In my case, my various doctors and clinics in the United States and the United Kingdom never turned to superovulatory drugs, since I seemed to produce plenty of eggs on Clomid alone—although those eggs did not transform into a viable baby.
In the confrontation between the stream and the rock, the stream always wins—not through strength, but through persistence.
Anonymous
3
Go East, Young Lady
The World of Complementary and Alternative Therapies
The months waiting for my appointment with Dr. Sacks went slowly. While waiting, I turned thirty-three years old. I was still taking Clomid, still not ovulating, and I couldn’t help feeling like I was wasting valuable time.
Over tea one day, Melissa, a close friend, former colleague, and fellow type A personality, suggested I look at acupuncture to help induce my period. She’d used it to calm muscle spasms. Another friend, who was a doctor, told me that in Europe, a study had demonstrated an increase in IVF success rates when acupuncture was paired with traditional treatment. And my friend Julie’s boyfriend used it for relief of back pain. I had never been one for alternative therapies, but what did I have to lose? At a minimum, perhaps it could help with the dreaded Clomid headaches.
The acupuncture clinic of Dr. Mengda Shu was not at all what I expected, although I am not sure exactly what I thought it would be like. A corporate attorney with a severe needle phobia, I was a bundle of nerves, skepticism, anxiety, and also excitement. Would it help? Would it hurt? Would I faint at the sight of needles? As soon as Dr. Shu greeted me in the welcoming waiting room, a sense of calm blanketed me. It was uncanny. A slim, graceful woman wearing a white lab coat, she exuded confidence and gentleness. Despite the extreme skepticism I brought with me into the room, I trusted her from the minute I met her.
This elegant woman in her fifties moved with a peacefulness that was infectious and intoxicating. She escorted me to a treatment room, deftly extracting my personal and medical history in fluid conversation, without need of the all-too-familiar medical history form. After telling me about her background, her training in China, her experiences in the United States, and a brief but very clear explanation of how acupuncture works, she felt the pulses on both of my wrists.
She proceeded. “Now please stick out your tongue so I may look at it.”
My tongue? How bizarre.
I complied. She studied its color, coat, shape, and size, and then rendered a startlingly accurate report of how I was feeling. My tongue apparently also provided a road map for plotting her course down the pincushion that was my body. She poked me full of tiny little (painless!) sterile needles and stood by my side during the treatment, sometimes talking to me, sometimes silent, sometimes gently tweaking my needles. I went into a state of relaxation that is hard to describe, rivaled only by the state of bliss attained after the best massage imaginable. She sent me home with noxious herbal potions that ironically were more painful to drink than the acupuncture needles that I had feared, and told me that I had to be patient.
“Do not expect any results in less than three months,” she told me. “But in about three months, we will see progress.”
I saw her every Saturday. Amazingly, the headaches went away with each treatment, and stayed away for days. After about a month, Richard mentioned that he couldn’t remember the last time I had a headache, or nausea, or any effects from the 150 mg of Clomid I was still taking, and we realized that all my symptoms were gone. Even if the Chinese medicine and acupuncture were not helping me to get pregnant, they were at least the antidote to the dreaded Clomid, enabling me to live a normal life on the pill that Western medicine believed would get me pregnant.
* * *
On a Saturday morning in May, three months after I began the weekly appointments that transported me to a land of hopefulness and bliss, and just a week before my coveted appointment with Dr. Sacks, Dr. Shu offered her congratulations. “Your pulses have changed,” she beamed.
“What does that mean?” I asked.
“It means you are pregnant.”
Silence.
“Pregnant? How?” I had still not had a period. I couldn’t be pregnant.
Dr. Shu laughed. “The old-fashioned way,” she said. “It is very early, but you are definitely pregnant.”
I left her office with my mind in a whirl. She was either brilliant or crazy.
If I was actually pregnant, I was a confirmed believer in acupuncture and traditional Chinese medicine forever. If I was not, should I even continue with the treatments? How could she tell me that news and get my expectations up when she couldn’t possibly be sure? But she told me she was positive, that the pulses, read by the Chinese for thousands of years as an early indicator of conception, were as certain as a urine test and more accurate in the early days. I wanted to believe her, especially since she had made my headaches go away, but I wasn’t convinced. I went straight to a pharmacy, picked up an over-the-counter pregnancy test, and raced home. I drank tons of water, forced myself to take a test.
Negative. I tried to console myself. Richard was away for work for three weeks, and I suddenly missed him desperately. Only he could console me. How could I possibly explain to family and friends the overwhelming disappointment of a negative pregnancy test after having my expectations raised by a Chinese herbal doctor and acupuncturist, who nobody knew I was seeing for a fertility problem that nobody except my parents really knew that I had? I was furious with myself for getting my hopes up.
The rest of the weekend, I waited for my appointment with the storied Dr. Sacks. On Monday, with Richard away, my anxiety and I made our way to the vaunted office. More than fifteen years later, I still remember the waiting room. It was yellow and bright and had a very friendly aura. What I remember most is the women in it—all anxious but hopeful, glancing at one another with tight little smiles and friendly but reserved nods. All there for the same thing. All frustrated. All hoping Dr. Sacks could help us.
I filled out the requisite questionnaire, similar to the many I would later fill out in London, New York, Geneva, Moscow. This was my first, and I remember one important question: “Number of days since last menstrual cycle: _____” Answer: “10+ months.” Seeing that number in print drove it home. 10+ months. Something was clearly wrong.
After the obligatory height, weight, and blood pressure checks and changing into the ubiquitous blue paper sheet that masquerades as a robe, I waited for what seemed like an eternity to meet the man himself. Dr. Sacks entered the room with a wonderful smile and a firm handshake. In stark contrast to my first doctor, he was wholeheartedly invested in my admittedly short fertility tale of woe. He made me feel like he had all the time in the world. We would start out with an ultrasound scan, he explained, so that he could take a look at my ovaries and uterus and then we would have a chat about next steps. I lay back on the medical table for my first of what must have totaled nearly one hundred ultrasound scans over the next many years. As Dr. Sacks scanned my ovaries, I tried to make sense of the fuzzy gray scale images in front of me. He then moved over to my uterus, and broke into a smile.
He asked me to raise my head a bit so that he could show me what we were looking at. He pointed at a tiny dark grayish-blackish dot near the inside edge of a paler gray fuzzy oval.
“Do you see that there?” He waited for my hesitant nod. “That is your baby. Congratulations to both of us. That is my fastest success story ever.”
Dr. Sacks went on talking for a while. Something about early days, just conceived, too early for a heartbeat, come back in two weeks when the fetus would be more than six weeks . . . I could barely hear him, for the buzz of happiness in my head.
My Chinese acupuncturist was a genius.
* * *
It is my belief that many women at the beginning stages of their journey would do well to explore the world of alternative therapies. Western research on acupuncture and infertility is ongoing, and its success rates remain controversial. Yet i
n light of Chinese research and practice and small Western studies indicating that acupuncture may improve pregnancy rates during IVF and IUI treatment, increase blood flow to the uterus, reduce stress and anxiety levels, improve ovulation among women with PCOS, strengthen the immune system, and decrease chances of miscarriage, it is easy to see why both patients and doctors are increasingly open to it. “[Acupuncture] can allow you to cross the line from infertile to fertile by helping your body function more efficiently, which in turn allows other, more modern reproductive treatments, like IVF, to also work more efficiently,” says James Dillard, MD, an acupuncturist, chiropractor, and medical doctor who served as assistant clinical professor at Columbia University College of Physicians and Surgeons, as well as medical director of Columbia’s Rosenthal Center for Complementary and Alternative Medicine.1 And while there are a variety of opinions on its efficacy, there is generally wide agreement that acupuncture is safe and produces no side effects.
Studies show that acupuncture can increase pregnancy rates among patients undergoing fertility treatments,2 and anecdotally, a great many women credit traditional Chinese medicine (TCM) and acupuncture in varying degrees to their fertility success. Imami, a thirty-eight-year-old petroleum engineer, was apprehensive about acupuncture. It had taken three years and multiple cycles of Clomid to conceive her first child, and when she returned to the fertility clinic for baby number two, after trying to conceive for ten months, her labs were discouraging. Her fertility specialist suggested she try acupuncture and TCM prior to any medicated cycles. To her great surprise, she became pregnant naturally after two months, using acupuncture, herbs, dietary therapy, and supplements. Similarly, thirty-two-year-old Julia was told by her ob-gyn that based on the results of her blood tests (FSH of 47 in addition to her AMH of .03), she had little chance of getting pregnant. She was directed to the same reproductive endocrinologist as Imami and was likewise encouraged to try acupuncture and TCM and then come back to repeat her blood tests before making any further decisions. Like Imami, Julia found herself pregnant after just over two months of acupuncture and TCM and gave birth to a healthy baby. Having returned to it again and again throughout my journey, I for one am a fan.
* * *
Western medicine tends to look at treating infertility from the perspective of “something’s broken, let’s fix it”—generally the fastest and most direct way. Not ovulating? Take Clomid and force the ovulation.
TCM and acupuncture, on the other hand, come from a completely different perspective, in which the body is seen as a complete ecosystem. As in nature, any one element out of balance can throw off the functioning of the system as a whole. The goal of TCM is to work with the body to bring it back into balance, to the point where it operates properly on its own, as opposed to forcing it. In the case of fertility, this entails regulating the hormones and menstrual cycle—rather than manipulating it with drugs—so that conception will occur naturally.3
“We fix the ovulatory problems, the egg quality, by fixing the whole system,” acupuncturist Jane Gregorie, MS, LAc, FABORM, explains. “If a woman had hypothalamic amenorrhea,I for example, rather than giving her hormones or fertility medications to override her system and force ovulation, the TCM approach would be to nourish a woman’s whole body so that her ovaries could function optimally. The TCM approach usually takes longer but works more holistically: by calming the nervous system and providing sustenance for the generation of her own endogenous gonadotropins, ovulation will happen naturally. We nourish the soil before we plant the seed.”4
This approach reminds me of my recipe analogy, and my own journey. The Western practice of combatting infertility takes all the ingredients that it needs and puts them together. Eggs? Check. Sperm? Check. But the traditional Chinese system focuses on the quality of the ingredients. Are the eggs and sperm of the highest quality they can be, and if not, why not? The emphasis is placed on what can be done to encourage the system to produce better “ingredients,” for a successful dish requires not only a good recipe but also high-quality components. Many women trying to get pregnant need both and increasingly look to Eastern and Western methods to aid them.
The Chinese approach to regulating the cycle is comprehensive, seeking to influence the timing of ovulation while at the same time balancing hormones, building and maintaining the endometrial lining, reducing pain and stress, and improving egg quality. Practitioners of TCM employ a variety of tools to achieve these goals, including acupuncture, herbs, supplements, dietary therapy, moxibustion (involving a warmed herbal compound), self-care practices, lifestyle modifications, and techniques like breath work and meditation.5
I discovered this myself over the years, seeing practitioners who worked in different countries and had trained in various schools that emphasized diverse elements of the practice and treatment. Following my initial experience with traditional acupuncture and Chinese herbal teas, Dr. Xiao-Ping Zhai, of the highly regarded Zhai Clinic in London, a pioneer of acupuncture for fertility in the West, introduced me to electroacupuncture, in which a small electric current is passed between acupuncture needles to heighten the effect, and also suggested that I eliminate all cold food from my diet. Louisa Gordon, an eternally optimistic British acupuncturist who treated me throughout numerous IVF cycles, added moxibustion into my mixture; it scared me at first, but I grew to love it. Moxibustion looks like little clumps of mud, but it is actually a nugget of the herb mugwort placed on the body—in my case on my abdomen—and burned close to an acupoint. The heat from the herbal embers is believed to increase the efficiency of the acupuncture.
The practice of TCM is complex, and it is best to find a practitioner well versed not just in TCM and acupuncture but also specifically trained in enhancing fertility. There are active professional associations that maintain lists of member practitioners devoted to teaching, research, and the practice of traditional and holistic Chinese medicine specifically focused on the treatment of reproductive disorders.6 Unfortunately, I didn’t know this when I moved to various places and set out to find myself an acupuncturist. I relied, for better or worse, on old-fashioned trial and error—sometimes, unfortunately, for the worse.
Dr. Randine Lewis, author of the The Infertility Cure and The Way of the Fertile Soul, summarized the contrast between Eastern and Western perspectives: “Although Western medicine views the reproductive system as an ever-deteriorating disease process waiting for intervention, Chinese medicine employs a different lens. We view the body/mind/spirit as an ever-adaptive system, which, when given appropriate environmental cues, has a miraculous ability to manifest its highest potential.”7
That adaptive process takes time, a precious commodity for those racing against the biological clock. In an instant-gratification culture in which nearly anything can be ordered on demand twenty-four hours a day, people are not accustomed to being told that a process might take at least six months, as I was told by Dr. Zhai in London after several failures. In light of this, it was somewhat surprising to find in my experience talking and corresponding with women across America and in Europe that it was the rare exception when a long-term fertility patient did not turn to acupuncture, TCM, or both. When confronted with multiple failures, or an inability to find answers solely within Western reproductive medicine, women are increasingly embracing this ancient Chinese method.
Notably, it is not simply of their own initiative that women are turning to Eastern methods. Cognizant of the increasing body of evidence supporting the efficacy of the treatments, respected fertility clinics are increasingly working with acupuncturists, sometimes bringing them in-house. Perhaps one of the strongest indicators that many Western fertility specialists are acknowledging the efficacy of the Chinese herbal medicines is that they often don’t want their patients taking herbs during an IVF cycle, largely because they do not know how to anticipate and accommodate the effects.
“My favorite patients, and the most dramatic success stories we have,” Gregorie tells me, “are those who
aren’t even candidates for IVF or Western fertility treatments because their FSH is too high or their AMH is too low. I am grateful for the open-minded REs [reproductive endocrinologists] who send these patients to us rather than telling them they have a hopeless case. My favorite physician colleague would say, ‘Go see Jane for three months and do whatever she says, and then come back for retesting.’ Sometimes these patients conceive naturally in that time frame because they respond to a more subtle, nourishing approach, and I don’t doubt that their doc’s belief in an intervention that can help them (even if Western medicine cannot) eases their mind, calming their fight-or-flight response so that the reproductive system is bolstered, not paralyzed by fear or hopelessness.”8
The Science of TCM and Acupuncture
Based on a classical Chinese theory of regulating vital energy flows, or qi, within a body, acupuncture relies on the painless but strategic placement of tiny needles into meridians, or pathways, that span the body from head to toe, nourishing the tissues. Acupuncturists believe the meridians can stagnate, leading to a variety of problems, including infertility. The needles are thought to stimulate certain key energy points that open the pathways and restore a person’s physical and emotional balance, enabling the body to function more efficiently.
In the case of fertility, acupuncture is used to regulate a woman’s cycle, to encourage egg production, and to improve the chances of a successful IVF cycle by, among other things, increasing blood flow to the ovaries and the uterus.9 This improved blood flow can help to both nourish the eggs in the ovaries and thicken the lining of the uterus, the intended home of the newly fertilized embryo, increasing the odds of conception. It is also believed to increase sensitivity to gonadotropins, the hormones injected throughout an IVF cycle to stimulate production of eggs.10
Conceivability_What I Learned Exploring the Frontiers of Fertility Page 4