Maggie McKay (Host): Trying to get pregnant can be so stressful, especially when it's not happening. So today, we're going to learn about all you need to know about the fertility toolbox and what resources are available with Dr. Meike Uhler, reproductive endocrinologist, and Peter Harvey, acupuncturist and owner of Eastern Healing. 

Welcome to Time to Talk Fertility presented by Fertility Centers of Illinois. I'm your host, Maggie McKay. Thank you both so much for being here. This is a topic that affects so many people. I can't wait to dive right in and learn more. So, let's start with you, Dr. Uhler. How is infertility defined and what are the most common fertility challenges that patients come to you with?

Meike Uhler, MD: Infertility is defined by both age of the female patient as well as time to conception. So if the patient is under the age of 35, then it is 12 months of trying to conceive without a pregnancy. And if the patient is over 35, then that interval is shortened to six months. The reason is because with increased age, we know that there is a decline in pregnancy rate, so we want to be able to do testing and start treatment earlier based on the age of the female patient.

Host: How do you determine the best fertility treatment for an individual or a couple?

Meike Uhler, MD: Well, I think that the best way to determine the treatment is to find out what the cause of the treatment is first. So, that's why, if you're having a struggle with infertility, it's good to talk to your doctor and get some basic testing started so we can identify the problem as either, a problem with ovulation or problem with the anatomy, the uterus, the fallopian tubes, or a problem with the male partner, or there could be unexplained infertility. So, testing is first followed by treatment. So for each of those problems, we have specific treatments, but first we need to find out what is the problem.

Host: Wow. Somehow I never knew that it could be just unexplained and they just can't figure it out. I always thought they find the root cause and treat it. So, that can be a thing, right?

Meike Uhler, MD: It is about 10% to 15% of patients and that means that the patient and her partner had done all testing and there is no identifiable cause. So yes, there is unexplained infertility and can be very frustrating for the patient. But because there is no cause found, those patients usually have a good prognosis for pregnancy.

Host: Oh, good. Okay. I was going to say that's a heartbreaker, but that's good to hear. How does age affect both male and female fertility? What options exist for those who want to conceive later in life? Like, I have to tell you, when I got pregnant, I went in, I think I was 35, and they said, "Oh, you're a senior mom." I'm like, "I'm 35.!" And they call you a senior mom. So, what age?

Meike Uhler, MD: Right. So ,age is the single most important parameter that will determine pregnancy. So, age affects, in the female, egg quality and egg quantity. So in males, it's not quite as defined. But recently, there have been a lot of studies directed to the male with advanced paternal age as well. So if a patient is much older and their egg quantity or quality has decreased, then options exist for them with donor egg, embryo adoption, regular conventional adoption. But age is the single most important parameter in determining pregnancy outcome.

Host: Wow. Okay. Can you explain how lifestyle factors like diet and exercise and stress, just for example, impact fertility?

Meike Uhler, MD: Yes. So, we do recommend that a patient has a good wholesome diet, exercises three to four hours per week. Of course, stress is very difficult to define because it's hard to measure, and it's probably even harder to manage. So, I do talk to patients about what is stressful for them, what can they do, what are different ways that, and exercise is one of the ways to relieve stress. And I think Peter is going to talk a little bit later about what he can contribute to decreasing stress. But all of those factors are important. We want to try and have normal weight and a good diet. And exercise and try and decrease stress as much as possible.

Host: Dr. Uhler, I think this next topic is so confusing when you're trying to get pregnant, the most important vitamins to take and supplements when you're preparing for pregnancy.

Meike Uhler, MD: So, the prenatal vitamin is important because it has the recommended daily allowance of folic acid, which is 0.4 milligrams or 400 micrograms. And folic acid is not a fertility drug. I know sometimes patients confuse the prenatal vitamin, but it's for a good, healthy pregnancy. So, folic acid can potentially decrease the incidence of neural tube defect, and it is recommended to take a prenatal vitamin the month before a patient tries to get pregnant.

So, other supplements that they may take, it depends on what their problem is, but there are some vitamins that may improve egg quality, such as coenzyme Q10 and DHEA. And also for sperm quality, we do recommend a men's daily formula vitamin for the men, as well as coenzyme Q10.

Host: Wow. Is that new? Or have they been doing that for years?

Meike Uhler, MD: I would say it's been a while now since the studies came out for the DHEA and coenzyme Q10 for women who may have low ovarian reserve. I think the men's studies are evolving because it seems to be that the women's studies came first and now we're just catching up with the men.

Host: That's good. Are there specific supplements that can improve egg and sperm quality?

Meike Uhler, MD: Well, those are the ones that I talked about. Like for the eggs, we usually recommend DHEA or coenzyme Q10. And for the sperm, a Men's Daily Formula vitamin and coenzyme Q10 as well. And I think that when we hear Peter talk about acupuncture and herbal medicine and decreasing stress, those are all things that can also help improve egg and sperm quality from a different mechanism of action.

Host: Okay, great. What are some of the biggest misconceptions that people have about fertility and infertility treatments?

Meike Uhler, MD: I think that some patients don't understand the significance of age. And I have to say that this is based on the media reports that we get. We hear all about movie stars getting pregnant later in life. And it just seems like it's being sensationalized, but the problem is they don't realize how those famous people or entertainers or movie stars are getting pregnant. But age is so important and not everyone realizes the importance as age increases, fertility rates decline, miscarriage rates increase, and the risk of having a baby with a chromosomal abnormality increases.

Host: Wow. You make a good point. It makes seem like anybody can get pregnant at any age, because you're right, you always hear about the celebrities or the woman in Italy who was 62 and had a baby, you know? That's not the norm.

Meike Uhler, MD: Exactly. They're sensationalized. Yes.

Host: So, Dr. Uhler, what advice would you give to someone who's just beginning to explore their fertility options?

Meike Uhler, MD: I think there are a few things that the person can do at home. Like, first of all, track your menstrual cycles. Put it on a calendar and see if they seem to be regular. If they're regular, that's great. If they're not regular, maybe see your doctor earlier and find out why not. If they're regular and you want to find out if you are ovulating or not, an easy way to do it is to have an ovulation predictor kit that you can get at Target or the grocery store. It is a stick. You can urinate on it. Five minutes later, it'll tell you whether you're ovulating or not ovulating. So, these are things that you can do at home. Do your best to try and, like we said, have a good diet. Have a good exercise. Try to keep caffeine intake two cups or less per day. Do not smoke. Try to limit alcohol intake. So, these are all things that, you know, you try to do for your body to put it in the best health as possible before pregnancy. But, like we said, look at your own menstrual cycles. Have you had problems in the past? Have you had surgeries on your abdomen that could potentially cause scar tissue or any medical problems that need to be optimized before you get pregnant? So, these are all things that you can do yourself.

Host: What about sugar? Does that play any part? Should you avoid it when you're trying to get pregnant? 

Meike Uhler, MD: Well, I mean, I think, we should try to minimize it. But I mean, if a person is at risk for, let's say pre-diabetes, then what happens in pregnancy is things happen more readily in pregnancy. So if you have a tendency towards diabetes, then you might be diabetic in pregnancy. You have a tendency towards high blood pressure, then that's going to happen because you're trying to take care of yourself and a baby. So, it kind of stresses the system a little bit. So, that's why we emphasize trying to be in the best health possible before getting pregnant.

Host: What do you tell your patients when they should start being concerned? Like, let's say you get married, you start trying because you want to get pregnant as soon as possible. And after a year, no luck the natural way. Do you say, "Maybe you should do some testing after a year" or wait longer? How does that work?

Meike Uhler, MD: I think I would go back to the first definitions of infertility, less than 12 months if you're less than age 35 or six months greater than age 35, unless there is a known problem. So, someone who has very irregular menstrual cycles, they only have menstrual cycles every three to four months, that person should not wait that period of time. Someone who's had problems with pelvic infections or multiple surgeries, or known endometriosis, or a male factor that they know they've had problems with sperm or history of it, those kind of patients should come in earlier because there's a chance they already have a problem. Other than that, I think staying with the definitions of infertility has worked well for most people.

Host: Oh, that's good to know. Well, thank you so much. Peter, let's talk about acupuncture and traditional Chinese medicine when it comes to fertility. How do they compliment fertility treatments and lifestyle changes?

Peter Harvey, L.Ac, MSOM: Hi, quite a bit actually. So when we talk about complimenting and enhancing it, so to speak, I think of the biggest things that we've noticed, and studies have shown this too, that it increases ovarian blood flow. It helps with uterine lining, relaxes the patient. There's been studies done in fertility and sterility showing that it does this. It could help if patients are having problems ovulating, getting them to ovulate, depending on the cause of it, of course, like PCOS, I'll keep referring to that. That's an easy one everybody knows about.

But there's been great studies done over the years that made acupuncture famous about doing it before and after an embryo transfer. And they found that it reduces uterine contractibility at transfer. And also, it improves sperm count, motility morphology. So, we tend to think of it as acting as a team with a fertility clinic when we work with that patient.

Host: And what are the key benefits of acupuncture for people who are undergoing fertility treatments?

Peter Harvey, L.Ac, MSOM: Well, some of what I mentioned, but it also helps mitigate a lot of the side effects of some of the drugs that some of these people are on. Some women, you know, have some side effects like bloating and everything. Another thing too is some women will get ovarian hyperstim. So, we're able to control and work with that. And we do things to try and help relax the patient through the whole process.

It's more than just acupuncture when we work with a patient. We'll work with them on their diet. Diet is, in my opinion, like the cornerstone of everything. We're doing Chinese herbs if it's not during IVF, to help with that as well; specific vitamin protocols, depending on what's wrong with the patient, what they present as.

Host: Peter, are there specific acupuncture points that target reproductive health?

Peter Harvey, L.Ac, MSOM: Yes, there are. Now, when an acupuncturist treats someone for fertility, we're always treating the whole body. So, there's a lot of points all over the place, but there are specific points. One of them is on the low abdomen, it's called Zigong, which means infant palace. And those just happen to sit over the ovaries. We will do other points like on their low back, where we use maybe mild electrical stim. What I like to do is there is a book that was written quite a while ago, and it's called The Infertility Cure, written by a Dr. Randine Lewis. And in her book she illustrates some of these acupuncture points that are used on people that a lot of women use as an acupressure point to help them while they're going through all this.

Host: Does acupuncture benefit some conditions like endometriosis or PCOS more than others?

Peter Harvey, L.Ac, MSOM: Where I found acupuncture always excels in is pain management. That's number one. Now, acupuncture is acupuncture. And when I use acupuncture, I'm using it in the context of acupuncture, herbs, diet, vitamins altogether. Acupuncture is not a cure for endometriosis, but it does help manage it. For PCOS, I've had really good success with getting women to ovulate and helping manage inflammation in the body. That's where I see a lot of it take place.

Blood flow is always important, and this is where acupuncture really helps a lot with increasing ovarian blood flow via using electro stim. And that works by a process of increasing nitric oxide in the body, which dilates the blood vessels. That's what electrical stim basically does. And that's always what we want to do because, when we look at especially women over 35, they have approximately five times less blood flow going to that area. And stress also decreases blood flow as well because they're always in a fight or flight situation. So, that's why we always want to work with them and strategize with them on how to decrease stress in their life. And thereby, it's going to affect them in reproduction by getting more blood flow to the area.

Host: Can acupuncture be beneficial for men who are struggling with fertility issues like low sperm count or motility?

Peter Harvey, L.Ac, MSOM: Yes, I see a lot of it now. Back, you know, when I first started 20 years ago, we rarely saw men come through. But now, I have a steady stream of men. Acupuncture is great for count, motility especially, and morphology. We use some great herb formulas and everything for it. There is one area where acupuncture really doesn't help men, and that would be in someone who has azoospermia where they have no sperm at all.

Host: Oh, well, what happens then?

Peter Harvey, L.Ac, MSOM: Well, that's why they talk to someone like Dr. Uhler and they have different options for them.

Host: Oh, okay. What's the best time to start acupuncture when you're preparing for fertility treatments?

Peter Harvey, L.Ac, MSOM: So, that's a great question. And the reason why I say that is in a perfect world, and it also depends a lot on what's going on with the patient, we would love to see them three to four months prior to doing any kind of IVF. And the reason for that is it takes about that length of time to start seeing changes in the body, both at the egg level and at the body level too. We want to try and get the patient as healthy as possible prior to IVF.

Now, a lot of times, we'll get the patients who are just starting the process and they're doing IUIs and that's fine too. You know, we work with them during that whole time. Maybe not doing herbs with them, but getting their diet in order, getting them on specific supplements. And then, typically, for most patients they're doing at least three rounds of IUIs, which is about three months. So by the time they get into IVF, they're already at that mark. It's okay though, we could see them at any stage of the game. We just have to change up our strategy with them a little bit.

Host: Are there any studies or scientific evidence supporting the effectiveness of acupuncture when it comes to fertility treatments?

Peter Harvey, L.Ac, MSOM: Yes, there are actually quite a few studies that are out there. I mean, like I talked about, electroacupuncture increases ovarian blood flow. That was in human reproduction, I believe in 1996. There was a retrospective study done back in 2015 on Whole System TCM, Acupuncture, Herbs, and Diet. They showed greater live births than just acupuncture alone or with IVF alone. That was done in 2015. We have Magarelli study done in 2004 where they found the acupuncture group, they had higher pregnancy rates, 53% versus 38% for the non-treatment groups. And of course, you know the famous one, the Paulus study back in 2002, where patients receiving acupuncture before and after an embryo transfer. They noticed 42% success versus 26% success in the non-treatment group. But I caution with that study because we still to this day get it. Patients are calling and saying, "Oh, I want to come in for acupuncture before and after." Most of those patients were getting acupuncture three to six months prior to their embryo transfer. So in other words, those patients were getting their bodies healthy prior to it, so their body responded better.

Host: Is there anything else you'd like to add that we didn't cover?

Peter Harvey, L.Ac, MSOM: Yes. A matter of fact, I look at acupuncture and traditional Chinese medicine, as I put it, a training program for your ovaries and for your body. I tell patients all the time, give it time to work. Spend this time to work on yourself. I think choosing an acupuncturist is important because not all acupuncturists are herbalists, and not all acupuncturists are board-certified in Reproductive Medicine. I am board-certified. It's called ABORN. I'm a fellow with the American Board of Oriental Reproductive Medicine. So, you want to get someone who really understands this and understands what doctors are doing too, because you don't want to interfere with their treatments. You have to be careful about herb formulas, you know, and especially during IVF.

One thing we didn't touch much on though is uterine lining. I do a lot of work with uterine lining where a lot of patients are having problems growing their lining during that time. And so, we do a lot with acupuncture, herbs, and diet. So, acupuncture's a great tool. It's great for stress reduction, at the very least, in improving blood flow to the ovaries and uterus. You know, there aren't really any negative side effects to the patient.

Host: Like you said, pain. I had knee issues and went to an acupuncturist, and it was like a miracle. It was just like a miracle. Well, this has been so informative, Dr. Uhler. Would you like to add anything?

Meike Uhler, MD: I think we've covered a lot today. Thank you for the opportunity to speak on this very important topic, especially as we're coming to National Infertility Awareness Week later this month, from April 20th to 26th.

Host: Well, thank you as well for all your great information. I mean, it was so informative. Every single answer was like, "Oh, I didn't know that. I haven't heard that." So, thank you both for sharing your expertise. This has been very educational.

Peter Harvey, L.Ac, MSOM: Thank you.

Meike Uhler, MD: Thank you.

Maggie McKay (Host): Thank you both. Again, that's Dr. Meike Uhler and Peter Harvey. Please call 877-324-4483 to schedule an appointment or visit fcionline.com. That's 877-324-4483 or go to fcionline.com. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you, I'm Maggie McKay. Thanks for listening to Time to Talk Fertility, presented by Fertility Centers of Illinois.