The International Council on Infertility Information Dissemination, Inc

The Miscarriage Manual: Coping with the Emotional Aspects of Pregnancy Loss by Elizabeth Carney

Miracles and Memories Family-Building Pins

Miracles and Memories Family-Building PinsFourteen years ago I gave birth to a baby girl. Four hours later she died because of an internal malformation that was undetectable during my pregnancy. During my short hospital stay, nurses and doctors seemed to avoid me and my questions. What they did say was about the same as what my friends and family were saying. "You're young. You'll have other babies. Try to forget." 

I didn't want any other baby; I wanted that one! Forget? How could I forget? Instead I was overwhelmed with crushing, breathtaking grief. I remember how empty I felt the day I left the hospital...an empty womb and empty arms. I never really knew her but I missed her and ached for her so desperately. 

Soon after I returned home, everyone acted as if they had already forgotten her, as if they expected me to also. Someone had removed all the baby items I had acquired before coming home, hoping to spare me the pain. Instead, it felt like a further denial of her existence. When I tried to talk about her everyone became very quiet, or changed the subject, or left the room. Friends were very careful not to say anything that might remind me of my experience. Baby shower invitations didn't come in the mail. Birth announcements didn't come in the mail. Many stayed away because they simply did not know what to say. My husband had three days to "get over it" before he was expected back at work. The world kept on spinning as if nothing had happened. I remember thinking that I must have lost my mind. I thought that if my baby had lived for a while, if people had gotten to know and love her, maybe then I would have been given the affirmation to grieve the way I needed to. But I was the only one with any memory of her, the only one who had the chance to love her. I had no one to share that with, not even my husband. Most of his grief was for me and for the dreams we had shared for this child. I felt all alone as I began my mourning. 

Over the years, after much healing, I have had the opportunity to speak with other parents who have had experiences which were similar to mine. As a result of that, and also as a result of my search for answers to all those unanswered questions, I have compiled a list of several "truths and non-truths" concerning the grieving process as it relates to perinatal bereavement. 

This is not intended to be the absolute word on the subject, but rather a gauge for the unexpected emotions felt by parents who have suffered this type of loss. Most of the parents I have spoken to agreed that the uncertainty of their grief was frightening and may have been alleviated had they known what to expect. 

Friends and family may also benefit from reading this over so they might understand the special kinds of pain and emotions involved in this type of loss and allow them to be expressed. 

The Truth Is...

1. The truth ISN'T that you will feel "all better" in a couple of days, or weeks, or even months. 

The truth IS that the days will be filled with an unending ache and the nights will feel one million sad years long for a while. Healing is attained only after the slow necessary progression through the stages of grief and mourning. 

2. The truth isn't that a new pregnancy will help you forget. 

The truth is that, while thoughts of a new pregnancy soon may provide hope, a lost infant deserves to be mourned just as you would have with anyone you loved. Grieving takes a lot of energy and can be both emotionally and physically draining. This could have an impact upon your health during another pregnancy. While the decision to try again is a very individualized one, being pregnant while still actively grieving is very difficult. 

3. The truth isn't that pills or alcohol will dull the pain. 

The truth is that they will merely postpone the reality you must eventually face in order to begin healing. However, if your doctor feels that medication is necessary to help maintain your health, use it intelligently and according to his/her instructions. 

4. The truth isn't that once this is over your life will be the same. 

The truth is that your upside-down world will slowly settle down, hopefully leaving you a more sensitive, compassionate person, better prepared to handle the hard times that everyone must deal with sooner or later. When you consider that you have just experienced one of the worst things that can happen to a family, as you heal you will become aware of how strong you are. 

5. The truth isn't that grieving is morbid, or a sign of weakness or mental instability. 

The truth is that grieving is work that must be done. Now is the appropriate time. Allow yourself the time. Feel it, flow with it. Try not to fight it too often. It will get easier if you expect that it is variable, that some days are better than others. Be patient with yourself. There are no short cuts to healing. The active grieving will be over when all the work is done. 

6. The truth isn't that grief is all-consuming. 

The truth is that in the midst of the most agonizing time of your life, there will be laughter. Don't feel guilty. Laugh if you want to. Just as you must allow yourself the time to grieve, you must also allow yourself the time to laugh. Viewing laughter as part of the healing process, just as overwhelming sadness is now, will make the pain more bearable. 

7. The truth isn't that one person can bear this alone. 

The truth is that while only you can make the choices necessary to return to the mainstream of life a healed person, others in your life are also grieving and are feeling very helpless. As unfair as it may seem, the burden of remaining in contact with family and friends often falls on you. They are afraid to "butt in," or they may be fearful of saying or doing the wrong thing. This makes them feel even more helpless. They need to be told honestly what they can do to help. They don't need to be told, "I'm doing fine" when you're really NOT doing fine. By allowing others to share in your pain and assist you with your needs, you will be comforted and they will feel less helpless. 

 

8. The truth isn't that God must be punishing you for something. 

The truth is that sometimes these things just happen. They have happened to many people before you, and they will happen to many people after you. This was not an act of any God; it was an act of Nature. It isn't fair to blame God, or yourself, or anyone else. Try to understand that it is human nature to look for a place to put the blame, especially when there are so few answers to the question, "Why?" Sometimes there are answers. Most times there are not. Believing that you are being punished will only get in the way of your healing. 

9. The truth isn't that you will be unable to make any choices or decisions during this time. 

The truth is that while major decisions, such as moving or changing jobs, are better off being postponed for now, life goes on. It will be difficult, but decisions dealing with the death of your baby (seeing and naming the baby, arranging and/or attending a religious ritual, taking care of the nursery items you have acquired) are all choices you can make for yourself. Well-meaning people will try to shelter you from the pain of this. However, many of us who have suffered similar losses agree that these first decisions are very important. They help to make the loss real. Our brains filter out much of the pain early on as a way to protect us. Very soon after that, we find ourselves reliving the events over and over, trying to remember everything. This is another way that we acknowledge the loss. Until the loss is real, grieving cannot begin. Being involved at this early time will be a painful experience, but it will help you deal with your grief better as you progress by providing comforting memories of having performed loving, caring acts for your baby. 

10. The truth isn't that you will be delighted to hear that a friend or other loved one has just given birth to a healthy baby. 

The truth is that you may find it very difficult to be around mothers with young babies. You may be hurt, or angry, or jealous. You may wonder why you couldn't have had that joy. You may be resentful, or refuse to see friends with new babies. You may even secretly wish that the same thing would happen to someone else. You want someone to understand how it feels. You may also feel very ashamed that you could wish such things on people you love or care about, or think that you must be a dreadful person. You aren't. You're human, and even the most loving people can react this way when they are actively grieving. If the situations were reversed, your friends would be feeling and thinking the same things you are. Forgive yourself. It's OK. These feelings will eventually go away. 

11. The truth isn't that all marriages survive this difficult time. 

The truth is that sometimes you might blame one another, resent one another, or dislike being with one another. If you find this happening, get help. There are self-help groups available or grief counselors who can help. Don't ignore it or tuck it away assuming it will get better. It won't. Actively grieving people cannot help one another. It is unrealistic, like having two people who were blinded at the same time teach each other Braille. Talking it out with others may help. It might even save your marriage. 

 

12. The truth isn't that eventually you will accept the loss of your baby and forget all about this awful time. 

The truth is that acceptance is a word reserved for the understanding you come to when you've successfully grieved the loss of a parent, or a grandparent, or a beloved older relative. When you lose a child, your whole future has been affected, not your past. No one can really accept that. But there is resolution in the form of healing and learning how to cope. You will survive. Many of us who have gone through this type of grief are afraid we might forget about our babies once we begin to heal. This won't happen. You will always remember your precious baby because successful grieving carves a place in your heart where he or she will live forever.

 

Please visit the INCIID Memorial Gardens

 

IVF Scholarships from INCIID

"From INCIID the Heart" IVF Scholarship

2019 Scholarships will be reviewed on a rolling basis as they are received each month.

The InterNational Council for Infertility Information Dissemination (INCIID -- pronounced “inside”) has the first and only national program designed to help individuals and couples -- From INCIID the Heart -- It provides an  In Vitro Fertilization (IVF) Scholarship to those in need through donations of funds and treatment from professional members, and consumers.    

 "Infertility care is sometimes portrayed as ‘wealthy couples creating designer babies. But nothing could be further from the truth".  The From INCIID the Heart is an important step in helping to eliminate the barrier preventing many couples from having children.

There are at least 6-7 million infertile couples in the U.S., and of those, approximately two million are unable to conceive without IVF treatment.  The majority have no insurance coverage for IVF and its associated medications, which can range in cost between $18,000 and $25,000 per couple. And  EMD Serono supports the program with donations of ovarian stimulation medications.
 
INCIID continues to gain support for the scholarship from a number of respected IVF clinics in the U.S. to donate their expertise and state-of-the-art facilities for patients who do not have the financial resources. Thes generous reproductive centers support the INCIID mission to help patients build families where they may not have the opportunity without help. The program will cover most of the basic expenses incurred during an IVF cycle.

Couples with financial and medical need may be eligible for participation in the program. The criteria are simple: No insurance covering IVF, Financial Need and Medical Infertility (as defined by the American Society for Reproductive Medicine - ASRM).  Final committee selections and decisions take cost-of-living in different regions of the country into account, applicants who may have student loan debt and a variety of other situations. Each application is processed based on an individual needs assessment.   INCIID required applicants provide copies of their most recent tax returns (2 years) and pay stubs (2 consecutive and most recent pay cycles), and supply a letter from their doctor recommending IVF as medically necessary. Selected recipients partner with INCIID in agreement to fundraise a small amount. 
Our goal is to give those without insurance coverage for IVF an opportunity to fulfill their dream of becoming parents.

For more information and to apply: READ the FAQ (Frequently Asked Questions) FIRST. Once you read the FAQ, download the application located at the end of the FAQ.

* All recipient/finalist cycles are subject to a final medical review and determination on whether the donated treatment is appropriate for the recipient. INCIID  may make changes in policies, procedures, offerings, and requirements at any time. The fundraising agreement in no way guarantees a cycle of IVF.

The application process is on-going. If you want to be considered for the program, please read the FAQ first and then send us your application. Applications are reviewed throughout the year. Before you apply: Please get the latest version of Adobe Reader.

INCIID is grateful to EMD Serono. for their support of this program.

Traditional Chinese Medicine in the Treatment of Infertility

Photo of Chines Stones with words representing the therapy (calm, smooth, peace)

Photo of Chines Stones with words representing the therapy (calm, smooth, peace)Traditional Chinese Medicine in the Treatment of Infertility

by Mike Berkley, L.Ac., FABORM 
The Berkley Center 
    (Note: Register and Join us on April 8 at 7:30 ET. Mike will answer your questions about how to use acupuncture and herbs to enhance fertility.)

Although the goals of Complementary medicine and conventional Western medicine are the same, their ideas about what causes a disease, the nature of the disease itself, and the process used to regain health are very different. The physician learns that disease must be cured by prescribing medicine or by surgery. There is nothing inherently wrong with this approach. It often works. But why does Complementary medicine succeed where conventional Western medicine sometimes fails? What is it about acupuncture and herbal medicine that can result in relief of symptoms or even a cure that is often lacking in conventional Western medicine? 

Though the ultimate result of Complementary medicine care is to cure the patient, the doctor of Complementary medicine attempts to do this by treating the whole person, taking into account the various attributes of an individual that, when combined, account for an individual’s health status.  A person, according to the tenets of Complementary medicine, is more than their condition. To treat just the condition may yield results, but, however impressive, these results are usually temporary. 

People are not, according to Complementary medicine, represented solely by their illness, but by the accumulation of every human interaction engaged in from the moment of their birth and by the culture they are exposed to. The emotional experiences, eating habits, work habits, work and living environment, personal habits, and social network all contribute to their disease, and are factors that, when changed appropriately, may lead to regained health.  

The power and effectiveness of Chinese medicine is evidenced by its long history of continued success. More than a quarter of the world’s population currently uses Complementary medicine as part of their health-care regimen. Chinese medicine is the only form of classical medicine that is regularly and continuously used outside of its country of origin.

The experienced doctor must use his or her own interpretive skills and consider not only what the patient reports to them about their condition, but also what they reveal without meaning too and what they don’t express. This leads to a better understanding of who the patient is and what the deeper, underlying cause of their condition may be.

The practitioner of Chinese medicine is trained to observe one’s tone of voice, complexion, eyes (in Complementary medicine, the shen or sprit of an individual is said to be revealed through the eyes), facial expression, overall demeanor, and how one walks, sits, and stands, and to use these observations to arrive at a diagnosis. Before the patient says one word, the doctor already has some idea of who this person is, clinically, simply by observing them.

A great doctor is one who can process a mix of medical knowledge with a personal sensitivity based on experience.  The practitioner of Complementary medicine specializes not just in inserting needles or prescribing herbal remedies, but in being able to see ‘hidden’ or subtle conditions that may not been seen or understood by practitioners of other types of medicine. This ability to see these hidden elements is difficult to master, and is done without the benefit of modern technology.

The only diagnostic tools used by practitioners of Chinese medicine are the “Four Examinations”: Observing, Listening/Smelling, Questioning, and Palpating. This method of diagnosis dates back over 3,000 years, and although it may seem quite simple, it is far from simplistic. Each of the Four Examinations can take years to master, and the astute practitioner uses them to arrive at a differential diagnosis.  With the advent of technology—as amazing, necessary, and beneficial as it is—there seems to be a direct correlation between advances in technology and a decline in doctor sensitivity to the patient, and thus, misdiagnosis.  The ability to listen and observe clearly, yields gems that are clues to the cause of disease.  This is the stuff of Complementary medicine.

Proper treatment in Complementary medicine is more than the elimination of the disease.  In addition to attacking a factor that is contributing to the disease process, it is the responsibility of the practitioner of Complementary medicine to support the individual in his or her goal of achieving overall total health, which includes the physical, psychological, emotional, and spiritual aspects of the patient.  This multidimensional approach is crucial to the process of healing. Without it, practitioner are merely “chasing” the sickness and forgetting that the patient is much more than their disease. They are a whole person—the sum of a lifetime of experiences.

Pathologies are guests (and we hope temporary ones!) in a home that serves as a gracious host—our physical, emotional, and spiritual selves.  Complementary medicine first is concerned with strengthening the immune function, which includes balancing the physical, emotional, and spiritual attributes of the patient, so as to be able to assist the patient in his or her endeavor to do battle and destroy the “enemy at the gates.” When people can’t sleep because they are anxious and depressed, they become chronically exhausted and chronically sick as a result of a compromised immune system.

The key to cure is to not view curing the disease itself as the be-all and end-all in treatment, but instead to treat the root of the disease—the anxiety and depression that causes the insomnia, which facilitates exhaustion, which lowers the immune function, which leads to chronic illnesses. So rather than prescribing antibiotics repeatedly, a practitioner of Complementary medicine might address the patient’s anxiety/depression syndrome or refer them to a psychotherapist for appropriate intervention while simultaneously providing Complementary forms of treatment.

Infertility and Complementary Medicine:  Mechanisms of Action

Historically, infertility—particularly “functional” infertility—was attributed to psychological problems of one or both partners. Preliminary works in the 1940s and 1950s considered “psychogenic infertility” as the major cause of failure to conceive in as many as 50% of cases. As recently as the late 1960s, it was commonly believed that reproductive failure was the result of psychological and emotional factors. Psychogenic infertility was supposed to occur because of unconscious anxiety about sexual feelings, ambivalence toward motherhood, unresolved Oedipal conflict, or conflicts of gender identity.

Fortunately, advances in reproductive endocrinology and medical technology, as well as in psychological research, have de-emphasized the significance of psychopathology as the basis of infertility. Stress does, however, play a part.

A study done at Harvard showed that stress reduces the hypothalamic-anterior-pituitary-ovarian axis function, and should thus be considered in the infertility workup. Acupuncture releases endorphins that mitigate one’s response to stressful stimuli, thus enhancing the possibility of conception. Biologically, since the hypothalamus regulates both stress responses as well as the sex hormones, it’s easy to see how stress may contribute to infertility in some women.

Excessive physical stress may even lead to complete suppression of the menstrual cycle, and this is often seen in female marathon runners, who develop “runner’s amenorrhea.” In less severe cases, it could cause anovulation or irregular menstrual cycles. When activated by emotional stress, the pituitary gland also produces increased amounts of prolactin, and elevated levels of prolactin can contribute to irregular ovulation. The female reproductive tract contains stress-hormone receptors; stress can affect fertility.

However, more complex mechanisms may be at play, and researchers still don’t completely understand how stress interacts with the reproductive system. This is a story that is still unfolding, and during the last 20 years, the new field of psychoneuroimmunology has emerged. This field focuses on how your mind can affect your body. Research has shown that the brain produces special molecules called neuropeptides in response to emotions, and that these peptides can interact with every cell of the body, including those of the immune system.  In this view, the mind and the body are not only connected, but inseparable, so that it is hardly surprising that stress can have a negative influence on fertility.

Stress can reduce sperm counts as well. Testicular biopsy specimens obtained from prisoners awaiting execution (who were obviously under extreme stress) revealed complete spermatogenetic arrest in all cases.

The stress factors that acupuncture addresses stems from both psychological and emotional factors as well as physical ones. For example, extremely painful premenstrual or mid-cycle pain can be debilitating. This type of physical stress no doubt produces emotional stress as a result of missed work, interference in activities, and the pain itself, which in turn can compromise the function of the reproductive system.

The insertion of acupuncture needles has been shown to effectively increase blood circulation. Enhanced blood flow to the reproductive environment clearly improves pregnancy outcomes.

A Diagnostic Window: East Meets West

It is becoming more and more prevalent that research conducted by Western scientists and physicians are highlighting the effectiveness of traditional Chinese medicine. In an article published in the December 2002 issue of the medical journal Fertility and Sterility, the authors reviewed existing evidence regarding the role of acupuncture in the treatment of infertility, and identified a number of studies indicating that acupuncture can increase the success rates of infertility treatments, including IVF.

In a study conducted by Dr. Wolfgang Paulus (Christian-Lauritzen-Institut, Ulm, Germany) and colleagues, half of a group of 160 women who were about to undergo IVF were randomly assigned to receive acupuncture therapy before and after embryo transfer. In the women who received acupuncture, the needles were placed at points believed to influence reproductive factors (for example, by improving blood flow to the uterus).

The acupuncture group had a higher rate of pregnancy compared with those not given acupuncture (43% versus 26%), suggesting that acupuncture can be used to improve pregnancy rates during IVF.

One alternative medicine diagnosis that exists which may be help to explain male or female infertility is called Liver qi stagnation. Key identifiers of an individual with this condition are anger, rage, frustration, depression, and anxiety.

Dr. Secondo Fassino (University School of Medicine, Turin, Italy) and colleagues recorded the personal characteristics of 156 infertile and 80 fertile couples, and measured their degree of psychopathology. When the researchers divided the couples according to the nature of the infertility—organic, functional, or undetermined—they found that anxiety, depression, and a tendency toward anger suppression could predict the diagnosis of organic or functional infertility in women with 97% accuracy. For infertile men, anxiety was also an important independent predictor of functional infertility, increasing the likelihood of having this form of infertility five-fold, while depression was more predictive of organic infertility. However, unlike in women, anger did not appear to influence infertility in men. These results suggest that, beyond the distress that accompanies the failure of repeated attempts to conceive a baby, psychological problems may contribute to functional infertility.

Herbal Medicine

The exact mechanisms of action of herbal medicine intervention are not, at this time, completely understood. However, herbal medicine has been used successfully to treat infertility for thousands of years.               

Practitioners of Chinese herbal medicine rarely use a single herb in treatment. Chinese herbs are formula based; many herbs are mixed together to create the perfect ‘decoction’ specifically designed for the individual patient.

Some formulas contain two herbs and some thirty or more herbs. Each herb has many functions. Each herb has its own flavor, nature, temperature and trophism.  Prescribing the correct herbal medicinals requires extensive training and clinical experience. 

Self-medicating with herbal medicine presents a dual dilemma. At best the herbs will be useless, as the key to correct formula prescription is an accurate differential diagnosis that can only be rendered by a licensed, Board-Certified, experienced practitioner. In the worst case, self-prescribing of herbal medicine may prove harmful.  

One should take herbs only when they’re prescribed by a Board-Certified herbalist. Not only is herbal medicine safe, it is highly effective and free of harmful side effects that often accompany pharmaceutical drugs. There are more than one million hospitalizations per year as a result of drug-induced side effects; not so with herbal medicine.

I have prescribed herbal formulas for 14 years to improve egg and endometrial quality. This is often effective, but, as in all fields of medicine, there is no guaranty of success.  Herbal medicine is also very often used successfully in treating certain sperm anomalies.

The Berkley Center: Treating Fertility Challenges

Clearly, further research is needed to fully understand the mechanisms of action of acupuncture and herbal medicine in treating the infertile patient. Nevertheless, it is my opinion, based on fourteen years of clinical care that the best-case scenario for patient faced with fertility challenges is to offer them every reasonable option which may serve to address their underlying condition. The integration of acupuncture and herbal medicine into the treatment protocol of the infertile patient, from a clinical perspective, based on current scientific and empirical data makes sense.

STUDIES

  1. BMJ  2008;336:545-549 (8 March), doi:10.1136/bmj.39471.430451.BE (published 7 February 2008)

Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis

Eric Manheimer, research associate1, Grant Zhang, assistant professor1, Laurence Udoff, assistant professor2, Aviad Haramati, professor3, Patricia Langenberg, professor and vice-chair4, Brian M Berman, professor1, Lex M Bouter, professor and vice chancellor (rector magnificus)5

1 Center for Integrative Medicine, University of Maryland School of Medicine, 2200 Kernan Drive, Kernan Hospital Mansion, Baltimore, MD 21207, USA, 2 Department of Obstetrics, Gynecology and Reproductive Services, University of Maryland School of Medicine, 3 Department of Physiology and Biophysics and Medicine, Georgetown University School of Medicine, Washington, DC, 4 Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 5 VU University Amsterdam De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands

Correspondence to: E Manheimer emanheimer@compmed.umm.edu

Objective To evaluate whether acupuncture improves rates of pregnancy and live birth when used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilisation.

Design Systematic review and meta-analysis.

Data sources Medline, Cochrane Central, Embase, Chinese Biomedical Database, hand searched abstracts, and reference lists.

Review methods Eligible studies were randomised controlled trials that compared needle acupuncture administered within one day of embryo transfer with sham acupuncture or no adjuvant treatment, with reported outcomes of at least one of clinical pregnancy, ongoing pregnancy, or live birth. Two reviewers independently agreed on eligibility; assessed methodological quality; and extracted outcome data. For all trials, investigators contributed additional data not included in the original publication (such as live births). Meta-analyses included all randomised patients.

Data synthesis Seven trials with 1366 women undergoing in vitro fertilisation were included in the meta-analyses. There was little clinical heterogeneity. Trials with sham acupuncture and no adjuvant treatment as controls were pooled for the primary analysis. Complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy (odds ratio 1.65, 95% confidence interval 1.27 to 2.14; number needed to treat (NNT) 10 (7 to 17); seven trials), ongoing pregnancy (1.87, 1.40 to 2.49; NNT 9 (6 to 15); five trials), and live birth (1.91, 1.39 to 2.64; NNT 9 (6 to 17); four trials). Because we were unable to obtain outcome data on live births for three of the included trials, the pooled odds ratio for clinical pregnancy more accurately represents the true combined effect from these trials rather than the odds ratio for live birth. The results were robust to sensitivity analyses on study validity variables. A prespecified subgroup analysis restricted to the three trials with the higher rates of clinical pregnancy in the control group, however, suggested a smaller non-significant benefit of acupuncture (odds ratio 1.24, 0.86 to 1.77).

Conclusions Current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation.

  1. Acupuncture and IVF Study Shows Early Promise for Increased Take Home Baby Rates

Posted on: Tuesday, 12 August 2008, 15:00 CDT

Dr. Paul C. Magarelli, a nationally noted specialist in the field of reproductive endocrinology and infertility, and Dr. Diane K. Cridennda, a recognized authority on acupuncture and Traditional Chinese Medicine, have announced early results of an ongoing study linking acupuncture to positive in-vitro fertilization (IVF) outcomes. The study, which includes the largest-ever participant pool for a study of its kind, explores the increase in take home baby rates associated with combined Eastern and Western medicine treatments.

Drs. Magarelli and Cridennda's ongoing research shows an astonishing 15 percent increase in pregnancies, with a 23 percent climb in actual births in IVF patients treated with acupuncture. In addition, of the 578 patients Magarelli has co-treated at the Reproductive Medicine & Fertility Centers and East Winds Acupuncture from 2003 to 2008, 26 percent more patients became pregnant with acupuncture treatments added to IVF, saving them the costs and heartache of having to repeat an IVF cycle. This savings would decrease the national IVF fertility costs by more than $150,000,000 per year in the United States alone.

"Infertility is a condition that affects more than 7.3 million people nationwide, and many of those couples are unaware of the potential that acupuncture holds for them," said Dr. Magarelli. "Our study demonstrates that acupuncture increases uterine blood flow, reduces stress and has an overall positive impact on our IVF patients. And the results really speak for themselves: one of every four of our patients who have used acupuncture in conjunction with IVF has not had to repeat an IVF cycle to create their families."

A three-part exploration of Drs. Magarelli and Cridennda's ongoing breakthrough acupuncture and IVF study will be published in Fertility Today magazine later this year. ABOUT DR. PAUL C. MAGARELLI

Dr. Paul Magarelli, MD., Ph.D., a member of the GENESIS Network for Reproductive Health (www.genesisivf.com), recently won the Practicing Physicians Award from the Pacific Coast Reproductive Society for his groundbreaking research on the impact of acupuncture on IVF pregnancies. Not only is he known for his instrumental work in creating new pricing structures to provide cost-effective, competent IVF care for the average wage earner, but he is best known to his patients for applying high-tech procedures with a personal touch. In addition to co-founding the Corona Institute for Reproductive Medicine & Fertility, he is the medical director of the Reproductive Medicine and Fertility Centers in Colorado and New Mexico, where he specializes in infertility and all aspects of hormonal pathology in women. Dr. Magarelli has been interviewed as an expert source for MSNBC, Fertility & Sterility and PregnancyandBaby.com. To learn more, visit www.ColoradoSpringsIVF.com and www.CoronaFertility.com.

ABOUT DR. DIANE K. CRIDENNDA

Diane K. Cridennda, L.Ac., (FABORM) is Board Certified in the field of Reproductive Oriental Medicine. She graduated from the International Institute of Chinese Medicine in l995 with her Masters of Oriental Medicine degree. She trained in Beijing, China to explore the root of this ancient healing art. She is NCCA certified, licensed in Colorado and is a member of Resolve, a national infertility support group. She has also had extensive training in Traditional Chinese Herbal Medicine. For more than seven years, Diane has been working with Reproductive Endocrinologists using a combination of Eastern and Western medicine therapies for the treatment of infertility. To learn more, visit www.EastWindsAcupuncture.com.

  1. Fertility & Sterility Journal Volume 85, Issue 5, Pages 1347-1351 (May 2006)

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Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study

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Stefan Dieterle, M.D.aCorresponding Author Informationemail address, Gao Ying, M.D.ab, Wolfgang Hatzmann, M.D.a, Andreas Neuer, M.D.a

4.      Can acupuncture boost my fertility?

Skrivet för BabyCentre UK

The BabyCentre Editorial Team svarar:

Research suggests that acupuncture may be helpful to couples undergoing in-vitro fertilisation (IVF), but the verdict is still out on whether it can improve fertility in general. Although smaller studies show promising results, more research is needed before we can say for sure that this age-old therapy can help you get pregnant.

Acupuncture is based on the theory that vital energy (or "qi," pronounced "chee") flows through the body along certain pathways. Acupuncturists try to balance this energy and restore health by stimulating specific points along the pathways with thin needles. Although it has been a staple of Chinese medicine for some 5,000 years, acupuncture has only gained acceptance in the Western medical community in the past few decades.

In 2002, a team of German researchers discovered that acupuncture significantly increased the odds of pregnancy among a group of 160 women who were undergoing IVF treatment. Forty-two per cent of the women who received acupuncture got pregnant, compared to 26 per cent of those who didn't receive the treatment.

Since then, more research has given support to the benefits of acupuncture for women undergoing IVF. One study, also in Germany, reported that conception and ongoing pregnancy rates were higher for women who had acupuncture treatment in the the second part of their menstrual cycle (the luteal phase) following IVF or ICSI. While a Danish study found that conception rates were best improved by having an acupuncture treatment on the day the embryos were transferred into the uterus. Their findings showed that having an additional acupuncture treatment two days later did not improve the chances of conception or ongoing pregnancy.

So how does it work? Nobody really knows, but researchers think that acupuncture may help increase blood flow to the uterus and relax the muscle tissue, giving the embryos a better chance of implanting.

Acupuncture may also help male infertility. Regular treatments have been shown to improve sperm counts and motility (the strength with which the sperm swim) for men with fertility problems but not always significantly. To improve the chances of pregnancy by natural means, acupuncture treatment would need to increase a man's sperm count over the threshold needed for conception. This means a minimum of 10 to 12 million moving sperm per ejaculate, and the men in these studies didn't get up to those levels.

However, for couples considering assisted conception, acupuncture can help by improving the quality of the sperm. In a study published in 2005, researchers analysed sperm samples from men with infertility of unknown cause before and after acupuncture treatments. They found that acupuncture was associated with fewer structural defects in sperm and an increase in the number of normal sperm.
 

Most experts believe that we need larger and better studies, ideally random and double blind trials, using fake needles for some patients and real ones for others, in order to really know whether acupuncture is effective. In some of the studies mentioned above, the patients and healthcare providers knew that acupuncture was performed, so the studies weren't "blind" and the success of the treatment might have been due to what's known as the placebo effect. Perhaps it was the patients' belief in acupuncture, rather than the acupuncture itself, that accounted for the treatment's success.

However, in the end it doesn't matter that much whether the success of acupuncture is a placebo effect or not. The bottom line is that acupuncture is relatively safe, and if it improves fertility, even if it's only because you think it does, it may be worthwhile.

The best first step to treating any fertility problem is to contact a specialist. If you do decide to try acupuncture, look for a registered acupuncturist, some of whom are also medical doctors. The British Acupuncture Council (www.acupuncture.org.uk) can help you find one near you.

Reviewed May 2007

Sources

Chang R, Chung PH, Rosenwaks Z. 2002. Role of acupuncture in the treatment of female infertility. Fertil Steril. 78(6):1149-53

Dieterle S, Ying G, Hatzmann W, Neuer A. 2006. Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study. Fertil Steril. 85(5):1347-51.

Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. 2002. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril, 77(4):721-4

Pei J, Strehler E, Noss U, Abt M, Piomboni P, Baccetti B, Sterzik K. 2005. Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility. Fertil Steril, 84(1):141-7

Siterman S, Eltes F, Wolfson V, Lederman H, Bartoov B. 2000. Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot study. Andrologia, 32(1):31-9

Siterman S, Eltes F, Wolfson V, Zabludovsky N, Bartoov B. 1997. Effect of acupuncture on sperm parameters of males suffering from subfertility related to low sperm quality. Arch Androl, 39(2):155-61

Westergaard LG, Mao Q, Krogslund M, Sandrini S, Lenz S, Grinsted J. 2006. Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertil Steril. 85(5):1341-6

Zhang M, Huang G, Lu F, Paulus WE, Sterzik K. 2002. Influence of acupuncture on idiopathic male infertility in assisted reproductive technology. J Huazhong Univ Sci Technolog Med Sci, 22(3):228-30

 

 

The Child That Never Was

Photo of a beach and shovel alone in the sand with some seaweed surrounding it

Photo of a beach and shovel alone in the sand with some seaweed surrounding itTHE CHILD WHO NEVER WAS

By Renée Henning

     I buried the child who never was in a fetid green pool in Guadeloupe.  It was not my first choice for the child’s final resting place.  Originally I had picked a rubbish-choked stretch of beach to serve as the junkyard of broken dreams.  However, when I arrived there, I discovered I was not alone, and I had planned a private funeral.

     The timing of the ceremony also posed a problem.  I did not want to hold the burial early in my vacation.  However, I had chosen the date five months before, prior to learning about the Caribbean trip.  I could not bear the thought of postponing the last rites and dreading them throughout my vacation.

     For a funeral there should be a religious service, and there was one.  It was the regular Sunday Mass in the old Catholic Church.  I wept behind my sunglasses during the service.  Occasionally I coughed, in the forlorn hope that the strangers in my pew would think I had a cold.

     The funeral differed from one I attended with 300 mourners.  I was the child’s only mourner in Guadeloupe because, except for my husband, I was the child’s only friend.

     After the church service I stepped into the glare of the tropical sun for the walk to the burial site.  Outside the church a tiny white goat was nibbling the grass of the town square.  The scene would have appeared totally charming, had it not been for goats’ links with kids and sacrificial rites of voodoo (still practiced on the island).

     What can I tell you about the deceased?  Almost nothing.  I do not know if the decedent was a boy or a girl, because you cannot tell pre-conception.  If the child took after its parents, it was blond with blue eyes, had an I.Q. high enough for Mensa, and loved life and sports.  But perhaps it did not take after its parents at all.  Perhaps it was better or worse than its parents.

     Most Americans do not realize how much it is possible to grieve for a child who never was.  In our society a mother is allowed to mourn for years the death of her child if the child was born alive.  Society also permits a brief period of grief in the case of a miscarriage, though even then the would-be mother may receive a get-well card rather than a sympathy note.  Yet society does not accept the idea that someone could mourn for an unconceived child, despite years of yearning, prayers, heartache, medical tests, drug treatments, and major surgery.

     It may sound crazy to stage a mock funeral for a mock child, but the funeral did make a difference.  There is a time to mourn, and a time to give up mourning.  You cannot begin the healing process while experiencing hope, then denial, and then piercing sadness with every menstrual cycle.  Because of the funeral, I was forced to face the truth: even though my husband and I had ultimately passed all of the medical tests, I would never bear a child, and we would never know why.

     Since the funeral I have begun to accept our barrenness.  I no longer weary heaven with prayers for the child, and I experience far less sadness at the start of each menstrual cycle.  I am even becoming reconciled to the approach of the menopause, with its impending months of delayed menstruation and thus of false hope.  The complications in setting up the funeral also worked out for the best.  Oddly, it has comforted me to imagine my baby curled in a dreamless sleep in a womb-like pond in the fertile lushness of Guadeloupe.

     I will be returning to the island about a year after the funeral.  I plan to stop by the fetid green pool for just a few minutes.  I am not going there to think about what might have been.  That time is past.  Instead, I will stop by to see for the last time the resting place of the child who never was.  I plan to float a cheery red hibiscus on the child’s watery grave.

POSTSCRIPT ADDED FIVE YEARS AFTERWARD

     The funeral took place in 1988.  The next year, after returning to Guadeloupe, my husband and I adopted a child from Latin America.  Two years later we adopted another child.  Both boys were infants at the time of the adoption referral, and for more than a year both used baby seats on car trips.  Words cannot express the joy I have known looking into the back of our automobile on car rides - because there sat two bonny sons snug in their baby seats.

     Our big boy is now four years old, and our baby is two.  Lively though they are, they still nestle together in my lap.  They are best friends.  Our beloved sons often sit with the older boy’s arm around his little brother.  My husband and I are blessed.

 

Multiple Miscarriage, Infertility and the Use of Herbal Medicine

Herbs used in Alternative or Complementary Medicine

by Mike Berkely

Herbs used in Alternative or Complementary MedicineBoth anticoagulants and antiplatelet mitigators are medicines that reduce blood clotting in an artery, a vein or the heart.

Heparin and Lovenox are anticoagulants and aspirin is an antiplatelet.  Antiplatelets such as aspirin decreases platelet aggregation and thrombus formation. They are mostly used in problems with arterial circulation where anticoagulants have little effect.

Anticoagulant medications make the blood 'thinner' and prevent the formation of blood clots and hence could prevent stroke. Both anticoagulants and antiplatelet medications have been used to treat chronic recurrent miscarriage due to thrombophilic disease.

There are several herbal medicines which possess antiplatelet and anticoagulant properties.
Jiang Huang and Yu Jin are herbs that possess antiplatelet properties. Chuan xiong has both anticoagulant and antiplatelet properties.

I am not recommending that a patient with a thrombophilic presentation use herbs instead of Western medicine which possess the required qualities necessary to prevent miscarriage via anticoagulant or antiplatelet activity. Sometimes however, a drug does not possess the same qualities of an herb. An herbal formula, for example, has a multitiered effect. The correct formula might for example, be used to reduce inflammation, reduce platelet aggregation and/or reduce coagulopathies as well as reduce stress, strengthen the immune function and help facilitate weight loss in an obese patient. All of these things would be required in a patient of this type to increase the odds of a successful on-going pregnancy; not just Heparin or Lovenox or Aspirin. This is important to consider in case you miscarry even when taking these types of meds.

A patient may need more intervention than these traditional Western medications are capable of providing.

Patients should follow the instructions of their reproductive endocrinologist  However, in the face of failure with traditional Western medical approaches, trying herbs may help contribute to a full term pregnancy. In my practice I have seen this occur multiple times.

Many patients faced with the difficult challenge of trying to conceive or who recurrently miscarry are instructed by their reproductive endocrinologists not to take herbs. This is because their doctor is trying to protect the patient. Western trained physicians with no education in Chinese medicine typically may not feel comfortable mixing Western medical techniques and practices with herbs. It is my experience and training in Chinese medicine as a board certified heralist that herbs can complement Western medications and patients who otherwise lost pregnancies can carry to term.

Herbs do not reduce the effectiveness of the medications nor, in most cases increase the potency. The only exception to this would occur herbs were prescribed in conjuction with medication that have anticoagulant/antiplateleet properties such as Lovenox or Heparin. This could present a potentiating and possibly dangerous effect.

Acupuncture can increase metabolic function and stimulate the flow of blood throughout the body. Increasing hemodynamics is not, however the same as actually reducing platelet aggregation or reducing hypercoagulation.  The benefit of using acupuncture with herbs is that the acupuncture will help ensure the distribution of the herbs throughout the body.

Typically when Western medical techiques for treating infertility and recurrent pregnancy loss fail, is to combine acupuncture, herbs and Western medicine to create a synergistic and complementary affect.

When seeking to use herbal medications be certain that a board certified herbalist is prescribing.

Email Mike.  Visit the Healing Arts Complementary Medicine Forum.

 

 

 

Use of Complementary Medicine for Miscarriage Prevention

by Mike Berkley, L.Ac,

A New Protocol Developed by Mike Berkley to Help Prevent Miscarriage

For many years I never needled the abdomen of a pregnant woman for fear of causing miscarriage. This method of behavior stems in part from fear of over-stimulating blood flow to the embryo or placenta. This thinking, as I have recently discovered, is incorrect. It has taken me ten years of study and research to enable me to fully understand what is happening in the uterus after a successful pregnancy and why abdominal acupuncture for the first three months of pregnancy is not only safe but serves significantly to prevent miscarriage.

At the luteal phase or secretory phase of the menstrual cycle the predominant hormone is progesterone. Progesterone is created from the follicle that has ovulated the mature egg. This follicle is now known as the 'yellow body' or corpus lutuem. The corpus luteum, under the influence of luteinizing hormone which emanates from the anterior pituitary in the brain secretes progesterone. This action is done to enable the uterine lining to be amenable to a successful embryo implantation and pregnancy. If pregnancy is not successful, the corpus luteum becomes atretic (dies) and progesterone levels diminish and menstruation starts.

When a woman does successfully become pregnant, the LH which is required to maintain high levels of progesterone (P) no longer comes from the anterior pituitary gland in the brain. It comes in fact, from the developing blastocyst itself. The blastocyst (developing baby), secretes HCG or Human Chorionic Gonadotropin which has a very similar molecular structure to LH. The HCG causes the corpus luteum to continue to secrete P (this is called corpus luteum- rescue), until the placenta is fully formed at which point the placenta itself secretes appropriate amounts of P to help maintain pregnancy.

So, if the developing blastocyst is responsible for secreting HCG to keep itself alive it made sense to me to use very few and well placed needles in the abdomen to gently stimulate blood flow to the blastocyst so that P would continue to be secreted from the corpus luteum.

This, in my opinion is one of the major ways that miscarriage prevention can be achieved with acupuncture. I am the first one to arrive at this idea and have been using it with great success.  My protocol consists of using acupuncture twice weekly for 13 weeks after IUI, IVF or donor-egg or after a natural pregnancy is confirmed. The majority of miscarriages occur within the first twelve weeks of pregnancy. Our goal is to take the patient one week outside of the danger zone; this is why we treat for 13 weeks and not 12.

After 6 or 7 weeks the placenta is formed and it secretes P. The corpus luteum is no longer necessary. But, one of the major causes of miscarriage is inappropriate blood flow to the placenta. One of the causes of this is due to thrombophilic disorders (The tendency to form blood clots).  But clinically what does this mean? Blood carries oxygen, hormones and nutrients to the placenta and excretes dead cells from it.

These dead cells are called 'debris'. By continuing to use abdominal acupuncture, we continue to gently stimulate  blood flow to the placenta (reducing the effects of poor hemodynamics which can occur due to thrombophilic disorder or just poor circulation), maintaining its ability to secrete P, estrogen, human placental-lactogen, relaxin and other hormones necessary for the maintenance of a healthy pregnancy.

I am constantly studying Western reproductive medicine and translating my findings into a Chinese medical model which serves to increase a useful knowledge-base to help couples achieve pregnancy. However, achieving pregnancy is only half the battle. The other half is maintaining a healthy pregnancy.  The focus of many acupuncturists is to help their patients become pregnant. This too is my first goal, but only my first. My second goal is to maintain a viable pregnancy and this is where my research and studies are now taking me.

This new Berkley Center protocol is working wonders for those suffering with repeated pregnancy loss, as well as those who have had difficulty in conceiving.

Acupuncture treatment for the infertile patient as well as the patient suffering with repeated pregnancy loss must be continued after pregnancy is achieved to increase the odds of a successful, full-term pregnancy.  Treatment should be continued for thirteen weeks, as 90% of miscarriages occur within the first trimester.

Mike Berkley, L.Ac., FABORM

Mike will answer your questions live on the Healing Arts Complementary Medicine Forum
 

 

Guidelines for Funeral Directors (Infant and Neonatal Loss) 2003

This handbook contains instructions for funeral directors for completing and filing records of death and fetal death.1 These instructions pertain to the 2003 revisions of the U.S. Standard Certificate of Death and the U.S. Standard Report of Fetal Death and the 1992 revision of the Model State Vital Statistics Act and Regulations. This handbook is intended to serve as a model that can be adapted by any vital statistics registration area.

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Guidelines for Funeral Directors (Infant and Neonatal Loss)

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If Only It Were September

 by MareFL on 20:27 6/25/2004:

You would be here if it were September
Then I would not have sadness to remember
You would be lighting up our lives in so many ways
Just like you did for only six days

I think of the things you and I did not have the chance to do
Such as changing your diaper or giving a coo
Oh, what life would be like if you were still here
There would be no more tears and definitely no fear

I would be singing you a silly song or two
Watching your face and loving you
Your big brother would be giving you a hug and a kiss
To see him with you would have been bliss

All we can do is sit here looking at pictures of you
Struggling to stay here on earth for us two
Leo, you will always be on my mind and in my heart
Constantly questioning why we had to part

You are our precious little baby boy
And will always be bringing us joy
Every month, every day, every hour, every minute
Life would have been great just to have you in it

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