Conceivability_What I Learned Exploring the Frontiers of Fertility

by Elizabeth L. Katkin

  Acupuncture may also help correct problems with the body’s neuroendocrine system, activating the brain to release hormones that will stimulate the ovaries, the hypothalamus and pituitary (known as the HPO axis), and other organs that are involved in reproduction.11 Additionally, acupuncture has been shown to assist in reducing stress and anxiety, both believed to interfere with getting pregnant, by releasing endorphins in the brain12—an effect I happily experienced myself.

  In the case of male factor infertility, acupuncture and TCM have been demonstrated in peer-reviewed studies to enhance sperm count, motility (movement), and morphology (shape).13

  The Western, scientific perspective on why acupuncture might work is—not surprisingly—a bit different. Rather than clearing pathways that have stagnated, some Western practitioners believe the needles stimulate the nerves where they are placed and trigger the release of hormones that may increase a person’s pain threshold and increase feelings of euphoria.14

  “These chemicals either change the experience of pain, or they trigger a cascade of chemicals and hormones which influence the body’s own internal regulating system,” says Jill Blakeway, acupuncturist and clinic director at the YinOva Center in New York City.15 With regards to boosting fertility, acupuncture may increase the effectiveness of medications taken to assist ovulation and fertility by working in tandem to increase the level of hormones traveling to the ovaries.16

  Dr. Raymond Chang, the medical director of Meridian Medical and a classically trained acupuncturist as well as Western-trained medical doctor, and Dr. Zev Rosenwaks, a well-known Cornell University reproductive endocrinologist, found a clear link between acupuncture and brain hormones, demonstrating that acupuncture increases the production of endorphins, which play a role in regulating the menstrual cycle.17 Interestingly, a team at the University of California, Irvine, examined the effect on the brain while patients received acupuncture treatment on a point on the little toe that was traditionally used by the Chinese to address eye pain.18 When the point on the foot was stimulated with the needle, the part of the brain that regulates vision lit up. When tested against a “fake” acupuncture point as a control, there was no reaction.

  Acupuncture can also improve success rates with IUI. Researchers at Tel Aviv University in Israel found that nearly a third more of the test group conceived when combining IUI with acupuncture and traditional Chinese medicine than the control group, who received no acupuncture or herbal therapy.19 This may be due in part to effects on sperm; both quality (fewer defects) and quantity of sperm have been shown to increase following acupuncture treatments.20

  Despite a dearth of large-scale Western studies, several smaller studies and a recent meta-analysis of larger patient groups indicate that both women experiencing infertility due to PCOS and women undergoing IVF are consistently helped by acupuncture treatments, increasing pregnancy rates by more than 50 percent. Men experiencing infertility with no known cause have also been shown to benefit from acupuncture.21 Additionally, acupuncture performed on the day of an embryo transfer, particularly when women receive acupuncture both before and after the transfer, has been shown to improve IVF success rates.22 While noting that acupuncture “is not a panacea,” Dr. Jamie Grifo, director of the division of reproductive endocrinology at NYU Langone Medical Center and the founder of its fertility center, observed that “it does improve pregnancy rates and quality of life in some people.”23

  Interestingly, while acupuncturists naturally welcome the support of Western studies indicating a positive result from acupuncture treatments on the day of embryo transfer, many in the field believe that longer-term acupuncture in conjunction with whole-systems TCM—typically a personalized acupuncture protocol, together with any combination of moxibustion, Chinese herbal medicine, dietary recommendations, and massage—leads to greater positive overall outcomes than transfer-day acupuncture alone.24

  The bottom line: the whole-systems TCM led to more births and fewer miscarriages.

  * * *

  I. This means that she was not ovulating because her hypothalamus was not producing enough gonadotropin-releasing hormone.

  You can have the rug pulled out from underneath you, or learn to dance on a moving carpet.

  Anonymous

  4

  You Always Remember Your First

  The Ups and Downs of Pregnancy and Loss

  After what felt like an eternity (which I later learned was more like a nanosecond) of trying to conceive, I finally had exciting news, and no one to share it with, apart from my acupuncturist, as Richard wasn’t due home until the end of the week. For days, I sat alone with my exciting secret. I couldn’t tell anyone before I told my husband, and I didn’t want to tell him over the phone.

  Richard finally returned home late Friday evening. I was exhausted, as I was every day then, but I waited up for him, perched on the kitchen stool in our front window, watching for his car from the airport to arrive.

  When the black Town Car pulled up, I ran to the door and greeted him with a huge hug. We soon settled down at the kitchen barstools, he with a Scotch in hand, me with an herbal tea.

  “I have something to tell you,” I said, suppressing a smile.

  “I have something to discuss with you too,” he replied. “You first.”

  “I’m pregnant. We’re going to have a baby.”

  Silence. Confusion.

  “The Clomid. The acupuncture. The herbal brews. I don’t know what it was, but something worked.”

  “Wow. This is amazing!”

  “Due February twelfth,” I continued. “Now, what did you want to tell me?”

  “They asked me to move to London.”

  “Whaaaaat? Who? When? Why?”

  Richard explained that he had been given an opportunity to go to London, but it was only for six months, maybe a bit more. His firm wanted him to move soon, as early as late June or very early July. As exciting and professionally beneficial as the move would be, however, he felt he’d have to pass it up. He thought it would be too disruptive to our lives and it didn’t make sense, especially now given the pregnancy.

  To his surprise, I disagreed. “Let’s do it,” I told him. “Why not? It will be a great adventure. It’s a fantastic opportunity for you. We’ll love it. We can travel. The baby will be born there. We’ll just have to stay a little longer than six months and your firm will have to deal with it. We’ll come back after the baby is born.”

  We discussed the situation late into the night, and over the next days and nights, getting more excited with each iteration. We chatted about it obsessively until the day arrived when it was time for us to go together to see my fertility specialist for a checkup and the all-important six-week scan that hopefully would yield us our first glimpse of our fetus’s heartbeat. We still had not told anyone about the pregnancy, and had been counseled to be cautious in our optimism until we saw a heartbeat, at which point the odds of a successful, healthy pregnancy increase dramatically. We waited for our turn in the cheerful, yellow office and then went in for the obligatory vitals, ubiquitous blue robe, and, finally, the scan, with Richard by my side. Unlike the first time I viewed a scan, I knew exactly what I was looking at when I saw the dark peanut in the pale gray circle-ish shape, throbbing. THROBBING. That was the heartbeat! The doctor showed us that little flashing plus sign on the screen, and the excitement kicked in. We were really having a baby. On (or about) February 12, 2002. That’s what the computer said.

  We made the final decision to move to London, and, all of a sudden, we had a lot to do. It was early June and we were expected to go by early July. We told our families our double news. We were having a baby (much excitement!) and moving to London for a while (mixed reception).

  Following my departure from the California tech firm, I had recently taken a new position at a law firm and had started one week before finding out that I was pregnant and just eleven days before learning that my husband’s company wanted him to move to London. Great timing. After
only twelve days working at the new firm, I had to go to the head of the corporate department, explain the situation, and ask to be transferred to the London office. It wasn’t a complete disaster, but it didn’t go as well as I had hoped. He didn’t think it was likely in the time frame I was talking about. “Maybe in six months?” he suggested.

  Emboldened by the thought of the little throbbing peanut inside me, I told him that wouldn’t work for me. Richard and I needed to be on the same continent. I spoke to a few headhunters. These were pre-9/11 days; the economy was booming, and it did not seem like it was going to be too hard to get a job in London. We decided to forge ahead with our plans, with or without my firm’s cooperation. Two days later, the head of corporate called to say I could go to London with Richard in July. The stars were finally aligning for us.

  The pregnancy seemed to be progressing swimmingly. I was extremely tired but had almost no morning sickness, and Dr. Sacks, seeing no further need for his specialized services, had passed me along to a local ob-gyn practice to monitor my pregnancy until the move. I had my first appointment at the new practice, and the doctor there took blood tests and did another ultrasound scan. All looked great. We saw the heartbeat, still looking strong, and the fetus was growing. This ultrasound machine showed an estimated due date of February 16, 2002. I asked about it, as I expected it to be February 12, 2002. Not to worry, the technician said. Machines can calibrate differently. Everything was fine.

  The practice saw me again just before we traveled to England. The doctor wanted to do one more scan before we left, and to review the results of the blood tests. To my surprise, the tests revealed what was described as a small problem. I had an elevated marker for toxoplasmosis.1 I had no idea what toxoplasmosis was, but my heart started beating rapidly. How could I be learning of a problem the day before the move? The doctor calmly explained that it might be nothing at all, that it was often detected in women with cats in the household (we had three), that it came from kitty litter, and that the markers might be present in my blood from an earlier infection. I was still concerned. The doctor drew more blood to send to a specialized lab in California and promised to call with the results of the blood analysis, which she warned might take weeks. She advised me to find an obstetrician in London right away and to both inform the doctor of the toxoplasmosis risk and get a scan as soon as possible. In parting, she told me not to think at all about the toxoplasmosis. It was probably nothing.

  Our good friends Steve and Shelley host an annual Fourth of July pool party that we were determined not to miss. We were planning to go straight from the party to the airport, and so they kindly turned it into a July 4 / bon voyage party. We had a spectacular time with family and many of our closest friends, and felt on top of the world. We were finally starting a family, as well as embarking on a new adventure. Although we were not yet at the end of the first trimester, when most people consider it “safe” to reveal the big news, given our multiple scans, heartbeat sightings, and assurances that all looked well, we shared our exciting news with everyone at the party. On the last flight of the night on July 4, we were bound for England. We saw fireworks from the plane as we began our overseas adventure.

  Unfortunately, it wasn’t exactly the rosy start I had envisioned to our life in London. It was a difficult flight, followed by a bumpy black cab ride to our new home, a super-expensive, super-tiny apartment on Weymouth Street in Marylebone. I arrived nauseous, exhausted, and excessively hormonal. Richard’s company had found the apartment and was covering the rent for the six-month stint. Given the exorbitant cost, I had been excitedly expecting a correspondingly lavish apartment. Now don’t get me wrong here. I grew up in a lovely, modest, middle-class home in Buffalo, New York, and my parents grew up in the Bronx. During graduate and law school, I had lived in housing so substandard in NYC that my brother, Ken, called the city’s office for poison control to complain about the rats. But given the astronomical rent, I’d had visions of those lovely Merchant Ivory period pieces. Instead, we arrived at a tiny, modern, characterless box. I burst into tears. Richard teases me to this day.

  I had been told to call the head of my law firm’s London office the morning I arrived, but, tired and nauseous, I crawled into bed. I lay there. Until my guilt got the better of me. Before I went to sleep for the rest of the day, I knew I should call the head of the office. His secretary put me on hold. When he came on the line, he said, “Welcome, hope the journey was good, can you come down to the office now?” I couldn’t answer. “Do you know the way? Sorry to bring you in today, but I am off on vacation tomorrow so it would be best if you could come in now.” Damn. My first morning off a red-eye? The doctors had told me to get lots of rest.

  Dejected, I pulled myself out of bed, somehow got myself into a suit, and headed out to the Great Portland Street Tube station, walking slowly in the drizzle past The Portland Hospital for Women and Children, not knowing at the time that it was perhaps the most famous maternity hospital in the United Kingdom, if not the world, and that I would be spending a fair amount of time there in my near future.

  After completing the necessary work-related introductions and tasks, I was shown to my new office and promptly began my first project—getting myself an ob-gyn and an appointment. Armed with the name of a doctor recommended by my close college friend Kathy, who is an ob-gyn in Boston, I placed my first phone call, hoping for an appointment that week. No, unfortunately, Ms. Maggie,I the doctor I was referred to, was away on a ten-week leave and wasn’t taking any new patients. Her receptionist referred me to a colleague, coincidentally also named Ms. Maggie, who couldn’t see me until the first week in August, which would be fine because I would be just over twelve weeks, nearing the end of my first trimester. In the meantime, the receptionist would refer me for a scan at an ultrasound clinic.

  I went for the scan at the end of that first week in London, eager to get another glimpse of the fetus and make sure everything was OK after the long journey. I was amazed by the ability of reflected sound waves to render an image of the tiny being in my womb. What an immense relief to learn that all was still fine: heartbeat strong and fetus growing. I noticed that the ultrasound machine showed an estimated due date of February 17, 2002. Strange, another day off, I thought, but I didn’t ask. I thought I would wait until I met my new doctor in early August.

  As I settled into work in the heart of the old City of London, I felt healthy and optimistic, and looked forward to meeting my new ob-gyn. My New York Jewish mother called religiously to make sure I was eating enough and getting rest. She’d waited a long time for this grandchild and was as excited as I was.

  I never got to meet Ms. Maggie. Less than three weeks later, I was in a meeting at my office and knew something was terribly wrong. I had horrible cramps. Everything was tightening. It hurt so much I had to fight back tears, although in retrospect it is hard to know if the tears were from the pain or from the knowledge that something was seriously wrong. I excused myself and went to the bathroom as calmly as I could, and although I was not entirely surprised, I gasped when I saw the blood in my underwear. From the bathroom stall I called Richard in a panic. He calmly told me to call the doctor and to try not to worry. I hastily attempted to clean myself up and make my way back to my office without arousing attention. When I called the doctor’s office, I was told that she was on vacation but that I could see her partner, Mr. R. I hailed a taxi and went straight to the office.

  Upon entering his office on the famed Harley Street, as distraught as I was, I could not help but notice my surroundings. A huge wooden desk with impeccable leather accessories. Oil paintings on the walls. A bronze sculpture. No computer. Sitting in a high-back black leather chair amid an array of nineteenth-century antiques, he greeted me politely, asking how I was, did I like London, wasn’t it a dreadful day outside indeed. He reminded me of Peter O’Toole in The Last Emperor. I was cramping and terrified of what had just happened, and not in the mood for British pleasantries. After he chatted with me fo
r what seemed like an unbearable amount of time, he sent me off to the Fetal Medicine Centre for an ultrasound scan without even examining me.

  I don’t remember the walk to the Fetal Medicine Centre, which was just a couple of blocks away, and I don’t remember calling my husband to tell him to meet me there, but I must have done both because I somehow got to the center and he showed up some time later. A kind doctor named Dr. Simona took me in for a scan. She didn’t need to tell me anything. Novice as I was, the lack of the constant pulse from the ultrasound screen, coupled with the forced, expressionless look on Dr. Simona’s face told me all I needed to know. There was no heartbeat. There was no baby. I had known it in my office. I knew it now. But why? What happened? I couldn’t bear it. I couldn’t accept it. Overwhelmed with grief, I cried and cried. I was actually shocked by how completely grief-stricken I was. I think I took it worse than I had ever taken anything in my life.

  Dr. Simona quietly explained that I’d technically had a “missed abortion” as the medical industry cruelly calls it. The fetus, absent a heartbeat, was still inside me; mercilessly true to its name, a “missed abortion” is even missed by the body of one experiencing it, which continues to feel pregnant. It was of little comfort to learn that miscarriages after seeing a heartbeat were rare and that only 1 percent of women suffer “missed abortions.”

  Later, much later, as the haze started to clear for bits of time and I would wander aimlessly around Regents Park, as I often did, or sit on a park bench staring into space, or sit on my couch as was my habit on the many rainy days, or the days when I simply couldn’t get up, I felt guilty. Guilty about all the people I knew who had experienced miscarriages and how little I had understood it. How little attention I had paid. I felt horror at my failure to empathize. I could not possibly have imagined the intensity of the loss a person could feel for a life that had not yet been born.