Preparing For Pregnancy Part 2: Your Eggs and What Research Says
Preparing for Pregnancy Part 1 covered how Chinese Medicine (primarily acupuncture and herbal medicine) could help you prepare for pregnancy. This post continues with evidence based information.
The Lifespan Of Your Eggs
According to the American College of Obstetricians and Gynaecologists (ACOG), a womb-bearing fetus typically has around 6–7 million eggs at 20 weeks of gestation, dropping to 1–2 million at birth. The average womb bearer has approximately 300,000-500,000 eggs when puberty begins. Though about 15-20 follicles are recruited beforehand, during ovulation, usually only one mature egg is released. Through natural cell death, approximately 1000 are lost each month. This number increases with age. Unlike other cells in our body, eggs do not regenerate. This is considered part of our Jing, in Chinese Medicine —the genetics we are born with. Though some parts of our health can be improved with lifestyle modification, much of our jing is what it is— consider how your eye color cannot be changed because you were born with it. This is one of the reasons why in Chinese Medicine, there is a larger emphasis on maintaining health and the prevention of illness as treatment. Jing is something to be protected, conserved and preserved throughout your life. Receiving acupuncture and taking herbal medicines can improve jing to an extent, but not without practices of rest and self care. There are no quick fixes or hacks in Chinese Medicine, despite what some people will try to sell you. This is why learning to be in tune with your body and what it’s asking you for is so important especially when it comes to planning for conception.
When considering pregnancy, the egg you hope to be fertilized, has been developing in you months before its released from the ovary. This is why it is recommended by many fertility specialists to begin preparing for conception a minimum of 3 months before you even begin trying. In Chinese Medicine, we often examine patterns that can be found in your menstrual cycle. The regularity and health of your menstrual cycle is an indicator of your fertility. When your cycles are balanced and healthy it indicates that your body is functioning optimally and your hormones are in balance. Egg quality and quantity are often used to determine likelihood of conception in Western Medicine, however too many people are told their menstrual cycle irregularities are normal and are only offerred a few solutions. This is where Chinese Medicine can really help you! Though there are tried and tested protocols in Chinese Medicine for fertility, we also are trained to look at the larger picture of an individual, their constitution, their unique presentation at the time, medical history as well as environment and lifestyle.
What Does Research Say About Acupuncture and Fertility?
A 2016 systemic review by Yi et. al determined that acupuncture improves clinical pregnancy rates in those undergoing IVF. Additionally, IVF outcomes were significantly improved when patients received acupuncture during controlled ovarian hyperstimulation.
A Pilot Randomised control trial in 2016 (Cochrane et. al) compared regular acupuncture treatments prior to concept compared with lifestyle modifications. For those that received acupuncture their fertility awareness and self reported well being improved. Those that received acupuncture and conceived during the trial did so in half the time compared to those who only underwent lifestyle changes without acupuncture.
In 2018 (Hullender Rubin et. al) an overview of current evidence was completed and determined that several acupuncture visits can improve the endometrial lining and reduce stress.
A quantitative study in 2019 by Çoksüer et. al concluded that acupuncture before and after embryo transfer greatly improved fertility results in those undergoing IVF.
Yun et. al’s 2019 review showed that any acupuncture or Chinese medicine intervention showed significant improvements in fertility and in cases of conditions like tubal, annovulation or PCOS. It also showed improvements in ovulation rates and endometrial thickness. It was additionally mentioned that acupuncture was associated with less adverse effects.
Recommended Frequency of Treatment
Starting regular acupuncture treatments as soon as possible is important. You should begin at least 3 months before you intend to get pregnant. Begin 6 months before, if you have menstrual cycle imbalances or irregularities. According to multiple studies it is recommended to have acupuncture a minimum of 1x a week as you are preparing for pregnancy. During IVF, expect to have acupuncture 1-2x a week during follicular recruitment, twice on the day of your embryo transfer (right before and right after transfer) and twice during your two week waiting period. Conditions like endometriosis, PCOS or fibroids may require more frequent treatment.
Though it is great to have evidence based research to support acupuncture, it is also important to understand that acupuncture treatments are tailored to an individual’s constitution and unique situation while many studies look at groups of people with predetermined similarities. This type of research does not always give accurate findings when it comes to individualized medicines but we can also consider that if treatments were better tailored in all studies that the results might even be more favorable. Additionally, most clinical trials acupuncture regarding fertility are conducted with those who are undergoing IVF. It is additionally helpful to consider all of this information contextually and know that the use of acupuncture and herbal medicine has been used for many years and is continually being used as complete systems of medicine in other countries for much longer than our current modern medicine model. This in itself, is evidence of its efficacy. There are a great number of studies outside of the ones I mentioned and cited here. Gathering information from multiple relevant sources whether they be experiential, ancestral, from another culture or evidence based research is important when it comes to healthcare decision-making.
Written by Dr. Emily Siy, DACM 1/2/2023
Photos by Chanel Matsunami Govreau, models Trevania Layne and Lisa Bacon with robes and blankets courtesy of Kitara
PREVIOUS POSTS you might find helpful on this site: Preparing For Pregnancy with Acupuncture and Herbal Medicine, Pelvic Steaming Awareness, Racial Injustices in Medicine and Uterine Fibroids, Birthing With Doula Support, 5 Things You Should Know About Vaginal Steaming
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Sources:
Cochrane S, Smith CA, Possamai-Inesedy A, Bensoussan A. (2016) Prior to Conception: The Role of an Acupuncture Protocol in Improving Women's Reproductive Functioning Assessed by a Pilot Pragmatic Randomised Controlled Trial. Evidence Based Complementary Alternative Medicine. 2016;2016:3587569
Coksüer, H., Barut, M.U., BozkurT, M., Agacayak, E., Sak, S., Demir, M., Calıskan, E. (2019) Acupuncture Enhances Chances of Pregnancy in Unexplained Infertile Patients Who Undergo A Blastocyte Transfer in A Fresh-Cycle Chinese Journal of Integrative Medicine April 25 (4): 298-302
Hullender Rubin, L.E., Anderson, B.J., Craig, L.B. (2018) Acupuncture and in vitro fertilisation research: current and future directions. Acupuncture Medicine Apr;36(2):117-122
Lawson CC, Whelan EA, Lividoti Hibert EN, Spiegelman D, Schernhammer ES, Rich-Edwards JW. (2011) Rotating shift work and menstrual cycle characteristics. Epidemiology May;22(3):305-12
Medical News Today, How many eggs does a woman have? https://www.medicalnewstoday.com/articles/how-many-eggs-does-a-woman-have#fertility-at-40
Qian Y, Xia XR, Ochin H, Huang C, Gao C, Gao L, Cui YG, Liu JY, Meng Y. (2017) Therapeutic effect of acupuncture on the outcomes of in vitro fertilization: a systematic review and meta-analysis. Arch Gynecol Obstet. 2017 Mar;295(3):543-558
Szmelskyj, Irina & Aquelina, Lianne (2015) Acupuncture For IVF and Assisted Reproduction Churchill Livingstone Elsevier
Yun L, Liqun W, Shuqi Y, Chunxiao W, Liming L, Wei Y. (2019) Acupuncture for infertile women without undergoing assisted reproductive techniques (ART): A systematic review and meta-analysis. Medicine (Baltimore). Jul;98(29):e16463
Web MD, Infertility and In Vitro Fertilization https://www.webmd.com/infertility-and-reproduction/guide/in-vitro-fertilization