החזרת עוברים-קצת ארוך

שלום. אני כבת 30, לאחר 2 כשלונות של החזרת עוברים. אציין כי העוברים היו איכותיים מאוד. בפעם הראשונה הוחזרו 2 עוברים. בפעם השניה הוחזר עבור אחד כי השניים האחרים לא שרדו את תהליך ההפשרה. רציתי לשאול לדעתך: האם ידוע על תרופות הורמונליות שגורמות לרחם להיות קר, בגלל נוזלים שמצטברים בבטן, עקב טיפול הורמונלי, ויש תרופות טבעיות שיכולות לפזר את הנוזלים ולגרום לחימום ברחם? האם יש עוד סוג של תרופות שיכולות לעזור בהשרשת העוברים ברחם? תודה

שלום מיקה אני שולח לך שני מאמרים בנושא. רפואה סינית מצליחה לטפל יפה במקרים אלו ושני המאמרים התפרסמו במגזיני רפואה רצינים. ::: A Study of the Effectiveness of Acupuncture as an Adjunct to In Vitro Fertilization. ::: Introduction: Infertility is a disorder that confronts couples attempting to embark on the major achievement in their life cycle. As a result of their frustrations and disappointments, patients often become motivated to try almost anything that may help them attain their goal - building their family. In recent years, this trek through medical therapies almost always leads to In Vitro Fertilization, which has become increasingly successful. However, as frustrations increase either due to repeated disappointments or inability to accomplish IVF for medical or financial reasons, many have sought alternative means to achieve a successful pregnancy. One of these most popular alternative therapies is acupuncture, a mainstay of Traditional Chinese Medicine (TCM), used to treat almost any ailment known to man. To say that acupuncture is all of TCM or that acupuncture entails only a single type or technique is misleading and an oversimplification. Acupuncture is the method of needling very specific points on a meridian representing various organs and ailments. Examination of an individual may expose various conditions affecting that person. Specific points on the meridian may be indicated based on either the examination and/or the condition the acupuncturist is attempting to treat. Infertility is treated with reported success using a variety of points on the meridian. The acupuncture when utilized as an adjunct to IVF is used to attempt to relax the uterus around the time of embryo transfer and thus make the environment for the embryo more conducive to implantation. Until recently, there have been few studies concerning the use of acupuncture in reproductive medicine. One study showed that electroacupuncture might reduce blood flow impedance in the uterine arteries of infertile women. (1) Auricular acupuncture was successfully used in the treatment of female infertility. (2) Utilizing the effect of acupuncture on the autonomic nervous system, the treatment was employed in another study to optimize endometrial receptivity. (3) Recently, a study of adjunctive acupuncture revealed improved pregnancy rates when this treatment was performed at the time of embryo transfer in an attempt to relax the uterus. In this recently reported study, clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, whereas the pregnancy rate was only 21 out of 80 (26.3%) patients in the control group. (4) The purpose of the proposed study is to evaluate the use of adjunctive acupuncture around the time of embryo transfer in a very successful IVF program. Objective: To evaluate the effectiveness of acupuncture as adjunctive therapy to In Vitro Fertilization in different age groups in a highly successful IVF program by comparing a patient group receiving acupuncture 25 minutes before and after embryo transfer with a control group receiving no acupuncture. Design: Prospective randomized study. Setting: Office based IVF program. Patients: After proper consent is obtained, 180 patients undergoing IVF are divided equally into the acupuncture treatment group (90) and control group (90) not receiving acupuncture through random selection. Materials and Methods This prospective randomized trial consists of an equal number of patients within each age group under 37, 37-39 and 40 and over divided into the experimental and control groups (30 in each group). A total of 180 healthy women will undergo IVF or ICSI (intracytoplasmic sperm injection). The age will range from 21-44 (mean = 35). Patients are to be assigned to a group by a computerized randomization method between the acupuncture group and control group. When the required number for any group has been obtained then no more will be recruited for that age group. To avoid bias, all patients under 37 will transfer two embryos. Patients 37-39 transfer two unless one of the embryos is either less than 6 cells or less than grade A and then three embryos are transferred. Patients, ages 40 and over, transfer 3 or 4 embryos based on the same criteria. Ovarian stimulation is individualized using agonist or antagonist and gonadotropin dose based on assessment of ovarian volume and basal follicular number. The smaller the ovarian volume and basal follicular number the higher the gonadotropin dose and more likely that antagonist is used after gonadotropin stimulation is initiated. The transvaginal ultrasound-guided needle aspiration of follicular fluid is performed 35.5 hours after hCG administration and is performed under sedation with propofol using continuous wall suction at 110mm Hg. The embryo transfer is performed using ultrasound guidance with placement of a 15ul drop containing embryos at about 1.25cm from the top of the endometrial stripe as described earlier (5) All ovarian stimulations, oocyte retrievals and embryo transfers are performed by the same physician who is blinded to the patient’s use of acupuncture as an adjunct to her IVF. The same stimulation guidelines, sperm preparation and culture conditions are utilized in both groups. In cases of male subfertility, ICSI is to be performed as previously described. (6) All embryo transfers are performed on day 3 after oocyte retrieval. The patient is placed in a dorsal lithotomy position with a full bladder. The cervix is washed with culture media prior to embryo transfer. A Wallace Embryo Transfer Catheter is inserted under abdominal ultrasound guidance. The inner catheter removed and outer sheath left in cervical canal while the embryos are loaded in a new Wallace Embryo Transfer Catheter. At the bedside, the inner catheter containing embryos is removed and inserted through the outer sheath already tunneled through the cervical canal. The catheter tip is inserted to a distance of 1.25mm from the top of the endometrial stripe at which time the tuberculin syringe is slowly plunged injecting the 15ul drop containing embryos into the uterine cavity. We will support the luteal phase using 200ug capsules four times per day. Progesterone administration is initiated on the day of oocyte retrieval with a 25mg Progesterone in oil injection. This dose is increased to 50mg until the day of transfer when it is replaced by the vaginal progesterone. Each patient in the experimental group receives acupuncture treatment 25 minutes before and after embryo transfer. Sterile disposable stainless steel needles are inserted in specific points on the meridian. Before embryo transfer, the following locations are needled: Cx6 (Neiguan), Sp8 (Diji), Liv3 (Taichong), Gv20 (Baihui), and S29 (Guilai). After embryo transfer, the needles are inserted at: S36 (Zusanli), Sp6 (Sanyinjiao), Sp10 (Xuehai), and Li4 (Hegu). The same well-trained acupuncturist using identical technique performs all treatments. Statistical analysis will be performed using chi-square to compare the two groups within each age group and in total. References 1 - Stener-Victorin, E, Waldenstrom U, Andersson SA, Wikland M. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Hum Reprod 1996; 11:1314-7. 2 - Gerhard I, Postneek F. Auricular acupuncture in the treatment of female infertility. Gynecol Endocrinol 1992; 6: 171-81. 3 - Stener-Victorin, E., Lundeberg T, Waldenstrom U, Manni L, Aloe L, Gunnarsson S, Janson PO: Effects of electro-acupuncture on nerve growth factor and ovarian morphology in rats with experimentally induced polycystic ovaries. Biol Reprod 2000; 63: 1497-503. 4 - Paulus W., Zhang M., Stehler E., El-Danasouri I., Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril 2002; 77: 5 - Kreiner, D., 6 - Study describing ICSI technique Acupuncture 'boosts IVF success' Acupuncture helped, but doctors do not know why Women undergoing fertility treatment could have their chances of success boosted by acupuncture. German researchers said they have increased success rates by almost 50% in women having in vitro fertilisation (IVF). The theory is that acupuncture can affect the autonomic nervous system, which is involved in the control of muscles and glands, and could therefore make the lining of the uterus more receptive to receiving an embryo. But the scientists admit they do not know for certain why the complementary therapy helped, and plan to carry out more studies in a bid to find out. Fertility techniques are used to help couples who cannot conceive naturally. The theory of acupuncture is based on pathways called meridians. Research has shown it can help relieve nausea caused by anaesthetics during surgery or chemotherapy and to relieve dental pain. It may also help relieve other conditions including headaches and menstrual cramps. 'A useful tool' A report published in the journal Fertility and Sterility found the pregnancy rate in the group receiving acupuncture was 42.5%, compared to the group which did not receive the therapy, where the rate was 26.3%. The German researchers worked with doctors at the Department of Traditional Chinese Medicine at Tongji Hospital in Wuhan, China. Of 160 women undergoing IVF, half received standard in vitro fertilisation, while half were given acupuncture treatments before and after. The researchers chose acupuncture points which traditional Chinese medicine says relax the uterus. They also used needles to stimulate meridians involving the spleen, stomach and colon, to improve blood flow and create "more energy in the uterus." Key relaxation points were also stimulated. The research team, led by Dr. Wolfgang Paulus and colleagues at the Christian-Lauritzen-Institut in Ulm, Germany, wrote in the journal: "Acupuncture seems to be a useful tool for improving pregnancy rate after assisted reproductive techniques". They add: "To rule out the possibility that acupuncture produces only psychological or psychosomatic effects, we plan to use a placebo needle set as a control in a future study." Such a study would involve people having needles inserted in the same way as in acupuncture, but not at the acupuncture points. Dr. Sandra Carson, president-elect of the American Society of Reproductive Medicine, which publishes the journal, said: "If these findings are confirmed, they may help us improve the odds for our (in vitro fertilization) patients' achieving pregnancy." Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy... Wolfgang E. Paulus, M.D.,[a] Mingmin Zhang, M.D.,[b] Erwin Strehler, M.D.,[a] Imam El-Danasouri, Ph.D.,[a] and Karl Sterzik, M.D.[a] Christian-Lauritzen-Institut, Ulm, Germany Prospective Randomised Study Results Published: FERTILITY AND STERILITY® VOL. 77, NO. 4, APRIL 2002 Objective To evaluate the effect of acupuncture on the pregnancy rate in assisted reproduction therapy (ART) by comparing a group of patients receiving acupuncture treatment shortly before and after embryo transfer with a control group receiving no acupuncture. Setting Fertility center. Patient(s) After giving informed consent, 160 patients who were undergoing ART and who had good quality embryos were divided into the following two groups through random selection: embryo transfer with acupuncture (n = 80) and embryo transfer without acupuncture (n = 80). Intervention(s) Acupuncture was performed in 80 patients 25 minutes before and after embryo transfer. In the control group, embryos were transferred without any supportive therapy. Main Outcome Measure(s) Clinical pregnancy was defined as the presence of a fetal sac during an ultrasound examination 6 weeks after embryo transfer. Result(s) Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the control group. Conclusion(s) Acupuncture seems to be a useful tool for improving pregnancy rate after ART. (Fertil Steril®2002;77:721- 4. ©2002 by American Society for Reproductive Medicine.) Materials and Methods This study was a prospective randomized trial at the Christian-Lauritzen-Institut in Ulm, Germany. It was approved by the ethics committee of the University of Ulm. A total of 160 healthy women undergoing treatment with in vitro fertilization (IVF; n = 101) or intracytoplasmic sperm injection (ICSI; n = 59) were recruited into the study. The age of the patients ranged from 21 to 43 (mean age: 32.5 = 4.0 years). The cause of infertility was the same for both groups (Table 1). Only patients with good embryo quality were included in the study. Using a computerized randomization method, patients were assigned into either the acupuncture group or the control group. Table 1 Descriptive data on acupuncture and control group (mean ± SD or total number). Control group Acupuncture group Statistics (n = 80) (n = 80) Statistics Age of patients (years) 32.1 ± 3.9 32.8 ± 4.1 NS No. of previous cycles 2.0 ± 2.0 2.1 ± 2.1 NS No. of transferred embryos 2.1 ± 0.5 2.2 ± 0.5 NS IVF (n) 54 47 NS ICSI (n) 26 33 NS No. of cycles with male factor infertility 46 47 NS No. of cycles with tubal disease 21 22 NS No. of cycles with polycystic ovaries 2 2 NS No. of cycles with unknown cause of infertility 11 9 NS Endometrial thickness (mm) 9.9 ± 2.7 9.1 ± 2.4 NS Plasma estradiol on day of embryo transfer (pg/mL) 1001 -± 635 971 ± 832 NS Pulsatility index of uterine arteries (PI) before embryo transfer 2.00 ± 0.56 2.02 ± 0,45 NS Pulsatility index of uterine arteries (PI) after embryo transfer 2.19 ± 0.52 2.22 ± 0,44 NS Pregnant 21/80 (26.3%) 34/80 (42.5%) P=.03 NS = not significant (P>.05). Paulus. Acupuncture in ART. Fertil Steril 2002. Study Details Ovarian stimulation, oocyte retrieval, and in vitro culture were performed as previously described (7). Transvaginal ultrasound-guided needle aspiration of follicular fluid was performed 36 to 38 hours after hCG administration. Immediately after follicle puncture, the oocytes were retrieved, assessed, and fertilized in vitro. Sperm preparation and culture conditions did not differ for either group. In cases of severe male subfertility, ICSI was preferred, as described in the literature (8). Forty-eight hours after the IVF or ICSI procedure, embryos were evaluated according to their appearance as type 1 or 2 (good), type 3 or 4 (poor), as described in literature (9). Just before and after embryo transfer, all patients underwent ultrasound scans of the uterus using a 7-MHz transvaginal probe (LOGIQ 400 Pro, GE Medical Systems Ultra-sound Europe, Solingen, Germany). Pulsed Doppler curves of both uterine arteries were measured by one observer. The pulsatility index (PI) for each artery was calculated electronically from a smooth curve fitted to the average waveform over three cardiac cycles. A maximum of three embryos, in accordance with German law, were transferred into the uterine cavity on day 2 or 3 after oocyte retrieval. For embryo replacement, the patient was placed in a dorsal lithotomy position, with an empty bladder. The cervix was exposed with a bivalved speculum, then washed with culture media prior to embryo transfer. Labotect Embryo Transfer Catheter Set (Labotect GmbH, Go¨ ttingen, Germany) was used for atraumatic replacement owing to the curved guiding cannula with a ball end, allowing the set to be used reliably even with difficult anatomic conditions. The metallic reinforced inner catheter shaft al lowed safe passage through the cervical canal. When the catheter tip lay close to the fundus, the medium containing the embryos was expelled and the catheter withdrawn gently. After this procedure, the patient was placed at bed rest for 25 minutes. All oocyte retrievals and embryo transfers were performed by one examiner using the same method. The examiner was not aware of the patient's treatment group (control or acupuncture). At the time of the embryo transfer, blood samples (10 mL) were obtained from the cubital vein. Plasma estrogen was determined by an immunometric method using the IMMULITE 2000 Immunoassay System (DPC Diagnostic Product Corporation, Los Angeles, CA). Luteal phase support was given by transvaginal progesterone administration (Utrogest®, 200 mg, three times per day; Kade, Berlin, Germany). Progesterone administration was initiated on the day after oocyte retrieval and was continued until the serum ß-hCG measurement 14 to 16 days after transfer and, in cases of pregnancy, until gestation week 8. Acupuncture Treatment Details Each patient in the experimental group received an acupuncture treatment 25 minutes before and after embryo transfer. Sterile disposable stainless steel needles (0.25 X 25 mm) were inserted in acupuncture point locations. Needle reaction (soreness, numbness, or distention around the point = Deqi sensation) occurred during the initial insertion. After 10 minutes, the needles were rotated in order to maintain Deqi sensation. The needles were left in position for 25 minutes and then removed. The depth of needle insertion was about 10 to 20 mm, depending on the region of the body undergoing treatment. Before embryo transfer, we used the following locations: Cx6 (Neiguan), Sp8 (Diji), Liv3 (Taichong), Gv20 (Baihui), and S29 (Guilai). After embryo transfer, the needles were inserted at the following points: S36 (Zusanli), Sp6 (Sanyinjiao), Sp10 (Xuehai), and Li4 (Hegu). In addition, we used small stainless needles (0.2 X 13 mm) for auricular acupuncture at the following points, without rotation: ear point 55 (Shenmen), ear point 58 (Zhigong), ear point 22 (Neifenmi), and ear point 34 (Naodian). Two needles were inserted in the right ear, the other two needles in the left ear. The four needles remained in the ears for 25 minutes. The side of the auricular acupuncture was changed after embryo transfer. The patients in the control group also remained lying still for 25 minutes after embryo transfer. All treatments were performed by the same well-trained examiner, in the same way. The primary point of the study was to determine whether acupuncture improves the clinical pregnancy rate after IVF or ICSI treatment. Student's t-test was used as a corrective against any possible imbalance between the two groups regarding the following variables: age of patient, number of previous cycles, number of transferred embryos, endometrial thickness, plasma estradiol on day of transfer, method of treatment (IVF or ICSI), and blood flow impedance in the uterine arteries (pulsatility index). Chi-square test was used to compare the two groups. All statistical analyses were carried out using the software package Statgraphics (Manugistics, Inc., Rockville, MD). Results A total of 160 patients was recruited for the study. Patients who failed to conceive during the first treatment cycle were not reentered into the study. According to the randomization, 80 patients were treated with acupuncture, and 80 patients underwent the usual therapy without acupuncture. As Table 1 shows, there were no statistically significant differences between the two groups with respect to the following covariants: age of patient, number of previous cycles, number of transferred embryos, endometrial thickness, plasma estradiol on day of transfer, or method of treatment (IVF or ICSI). Clinical indications for ART were the same for patients of both groups. The blood flow impedance in the uterine arteries (pulsatility index) did not differ between the groups before and after embryo transfer. The analysis shows that the pregnancy rate for the acupuncture group is considerably higher than for the control group (42.5% vs 26.3%; P=.03). As we could not observe any significant differences in covariants between the acupuncture and control groups, the results demonstrate that acupuncture therapy improves pregnancy rate. Our Female Healthcare Philosophy At the Women's Natural Health Practice we specialise in providing comprehensive natural, reproductive, gynaecological, obstetric and general healthcare for females from adolescence to post-menopause. Our approach is to integrate techniques in both oriental and western medical diagnosis in order to formulate a naturally oriented treatment plan combining acupuncture, herbal medicine, nutritional therapy, exercise and lifestyle. Each treatment plan is tailored specifically to each individual woman maximising results. Please email us at [email protected] with questions, we are more than happy to provide any information via email that will assist you in deciding which treatment approach would be best for you בהצלחה טל

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כדי לתת לנו מאמר כזה ארוך ועוד באנגלית? אתה לא יכול לתמצת בכמה משפטים: כן או לא? שחור או לבן? משהו שבאמצע? סליחה על התוקפנות, אבל לקרוא מאמרים בעניין, גם אני יכולה לחפש ולקרוא.