. Frequency of electro-stimulation is set to increase the uterine blood flow and conducted twice a week, 4 weeks prior to transfer.
How many treatments do you recommend and when in the cycle is the best time for treatment?
Typically we recommend a minimum of three months. This is about 10-12 sessions.
How does acupuncture help to deal with the stress of infertility?
Acupuncture is great to help with stress. We also do auricular acupuncture, which is acupuncture on the ears. This type of protocol is often used with patients with post-traumatic stress disorder, but is quite helpful to help deal with the stress associated with infertility. This technique was developed by French neurologist, Paul Nogier: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2206232/.
The auricular acupuncture helps to improve the function of the endocrine system and the adrenal function.
We also collaborate with other practitioners with support groups from our clinic such as our Psychotherapist and Mental Health Nurse Talia Singer and Amira Posner who runs a 6-week mind body fertility group for mindfulness at Mt. Sinai Hospital. Mindfulness is very powerful and can help with anxiety, stress and panic attacks
What should a patient look for in an acupuncturist or TCM practitioner?
Visit www.ctcmpao.on.ca to find a Traditional Chinese Medicine and Acupuncturist. You can enter the TCM and acupuncturists name and location and find out if they are registered. You can then review their bio. It is important to ensure they primarily work with women’s health and fertility. If you find that the R. Ac is seeing patients mostly for sports related injuries but also does some fertility as well then it’s probably not the best choice. Look for how long they have been practicing and see if they have any additional training such as continuing education courses related to fertility. Jasmine and I have been in practice for almost 10 years and 85% of our patients are for male and female fertility and women’s health related issues. We work with other health professionals at Acutoronto who also has a special practice focus on pregnancy and fertility.
Are there any self-care treatments that you can recommend to practice at home?
The auricular acupuncture can be done at home. Also practicing mindfulness and meditation for even 10 minutes per day is great.
My favourite apps are:
Breathe to Relax – (guide to taking deep long breathing)
What books and resources do you recommend?
Infertility Cure – Randine Lewis
Making Babies – A Proven 3 month program for maximum fertility – Sami David and Jill Blakeway – helps with charting (explaining it in TCM philosophy)
Some additional websites to check out are:
www.acutoronto.com has great articles on fertility
Some of my colleagues have great resources and research on their websites too:
www.fertilitytoronto.ca – Kaleb Montgomery
www.drewnesbitt.ca – Drew Nesbitt
Could you share a success story with us?
I treated a couple where the female had low AMH levels and the male had male factor infertility. This couple was very determined to try naturally. They BOTH made dietary changes, saw a naturopath for supplements and whys to help support her immune system, had weekly acupuncture and herbs and made the diet and lifestyle changes. It was not easy and they went through the typical roller coaster of emotions associated with infertility. It took over a year but they were able to get pregnant naturally. They had their baby boy in January 2015.
Another patient I was seeing with low AMH also had one fallopian tube. Her fertility specialist recommended IUI. We worked with her to stimulate her on the right side, where her fallopian tube was intact. She was able to have two successful pregnancies.
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An integrated approach to fertility that incorporates western medicine and complementary therapies such as Traditional Chinese Medicine, acupuncture, diet and lifestyle changes can be a powerful combination to get you closer to your dreams of having a baby.
Sarah Clark empowers couples to discover how lifestyle and diet can dramatically impact their chances of conceiving. She was diagnosed with premature ovarian failure at 28 and had both her kids with donor eggs. Not until years later did she discover that the root cause of her infertility was a food intolerance. Ready to gaze into your baby’s eyes….but struggling. Download 10 step Checklist here