Last week, after a wonderful Jivamikti yoga class at one of my favorite studios in New York, my friend Susan and I decided to join an informational Webinar on Ovarian Reserve Assessment testing available for infertile couples.  Not only was the whole format of the webinar totally awesome (simultaneous video/audio of the presenter, power-point and live chat-feed from the participants – it’s amazing where education and technology are going), but the information discussed was enlightening.  Here is a recap of some of the developments in fertility testing and a little insight as to how acupuncture and herbs can help.

If you have ever had difficulty trying to conceive and involved the aid of a Reproductive Endocrinologist (RE), then most likely one of the first tests they ran was a hormone panel on Day 3 of your menstrual cycle.  Specifically looking at:  Follicle Stimulating Hormone (FSH), LutenizingHormone (LH), Estrodial (E2), and Prolactin.  The levels of the aforementioned hormones (among others) and their ratio to each other can give insight into the general quantity of eggs a woman has left to ovulate.  However, hormones are finicky creatures, and can change drastically month-to-month due to other illness (like thyroid disease or poly cystic ovarian syndrome, for example) or just from plain old-fashioned stress.

New findings are showing that the typical Day 3 FSH testing gives inaccurate values of a woman’s ovarian reserve one out of every six tests.  This is to say that every sixth woman to undergo traditional fertility testing may have  false lab results – offering an unnecessarily grim outlook on their hopes of ever conceiving.  How disturbing. (And probably part of the reason that one of the next steps in fertility treatments – IVF – has only a 30% success rate).  Women who are lumped into the “never will get pregnant” category regularly prove that wrong, and others who are in good health are for some reason never are able to fulfill their dream of having children.  A possible reason for this discrepancy is the inability to accurately asses ovarian reserve or egg quality.  At the very least, it is clear that the diagnosis and treatment of infertility must continue to develop in order to understand what is happening at the clinical level.

ReproSource is a lab dedicated to fertility testing and they work with patients and RE’s around the world.  Dr. Ben Leader, a scientist who works for ReproSource, presented in last night’s lecture on their newest test that indexes three specific hormone levels on Day 3: FSH, AMH (anti-mullarian hormone), and Inhibin B.  The index of the three, according to Dr. Leader, will give a much more accurate assessment of a woman’s ovarian reserve.  The results come up on a sliding graph as well, rather than the typical ‘within normal limits’ or ‘out of normal limits’ / ‘you’ll conceive’ or ‘you won’t’ – which is much easier to understand and interpret.  Other experts in the field are finding that AMH can be tested on its own at any point in a woman’s menstrual cycle and will give more accurate and consistent insight to ovarian reserve than even the day-3 FSH test.

The results of all of the aforementioned tests indicate what potential a woman has to work with while trying to conceive – of vital importance to any health care provider helping her on this journey.  We can do all the acupuncture or fertility medicine in the world, but if there simply aren’t any eggs left for a woman to ovulate, that is one thing we cannot create (in this case, donor egg is often offered as a viable option).  A woman is born with all the eggs she will ever have in her lifetime, and depending on the delicate nature of the menstrual cycle, genetics, hormonal balance and other factors will determine at what point she will run out – essentially beginning menopause (with normal onset somewhere in the neighborhood of age 50).

The fact that such testing is more specific for detecting egg quantity, it cannot be used to determine egg quality – the part that we as acupuncturists have the potential to improve.  The best way to consistently determine egg quality is still by a woman’s age: the younger the woman, the better the egg quality -regardless of ovarian reserve (although this is often debated).  It is quite interesting to me that with all the new developments in fertility therapy that they have yet to determine a quantifiable way to detect poor or high egg quality.

This is where we come in.  Acupuncture and herbal medicine have been used for thousands of years to help couples conceive.  By invigorating blood flow to the pelvic area, regulating a woman’s menstrual cycle, and alleviating stress we are able to accomplish the task in question: improve egg quality. If the issue is male-factor, acupuncture and herbs can also help improve sperm quality in addition to sperm quantity due to the simple fact that males regenerate new sperm avery three months (please note that success depends on the etiology of low sperm count, motility, or morphology issues). Depending on a couple’s history, age, lab work and diagnosis, acupuncture and herbs can help couples to safely and effectively conceive – either naturally, or alongside western fertility treatments.

In order for Chinese medicine to have an effect on improving egg/sperm quality, it does take time. To regulate a woman’s cycle can take anywhere from three-six months, and the same goes for impacting a change on male sperm production.  Therefore, I recommend beginning to work with an acupuncturist/herbalist either when you are just beginning to try and conceive or beforehand.  I have personally studied under renowned fertility acupuncturist and herbalist, Dr. Mike Berkley, and seen the amazing power of Chinese medicine in conjunction with modern developments.  Tests like the FSH/AMH/Inhibin B Index are useful to patients, RE’s and acupuncturists alike.  With more accurate clinical findings and continued research, we can all be better internists in this challenging field.

This post is proudly a part of Prevention Not Prescriptions Tuesday @ The Kathleen Show.  For more information and to check out some other great health blogs, check this site.

2 Responses to “New Fertility Testing & How TCM Can Help”

1. Sky says:

   November 3, 2009 at 6:08 AM

   Thanks for this info, Erin. Fascinating. Just one question… Are the FSH/AMH/Inhibin B screening tests, or are they diagnostic in nature? It seems to me that they would be a screen, givin the high false positive rate (kind of like First and Second Trimester Screening in pregnancy). Also, would you recommend TCM for all women trying to conceive, regardless of fertility issues?

   Yay talking shop! Lots of love and blessings to you!
   Sky

   Reply
   • Erin says:

     November 3, 2009 at 9:53 AM

     Sky – good questions. The AMH test is far more accurate than the FSH test, which will hopefully lead to more accurate readings of ovarian reserve. Based on the results and individual cases, further testing may be needed. The results show a relative potential for conception based on ovarian reserve, and western/eastern medicine alike can’t impact change on this aspect of fertiltiy. So, do they diagnose vs screen? I’m not sure.
     I recommend fertility TCM for any women with irregular cycles who may be trying to conceive, or who are older. It will help to regulate ovulation and improve egg quality.

     Thanks for commenting!

     Reply