Women and couples who are trying to conceive often experience loss and disappointment. Pulling Down the Moon’s Dealing with Disappointment program offers patients an opportunity to come together in community and share those losses in a supportive environment.

Check out our video for more information about this program which happens quarterly.  This month, the program will be held on Thursday, March 11.

By Anna Pyne LAc MSOM

A recent study entitled “Acupuncture as an Adjunct to In Vitro Fertilization: A Randomized Trial” was published in the journal Medical Acupuncture showing that electro-acupuncture used in conjunction with Traditional Chinese Acupuncture doubled the pregnancy success rates of IVF patients as compared to the national average of patients undergoing IVF.*    The study was conducted at Acupuncture and Chinese Medical Center in Ann Arbor Michigan using a total of 52 IVF patients with the average age of 38 years.  The patients in the study were randomly divided into three different groups:  1) traditional Chinese acupuncture (TCA) plus electro-acupuncture (EA), 2) TCA-only, or 3) EA-only.   All patients also underwent “standard IVF medication regimen.”   The authors of this study did not include an IVF-only control group and compared their treatment outcomes to average U.S. IVF success rates. 

According to the Center for Disease Control and Prevention the average success rate of IVF alone is about 40%.  In this study all groups had higher IVF success rates than the average U.S. success rate, and the improvement was greatest when TCA and EA were used in conjunction.  The authors conclude a “marked increase with the combination of TCA and EA (81.8% success rate)”!*  The TCA alone group had a 64% success rate, and the EA alone group had a 63% success rate.  The points used in the TCA and EA group were determined based upon the patient’s individual traditional Chinese medical diagnosis.  This study proves that traditional Chinese acupuncture in combination with electro-acupuncture “…is a promising new technique for the treatment of infertility with a higher IVF success rate than that of TCA or EA alone.”*   

While this study would have been strengthened by the addition of an IVF-only control group, the findings of this study are supportive of the growing body of evidence that treatment with Traditional Chinese Acupuncture does increase a woman’s chances of conception with IVF. 

*Medical Acupuncture Volume 21, Number 3, 2009 “Acupuncture as An Adjunct to In Vitro Fertilization: A Randomized Trial”

By Breea Johnson, MS RD LDN

Fish oil with Omega-3s (that supply DHA and EPA) are a class of supplements commonly recommended for women with infertility. While nutritionists stress the importance of quality when choosing supplements, many people buy fish oil from their local store for convenience or to save money. This past week a lawsuit was filed in California against fish oil manufacturers [CVS Pharmacy Inc.; General Nutrition Corp. (GNC); Now Health Group Inc.; Omega Protein Inc.; Pharmavite LLC (Nature Made brand); Rite Aid Corp.; Solgar Inc., and TwinLab Corp]. The lawsuit charges that these companies sold fish oil that contained “undisclosed and unnecessarily high levels of contamination with polycholorinated biphenyl (PCB) compounds.”

What are PCBs? PCBs are a class of chemicals that are now illegal. However, they were utilized for many different purposes in industrial manufacturing – such as in coolants, PVC piping, pesticides and paints among other things. They are now considered one of the POPs (Persistent Organic Pollutants), a group of the most toxic compounds that still exist in our food and bodies despite being outlawed years ago. According to the EPA, PCBs have been shown to cause cancer in animals, and negatively affect the immune system, reproductive system, nervous system, and endocrine system, amongst other ill health effects. Here is an excerpt from the EPA’s website about the effect of PCBs on reproduction in animals and humans:

“PCB exposures were found to reduce the birth weight, conception rates and live birth rates of monkeys and other species and PCB exposure reduced sperm counts in rats. Effects in monkeys were long-lasting and were observed long after the dosing with PCBs occurred.

Studies of reproductive effects have also been carried out in human populations exposed to PCBs. Children born to women who worked with PCBs in factories showed decreased birth weight and a significant decrease in gestational age with increasing exposures to PCBs. Studies in fishing populations believed to have high exposures to PCBs also suggest similar decreases. This same effect was seen in multiple species of animals exposed to PCBs, and suggests that reproductive effects may be important in humans following exposures to PCBs.”

According to the Environmental Working Group, one of the highest food sources of PCBs include farm-raised (or Atlantic Salmon), with 16 times the amount of PCBs as wild salmon. Thus, supplementing your diet with a fish oil that contains PCBs or eating farm-raised salmon to obtain omega-3s may do more harm than good. It’s important to know where your supplements (and food) are sourced from, and how the companies treat and process it to form a supplement. There are many companies that sell high-quality fish oil. Read more about the quality of our fish oil here. Please consult with a Pulling Down the Moon nutritionist if you have more questions concerning this matter.

For more information:

www.fishoilsafety.com

www.ewg.org

If you build it, they will come. Co-Founders Beth Heller and Tami Quinn share their story on why they decided to create Pulling Down the Moon.

Here’s a good new/bad news situation.  The bad news is that more women are likely to receive a diagnosis of  Gestational Diabetes Mellitus (GDM) in the coming months.   The good news is that if you’re in the trying to conceive process and eating a fertility-friendly diet like the one we use at Pulling Down the Moon you are well on your way to preventing this condition which can be dangerous to mother and baby. 

Previously, a diagnosis of GDM was based on blood sugar measurements that identified women at higher risk for developing diabetes later in life.  The new standards take into consideration risks to the mother and baby, including overweight babies, early delivery, c-section delivery and pre-eclampsia (a life threatening rise in blood pressure that endagers health of mom and baby).  When these outcomes were added to the equation, experts found they needed to make the diagnostic criteria more stringent.  With the new guidelines, it’s estimated 16% of pregnant women will be found to have GDM instead of the 4-6% who currently get diagnosed.

Just in case you needed a bit more motivation to either get started or keep going with your fertility-friendly diet, do it for diabetes prevention and the health of your future child!

The most recent issue of Body Sense Magazine features Pulling Down the Moon’s Massage Director Meredith Nathan on the topic of how massage can help you lose weight.  When we asked Meredith about this topic, she came up with three ways massage helps us meet our weight loss goals right off the bat: 

1.  Massage lowers stress hormone levels.  Stress hormones like cortisol can increase our appetite, especially for sweet foods, and make our body more prone to gain weight around the middle.  Reducing stress reduces “stress eating” and mindless munching.

2.  Massage helps to release the aches, pains and to heal chronic injuries so we are more apt to get up and move our bodies.

3.  For those of us who like to treat ourselves for good work and good behavior, massage is calorie free and ultimately makes us feel better about a job well done than a hot fudge sundae. 

So, if you’re struggling to attain/maintain a your fertile weight, massage may be the missing link!   Click here to read more about what the experts have to say…

Guest Blogger:  Kimberly Wong, RD, LDN

Stress. There’s work stress, family stress, fertility stress…but now oxidative stress? Oxidative stress is natural body process that is essential to physiological function. As we breathe, our cells produce energy, and our body uses oxygen in the process. As a result of these normal metabolic actions, Reactive Oxygen Species (also called free radicals) are produced. In layman’s terms, we can understand ROS’s as highly-reactive molecules that have lost an electron during a chemical reaction and roam around “stealing” electrons from other molecules. While this doesn’t sound particularly scary, this chain reaction actually causes a tremendous amount of trouble on a chemical level. Enter antioxidants.

Antioxidants are chemical compounds that happily give electrons to free radicals in order to keep chemical peace. Antioxidants are present inside the body and also come from food. Antioxidant vitamins include Vitamin E, A and C, alpha-lipoic acid (ALA) and other compounds found in fruits and vegetables. As long as our body’s antioxidant capacity is adequate to manage ROS production, all is well. But when the balance tips, and ROS production outstrips our antioxidant ability, free radicals begin to wreak havoc on DNA, cell membranes and tissues. This condition is called Oxidative Stress (OS). Oxidative Stress can cause damage to our cell membranes, alter protein and DNA and cause cell death. OS is implicated in chronic diseases like cancer and heart disease…and now fertility.

So, what about oxidative damage does a girlfriend need to know? In general, our body knows what to do with free radicals. The body has abundant antioxidant systems that involve antioxidant substances like vitamins C and E, and their cofactors, selenium, zinc, and copper, which swoop through the body and dispose, scavenge, and/or suppress the formation of ROS. Yet it’s a delicate balance that our modern lifestyle with its pollution, over-processed/nutrient-bare foods and stressful pace is likely to upset.

“Oxidative Stress is increasingly recognized as a very important participant in many health disorders, including male and female infertility,” says Dr. Robert Stillman of Shady Grove Fertility.  “Our understanding of oxidative stress and of Reactive Oxygen Species – and their reduction – can improve the overall quality of health of our patients – and their fertility”

In terms of fertility, when the bad stuff (ROS) begins to outpace the good stuff (our antioxidant defenses), our fertility may begin to suffer. Because sperm are basically “DNA torpedoes” with one simple mission (swim fast and fertilize egg), they don’t have extensive antioxidant defense systems and are vulnerable to ROS. In addition, they have a high polyunsaturated fat content, which makes them susceptible to lipid peroxidation (read: damage) in the cell membrane. Various environmental and life-style behaviors can tip the balance of OS for sperm, including STDs, automobile pollution, smoking and potentially diet. OS in sperm has been associated with deceased sperm motility, sperm number, and sperm-oocyte fusion (Desai 2009)

In women, the female ovary is the source of both oocytes (eggs) and the hormones that regulate reproduction. As such, the environment around the ovaries is of particular importance to optimal fertility. The ovaries are also “power houses,” and contain more mitochondria (cellular power plants) than any other cells, including muscles (Bentov 2010).  For this reason, oocytes use lots of energy and oxygen, especially as they are maturing in preparation for ovulation, r oxidative stress. Oxidative stress has been implicated in every stretch of the conception-to-birth cycle imaginable, including endometriosis and miscarriage, yet no direct research has been conducted on the effect of OS on female fertility.  However, studies have shown that women with unexplained infertility show increased free radicals in the peritoneal fluid (the fluid around the egg) and, conversely, lower levels of peritoneal free radicals are associated with successful IVF procedures (Ruder 2008).

The good news is that there are simple strategies for coping with oxidative stress. Here’s the “need to know:”

• Quit smoking and avoid exposure to second-hand smoke. 
• Limit alcohol consumption to < 3 servings per week. Choose red wine for its antioxidant benefits.
• Oxidative stress may also be higher where inflammation is present, so ensuring good digestion and gut health may reduce circulating levels of ROS. If you’re experiencing diarrhea, bloating, constipation, cramping or other digestive symptoms, it may be worthwhile to meet with a nutrition specialist to determine if food sensitivity or other digestive disorder is present.
• Where possible, use organic cleaning products.
• Increase your dietary antioxidant consumption. A diet that is wholesome and rich in fruits, vegetables, tea, and healthy fats will improve our body’s defenses against oxidative stress. Be aware that many sources of healthy fats in the diet (fatty fish, flax seed) should be consumed intelligently to avoid excess intake of environmental toxins (fish) and phytoestrogens (flax).
• Consider an antioxidant supplement or insure your prenatal vitamins have adequate anti-oxidant levels. 
• Avoid high intensity/high impact exercise. The huge aerobic and mechanical demands of strenuous exercise can actually increase oxidative damage to cells in the body. On the flip side, moderate intensity/low impact exercise increases our body’s defenses against oxidative stress.
• Learn to relax, practice yoga or meditate. Life stresses may elevate levels of ROS in the body.

Now, with a firm basis in OS and its effect on fertility, a gal is ready to face the fertility journey. Always at your availability is the advice of a Pulling Down the Moon nutrition specialist who can help you optimize your dietary intake. Our ART Recovery/Prep Nutrition program is specifically designed to reduce inflammation and oxidative stress as well as provide optimal nutrition for fertility.

Most doctors agree that the most effective first-line treatment for Polycystic Ovarian Syndrome is diet and exercise.  Eating a low-glycemic diet that helps regulate blood sugar levels and exercising regularly to improve glucose metabolism can help re-start ovulation in many PCOS patients.  However, at the Moon we think this “prescription” is missing something – and that something is stress reduction.

Interestingly, both overweight and normal weight patients with PCOS show altered cortisol metabolism, with PCOS patients showing an increase in circulating stress hormones likes cortisol.   Higher levels of cortisol are not optimal for either overall health or for fertility.  Cortisol can disrupt our menstrual cycle, increase appetite (particularly for sugary foods), promote weight gain, especially around our middle where it is more harmful to our health and impair our immune function.  While experts cannot yet agree why cortisol is higher in PCOS patients, they should agree that taking steps to lower cortisol is likely to improve overall health of women with PCOS as well as their fertility.

Techniques that have been shown to lower stress include:

Acupuncture:  Recent studies have found that the increased muscle sympathetic nerve activity (a sign of increased stress hormone activity) in PCOS patients can be significantly lowered with acupuncture treatment.

Exercise:  We all recognize the stress reduction component of fertility-friendly workouts.  Exercising regularly controls stress and makes us feel better about ourselves.

Yoga/Relaxation Training:  Yoga has been shown to be as effective as cognitive-behavioural therapy at improving psychological and physiological measures of stress. 

Bottom line:  if you have PCOS, by all means continue with your healthy eating and exercise program but consider adding acupuncture to your regimen and taking at least 15 minutes a day to practice yoga stretches and breathing.

What do U.S. soldiers returning from Iraq and infertility patients have in common?  They both might benefit from a form of yoga called Integrative Restoration or iRest.  A feasibility study conducted at Walter Reed Army Medical Center in Washington, D.C., indicated that a particular approach to yoga called Yoga Nidra is having a positive effect on military personnel suffering from post-traumatic stress disorder (PTSD).  Participants in the program have reported that through the use of progressive relaxation, deep breathing and meditation, symptoms of anxiety, depression, insomnia and pain have lessened. 

Meanwhile, on the infertility battlefield, PTSD takes a different yet familiar form: anxiety, depression, loss, isolation from friends, marital stress, financial burdens, spiritual crisis and feelings of being broken.  Is it possible this same technique of Yoga Nidra could help fertility patients relieve their symptoms of distress just as it has helped our soldiers? Richard Miller, PhD. Psychologist, who developed the protocol of iRest used in the Walter Reed study says, “yes.”  Dr. Miller adds, “The ultimate design of iREST/Yoga Nidra is to help people live contented lives, free of conflict, anxiety, fear and suffering.  iREST accomplishes its goal through two basic steps: (1) the embodiment of pure awareness and (2) the release of negative body sensations, emotions, beliefs and stress that give rise to self-destructive patterns.”

Embodiment of Pure Awareness

Yoga Nidra, a Sanskrit phrase which means “sleep of the yogi’s,” has been practiced by yogis and sages for thousands of years.  It is based on the idea that we have three states of consciousness: the wakeful state, dream state, and the deep dreamless sleep state.  It is thought that the dreamless sleep state is the purest form of consciousness and a connection with it ultimately leads to a greater knowledge of God or Spirit. This concept of the dreamless sleep state maybe difficult to grasp but when you are asked in the morning how you slept the night before, you usually have a deep knowledge of the answer.  You say, “I slept great” or “I tossed and turned all night.”  How do you know if you are asleep?  There is awareness within this deep, dreamless state of consciousness which the yogis contend offers the greatest opportunity for a student to experience an understanding of her innate nature.  This consciousness is pure awareness that never sleeps and welcomes every moment as it is, without analysis, judgment or conclusion.  By welcoming things as they are, a student begins to see that they are not separate, finite beings, rather infinite and eternal.  Connecting with this state of consciousness offers an opportunity to resolve mental, physical and spiritual confusion, conflict and suffering. It’s like having an internal disarmament mechanism built right into your psyche and that’s not a bad thing to have in your fertility tool belt, particularly if you find yourself among those who experience stress and self-destructive patterns while trying to conceive.

Release of Negativity

The practice of Yoga Nidra is not auto suggestion, hypnosis or a series of postures.  It is a guided process of relaxation, self-inquiry and sensory withdrawal which leads to profound contemplation and healing.  The great news is, anyone can do it.  You don’t need to have Gumby-like flexibility, a fit physique or a calm mind to practice the technique.  In fact, if you like sleeping, you will love iRest because the practice is done while lying down in a savasana style (dead man’s corpse) position.  Those who are new to the practice often fall asleep and have no conscious recollection of what might have happened during iRest.  When they wake, they feel rested and relaxed.  Interestingly, it is believed that 30 minutes of Yoga Nidra is like having three hours of regular sleep.  Take that to the sleep bank during your two-week wait! 

Yoga Nidra is a little bit of body awareness, a little bit of breathing and a whole lot of guided meditation which is meant to help the student process all of the negative emotions and situations which constantly bombard the physical world.  You can hop on the treadmill and feel a sense of stress reduction when you are finished, but just like any given point on the conveyer belt of your running machine, your problems and their associated emotions will keep popping up from time to time.  Yoga Nidra teaches us to get off the treadmill by acknowledging our stresses, emotions and problems rather than reacting to them.  In so doing, we will experience a more lasting type of healing.

Infertility and Trauma

            Yoga, military veterans and holistic fertility are three phrases one would not expect to find in the same article.  While some may find it a stretch to connect the stresses of battle with the stress of infertility, the fact is that studies have shown that women undergoing IVF have depression and anxiety rates similar to women with cancer and AIDS (Domar AD et al.  The psychological impact of infertility:  a comparison with patients with other medical conditions.  J Psychosom Obstet Gynaecol 1993;14 Suppl:45-52).  For those that haven’t experienced difficulties getting pregnant, it’s difficult to truly recognize the trauma that can occur.  At Pulling Down the Moon, we find that many women actually seek out holistic treatment following a particular trauma – a miscarriage, failed cycle or devastating piece of news.  Take Eleanor, for instance, who finally conceived after years of fertility treatment only to have her baby die in utero from a cord incident.  Or Steve, who learned after a routine sperm analysis that he has no viable sperm and no chance of fathering a biological child. Or Amy, whose gynecologist diagnosed her with early menopause at the age of 27.   Such events, while not life threatening, are deeply shocking and challenge one of our most primal drives – the drive to procreate.  In addition, they assail deeply held beliefs of marriage, partnership and family.

            Time and again in our classes we hear traumatic stories of miscarriages, phone calls from the nurses with “devastating” news, and the overpowering fear of having to try again only to experience another failure or loss.  These memories are often denied or pushed below the surface without sufficient time for grieving and/or processing because infertility is largely a private experience that occurs simultaneously with daily life, work and relationship experiences.  Unlike death in the family or major illness, there is no established societal framework for honoring and working through the losses and challenges associated with infertility.  Many former fertility patients report that routine ultrasounds, a television commercial that features a swimming sperm or even a phone call from a newly pregnant friend can evoke feelings of panic and helplessness well beyond the resolution of their fertility treatment. 

Are you Sleeping?

Since research has shown that women who are depressed or anxious have significant declines in IVF success rates (Chen TH, Chang SP, Juang KD. Human Reprod. 2004; 19:2313-2318), it is easy to see the value of a practice like Yoga Nidra which reduces stress and helps a woman feel more empowered while trying to conceive.  At Pulling Down the Moon we incorporate Yoga Nidra into our Tools for Healing Yoga Class and are offering a new class called WeRest for couples in September of 2007.  Beyond the practical value of stress reduction, our students state that one of the most profound experiences of the practice is using deep relaxation for setting a private intention or Sankalpa.  This allows them the opportunity to ask for their heart’s desire in a way in which they, themselves, suspend judgment on the nature of the intention and its outcome. The teacher then instructs them to believe that this intention has already manifested.  This puts motivation and energy behind the intention so the student feels as though they are actively working toward, and have the ability to attract those things they want in their life.  Similarly, they are getting rid of those things that are not conducive for achieving their intention. 

What we see in our classes is that women going through fertility are often “sleeping” or at war with themselves.  The series of tests, treatments and disappointing outcomes take them further away from their purest form of consciousness and throws them into a state of confusion and separation.  They are not truly “awake” to their true potential.  When they start welcoming life as it is rather than how they imagine it should be, they awaken from their own symbolic “sleep” and experience the genie in the bottle that exists in each and every one of us.  

If you are interested in practicing Yoga Nidra/iRest make sure you seek out a yoga instructor who has been specifically trained and certified to teach its methods.  As an alternative to private or group instruction, there are several CD’s which offer exceptional value in taking a student through the process such as Richard Miller’s, “Infinite Awakening: The Principles and Practice of Yoga Nidra,” and Rod Stryker’s “Relax into Greatness.”  For more information about iRest or Yoga Nidra, or to find Yoga Nidra CDs for practice, you can visit www.pullingdownthemoon.com or www.nondual.com.  We also offer iRest for Fertility workshops at our Rockville location.  Click here for details.

A new study was published this week in the Journal of Obstetrics and Gynecology which showed that acupuncture can help treat symptoms of depression in pregnant women.  In the study, depressed women were placed into three groups:

Groups underwent 12 treatments over an eight-week period of time and were then asked to take the Hamilton Rating Scale for Depression.  Results showed the severity of depression in the acupuncture specific group to be significantly lower than that in both of the control groups.   

This was encouraging news since we are often asked at Pulling Down the Moon what holistic therapies might be available to patients who become depressed during pregnancy or what patients can do if they do not want to take their anti-depressants while TTC or pregnant.  Understandably, many women are concerned about taking or starting medications during their pregnancy due to potential risk to their babies.  Interestingly, research has shown that women with depression tend to have a greater liklihood of developing postpartum depression and they are more likely to have babies with lower birth weights.  For these reasons, it is important to talk with both your doctor and your acupuncturist about integrating their care to make your treatment plan as seemless as possible. 

For information about the study, check out this Wall Street Journal Article:

http://online.wsj.com/article/SB10001424052748704454304575081753471294546.html