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Infertility and Assisted Reproduction

Assisted reproductive technology (ART) is available to two-thirds of the world’s population, and world-class experts, representing research from 18 different countries, have contributed to this groundbreaking textbook, detailing the techniques and philosophies behind medical procedures of infertility and assisted reproduction. This is one of the most rapidly changing and hotly debated fields in medicine. Different countries have different restrictions on the research techniques that can be applied to this field, and, therefore, experts from around the world bring varied and unique authorities to different subjects in reproductive technology. Encompassing the latest research into the physiology of reproduction, infertility evaluation and treatment, and assisted reproduction, it concludes with perspectives on the ethical dilemmas faced by clinicians and professionals. This book will be the definitive resource for those working in the areas of reproductive medicine world wide.

THE REVOLUTION OF ASSISTED REPRODUCTIVE TECHNOLOGIES: HOW TRADITIONAL CHINESE MEDICINE IMPACTED REPRODUCTIVE OUTCOMES IN THE TREATMENT OF INFERTILE COUPLES

Paul C. Magarelli, Diane K. Cridennda, Mel Cohen
Traditional Chinese Medicine (TCM) has gained a foothold in the Western medical modalities for pain, sports injuries skin conditions, anesthesia, and overall health maintenance (see WHO report; http://www.who.int/enl). Prior to 1990s, assisted reproductive technologies (ART or IVF - in vitro fertilization) depended on massive technical, pharmaceutical, and medical interventions to produce modest enhancements in expected outcomes (i.e., live births from treatments; see CDC at www.cdc.gov). The scope of the improvement was about 1 percent per year elevation in live births per embryo transfer from 1986 to 2000 (www.cdc.gov).

In 1996, a sentinel paper was published in Human Reproduction by Stener-Victorin et al. (1), which created a groundswell of interest by TCM practitioners in ways to assist IVF patients. She reported that acupuncture (Ac) in the form of electro stimulation (e-Stim) Ac increased uterine artery blood flow in IVF patients. This was followed by another paper published in Fertility and Sterility (F&S) by Paulus et aL 2002 (2) that demonstrated enhanced pregnancy rates when Ac was used before and quickly after embryo transfer (ET). Although these studies provided important information, Western clinicians considered it far from proven, with editorials expressing condescension about premature adoption of CM for IVF patients.

Although the initial reaction by reproductive endocrinologists and infertility specialists was one of cautious resistance, persistence by D.K.C. in 1999 resulted in the first true collaboration of East and West research in this area. This chapter discusses our data, and we have diagrammed our approaches to answering the question: does adding Ac to IVF treatments improve outcomes and more importantly, how does it do this and what are the mechanisms? Outlined below are the scientific studies that form the basis for this chapter:
1. Ac and IVF poor responders: a cure? (5).
2. Ac and good-prognosis IVF patients: synergy (6).
3. Ac: impact on pregnancy outcomes in IVF patients (7).
4. Improvement of IVF outcomes by Ac: are egg and embryo qualities involved? (8). -
6.Ac and IVF: does the number of treatments impact repro-ductive outcomes? (9).
7. Impact of Ac on prolactin and cortisol levels in IVF patients (10).
8. The demographics of Ac's impact on IVF outcomes: infertility diagnosis and SART/CDC age-groups (11).

 

ART provides reproductive services to infertile couples throughout the world in the form of IVF. The process of IVF began with the birth of Louise Brown in 1978 by Edwards and Steptoe. The process has evolved into a technology rich in equipment, scientific jargon, steeped in tradition, and pregnant with innovation. Like the first heart transplant, IVF has gone from medical wonder to "standard of care." Unfortunately, this has also led to a somewhat depersonalized technology, which is the antithesis of what these desperate, injured, infertile couples need. Today more than 1,000,000 IVF cycles are performed each year around the world for a population of six billion humans. Most estimates of infertility when calculated represent 15 percent of married/bonded couples. This would predict many more couples in need of reproductive care who are not receiving this gift of family building. What is happening?

Part of the problem is access and cost. Others include the depersonalization of the process and resistance factor on the part of the couples themselves! Fertility is a personal matter, which is publicly controlled.....