Ethics of herbs used during the luteal phase of women trying to conceive

[Guest guest]

Hi All,

 

I would like to start a discussion on your thoughts and experiences relating to

the use of Blood invigorating medicines during the luteal phase of women trying

to conceive. The main point being, will herbs that invigorate blood and dispel

stasis prevent implantation? Or will implantation not even happen without their

use?

 

My thoughts and limited clinical experience (2.5 years in the field of

fertility) has shown me that in cases where blood stasis could be clearly

diagnosed, women have been able to become pregnant, even while on herbs such as

E Zhu and San Leng. Meaning when the Rx fits the Dx, the outcome will be good.

 

Of course this is very contraversial, as the text books we use greatly caution

this approach.

 

Personally, I like to have women avoid trying to conceive (TTC) for at least 3

months to allow time for the stasis to resolve, but what about those impatient

women who do NOT want to waste any time not trying. But who still have stasis

which needs to be addressed.

 

Do you have them sign a waiver, giving the Okay to use the blood invigorators

while TTC? Do you just go light and hope for the best?

 

I would love to hear peoples thoughts, experiences, research, etc :-)

 

Thanks in advance,

 

Trevor

[Guest guest]

Hi Trevor,

 

I went to a class in NYC a couple of weeks ago with Mike Berkeley and Daniel

Camburn. The topic was the treatment of endometriosis, but they both

exclusively treat fertility patients. I asked a similar question during

Mike's lecture, and he basically touted the " treat the pattern and

everything will be fine " philosophy.

 

 

 

I have been specializing in women's health and fertility for about eight

years, but I was curious how Mike handled the patient who's doctor told them

the reason their IVF didn't work was because of the herbs they were taking.

His stance was this was total BS, that it is pretty difficult to cause a

miscarriage with Chinese medicine. It was a familiar response, I find. It

kind of makes you feel better, but there is still some uncertainty there. I

suppose I go to the extreme and picture myself being sued for malpractice

and having the prosecuting attorney ask me how I know the herbs didn't cause

the miscarriage? What proof is there? Don't you know that the German

Commission E monograph clearly states that Panax ginseng causes... Yikes

 

 

 

He gave a case study where a woman in her late second or maybe third

trimester presented with a subchorionic hematoma. He told her the herbs he

was going to give her would either cause her to lose her baby or save her

baby, but if she did nothing she would certainly lose the baby. The woman

chose the herbal formula which had high dose E Zhu and San Leng in the raw

herb decoctions(maybe even some Shui Zhi..can't remember). The woman ended

up carrying to term.

 

Others have stated that the taboos we read about are generally meant for

situations when a particular herb or point doesn't fit the pattern.

 

I think the best/all we can do is treat the pattern to the best of our

ability. If you do a lot of fertility treatment there will always be

miscarriages that occur coincidentally, and as a practitioner I think you

will always wonder if you had something to do with it.

 

 

 

 

 

Sean

 

 

 

 

On Behalf Of Trevor Erikson

Tuesday, August 18, 2009 11:49 AM

 

Ethics of herbs used during the luteal phase of women trying

to conceive

 

 

 

 

 

Hi All,

 

I would like to start a discussion on your thoughts and experiences relating

to the use of Blood invigorating medicines during the luteal phase of women

trying to conceive. The main point being, will herbs that invigorate blood

and dispel stasis prevent implantation? Or will implantation not even happen

without their use?

 

My thoughts and limited clinical experience (2.5 years in the field of

fertility) has shown me that in cases where blood stasis could be clearly

diagnosed, women have been able to become pregnant, even while on herbs such

as E Zhu and San Leng. Meaning when the Rx fits the Dx, the outcome will be

good.

 

Of course this is very contraversial, as the text books we use greatly

caution this approach.

 

Personally, I like to have women avoid trying to conceive (TTC) for at least

3 months to allow time for the stasis to resolve, but what about those

impatient women who do NOT want to waste any time not trying. But who still

have stasis which needs to be addressed.

 

Do you have them sign a waiver, giving the Okay to use the blood

invigorators while TTC? Do you just go light and hope for the best?

 

I would love to hear peoples thoughts, experiences, research, etc :-)

 

Thanks in advance,

 

Trevor

 

 

 

 

 

 

[Guest guest]

Hi Trevor,

 

I went to a class in NYC a couple of weeks ago with Mike Berkeley and Daniel

Camburn. The topic was the treatment of endometriosis, but they both

exclusively treat fertility patients. I asked a similar question during

Mike's lecture, and he basically touted the " treat the pattern and

everything will be fine " philosophy.

 

 

 

I have been specializing in women's health and fertility for about eight

years, but I was curious how Mike handled the patient who's doctor told them

the reason their IVF didn't work was because of the herbs they were taking.

His stance was this was total BS, that it is pretty difficult to cause a

miscarriage with Chinese medicine. It was a familiar response, I find. It

kind of makes you feel better, but there is still some uncertainty there. I

suppose I go to the extreme and picture myself being sued for malpractice

and having the prosecuting attorney ask me how I know the herbs didn't cause

the miscarriage? What proof is there? Don't you know that the German

Commission E monograph clearly states that Panax ginseng causes... Yikes

 

 

 

He gave a case study where a woman in her late second or maybe third

trimester presented with a subchorionic hematoma. He told her the herbs he

was going to give her would either cause her to lose her baby or save her

baby, but if she did nothing she would certainly lose the baby. The woman

chose the herbal formula which had high dose E Zhu and San Leng in the raw

herb decoctions(maybe even some Shui Zhi..can't remember). The woman ended

up carrying to term.

 

Others have stated that the taboos we read about are generally meant for

situations when a particular herb or point doesn't fit the pattern.

 

I think the best/all we can do is treat the pattern to the best of our

ability. If you do a lot of fertility treatment there will always be

miscarriages that occur coincidentally, and as a practitioner I think you

will always wonder if you had something to do with it.

 

 

 

 

 

Sean

 

 

 

 

On Behalf Of Trevor Erikson

Tuesday, August 18, 2009 11:49 AM

 

Ethics of herbs used during the luteal phase of women trying

to conceive

 

 

 

 

 

Hi All,

 

I would like to start a discussion on your thoughts and experiences relating

to the use of Blood invigorating medicines during the luteal phase of women

trying to conceive. The main point being, will herbs that invigorate blood

and dispel stasis prevent implantation? Or will implantation not even happen

without their use?

 

My thoughts and limited clinical experience (2.5 years in the field of

fertility) has shown me that in cases where blood stasis could be clearly

diagnosed, women have been able to become pregnant, even while on herbs such

as E Zhu and San Leng. Meaning when the Rx fits the Dx, the outcome will be

good.

 

Of course this is very contraversial, as the text books we use greatly

caution this approach.

 

Personally, I like to have women avoid trying to conceive (TTC) for at least

3 months to allow time for the stasis to resolve, but what about those

impatient women who do NOT want to waste any time not trying. But who still

have stasis which needs to be addressed.

 

Do you have them sign a waiver, giving the Okay to use the blood

invigorators while TTC? Do you just go light and hope for the best?

 

I would love to hear peoples thoughts, experiences, research, etc :-)

 

Thanks in advance,

 

Trevor

 

 

 

 

 

 

[Guest guest]

Trevor,

Great idea for a discussion since I believe all of us who work in fertility

have dealt with this subject. This year I spent 6 weeks in Nanjing following

two famous fertility docs who have over a 100 years of practice between them.

They regularly give strong blood movers during the luteal phase. From what I

understand the question of preventing pregnancy during treatment is not about

the strength of blood moving in the formula but whether or not the patient is

ready to carry a fetus to term. It is not that we may cause a miscarriage but

that if the patient is not ready for a pregnancy a miscarriage will only weaken

the patient.

I give moderate blood movers (ex. Chi Shao, Hong hua, Tao ren) during

luteal phase when necessary and haven't had any problems. Since being in China

I have increased this to include San Leng (the docs I saw didn't use much E

Zhu)when necessary. I wouldn't go up to bugs unless there was something like

the case that Berkeley discussed.

On another note I would like to know if anyone knows of someone being sued

for the effects of an herbal prescription. Here in Illinois its not even in

our scope so we are completely uncovered by our malpractice insurance. I think

that in general we have a different relationship with our patients and don't get

sued very much..This is clearly evident in our ridiculously low malpractice

insurance premiums.

 

Rich Blitstein

 

 

, " Trevor Erikson " <trevor_erikson

wrote:

>

> Hi All,

>

> I would like to start a discussion on your thoughts and experiences relating

to the use of Blood invigorating medicines during the luteal phase of women

trying to conceive. The main point being, will herbs that invigorate blood and

dispel stasis prevent implantation? Or will implantation not even happen without

their use?

>

> My thoughts and limited clinical experience (2.5 years in the field of

fertility) has shown me that in cases where blood stasis could be clearly

diagnosed, women have been able to become pregnant, even while on herbs such as

E Zhu and San Leng. Meaning when the Rx fits the Dx, the outcome will be good.

>

> Of course this is very contraversial, as the text books we use greatly caution

this approach.

>

> Personally, I like to have women avoid trying to conceive (TTC) for at least 3

months to allow time for the stasis to resolve, but what about those impatient

women who do NOT want to waste any time not trying. But who still have stasis

which needs to be addressed.

>

> Do you have them sign a waiver, giving the Okay to use the blood invigorators

while TTC? Do you just go light and hope for the best?

>

> I would love to hear peoples thoughts, experiences, research, etc :-)

>

> Thanks in advance,

>

> Trevor

>

[Guest guest]

Am very glad to hear of the experience of others in this regard.

 

I've been treating OB/Gyn for 14 years - was a midwife for 16 years before that.

 

Most of my infertility patients are not taking herbs at all during a conception

cycle if they are undergoing concurrent care with a RE. This makes the treatment

of patients with blood stasis patterns a little more difficult. Most of these

women are >37 y.o. (many in their 40s) and may not have the " time " to do 3-6

months of treatment prior to a conception attempt. I am treating a patient now

with a clear blood stasis pattern who did not take herbs before initiating her

last IVF cycle (on the advice of her RE), and had an ectopic pregnancy (which I

see as the still unresolved blood stasis). However, at 41, she does not feel

that she has the time to not follow the advice of her RE before another attempt.

At her age, I'm not at all sure that even if we did treat the blood stasis

pattern, that she would have a more positive result. What I do is present the

options and the reasons for them to my patient. Ultimately they have to decide.

 

I have been recently fascinated with the Western science involving placental

implantation. Some current theories describe very early implantation as being a

slightly hypoxic event, as chorionic villi invade intervillous spaces. The

follow up studies to the Paulus protocol suggest that acupuncture for IVF if

done at a site or time 24 or more hours after an IVF procedure have less

successful live birth rates than the original Paulus study. I have to admit, I

do not do acupuncture for a woman undergoing RE services after the procedure

until a pregnancy is confirmed, and then keep treatments at few needles. I begin

to prescribe herbs again if and when morning sickness develops.

 

I have also treated someone with a subchorionic hemorrhage at 20 weeks, using

Gui Zi Fu Ling Wan with tao ren and mu dan pi. It was very effective. The

patient was fully informed about the blood moving nature of the herbs, and why

she fit this pattern. She took herbs, and the bleeding stopped. She stopped

herbs, and the bleeding returned; she took them again, the bleeding stopped. I

think it was a month to 6 weeks of on/off treatment, but eventually the bleeding

was controlled and she delivered at term.

 

The incomplete invasion of maternal spiral arteries by syncytiotrophoblast or

the formation of micro clots at those sites is noted as a cause of some (about

30%) early pregnancy loss. This suggests (when I allow myself to draw a straight

association with Western medicine) the need to treat blood stasis when

warranted.

 

But I caution myself all the time to not draw any conclusions from the studies

on women undergoing IVF to other populations of infertility, or to other

pregnant women.

 

In the end, when there is a blood stasis pattern, 3-6 months of treatment prior

to conception I think is the most critical. Do others have some experience that

blood stasis resolving beyond the third week of pregnancy is essential?

 

In treating women with endometriosis or PCOS, at ovulation, I use some stasis

resolving medicinals. Often zao jiao ci, perhaps mu dan pi or tao ren, chi shao.

After this discussion I might consider san leng. If I know a patient is trying

to get pregnant, I rarely continue this treatment principle into the fourth week

of the cycle.

 

 

Valerie Hobbs, LAc

 

 

, " richblit " <richblit wrote:

>

> Trevor,

> Great idea for a discussion since I believe all of us who work in

fertility have dealt with this subject. This year I spent 6 weeks in Nanjing

following two famous fertility docs who have over a 100 years of practice

between them. They regularly give strong blood movers during the luteal phase.

From what I understand the question of preventing pregnancy during treatment is

not about the strength of blood moving in the formula but whether or not the

patient is ready to carry a fetus to term. It is not that we may cause a

miscarriage but that if the patient is not ready for a pregnancy a miscarriage

will only weaken the patient.

> I give moderate blood movers (ex. Chi Shao, Hong hua, Tao ren) during

luteal phase when necessary and haven't had any problems. Since being in China

I have increased this to include San Leng (the docs I saw didn't use much E

Zhu)when necessary. I wouldn't go up to bugs unless there was something like

the case that Berkeley discussed.

> On another note I would like to know if anyone knows of someone being

sued for the effects of an herbal prescription. Here in Illinois its not even

in our scope so we are completely uncovered by our malpractice insurance. I

think that in general we have a different relationship with our patients and

don't get sued very much..This is clearly evident in our ridiculously low

malpractice insurance premiums.

>

> Rich Blitstein

>

>

> , " Trevor Erikson " <trevor_erikson@>

wrote:

> >

> > Hi All,

> >

> > I would like to start a discussion on your thoughts and experiences relating

to the use of Blood invigorating medicines during the luteal phase of women

trying to conceive. The main point being, will herbs that invigorate blood and

dispel stasis prevent implantation? Or will implantation not even happen without

their use?

> >

> > My thoughts and limited clinical experience (2.5 years in the field of

fertility) has shown me that in cases where blood stasis could be clearly

diagnosed, women have been able to become pregnant, even while on herbs such as

E Zhu and San Leng. Meaning when the Rx fits the Dx, the outcome will be good.

> >

> > Of course this is very contraversial, as the text books we use greatly

caution this approach.

> >

> > Personally, I like to have women avoid trying to conceive (TTC) for at least

3 months to allow time for the stasis to resolve, but what about those impatient

women who do NOT want to waste any time not trying. But who still have stasis

which needs to be addressed.

> >

> > Do you have them sign a waiver, giving the Okay to use the blood

invigorators while TTC? Do you just go light and hope for the best?

> >

> > I would love to hear peoples thoughts, experiences, research, etc :-)

> >

> > Thanks in advance,

> >

> > Trevor

> >

>

[Guest guest]

Valerie,

 

Do you have references for the studies you mentioned about acupuncture

decreasing IVF success rates? It seems there are studies that prove every

outcome at this point-increase, decrease, no influence but relaxing to the

patient etc... What did you find compelling about the studies you

referenced?

 

 

 

Rich,

 

RE: malpractice cases. I wasn't personally aware of any, but did just see

this case

http://www.onpointnews.com/NEWS/chinese-medicine-doctor-sued-over-dangerous-

herbs.html It is alleging a prescription of herbs containing aristolochic

acid caused kidney failure.

 

 

 

 

 

Sean