How to Improve
It's the front and back of mind panic subject of the great majority of fertility patients.
It’s the focus of the “poor embryo” conversation at the RE’s office.
It’s the hot media and chat- room topic.
For women who bravely wait for love, the right partner, or have the creativity, stamina and drive to walk the career path before beginning families, egg quality is perhaps the number one concern they share.
Those diagnosed with Premature Ovarian Failure, those who’ve been through medical odysseys, such as cancer, or find themselves carriers of certain genes, are all swirling with concern about egg quality. PCO/PCOS women have their own variations on challenges to healthy embryos as well.
Egg quality issues show up in ART (assisted reproduction technology) as fewer numbers of eggs available, fewer of those sensitive to hormonal stimulation and able to fully mature and be fertilized, fewer embryos free of inclusions, and blastocysts free of chromosomal abnormalities.
This is the painful experience of so many.
Yet, it’s not been demonstrated by medical research that Nature serves her best eggs first, putting them in a queue. “All A’s to the head of the line. F’s – you hang back, we’ll keep you until the very end.”
What has been demonstrated, however, is that egg quality is not fixed, but affected by multiple ongoing and fluctuating factors.
And so, in my work with women who are mostly somewhere in their late 30's to late '40s, egg quality is an ongoing conversation. Yet, we’re having a slightly different conversation. With great frankness and respect for what the numbers (including age) are for her, we get busy discussing and capitalizing on the unfixed variables that can have an enormous impact on egg quality.
From Menopausal to Expecting
This lovely Physical Therapist came to see me when she was just turning 42.
Cancer had been the focus of the last four years of her life.
Her oncologist had given her a “clean bill of health” six months after completing chemotherapy. He told her she could “start trying” when her period returned.
But her period did not return. So she went to her gynecologist. Her gynecologist sent her to the RE.
The RE explained that she had entered menopause. Her FSH was 127 and no follicles showed on ultrasound. Rochelle learned from the RE that she would never conceive on her own or through IVF, but she did still have one option -- Donor. Open but not ready, she called one of her healthcare providers, who referred her to me.
Three months after we started our work together Rochelle got a period. Three months after that, sweet little Olivia was conceived the old-fashioned way.
Healthy babies come from healthy eggs. So Rochelle not only had eggs, they must have been darn good ones!
Rochelle’s 6-month journey from menopausal to expecting is really the story of our capacity to heal and rejuvenate. It’s the story of the whole being much more than the sum of its parts. It’s the story of the microcosm (healthy eggs) issuing from the macrocosm (healthy person).
Rochelle’s lesson for us is that the ovaries and the follicles they house are responsive . . . to the vast complex network known as “you.”
Improving Egg Quality:
A Strategically Holistic Approach
When we wish to improve something specific, such as egg quality, we need a two-pronged approach.
We have a very specific goal, so we need to take into account all science teaches us about the requirements of an egg or follicle. What does it need? We must supply those things. What must it be protected from? We must work to minimize those influences.
At the same time, our specific goal cannot derail us from common sense and basic facts. Therefore we put down the irrational and just plain proven wrong notion that egg quality is something that exists by itself. The fruit always comes from the tree.
So we must create a strategically holistic approach.
The approach will address the universal requirements shared by all of your cells, the special "issues" you have, and the specific requirements of follicles. The approach will foster your health in general with highlighted and targeted attention to your unique bio-individuality. Looking through the lenses of both biomedicine and Chinese medicine, we see our work cut out for us.
Egg Quality Lessons from a Tree
Just about every woman I work with has egg quality issues. To illustrate the importance of environment on egg quality, and to jump-start a new egg quality conversation (or a new twist on the age and genetics conversation), I turn to the analogy of the tree. This simple story helps us wake from our fear of inadequacy and leads us back to reality.
Nature's cut-off point (menopause: a full year without menstruation) is firm. Up to it, there is opportunity to nourish remaining potential and conceive. How we do that is by working your "environment."
Holding out my fists, I explain I’ve got two acorns from the same gorgeous ancient oak tree, one in each hand. I say I’m going to plant one in the Hudson Valley (that’s New York speak for country valley near a river where there’s lots of sunshine and organic farmlands and birds and bees and Nature).
Then I say I’m going to plant the other along the BQE (that’s New York code for stressful highway with lots of traffic, pollution, noise, and barely a patch of soil or anything else a tree might require). And then I ask, “Which one do you think will become the giant oak?” Of course, some trees do make it along the BQE, but the fertility of the Hudson Valley is undeniable, with its barely contained forests and orchards sprawling everywhere.
In medical research, the importance of the environment is startlingly illustrated by an oophorectomy experiment on rats. They took the ovaries of rats past litter bearing age and transplanted them into younger rats. Those ovaries got reactivated and healthy new rats were born. But when they did the reverse, putting young ovaries in the older rats, those recently fertile ovaries shut down. (1)
Ovaries and Follicles
Are Responsive to Their Environments
Responsive means that at a certain point in development, follicles move toward the surface of the ovary and become “biologically activated.”
That’s when Life catches up with our eggs. And, that’s one reason strategically holistic medicine is able to improve egg quality.
For most of their [decades] long lives, ova live blissfully and safely secured deep in the cortex of the ovary, tucked away from interaction with the rest of the body’s physiology (healthy function) and pathology (unhealthy disruption).
It’s when Nature selects them to move up to the surface of the ovary, to get in queue for their future candidacy for an ovulation cycle, that their precious DNA cargo becomes exposed and vulnerable. For at this point the follicles, just like every other cell of every other organ and gland, become dependent on the “environment” they live in – which will make or break them.
The environment is the key. And it’s the actionable part. We cannot select a different family line to change which genes we inherit. We cannot change how many years we’ve been on the planet. We can’t rewrite history and find our love match earlier. What we can do is put any guilt down, nourish our follicles, and ourselves, into our most fertile potential.
Hormones are Results
Chinese medicine, we pay a great deal of attention to cycle regulation. This is because the cycle itself is both the product and the environment, of the follicles. In a way, it can be thought of as an expression of egg quality.
So when we analyze hormone values, we’re thinking about them as egg quality clues.
They give us good information (elevated FSH, low estrogen, etc.) about where we need to focus. Each phase of the cycle (menstrual, follicular, ovulation, luteal, premenstrual) builds on what has come before and sets the stage for the next phase.
The dance between the ovaries, the brain and the master gland that shapes your cycle, is a complex tango where the dancers follow each other’s leading nuances with great sensitivity. In biomedicine, this dance is called the HPO, or hypothalamic (brain) – pituitary (master gland) – ovarian axis.
When we regulate the cycle, what we are doing is healing the HPO.
~ When we heal the HPO, we nurture the follicles.
~ When we nourish follicles, we improve egg quality.
~ When we improve egg quality, our hormones come into balance.
~ When our hormones are in balance, natural conception is more likely.
~ Or we are more eligible to be successful in IUI, IVF, embryo banking, etc.
That is Rochelle’s story. We worked on healing her HPO by focusing on restoring her cycle, which allowed follicles to emerge. We used breathing and Qi Gong movement meditations to calm her heart and mind so stress was not undermining her progress.
We fed her cells with nutraceutical supplements, diet, and herbs, which gave her emerging follicles the nutritional requirements they needed to mature and her uterus what it needed to foster any embryo that implanted. The cycle in which Rochelle conceived naturally her FSH was 28. We don’t need to be textbook perfect.
At 40, when Dania first came to see me, she had already been through two top-tier private fertility clinics and was on her third big university medical center in New York, always seeking “the best” doctors.
Three IUI’s and seven IVF’s behind her, she’d gone from stimulating well to completely unresponsive, with embryo grades sliding downward in between, fewer and fewer chromosomally normal blastocysts each time.
Like Rochelle, the counsel was Donor. She was on Synthroid for underperforming thyroid and reported psoriasis and eczema. I sent her for a full autoimmune workup. The psoriasis and thyroid were flags to me and turned out to be the tip of an autoimmune iceberg.
We agreed to a three-month time-out from RE care as her spouse was completely against Donor and she was undecided, and that’s the only option they were still offering. We dove into strategically holistic care.
With so many autoimmune markers on the table, from NK cells to thyroid antibodies, the first task was to help her body calm down and protect itself.
We started with her gut. Already a healthy eater and exerciser, she had a good headset and platform to build upon. We skipped sending her for expensive testing for intestinal permeability, SIBO (small intestine bacterial overgrowth), food allergies, and other gut-related AI (autoimmune) detail and agreed to “act as if” because gut integrity is critical to resolving in autoimmune conditions. Gluten, including cross-reactive gluten mimic foods, along with dairy and fruit (healthy sugar) came off the menu. It felt drastic but necessary to her.
Simultaneously, we had her do a special cellular inflammation herbal detoxification program.
Her psoriasis and eczema cleared up within 3 weeks of starting our work and we knew we were on the right track.
Her next two periods were brighter and fuller.
We targeted the systemic patterns of inflammation while opening the meridians (energy channels) that passed through her ovaries, tubes, and uterus. We had her stimulate acupressure points on her feet and hands (while she watched TV at night to wind down from a stressful job as a music industry executive) to keep her body’s healing attention on her ovaries and reproductive complex.
Being “left-brained” and "type A," as Dania described herself, she liked tracking her numbers.
So just two months into our work she had blood work done. Her autoimmune markers were way down. Her hormone values were already in the IVF eligible range. She decided to go back to the RE she’d liked best, even though our plan had called for three months. Options open as we go along.
She made 3 normal blastocysts, the first of which became Nelson, her first child, and she preserved the other two.
She continued herbs throughout pregnancy and postpartum, and then I only heard from her through amazing photo updates of Nelson. Eighteen months later she came back “to go all in” before doing a FET (frozen embryo transfer) with one of those remaining beautiful blastocysts. We again decided on a three-month prep. But before she could get to the RE, she fell pregnant. Jaw-dropping does not begin to describe her surprise!
She worried all throughout her pregnancy, but Horatio made it past the due date and came out perfect. We don’t need to “stay positive”; we need to be ourselves and positively show up.
There is no crystal ball to look into and pronounce our future.
As the saying goes, “We understand our lives backward, but have to live them forwards.” Most of us wish to do our best and try everything we can to create the positive future we envision for ourselves.
The strategically holistic approach treats the causes of infertility naturally and in partnership with physicians.
Our positive future begins when we decide to follow what is in our hearts, sometimes stepping away from mainstream information and opinion. I call this taking back power. Because we need the help of experts, we sometimes hand them the CEO role in our lives and health.
What makes sense to you?
As you ponder that, I’ll leave you with this inspiring study from the journal of Reproductive Biomedicine Online, and offer you my very best wishes for your fertility journey!
In a retrospective cohort study of 1231 IVFs (using live birth as the measure), 61.8% of those in a Chinese medicine-based layered care program + IVF had success compared to 48.2% in the IVF alone group, and 50.1% in the IVF + acupuncture at embryo transfer group. (2)
(1) New Harvest: Transplanting Body Parts and Reaping the Benefits, Don Keyes, Walter E. Wisest, © 1991,p. 102
(2) Lee E. Hullender Rubin, et al., Impact of whole systems traditional Chinese medicine on in vitro fertilization outcomes, Reproductive BioMedicine Online (2015), DOI: 10.1016/j.rbmo.2015.02.00 in this area