Acupuncture for IVF and Assisted Reproduction, 1st Edition

• Simplifies complex information into easily accessible and understandable material
• Explains reproductive anatomy and physiology from the perspectives of both orthodox medicine and TCM
• Explains the underlying basis of orthodox medical fertility tests and investigations
• Explores the pathology and aetiology of TCM syndromes
• Provides detailed information on how to take a fertility medical history and how to diagnose TCM syndromes
• Presents the evidence for the influence of various lifestyle factors on fertility and ART success rates
• Provides guidelines on how to regulate the menstrual cycle in preparation for IVF treatment
• Explains how common fertility-related conditions such as endometriosis, Polycystic Ovary Syndrome, thyroid disease, and male factor infertility affect ART success rates
• Explains how to adapt acupuncture treatment to different ART protocols
• Provides case history templates, algorithmic acupuncture treatment pathways and patient fact sheets

• Explains how to manage patients with complex medical histories
• Looks at Repeated Implantation Failure, reproductive immunology dysfunction, and recurrent miscarriages
• Explains how to support patients if their IVF is unsuccessful and how to treat patients during early pregnancy
• Examines ethical considerations relevant to fertility acupuncture practice

1. Subfertility overview

Introduction / Definition of infertility disorder / Prevalence of infertility / Major causes of subfertility from an Orthodox Medical point of view / Contributory subfertility factors: the Orthodox medical perspective / Causes of subfertility from TCM point of view / Reproductive history and development from an Orthodox Medical perspective / Reproductive history and development from a TCM perspective

2. Anatomy and physiology of the reproductive system: pre-requirements for conception

Functional anatomy of the reproductive system from an Orthodox medical perspective / Sperm and egg production / Reproductive physiology from an Orthodox medical perspective / Reproductive physiology from a TCM perspective

3. The magic of conception

Sexual intercourse / Sperm transportation up the female reproductive tract / Pre-fertilization sperm changes / Egg maturation and ovulation / Egg fertilization / Transportation of embryo down the female reproductive tract / Comparison of natural fertilization (in vivo) with ART fertilization (in vitro) / Embryogenesis / Implantation: the first communication between the mother and her embryo / Conception from TCM point of view

4. Orthodox medical tests and investigations: optimising patient care

The initial consultation / Tests and investigations overview / Tests and investigations- female / Tests and investigations- male

5. Investigations from a TCM Perspective

Medical and fertility history taking / Clinical observations / TCM syndromes diagnosis in subfertile patients / Basal Body Temperature (BBT) charting as a diagnostic aid

6. The fundamentals of ART

Introduction / Types of ART treatment / Pharmacological drugs used in ART / Embryo grading / Advanced ART techniques / The role of acupuncture in ART / Future advances in ART: a potential role for acupuncture?

7. Pre-conception care in preparation for ART

Weight / Smoking / Alcohol / Caffeine / Recreational Drugs / Medication / Environmental and occupational factors / Nutrition and supplementation / Exercise and rest / Stress / Relationship and sexual issues

8. Identification and management of conditions detrimental to IVF outcome

Tubal pathology / Ovulatory disorders / PCOS / Thyroid disease / Endometriosis / Unexplained subfertility / Secondary subfertility / Male factor subfertility / Regulating the menstrual cycle with acupuncture / Treatment planning: setting realistic goals

9. Acupuncture during ART

Treatment during IVF / Adapting treatment principles to natural IVF / Adapting treatment principles to mild IVF / Adapting treatment principles to Frozen Embryo Transfer (FET) / Adapting treatment principles to ovulation induction / Adapting treatment principles to IUI / Adapting treatment principles to egg donor IVF / Adapting treatment principles to surrogacy and gestational carrier / Adapting treatment principles to ZIFT/GIFT / Adapting treatment principles to IVM

10. Clinical issues during ART

Poor follicular development / Immature or no eggs / Suboptimal endometrial lining / No sperm / Fertilization failure / Poor embryo growth or growth arrest / Difficult embryo transfer

11. ART complications

Ovarian Hyper Stimulation Syndrome (OHSS) / Multiple gestation

12. Managing the patient with a complex medical history

Repeated Implantation Failure (RIF) / Miscarriages and pregnancy loss / Reproductive immunology / Reproductive immunology from TCM point of view / Implications for acupuncturists: to refer or not to refer?

13. The therapeutic relationship in acupuncture practice

Mutuality / Trust / Care / Challenge and performance / Return to mutuality / Measuring the success of acupuncture treatment / The effect of subfertility on patients / Legal and ethical considerations

14. Aftercare

Negative outcome / Positive outcome: healthy transition from subfertility to pregnancy / Acupuncturist’s self-care: saying goodbye to patients

Appendices

1. Templates

2. Basal body temperature (BBT) chart template and instructions

3. Investigation reference ranges at a glance

4. Fertility factsheets

5. Commonly used medications in ART

6. Medications known to adversely affect fertility

Glossary of Orthodox Medical Terms

Glossary of Traditional Chinese Medicine (TCM) Terms

Irina Szmelskyj, DipAc MSc MBAcC, Lead Clinician, True Health Clinics and Founder of The Fertility Foundation, Godmanchester, Huntingdon; Lecturer and MSc Supervisor, Northern College of Acupuncture, York; Guest Lecturer, University of Lincoln, Lincoln, UK, Lianne Aquilina, BSc Hons MBAcC ATCM, Lead Clinician, Founder Aquilia Fertility, Stamford, Lincolnshire; Acupuncture Clinical Supervisor, Guest Lecturer, Traditional Chinese Medicine in Fertility/IVF, University of Lincoln; Guest Lecturer, Northern College of Acupuncture, York, UK and Alan Szmelskyj, DO MSc AdvDipClinHyp FRSPH, Senior Clinician, True Health Clinics, Godmanchester, Huntingdon; Scientific Advisor, The Stress Management Foundation, Godmanchester, Huntington, UK