What is In vitro Fertilisation?
In vitro fertilisation (IVF) refers to the fertilisation of an egg outside the body. During IVF, the woman’s menstrual cycle is monitored closely, so that medications can be given to ensure optimal follicular growth and to retrieve the eggs at the point of maturation before they are released from the ovaries. The retrieved eggs are combined with sperms in the laboratory to achieve fertilisation. The fertilised eggs are then allowed to grow for a few days before being transferred into the woman’s uterus.
For some, IVF is the last resort in terms of fertility treatment. However, IVF is also widely used for many infertility conditions, such as blocked or damaged fallopian tubes, pelvic adhesion, severe endometriosis, advanced maternal age, abnormal sperm production (low sperm count or poor sperm movement), and unexplained infertility.
IVF Facts & Statistics in Singapore
Despite being one of the most effective infertility treatments, the success rate of IVF remains relatively low and many have to go through multiple IVF cycles to conceive a healthy baby. According to the Ministry of Health (information last updated 11 May 2015), the average success rate of IVF treatment in Singapore, calculated in terms of the percentage of fresh cycles performed which resulted in a live birth, was 22% in public hospitals and 20% in private healthcare institutions. Besides, the fee for IVF treatment is costly, with an average charge per stimulated IVF cycle ranging from $6,000 to $13,000.
To top it all, the IVF treatment is both physically and emotionally demanding. Dealing with the side effects of the IVF medications, such as headaches, hot flushes, bloating, mood fluctuations, insomnia, is already exhausting, while the intense time commitment required and the uncertainty about the outcome add on to cause tremendous stress. In the event that the IVF cycle is unsuccessful, the sense of loss and disappointment can be difficult to bear, and some may find their emotions going out of control.
Improve IVF Success Rates with TCM & Acupuncture Support
In view of all these, many are turning to alternative medicine in the hope of improving IVF success rates, and to reduce the stress and discomfort symptoms that accompany each IVF cycle. A number of researches have been carried out to study the use of acupuncture and Chinese medicine to improve IVF success rate, and several protocols have been established.
TCM Treatment Principle in accordance with Different Phases during IVF
Ideally, a woman should start receiving TCM treatments three to five months before going through IVF. This gives the TCM physician a chance to assess and adjust the underlying body constitution to improve fertility and increase chances of conceiving. Enhancement of Qi and Blood flow to the reproductive organs is achieved by stimulating acupuncture points on the meridians that flow through the pelvic. TCM physicians experienced in treating infertility will take a further step to relate Western medical diagnosis to the various TCM disharmony patterns. For example, women with blocked fallopian tube(s) are often caused by Qi stagnation and Blood stasis, or Phlegm-damp obstruction. Acupuncture points (acupoints) and Chinese Medicine are then prescribed accordingly.
1. Down-Regulation Phase
Once the IVF cycle starts, TCM physicians who are experienced in supporting IVF treatments will take into consideration the use of the IVF medications, and TCM treatments will be adjusted to synchronise with the goal of the IVF medications. Often, IVF cycle begins with down-regulation of hormones, giving the ovaries time to “rest” before stimulation. Many women are given oral contraceptives followed by injectable medications to turn off the body’s production of hormones that stimulate the ovaries. During this phase, TCM treatments aim to help the body relax and rejuvenate. Acupuncture points along the Liver meridian are often chosen, as TCM considers a smooth flow of Liver Qi essential to emotional wellness. Chinese medicine, such as radix bupleuri (柴胡), cortex albizziae (合欢皮), curcuma aromatica (郁金) are often prescribed to enhance the effect. In addition, the use of IVF medications, such as Lupron, often results in Yin deficiency with Heat symptoms. This is managed by choosing acupoints to gently nourish the Yin and clear the Heat.
2. Ovulation Induction Phase
During the ovulation induction phase, gonadotropin drugs are given to stimulate the production of multiple follicles. The focus now is on tonifying the Blood and nourishing Kidney Yin. Radix Rehmanniae Praeparata (熟地黄), Angelica sinensis (当归), radices paeoniae alba (白芍) are some of the very effective Chinese herbs used for nourishing both the Yin and Blood. ST-36 (足三里), well-known for its effectiveness in nourishing Blood and reinforcing Qi to activate Blood circulation, is an important point to use during this stage. KID-3 (太溪) is also often chosen for its effectiveness in tonifying Kidney Yin. In addition to improving blood circulation to the pelvis, the treatment also helps to regulate the body’s response to the medications, so that any over-stimulation or under-stimulation is rectified. This is often supported by ultrasound and blood tests showing optimal hormone levels and good follicle and endometrial lining development. It is advisable to receive three to four acupuncture sessions during this period till before egg retrieval.
3. Final Maturation Process and Egg Retrieval
When the follicles grow to appropriate size, an injection of hCG (human chorionic gonadotropin) is given to initiate the final maturation process of the eggs, and egg retrieval is performed 34 to 36 hours after the hCG injection, before the eggs are released and lost in the abdominal cavity. The retrieved eggs are fertilised by mixing with a high concentration of sperms or by a process called intra-cytoplasmic sperm injection (ICSI), whereby a single sperm is injected into each egg to facilitate fertilisation. The fertilised eggs, also known as embryos, are then left in the incubator to grow for three to five days, before they are transferred back into the uterus.
4. Embryo Transfer
Research demonstrates a significant improvement in the IVF pregnancy and live birth rates for those who receive acupuncture treatments 25-30 minutes before and after embryo transfer. Clinically, many physicians perform acupuncture treatments 12 – 24 hours before and after embryo transfer. The aim is to reduce stress and relax the mind and body, regulate blood flow to the uterus to help lessen uterine contractions, and improve uterine lining to promote implantation.
Implantation usually occurs six to ten days after egg retrieval, which is just a few days after embryo transfer. During the implantation window, the endometrium cells change to aid in the absorption of the uterine fluid, which in turn bring the fertilised egg (blastocyst) closer to the endometrium and immobilise it at the same time. However, it is still possible for the fertilised egg to be flushed out of the uterus. At this stage, the emphasis is on warming the Kidney Yang and the uterus to facilitate the implantation and prevent miscarriage. The goal is to bring about a healthy and receptive uterus lining which is rich in blood and nutrients. Eucommia ulmoides (杜仲), radix dipsaci (续断), herba cistanches (肉苁蓉) are often prescribed. While the focus is on firming up the Yang, Yin-nourishing herbs such as Chinese wolfberry (枸杞子) and fructus ligustri lucidi (女贞子) are often added to support the foundation of the Yang. Acupuncture treatment during this time also aims to support the Yang and strengthen its holding function. It is beneficial to have an acupuncture session three to five days after the embryo transfer and another session a week later, before going for the pregnancy test. By then, hopefully all is well, and the joy of pregnancy prevails.