Enhancing Implantation with Chinese Medicine

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By Lauren Barrett, L.Ac., MSTOM

For a pregnancy to occur, an embryo must burrow into a woman’s healthy, receptive uterine lining and connect to the blood supply. Her immune system must allow this invasion, and the blood flow to the developing fetus must flow well enough to sustain its development. An implantation “window” (the time when the lining is optimal for an embryo to attach itself) is present during a woman’s menstrual cycle about 6-10 days after ovulation. After an IVF transfer with a blastocyst, the window is the following 4 days. For many women, this may be a particularly anxious time and we often get asked what can be done during this time to increase the likelihood of a pregnancy. 

While it is helpful to care for your body and mind during this time, the most effective way to influence your implantation window is with early preparation, ideally in the months leading up to your transfer, IUI, or timed intercourse. This can include acupuncture and herbs, as well as diet and lifestyle adjustments to support a healthy uterine lining, hormone balance, and uterine circulation. Successful implantation is a complex event requiring many factors including expression of the correct receptors in the endometrium, good egg and sperm quality (creating a chromosomally normal embryo), adequate lining thickness and blood flow to the uterus, and a healthy immune system. 

Here are some ways to maximize the implantation window:

Chinese Herbs

A recent study showed that a Chinese herbal formula (Traditional Chinese Medicine diagnosis-specific) taken in the menstrual cycles leading up to an IVF  and transfer may help support healthy endometrial receptivity by increasing the expression of DNMT1, a protein which may regulate the endometrial genes associated with implantation[1]. Some Chinese herbal formulas, especially when combined with acupuncture, may also help thicken the lining[2].

Acupuncture 

During the implantation window acupuncture treatment focuses on reducing factors that hinder implantation. This includes lowering stress by reducing the stress hormone cortisol and increasing endorphin levels, as well as preventing uterine contractions by maintaining relaxation of the smooth muscles of the uterus. In IVF embryo transfer cycles, some studies show that acupuncture treatments pre and post transfer help to encourage implantation. In a natural cycle, acupuncture not only supports healthy ovarian function and uterine lining, but may also help to relax the fine muscles of the fallopian tubes to assist movement of a developing embryo and prevent spasm. 

Lifestyle 

Avoid high impact, strenuous, intense cardio routines and opt for more moderate, low impact exercises such as yoga, walking, and jogging which relieve stress. For most women, it is ok to continue an exercise routine that your body is used to at this time, with reduced frequency or intensity but may be contraindicated in some (women with fresh embryo transfers).  Check with your doctor about what is right for you. 

Avoid hot baths, saunas, heating pads, and hot yoga, activities that may raise body temperature.  

Embrace your mindfulness practices and look to ways to promote relaxation such as meditation, acupuncture, and fertility massage.  

Laugh and enjoy! A study found that women who received entertainment from a comedic performer post transfer had higher rates of implantation[3].

Avoid taking NSAIDs such as Advil (Ibuprofen) at this time. Anti-inflammatories can interact with the receptivity of the uterine lining and are also problematic for embryos. Consider taking Tylenol (acetaminophen) for cramping instead[4].

Continue taking a prenatal with adequate folic acid (800-1000mcg) and supplement with vitamin D if levels are low[5][6].

Eat a variety of nutrient-rich foods to support healthy progesterone levels including organic and hormone free meat and fish and organic produce. Many women like to include pineapple fruit and its core around this time. There are no studies confirming that it is helpful for implantation, but since it is a delicious fruit, we say why not!  Try 1/5 of a pineapple a day including the core. 

 

What to Expect
Many women do not experience any signs or symptoms during the implantation phase, but some do. Possible symptoms include light spotting, cramping or pulling in the lower abdomen, and tender breasts.

Whether conception occurs or not, it is important to remember that this is the area of fertility that we cannot control yet. Embryo quality and the uterine lining health are typically the biggest determining factor for a successful implantation, not what one did or didn’t do during the implantation window.  If you are struggling with implantation or conception, consider consulting a fertility acupuncturist or Reproductive Endocrinologist. 

 [1]Fang, L., Rui-Xia, W., Feng-Mei, M., Zhen-Gao, S., Li-Hong, W., & Lei, S. (2013). Effects of Chinese medicines for tonifying the kidney on DNMT1 protein expression in endometrium of infertile women during implantation period. Journal of alternative and complementary medicine (New York, N.Y.)19(4), 353-9.

 [2]Guo JLi DLiu CJi XLi RDu X. Effects of Chinese herbs combined with in vitro fertilization and embryo transplantation on infertility: a clinical randomized controlled trial. J Tradit Chin Med. 2014 Jun;34(3):267-73.

 [3]Friedler, S., MD, Glasser, S., MA, Azani, L., MSc, Freedman, L., PhD, Raziel, A., MD, Strassburger, D., PhD, Lerner-Geva, L., MD, PhD. (n.d.). The effect of medical clowning on pregnancy rates after in ... Retrieved from https://www.fertstert.org/article/S0015-0282(10)02958-4/fulltext

 [4]De-Kun, L., PhD, Ferber, J., MPH, Odouli, R., MSPH, & Quesenberry, C., PhD. (2018, September). Use of nonsteroidal anti-inflammatory drugs during pregnancy and the risk of miscarriage. American Journal of Obstetrics and Gynecology. Doi: 10.1016/j.ajog.2018.06.002.Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29890124

 [5]Rudick, B.J., Ingles, S.A., Chung, K., Stanczyk, F.Z., Paulson, R.J., & Bendikson, K.A.(2014). Influence of vitamin D levels on in vitro fertilization outcomes in donor-recipient cycles. Fertility and Sterility, 101(2) 447-451. Doi:10.1016/j.fertstert.2013.10.008

 [6]Garbedian, K., Boggild, M., Moody, J., & Liu, K. E. (2013). Effect of vitamin D status on clinical pregnancy rates following in vitro fertilization. CMAJ Open, 1(2). doi:10.9778/cmajo.20120032

 

Environmental Toxins to Avoid While Trying to Conceive

By Lauren Barrett, L.Ac, MSTOM

If you are trying to conceive, you most likely have heard the term ‘egg quality’ used quite a bit. “Good egg quality” refers to the chromosomal make-up inside an egg and is critical for the success of an egg to fertilize, develop into an embryo that can implant, and turn into a healthy baby. Women are born equipped with all of the eggs they will ever have, and while age is the biggest influencer on egg quality over time, research suggests that some diet and lifestyle choices as well as environmental factors can also impact the quality of eggs. Specifically, some environmental chemicals can have a negative impact on fertility and egg quality, which we will explore below. 

It takes about three months for an immature egg to go through the different stages of maturation and ovulate. Therefore, to optimize egg quality, avoiding specific toxins several months prior to trying to conceive is ideal. Whether a woman is trying to conceive naturally or preparing for Assisted Reproductive Technology (ART) cycles like In Vitro Fertilization, it is never too late to improve conditions in the body that may affect egg quality. It is also important to remain aware and limit exposure to these harmful chemicals during pregnancy.

Toxins to Avoid

Bisphenol A (BPA) A major chemical used in plastics, BPA is found in plastic food storage containers, canned food and beverages, and paper receipts. BPA interferes with the hormonal system including estrogen, testosterone, and thyroid hormones and is referred to as an endocrine disruptor. [i] There is also strong evidence that BPA exposure causes chromosomal abnormalities. Even ‘BPA free’ labeled plastic/canned products can contain harmful alternative chemicals that may interfere with the endocrine system and fertility. 

Phthalates (DBP, DEP) The majority of phthalates are found in common bathroom products. These include soft plastics, vinyl/PVC, cleaning products, nail polish, air fresheners, cosmetics, personal care products, and, for the most part, anything fragranced. Phthalates are recognized as endocrine disruptors and researchers have found that phthalate exposure can interfere with ovarian follicle growth in a number of animals largely due to its ability to decrease estrogen production. [ii]

Glycol Ethers (EGBE, DEBME) Organic solvents, glass cleaners, carpet and floor cleaners, oven cleaners.

Perflourinated Chemicals (PFC’s) Includes grease resistant products such as nonstick coated pans heated to high temperatures.

Heavy Metals such as Cadmium, Lead, and Mercury. High levels of Mercury are found in fish at the top of the food chain such as king mackerel, shark, orange roughy, ahi and bigeye tuna, tilefish, and swordfish. 

Other toxins to avoid: Organophosphate Pesticides, Dioxin, Atrazine, Perchlorate, Fire Retardants, and Arsenic.

How to limit exposure

Environmental toxins are lurking everywhere in our modern-day world; the water we drink, the food we eat, the products we use, etc. Thankfully there are small and simple lifestyle changes we can make to limit exposure that can have a great impact on lessening toxicity and improving egg quality. It’s impossible to avoid them all, but taking steps to reduce exposure can be helpful for fertility and overall health.

Here are some tips:

Replace plastic with glass, especially in the kitchen. Choose fresh or frozen organic foods over canned. Avoid prepared and plastic packaged options, including take-out that comes in plastic containers. Switch to cooking in cast iron or stainless-steel cookware instead of non-stick.

Switch from skin, hair, and self-care products that contain phthalates, DBP, and DEP to products that are ‘fragrance free’ ‘phthalate free’ and are made from mostly natural ingredients. Phthalates are often used in fragranced items such as lotion, perfumes, nail polish and shampoo. Phthalates are also in soft plastics and may be in more inconspicuous items such as raincoats, shower curtains, and yoga mats.

Replace cleaning products, laundry detergents, and fabric softeners with products that are ‘phthalate free,’ plant based, and do not contain 2-butixyethanol (EGBE) or methoxydiglycol (DEBME). Use a water filter that removes arsenic, atrazine, and lead.

Get in the habit of checking labels! For consumer guides and product ratings for many brands, check out the Environmental Working Group site and their Skin Deep guide to cosmetics!

 

 

 

[i] Kitamaura A, Suzuki T, Sanoh A, Kohta R, Jinno N, Sugihara K, Yoshihara S, Fujimoto N, Watanabe H, Ohta S. Comparative Study of the endocrine-disrupting activity of bisphenol A and 19 related compounds. Toxicol Sci. 2005 Apr;84(2):249-59;  

Welshons WV, Nagel SC, vom Saal FS. Large effects from small exposures. III. Endocrine mechanisms mediating effects of bisphenol A at levels of exposure. Endocrinology. 2006 Jun;147(6 Suppl):S56-69. (“Welshons 2006”).

[ii] Grossman, D., Kalo, D., Gendelman, M., & Roth, Z. (2012). Effect of di-(2-ethylhexyl) phthalate and mono-(2-ethylhexyl)phthalate on in vitro developmental competence of bovine oocytes. Cell Biology and Toxicology, 28(6), 383-396. doi:10.1007/s10565-012-9230-1

 

Managing PMS with TCM

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By Lauren Barrett, L.Ac, MSTOM

While awareness of PMS (Premenstrual Syndrome) is widespread, most do not fully understand the condition. The undesirable physical and psychological symptoms that women of reproductive age may experience during their luteal phase, around ten to fourteen days before their period, are attributed to PMS. Irritability, anxiety, depression, emotional lability, anger, difficulty concentrating are common psychological symptoms associated with the condition. However, PMS can also present physically as food cravings, bloating, nausea/vomiting, cramping, back pain, breast tenderness, abdominal discomfort, constipation, insomnia, migraines, and fatigue. Some women may also notice an aggravation of existing muscular/skeletal/joint pain, low immunity, and/or low-grade fevers. PMS symptoms can vary in intensity and severity, from woman to woman, and from month to month, and occur in seventy-five percent of women. [i] Premenstrual Dysphoric Disorder (PMDD) is a more extreme presentation of PMS characterized by severe and disabling symptoms, affecting five percent of women. [ii]

What causes PMS?

The menstrual cycle involves a careful orchestration of hormones, particularly estrogen and progesterone, which are released from the ovary over the course of the cycle to thicken and prepare the uterine lining to receive an embryo. One likely contributor to PMS is “estrogen dominance”, which refers to excessive amounts of estrogen in relation to progesterone in the luteal phase. This can occur when estrogen is normal, but progesterone is too low in the luteal phase or when estrogen levels are too high. Elevated estrogen levels can be caused by a number of factors including impaired liver function and digestive issues (it is the liver’s job among other digestive system organs to break down and rid the body of extra estrogen), chronic stress, environmental exposure to hormone disruptors, and gynecological conditions like PCOS, endometriosis or perimenopause. When estrogen is too high in the presence progesterone, it affects hormone-sensitive tissue like the breasts, gut, and brain. In the brain, estrogen and progesterone affect serotonin and GABA levels. [iii] When progesterone is low, GABAergic pathways may be negatively affected resulting in symptoms of anxiety, depression and insomnia. [iii] Progesterone levels also affect dopamine

While the balance of estrogen and progesterone levels are important, the gross fluctuation of these hormones is also significant. The sudden drop of estrogen and progesterone levels responsible for the shedding of the uterine lining (one to two days before the period begins) often causes physical symptoms such as cramping and migraines from the withdrawal. Additionally, prostaglandins released in the uterus in women who experience severe cramping can cause diarrhea due to the close proximity of the bowel. [iv] 

How to Manage PMS 

The menstrual cycle should not be correlated with intense suffering. Because so many women experience PMS symptoms, most assume it is normal and don’t seek help. Diet and lifestyle choices can heavily influence hormone balance, and therefore PMS symptoms. Supplements, herbs, and acupuncture can help too.

Dietary Recommendations

1.     Avoid or reduce alcohol, caffeine, and refined sugar

2.    Eat more cruciferous vegetables. 

Broccoli, kale, Brussels sprouts, cauliflower, and cabbage, contain phytochemicals such as Indol-3-carbinol which increase the metabolism of estrogen by the liver. [v]

3.    Emphasize foods high in magnesium, zinc, and iron or incorporate these as supplements. 

4.    Follow a low animal fat, high fiber diet, which has been shown in studies to lower estrogen levels in the blood without affecting ovulation. [vi]

5.    Supplement with Vitex (Chaste Tree berry), which contains dopaminergic substances as well as compounds that influence the pituitary gland and may help progesterone production, which can reduce PMS symptoms. [vii] 

Lifestyle Recommendations

Reduce Stress 

Incorporate mindfulness practices into your daily routine, such as meditation, yoga, and breathing exercises.  Under stress, the adrenal glands produce excess cortisol. Chronic stress disrupts the Hypothalamic-Pituitary-Adrenal Axis (HPA) and prioritizes cortisol production over sex hormones (estrogen and progesterone). Stress also reduces the liver’s function to eliminate excess estrogen. Because of this disruption, stressful or intense emotional events during the course of the cycle have the ability to throw off ovarian function, in turn affecting the cycle and hormone balance. 

Sleep

Sleep is necessary for the body to repair, recover, and renew and depriving the body of sleep is thought to affect hormone balance. Unplug and get at least seven to eight hours of sleep.  If you struggle with insomnia, acupuncture and targeted herbal therapy may help.

Exercise 

Exercise has been shown to improve mood, stabilize blood sugar, and reduce PMS in women.  In Chinese Medicine, PMS symptoms are often attributed to stagnation in the body, so it makes sense to move your body to improve overall circulation, mood, and wellbeing. 

Reduce Hormone Disruptors 

Modern day environmental factors are also a leading cause of estrogen dominance. Environmental factors that interact with the endocrine system are called hormone or endocrine disruptors. Our skin is the largest organ of our bodies. Take a moment to think about everything you put on your skin on a daily basis and what you come in contact with regularly. Often unavoidable, these chemicals can be found in our everyday products such as detergents, beverages and food packaging, toys, plastics, cosmetics, and pesticides. Look out for and avoid products with phthalates (may be listed as DEP, BPA, DHEP,DBP, DEP), PFCs (perfluorinated chemicals), pesticides containing DDT, and flame retardants. Although complete avoidance of these substances is unrealistic, limiting exposure as much as possible is helpful. It may take an extra moment to check labels, but your body will thank you!

Acupuncture and Chinese Medicine 

Acupuncture and Chinese Medicine balance internal regulatory systems such as the nervous system, the endocrine system, and the neuroendocrine system.  Studies show that acupuncture effectively treats and manages PMS symptoms. In a study comparing pharmaceutical treatment with acupuncture, women who received acupuncture were 1.5 times more likely to have PMS symptoms improve compared to those on hormonal medications. [i] Acupressure, was also studied to relieve PMS. In a clinical trial, applied pressure to specific acupuncture points was found to decrease the severity of PMS symptoms, decrease anxiety and depression, and improve quality of life measures. [viii] 

In addition to acupuncture, Chinese herbal medicine can relieve symptoms related to PMS.  A recent study showed that several months of Chinese Herbal therapy successfully reduced the severity and occurrence of physical and psychological PMS symptoms. [ix] 

Think of these signs and symptoms as a signal. Pain and discomfort can be the body communicating that there is an imbalance within. Take this time to listen to the body without judgement and treat it with the respect and care it deserves. 

  

i.  Kim, S., Park, H., Lee, H., & Lee, H. (2011). Acupuncture for premenstrual syndrome: A systematic review and meta-analysis of randomised controlled trials. BJOG: An International Journal of Obstetrics & Gynaecology, 118(8), 899-915. doi:10.1111/j.1471-0528.2011.02994.

ii. Pinkerton, J. V., MD. (2017, September). Premenstrual Syndrome (PMS) - Gynecology and Obstetrics. Retrieved from https://www.merckmanuals.com/professional/gynecology-and-obstetrics/menstrual-abnormalities/premenstrual-syndrome-pms

iii. Barth C, Villringer A, Sacher J. Sex hormones affect neurotransmitters and shape the adult female brain during hormonal transition periods. Front Neurosci. 2015;9:37. Published 2015 Feb 20. doi:10.3389/fnins.2015.00037

iv. Csapo Al: A rationale for the treatment of dysmenorrhea. J Reprod Med 1980; 25:213-221.

v.  https://www.sciencedirect.com/topics/medicine-and-dentistry/indole-3-carbinol

vi. Bagga D, Ashley JM, Geffrey SP, et al. Effects of a very low fat, high fiber diet on serum hormones and menstrual function. Implications for breast cancer prevention. Cancer. 1995;76:2491-2496.

vii. Rafieian-Kopaei, M., & Movahedi, M. (2017). Systematic Review of Premenstrual, Postmenstrual and Infertility Disorders of Vitex Agnus Castus. Electronic physician9(1), 3685-3689. doi:10.19082/368

viii. Bazarganipour, F., Taghavi, S., Allan, H., Beheshti, F., Khalili, A., Miri, F., . . . Salari, S. (2017). The effect of applying pressure to the LIV3 and LI4 on the symptoms of premenstrual syndrome: A randomized clinical trial. Complementary Therapies in Medicine, 31, 65-70. doi:10.1016/j.ctim.2017.02.003

ix. Chou, P., Morse, C., Xu, H., & Wiebrecht, A. (2009). A Controlled Trial of Chinese Herbal Medicine for Premenstrual Syndrome. Deutsche Zeitschrift Für Akupunktur, 52(1), 53-54. doi:10.1016/j.dza.2009.02.011 

Menopause: The Second Spring

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By Lauren Barrett, L.Ac, MSTOM

In Chinese Medicine, women are said to age in seven-year cycles. The seventh cycle (age 49), referred to as ‘Second Spring’, is approximately the age when a woman reaches menopause. At this stage in a woman’s life, the creative energy shifts from providing resources for a new being to conserving, sustaining, and nourishing her own body.

Menopause is a natural biological event that signifies the end of the menstrual cycle. Guided by the wisdom of the body, this natural progression helps to balance its systems. A woman reaches menopause when menstruation ceases for one full year. Leading up to menopause and one-year following is a process referred to as perimenopause. Most of the undesirable symptoms that women associate with menopause occur during this phase. 

Acupuncture and Chinese Herbal Medicine provide a holistic approach to manage and treat signs and symptoms associated with menopause.  Similar to menstrual irregularities, menopausal signs and symptoms have become normalized, but they are not something one must suffer through. While menopause is homeostatic by nature, it can exacerbate pre-existing imbalances, presenting as hot flashes and night sweats, vaginal dryness, insomnia, emotional disturbance, weight gain, and migraines. 

Menopause is an event that occurs within the endocrine system, but its symptoms involve many other areas of the body. Research studies show that acupuncture affects internal regulatory systems, including the endocrine, neuroendocrine, and sympathetic nervous system.[i] This is important when it comes to treatment of menopausal symptoms because the occurrence, intensity, and severity of these symptoms involve an interaction of all three of these systems. In a randomized controlled trial, acupuncture treatment was found to significantly reduce hot flash frequency and severity as well as improve sleep, anxiety, memory, and mood compared to no treatment in menopausal women.[ii]Unlike most therapies, acupuncture addresses the entire being and helps to balance the body and mind. It was also studied to stimulate endorphin release and possibly other neurotransmitters including dopamine and serotonin, which can enhance mood. [iii]

Embrace your Second Spring! Menopause offers a challenge and a chance to transform the condition of your health and accept the beautiful process of transition. Adopting more sustainable and supportive lifestyle and dietary changes in addition to Acupuncture and Herbal medicine can significantly prevent and relieve symptoms associated with Menopause. 

 

[i] Stener-Victorin, E., & Wu, X. (2010). Effects and mechanisms of acupuncture in the reproductive system. Autonomic Neuroscience, 157(1-2), 46-51. doi:10.1016/j.autneu.2010.03.006

[ii]  Avis, N. E., Coeytaux, R. R., Isom, S., Prevette, K., & Morgan, T. (2016). Acupuncture in Menopause (AIM) Study: a Pragmatic, Randomized Controlled Trial. Menopause (New York, N.Y.)23(6), 626–637. http://doi.org/10.1097/GME.0000000000000597

[iii] Cheng, K. J. (2014). Neurobiological Mechanisms of Acupuncture for Some Common Illnesses: A Clinicians Perspective. Journal of Acupuncture and Meridian Studies, 7(3), 105-114. doi:10.1016/j.jams.2013.07.008