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Written by:  Carol McGarrahan
Date: July 1, 2009

Shannon Thornburg and her husband, John, of Durham, endured a host of fertility issues prior to conceiving twins who are now 11 months old. The Thornburgs’ treatments began with surgery for a varicocele, which is an enlargement of the internal spermatic veins that can cause male infertility. Then there was surgery for uterine fibroids, the crushing loss of a miscarriage at 13 weeks, a miscarriage of another baby, and finally, a cycle of in vitro fertilization that resulted in the birth of their twins.

Shannon Thornburg says cognitive behavioral counseling and relaxation techniques she practiced with Julia Woodward, Ph.D., who counsels patients at the Duke Fertility Center, were invaluable in helping her through the process and continue to assist her today in dealing with daily stressors. Thornburg also underwent acupuncture during her cycles of in vitro fertilization. She says she figured it would do no harm, and might help.

Fertility and complementary medicine

One in eight couples in this country will cope with infertility, according to the 2002 National Survey of Family Growth. And more of these couples are turning to traditional Chinese medicine techniques such as acupuncture, often in conjunction with Western medical treatments, to enhance fertility and reduce stress.

A February 2008 article in the British Medical Journal reported preliminary evidence that acupuncture given with embryo transfer resulted in improved pregnancy rates and live birth in women receiving in vitro fertilization. In vitro fertilization, or IVF, is a commonly used treatment that involves retrieving a woman’s egg, fertilizing the egg in the laboratory, and then transferring the embryo back into the woman’s uterus. Although Western medical practitioners say more evidence is needed, fertility clinics appear more open to the use of acupuncture in conjunction with medical treatments like IVF.

“We focus on the fact that alternative methods can be helpful with stress reduction,” says Susannah Copland, M.D., assistant professor in the Division of Reproductive Endocrinology and Fertility at Duke Fertility Center. “There is early literature suggesting that acupuncture might be beneficial for actual fertility — but there are not a lot of randomized studies to confirm that,” she adds.

The Duke Fertility Clinic refers patients to Duke’s Center for Integrative Medicine for therapies such as yoga and massage.

Infertility is defined as the inability to conceive after one year of unprotected intercourse (six months if the woman is older than 35) or the inability to carry a pregnancy to live birth. That diagnosis, as well as the medical treatment for it, can put women (and couples) into a huge tailspin, particularly if the fertility challenges remain unexplained and unresolved for long periods of time. Women often end up feeling frustrated, hopeless and isolated as they watch their peers effortlessly become mothers.

“The combination of acupuncture and the cognitive behavioral work with Dr. Woodward really helped me personally and not just with fertility,” Thornburg says. “The acupuncturist treated a lot of points to increase blood flow to the uterus along with relaxation points. It really helped with morning sickness. I went all the way into the third trimester until it became too uncomfortable to lie still that long.”

Woodward says women are interested in services such as yoga, nutritional counseling and acupuncture. “Our patients really want those types of services, and they certainly help our patients cope and feel better along the way.”

Coping with stress

No matter which type of treatments couples choose, fertility issues are stressful. Thornburg’s suggestion to others on this path is that there is no shame in asking for help through the process. “You are going to the doctor all of the time and you feel as a woman that this is supposed to be such a natural thing, and for you, it’s not.”

Woodward at the Duke clinic says couples should admit that they are truly in a hard situation. She offers these stress reduction tips:

- Reach out to family members, friends or counselors.
- Find a support group.
- Use stress reduction techniques such as yoga, meditation, journaling, mindfulness, progressive muscle relaxation or guided imagery.

“People need to be sure to take some sort of look at what they have done to provide themselves with peace and make that an active, planned for part of their week,” Woodward says. She also suggests couples plan in advance points along the way when they might stop treatment and review their options.

Retreats for the fertile soul

Randine Lewis, author of The Infertility Cure and The Way of the Fertile Soul, offers retreats for women experiencing fertility challenges. Retreats include an introduction to traditional Chinese medicine and an evaluation of the various energetic components that may impact fertility.

Lewis, who has a doctorate and a master's of science degree in Oriental medicine, has studied both Western and Eastern treatments for reproductive health and provides education and information in the hope that she can create a shift in attitudes for women. She likes to detour from the problem-oriented “what is wrong with me” view of fertility toward recognizing and overcoming impediments to fertility.

“Chinese medicine is completely based in finding balance in the body, mind and soul,” she notes. “And when that is achieved, oftentimes the natural expression of fertility is the result.”

Lewis does not discount anatomical manifestations of fertility issues, but says it is important to have a complete view of a person, rather than just focus on one physical problem.

Advances in IVF offer more options

Recent advances in Western medicine have increased the options and success for couples with fertility challenges. Temer Yalcinkaya, M.D., assisted reproductive technology director at the Wake Forest University Center for Reproductive Medicine, notes recent advancements in IVF including:

- The ability to screen embryos for diseases such as cystic fibrosis and sickle cell prior to implantation. Preimplantation genetic diagnosis has been growing in availability since it was first reported in the 1990s. Some labs nourish the embryo for a longer period prior to transplantation to achieve what is known as the “blastocyst” stage, which occurs at day five. This practice is not widespread because some labs do not have the capability or are not comfortable with the technique.

- Improved freezing techniques allow for more success in preserving eggs, ovarian tissue and embryos. A new vitrification, or rapid freezing, technique enables physicians to freeze tissue in a manner that is less damaging to the cells. This option is particularly helpful for women with diseases like lupus, vasculitis or cancer who want to preserve tissue for future use.

“These advances in offering fertility preservation to patients who will be getting chemotherapy have really come to the surface in the past two years,” says Copland of the Duke Fertility Center. “Oncofertility, offering fertility preservation to patients anticipating chemotherapy, became high profile two to three years ago, and we are still working hard to get the word out about the availability of fertility preservation options.”

Both Duke and Wake Forest have good IVF success rates. Given ethical, financial and age-related concerns unique to IVF, it’s best for prospective patients to look at clinics and data based on their individual needs. The Sociey for Assisted Reproductive Technology provides success rates at clinics nationwide at www.sart.org.

Attitude and support

No matter where people seek help, it’s important for patients to feel validated and uplifted during this difficult process

“Our philosophy is to work as a team to make this as smooth and successful an experience as possible for the patient because we recognize this is a stressful event and work for the highest success for the patient,” Yalcinkaya says.

Missy Durkin of Charlotte, who went to several clinics before seeking help at the Wake Forest Center for Reproductive Medicine, says she never felt comfortable until she went to Yalcinkaya.

“In my experience, when you go through infertility, especially unexplained infertility, it can really leave you lacking in confidence,” Durkin says. “I needed a team of people with that sense of a positive attitude that this can happen, and I never found that until I got to Dr. Yalcinkaya.”

Lewis, who offers the fertility retreats, says hope is crucial. “What I try to do at retreat is bring people to an inherent feeling of hope.”


Infertility Facts

* Infertility affects 7.3 million people in the U.S., or one in eight couples. (2002 National Survey of Family Growth)

* Approximately one-third of infertility is attributed to the female partner, one- third attributed to the male partner, and one-third is caused by a combination of problems in both partners or is unexplained. (American Society for Reproductive Medicine, www.asrm.org)

* A couple ages 29 to 33 with a normal functioning reproductive system has a 20 to 25 percent chance of conceiving in any given month. (National Women’s Health Resource Center)

* After six months of trying, 60 percent of couples will conceive without medical assistance. (Infertility As A Covered Benefit, William M. Mercer, 1997)

* Approximately 44 percent of women with infertility have sought medical assistance. Of those who seek medical intervention, approximately 65 percent give birth. (Infertility As A Covered Benefit, William M. Mercer, 1997)

* Approximately 85 to 90 percent of infertility cases are treated with drug therapy or surgical procedures. Fewer than 3 percent need advanced reproductive technologies like in vitro fertilization (IVF). (www.asrm.org)

* The most recently available statistics indicate the live birth rate per fresh non-donor embryo transfer is 28 percent. (Assisted Reproductive Technology Success Rates, U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2005)

Source: RESOLVE: The National Infertility Association

Carol McGarrahan is a health writer who lives in the Triangle.



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