Data were examined on 5124 women between the ages of 15 and 45 years from the Quebec Pregnancy Registry who had clinically verified miscarriages between the years 1998 and 2003. A total of 10 matched control patients were also randomly selected for each case.

The investigators found that of the women who miscarried, 5.5% (284/5124) had taken antidepressants during their pregnancy compared with 2.7% (of 51,240) of the matched control patients.

After adjusting for potential confounders, “antidepressant use during pregnancy was found to be associated with an increased risk of spontaneous abortion compared to those with no use” the study authors wrote.

In addition, SSRIs used alone, SNRIs used alone, and a mix of antidepressants from different classes used together were also associated with an increased risk for spontaneous miscarriage.

When the investigators compared type of antidepressant used vs not used, they found that paroxetine alone and venlafaxine alone were both significantly linked to an increased risk for miscarriage.

Source: http://cme.medscape.com/viewarticle/723297?src=cmenews&uac=123618HT

How did you arrange your IVF trip to the Check Republic?
We used the Reprofit International Clinic in Brno. This was scheduled for us through My IVF Alternative (MIA), a US contact who made sure that we had all of our health records and tests done, advised when to start which medications, and acted as a go-between for Reprofit. MIA also arranged for our accommodations, airport transfers, and someone to take us to our appointments (there were 4 appointments total).

Did you have any problems along the way?
One issue that I had with MIA was that they claim to assist you with getting your medications for free. Although they did send me the paperwork to apply for the medications through a US non-profit, they did not let me know that I needed a US doctor to write me the prescription until after I had paid for their services. This ended up costing us an additional $1700 because my doctor would not help me with the prescription, so I could not use the non-profit. If MIA had told me this detail in advance, I would have researched other options. I felt that this was a bit sneaky on their part. When I called them with my concerns about this extra cost, my contact in Phoenix labeled me a “problem case” when she accidentally sent an email to me rather than the owner of MIA.

Where did you get your medications before the trip?
I ended up getting the prescription for the ovulation drugs through a British company, using the prescription from Reprofit, which was less expensive than using my local pharmacy.

How was your experience at the clinic in Brno?
The clinic in Brno was very clean and professional. I went in twice after my arrival for ultrasounds, to make sure that I was responding to the ovulation drugs. The third visit was to retrieve my eggs, and for my husband to give his sperm sample. After the egg retrieval, I could call daily to see how the fertilization process was going. The last visit was to have the embryos implanted. The staff was very nice to work with, and all of the people we saw spoke English. I would highly recommend this clinic.

Any recommendations about the city of Brno?
Brno is a pretty boring city, especially if you stay there the entire 2 weeks needed for this procedure. Be sure to make arrangements to travel – Vienna is nearby via train, as is Prague. We ended up renting a car with a GPS so that we could explore more of the area and only stayed in Brno around the times of our appointments.

Would you do this again? Any other tips?
I would go back for another IVF at Reprofit if needed – but book it directly through them. We ended up pre-paying all 2 weeks hotel/apartment through MIA, plus we had to pay for our hotel nights when we were not staying in Brno (a price we were willing to pay to get out and see other areas). There are many hotels within walking distance to the clinic, but we would rent a car again. Plus, MIA’s website says that they assit you with travel arrangements to visit outside of Brno. This is not true. When we asked our local contact about travel, she was not any help. We had tried to make some of our travel arrangements prior to leaving the US, but were advised that it was best to wait until we arrived in Brno.

If you have not traveled internationally before, I do recommend using a go-between, like MIA (there is another Reprofit in Zlin and they have a similar company like MIA who books US couples). But, if you consider yourself pretty adventuresome, you could easily do this on your own.

I am happy to report that my patient’s IVF trip was a success. She is currently expecting a baby girl.

Diagnosis

Fallopian tube obstruction can be diagnosed in a number of ways.  Laparsocopy is a surgical procedure which uses a small lighted tube that is inserted through a tiny incision (cut) on the abdomen.  With this procedure, a surgeon is able to see directly into the abdominal cavity and check the state of the fallopian tubes on the outside and the inside by injecting colored dye through the cervix and watching for its appearance at the end of the tube.

Hysterosalpingogram is a procedure in which a dye is injected into the uterus and the uterus is examined via X ray to see if the dye spills into the tubes and pelvic cavity.  These diagnostic techniques are quite invasive so they are not done routinely unless a woman has been trying to conceive for a long period of time without  success (and male factor infertility has been ruled out).

Causes

The common reason for the fallopian tube blockage is a pelvic infection which may produce minor symptoms or no symptoms at all.  However, if the infection was left untreated it can cause scarring, adhesions and complete obstruction of one or both tubes.  In cases of PID (pelvic inflammatory disease), opportunistic bacteria coming from the uterus can spread to the fallopian tubes since they are the structures closest to the uterus.  If a woman is experiencing acute infection, antibiotic therapy is indicated in order to prevent damage to the fallopian tubes.  However, if a woman already has obstruction and damage of the fallopian tubes, a surgery that can repair the damage may be indicated.

Endometriosis can be another possible cause for fallopian tube obstruction.

It’s also possible that fallopian tubes are blocked only some of the time.  This type of blockage is referred to as a “functional blockage”.  This scenario is typical in women who experience a lot of stress.  Stress tends to constrict pelvic musculature and decrease blood flow and this can be a factor in inability to conceive.  This type of functional blockage responds very well to acupuncture as well as Chinese herbal medicine.   Also, excessive mucous buildup within the tube can create a plug and cause blockage.  In Chinese medicine, this would be refered to as “damp accumulation” and would be treated through dietary therapy, herbs and acupuncture.

Infertility Treatment for Blocked Fallopian Tubes

If there is an extensive damage and scarring in both fallopian tubes  it is very difficult (or nearly impossible) for a woman to conceive and IVF is probably the best route to take.  IVF was actually developed for women with extensive fallopian tube obstruction and damage since it can bypass the problem.

Using acupuncture prior to an IVF treatment is a wise decision since  it can help decrease side effects of drugs, decrease stress levels and remove any stagnant blood and energy in order to ensure successful implantation.

Microsurgery is another treatment option for women whose tubes are not damaged along too much of their length.  Surgery seems to be more effective if the damage is in the area closer to the uterus.

The good news is that modern technology does help women with tubal blockage have a healthy pregnancy and birth. If you decide to use assisted reproductive technology, you should make an effort to take good care of yourself in order to create optimal conditions for a new life to flourish. Nutritious diet, proper rest, moderate exercise and stress reduction are the most important things that you can do to improve your health as well as increase your chances of conception.

So, you have decided you want to try acupuncture for your fertility concerns.  If you don’t know anybody who is seeing an acupuncturist or if your doctor does not have any referral sources, what do you do?  Do you start searching the Internet first or do you get your phone book out and call the first person that you randomly selected by sticking a pencil into the page with your eyes closed?  How do you find an acupuncturist that you can trust who can address your needs?

Searching for the right practitioner is not an easy task.  Some practitioners might have great personalities and charisma but have mediocre medical skills.  On the other hand, some might have strong personalities and terrible bed side manners but excel in their medical knowledge.  Just like in any profession, there are practitioners who devote lots of time and energy to constantly better their skills while there are others that are happy with what they already know and don’t put much effort into increasing their knowledge.

Acupuncture for the treatment of infertility has received a lot positive of press in the past couple of years .  As a result of that, more and more practitioners of Chinese medicine are deciding to advertise infertility treatment as part of their practice.   The truth is, most practitioners of Chinese medicine receive very minimal training in treating infertility. Chinese medicine schools don’t offer specialties, so if an acupuncturist calls him/herself  “specialist”  in any area, that does not necessarily mean that they received years of extra training in that particular area.  It is not equal to a “specialist” title in Western medicine which usually required years of extra medical training.

Clinical doctorates in Chinese medicine are a recent offering to practitioners who wish to receive more training in a particular area of interest.  Some colleges offer focused study on cancer therapies, women’s health, geriatric medicine etc.  Those programs definitely offer a more in depth study in particular areas and there is a lot of interest in Chinese medicine field in making a doctorate degree a standard education requirement for future incoming students.  That process may take a long while to become effective since most acupuncture schools are small and operate on non profit basis.

When I graduated with the Master’s degree in Chinese medicine in 2003, I started out as a general practitioner who treated anybody who would come through my door.  As time went by I started receiving more and more phone calls and interest from patients who were asking me if I treated infertility.  My answer was simple: “Sure, I treat infertility, no problem.”

The truth is, I didn’t even know how much I didn’t know about treating infertility.  I only knew the basic information that was presented to us in school which (now I realize) was not nearly enough to create a comprehensive treatment plan.  As I realized that I really enjoyed working with women and helping them with their infertility problems I decided to do more research, take continuing education classes, read more books, enroll in doctorate program …I was constantly amazed with the wealth of information available on the subject of infertility and I definitely learn something new every single day.  So, how does this information help you?

When trying to chose a practitioner who can help you with your fertility concerns you should be proactive and not be afraid to ask them questions.  Here are some of the examples that may help:

-How much of your practice focuses on infertility treatment? A practitioner who devotes most of his/her time to treating infertility is most likely more knowledgeable in that area.  A practitioner who sees an occasional infertility patient may not have enough experience or expertise to offer the best treatment available (which does not mean that they can not be helpful at all).

-Did you receive any extra training in infertility treatment? Where, how much and by whom? I think that this is an important piece of information since extra training is definitely needed in this particular field.

-Where you trained in herbal medicine? Some colleges offer programs in acupuncture only which do not include herbal training.  In China, herbal medicine has been the main therapy for treating infertility throughout the centuries.  Acupuncture is considered an adjunct therapy that is usually not used as a sole therapy for infertility.  Most of the time, it is common for women to have to take different herbal formulas at different parts of their menstrual cycle depending on their individual condition.  Don’t be surprised if you get 4 different herbal prescriptions to take throughout the month.

Just like with any medical treatment, you should be encouraged to ask questions and understand your treatment plan and options. Chinese medicine has a completely different way of looking at the human body. Sometimes it can be challenging to understand the theory behind it but your practitioner should explain to her/his best ability what it would take to treat your condition and what would be a reasonable prognosis.

Your practitioner should encourage you to get evaluated by a reproductive endocrinologist in order to get a clear picture of your condition. For example, if you have severe fallopian tube obstruction your only option may be the use of Western medicine in order to conceive. In that case, Chinese medicine can be used as an adjunct therapy to prepare you for assisted reproductive treatments like IVF. However, if your practitioner is unaware of that diagnosis you could be wasting precious time pursuing natural treatment.

Things to stay away from:

-Practitioners who give you promises that sound too good to be true e.g. “You can get pregnant in a month”. Nobody can really guarantee any results for sure. However, it is common for natural treatments to take longer in order to be successful. Three months of treatment are the minimum amount of time that you should consider. Some patients may require as much as one year of treatment. If you have been treated for over a year without success it is definitely time to consider other options.

-Practitioners who list unreasonably high success rates e.g. “75-80% of all my patients get pregnant”. It is important to know how big is their sample size. If somebody treated 3 infertility patients and all 3 happened to get pregnant that their success rate is 100%! Are the practitioners who list success rates counting live births or just pregnancies? Are practitioners counting patients who went through IVF and had acupuncture as their success stories? All of this questions are important when determining whether listed success rates are useful or not.

-Practitioners who claim that they have one and only special secret method that will bring you success. Needless to say, there isn’t a secret acupuncture point or herb that will cure your infertility. A successful treatment will probably have to include various diet and lifestyle changes, use of herbal medicines that are available to any practitioner and set of acupuncture points that every practitioner had to study.

I hope that these guidelines will be helpful for you and that you will be able to find the practitioner that meets your needs. I wish you all the best in your journey to become a parent!

If you trying to conceive it is important that you refrain from taking drugs that belong to NSAID category especially around ovulation time.  Tylenol can be used since it does not belong to this category but it is definitely better to avoid any over the counter medications if possible.

If you are suffering from chronic pain, it is important to address the root cause of the  issue and use safer and more gentle alternatives like acupuncture, herbal medicine, physical therapy, massage, yoga therapy, nutritional therapy, essential oils and others.

Common herbs that are used to decrease inflammation and relieve pain are ginger and turmeric. Both are commonly used in cooking in China and India.  Adding ginger and turmeric to your food will not only add nice flavor and color to your dishes but also help with pain control.  Magnesium is a muscle relaxant so if you suffer from muscular pain and stiffness taking an Epsom salt (magnesium) bath can help.  Fish oil and cold liver oil can also help decrease inflammation and provide pain relief.

Myrrh, the resin of a tree Commiphora myrrha, has been used in both traditional Chinese and Ayurvedic medicine to fight pain caused by inflammation.  It is commonly paired with frankincense to create a powerful pain control formula.

Please consult with the licensed health care professional for treatment option that is appropriate for your condition.

“Prebirth acupuncture refers to a series of treatments in the final weeks of pregnancy to prepare women for childbirth.  Research has demonstrated that the mean duration of labor in a group of women giving birth for  the first time was reduced from eight hours and two minutes in the control group (7o women) to six hours and 36 minutes in the group of 70 women who have received prebirth acupuncture.   In clinical practice acupuncture is an ideal method to help women prepare themselves to have the most efficient labor possible.  Feedback suggests that prebirth acupuncture offers a range of positive effects that goes beyond reducing the time spent in labor, with midwives reporting a reduced rate of medical intervention.”

Since ancient times, Chinese medicine, including acupuncture and herbal medicine, has been used to help women during pregnancy, labor and postpartum period.  Modern research is validating its efficacy especially in the period leading up to labor and during labor.  Expectant mothers may be experiencing symptoms which include heart burn, fatigue, insomnia, anxiety, bleeding gums, back ache (to name a few) which are considered normal.  Western medical approach during last 2-3 weeks of pregnancy includes weakly visits to a gynecologist in order to monitor fetal position and heart beat but unfortunately has very little to offer for relief of these  bothersome symptoms.  Acupuncture on the other hand, is not only able to prepare a woman’s body for more efficient and shorter labor but it is also able to relieve pregnancy induced symptoms including increased worry and anxiety.

Whether you are expecting your first child or third child, if you are interested in increasing your chances of natural birth and delivery, acupuncture is definitely a gentle and  safe treatment method for you to consider.

Source:  The Essential Guide to Acupuncture in Pregnancy and Childbirth by Debra Betts

The hormone responsible for the production of fertile cervical mucous is estrogen and its production peaks at about 6 days before the actual ovulation starts.  However, not all mucous is created equal!  There are four types of fertile mucous and while some types facilitate the movement of sperm others tend to block it.  The mucous that is produced by the cervical glands during infertile times is called G-type and its quality is thick, pasty and impenetrable.  As the ovulation time gets closer, estrogen levels increase which makes the mucous more stretchy and slippery.  L-type mucous causes the woman to feel a more sticky and wet sensation in her vaginal area but it is not until S-type mucous appears that the woman can actually notice a discharge which usually resembles an egg white consistency.  Finally, as the ovulation is imminent, P-type mucous is secreted from the top of the cervical canal and even though it does not appear as stretchy as S-type mucous, it is extremely lubricative and rich in potassium (thus the name P-type).  “The last day that P mucous is produced is the most fertile day of the whole cycle i.e. the day before the egg is released or the day it is released. “

The importance of paying close attention to the changes in woman’s cervical mucous production lies in the fact that it proceeds ovulation and alerts a woman of her most fertile days.  “Producing the fertile mucous to facilitate the sperm’s journey up the cervix in the days before ovulation is aimed at getting these sperm inside the female reproductive tract well before the egg is released.  This is because this largest single cell in the body is one of the shortest lived, being fertilizable for only 6-12 hours.  Some of the millions of lively little sperm cells, on the other hand, have been known to survive for 5 days  in the female reproductive tract, although they are most able to fertilize the egg in the first 48 hours after delivery to vagina […]  Some studies have indicated that the day for sexual intercourse which then leads to the highest conception rate is in fact 2 days before ovulation.”

Chinese medical practitioners frequently ask questions about vaginal discharge in order to determine the yin status of the body.   Yin energy within the human system corresponds to all the fluids flowing within our bodies including blood, urine, sweat as well as vaginal discharge in women.   If the woman does not notice any vaginal discharge during any part of the cycle or if the discharge seems to be very scant and never reaches the stretchy and egg like consistency, she is usually diagnosed with some form of yin vacuity. In Chinese herbal medicine there are herbs which are given to tonify the yin and stimulate the production of fluids.  The results of more mucous production should be seen within 3 months of herbal and acupuncture treatment.  However, I frequently encounter patients who have vaginal discharge throughout the whole month which tends to be thin and watery.  In those cases, more questions should be asked about digestive health and herbs that strengthen Spleen and Stomach energy can be helpful.  Patient should also be evaluated for a possible infection.
Medications that can potentially dry up the cervical mucous include clomid and  antihistamines,   Also taking a large dosage of vitamin C can potentially make the mucous too acidic and therefore hostile to the sperm.

Foods which increase the production of yin and fluids in the body and therefore increase the production of cervical mucous are:  all dark colored beans e.g. black beans, eggs, dairy, small amounts of pork and duck meat, asparagus, seaweeds, leafy green vegetables, berries like: blueberries, strawberries, blackberries and raspberries.  Over consumption of spicy foods and stimulating drinks can lead to dryness.  Staying well hydrated is important since women (and men) with yin vacuity have a tendency toward thirst and dryness.

Smoking has a drying effect on the body and should be avoided especially if you are planning a pregnancy.   Not getting enough sleep, overworking and high levels of stress tend to injure the yin so making sure you are getting enough rest while trying to keep your stress in check should be the first steps to take toward a healthy conception and pregnancy.

You can check out www.fertilityfriend.com for more info on how to determine your  fertile days

Directions
It’s easier to perform femoral massage if somebody else does it for you.  However, it is possible to do it alone as well.  If you are planning to do it alone, I recommend that you use a tennis ball instead of using your hands and lay on your abdomen instead of laying face up.

Locate the femoral artery in your groin area.  It is a large artery just beneath the crease in your groin between your thigh and lower abdomen.  Search around the groin area for a pulsing sensation.
Once you have located the femoral artery, apply pressure over it with your fingertips.  You want to apply enough pressure to stop the pulsing of the artery.  Hold the pressure for 30-45 seconds.  The blood is now backing up and increasing the pressure in the iliac arteries, forcing more blood into the pelvic organs.
Release the pressure and let the blood flow normally.  When the hold is released, you should feel a warm sensation rushing down your leg as the blood supply returns to the lower extremity.
Repeat on the opposite side.  Perform this femoral massage sequence 3 times in a row, twice a day, before ovulation time.

Cautions
Do not perform femoral massage if you are or might be pregnant.  Also, do not practice this technique if you have high blood pressure, heart disease, circulatory problems, or a history of strokes or detached retinas.

Acupuncture is another great treatment technique that can decrease overall stress, normalize hormonal secretions, increase blood flow to the pelvic organs and strengthen the immune system.  In combination with Chinese herbal medicine it is a powerful, natural and safe way to enhance fertility and increase overall health.

A study published in the journal, Fertility and Sterility, in February of 2002 talks about the success rates of people using acupuncture in order to increase their rate of conception. In this study, 160 women underwent routine IVF. Half of them were randomized to have acupuncture both before and after the embryo transfer and half were not. The results were also blinded to those who had acupuncture and those who didn’t. Randomization and blinding make this study a good quality study. The acupuncture group had a pregnancy rate about 40% higher than the group that did not have acupuncture. While this study shows very promising results when acupuncture is combined with IVF, I believe that patients would experience even better results if acupuncture treatments are started at least 3 months before the actual IVF embryo transfer.  It only makes sense to me to think that if a person can increase their overall health and decrease stress levels (all achievable with acupuncture treatments) before the procedure that their odds of success would be even better.  In my practice, I have noticed that patients who prepare their bodies for 3 months before the IVF have better outcomes than the patients who utilize acupuncture only pre and post embryo transfer.

You can not force a pregnancy, you can only allow it to happen.  By creating optimal conditions within your body and increasing your health you will definitely increase your chance of succesful conception and healthy pregnancy.

More info: BBC article

When Should I Seek Treatment?

Statistics indicate that without using birth control, 25% of couples conceive in 1 month, 60% within 6 months, 80% after a year and 90% by 18-24 months.  A woman’s peak fertility occurs between ages of 20 to 25, it becomes less optimal after 30 and tends to be the lowest after 40.  Similarly in men, male fertility is optimal in mid 20s, less optimal in his 30s and starts declining in his 40s even though it never terminates completely.

If you are a couple in your early 30s who has been trying to conceive for over a year you should probably start seeking medical help.  If you are a couple over 35 years old who has been trying to conceive for 6 months with no results it is time for you to get evaluated.

Where should I seek medical help?

My recommendation for a couple facing fertility problems is that they should first take advantage of the Western medicine diagnostic techniques.  Semen analysis, blood tests, ultra sounds and X-rays are a good way to determine if there is a major impediment to fertility like blocked fallopian tubes or very low sperm count.  Consulting a doctor who specializes in fertility problems like reproductive endocrinologist may save you lots of time and energy is obtaining the right diagnosis.

Once I have my diagnosis, what kind of treatment is the best for me?

Once you have a clearer diagnostic picture about your condition (I say “clearer” because about 10% of couples facing fertility problems are labeled as “unexplained” infertility) here are the guidelines on how to proceed with your treatment options:

If there is a major impediment to your fertility e.g. blocked fallopian tubes or very low sperm count, ART (assisted reproductive technology e.g. IVF or in vitro fertilization) is probably your best option.  Using Chinese medicine in conjunction with ART will make the whole process less stressful, you will suffer less side effects and you can increase your success rate by as much as 40%.  Starting a treatment with Chinese medicine at least 3 months prior to your IVF cycle should give you enough time to prepare your body for such a procedure.

If there is a minor impediment to your fertility (e.g. irregular ovulation, mild endometriosis, vague hormonal imbalances, slightly low sperm count) and the woman is less then 35 years old, Traditional Chinese medicine is the best place to start.  Three months is the minimum amount of time that you should consider for treatment. According to Traditional Chinese Medicine, the environment where follicles are developing needs to be enhanced for three months before the egg release. Depending on the severity of the condition, some patients may require treatment for longer periods of time.

If there is an unexplained infertility and the couple has been trying to conceive for a long period of time it is most probable that a combination of minor factors in either or both partners is present and is impeding fertility.  Statistical analysis tells us that two minor factors in combination can reduce fertility so dramatically that it can take on average 7 years to get pregnant.   Couples who have no detectable abnormality can feel even more frustrated since they are being told that there is nothing wrong but they still can’t get pregnant.  Since Chinese medicine views the body as whole, it is able to detect subtle imbalances they may not be measured by standard medical testing.  Thorough a detailed patient interview, pulse and tongue diagnosis, Chinese medical practitioner is able to arrive to diagnosis and  treat the  subtle imbalances that can impede fertility but are not necessarily detectable by standard medical testing.

Which ever route you decide to take in your fertility journey know that you are not alone and that you have more control than you think you have.  Find a support group (if there isn’t one in you area start one!  Every community has people who face fertility challenges).  Work on improving your emotional and physical health.  Talk to a counselor who specializes in fertility counseling.  Educate yourself about your choices and pick the options that feel the most comfortable to you.

I wish you all the best in your journey!

Sources:

1. Jansen R 1997 Getting pregnant.  Allen and Unwin, Sydney

2. Lyttleton J. 2004 Treatment of Infertility with Chinese Medicine. Churchill Livingstone, Edinburgh

3. Sloane E. 1993 Biology of Women. Delmar Publishers, Albany, New York