Midwest Reproductive Symposium

Me with Elizabeth Brown, the first “Test Tube Baby”

Midwest Reproductive Symposium International, June 6-9.

My goals in attending this conference were to:

  • Gather information helpful to my patients.
  • Meet attendee Elizabeth Brown, who was the first IVF baby (born in 1978).
  • Learn about Dr. Ali Domar’s latest research.
  • Pick up cool give always from vendors and exhibits.

THE PEARLS

Fertility Apps: Although I often feel that my patients are too reliant on fertility apps and on-line “support” groups, Dr. Ali Domar’s new apps for self-help fertility support are awesome. They are based on her many years of experience using Cognitive Behavioral Therapy (a form of talk therapy) with couples struggling with infertility. The app for women is called FertiCalm and the one for men is FertiStrong. They are fee and can be downloaded at www.FertiCalmApp.com. I tend to favor in person counseling, but these apps are truly impressive.

Genes and genetic testing: While science is racing ahead in this arena, there are differing views on the value of and indications for pre-implantation screening of embryos, based not so much on conflicting data, but interpretation of the data. Reproductive endocrinologists Dr. Richard Paulson and Dr. Richard Scott had a lively debate that included a discussion of the so called “mosaic embryos”, which have a mixture of normal and abnormal cells. If I understood them correctly, the decision to transfer a mosaic embryo should probably be done on a case by case basis.

Genetic Counselors: There were several “shout outs” to genetic counselors and how important they are in view of the increase in testing. For anyone looking for a career, as one doctor stated, “We don’t have enough genetic counselors”.

Interesting dessert!

Sperm quality and miscarriage: Research shows that sperm quality can adversely affect miscarriage rate, and sperm quality does decrease starting at age 45 or 50. A tool on the wish list for RE’s would be a microscope that could visualize the DNA in a sperm without having to open it up and therefore render it unusable. It was one speaker’s opinion that sometime in the future this microscope will be invented.

QUESTIONS I GOT ANSWERED

I often ambush speakers after their presentations to ask them questions that are related to their area of expertise and involve information I often discuss with my patients.

Can endocrine disruptors such as BPA which we are exposed to through plastics, influence the development of endometrioses ? Is there any point in trying to avoid exposure ?

For this question, I ambushed Dr. David Adamson, a reproductive endocrinologist from Stanford who has special expertise and experience in treating endometrioses. He was totally on board with the idea that the endocrine disruption of plastics could be a contributing factor in endometrioses for some individuals. It was good to hear his answer, since as my patients know, I have been preaching for years about the importance of cooking with and eating from glass and stainless steel, as well as avoiding personal care items that contain harmful chemicals.

Why aren’t more of my male patients with varicoceles referred for corrective surgery since it has been shown that many men go on to father children after the problem is corrected? (A varicocele is like a varicose vein in the scrotum that can negatively affect sperm quality)

I didn’t have to ambush Dr. Rodrigo Pagani for this answer as I attended his workshop which was a small group. As a urologist at the University of Chicago and team member at INVIOS, he indicated that he has the same question. He is supportive of “working up” the man when there are male issues rather than going straight to IVF. He said that there probably are men who should be evaluated for surgery if there is a varicocele, and are not being referred. There is even some evidence that correcting the varicocele could positively affect a man’s future health. But he added that unless the varicocele is palpable on exam or painful, surgical correction is not suggested. I also asked him:

Does marijuana have a negative effect on sperm health ?

Dr. Pagani was quick to say YES. Marijuana can cause DNA fragmentation in sperm. It also converts a man’s testosterone to estradiol, which can disrupt endocrine function. With the increasing legalization of marijuana, it will be interesting to see if fertility rates are indeed impacted in users.

Another interesting dessert!

Is CoEnzyme Q10 helpful for enhancing egg quality ?

Dr. Doody said “yes”, probably because this body enzyme increases “ATP” which facilitates the movement of chromosomes between cells as they divide. He said that women under age 36 probably do not need this help. A 400-600 mg dose per day is good, although divide it, because only 200mg can be absorbed at once. Sperm parameters seem to improve with the CoQ10 as well. I was impressed with one of the CoQ10 vendors at the meeting if anyone wants to contact me about that info.

It was nice to hear again that:

Anti-depressants in the SSRI category seem to be generally safe in pregnancy, although some data show there may be some issues. However, Paxil was an exception however and is considered unsafe in pregnancy so it is best to talk with your doctor about switching to a different medication before conceiving if you are taking Paxil (Dr. Marcelle Cedars, UCSF).

Vitamin D levels, pre-conception Vitamin D levels, of greater than 30ng/ml may help to increase pregnancy rates and decrease miscarriage rates. (Dr. William Kutteh)

The National Fertility Support Center, which seeks to educate people about donation of embryos currently has a grant to help with some of the costs of adopting an embryo. Debra Peters, the executive director, said that they are unsure about how long the money will last.

Summary

I left the conference with the same feeling I always leave these conferences with—a sense of sadness at the huge industry that has grown up around the need for fertility services. The large hall of exhibitors and vendors offering eggs, sperm, medications, options for genetic testing, financing, equipment needed for IVF, etc. is overwhelming. I am sad because I think of how my patients grew up assuming when they were ready to start a family it would not be this hard, expensive, and complicated. But given the reality of fertility challenges, I am happy that knowledge and options are increasing.

First Annual Walk of Hope for Infertility Awareness

Staff members from the Froedtert and Medical College Wisconsin Reproductive Medicine Department.

The First Annual Milwaukee Walk of Hope took place at the Kettle Moraine State Park on September 30, 2017. The purpose was to raise infertility awareness as well as funds for RESOLVE, the National Infertility Association. More information about the organization can be found at Resolve.org.

It was a beautiful day for walking and this event afforded me the opportunity to meet some members of the amazing team from the Department of Reproductive Medicine at the Medical College of Wisconsin. Although we have referred patients to each other throughout the years, I had not met many of the staff face to face. It was truly heart-warming to see this dedicated group of professionals come out on a Saturday to support their patients and this great cause.

It happens that I attended two other fundraisers a few days later. The Breast Cancer Pinktacular Fashion Show was held at the Italian Community center on October 5th, and it was truly awesome to meet so many survivors and their supporters. That night I went down to the 6th Street Community Health Center fundraiser which included incredibly good food from Downtown Kitchen, a line dancing demo by the patients enrolled in the diabetes management program, and a “Roast” of the Bucks president Peter Feigin. The best part was seeing dear friends that I worked with during my time as an RN at the clinic. I have been to many charity events throughout the years, but this year all three events seemed to have a level of energy and enthusiasm that I have not seen in a while at charity events. Perhaps at this time of tension in the world, it is a reflection of people really wanting to pull together and give help where help is needed. I hope so.

Choosing Your Team

I was disturbed by a recent brochure I received from a medical marketing company targeting Reproductive Endocrinologists. The company offers to help reproductive endocrinologists ”Fight back against aggressive competition, win at digital marketing, make new locations more profitable, increase revenues consistently, and increase your IVF volume”. Fourteen deliverables were mentioned, none of which mentioned attracting patients by providing great care, which many of the RE’s that I know do indeed provide.

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As you whole-heartedly seek to have a baby, I am saddened by the idea that you are treated as a commodity to be captured. But with the money that people spend each year on fertility care ( 2 billion dollars) the reality is that many practitioners and professionals have built their careers around your business. In addition to Reproductive Medicine Centers, entities wanting your business include “Attain” type insurance programs, fertility coaches, sperm banks, and yes, acupuncturists.

So to assemble the best team of practitioners, rather than be directed by search engines to slick websites, I have a few suggestions for you.

Many of my patients do indeed cautiously vet the doctors they ultimately choose. Others are understandably overwhelmed by the choices.

Here is my advice on sorting through the myriad of practitioners and services offered:

  1. Educate yourself about a doctor’s work. Many of you know that fertility clinic’s success rates can be checked through the data bank of the Society for Assisted Reproductive Technology ( SART.org) But I think you also probably know that statistics cannot always tell you what you as an individual need to know, and which statistics actually apply to you. The stats on SART cannot always tell you which doctors you will connect with and have confidence in, and receive personalized care.
  2. If you do want to research the methods or protocols a doctor uses, remember that the mountains of information on the internet are truly a force to be tamed. Stay out of the “rabbit holes” of articles that you may think apply to you, but that actually may not. If you find information that you think applies to you, do not hesitate to ask your doctor about it. A good doc will discuss whether the information applies to you without making you feel bad for asking.
  3. If you do spend time researching articles on the internet, stick to sites associated with accredited medical centers and peer reviewed journals. Even those can misstate or endorse medical information that is not solidly proven. A good basic set of questions, answers and fertility information can be found on a site maintained by the American Society for Reproductive Medicine: reproductivefacts.org. I often follow Google word searches with the word NIH.gov, to more quickly access articles in peer reviewed journals. But if you do look at academic sites, be prepared to assume you may not understand all of the information or may misinterpret it.
  4. Assemble your “team” of practitioners based as much on personal references as “stats”. Slick websites and brochures are inanimate marketing tools and in my opinion, are outweighed by the experiences of real people that you might know. Checking for personal references applies to doctors as well as acupuncturists.
  5. Once you have assembled your team, TRUST them. Try not to second guess and check on everything they do. This does not mean that you don’t ask questions about anything at any time. If knowing the “why” of something that is being done or prescribed, will help you relax, do not hold back. If you choose to get second or third opinions if you have not conceived, know that caring docs (as opposed to those who see you as a commodity) are supportive of additional consults. Your doctors want you to have every chance at having a baby. My doctor husband always welcomed the idea of patients getting a second opinion, to make sure he was right or had not missed something.

There are several sites and blogs where people going through fertility treatment can post information on their experiences with fertility doctors. FertilityIQ.com is one of the sites and has well done articles on a variety of topics including how to pick an IVF doctor. However, when looking at rating systems, realize that sometimes a doctor is very skilled and caring, but perhaps was the first person to present information that was difficult to hear. When a doctor may have said that a donor egg or donor sperm will provide the best chance of bringing a baby home soon, this can be very hard to hear even though it may be statistically true. What the doctor may have heard was that a patient has been trying for several years, and is close to empty on money and emotional reserve. So the doctor may have been inspired to present donor options, without really intending to inflict emotional pain that can surface when a patient has not previously considered this option.

In the future, I intend to write about how to determine what alternative and complementary methods may or may not enhance your fertility, and how to evaluate specific types of practitioners.

In the meantime, keep moving forward on your great goal of having a baby.
Jane

Reproductivefacts.org, found on the American Society of Reproductive Medicine website
FertilityIQ.com, an independent site with Fertility articles and information
SART.org, the site that contains a data bank for fertility clinic success rates.

My Souvenir Thoughts For You From Italy

In May I went on a ten-day bicycling trip through Puglia, Italy. The area is located on the “heal of the boot” and is considered the undiscovered coast of Italy. I biked on narrow rural roads along the Adriatic Sea past miles of two thousand year old olive trees and Roman ruins. I had forgotten how silence, fresh air, and blue skies can reduce stress and inspire creative thoughts.

I did not plan this vacation to escape from my busy practice of acupuncture for infertility. I love my practice and always feel a renewed commitment to my patients when I return from a break. On my travels, I look for new ideas and thoughts I can share with couples seeking acupuncture for infertility. For example, on my trip to Japan I searched all over Kyoto for a Buddhist Temple with a special “chapel” housing a statue of a fertility goddess that women visit to pray for pregnancy and a baby. When I asked permission to enter (only one person at a time is allowed in) the Buddhist monk looked at me quizzically, no doubt wondering if I really thought I could conceive at my age. I did not try to explain in Japanese that I was there on behalf of my acupuncture for infertility patients. Although I am sure Google Translate could have come to the rescue.

Back to Italy and the souvenir thought I brought back for my acupuncture for infertility patients: There were some tough hills to ride up on some days. Normally I walk my bike up in these situations, unconcerned about fellow riders cruising past me. But I was determined to ride up the last hill of the trip—a 6% grade for one solid mile. Before I got to the hill that day, the young Italian tour guide took me aside and said, “I’ve been watching you ride up hills. You attack them. Don’t attack them. Don’t fight them. Just put your bike in low gear and peddle as easily as you need to”. I truly had been pushing myself so hard that I would arrive at the top of even small hills exhausted and not enjoying the ride. So for this last incline I put the bike in the easiest gear possible, breathed slowly, and focused on the blue sky instead of the hill in front of me. I made it.

And then it came to me. Many women that I have the pleasure of helping have had to push SO hard to try to conceive. They have had to fight to get their body to ovulate, fight with insurance companies to cover costs and attack the many emotional potholes on the road to conception.

My patients have heard me describe how in the United Kingdom, medical practitioners do not use the verbage “get pregnant”. Their obstetrical case histories will read that a woman “fell pregnant after three rounds of Clomid”. In French, the phrase for conceiving is “tromber enciente” from the French verb tromber, which means to fall. The imagery of “Getting” verses “Falling” pregnant illustrates the importance of not fighting and attacking the process of trying to conceive. Eastern medicine and acupuncture for infertility encompasses many strategies but one of them is to reduce tension so that our “Qi” or life force can flow and a woman can “fall” pregnant. Yes, conception is basically about sperm meeting the egg, but because conception does not occur reliably, it seems logical to me that that how we “fall pregnant” still involves an element of mystery.

So this is the souvenir thought I have brought back from Italy for my patients. Try to reduce the noise in your life, walk (or ride) in nature. Experiment with riding in the lowest emotional gear possible. Trust the medical team you have chosen, and above all, keep trusting in yourself and your ability to fall pregnant.

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Jane Gleeson
Acupuncture for Infertility and Lifestyle Coaching for Conception

Summit on Environment, Reproductive, Nutritional and Genetic Factors Affecting Reproduction

In my acupuncture for fertility practice I have been talking with patients for years now about the hormone disruption caused by environmental chemicals, as well as how nutrition affects reproduction. So I was eager to attend the March 5th Environment and Reproductive Science Summit 2016  in Dallas and to share what I learned.

This conference was sponsored by the American Society for Reproductive Medicine, The Society for the Study of Reproduction, and the Society of Reproductive Biologists and Technologists. The presenters and the attendees were MD’s who do IVF, as well as accomplished researchers in the area of reproductive biology and technology.

I thought that I might be the only practitioner who does acupuncture for infertility at the conference, but I was delighted to see MD and mentor, Dr. Sadhna Singh, who was trained in Obstetrics and Gynecology, and practices acupuncture for fertility in Houston , Texas.

I knew that I would return with more questions than answers, and with frustration that many of the findings cannot yet be clinically applied. Indeed, much of the research has not been published yet. But the direction of the data definitely supports the dreadful fact that as a species our fertility may be declining and we are possibly headed toward the need for more assisted reproduction. Attending the conference also validated my efforts for the last twelve years at educating my patients in regard to limiting exposure to endocrine disrupting chemicals.

Researchers from Harvard, UCLA, UCSF, etc., and the National Institute of Health presented information on male and female fertility that was gathered from original research in humans and animals, as well as from surveys and retrospective studies. The focus for all of the studies was Environmental, Nutritional, and Genetic Factors Affecting Reproduction. The endocrine disrupting chemicals, or EDC’s that were discussed included those that come from plastics, pesticides, polluted air, and personal care items.

Scientific “pearls” and notable information included:

  • Components of plastics are “covalently unstable” which means they do indeed leach out of items and enter the human body.
  • Organic diets significantly reduce levels of pesticides in our bodies.
  • Some endocrine disruptors such as the fungicide vinclozolin causes “Transgenerational epimutations”. This means that the negative affects of the fungicide are passed on to at least three generations of offspring.
  • Phthlates, used to soften plastics, caused a decrease in sperm and genital malformations in mice.
  • BPA (bisphenol-a) used to harden plastics, caused meiotic (cell division) errors and spermatocyte (early sperm cell) loss.
  • Endocrine disruptor exposure in mice affected timing of puberty, weight, and gene expression in mice.

Information from surveys included a presentation from a researcher at the National Institute of Health who profiled the ENDO, Life Study and the Oxford Conception Study which show a connection between stress and fertility. It is important to remember that showing an association is not the same as showing cause and effect.

In an effort to present balanced information, I must tell you that not everyone in the scientific community believes that there is enough evidence to supporting a clear connection between exposure to environmental chemicals and endocrine disruption that impairs fertility. But better safe than sorry, and if we cannot eliminate all of the exposure around us, why not limit our exposure as best we can? Drink, cook, eat, and store in glass and stainless steel. Use lotions, potions and personal care products that do not have endocrine disrupting chemicals in them. Reach for the baking soda and vinegar for cleaning. I have shared with all of you that have come to my office for fertility acupuncture, the literature from the UCLA Center for Reproductive Health and the Environment.  Their pamphlet will give you information on finding products without potentially dangerous chemicals in them.

The speaker I truly wanted to hear was Dr. Jorge Chavarro, from Harvard. He is an MD and a nutrition researcher, and I have lent many of you the book he wrote with Dr. Walter Willet, The Fertility Diet. He presented data on the association between high pesticide exposure and low sperm count and plastic exposure and low birth weight. But finally there was some good news (and things we can do) from a presenter: Omega-3 fats from fish result in higher sperm counts and higher mono-fat intake  (olive, peanut, almond, sunflower, safflower oil, avocados) is associated with higher birth rates. He did add that he was disturbed by one of his recent findings: evil “transfats”, aka, partially hydrogenated fats can still be found in men’s sperm even though it has been largely eliminated in the food supply.

Attendees asked many hard questions of the presenters, such as does the IVF process expose embryos to potentially harmful chemicals, and if so, what is the affect ?  Of course you can imagine that the answer was a big fat “We don’t know”. However some researchers are looking at epigenetic, chromotin, and mitochondrial dysfunction (things related to gene function) in regard to the IVF process. If all this seems alarming or confusing, remember that it is a good thing that these issues are being looked at, because it ultimately may be a step to improving the process, safety, and outcomes of IVF. And the bottom line is that every year I get amazingly beautiful Christmas card photos of perfect, beautiful babies.

If any of you would like to talk with me about the conference, do not hesitate to call or e-mail.  

Jane Gleeson 

Jane Gleeson Infertility Acupuncture Wisconsin, Milwaukee

Jane Gleeson Infertility Acupuncture Wisconsin, Milwaukee

Happy Allomothers’ Day !

Allomothering is a phenomenon observed in animals, particularly monkeys, elephants, and birds. “Allo” is a Greek pre-fix meaning “other” and allomothering refers to nurturing behaviors performed by adults who are not the mothers of the infant they are helping, and are acting as “other mothers”.  Allomothering includes such behaviors as carrying, touching, nursing, and protecting. These activities are performed by males and females.  Animal scientists believe these helpful activities give a respite to the mother, help the infant mature faster, learn valuable social skills, and pass on important mothering skills to the infant.

I have the pleasure of knowing so many wonderful “alloparents’ who as aunts, uncles, or good friends have enriched the lives of the children they know.

HAPPY ALLOMOTHERS DAY TO YOU ALL !

Jane Gleeson Infertility Acupuncture Wisconsin, Milwaukee

 

Jane Gleeson is now a Clinical Instructor for the Medical College of Wisconsin

imagesI was very pleased in September to become a clinical instructor for the Medical College of Wisconsin.  This position involves mentoring first year Internal Medicine residents who are doing a Womens’ Health rotation at the Milwaukee Veterans’ Hospital.  The residents spend time in my clinic, and have the opportunity to learn about the Eastern approach to womens’ health.  Many of my patients are seeking acupuncture for infertility, so it has been my role to explain to couples how and why acupuncture can help with infertility.  Since many people ask their doctors about whether acupuncture might be helpful for infertility and other womens’ health issues, bravo for the Medical College of Wisconsin for giving residents the opportunity to learn about complementary medicine.

 

Importance of a Father’s Diet

CheeseballsWhen I meet with a woman seeking acupuncture for infertility, I emphasize the importance of including her spouse or male partner in our two hour session. This is because in addition to information about acupuncture and infertility, I share a lot of information about nutrition and how the nutritional status of both the man and the woman affects fertility and the health of the baby.

Scientific studies have shown that the offspring of male mice who were fed low nutrition diets had more neurological, developmental, and psychological disorders than the control group who were fed a more nutritious diet.

Human studies on pre-conception and pre-natal nutrition are equally interesting. Although it has been shown that a women’s lack of folate (B9) may be responsible for brain and spinal cord defects in a baby, research indicates that a man’s lack of folate can result in passing on damaged DNA and RNA via his sperm. “We should be looking carefully at the way a man is living his life”, said study author and reproductive biologist Sarah Kimmins of McGill University.” “Environmental exposure is remembered in the developing sperm and transmitted to offspring.”

Other things in a man’s life, such as high fat and stress, have also been shown to possibly affect fertility and the health of a child.

Sharing information on some of these issues has been rewarding in my acupuncture and infertility practice, as I see so many women who feel that because they “carried” the baby, they are solely responsible for any miscarriages or defects.

We all know of people with unhealthy lifestyles who break all the rules and become pregnant anyway. This is because conception, like birth, is complex and miraculous. In my acupuncture practice I try to help couples struggling with infertility to embrace this fact and just keep going forward, not trying to achieve perfection, but doing the best they can.

 

I was in a room with the happiest person in the world!

Dalai LamaOn May 15th I attended the “Change your Mind, Change the World” conference in Madison.  “Thought leaders” from around the world discussed how economics, environments, and healthcare combine to make the world a happier, healthier place. The honored guest was the Dalai Lama, who indeed seems like a very happy person. He and many Buddhist monks practice mindful meditation on a regular basis, for hours at a time. Matthieu Ricard, a French Buddhist monk and a protege of the Dali Lama also attended the conference.

This year he was deemed by scientists to have scored “off the charts” in regard to his left pre-frontal cortex activity, “giving the monk a huge capacity for happiness.”  Since most of us do not have the luxury of having a few hours each day to meditate, it was indeed good news to hear that recent research has shown that even 15 minutes a day of meditating can show positive results in regard to positive health and well-being.
Personal happiness is affected by many factors, like economics and physical health. More of the panelists thoughts on this can be found at:  http://www.huffingtonpost.co.uk/richard-layard/why-happiness-should-be-a-global-priority_b_2900256.html

More Evidence that BPA is an Endocrine Disruptor, and May Affect Infertility

A new study on fetal exposure to bisphenol-A (BPA) completed by Washington State University geneticist Dr. Patricia Hunt, and published in the Proceedings of the National Academy of Sciences, has revealed that exposure to this plastic additive can cause denseness in the mammary tissue. Dense mammary tissue has been linked to an increased risk of breast cancer.

Although the study was completed on monkeys, and not humans, it exposes yet another issue that may have serious implications on fertility. That is, this is more evidence that BPA disrupts the processes of hormones and the endocrine system.

During your first visit, I will teach you how to eliminate BPA from your life in as many ways as possible, which will help enhance your fertility and increase your chances of becoming pregnant.

To read more about my approach to acupuncture and fertility, click here.