WHAT YOUR DOCTOR MAY NOT TELL YOU ABOUT (TM): GETTING PREGNANT

Copyright

Copyright © 2007 by Raymond Chang, M.D., and Lynn Sonberg

All rights reserved. Except as permitted under the U.S. Copyright Act of 1976, no part of this publication may be reproduced, distributed, or transmitted in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher.

Warner Books

Hachette Book Group

237 Park Avenue, New York, NY 10017

Visit our website at www.HachetteBookGroup.com.

First eBook Edition: June 2009

ISBN: 978-0-446-56226-3

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FERTILITY FACT

How can I increase my chances of getting pregnant?

In recent years, Western medicine has made great strides in increasing fertility, with innovating techniques such as in vitro fertilization (IVF) and assisted reproductive technologies (ART). But even these remarkable and very expensive procedures are not always successful on their own. Recent findings have revealed that a multifaceted approach combining Western medical technologies with traditional Chinese medicine and holistic medicine can produce dramatic increases in fertility.

GET ALL THE INFORMATION YOU NEED WITH . . .

WHAT YOUR DOCTOR MAY NOT TELL YOU ABOUTTMGETTING PREGNANT

"Dr. Chang is well known for his integrative East-West approach . . . He has now successfully shown how he integrates the best technology at the disposal of reproductive endocrinologists with a holistic approach that optimizes chances for successful pregnancy. This is must reading for all those having difficulty getting pregnant."

—Allan Warshowsky M.D., F.A.C.O.G., A.B.H.M., integrative holistic gynecologist

"Dr. Chang offers a full panoply of little known facts that can save you from years of unnecessary heartache."

Julia Indichova, author of Inconceivable and The Fertile Female

"This book offers an innovative 'East meets West' approach to infertility, from medical to surgical therapies options, from female to male factor, and from simple to advanced, state-of-the-art infertility treatments."

—Pak H. Chung, M.D., associate professor and attending, the Center for Reproductive Medicine & Infertility, Weill Medical College of Cornell University

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To Carolyn, miracle from Erawan, And her mother, Anne

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Acknowledgments

I would like to thank the many who illuminated my path on learning about the miracle of birth and health from the Western as well as the Asian traditions. These individuals include Jeremiah A. Barondess, M.D., and Mary E. Charlson, M.D., who were my mentors during my fellowship training at Cornell/New York Hospital. Thank you also to Woodson Merrell, M.D., in New York for encouragement and support when the Alternative Medicine discipline was still in its infancy, and Dr. Jin Yu of Shanghai, who opened my eyes to the power of acupuncture both in fertility and for reproductive health.

Special thanks need to be extended to Pak Chung, M.D., who has been a true mentor, friend, and colleague from the onset when I became involved in treating infertility over a decade ago, and his colleagues at Cornell's Center for Reproductive Medicine, led by Zev Rosenwaks, M.D., for their openness, confidence, and kind referrals over the years. Special thanks also to James A. Grifo, Ph.D., M.D., for his openness and confidence not only in referring to me but in launching a clinical trial to study the effects of acupuncture on fertility. And I must also thank my Alternative Medicine colleague Pamela Yee, M.D., for her careful review of the manuscript.

Of course, I need to thank Yu Chen, L.Ac., my collaborating acupuncturist for many years, for her many insights and special devotion to fertility and for her special caring kindness to our patients that was indispensable to the success of our program in New York. Special thanks also to my office manager Raquel Acero for taking such special care of our patients and praying for them.

I would also like to thank my highly skilled collaborator, Elena Oumano, who contributed substantially both in form and content to this volume and who was ever patient, versatile, and resourceful throughout the writing process. I am also indebted to Lynn Sonberg, who initially approached me and suggested writing this book. But finally, I must thank my patients, whose persistence and faith taught me to never give up and that there is always a way—or an alternative way—even when conventional medicine has given up—to achieve the baby they prayed for.

Raymond Chang, M.D.

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Introduction

Why Modern Life Undermines Fertility

For most couples, fertility is not a problem, but for a significant number, the dream of parenthood is elusive. If you haven't been able to conceive, you may feel alone in your predicament, particularly if everyone around you seems to be birthing babies at will. Couples confronted with the issue of infertility are often embarrassed over their inability to conceive and are therefore reluctant to share this with others. That's too bad, because chances are they already know another couple challenged by the same problem. If this is your situation, you've probably been digging up research, seeking opinions, listening to counsel, and, when you still can't get clear-cut answers, are asking, "Why me?"

We have witnessed tremendous advances in conventional medical science's ability to reverse infertility in many couples. Today, even a sixty-two-year-old woman can give birth, with the aid of a donor egg and assisted reproductive technologies (ART). However, despite the scientific advances of recent years, a key part of the infertility problem is widespread lack of education about reproduction, infertility, and the broad array of fertility-bolstering options that increase odds of conception. For example, some people may not even be clear about the difference between infertility and sterility. Infertility refers to a temporary state—the delay of conception or the inability to sustain a pregnancy. Sterility describes a permanent state, although even sterility can sometimes be reversed.

If you believe your doctor hasn't told you everything you need to know about fertility, you may be right. First, there's so much to tell. Second, your doctor may not be aware of how traditional Chinese medicine (TCM), which includes acupuncture and other alternative healing options, may successfully treat infertility.

In this book we have gathered together all the information you need in order to make the right reproductive choices. You'll know all your fertility options after we guide you through all the possible causes of infertility—from the obvious to the subtle and often overlooked. You'll find cutting-edge information on the latest fertility-enhancing medical technologies, mind-body discoveries from modern alternative medical research, and ancient fertility-promoting treatments from proven traditional Asian healing modalities.

My vision of medicine and the problem of infertility is, in part, a natural result of living in two worlds. I am originally from Asia, and I came to the United States to attend undergraduate college and medical school. I'm trained in Western medicine, and I also draw inspiration and knowledge from my roots in Asian philosophies and healing traditions, especially TCM. Although my original medical specialty is cancer treatment, working with fertility issues in our clinic has allowed me to create balance in my lifework. Comforting and helping those confronted by death and the process of dying—an all too regrettable accompaniment to a diagnosis of cancer—is countered in my fertility practice by helping bring forth new life.

Let's begin with the hard facts: in a country where 50 to 70 percent of all pregnancies are unplanned, many other couples trying to have children find the road to parenthood quite difficult. Experts estimate that up to 20 percent of North American couples are plagued by infertility, which is sometimes medically defined as not conceiving after one year of unprotected sex. Ten percent of those infertile couples are given the diagnosis of "unexplained infertility." Even under ideal conditions, it's estimated that only 42 percent of a fertile woman's cycles will result in a full-term pregnancy from a fertile partner. Although most experts believe that 90 percent of the time a physical cause is the reason for delayed conception, there can be many possible reasons for not conceiving:

• Sociocultural factors, in particular the widespread pattern of postponing a family until a later age, are a major cause of infertility.

• Common, often asymptomatic, venereal infections can cause scarring in women's reproductive organs and sterility in men.

• High rates of endometriosis, uterine fibroids, and other mechanical problems can prevent a fertilized egg from implanting in the uterine wall.

• Increased emotional and physical stress can turn down the reproductive "thermostat."

• Environmental hazards can cause infertility.

• Overexercise can cause infertility.

• Low body fat and/or poor nutrition can cause infertility.

• Various disruptions within the body's endocrine, nervous, or immune systems can cause infertility.

As you read on, you'll learn the about the following:

• Conventional medical approaches to remedy structural and hormonal blocks to infertility

• TCM and other alternative healing approaches to hormonal obstacles and "unexplained infertility"

• How you can combine conventional medical and TCM for a "best of both worlds" integrative approach to infertility

Susan and Ben had shared the dream of parenthood almost from the moment they met, but the "right moment"—when they'd achieved a stable lifestyle with enough time and money to raise a family—didn't arrive until they were in their midthirties. After months of unprotected sex had slipped into a year, Susan and Ben went for a fertility workup. Ben's sperm proved to be fine—millions of little swimmers were ready to impregnate Susan's eggs. The problem was that Susan wasn't releasing any eggs; she wasn't ovulating. Her gynecologist prescribed Clomid, an ovulation-inducing pill that tends to have difficult emotional side effects. Susan endured the emotional roller coaster and the rote sex-on-a-timetable formula: take Clomid, wait seven to ten days, have sex, prop pelvis on pillow, lie quietly for twenty minutes, wait fourteen days for results, and repeat if necessary.

Two expensive in vitro fertilizations (IVFs) didn't work either. Susan and Ben were heartbroken, stranded at the "why us?" end stage of their journey, so when their fertility doctor recommended a visit to our clinic, the Meridian Medical Group, along with one last IVF treatment, they grabbed this "last resort." After only four months of acupuncture, herbs, and simple lifestyle changes, Susan's next IVF treatment took. Nine months later, she and Ben became the proud parents of a beautiful little girl.

It seems as if more and more couples are like Susan and Ben, struggling to be parents and discovering that even the latest, cutting-edge conventional fertility technologies may not be enough.

In cases like Susan's, where the apparent cause of infertility is lack of ovulation, conventional medicine views this as a specific health problem rooted in a specific body part, in particular, the ovaries. In contrast, traditional Chinese medicine views failure to ovulate within a broader context that takes into account the person's entire body and mind (thoughts and emotions) as a fully integrated, interdependent, functioning unit, in which a disruption in healthy function and balance of a single part anywhere in that system can adversely affect the whole. From the perspective of the TCM practitioner, failure to ovulate is not just a problem in the ovaries or even the endocrine (hormone) system. Instead, failure to ovulate is likely to be the end result of another, even more significant and deeply rooted disturbance located elsewhere in the body or mind.

My clinic at the Meridian Medical Group takes this holistic mind-body approach to fertility issues—either using TCM alone or combining TCM and other alternative healing methods when a patient also undertakes reproductive technologies such as IVF. Our program owes a great deal to the work of Dr. Jin Yu, one of the foremost reproductive physicians in China, who pioneered ways to treat infertility with acupuncture, as well as to her scientific studies that confirm how effectively acupuncture treats this medical issue.

Although I met Dr. Yu in New York City, I was able to study her methods in depth during the time I was a visiting professor at Shanghai Medical University in China. I learned about her amazing experiments (which have been published), in which she used acupuncture to induce ovulation in young rabbits that as a species otherwise do not ovulate until they are sexually active. It worked, and the implications are astounding. If we can make otherwise non-ovulating virgin rabbits ovulate with acupuncture, we can biologically readjust nature. Dr. Yu's experiments proved that we can alter an animal's biological functioning despite its natural programming. (And we too are animals.) Patients were queuing up at the front door of Dr. Yu's clinic to be treated. Well known throughout China, Dr. Yu has had amazing success treating women's infertility and menstrual problems with only acupuncture and herbs.

Practitioners of TCM have been using acupuncture and herbs to help women become pregnant for centuries; Dr. Yu was a pioneering TCM practitioner because she applied Western methods of scientific inquiry and rigorous studies to demonstrate clearly that acupuncture and herbs work.

After my studies in China were finished, I invited Dr. Yu to visit our clinic in New York, and together we developed a program to treat infertility with acupuncture and herbs. Our program eventually expanded to include other mind-body modalities, with emphasis on nutrition, stress management, relaxation techniques, visualizations, and hypnosis. Our experience with our patients led me to develop another key component of our fertility treatment—an evolution-based theory of infertility that can make all the difference for you.

As recently as the year 2000, hardly any Western fertility specialists were aware that acupuncture helps increase fertility, yet today it is common knowledge based on our results and publications. Our results have won the confidence of leading doctors at major fertility clinics in New York City and elsewhere in the nation, such as the programs at Cornell and New York University. We have been conducting joint trials with these and other fertility centers, as well as providing complementary care for patients who are also undergoing in vitro fertilization treatments at the centers. In addition, we treat patients who seek out our services for TCM and alternative treatment only—acupuncture along with the individualized mind-body programs we develop for each individual, according to his or her needs.

Most of our patients, though, are referred by fertility centers, many after several unsuccessful attempts with IVF. In our experience, with acupuncture and other holistic strategies we can easily improve the success rate of IVF by up to 30 or 40 percent. Our high success rate also provides hope to those who have been deemed ineligible for conventional fertility programs because of poor ovarian reserve (lack of sufficient viable eggs), even in very resistant cases.

Most of what we have learned in our clinic and what we practice is in this book, so it can be your step-by-step resource for overcoming infertility. In it, you will learn about all the possible causes of infertility. You will be guided through a diverse range of fertility-boosting strategies culled from modern medical science, traditional Asian healing wisdom, and new alternative and holistic approaches so you can make the right choices. You'll know when surgery might be necessary. You'll also understand why TCM can be the most effective "natural" system to help you conceive and deliver a healthy child, one you can use alone or in combination with the any of the modern conventional fertility-enhancing procedures grouped together as assisted reproductive technologies (ART). With the information you'll gather here, you'll know what to do and what not to do in order to optimize your chances for conceiving and bearing a healthy child. You may be surprised to learn that many of our fertility strategies are no more than painless, health-promoting adjustments to your overall lifestyle.

You may be even more surprised to learn how profoundly your mind can impact your ability to conceive and bear a child. You'll learn how the deepest part of the human mind, which we refer to as innate wisdom or collective unconscious, can affect your ability to reproduce. In fact, as your read further, you will understand why overcoming infertility can be a matter of understanding and harnessing your built-in survival instinct to improve your odds of reproduction.

Some information you'll read here overturns long-held but mistaken "rules" of conception; but if you allow it, this book can guide you to preparing your mind and body for the gift of a child.

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Chapter 1

A Complementary View of Fertility: The Turns of Fortune's Wheel

As you're reading, you may be planning ahead for a future pregnancy or you may be in the midst of intense hormonal treatments. You may have tried IVF without success. Or you may not be seeking medical treatment at all, simply growing increasingly frustrated over the number of months you've been trying to achieve a successful pregnancy. You may believe it's your fault, yet statistics indicate the cause of infertility is almost as likely to rest with your partner as with you.

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Approximately 35 percent of fertility problems are caused by the man's issues, another 35 percent are caused by tubal and pelvic problems in the woman, 15 percent from ovulation dysfunction, 5 percent by immunological, anatomic, or thyroid problems, and 10 percent are attributed to "unknown" causes.

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It is important to keep in mind that while studies indicate that one in ten women between the ages of fifteen and forty-four years old will experience infertility, more than 95 percent of couples who seek treatment will not need to undergo advanced reproductive techniques such as in vitro fertilization in order to conceive. Of the 10 percent of infertile couples diagnosed with "unexplained fertility," almost half will conceive within three years. As a general rule, of couples trying to conceive:

• 57 percent succeed within three months

• 72 percent succeed within six months

• 80 to 85 percent succeed within one year

• 90 percent succeed within two years

HOW CONCEPTION OCCURS

Before we explore what can go wrong, let's go through what happens when everything works. The fertilization process takes approximately twenty-four hours, and it begins with ejaculation. Immediately after being deposited in the vagina, semen coagulates—perhaps as a defense mechanism against the vagina's acidic environment, which allows only about 10 percent of sperm to survive the first ten minutes inside. After about twenty minutes, the sperm become fluid again and swim up to the cervix, where protein strands in cervical mucus that are present only just before or during ovulation carry the sperm into the uterus. Since the released egg is viable for twelve to twenty-four hours and sperm live for forty-eight to seventy-two hours, the window of opportunity opens for only about two to three days. Some experts believe that the chance for conception increases if the woman and man experience orgasm simultaneously, because the rhythmic contractions of vagina and uterus during orgasm help propel the sperm closer to the cervix. On the other hand, if the woman experiences orgasm before the man ejaculates, that could lessen chances for conception.

Among the hundreds of sperm that reach the uterus and then the fallopian tubes, some become lost or embedded in the lining of the fallopian tubes. By this point, the headsof the sperm have lost their protective coating, so they can penetrate the egg. (During "sperm washing," a procedure used in artificial or assisted conception, this protective membrane is removed artificially.)

Once a sperm reaches and penetrates the egg, the egg undergoes biochemical changes to ensure no other sperm can enter it, and the sperm and egg combine their genetic material. Unlike egg follicles that retire gracefully once a victorious follicle declares itself the "follicle of the month"—the one with the egg that can be fertilized to create new life—sperm rushing out the testes upon ejaculation compete furiouslyto beat each other to the finish line. They even refuse to accept defeat after one sperm has penetrated the egg and the winner has been declared, by continuing their attempts to enter the egg.

The fertilized egg then takes a four-day journey to the uterus, where it secretes a hormone called human chorionic gonadotropin (HCG) (detectable by home pregnancy kits) and implants itself in the uterine lining. If the egg doesn't make it to the uterus, it can grow in the fallopian tube, forming what is known as an ectopic, or tubal, pregnancy that must be removed surgically. This is more common in women with scarring from endometriosis, sexually transmitted diseases, or previous pelvic surgery.

Structural problems that can cause ectopic pregnancy or infertility also include fibroids and other malformations. All reproductive specialists—conventional, alternative, and TCM—agree on at least a single point: that "mechanical" or structural reproductive obstacles to fertility must be treated before any other problems are addressed and a successful pregnancy can occur.

WHAT IS INFERTILITY?

For a couple, infertility is defined as being unable to become pregnant after one year of steady, unprotected intercourse. Infertility is the reduced ability to have a child. Infertility is not sterility, that is, a lifetime verdict that means you will never have a child. Infertility leaves open the possibility that you can have a child at some point. In the up to 20 percent of all couples who are infertile, only 1 to 2 percent of them are actually sterile.

For most couples, infertility is a temporary crisis, one that can be overcome. Even better news, once you are armed with the information and strategies you'll learn here, your chances of a pregnancy that results in the birth of a healthy child will be even greater.

In general, several possible factors hamper fertility in women:

• Lack of ovulation (release of eggs from the ovary) due to hormonal imbalance or cysts in the ovary

• Failure of tubes to carry eggs from the ovary to the uterus, often due to scarring (adhesions) of the fallopian tubes caused by endometriosis, or infections such as gonorrhea and chlamydia, or prior surgery

• Irregular ovulation accompanied by poor cervical mucus that damages sperm or impedes their progress

• Implantation issues in which the embryo cannot implant itself in the uterine lining, caused by fibroid tumors, endometriosis, adhesions, infection, or prior surgery

• The subtle, energetic mind-body imbalances that conventional medicine rarely diagnoses or treats (We will deal with this often overlooked important cause of infertility in women, especially in chapter 11.)

Common causes of infertility in men include:

• Sexual dysfunction (erectile dysfunction or impotence)

• Low sperm count (too few sperm in the ejaculate fluid)

• Low sperm motility (the sperm are not good swimmers)

• Malformation of the sperm

• Blocked sperm ducts

No single fertility treatment is ever successful for everyone, but research has shown that a combination of simple treatments and precautionary measures can greatly enhance a couple's odds of conceiving. This is where TCM is so helpful, either by itself or in partnership with modern Western medical techniques.

SEEING THE BODY AS A WHOLE

Before we talk about what traditional Chinese medicine and other alternative and complementary approaches can do for you, it's worth understanding what these healing modalities really are. Although these approaches are diverse, they share certain principles:

• First, do no harm. TCM and other alternative health care providers generally begin by prescribing less invasive and risky strategies, such as diet and other lifestyle changes, than conventional physicians prescribe.