In Vitro fertilisation

Question 1

What is IVF?

Answer 1

• Involves the collection of oocytes from the ovary, followed by combining the egg and sperm outside the body, in vitro. The resulting embryo is then placed into the uterus.
• Involves controlled ovarian hyperstimulation in which fertility medications are used to stimulate the development of multiple ovarian follicles that then aspirated by ultrasound guided oocyte retrieval (egg collection) for use in IVF.

Question 2

What is Clomiphene Citrate (Clomid)?

Answer 2

• Is an oral medication used to induce ovulation in cases of anovulatory infertility.
• From a TCM perspective, clomid is a hot, yang stimulating drug.
• Its heat consumes fluids, depleting Kidney yin and Liver blood.
• Symptoms of increased dryness are common after taking clomid, with patients experiencing increased sweating, headaches, dizziness, itching, dry eyes and a dry mouth.

Question 3

What is IUI?

Answer 3

• Involves placing a prepared sperm sample into the uterus around ovulation
• Pre IUI treatment: support growth of follicles, thickness of the endometrium and promote ovulation
• Post IUI treatment: support growth of corpus luteum, promote implantation and support possible pregnancy.

Question 4

What is ICSI?

Answer 4

• Intra cytoplasmic sperm injection (ICSI) is part of the IVF process involving the injection of single sperm into each egg to assist with fertilisation

Question 5

What is infertility patterns in TCM?

Answer 5

• Kidney Yin Xu complicated by Liver Qi stagnation
• Kidney and Spleen Yang Xu complicated by damp-phlegm
• Kidney and Liver Yin Xu with empty heat
• Liver fire generated by Liver Qi Xu
• Accumulation of damp-heat in the lower jiao

Question 6

What are the 6 stages of IVF?

Answer 6

1. Preparation: Establish a differential diagnosis and regulate conception vessel and penetrating vessel
2. Down regulation: Acupuncture treatment to nourish depleted blood and jing post-hormone suppression
3. Menstruation: Invigorate blood
4. Ovarian stimulation: Tonify Kidney and promote follicular development
5. Egg collection: Acupuncture treatment to tonify Qi and calm shen post egg collection
6. Embryo transfer: consolidate conception vessel and penetrating vessel

Question 7

How do IVF protocols deplete Yin and create empty heat?

Answer 7

IVF that has failed / failed cycle can cause emotional stress, disappointment and grief which leads to Liver Qi stagnation which causes heat and turns into Liver Blood xu.

Question 8

What is the preconception checklist?

Answer 8

Diet + exercise, age, medical conditions, smoking, alcohol, illicit drugs

Question 9

What is the Paulus protocol?

Answer 9

IVF protocol
Pre-transfer: P6, LIV3, SP8, ST29, GV20, EAR (shenmen, uterus, endocrine, brain

Post-transfer: LI4, SP6, ST36, SP10, Ear (Shenmen, uterus, endocrine, brain).

Question 10

What are the most common causes of infertility?

Answer 10

PCOS, Endo, Fallopian tube damage, uterine fibroids, ageing