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A:  There is no reason why someone should not have both styles of treatment at the same time. Many practitioners would argue, in fact, that many of the treatments used in fertility treatment can become a little formulaic, and would aim to supplement them or adapt them for purpose. This is an argument often deployed within the TCM fraternity with treatments like the Paulus Protocol used at the time of embryo transfer in IVF. While it is suitable as it is for the greater majority of people, there are some for whom further refinement would make it far more effective.

As far as Five Element and TCM are concerned, these can often be dovetailed to great effect, and indeed, one of the major teaching institutions, the College of Integrated Chinese Medicine, was founded on the basis of integrating these styles for the benefit of the patient. The received wisdom is that it can be compared to treating different levels within the body, and many 5-E practitioners see the use of the more generic treatments as a great way of supporting the patient as a whole while the more targeted work is done and of anchoring the results gained by using TCM. 

 The reality is that it is all one system of medicine in which styles have been identified which draw on common roots. Hence there are people who integrate 5-E, TCM, Japanese Meridian Therapy, Stems and Branches and many other variations, and all to great effect. 

We are very sorry to hear of your problems. Our experience of working with women with several IVF attempts behind them is that the emotional consequences of the constant cycle of hope and disappointment can weigh heavily for a very long time.

However, the fact that you are still producing good quality eggs is a cause for hope, although your age is starting to become a factor. While this is the case, and while your partner's sperm are still in good shape, there is still a chance of a natural conception, and the use of acupuncture can perhaps make the body as well prepared as it can be for this.

An increasing number of our members now undertake specialist postgraduate training in fertility and obstetrics, and while we pride ourselves on our generalist practice, we are likely before long to recognise one or two areas of expert practice, this being one and paediatrics the other. This would mean recognising the training which someone had and allowing them to claim expertise. As such we are not yet in a position to point you towards someone in your area with that particular form of expertise, but if you type 'acupuncture fertility and your home town' into google we suspect that two or three names at least will pop up with the requisite background.

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speaks of a number of studies of mixed quality which suggest that acupuncture can have an impact, but there are no special points to use which make conception more likely. Our experience is that dealing with someone's overall balance, as we do with all patients, is often the single best way of helping someone to conceive. The reasons why conception fails are often linked to functional disturbances in the system as a whole, and correcting these maximises the chance of a natural pregnancy simply by improving someone's overall health. The advantage of seeking out someone with specialist training, though, is that there are often related factors to do with diet and exercise which can help a woman to have a better chance to conceive, and these may not be a factor in everyone's undergraduate training.

The majority of our members are happy to give up a little time without charge to discuss with prospective patients whether acupuncture might be a good option for them, and we recommend this as your first move. We are confident that the advice that you give will have your best interests at heart, not simply an invitation to sign up immediately

Q: I am having an IVF embryo transplant this afternoon followed by another acupuncture session. If I have one more session tomorrow is that safe or is it too much?

A:There is nothing to worry about, as far as we can see. Many of the protocols which have been devised for assisting in IVF are focused on the point of implantation, and the most well known of these, the Paulus Protocol, involves using acupuncture within twenty minutes of the implantation. It would not be at all surprising if someone had developed a protocol which extended this to a slightly longer time frame and to involve multiple sessions. The evidence base for the success of these protocols, especially the Paulus, is good, and even though the treatment is a formula and not the traditional acupuncture which we practise it is a good baseline from which to move forward. You can read the about Paulus here

As far as frequency of treatment is concerned it is not uncommon in China for someone to receive treatment daily for ten days, and because the treatment is offered in the outpatient departments of hospitals within the national health scheme it is accepted as a viable process for short term acute problems. There is no suggestion that over-treatment can be a problem. Acupuncture is a very safe treatment, and if the body has had enough it simply fails to respond any further. Excessive treatment might make someone very tired or a little whoozy, possibly even a little nauseous, but these effects would be very short lived.

In short it sounds as though you are in safe hands with someone who knows what they are doing, and we very much hope that it has the desired result.

Q: I've had three acupuncture sessions to try and improve my chances of conceiving. My acupuncturist said this was 'laying the foundations' for improving my fertility. She  recommended fortnightly treatments after that. Could you advise what she might have meant by 'laying the foundations'?

A: It is always a little difficult to be entirely sure what a practitioner was intending, but we think it is highly likely that she is simply describing the way that many of us work with conditions or patients where it would be unrealistic to expect quick fixes for their problems. In the treatment of migraines, for example, we might often treat someone for four or five sessions once a week, and then step back, depending on progress, to a number of monthly sessions and eventually maintenance treatment a few times a year.

 This reflects our overall view of what we are trying to achieve. Traditional acupuncture treats the person rather than the condition, so although each patient comes to us with presenting signs and symptoms our job is to make sense of these within the overall context of their energies and try to restore an overall balance. The challenge is that many of the patterns which people have in their energy systems have become deeply entrenched, so it is as much a matter of encouraging and retaining a change in the face of some resistance as it is of immediately reversing a pattern. In order to do this we often speak of using the first few sessions as a kind of foundation for what follows on which we can then build. One of our old teachers used to talk about watering plants - when you rescue a plant you might have to douse it two or three times but after that you would water less frequently to let nature take its course. Once the tide has turned, so to speak, then you can guide the changes as much as looking for major reversals.

 Fertility problems are particularly challenging in terms of treatment planning because the desired outcome, a pregnancy, is going to be possible only for a few days each month. Many practitioners undertake special postgraduate training to work with these issues, and great care is taken to address the different energetic needs at times of the cycle to encourage the best overall pattern. Early sessions would establish the overall pattern, and involve any major changes which a practitioner might want to encourage, and after that it would it building on this by carefully targeting what the following sessions aimed to do.

 We hope that this makes sense, and also that it reflects what the practitioner intended. We think it may have been to our detriment over the last decade or so to have become more focused on named conditions in our PR and marketing because this inevitably invites comparison with Western medicine which usually has set protocols involving specific numbers of treatments for many problems. In Chinese medicine each patient is unique and different, and the treatment of the same named condition in a dozen patients may be different in every case. Our aim is to restore balance to the whole system in the belief that this enables the body to put right whatever symptoms might have appeared as a consequence. Once you look at treatment in this way the notion of laying foundations makes a great deal more sense.


Q:I have recently started acupuncture to aid fertility (my husband and I have been trying to conceive for 18 months with no luck). I am currently receiving acupuncture every fortnight and have been doing so for the past three months. Since starting the treatment I have been experiencing irregular spotting for about a week before my period is due. Is this normal? I am starting to think it is doing more harm than good.

A: We are sorry to hear of your problem. We would probably need a great deal more detail before we could offer a more specific view - what kind of bleeding, how long, any triggers and the background context of your normal cycle and problems with conceiving. Even then we would be cautious; there are several reasons why someone can start spotting, and it would be incautious to be offering too definitive a view at long range.

 What we can say with certainty, though, is that it is highly unlikely that acupuncture treatment has caused anything in the body to malfunction. The only harm that acupuncture treatment can ever do is physical damage to the body by putting a needle into internal organs by needling incorrectly, or by the simple act of insertion itself - nerve damage, minor bruising. We all train for a minimum of three years to ensure that these sorts of accidents don't happen, and the safety record of acupuncture treatment is exemplary. Research studies published in the BMJ a decade ago reveal how few even minor adverse events there are, only about 14 in 66,000 treatments.

 There are occasionally reactions like this when the body starts to return to normal function, and sometimes energetic reasons why a patient might be losing blood in the later part of the cycle. However, were this to happen to any of our patients our first action would be to refer them to their GP or consultant for further testing and investigation. The majority of reasons for spotting at this stage of the cycle are benign but some aren't, and these need to be checked out immediately. It may be that the acupuncture treatment and the advent of spotting are purely coincidental, and we have had to deal with a number of cases in the past where arguments have kicked off about what caused a problem while the problem itself has gone uninvestigated. Finding out what is happening should always be the first step; what caused it usually emerges from getting the answer.

 The other thing we would do is to seek the advice of experts within the acupuncture profession in the treatment of fertility issues. Although we have yet to formally recognised specialisms there are two or three areas like paediatrics and obstetrics/fertility where practitioners have undertaken significant postgraduate study and where leading practitioners have dedicated their practice solely to these areas. Many BAcC members undertake training with them, and have access to their advice and expertise. We would hope that any member who did not fully understand why a specific symptom was happening to ask for specialist advice to set a patient's mind at rest.

 We hope that this isn't too woolly, but without greater detail we would be unhappy to be more specific. We think the best advice is to talk the matter through with your practitioner, and if they cannot offer a satisfactory explanation then they should be talking to someone who can. In any event, we would advise you to get the symptom checked anyway just to eliminate some of the more rare reasons why spotting can start to happen.


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