Lecture 12 October 15th-fertility

1MEN’S AND WOMEN’S HEALTH – OCTOBER 15TH, 2007 FERTILITY LECTURE 12 Naturopathic Fertility Centre in Toronto – Judith Fiore ND Success rates of conventional fertility treatments is 25-30%. There is more to it than just insemination, IVF. Dr. Fiore: says her success rate is 60%-80% 20-40 million sperm: absolute minimum number of sperm needed for women to conceive naturally. Normal sperm counts should be around 140 million. Sperm counts are much lower than they used to be. There is a lot we can do for female concerns (in chart). Start by asking women about their cycles: how long does she bleed for, spotting… these questions aren’t generally asked at fertility clinic. Amount of cervical mucous at ovulation: ask this too. IUI= intra-uterine insemination Lifestyle factors are really important! Daily grind, long commutes… Make sure that male has semen analysis done before other exploratory procedures done. Can have family doctor do this, or they will be referred to fertility clinic. Below 5 million, have to go right to IVF. Motility and morphology can be factors too. DNA fragmentation rate, up to 15% is normal, but 30% or higher is cause for concern re: morphology. Add FSH to diagnostic tests done for women. Looks at “ovarian reserve”, but these levels can fluctuate, especially in times of stress. Hysterosalpingogram: forces dye through fallopian tubes. Very uncomfortable test. Sonohystogram: same as above, but uses saline solution and see if there is any spill into peritoneal cavity from Fallopian tubes. (re: varicocele: put frozen gel-packs around testes, 1-2 times a day. Castor oil packs, not with heat.) Test question? (TQ): know about the postcoital test. Generally try 3 IUIs and then say have IVF. People should have more tries at it! Maybe 6? If she is older or there are other concerns, this might be appropriate, but IVF brings in a lot of money, and this may be part of the push towards IVF. Clinics may put women on drugs to make them ovulate so there are more follicles, more chances of conception. Minimum size is 1.7-2.3cms to be fertilizable. IUI: man provides a sample in clinic, or brings in fresh sample. Have to wash the sperm as it bypasses the vagina when you use IUI. “post-wash” number are much lower than pre-wash. Some clinics will do 1 insemination, others will do another the next day. IVF: Done after a few unsuccessful IUIs. Start by suppressing the woman’s ovulation, she is put into “instant menopause”. Can lead to depressive, emotional state. Look for antral follicle count. Want FSH levels to be below 10 (if higher, it is hard to get more follicles produced). Most women are at 5-8. Flexible needle inserted through vaginal wall, through ovaries, follicles are aspirated. Passed right through to lab, put in dish with sperm. ICSI: Inject sperm right into woman’s egg. (done with IVF) GIFT/ZIFT: not really done any more. 15-20% ectopic pregnancy with this procedure. Don’t worry about these so much. Page 4 With acupuncture, success rates almost double. 45-50%. Acupuncture is main therapy that Dr. Fiore uses in clinic. Page 5 Make sure you cover food in intake. Variety in diet is good. MEN’S AND WOMEN’S HEALTH OCTOBER 11TH, 2007 – PAGE 1

Recurrent pregnancy loss? May help to get off gluten. All grains on page 5 are gluten-free except for barley. (Oatmeal??) Plain organic yogurt, fuller fat yogurt. Low fat dairy: a study found that there might be a link to infertility? (need fat!) Increasing water intake, this is one of the most difficult changes to make for many people. Good to drink room temperature water, even warm water. Seed protocol: see notes. Moon cycle: day of new moon is day 1. Sleep with curtains open, moonlight coming in for day before/of/after full moon. Women may find they have regular cycles when they are camping outside for the summer, away on vacation and outdoors for the days/nights. This protocol gives women some subtle support, also gives them a sense of control during fertility treatments. Page 6 Keep flax seeds at lower level in men. Lifestyle changes: TQ: BBT is least reliable indicator, cervical mucous is most reliable indicator. Dry skin brushing: always move towards the heart. Stimulates lymphatics Castor oil packs: do them between days 5-12 of cycle. Increase circulation, lymphatics. Kill microorganisms in periotoneal cavity, break down scar tissue, good for liver. Put castor oil over entire abdomen, covering liver and uterus. Don’t do this in first trimester. Breaks down scars, might impact fetus. Page 7 Exercise: if women are exercising vigorously before pregnancy, don’t cut it out completely. Reduce. Page 8 Vitamin C: Dr. Fiore uses no more than 2 grams/day for women. Folic acid: recent research says it increases quality of eggs. Page 10 Rubeus: Wait until 4th month before taking it. Can shorten labour time (clinical) Dr. Fiore likes to work with homeopathy first, tries to avoid using botanicals. Ginkgo: good if person has a lot on their mind. Uses a lot of glycyrrhiza: synergist, gives direction to herbal formula. Good for women with low estrogen levels Ginseng suggested to male patients Saw palmetto: definitely. Skullcap: “fantastic!” Vitex: the best thing for bringing down FSH levels in women. Increases LH production. Better communication btwn ovaries and brain. Improves ovarian function. Acupuncture & TCM • YIN points for 1st half of cycle – CV, KI (esp KI3), SP (SP 6 & 9 & 10), ST 28, 29 & 30 (29 and 30 directly affect fallopian tubes so important for IUI) • KI 13, • Liver stasis: LV 13, 3, 2. • Yin= estrogen, cooler; Yang= progesterone, increasing temperature • 2 x per week for acupuncture. • UB 23, 32, 52. Add electroacupuncture to 23, 32. Gives continual stimulation to points. • Can increase ovulation, blood flow to ovaries Homeopathy: still focus on treating the person. “acupuncture in a bottle” Works REALLY WELL for fertility. Often menstruating again between 3-6 months. Single remedies: not covered in detail in lecture. First month or 2, do diet and lifestyle changes and see what they change on their own. MEN’S AND WOMEN’S HEALTH OCTOBER 11TH, 2007 – PAGE 2

Mindful meditation techniques for managing stress. Support implantation: ST 28, 29, 30. Warm the uterus. Day 3 transfer: can do spleen 6 before transfer. Yin type points before transfer. Shen men, Ying tang. Don’t do LV in first month of pregnancy, or suspected pregnancy. More Yang (KI7, KI9, ST 36) after transfer

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