AMH TEST

As an acupuncturist and naturopath, working with women trying to conceive is a big part of my daily clinic life.  Recently, many of them have asked me about the new AMH blood  test hitting the headlines in New Zealand. While it’s early days and there appears to be yet more research to do, this simple blood test appears to be a very useful tool  for women wanting a true insight into the state of their remaining fertility.

The AMH tests levels of Anti-mullerian hormone.  This hormone is produced by egg follicles that the ovaries grow in order to prepare an egg for release.  In a nut shell, the more of this hormone you have in your bloodstream, the better off you are in the fertility stakes.  Hormone levels reduce with age, and the lower your levels, the less likely you are to conceive.

AMH levels are a reflection of how many egg follicles you have remaining in your ovaries, and it’s also a reflection of the biological health and vitality of those remaining eggs.  The biological age of a woman’s eggs can differ from her chronological age.  You can be a fit and sprightly 35 year old for example, but have eggs more like those you’d expect to find in a 40 year old woman. A baby girl is born with all the egg follicles she will ever have, and once she starts ovulating from her early teens onwards, the number of egg follicles gradually decline until menopause.  The existing test used to guage fertility is the FSH or Follicle Stimulating Hormone test.  This test is much less sensitive than the AMH test, and is only able to tell a woman her fertility is declining, at an advanced stage of the process.

Developers of the AMH test are really emphasising this use for the test, suggesting that women in their thirties have a test to determine their likely fertility for the following two years.  Based on their results they have a clearer understanding of the potential cost or otherwise of delaying conception.  Perhaps they want to travel overseas; take a job promotion… or simply find a man of “fathering” quality.  A poor AMH result would give them the option of trying to conceive sooner rather than later.  Test results are thought to be 70% accurate.

The AMH also makes the stressful process of fertility treatment a little less of a lottery.   AMH testing of women about to undergo IVF allows specialists a clearer idea of the likelihood of success for a particular woman.  Understanding the biological age of a womans eggs will allow doctors to tinker with fertility drug doses to maximise a womans chance of success, while minimising the risk of “hyperstimulating” her ovaries… a potentially fatal situation. 

Working with women experiencing the grief of infertility, I personally see  a great benefit in this new test.  I would encourage all my 30 something patients, still putting off pregnancy for yet another year, to have this test.

Lynda Wharton is a Traditional Chinese Acupuncturist and Naturopath with 25 years experience in Holistic Woman’s Health.  She is also the author of “Wellbeing – an essential guide to vibrant good health for women available online at www.lyndawharton.com

It is the most powerful of biological urges… the urge to reproduce.  In an age when we believe we can have it all, it comes as a shattering blow to increasing numbers of couples to discover there is one thing they cannot have – a baby.  

Infertility rates are rising, partly as a result of women delaying their attempts to conceive until their thirties.   With age, female fertility declines steeply.  Once the career ladder has been mastered, the overseas holidays had and the mortgage under control,  biology may simply refuse to cooperate.  Sometimes a couples infertility is nothing to do with age,  and is the result of hormonal or physical problems such as low sperm count, blocked fallopian tubes or absence of ovulation.

When all the natural options have been exhausted and there is still no pregnancy,  Artificial Reproductive Technology (ART) is the next step.    Sometimes a positive pregnancy test takes nothing more than a cycle or two of drug therapy to induce ovulation.   Other times, it takes the most expensive and technologically challenging fertility intervention – In-vitro Fertilisation, commonly known as IVF.

In Australia and New Zealand in 2007 alone there were over 56,000 IVF cycles, up a massive 54% from 2003.  These 56,000 nail biting, stressful and expensive cycles resulted in 10,856 actual babies being born into the world.   Do the maths and its easy to see that for every couple experiencing the elation of a positive pregnancy test, there were another four couples who faced heart crushing disappointment.

Australian and New Zealand fertility clinics have an average pregnancy rate of around 22% for each IVF cycle, with a live birth rate of around 17%, largely due to early miscarriage.  The likelihood of success for a particular woman is greatly influenced by her age, or more specifically the age of her eggs.    Between the ages of 35 and 40 success rates dip steeply, with an even more precipitous decline over the age of 40.

With so much hope, and a significant financial investment in every successive IVF attempt, most couples are keen to do anything and everything to increase their likelihood of success. 

One such proven step is the decision to augment their IVF cycle with the use of acupuncture.   Hardly the new kid on the block, acupuncture is a complete system of healing that has been practiced for thousands of years; and is now used in hundreds of countries around the world.  Today, modern scientific study has proven a uniquely modern use for this ancient art – improving the success rate of IVF.

Recently the esteemed British Medical Journal reviewed 108 acupuncture and IVF studies, and rejected all but 7 of them because of design faults.  The remaining 7 studies were all published since 2002 and carried out in four western countries, and involved 1,366 women.   In these trials the women were given acupuncture immediately before and after  embryo transfer.   The pooled results were impressive – a 65% increase in the chance of becoming pregnant,  an 87% increase in continuing pregnancy and a 91% increase in live births.

Exactly how acupuncture exerts its beneficial effects is still not clear.  It is possible that acupuncture performed at the time of embryo transfer may reduce uterine contractions which might otherwise expel an embryo or prevent it from embedding properly.

The acupuncture points used after an embryo transfer are points which are known to have a moderating effect on the immune system, which again may help to reduce the rejection of embryos.

All the acupuncture/IVF studies have involved just two treatments at the time of embryo transfer.  However, traditional Chinese acupuncturists prefer to treat a woman several times in the weeks leading up to the transfer, to ensure she is in optimal biological and energetic health at the time of her conception.    Preliminary studies are confirming what acupuncturists already know –  acupuncture treatment during this phase of the IVF cycle helps to reduce stress hormones and increase feelings of relaxation and balance.   

While western scientists work to quantify the biological effects of acupuncture in terms of hormones and chemicals, TCM acupuncturists are more interested in looking at the state of a woman’s “blood” and “qi”.  From their perspective, the strength and free flow of these vital energies determines not only how a woman feels, but also the likelihood of her IVF success.

Often, after months of trying unsuccessfully to conceive naturally; and perhaps months more ART treatments,  a woman’s vital forces are greatly depleted.  Restoring balance, strength and free flow to her qi and blood,  not only helps her to feel subjectively much healthier and more balanced; from a TCM perspective it also makes her more receptive to fertilisation. 

This is what acupuncture classics have said for thousands of years.  Now, it seems that western scientific medicine is concurring with the great acupuncture masters of ancient China!   

BOX

Acupuncture can help improve fertility in many ways, and is an effective fertility enhancing therapy for women who are trying to conceive naturally as well as those undergoing assisted reproduction.

Researchers from New York’s Weill Cornell Medical Centre reviewed existing acupuncture studies and concluded that acupuncture helps fertility in the following ways:

1.  Reduces stress hormones which may interfere with normal ovulation.

2.  Normalises the hormones that regulate ovulation so that an egg is released.

3.  Increases bloodflow to the uterus, improving the chances of a fertilised egg implanting.

4.  Helps to restore normal ovulation in women with Polycystic Ovaries.

5.  Improves the pregnancy rates in women undergoing IVF.

BOX

What is involved in pre and post embryo transfer acupuncuture?

First, a visit to your acupuncturist some time in the hours just prior to embryo transfer.  Some acupuncturists will come to you at the IVF clinic.   Several fine stainless steel disposable acupuncture needles are gently inserted into acupuncture points on the lower abdomen, legs, wrist and head (usually around 9 or 10 needles in total).  The needles are left in place for twenty minutes while you lay quietly and relax.   After the embryos have been transferred, it’s back to the acupuncturists on the way home, for a second, different treatment.  This time needles are inserted into hand and leg points and again left in place for twenty minutes. 

There is little sensation or discomfort with needle insertion, and once the needles are retained patients often feel a deep sense of relaxation and wellbeing.   Ensure that the acupuncturist you choose is registered; and experienced working in the area of fertility.

Lynda Wharton is a registered Traditional Chinese Acupuncturist and naturopath.  She has had over twenty years specialising in the field of holistic woman’s health.

 www.lyndawharton.com