Posts Tagged ‘follicle development’

Can acupuncture help?

Wednesday, September 23rd, 2009

There’s a very interesting difference between Western and Chinese medicine on how fertility is viewed. Western doctors tend to focus on the cycle in which your eggs are produced (e.g. the cycle in which you do IVF), whereas Chinese medicine takes a much more long-term view.

To help understand the difference in thinking, here’s a quick (and hopefully not too inaccurate) summary of where eggs come from.

The process starts about a year before you actually ovulate, when a bunch of ‘primordial follicles’ are recruited within the ovary. These are developed very very slowly over the course of several months.

At about three months before ovulation, these primordial follicles start a different phase in their development and are now known as ‘antral follicles’. At the very start of any given cycle, an ultrasound will show several small antral follicles that are ready to go. In fact, this antral follicle count (AFC) is a good rough indicator of your ovarian reserve – check out this guide to how AFC helps predict a patient’s response to IVF stims.

During a natural cycle, just one or two of these antral follicles are recruited and will mature, leading to ovulation of an egg or sometimes two. The remaining antral follicles just fizzle out and undergo ‘atresia’ (basically, they bow out of the race). Here’s a link to a really excellent animation showing what happens in an ovulation induction (e.g. Clomiphene) cycle, which is not that different to what happens in a natural cycle (in a natural cycle you usually only ovulate one egg).

During an IVF cycle, the goal is to try and get more of those antral follicles to mature and fewer of them to undergo atresia.

So, how do the Western and Chinese perspectives on this process differ?

Your Western specialist tends to focus on a particular treatment cycle (i.e. that one month), which is the journey from antral follicles to ovulated eggs, fertilisation and beyond.

A Chinese medicine doctor, in contrast, takes a much more long-term view of the process. The intent is to create the optimal and best balanced environment for the development of your primordial follicles and then their further development once they become antral follicles, and then finally (the last and very short conclusion of the journey), the recruitment of antral follicles to produce an egg, get it fertilised, etc.

This is why the Western view is that there’s nothing you can do to influence egg quality – you are dealt the hand you’ve got; you just have to harvest as many eggs as possible, play the numbers game and hope that one of them is good.

The Chinese medicine perspective is that, although age and heredity are huge determinants of egg quality, eggs and their chromosomes can also be damaged during their development if they are subjected to toxins or have to grow in a sub-optimal environment. So, if you maximise the quality of the ‘soil’ in which they develop, then you will be able to get the best possible eggs that the woman can produce at her age.

This is why acupuncturists (and naturopaths, for that matter, who subscribe to a similar view) will tell you that you should do acupuncture for at least three months before expecting to see real benefits. Here they are talking about optimising the development of your antral follicles prior to a particular cycle. And if you do acupuncture for a year, you are not only helping this part of follicle development, but also the development of the primordial follicles as well.

Is there any actual research that shows acupuncture works?

Yes!! OK, acupuncture is hard to evaluate because treatment is very individualised (you can’t just standardise and expect the same treatment to work on different people). Also, it’s highly dependent on the competence of the practitioner. But there have been some very good studies done that show the benefits of acupuncture on fertility. Dr. Vitalis in Auckland has posted a really excellent summary of the effectiveness research on acupuncture – check it out.

I hope all this makes sense! Please post comments or questions below if not, or if you have something to contribute. Thanks!