Kirsten McIntyre’s Story
Archive for June, 2010
“High FSH”…“Poor Responder”…“Old Eggs”…“Advanced Maternal Age”…“Donor Egg Candidate” …
These are the most devastating reproductive diagnoses a woman can receive. The majorities of my patients who have high FSH, are over 35 years of age, and have been labeled this way. Yet, nobody starts out with these diagnoses. Most women end up with these labels after years of failed reproductive treatments.
Laura had been given each of these diagnoses from her reproductive endocrinologist, and has just given birth to her son, whom she conceived naturally. 44 year old Kathleen was told she would never become a mother unless she used a younger woman’s donated eggs. Her doctor was wrong. When her reproductive system was nurtured and cared for naturally, she conceived her healthy daughter on her own.
Last week a reporter queried me on a quote a reproductive endocrinologist gave her:
“2/3 of women over the age of 35 require medical intervention in order to conceive.”
These attitudes are not only wrong, they are downright harmful. Keep in mind there is a large financial incentive for you to believe these demoralizing prognoses – reproductive medicine is an ever growing multi billion dollar per year cash industry, whose financial rewards grow exponentially when you submit to the belief that your only chance of becoming a parent is through medical intervention. They make no money when you conceive on your own. They make maximum profit when multiple women are involved in helping you achieve a pregnancy at all costs.
Certainly, some women do require medical intervention. Yet, it should not be offered as a blanket solution to all infertility problems. It is accepted medical tradition that the simplest, least aggressive, and most cost effective treatments should always be exhausted first. Yet most women who ask their doctors “Is there anything I can do to improve my reproductive status?” are told definitively “No, you are simply too old.” Since most insurance companies don’t cover infertility treatment, and since there is an automatic medicolegal defense against litigation (“You came to me infertile, what’s the damage?”), Western reproductive specialists feel safer in offering a more aggressive approach, and we capitulate to their treatments because we are in a state of panic.
Medical charts abound with these types of unsettling comments: “Mrs. Nesbitt is a three time clomid failure.” “Ms. Callahan is a poor responder to maximum stimulation, and an IVF failure. Recommend donor.” Then they come to me as a last resort, hopeless, and depleted – financially and spiritually. They don’t feel good about themselves, their bodies, or their lives.
My intention is not to bash reproductive medicine, but to put it in its proper perspective. Yes, we hear of reproductive successes when ‘infertile’ celebrities end up with a couple of offspring in toe, most often the result of someone else’s eggs. Yet, month after month, and year after year, I pick up the pieces of broken lives, broken promises, and broken dreams. And the stories don’t ever change. The histories begin with unexplained infertility after one year of unprotected intercourse, and end up with “IVF failure, recommend donor.” Every time.
I propose that reproductive medicine more often than not fails us! Yet we are the ones who are conditioned to feel that it’s our fault when their drugs don’t work on us.
Reproductive medicine has one thing to offer women to help them conceive – that single drug is the all powerful, commanding hormone, FSH. And if you have any of those dreaded reproductive diagnoses listed above, FSH will cease to be effective in your body.
And you know the old adage, “If all you have is a hammer, the whole world looks like a nail.” When you are no longer the perfect nail, they try to bend and straighten and flatten you with the only tool they have.
There is another option that has been grossly overlooked. The reason it is overlooked is that physicians do not learn anything about reproductive health when they study medicine. In medical school, we were trained to treat disease. And infertility is not a disease. It is an epidemic of ignorance. We have not been taught how to care for our own reproductive systems.
Let’s pretend for a minute that there are no such things as hammers and nails. Consider the possibility that we have all of our fertility solutions within our very makeup. Ovarian health depends upon three factors – nutritional status, blood flow, and the balance of reproductive hormones with stress hormones.
1) Nutritional status – the reproductive system, like the rest of our body, has certain nutritional requirements. Most of my patients are asked to avoid sugar, wheat, and dairy. They take nutritional supplements specific to their TCM pattern of imbalance. Most women with high FSH or poor ovarian reserve take supergreens like wheatgrass, royal jelly, and Co-Enzyme Q-10, to name a few.
2) Blood flow – a woman of age 40 typically has five times less blood flow to her ovaries than a woman of age 20. This dramatically impedes the attention that the ovary requires during the follicles’ all important growth phase, the 90 day process before ovulation in which the quality of the egg is determined. The follicles insist upon adequate oxygenation and circulation to function efficiently (i.e., with a healthy egg, capable of fertilization and implantation.) I teach women exercises which redirect the circulation to the ovaries. And, as always, their bodies respond.
3) Hormonal balance – the endocrine system is a delicate interplay of the reproductive hormones, stress hormones, and emotions, in symphony with each other. This system operates via feedback, which means that anytime you introduce an outside hormone into its influence, it shuts that system down. Synthetic hormones can’t cure hormonal imbalances, they can only override them. The endocrine system is the most sensitive bodily system which requires the perfect balancing act of multiple factors, inside and out. Like all other mammals, our bodies do not want us pregnant when our endocrine systems are stressed. At our retreats, we employ natural techniques to rebalance the hormones. These methods gently encourage the reproductive system to operate efficiently, while reducing the internal stress response. When we abide by nature’s own directives, an internal order awakens inside, and automatically knows the rules.
Like Laura and Kathleen, when we pay attention to these three factors, our reproductive systems respond beautifully, as if this is what they were waiting for all along.
Christine, age 33, was given the diagnosis of premature ovarian failure when her FSH was found to be marginally elevated. Her doctor put her on three cycles of clomid, an anti-estrogen drug which raises FSH, and her body did all it could to save her – her reproductive system completely shut down in response to the clomid (don’t ever take clomid if your FSH is elevated, even borderline). She quit menstruating, her FSH rose ever higher, and she was left with two options – donor egg or adoption.
Christine didn’t blame her doctor for giving her the wrong medicine, she did what most all infertility patients do, quietly suffer alone in agonizing despair. Then she heard about my retreats, and something within her said, “this makes sense.” Christine came to two retreats, a few months apart. After one month of natural treatment of diet, nutritional supplementation, ovarian exercises, acupuncture and herbs, her period returned. Christine went back to her infertility specialist and asked her if there was any hope for her. Her doctor told her if she conceived on her own, she would “eat her shoe.” During Christine’s second retreat, she looked me in the eye with severe intensity and begged, “Do you think there might be hope?” I looked back with the same intensity in my gaze, said, “Yes, Christine. There is hope.” She believed me. More importantly, she believed in herself, and her body’s ability to heal herself. She had one more period. That is, until she conceived, naturally, with their first miracle child. And, as far as I know, no shoes were ingested.
Listen to your own internal wisdom. Do you want a child, any child, at all costs, or can you allow yourself the gift of reclaiming your reproductive, physical, mental, emotional and spiritual health.
Markers of Ovarian Reserve Viewed Through the Lens of Chinese Medicine
Randine Lewis, Ph.D., L.Ac.
Estradiol FSH – Follicle Stimulating Hormone
Inhibin B AMH – Antimullerian Hormone
“Ovarian reserve” testing can be intimidating and daunting. The results often feel like a fertility death sentence. When viewed through the eyes of Chinese medicine, however, these laboratory markers of ovarian potential can actually make diagnostic sense, and help determine the best natural therapeutic course for you.
It will be helpful to understand a little reproductive physiology first.
The pituitary gland, which sits behind your eyebrows, emits FSH (follicle stimulating hormone) in response to messages translated by the hypothalamus, which secretes Gonadotropic releasing hormone (GnRH) in response to the hormone levels in your blood, and your emotional response to your environment. This hormonal command post, like all of the hormones in your body, responds to internal chemical messages conveyed through the blood, and emotional interpretations of your external environment.
These external and internal messages determine how the pituitary hormones interact with and are able to communicate with your ovaries, and how the ovarian output communicates back to the hypothalamus and pituitary gland.
Activin and Inhibin B are protein complexes within the ovarian follicule. Activin enhances FSH secretion, cellular proliferation and plays a role in menstrual regulation. Inhibin B, on the other hand, down regulates and inhibits GnRH from the hypothalamus, and FSH secretion from the pituitary gland.
When the system is in sync, the hypothalamus secretes GnRH to trigger the pituitary gland to release small amounts of FSH during the last few days of the previous menstrual cycle, which rise until the beginning of the next follicular phase. FSH recruits Graafian (or antral) follicles, which have been growing within the ovary for the better part of a year. Around three months before these follicles are ovulated, they enter the tonic growth phase, where protein synthesis occurs. Follicles that have interacted optimally with the internal environment have the potential to become dominant follicles, primed by FSH. They then secrete estrogen, and express LH receptors, which allow the chosen dominant follicle to mature and become capable of ovulation.
Higher levels of Inhibin B indicate that the ovarian follicle is doing its job of putting out adequate estradiol. Inhibin B provides negative feedback to the hypothalamus and pituitary gland to let them know to turn down the GnRH and FSH, as output is sufficient.
The High FSH Craze
Within the last ten to 15 years, reproductive medicine has been making quite a fuss over high FSH levels. Chinese medicine doesn’t focus so much on the unqualified meaning of laboratory values like Western medicine does; we view lab results energetically according to what is behind them, rather than providing meaning to the absolute numerical value.
The body energetically views the ovaries as “essence”, an elemental potential, like the primordial follicles within them. Follicles are only potential until they begin to interact with their internal environment, which is responding to cues coming from our interpretation of our external environment. All of this is subject to change, when we change our internal environment, and our response to our external environment. FSH, on the other hand, is viewed as “heat”, which activates the potential of the ovaries’ essence in the form of eggs, and resulting blood levels of estradiol (or yin). When the essence is adequate, it doesn’t require much heat to ignite the ovaries. When the essence is weak (due to stress, lack of restoration, follicular malnourishment, and the demands of life), it takes more heat to induce the necessary ovarian response, indicative of present ovarian health.
To put it simply and in energetic terms, those who have high FSH and low estradiol levels generally have too much heat, in relation to the underlying essence capable of responding to FSH stimulation. Although optimal FSH values are seen as <10, The Fertile Soul Retreat process has helped women whose FSH values are well over 100 conceive naturally. First, however, we have had to energetically reduce their heat, and maximize their essence, which allows the FSH to activate healthy follicles.
Although Western medicine views the reproductive system as an ever-deteriorating disease process waiting for intervention, Chinese medicine employs a different lens. We view the body/mind/spirit as an ever adaptive system, which, when given appropriate environmental cues, has a miraculous ability to manifest its highest potential.
The Low AMH Frenzy
As if high FSH values, and low estradiol/inhibin-b levels weren’t enough to convince you of your need for drastic intervention and donor eggs, the newest craze in ovarian reserve testing is a hormone known as Anti-Mullerian Hormone or AMH.
Again, some reproductive physiology will be helpful to make sense of this hormone.
During embryonic development, male testes produce AMH, to inhibit the expression of Mullerian ducts, which become female sexual organs. In the presence of AMH, the primordial urogenital ridge bears Wolfian expressions of prostate, testes and vas deferens, rather than the female Mullerian expressions of fallopian tubes, uterus and vagina. We could look at Anti-Mullerian Hormone as a “holding back” hormone. After birth, AMH becomes expressed by females, within the granulosa cells of the ovary, where it inhibits the responsiveness of growing follicles to FSH. Since human beings aren’t made to raise litters, the body’s internal wisdom does not allow the recruitment of all of the primordial follicles, as only one dominant follicle is chosen for ovulation during each menstrual cycle. If FSH is viewed has heat, and estradiol is viewed as yin, AMH is viewed as the “essence potential”, or the ability to hold back the ovarian essence from interacting with the pituitary gland’s igniting fire. The greater the body’s ability to hold back ovarian essence, the easier it is for the FSH igniting potential to activate a response in the form of a healthy egg and its resulting estradiol levels. Therefore, higher AMH values are indicative of a greater abundance of interactive follicles. The “normal” values of AMH are between 0-6 ug/L. The closer you are to 6, the greater the force behind the dam. Once again, The Fertile Soul Retreat Process has helped women whose AMH values were zero conceive naturally. How does this work?
cont’d below with Part 2…
cont’d from Part 1 above…
Putting It All Together
We are endowed with a primordial pool of follicles during fetal development. At birth they measure near one million; by the time we enter menarche, they number about 500,000, and by the time we approach the perimenopausal years we have around ten thousand. These primordial follicles do not undergo any change or deterioration until they begin to circulate within the ovaries’ response to its internal environment, which is an inner result of how we relate to our external environment.
The hypothalamus interprets our emotional response to our environment (via neurochemicals), and translates it into hormonal messages in the form of GnRH or Gonadotropin Inhibitory Hormone. These chemicals then trigger the appropriate response from the pituitary gland, whose hormones signal the gonads to release their germ cells and hormones. The resulting blood laboratory values are a manifestation, not a cause. These circulating hormone levels feed back to the hypothalamus, along with our emotional response, to regulate its ongoing release of brain hormones. Because of this adaptive feedback system, supplying external hormones will not improve the function of the ovaries; only suppress their release. In order to improve the functioning of any part of this system, the entire system must be addressed.
Tiny follicles leave their primordial pool (again, not changed since before birth), and enter into the growing pool of follicles, where the dominant follicles are activated by FSH fire from the pituitary gland. The number of circulating follicles depends upon many factors – blood flow to the ovaries (which can be enhanced), nutritional and hormonal fuel to the ovaries (which can be enhanced), our emotional response to our environment (which can be enhanced), our ability to restore and access the follicles to allow them to enter into a healthy internal environment (which can be enhanced.) The number of follicles in the growing pool determines the levels of AMH. Only the chosen dominant follicle will mature in response to the pituitary gland’s release of luteinizing hormone during ovulation. LH can be viewed as the energetic trigger, causing the entire cascade to produce the potential for release, fertilization, implantation and continued growth.
An early antral follicle releases estradiol in the form of yin. If the endocrine system provides messages that this system is conducive to new life, the ovaries perceive a great internal potential to produce more follicles. They will respond with more yin, access more essence, and the entire cascade will dance into full expression. AMH values will rise. FSH values will tend to lower, as very little flame is necessary to keep the fire going. More follicles will produce greater levels of inhibin B. The body will select a dominant follicle; LH will mature its residing egg, and allow the release of a healthy potential.
Keeping The Fire Burning
A simple analogy – FSH is the flame. The uterus is the oven. LH is the opening of the flue. The ovaries are the wood; Estradiol measures the available wood for burning, inhibin B could be seen as the damper that keeps the fire from burning out of control, and AMH could be seen as the lighter fluid. If we are trying to ignite the spark of life and keep it going, we need to ensure all of our provisions are adequate. Assisted reproductive technology gives you one tool – more fire. However, if we need a drier oven, if we need to gather more wood, soak it in more fluid, or reduce the wind that is keeping the spark from igniting, more fire is not the only answer. In fact, sometimes more fire actually keeps the materials from being able to burn on their own. A flame-thrower is not the best way to tender the gently burning fire of life. Some ways you can improve your capacity on your own:
Perform reproductive and femoral massage
Eat organic, natural fruits and vegetables
Get adequate rest
Practice internal deep breathing techniques
Keep yourself in supportive environments
The Fertile Soul Method ® is proven to maximize your reproductive potential. Most of our patients are 40 or over; most have high FSH, low AMH, other hormonal abnormalities, or have been diagnosed with poor ovarian reserve, poor egg quality, endometriosis, or recurrent miscarriages. Most have not found their answers solely within Western reproductive medicine. Most have been able to rectify their internal energetic imbalances through our program, and produce new life.