The Basics of Egg Freezing

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By Mary Sabo, L.Ac, DACM

On average, women in developed countries are delaying childbearing until later in life.[i]Many modern women are waiting until their 30s and early 40s to start a family in order to focus on their careers, gain financial stability and find the right partner.[ii]Women who learn to take excellent care of their bodies and health can sometimes delay the appearance of aging and feel great, but unfortunately eggs and ovarian function decline whether they are in perfect health or not, and the age at which they decline can, unfortunately, be unpredictable. 

In Chinese medicine, we support fertility naturally using herbs, acupuncture, and dietary and lifestyle changes. We help women conceive with these tools either alone, or in conjunction with assisted reproductive techniques like In Vitro Fertilization (IVF) and Intra Uterine Insemination (IUI). Acupuncture and herbs can improve hormone balance and overall health, which optimizes fertility at any age. However, the biggest determinant of conceiving a healthy child is the chromosomal quality of eggs and sperm, which declines naturally as we age. We now know that the uterus can remain healthy and able to carry a baby long after the ovarian health and egg quality prohibits pregnancy. For this reason, egg freezing has become a popular option for women to preserve their younger egg health for use later in life. It’s a type of fertility insurance. Egg freezing is more affordable than ever and new advances in techniques have made it more reliable, improving outcomes. 

Plenty of women conceive easily in their thirties and early forties, but the likelihood of struggling with fertility at this age is higher.[iii]Screening for infertility in women not trying to get pregnant is not yet standardized in our medical system and many couples who struggle to conceive are “unexplained”, meaning that all tests look normal but pregnancy is still not possible. Conceiving as an older woman can become a bit of a gamble then. Miscarriage rates are higher in this population and the reasons for both higher rates of infertility and miscarriage are commonly the “quality” or chromosomal makeup of the eggs and sperm. Researchers are exploring ways to influence this chromosomal content, and it is suspected that some agents like antioxidants can influence the overall health of the egg, which can potentially improve the quality, but currently the biggest determining factor is age. The older a woman gets, the more eggs in her ovaries mature with chromosomal abnormalities. Until we understand how to directly influence this development predictably and reverse the effects of aging on eggs, the best way to preserve them is to extract and freeze them when we are young.  

Currently, there is no test to determine egg quality. There are some tests to determine the health of the ovary and the “ovarian reserve”, but they do not assess the health of the chromosomes inside the eggs. According to Reproductive Endocrinologists at CCRM New York and authors of Truly-MD.com, Dr. Jaime Knopman and Dr. Sheeva Talebian, the ideal time to freeze eggs is between 30-34 years of age. Freezing at a younger age, in theory, will produce healthier eggs, but you’ll pay more over time to keep those eggs frozen longer as facilities charge an annual “rent” for your frozen eggs. You also may not need them. Waiting until later means more eggs may be abnormal. However, if you are older than 34 and having a child is nowhere in sight, it’s worth discussing your options with an RE. Egg freezing is insurance, not a guarantee, but it is the only option for women who know they’d like to have a family one day, but it’s taking a bit longer to feel ready than they expected. 

If you are considering freezing your eggs, you can take some steps now to improve your health and potentially optimize the health of your eggs. Dr. Knopman and Dr. Talebian recommend stopping smoking, decreasing alcohol use, and increasing foods that are high in antioxidants for three months before your egg freeze cycle.  I also work with women in those three months before their egg freeze cycles to optimize overall health and egg quality with acupuncture, customized dietary and lifestyle changes, and customized supplement and herbal plans. Because fertility potential and egg health cannot be determined until a woman starts trying to conceive, there is no way to know your fertility status or egg quality, but you can absolutely maximize your chances of freezing healthy eggs with the right support and empowering changes. 

 

[i]Matthews TJHamilton BE. NCHS Data Brief.Delayed childbearing: more women are having their first child later in life. 2009 Aug;(21):1-8. 

[ii]Hammarberg K1, Clarke VE. Reasons for delaying childbearing--a survey of women aged over 35 years seeking assisted reproductive technology. Aust Fam Physician.2005 Mar;34(3):187-8, 206.

[iii]Baird DTCollins JEgozcue JEvers LHGianaroli LLeridon HSunde ATempleton AVan Steirteghem ACohen JCrosignani PGDevroey PDiedrich KFauser BCFraser LGlasier ALiebaers IMautone GPenney GTarlatzis BESHRE Capri Workshop Group. Hum Reprod Update.2005 May-Jun;11(3):261-76. Epub 2005 Apr 14.

An Integrative Approach to Managing Endometriosis

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By Mary Sabo, L.Ac, DACM

Endometriosis is a condition where endometrial cells that normally grow inside the uterus grow elsewhere in the body. It affects about 10% of women and can range in symptoms from extremely painful periods, severe PMS, painful intercourse, painful urination or bowel movements to absolutely no symptoms at all. Many women do not realize they have endometriosis until it interferes with their fertility. While it can be a confusing condition to diagnose and treat, there are many ways to manage symptoms and improve fertility using both Western and Chinese medicine techniques. Recent studies have also shown promising results when integrating the two.

Endometrial cells are sensitive to hormone fluctuations and are responsible for building the uterine lining, which grows and sheds each menstrual cycle. While these cells are part of our own bodies, when they grow outside the uterus where they shouldn’t grow (often on the bladder, fallopian tubes, ovaries, intestines, outer uterine wall, or peritoneum), the body can treat them as if they are invaders and will launch immune and inflammatory responses. This reaction can potentially interfere with egg quality, ovarian health, uterine receptivity and therefore, fertility. The confusing thing about endometriosis is that many women with the condition are able to conceive and carry to term easily. Because of that, women are not screened for it in initial fertility testing and it is often only considered once a woman has undergone In Vitro Fertilization (IVF) with multiple failed embryo transfers or miscarriages. 

While endometriosis can be difficult to detect and diagnose, some testing is possible.  Endometrial cysts can be seen on ovaries in an ultrasound. MRIs can reveal lesions in the abdomen, most commonly in advanced cases. Exploratory laparoscopic surgery is the gold standard for diagnosis and treatment to remove obvious lesions inside the abdomen, but microscopic lesions can be left behind, as well as scar tissue. An endometrial biopsy can assess inflammatory markers that reflect a high likelihood of endometriosis or inflammation in the uterus. Treatments to decrease endometrial growth such as Lupron after laparoscopic surgery or in the months leading up to a frozen embryo transfer cycle from an IVF may help decrease inflammation and immune activity, improving implantation and pregnancy rates.

Acupuncture and customized Chinese herbs, along with following an anti-inflammatory diet, have been shown in studies to help decrease the size of lesions, improve fertility, and reduce associated symptoms of endometriosis[1]. I also find some supplements helpful in my clinical practice, including N-Acetyl Cystein (NAC) and pycnogenol[2]. Because patients with endometriosis can have different underlying diagnoses in Chinese medicine theory, it is wise to work with an experienced practitioner who can prescribe an appropriate custom blend of herbs as well as dietary and lifestyle changes. Acupuncture can be helpful in reducing inflammation and regulating the immune system while patients are preparing or undergoing IVF and are in treatment or recovery for endometriosis.

Whether you are trying to manage endometriosis symptoms, trying to conceive naturally, or are undergoing fertility treatments such as IVF, working with an experienced acupuncturist can be a helpful addition for managing endometriosis.

 

[1] Sai Kong, 1 Yue-Hui Zhang, 2 , 3 Chen-Fang Liu, 1 Ilene Tsui, 4 Ying Guo, 1 Bei-Bei Ai, 1 and  Feng-Juan Han 2 ,*The Complementary and Alternative Medicine for Endometriosis: A Review of Utilization and Mechanism. Evid Based Complement Alternat Med. 2014; 2014: 146383

 

[2] Maria Grazia Porpora, 1 Roberto Brunelli, 1 Graziella Costa, 2 Ludovica Imperiale, 1 Ewa K. Krasnowska, 2 Thomas Lundeberg, 3 Italo Nofroni, 4 Maria Grazia Piccioni, 1 Eugenia Pittaluga, 2 Adele Ticino, 1 and  Tiziana Parasassi 2 ,*. A Promise in the Treatment of Endometriosis: An Observational Cohort Study on Ovarian Endometrioma Reduction by N-Acetylcysteine. Evid Based Complement Alternat Med. 2013; 2013: 240702. 

 

 

 

This Ancient Philosophy on Miscarriage Makes So Much Sense

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This blog by Mary Sabo, L.Ac DACM was originally published on the national blog MindBodyGreen.  For the full article, click here!

The elation that comes with a positive pregnancy test when trying to conceive is often euphoric followed closely by the joyful excitement that surrounds planning for a new baby. But for women who have experienced a miscarriage, this news often comes with a whisper of doubt and fear of another potential loss. According to the American Pregnancy Association, around 25 percent of pregnancies result in a miscarriage. With this high rate—one in four—one would suspect women are miscarrying everywhere, and it would be more normalized, but most couples suffer in silence, and it is not uncommon for women to feel shame on top of the grief that goes along with it.

There is no protocol for dealing with a miscarriage. 

There are no guidelines for grieving this loss. And in our culture, most women think of pregnancy as something they created and therefore a miscarriage is something they "created" and then "lost." It can elicit philosophical questions like "Is something wrong with me?" "Why me?" "Am I being punished?" "What did I do wrong?" "Can I carry to term?" These questions, along with hormones dropping and trying to renormalize, can create quite a bit of emotional suffering. 

While I was getting my degree in Chinese medicine, we learned of a different belief system regarding miscarriage that was rooted in the ancient Buddhist philosophy. They believed that the souls of our potential children hang out with the parents and wait for the right moment to "jump in" and activate a pregnancy. This was their explanation for the spark of life and why some cycles work and some don’t. If something goes wrong with the "vessel" or physical form of the fetus once a pregnancy is established, the soul jumps out and waits for another opportunity. I find this way of thinking as a much kinder one that can offer some relief to women grieving a miscarriage, especially if she is open to other religious or philosophical systems. 

The majority of miscarriages cannot be controlled or prevented.

We now know that the majority of miscarriages are due to genetic abnormalities in the embryo, meaning the fate of that fetus was determined at fertilization and would never become a healthy baby. A much smaller percentage of miscarriages can be prevented if a problem is detected with blood clotting in the mother or occasionally an immune disorder. Infections in the uterus, hormone imbalances, uterine abnormalities, and tubal disorders can also play a role and be treated. But the majority of miscarriages cannot be controlled or prevented. Many women blame themselves, creating unnecessary suffering, and it is my hope that with more awareness about miscarriage, this self-blame and suffering will be reduced.

Miscarriage is so common that most OB/GYNs won’t do any additional testing until a woman has had two or three of them. However, by that point, the emotional roller coaster for the potential parents can be quite intense, resulting in stresses on a physical and psychological level. Patients often come to me for acupuncture and Chinese herbs, both of which can offer emotional support but may also help correct some of the mild abnormalities that are associated with miscarriage, such as hormone imbalances and mild clotting or immune issues. If a woman has already had several miscarriages, I prefer to work collaboratively with a miscarriage specialist physician, supporting my patient with acupuncture, herbs (if appropriate and approved by her doctor), and dietary advice, while she undergoes testing and treatments directed by her doctor. In some cases, artificial reproductive technologies like in vitro fertilization (IVF) with embryo biopsy can be quite helpful in controlling the quality of the chromosomal makeup of the embryos that make it to the uterus. When combined with acupuncture, IVF results can be even better.

Click here to read the rest of the article on MindBodyGreen.