urgent fertility question

[Guest guest]

Dear David K, To be frank, my question to Sean was rhetorical insofaras the

importance of progesterone in sustaining a pregnancy. It is one way I

communicate and it may be an abysmal fault of mine, as it often bites me back

just as it did here. I know from treating quite a number of IVF patients that

they are always (not 'nearly' in my experience, but always) prescribed

progesterone after the transfer, and yes, you know it too from your 'dozens upon

dozens' of patients. But Sean is learning and doesn't know yet. I think this is

a key point to understand when embarking on the challenge of helping shepherd

all a woman's resources in order to reproduce. I was just trying to point him in

the direction, i.e., progesterone represents the luteal phase, etc.., the warmth

of incubation, etc.., the requirement for the generative power of kidney yang,

etc. Lyttleton talks about this in her book and I don't need to repeat it here.

She provides a superlative

discussion of herbs at each phase. So, I gratefully accept your invitation

David to " be advised that nearly ALL women are prescribed progesterone.. " but I

am aware of it. As limited as my powers of intellect are, I do try to think

critically and not assume (that her progesterone was low - I don't know

'anything' about this individual woman really). Having said that however, with

the bit of clinical experience I have, when I see a miscarriage in the first

week after transfer, my bet is this is a woman who may be a 'poor responder' and

may not have had the kidney yin base to support the yang progesterone. Really it

irks me that the docs will see this as a successful IVF. In an ideal world we

could integrate care and balance her so the high tech procedure had a better

chance of working if 4 cycles or so of TCM hadn't done the trick yet and the

ovarian reserve is an issue. But it's not an ideal world. And also, I would say

that Sean should still try to

parse/understand/embody the 'mystery' as you refer to it, of the hormonal

orchestra going on so he can critically apply his TCM to it.

Secondly you mentioned " For this reason, I thought the patient might take

comfort that there was a plausible and clinically sound explanation for her

symptoms outside of the Chinese Herbs theory. " Do you have evidence to support

thatit is the meds that cause mid-cycle bleeding and irregular menses? On

another level, after having been systemically manipulated from an IVF cycle,

there is no " normal " cycle going on after the procedure - the body has to reset

itself if a pregnancy has not occurred. -Pamela

 

Thanks so much for your response Pamela, to answer your question:

 

>Was she taking supplementary

>progesterone after the IVF? Her progesterone issue would be the

>source of my treatment plan from here out.

 

I don't know, but I'll find out, though upon examining this case more

closely, I'm very surprised that she didn't mention her progesterone

levels. I purchased Lyttleton's book a few months ago, and just

recently began reading it (yes, it is an amazing resource!). I'll

continue to treat my patients pattern of Ki Yin Xu and Sp Qi Xu with

the addition of herbs and pts to calm spirit. I imagine that

including Ki Yang herbs like Ba Ji Tian, Tu Si Zi, and Lu Jiao Jiao

will support her progesterone levels without depleting her yin too

much. However, if you have more specific advice concerning " her

progesterone issue " I would love to hear it! And if you do come

across the Chen/estrogen series I would love to see that as well.

Thanks again Pamela

 

Sean

 

, Pamela Zilavy <chexin

wrote:

>

> This woman did not have enough progesterone to sustain the

pregnancy, this is why the 'successful' IVF resulted in a miscarriage.

Was she taking supplementary progesterone after the IVF? Her

progesterone issue would be the source of my treatment plan from here

out. Regarding your question about estrogenic herbs, this is an

excellent question and anyone treating fertility should be aware of

it. All OB/Gyns will ask this question if they know a pt is taking

herbs. I would have to disagree with the post about " have her check

with her IVF doctor to > see if this may be a common side-effect of the Follicle

Stimulating

> medications or progesterone injections. " As soon as the doc knows

the pt is taking herbs, they will 99% surely 'blame' the herbs. This

is not a 'common' side effect of hormone stim. I'm not sure why the

concern about bleeding. The ART took over her hormones, then she had a

miscarriage, now her body is resetting itself to start having menses.

It may be a short cycle but that is the consequence of what her body

has been through.

> John Chen did a three part series about estrogenic herbs. I will try

to find that for you Sean. In the meantime, I'd recommend getting the

Jane Lyttleton book on Treating Infertility with TCM. It's worth it's

weight in gold. -p

> Pamela Zilavy, L.Ac.

> chexin

> http://www.change- exchange- interchange. com

> 415) 279-8376

>

>

[Guest guest]

Thanks for the reply David. Have you found using Blood nourishing

herbs has a detrimental effect on IVF procedures where preventing

ovulation until transfer is done (I hope I have that worded

correctly). I believe that there are several blood tonic herbs that

have an effect on stimulating ovulation / hormone levels (ie, dang

gui)- but I'm not sure if it's an actual detrimental effect or only

theoretical.

 

Geoff

 

, " thecornerstoneclinic "

<thecornerstoneclinic wrote:

>

> Dear Geoff,

>

> You asked, " If any of the more senior practitioners here have

> any advice, I'd love it if you wouldn't mind sharing! "

>

> I don't know that I would consider myself a 'senior practitioner,'

> per se. But, I do see dozens and dozens of IVF cases each year.

>

> Do you have a more specific question(s)? I don't mind sharing our

> experiences working with IVF patients, but I'm not too clear about

> what you are asking.

>

> David Karchmer

> The Texas Center for Reproductive Acupuncture

> www.texasfertilityacupuncture.com

[Guest guest]

Geoff,

 

I usually try to nourish the blood and Yin during the super-

ovulation phase of an IVF procedure. This is when patients are

taking drugs like gonal-f or follistim. This is particularly tru in

patients who do not stimulate well, have POF or poor ovarian

reserves, or who have stimulated poorly (i'e. produced few eggs)

during a previous IVF.

 

During this phase, while the drugs are helping the body to 'ripen'

as many eggs as possible, I find blood and yin building substances

are indicated. I often try to clear deficiency heat as well as hot-

flashes, night-sweats, restlessness and thirst are frequent side-

effects of the medications.

 

In reality however, I rarely prescribe herbs during the stimulation

phase of an IVF protocol, because most of the REI doctors in my area

forbid the use of herbs during this time.

 

David Karchmer

 

, " G Hudson " <crudo20

wrote:

>

> Thanks for the reply David. Have you found using Blood nourishing

> herbs has a detrimental effect on IVF procedures where preventing

> ovulation until transfer is done (I hope I have that worded

> correctly). I believe that there are several blood tonic herbs

that

> have an effect on stimulating ovulation / hormone levels (ie, dang

> gui)- but I'm not sure if it's an actual detrimental effect or only

> theoretical.

>

> Geoff

>

> , " thecornerstoneclinic "

> <thecornerstoneclinic@> wrote:

> >

> > Dear Geoff,

> >

> > You asked, " If any of the more senior practitioners here have

> > any advice, I'd love it if you wouldn't mind sharing! "

> >

> > I don't know that I would consider myself a 'senior

practitioner,'

> > per se. But, I do see dozens and dozens of IVF cases each year.

> >

> > Do you have a more specific question(s)? I don't mind sharing

our

> > experiences working with IVF patients, but I'm not too clear

about

> > what you are asking.

> >

> > David Karchmer

> > The Texas Center for Reproductive Acupuncture

> > www.texasfertilityacupuncture.com

>