Assisted Reproductive Technologies

In Vitro Fertilization (IVF)

In Vitro Fertilization (IVF) means that the embryo is fertilized outside of the body, incubated, and then transferred back to the uterus for implantation and continued pregnancy. The first IVF baby to be born was Louise Brown in 1978.  Since then, over 5 million babies have been born through IVF in the U.S. Technology has advanced dramatically since then, with a reduction in multiple gestations, increases in pregnancy success rates per embryo transfers and an increase in the number of single embryo transfers. The advances have been attributed to improved IVF laboratory techniques, upgraded instruments/equipment, enhanced physician training, advancements in research, frozen embryo transfer and the availability of pre-implantation genetic testing.

Assisted Laboratory Procedures

When beginning an IVF cycle, the ultimate goal for the RFC team is to work with the patients to create a healthy baby while minimizing the risk of multiples. New advances in laboratory techniques have recently enabled us to maximize success rates while minimizing the incidence of multiples. Assisted reproductive technologies, including intracytoplasmic sperm injection, blastocyst culture, assisted hatching, preimplantation genetic diagnosis and cryopreservation, are laboratory techniques used to work with and care for the eggs, sperm and embryos outside the body.

IVF + PGS + FET

Single Embryo Transfer

On the day of your embryo transfer, report to RFC approximately 30 minutes prior to your scheduled pre-embryo-transfer time. While partners are encouraged to be present, their presence is not imperative. However, you will need someone to drive you to and from the clinic.

The embryo transfer procedure is similar to a pap smear. A speculum is inserted into your vagina. An abdominal ultrasound examination is performed, then a catheter and guide is inserted into the cervical canal and the catheter is fed into the uterus. Occasionally, you may feel some cramps as the catheter is placed into the uterine cavity. The embryos are then placed into the uterus. The embryologist then inspects the catheter under a microscope to make sure that all the embryos were transferred.

Embryo transfer is usually a short procedure. There is generally little discomfort, if any at all. Following the procedure, you may get dressed and be driven home. You will NOT be able to drive yourself home. Bed rest is recommended for the next three days. Please remember that you are to continue your progesterone (and any other prescribed medications such as heparin, estrogen, or baby aspirin) until we have the results of your pregnancy test. Following transfer, some patients may pass a small amount of bloody fluid or air from the vagina. Please do not worry about this, it does not mean that you are expelling the embryo(s). From the time after bed rest until your pregnancy test, you are to continue the medication, including progesterone shots and suppository until you are specifically instructed to stop them. If your pregnancy result is positive, you will be on the medication for at least a few weeks.

It is normal to blame yourself or something you may or may not have done during this time if your pregnancy test is negative. Therefore, we strongly recommend that our patients adhere to the guidelines we have itemized below to encourage a more positive result and outlook:

  • No tub baths or swimming for 48 hours after replacement
  • No douching
  • No tampons
  • No intercourse or orgasms until the fetal heartbeat is seen on ultrasound or the pregnancy test is negative
  • No jogging, aerobics, tennis, skiing, mountain climbing, etc.
  • Do not begin any new physical activity
  • Do not taken any non-prescription medications or other prescribed medications without the approval of the IVF team
  • No heavy lifting
  • Try to keep busy; remaining mentally distracted will help the ten to twelve days pass easier
  • It is not unusual for you to have some vaginal spotting or bleeding prior to your pregnancy test. Approximately 50% of our pregnancy patients have spotting prior to pregnancy tests, or even afterwards. Think Positive! You must have the blood work drawn even if you think your period has started.

Intracytoplasmic Sperm Injection (ICSI)

This procedure involves direct injection of a single sperm into a mature egg. This procedure is selectively used in cases involving significant decreases in sperm counts, motility, or morphology. This procedure may also be used in cases where there is a history of previous failed fertilization despite normal sperm testing.

Assisted Hatching

This procedure involves making a small hole in the zona pellucida (sugar-protein membrane) that surrounds the pre-embryo at the 6-8-cell stage approximately 1 hour prior to embryo transfer. As the embryo continues to grow, the hole becomes larger, making it easier for the embryo to “hatch” out of its shell, which is necessary for implantation to occur. This procedure is performed in patients with a thickened zona pellucida, as well as in patients over 35, or with other histories.

Low stim/ natural cycle IVF

A low stimulation or natural cycle IVF typically refers to an in vitro fertilization cycle that uses an oral medication in lieu of an injectable gonadotropin medication. The oral medication provides milder stimulation of the ovaries than the injectable medication. Currently, the advances in reproductive medicine point to the use of genetic testing of embryos as the best option for patients, as the testing provides more information about the embryos, lowers miscarriage rate, and increases pregnancy rate per embryo transfer procedure. Therefore, the downside of a low stimulation/natural cycle IVF is that much less eggs are stimulated hence retrieved, and the patient has a much higher chance of having no “normal” embryo to transfer.

Day 3 Embryo Transfer and Day 5 blastocyst transfer

An embryo can either be transferred back to the uterus for implantation on Day 3 or Day 5. Most IVF cycles will involve a Day 5 blastocyst transfer of an embryo that has been tested normal by Pre-implantation Genetic testing. However, under some circumstances, a Day 3 transfer may be considered based on what’s best for that patient.

Transferring Embryos to the Uterus

Embryos are transferred on either day three or day five of development. The embryologists at RFC are highly skilled in identifying “healthy” embryos and in some cases will recommend that a patient extend embryo development to day five, known as the blastocyst stage. Blastocyst transfer has become quite common in IVF cycles as it can increase chances for success while decreasing the likelihood of multiples. Your physician will work closely with the embryologists to determine if a day three or day five transfer would be ideal for your cycle.

Embryos are transferred to the uterus through a small tube (catheter). This procedure is much like a pap smear and does not require any anesthesia and is usually painless. The embryos are placed in a small amount of fluid inside the catheter, which is passed through the cervix at the time of a speculum examination. The embryos are placed in a manner so they reach the top part of the uterus. The number of embryos transferred depends on individual circumstances of the couple, and this decision will be made collectively by you, your physicians and the embryologist.

Typically, two to four embryos will be transferred in one treatment cycle.

Embryo transfer can cause mild cramping. Although unlikely, during the embryo transfer the embryo(s) may be displaced through the cervix (causing loss of embryos) or into the fallopian tubes (causing possible tubal pregnancy). There is a small risk of bleeding or infection as a result of the transfer procedure.

After transfer, the patient may get dressed and leave after a brief recovery period. A pregnancy test will be done twelve to fourteen days after the transfer, regardless of the occurrence of any uterine bleeding.

The transfer of several embryos increases the probability of success. A multiple embryo transfer also increases the risk of a multiple pregnancy. Any multiple pregnancy carries an increased risk of miscarriage(s), premature labor and premature birth as well as an increased financial and emotional cost. Pregnancy-induced high blood pressure and diabetes are more common in women pregnant with more than one fetus. Prolonged hospitalization may be necessary for these pregnant women and for the mother and babies after delivery. Tubal (ectopic) pregnancy is also possible, and a combination of normal pregnancy and ectopic pregnancy may occur. A tubal pregnancy is a condition that may require laparoscopy or major surgery for treatment. Like spontaneous (natural) conceptions, pregnancies that arise through IVF may result in miscarriage. In the event of a miscarriage, a dilatation and curettage (D&C) may be necessary. Couples have a choice of what to do with the remaining embryos that are not transferred. The following are the options:

  • Freezing (cryopreservation) of remaining embryos for use by the couple in future treatment cycles
  • Allowing the embryos to develop in the laboratory until they perish, at which time they would be disposed of in a manner consistent with professional ethical standards and applicable legal requirements (this usually occurs within six to eight days after egg collection)
Pre-Implantation Genetic Diagnosis and Screening (PGD and PGS)

Pre-implantation genetic diagnosis (PGD) is a technique used in In Vitro Fertilization (IVF) which allows genetic evaluation of an embryo before transfer and subsequent implantation (hence the term, “preimplantation” genetic diagnosis). This technique involves the removal of a single cell from a 6-8 cell embryo. The cell is fixed and can be analyzed for genetic abnormalities. The embryos are allowed to grow to blastocyst (more advanced stage) and embryos tested normal are then transferred back for implantation. Common indications for PGD include carriers of single-gene disorders such a cystic fibrosis, patients with a family or personal history of inheritable disorder, and carriers of abnormal chromosomes. Other patients groups that may benefit from PGD include recurrent pregnancy loss (RPL), increased reproductive age of the female partner, repeated implantation failure (i.e. multiple failed IVF cycles).

Potential limitations of this technology are:

  • Requires adequate numbers of embryos to allow blast transfer
  • Risk of no embryos for transfer
  • Misdiagnosis
  • Low risk of damage to the embryo during biopsy
Frozen Embryo Transfer (FET)

Frozen embryo transfer (FET) is the process of transferring embryos from a previously cryopreserved (frozen) state to the uterus of a patient.  Embryos that were not transferred in a previous cycle, may have been cryopreserved and stored for future cycles.  Patients that undergo FET are monitored through ultrasound and blood tests to determine the most opportune time to transfer the embryos for implantation.  In some cases, patients may receive hormone medication to ensure a successful transfer.  While frozen embryo transfer (FET) cycles require less medication, minimal monitoring and are much less expensive than a fresh cycle, they still provide high pregnancy rates.

Egg Donation (Anonymous/Known Donor)

Donor eggs may be used in IVF for women that have been unable to achieve a pregnancy with their own eggs. The eggs may come from a known or anonymous donor. Donor eggs are then fertilized with the sperm of the recipient partner (or with donor sperm as indicated), with subsequent embryos transferred to the recipient’s uterus. For anonymous egg donation (recipient couple does not know the identity of the egg donor), our Center provides a list of donors to choose from which match the recipient couple’s desired characteristics. All donors undergo a thorough medical, genetic, psychological and laboratory screening prior to donation and are contractually bound by legal documentation on their agreement to donate their eggs.

Sperm Donation
Sperm donors go through a similar process as egg donors.  Sperm donors typically come from a friend, relative, or can be an anonymous donor from a cryobank.  The donor must submit to FDA required infectious disease screenings prior to donating.  Patients are able to arrange for a private donor as their sperm donor for their IVF cycle.  They may also choose a sperm donor from a cryobank and have the sperm shipped to our center for their upcoming fertility treatment cycle.
Embryo Donation
With the advances in embryo genetic testing and better embryo freezing techniques, embryo donation is becoming a more viable option than before.  In the past, the success rates of frozen, donated embryos were lower due to the freezing techniques, media, and the lack of genetic testing.  Currently, an embryo that has been tested normal would have a better chance of leading to a live birth.
Gestational Carrier/ Surrogacy

RFC works with gestational carriers, described as women that do not have a genetic link to the baby, but choose to carry the pregnancy for intended parents.   We also work with intended parents that are in need of a gestational carrier. This procedure is generally used for patients who have severe damage to their uterine cavity, have had their uterus removed, or cannot carry a pregnancy for health or other reasons. Some couples provide their own gestational carriers and we proceed with the same treatment plan as we do for those that allow us to provide a surrogate.

Egg Freezing/ Fertility Preservation

Egg freezing can be used as a way to preserve fertility, sometimes for patients who are planning to undergo cancer treatments.  However, egg freezing is still considered an experimental procedure.  It is more difficult to freeze eggs than it is to freeze sperm or embryos because of eggs’ high water content.  We recommend that you fully discuss the benefits, risks, advantages, and disadvantages with our physician prior to making the decision to freeze your eggs.

Sperm Cryopreservation

Sperm can be frozen and stored for future use in either artificial insemination or IVF. This frozen sperm can be used as a backup should future ability to produce viable sperm be diminished. Some reasons for considering sperm cryopreservation include the following: as a precaution when undergoing cancer therapy or prior to a vasectomy if there is a possibility that you may want to have children in the future. Furthermore, during vasectomy or testicular biopsy, it is wise to freeze a specimen of the sperm that is available at the time of the procedure to avoid the potential need for a second surgery. Specimens obtained during surgery will contain low numbers of sperm and can be used only in conjunction with IVF with ICSI.

Requirements

Before semen can be frozen, a storage consent agreement must be completed. The consent agreement outlines the responsibilities for both the laboratory and the patient in the process of maintaining the frozen specimen(s). Specimen collection requirements are the same as described above, with special attention to collecting a clean specimen free of contamination.

Oncofertility (Cancer and Fertility)
While the diagnosis of cancer is devastating enough, the patient may also need to consider preserving his or her future fertility by freezing their sperm, eggs or embryos prior to cancer treatment, as cancer treatments may often damage the reproductive organs which may lead to infertility after the treatments.

Oncofertility specializes in joining oncology and fertility.  Its purpose is to traverse the nature of both fields and find remedial ways of increasing the reproductive conceivability for both male and female cancer patients.  Women attempting to conceive may find that cancer treatments hinder their ability to produce viable oocytes (eggs), may cause pre-menopause, damage the ovaries and/or effect their overall reproductive system.  In some cases, female patients may choose to freeze their eggs prior to their cancer treatment.  This process will allow for the availability of uncompromised eggs that may be fertilized to create embryos when they are ready to move forward with infertility treatments.

In men being treated for cancer, there may be damage to the testes which may lead to difficulty producing sperm and testosterone, both of which would affect their ability to fertilize the female egg.

Because the protocol for cancer treatment may involve radiation, chemotherapy, and/or surgery, safeguarding against permanent damage to the reproductive system is a high priority for our oncofertility specialists.  We work to mitigate and minimize the treatment affects by working closely with our patients to identify diagnostic variables that may lead to long term damage of their reproductive systems.  Our experts provide consultations on the options that are available prior to cancer treatment or in parallel with the cancer treatment plan.

Intrauterine Insemination (IUI)

Intrauterine insemination (IUI) is a procedure in which sperm are placed directly into the uterine cavity through a catheter near the time of ovulation. This procedure is most commonly performed when there are problems with the sperm, such as low count or low motility, or an incompatibility between the sperm and the cervical mucus. It can also be performed to overcome problems associated with a man’s inability to ejaculate inside the woman’s vagina due to impotence, premature ejaculation or other medical conditions. IUI increases the chances of pregnancy because the sperm are placed directly in the uterus, bypassing the cervix and improving the delivery of the sperm to the egg.

IUIs can be performed either with the partner’s sperm or with donor sperm. It is recommended that the patient abstain from sexual intercourse for two to three days before the procedure. In some cases, it may be necessary for the female to take medication to induce ovulation if her cycles are not regular. The male will provide a semen sample one to two hours before the procedure is to be performed. The semen will be washed, a procedure in which the sperm is separated from the seminal fluid and the quality of the sperm is analyzed. Following the wash, it is time for the insemination procedure, which only takes a few minutes and does not cause much, if any, discomfort for the female. The doctor will insert a small catheter into the uterine cavity through the cervix and inject sperm directly into the uterus. The patient is able to resume normal activity immediately following the IUI procedure. If pregnancy does not result from the initial IUI, the procedure may be repeated during the following cycles.

Some patients who receive fertility medication will also undergo intrauterine insemination (IUI), a process by which sperm are specially prepared, and then injected into the woman’s uterus in a simple office procedure. This can be done using either husband or donor sperm. Sperm preparation is performed in our Andrology Laboratory by highly trained andrologists, who utilize meticulous specimen handling and quality control measures to ensure safety.

TESE/ MESA/ PESA

Microepididymal Sperm Aspiration (MESA)/Testicular Sperm Extraction (TESE)/Percutaneous Epididymal Sperm Aspiration (PESA)

This is a procedure in which sperm are aspirated or extracted from the male reproductive tract (testes or epididymis), sometimes requiring the use of a microscope. The retrieved sperm are immediately taken by our embryologist and then used to fertilize an egg or frozen for future use. This procedure is performed by a urologist with specialized training in male infertility.

Reproductive Treatments

Ovulation Induction

Ovulation induction medications, often referred to as fertility drugs, are used to stimulate the follicles in your ovaries resulting in the production of multiple eggs in one cycle. The medications also control the time that you release the eggs, or ovulate, so sexual intercourse, intrauterine insemination, and in vitro fertilization procedures can be scheduled at the most likely time to achieve pregnancy.

There are risks associated with the use of ovulation induction medications including an increase in the chance for high order multiple births and the development of ovarian cysts. A rare side effect that may occur is ovarian hyperstimulation syndrome (OHSS); symptoms include severe pain in the pelvis, abdomen and chest, nausea, vomiting, bloating, weight gain and difficulty breathing. The medications most commonly used in fertility treatment are clomiphene citrate, gonadotropins, Metformin and Parlodel.

The purpose of “super ovulating drugs” is to stimulate the ovaries to produce more than one egg. Bravelle, Repronex, Pergonal (hMG), Follistim and Gonal-F (FSH) are given as an injection once or twice a day to recruit multiple eggs.

After receiving injections for approximately five days, a transvaginal ultrasound will be performed at RFC. You will be asked to empty your bladder and proceed to the examining room, where you will undress from the waist down. A vaginal transducer will be inserted into your vagina. You may experience some vaginal discharge after the procedure as transmission gel is used on the vaginal probe, but the procedure itself should not cause discomfort.

Ultrasound is a process whereby high-frequency sound waves are transmitted through tissue. As the ultrasound waves strike the tissues, they project a white image on the ultrasound screen. Follicles are round sacs of fluid within the ovaries. Therefore, the follicles appear as dark circles on the ultrasound screen. Hopefully, each follicle contains an egg; however, the eggs cannot be seen during the ultrasound. In some cases, the follicle has no eggs and in others the follicle contains more than one egg. The number of follicles, therefore, does not correspond to the number of eggs. We monitor follicular growth and also the number of follicles being produced.

Beginning approximately treatment day 6, you will undergo daily blood sampling to determine your estradiol level. This level is used to individualize your medication treatment for that afternoon and the following morning. Estradiol is produced by the lining of the follicle (fluid filled structure where the egg develops). In addition, a progesterone and LH determination may be made if your estradiol level is rising rapidly.

After physician review of your estradiol numbers, you will be notified of any change in your medication dosages. We are not looking for specific numbers when we perform ultrasounds and run blood work. We are looking for the relationships between the blood work and the ultrasound findings.

When your physician determines that you are ready for retrieval, you will be given instructions on how to administer an injection of hCG (Ovidrel, Novarel). This injection is given late in the evening approximately 37 hours prior to retrieval. This medication ripens the developing eggs and initiates ovulation. Ovulation occurs about 42 to 48 hours from the time of injection if you do not have an egg-retrieval procedure. Many patients experience abdominal discomfort after the hCG due to ovarian enlargement and are convinced that they are ovulating. Rest assured that we are monitoring you very closely and the chance of ovulating prior to retrieval is extremely slim, and almost zero if you are receiving Lupron, Antagon or Cetrotide.

Sexual abstinence too long before retrieval (more than five days) or relations too close to retrieval (24 hours) could possibly decrease the quality of the semen sample. If you did not have sexual relations the day before hCG, we recommend that you do the day of hCG. If your husband has a low sperm count you may need a four to five day period of abstinence. Discuss this with your physician early in your cycle.

Chronic Pelvic Pain

There are many causes of pelvic pain not related to infertility including hernias, chronic appendicitis, bowel disease, and irritable bowel syndrome to name a few. Pelvic pain related to infertility maybe due to a number of causes including endometriosis, adhesions, pelvic inflammatory disease, adenomyosis, and fibroids.

Endometriosis is when tissue from the endometrium is found outside of the uterus. This tissue may adhere to the ovaries, bladder, outside of the uterus and bowel. This tissue can cause pain and infertility issues although it is unclear why some women develop endometriosis. Endometriosis is thought to be present in 10% of women and in up to 50% of women with infertility.

Pelvic adhesions may be due to endometriosis, pelvic infections, or surgeries. Scar tissues can cause organs to adhere or stick to each other causing pain or discomfort.

Adenomyosis is when the endometrium grows into the wall of the uterus and usually causes painful and heavy menstrual periods.

Fibroids (also known as myomas or leiomyomas) are benign tumors of the muscle in the uterine wall. They can be found in different locations in the wall. Subserosal are found in the outside wall of the uterus, intramuaral are found in the middle of the uterine wall, and submucosal are found in the uterine cavity.

Recurrent Pregnancy Loss

Miscarriage is defined as the loss of a pregnancy before 20 weeks of gestation. Nearly 20% of pregnancies end in miscarriage, most often within the first 12 weeks. Recurrent miscarriage, or habitual pregnancy loss, is defined as three or more consecutive, spontaneous pregnancy losses.

Often no cause for miscarriages is found but possible causes include genetic defect, abnormally shaped uterus, uterine fibroids, scar tissue, hormonal imbalances and illness such as diabetes. Increased age, habits such as smoking, caffeine and alcohol, and the use of certain medications increase a woman’s risk for miscarriage.

There are a number of tests that your physician may run, in addition to reviewing your medical history and conducting a pelvic exam to diagnose the possible cause of your recurring miscarriages. These tests may include a mapping of your chromosomes to detect genetic defects, a hysterosalpingogram, blood tests to detect immune system abnormalities and measure hormone levels, a vaginal ultrasound and an endometrial biopsy. Once the cause has been determined, your physician will work with you to map out a treatment plan, which may include surgery to correct problems with the shape of the uterus or medication to correct immune problems and hormone imbalances.

With the latest advances in pre-implantation genetic testing, pregnancy loss may be prevented and the causes discovered. Many miscarriages are the result of abnormalities in an embryo although it may not exhibit any physical characteristics under the microscope, but it may be discovered in a genetic test of a single cell excised from the embryo. Abnormal embryos are not and cannot be transferred back into the uterus for pregnancy.  Only embryos tested normal may be transferred into the uterus.

Laparoscopic Surgery

Laparoscopy is a telescope which is inserted through a small incision in the umbilicus (belly-button) and allows direct visualization of the pelvic organs. It is performed as an outpatient procedure and requires general anesthesia. Placing 1-3 additional ports through small (1/2 cm incisions) also allows for surgical procedures to be performed. This usually includes laser/cautery of endometriosis, or adhesiolysis (cutting scar tissue). Repair of some tubal blockage can also be performed, but this is only successful if the fimbria (“fingers” on the end of the tubes) are normal. If the tubes are completely destroyed at the ends and are swollen (hydrosalpinges), removal of the tubes or tubal ligation is recommended prior to undergoing IVF and may be performed at the time of laparoscopy.

  • Laparoscopy is a surgical procedure your doctor uses to look at your uterus, ovaries, and fallopian tubes. If any problems are diagnosed, your doctor can sometimes correct them during this procedure.
  • It can help your doctor diagnose fibroids, scar tissue, endometriosis, and blocked fallopian tubes- all of which can cause infertility.
  • Using a narrow, fiber optic telescope inserted through a tiny incision near your navel, your doctor can examine your ovaries, fallopian tubes, and the outside of your uterus.

How is this procedure performed?

  • Laparoscopy is a short surgical procedure performed under general anesthesia, so it is usually done in a hospital or surgery center.
  • Infection is the most common risk for Laparoscopy procedures.
Hysteroscopic Surgery
A small telescope is inserted through the cervix and into the uterine cavity while saline solution is infused. An attached camera allows direct visualization of the uterine cavity. Larger telescopes with an operating channel can be used to remove fibroids, polyps, uterine septa and scar tissue, allowing not only diagnosis, but also treatment. The operative portion of the procedure usually requires anesthesia and is performed as an outpatient procedure.

Integrative Medicine

Our office is designed around your needs and making sure your experience is as comfortable as possible. Our patients regularly tell us that they feel like they are at a day spa.

Acupuncture

ACUPUNCTURE: WHAT IS IT?

Acupuncture is a method of encouraging the body to promote natural healing and to improve functioning achieved by inserting disposable solid needles, applying heat or electrical stimulation to multiple acupuncture points.

HOW DOES ACUPUNCTURE WORK?

The classical Chinese explanation is that channels of energy run in regular patterns through the body and over its surface. These energy channels, called meridians, are like rivers flowing through the body to irrigate and nourish the tissues. An obstruction in the movement of these energy rivers is like a dam that backs up in others. Diagnosis and etiology guide treatment protocols based on this system.

The meridians may be influenced by needling the acupuncture points allowing the acupuncture needles to unblock the obstructions at the dams and reestablishing the regular flow through the meridians. Acupuncture treatments can therefore help the body’s internal organs to correct imbalances in their digestion, absorption, and energy production activities, and in the circulation of their energy through the meridians.

The modern scientific explanation is that needling the acupuncture points stimulates the nervous system to release chemicals in the muscles, spinal cord, and brain. These chemicals will either change the experience of pain, or they will trigger the release of other chemicals and hormones, which influence the body’s internal regulating system.

The improved energy and biochemical balance produced by acupuncture results in stimulating the body’s natural healing abilities, and in promoting physical and emotional well-being.

DO THE NEEDLES HURT?

Each person experiences acupuncture differently and each practitioner has a different style. Most patients feel only minimal sensation at certain points; at other points there is no sensation felt. Once the needles are in place, endorphins are released and a relaxation response is experienced.

DO I HAVE TO BELIEVE IN ACUPUNCTURE FOR IT TO WORK?

No. Acupuncture is used successfully on animals. These animal patients do not understand or believe in the process that helps them get better. A positive attitude toward the process may reinforce the effects of the treatment received. A neutral attitude (“I don’t know if I really believe in this.”) will not block the treatment results.

HOW MANY TREATMENTS WILL I NEED?

You may choose to only have acupuncture on the day of your embryo transfer to decrease uterine cramping and aid in relaxation, to decrease side effects during hormonal stimulation or simply to decrease stress during this time. You may consider using acupuncture to prepare for IVF/IUI. A treatment plan will be created based on the infertility diagnosis for each partner. For those interested in natural conception, the number of therapeutic treatments will be based on the diagnosis and general health of each individual. A treatment plan of two treatments per week for several months may be recommended.

HOW WILL ACUPUNCTURE HELP DURING THE IVF CYCLE?

On WebMD; James, Dillard, MD of Columbia University states 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.” How does it help the body function more efficiently?

  • Acupuncture increases blood flow to the uterus (proven by research), encouraging an efficient remodeling of the endometrial layers such that the uterine lining is conducive for implantation of an embryo.
  • Acupuncture increases blood flow to the ovaries, increasing maximal delivery of nutrients, oxygen and drugs to the follicles as they are developing & may aid the recruited follicles to grow at a similar rate for retrieval.
  • Reduces stress and anxiety to bolster the patient’s resilience.
  • Decreases side effects: Headaches, high blood pressure, nausea, insomnia, dizziness, rashes, night sweats, abdominal distention, constipation and pain.
  • On The Day of the Embryo Transfer: Acupuncture relaxes the uterus; reducing cramping and tension to aid implantation. Stress reduction alone may also increase implantation rates. Multiple research studies have found acupuncture on this day increases live birth rates.
  • Studies have found acupuncture increases live births, decreases and decreases miscarriage rates when combined with IVF.

HOW DOES ACUPUNCTURE PREPARE US FOR IVF/IUI?

  • SPERM QUALITY: specific acu-points have demonstrated an improvement in the microcirculation in testes, which diminishes with age. Acupuncture increases blood supply (oxygen and nutrients) to the testicles.
  • Acupuncture has an effect on the follicular microenvironment; increasing blood flow (oxygen and nutrients) to the follicles.
  • Increase oocyte mitochondrial ATP output (increased energy within cells of eggs), to enhance egg quality with certain Chinese herbs.
  • Enhance follicle antioxidant defenses with certain Chinese herbs
  • PCOS: Acupuncture improves ovarian function by regulating hormone levels (e.g. LH, testosterone)
  • Reduces stress hormones associated with reduced IVF success.
  • Improve follicle environment by reducing inflammatory cytokines with certain Chinese herbs to improve egg quality affected by endometriosis.

CAN ACUPUNCTURE HELP US GET PREGNANT NATURALLY?

Acupuncture may stimulate proper ovulation. Raymond Chang M.D. “When you compare the pregnancy rates for a drug such as Clomid to acupuncture alone, the rates are equal.”

We offer comprehensive treatment protocols to aid ‘natural’ conception, (protocols are holistic and may include acupuncture, Chinese medicine, stress management, as well as recommendations regarding nutrition and exercise). A consultation and evaluation of your medical history is necessary to determine if you are a good candidate.

  • Unexplained infertility
  • Secondary infertility
  • Luteal Phase Defect
  • Amenorrhea/Dysmenorrhea
  • Sperm Quality: Motility and Morphology
  • Immune Factors
  • PCOS
  • Endometriosis
  • Diminished Ovarian Reserve
  • Ovulation irregularities
  • Recurrent Pregnancy Loss 

WHAT ELSE DO YOU TREAT OTHER THAN FERTILITY?

Acupuncture may be effective as the only treatment used or as support or adjunct to other medical treatment forms in many medical disorders.

  • Digestive disorders: gastritis and hyperacidity, spastic colon, constipation, diarrhea
  • Respiratory disorders: sinusitis, sore throat, bronchitis, asthma, recurrent chest infections, allergies
  • Neurological and muscular disorders: pain, headaches, migraines, facial tics, Bell’s palsy, neck pain, rib neuritis, frozen shoulder, tennis elbow, various forms of tendinitis, low back pain, pelvic pain, sciatica, osteoarthritis
  • Post-surgical pain
  • Adjunct Cancer Care: nausea/vomiting, neuropathy, low platelet count, xerostomia (dry mouth), stress, pain, digestive complaints
  • Acupuncture is particularly useful in resolving physical problems related to tension, stress and emotional conditions (depression, anxiety, insomnia, nervousness, and addictions)
  • Acupuncture During Pregnancy: any of the above conditions are treated in our office with acupuncture, as well as hemorrhoids, recurrent urinary tract infections (UTI), itching, nosebleeds.
  • Preparation for birth: research shows acupuncture decreases medical interventions and time spent in labor
  • Attempting a vaginal birth after previous C-section

WHAT IS THE SCOPE OF PRACTICE OF AN ACUPUNCTURIST?

Acupuncture is provided by state licensed Acupuncturists (L.Ac.), which are required to hold a Master’s degree as an entry-level standard for professional practice in the U.S. prior to licensure.

In the state of California, a L.Ac. is considered a primary health care professional which has the ability to diagnose, prescribe and administer treatments. The scope of an acupuncturist’s license authorizes the holder thereof to engage in the practice of acupuncture, to perform or prescribe the use of acupressure, breathing techniques, exercise, heat, cold, magnets, nutrition, diet, herbs, plant, animal and mineral products, and dietary supplements to promote, maintain and restore health.

Music Therapy

The clinical use of music to reduce stress, pain, and promote relaxation is well documented and researched. RFC takes full advantage of the beneficial effects of music to counteract what our patients may experience during procedures. We work with music therapists who specialize in working with pain and stress management in the medical setting. At a patient’s request, we can provide music therapy sessions during procedures.

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