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Premature Ovarian Failure

Premature Ovarian Failure and Infertility

What is premature ovarian failure?

Premature Ovarian Failure, also called Primary Ovarian Insufficiency, is when ovaries lose their function before a woman has reached her normal menopausal age. This disease affects 4% of American women.

Symptoms:

There is no period, or the period comes only every few months, with hot flashes, night sweats, low energy, low sex drive, early onset of osteoporosis, weight gain, vaginal dryness, mood swings, bladder control problems, drooping muscles, arthritis, shoulder pain, and insomnia.

What could cause premature ovarian failure?

  1. Viral infection can destroy the pancreatic, ovarian and other glandular functions leading to hormone imbalance and infertility.
  2. Autoimmune disease, when the body produces anti-bodies to attack the ovaries because the immune function is out of balance. Women with MS, Hashitomo’s disease, eczema, psoriasis, rheumatoid arthritis and allergies tend to develop premature ovarian failure and infertility. If women do not correct the imbalance, they will have lower successful rate with IVF because all the hormone injection can cause more imbalances of immune system.
  3. Too many stimulants such as coffee can bring all the energy to the brain and muscles, while the ovaries have insufficient blood and energy flow most of the time. This is one of the reasons why women who drinks more than two cups of coffee tend to have infertility and premature ovarian failure.
  4. Surgical removal of ovaries. A few years after women have hysterectomy, they tend to develop AF, PVC, frozen shoulder, arthritis, back pain because the estrogen and progesterone level drop too fast and their bodies have no time to compensate. With low estrogen and progesterone, muscles and tendons become more fragile and repairing of the ligament and muscles becomes much more difficult.
  5. Using birth control pill too early and for too long can make ovaries stop functioning early because “if you don’t use it, you lose it.” Women may be happy to have no period any more, but they can develop depression, hot flushes, endometriosis, severe back pain, fibroids, insomnia and allergies, because the immune function will be out of balance without sufficient progesterone. You can take artificial progesterone, but most women will gain weight and develop memory loss because artificial progesterone is different from your own progesterone produced from your ovaries and adrenal glands.
  6. Genetic defects, when certain chromosomes are abnormal, your ovaries can lose their function much faster especially when you take birth control pill for many years and you will tend to develop premature ovarian failure and infertility in early thirties.
  7. Enzyme function problems or Celiac disease, causing insufficient absorption of vitamins and minerals which influence the production of estrogen and progesterone. When estrogen level is too low, your ovaries will lose function prematurely and you can develop infertility.
  8. Chemo or radiation therapy for treating breast or other cancers. Women tend to stop their period shortly after the harsh treatment.
  9. Abnormal function of the pituitary or hypothalamus: when these two glands cannot produce the right amount of the hormones to stimulate the ovaries, women will stop their period prematurely and develop infertility.

How acupuncture can help with this condition?

One theory is that electro-acupuncture promotes the function of the hypothalamus-pituitary-adrenal axis (HPAA) by increasing the synthesis and secretion of one of the adrenal steroid hormones, androgen. This androgen then is transformed into estrogen in the fat tissues and thereby restores the normal function of the HPAA, benefiting the function of the corpus luteum, the residual part of the follicles after the eggs have been released. This is very important in restoring the health of the women with premature ovarian failure, or an insufficiency of the luteal phase after ovulation.

If a woman is diagnosed with premature ovarian failure, her FSH level can be above 30. Theoretically, she has already started “menopause”. Can the ovarian function be restored with acupuncture and herbs? It depends on how serious the ovarian function has deteriorated. Generally speaking, if women have healthy diet and exercise regularly during the infertility treatment, they can restore their ovarian function within 6 to 24 months.

In most situations, an endocrinologist would suggest that a woman with premature ovarian failure seek out a donor’s egg to get pregnant. With a healthy donor’s egg, a woman still needs a healthy uterus, which can provide the best environment for the embryo to grow. In this situation, acupuncture can help improve the blood flow to the uterus, thyroid gland, adrenal gland and ovaries to coordinate all the glands’ functions because a healthy pregnancy relies on the functions of all of those glands.

Combining acupuncture and DHEA, ovarian function can be improved:

Drs. D.H. Barad and N. Gleicher of Albert Einstein College of Medicine published a case of a 42-year-old woman whose ovarian function was dramatically improved by using the dietary supplement dehydroepiandrosterone (DHEA) and acupuncture. In a private IVF center, this patient initially presented with severely decreased ovarian reserve with infertility for many years. The doctor used medication to induce ovulation while she was taking DHEA and undergoing acupuncture treatment. In her first treatment cycle, her peak estradiol was 1,211 pmol/mL.  After seven months of DHEA supplementation and acupuncture treatment once or twice a week, her peak estradiol in cycle 8 was greater than 18,000 pmol/mL. Because of fear of hyper-stimulation, her endocrinologist reduced her gonadotropin stimulation by 25%. In the ninth cycle, her peak estradiol was 9,178 pmol/mL, and she produced 17 eggs that gave rise to 16 embryos. During the 11 months of treatments, the patient had undergone nine treatment cycles while continuously and dramatically improving her ovarian response and banking 66 embryos overall. This case illustrates the possibility that ovarian function may be improved with proper treatments, even in women of advanced reproductive age with the help of acupuncture treatment .

Case one: How acupuncture can help lowering FSH to solve the infertility with poor egg and sperm quality

Glenda was a 35-year-old woman. Her FSH was 60 and was diagnosed with premature ovarian failure. Her husband had almost no sperm. She was told that she had no hope to get pregnant even with a donor’s egg at the infertility clinic. Her friend referred her to an endocrinologist in New York. The specialist in New York got a few sperm from her husband’s testicles surgically, and then fertilized her eggs in a test tube. She started acupuncture for her infertility three months before she went to New York and continued with acupuncture twice a week during the whole procedure. Miraculously, she got pregnant with one of those two sperms. Considering that a normal sperm quantity should be at least 20 million in order to fertilize eggs, this story should give many women hope and confidence to try to improve their ovarian function with acupuncture before starting IVF procedures.

This case verifies that if women can combine acupuncture with IVF during the infertility treatment, they can improve their successful rate even though they have high FSH and husbands have very low number of sperm. If you would like to spend so much money to do IVF, combing acupuncture can help improve your ovarian function during the infertility treatment. Furthermore, you can avoid severe menopause symptoms because you can cut down the number of IVF cycles dramatically with acupuncture treatment for infertility.

Case Two: Genetic factor only has 30 percent effect for infertility.

Gina was a 34-year-old teacher with a passion for children. She had started trying to get pregnant 5 years ago when she was 29 years old. She tried 8 IUI and 5 IVFs without success. Then she was told that she may have premature ovarian failure due to a genetic factor. Her mother had stopped having periods at age 41, which increased the odds that this was true. She tried acupuncture for a year during the 5 IVFs but without luck. When she came to see me, she was ready to accept donor’s eggs, which would have been extremely expensive and difficult.

I examined her tongue and pulse and found out that her tongue color and sublingual vein looked good, without blood stasis. She was a little bit overweight. She is a very happy and nice woman. Since she was still young, I advised her to try acupuncture and herbs to balance her hormones while she looked for donors. I also told her to take herbs to prolong her ovarian function so that she can postpone her menopause age.

She was already showing symptoms of peri-menopause: increased FSH levels, waking at 4:30 and unable to fall back asleep, craving sweets, weight gain, headaches, neck, back, wrist and hip pain, and anxiety. She was a healthy eater with a lot of vegetables and fruit in her diet. But she had been on BCP for 6 years to control her heavy period. After so many IVF cycles, her menstrual cycle had recently become shorter, down to every 24 or 23 days. She had had acupuncture for 3 years once a week, yet did not get pregnant, although it did improve her period.

She loved sweets and ate a lot of chocolate. By the time she came to see me, she ate dark chocolate twice a week. Her estrogen level tended to be low, and her husband’s sperm was abnormal with less than 40% of the sperms normal. Her temperature chart showed shortened luteal phase: the basal temperature rose slowly, and then dropped too early. She tended to feel warm, indicating kidney yin deficiency.

She started the Chinese herbs, hoping she could get ready for her donor’s egg. In her next cycle, ovulation was on day 17, with clear discharge on day 16; her follicular phase had become longer, allowing her follicles more time to mature.

Her sleep had improved dramatically. She tried so hard to cut down on her sweets, and she got her period on day 26 the first cycle after her acupuncture and herbal treatment combination. But the luteal phase was still slightly short. After her one month of herbal intake, her period became lighter and lasted shorter time, although she still had menstrual cramps. After another month of taking the herbs, she noticed that she became very hungry in the morning, and she tended to get lightheaded during morning exercise. I suggested she practice yoga and Qi Gong and go for walks instead of intense exercise.

She took two formulas. Formula 1 was before her ovulation to invigorate the circulation in the ovaries and uterus. Formula 2 was for after ovulation to bring up her progesterone and relax her uterus to get ready for implantation. With Formula 2, and her basal temperature jumped from 96.6 to 97.8 to 98.2. She became happier and more energized.

After her two months of herbal intake, her period came on day 28. She had a two-day heavy flow with cramps and a lot of clots, and the bleeding stopped for one day, with another day of full flow. She was very tired with facial swelling even though her sleep has been good. This indicated increased progesterone level.

The following cycle came on day 18, with a very short period, mood swings and unhappiness before the period after she ate a lot of sweets. This earlier and shorter period indicated that her diet played a very important role in her already compromised ovarian function. Sweets can harm ovarian function because it causes inflammation in the blood vessels and ovaries. Sweets can also increased the insulin level sharply leading to imbalance of the hormones. She was determined to stop sweets.

After the very abnormal cycle, she did not get her period on the 29th day, but she had mood swings and headaches, indicating that her estrogen and progesterone had gone up. On day 35, her HCG was 1932. Soon after, she had a vaginal ultrasound, which showed two sacs in her uterus. She was tired and felt cold all the time, which were all good signs for a good pregnancy. She was so thrilled and could not believe she could get pregnant by herself by doing acupuncture and herbs for only four months. She even called me and asked if the herbs could cause false positive result in pregnancy test. The answer is no.

On the eighth week of her pregnancy, ultrasound showed two normal heartbeats. She had morning sickness, and a little spotting, which scared her so much that she decided to continue her acupuncture until the babies are delivered. With two fetuses growing inside her, the dramatically increased hormone levels made her very sensitive to smell.

Interestingly, she did not crave for sweets any more but instead craved salty foods. She had loose stools three times a day instead of her constipation in her first trimester, which is quite different from the majority of the pregnant woman. By week 13, Gina had no nausea, and ultrasound showed a boy and a girl. She continued her acupuncture treatment during the whole pregnancy. She only had slight back and hypochondriac pain. She ate a very healthy diet during the whole pregnancy.  By the end of 35 weeks, her legs were swelling, but after a few acupuncture treatments, the swelling went down dramatically. At the 36th week, ultrasound showed boy was breeched, so we added some points to make the baby move. After four weeks, both babies were in the right position.

Of interest, when her progesterone went up, her sleep pattern also changed; she was able to sleep from 10pm to 6am instead from 9pm to 4am. At the end of the pregnancy, she started having hand pain, swollen ankles and heartburn due to the water retention and changed digestive function with increased progesterone levels. She began acupuncture every week again to reduce her hand pain and acid reflux. Just before her due date, her sleep pattern changed again: she would sleep 4 to 5 hours, wake up for two hours, and fall back to sleep again. She continued with her acupuncture treatment to the end of the pregnancy. Gina delivered two healthy babies.

Two months after she delivered her babies, she started acupuncture treatment to reduce the carpel tunnel syndrome resulting from pregnancy. She was worried she would lose her period after her two babies were born, so she came back to take herbs and acupuncture to restore her progesterone levels. With two newborn babies, she could only come every two weeks for acupuncture treatment when she had a babysitter. Her period now came every 24 to 26 days, without hot flushes or night sweats. She noticed that if she had fewer sweets and more vegetables, her luteal phase could reach 14 days. During Christmas time, her period was shortened to 22 days with more cramps and breast tenderness due to the diet changes. More sweets can lead to high insulin level, which compromise the ovarian function. If women combine too many sweets with spicy food, they can develop systematic inflammation and infertility in their twenties.

Now Gina is 44 years old, and she still has regular periods with 6 to 7 hours of sleep. With regular acupuncture treatments, her wrist pain is almost gone. She is a truly believer of Chinese Medicine and acupuncture treatment. One time her twins had a cold when they were toddlers, so she gave them some herbs, and the coughing and sore throat went away within two days. Now she usually has two bottles of herbs: one is for cold and flu, and the other is for her hormone balance.

What can be done to restore or improve ovarian function?

  1. Consuming sufficient raw vegetables and fruit to provide the necessary nutrients for restoring the ovarian function. Even though the ovaries do not produce sufficient estrogen and progesterone, the adrenal glands can still produce some estrogen, testosterone and progesterone. The green juice made from kale, lemon, apple, spinach and berries will help adrenal gland produce more estrogen and progesterone, which can help improve ovarian function. The green juice can also help the estrogen dominance condition during IVF cycle because the cruciferous vegetables can inhibit the aromatase  and help balance estrogen and progestin level, especially during the infertility treatment or menopause time.
  2. Reducing stress with meditation, Qi Gong, Tai Chi and yoga will help the adrenal gland and ovarian function. Even menopausal women can release eggs when all her hormones are in good balance, which is why some 50 year olds can get pregnant occasionally when they are in a stress-free environment. Stress can increase cortisol level and reduce the progesterone level because they share the same precursor. Furthermore, stress can stimulate the fight and fight hormones and constrict the blood vessels of the ovaries, uterus, adrenal and thyroid gland.
  3. Taking Chinese Herbs can bring the energy to ovaries and digestive system with some herbs such Yin Yang Huo, Xian Mao, Shan Yao, Goji berries have phyto-estrogen effect, creating an environment beneficial for egg production.
  4. Getting electrical acupuncture twice a week for two to three months to improve ovarian, pituitary and hypothalamus functions. Once these three glands are in good condition, there may be ovulation every two to three months. Progesterone injections can induce a period initially, but it never can improve ovarian function. After few years, the injections will stop working. Electrical acupuncture has been verified to balance the sympathetic and parasympatheic nervous function, so more blood flow will go to the ovaries and uterus.
  5. Regularly eating fermented soy such as tofu will also help restore the ovarian function because tofu can serve as beneficial  phyto-estrogens which help ovaries produce the right amount of estrogen and progesterone.
  6. Stop eating sweets such as ice cream, chocolate and cookies to reduce inflammation in the ovaries, especially during the infertility treatment.
  7. Cooking this porridge of herbs two to three times a week: Yi Mi 40g, Shan Yao 30g, Go Ji 15g, Gui Yuan 12g, adding sufficient water.
  8. Drinking Raspberry tea every day, or add wheat grass in your green drink because the vitamins and minerals in Raspberry tea and wheat grass can help produce more progesterone. Women feels more relax when they drink Raspberry leave tea and can sleep better, which help rejuvenating the ovarian function.
  9. Massaging the following points to bring the energy to uterus, kidneys and ovaries: Using the palm of your hand as a measurement unit, from the belly button, measure one palm down. This point stimulates the reproductive organs, uterus and energy production. From this first area below the belly button, measure right and left one palm. There are two points in these areas that stimulate the ovaries, so the massage area is about the size of your palm clockwise. The area around the belly button is important to stimulate energy for the reproductive system as well. Massage around the belly button moving clockwise. Lastly, on the inside of your ankles, in the divot between the ankle bone and the Achilles tendon, there is an important point to stimulate energy and reproductive organs. You can massage each of these points for one minute 2-3 times daily.

Questions for Acupuncturist and Herbalist:

  1. What can cause premature ovarian failure and infertility?
    • Autoimmune disease such as MS and Hashimotos’ disease.
    • Hysterectomy
    • Virus infection
    • Chemotherapy
  2. Why electrical acupuncture can help premature ovarian failure and infertility?
    • Electrical acupuncture helps balance the sympathetic and parasympathetic nervous system.
    • Electrical acupuncture helps improve ovarian function.
    • Electrical acupuncture helps produce balanced estrogen and progesterone.
    • A, B, and C.
  3. What is the percentage in which genetic factor can contribute to premature ovarian failure and infertility?
    • 30%
    • 70%
    • 80%
    • 100%
  4. Why birth control pill can lead to premature ovarian failure and infertility?
    • Birth control can stop the ovulation.
    • Birth control pill interrupted the hormone balance.
    • Birth control pill can increase the progesterone production naturally.
    • A and B
  5. Why women tend to develop AF, frozen shoulder, arthritis if they have premature ovarian failure?
    • Because women have too much estrogen after they develop premature ovarian failure.
    • Because the estrogen level drops too fast and women have no time to compensate the sudden hormone drops after they develop premature ovarian failure.
    • Because women have too much progesterone after they develop premature ovarian failure.
    • None of the above reasons.
  6. Why eating too many sweats can cause premature ovarian failure and infertility?
    • Sweets can lead to inflammation in blood vessels and uterus
    • Sweets can make the insulin go up too fast.
    • Sweets can cause dysfunction of ovaries.
    • A, B, and C.
  7. Why do women tend to have mood swing during IVF and menopause time?
    • The imbalance of estrogen and progesterone can cause mood swing and depression.
    • During menopause, progesterone level is much lower than estrogen, which can lead to mood swing and depression.
    • During IVF, estrogen level can go up very high if the stimulation from artificial hormones is too strong.
    • A, B, and C.
  8. Why do women tend to develop carpel tunnel during pregnancy and IVF treatment?
    • They may crave high salt diet, so they tend to retain more water.
    • They have elevated progesterone level during pregnancy.
    • They may eat too much vegetable and fruits.
    • A and B.
  9. Why can stress cause infertility and premature ovarian failure?
    • Stress can reduce the progesterone level because when stress hormone goes up, the progesterone level goes down.
    • Stress can lead to hyperactive sympathetic nerves, which can reduce the blood flow to ovaries and uterus.
    • Stress can compromise the digestive function and reduce the production of progesterone.
    • A, B, and C
  10. Why do certain Chinese herbs help infertility and premature ovarian failure?
    • Chinese herbs can improve blood flow to ovaries and uterus.
    • Certain Chinese herbs can serve as phyto estrogen to help initiate ovulation.
    • Chinese herbs can help reduce the stress level
    • A,B and C.
  11. Why can Tofu help infertility and menopause ?
    • Tofu can improve the blood circulation.
    • Tofu can serve as phyto estrogen to help reduce the hot flushes and night sweats.
    • Tofu can help improve digestion.
    • A and B.

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