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Journal of Chinese Medicine • Number 91 • October 2009 The treatment of Elevated FSH Levels with Chinese Medicine The treatment of Elevated FSH Levels with Chinese Medicine Follicle stimulating hormone (FSH) levels are routinely tested during biomedical investigations into female fertility. An appropriately low FSH level is frequently required by fertility clinics as an entry requirement for women wishing to receive assisted reproductive technology (ART) treatment such as in vitro fertilisation (IVF). This article presents the diagnosis and treatment of elevated FSH levels according to traditional Chinese medicine (TCM), and puts forward the view that high FSH levels do not necessarily mean that a woman is approaching menopause, but rather simply indicate the current status of ovarian functioning at the time of the test. The author asserts that with the appropriate treatment using acupuncture and Chinese herbal medicine, the proper functioning of the ovaries and anterior pituitary gland - in cases where they have been pathologically affected - can be restored. This process does not, however, necessarily imply that treatment has reversed the aging process or affected the quality of eggs produced. The theory presented is illustrated with three case histories from the author's own clinical practice.
IVF, follicle stimulating to menopause, as well as reflecting the quality of eggs For practitioners of traditional Chinese medicine she is producing. This accepted view has recently, (TCM) treating those women experiencing however, come under more scrutiny.3, 4, 5fertility problems who are also under the care of Western fertility clinics, follicle stimulating hormone (FSH) levels have become an important aspect of both Many patients have started to view low FSH levels as
diagnosis and prognosis. FSH levels are usually taken an entrance requirement to ‘get into' their preferred
to be an indicator of a patient's ovarian function, egg quality and their suitability for receiving assisted reproductive technology (ART); as such they are increasingly being used as a marker for a woman's FSH testingability to conceive.1, 2 Because many fertility clinics The basal FSH level is taken by blood test between use FSH as part of their patient screening criteria, days two and five of the menstrual cycle, and must and decide not to treat patients where the levels are always be taken together with an oestradiol reading too high, many patients have started to view low in order to obtain a meaningful result. Due to the FSH levels as an entrance requirement to ‘get into' feedback mechanism explained above, elevated their preferred clinic. As a result of this, a growing oestradiol levels may reflect lower FSH, and vice number of patients are presenting for Chinese versa. Table 1 gives the typical ranges for FSH levels, medical treatment with the specific aim of reducing although individual fertility clinics and laboratories this hormone level.
may use different ranges, which may be stricter than FSH is produced by the anterior pituitary gland those given below.6 and functions to stimulate the ovaries. During the follicular phase of the menstrual cycle, FSH secreted by the pituitary gland stimulates the production of ovarian follicles and oestradiol. This continues until Elevated or peri-menopausal the oestradiol level peaks, causing the pituitary gland to increase its production of luteinising hormone (LH), which then acts as the trigger for ovulation to Table 1: Follicular phase FSH levels (IU/L) measured on occur. If the ovary responds poorly to the FSH, and day two of the menstrual cycle.7the level of oestradiol does not rise sufficiently, the pituitary gland recognises this and secretes more FSH and Western fertility treatmentFSH to further stimulate the ovary. In this feedback Because much Western fertility treatment, and system the FSH level rises as the ovary becomes less in particular in vitro fertilisation (IVF), works by responsive. FSH levels have therefore traditionally stimulating the ovaries with additional FSH to been considered a measure of how close a woman is produce multiple follicles,8 the patient's own FSH level The treatment of Elevated FSH Levels with Chinese Medicine Journal of Chinese Medicine • Number 91 • October 2009 is used as a marker for the likely success or failure of TCM patternstreatment, and indeed whether treatment should be A woman's journey towards the menopause, with its embarked upon at all. It is generally considered that if accompanying decline in ovarian function and egg the ovary already requires high levels of stimulation quality, is described in Chinese medical terms as a in order to function at a normal level, then adding natural decline in Kidney essence (jing), Kidney yin further FSH is unlikely to be beneficial, especially and Kidney yang. If it is the case that Kidney essence given that multiple follicles are required in an IVF has declined, FSH levels will also inevitably rise, due cycle in order to provide a reasonable selection of to the greater stimulation required by the ovaries to embryos from which to choose.
produce follicles. Because it is not possible to reverse the effects of aging, trying to reduce FSH levels in such a situation (even if it were possible) would have The aim of treatment in reducing FSH levels is not, little or no benefit to the patient ‑ the egg quality and
therefore, to try to improve egg quality, but rather function of the ovaries would remain poor. Reduced
to improve the functioning and responsiveness of ovarian function is not, however, always due to aging
(see below). The output of the pituitary gland is also the ovaries.
not always reflective of the true functioning of the ovary.15, 16 It is in these situations that TCM treatment Treatment of elevated FSH levels is made more can be useful and effective.
difficult because Western reproductive medicine For the practitioner of Chinese medicine it is useful is currently undecided on the true importance of to consider FSH levels simply as an indicator of how FSH levels. Some clinics maintain that elevated FSH hard the ovaries need to be pushed in order to produce levels are a clear indicator that a woman is nearing follicles. The aim of treatment in reducing FSH levels the menopause, and that a woman's eggs are ‘only as is not, therefore, to try to improve egg quality, but good as her highest FSH level'; in such cases the clinic rather to improve the functioning and responsiveness would ignore any subsequent lowering of FSH levels. of the ovaries. It is important to clarify this point with Other clinics have the perspective that FSH levels are the patient prior to treatment, as they may have been a measure of the current functioning of the ovaries, told by their Western fertility clinic that that there is a and therefore on months where the FSH level is lower direct link between FSH levels and egg quality. These there is a greater chance of stimulating the ovaries patients will then presume that a reduction in FSH successfully. Yet other clinics assert that FSH levels indicates improved egg quality; this is not necessarily are frequently more misleading than they are helpful, true.
and that the only real test of how a woman's ovaries In the clinic one usually finds that treatable17 will respond to treatment is to put them through elevated FSH levels are the result of pathogenic heat, the full IVF stimulation process. They suggest that although a variety of pathologies can be involved. FSH levels are at best a rough indicator of what will In some cases the elevated FSH is an appropriate happen. Consultants from these clinics have called response of the pituitary to poor functioning of the for patients not to be rejected from treatment on the ovaries, whereas in others it is the pituitary gland basis of elevated FSH levels alone.9 It has also been itself that is secreting an unnecessarily high amount of suggested that, in the competitive (and predominantly FSH. An accurate TCM differentiation of syndromes privately financed) market‑place of IVF treatment, will lead the practitioner to understand which of these clinics are refusing to treat patients with elevated FSH events might be occurring. High FSH can therefore be levels simply to maintain their position in fertility differentiated according to the following patterns:league tables.10 Because of these differing opinions on the value of FSH testing, another hormone test ‑ Kidney yin deficiency with empty heatanti‑Mullerian hormone (secreted by small antral Signs and symptoms: Elevated FSH, shortened follicles in the ovary) ‑ is becoming increasingly follicular phase, hot flushes, night sweats, malar flush, popular at fertility clinics,11 although this is not part dizziness, scanty cervical mucus, scanty period and of current routine testing.12, 13 Despite such varied vaginal dryness. Tongue: red with a thin yellow or no perspectives regarding FSH, the majority of clinics coat. Pulse: Fine and rapid, or empty and floating.
use FSH levels as the primary hormonal marker to In the case of Kidney yin deficiency with empty screen patients before allowing or refusing them IVF heat, whilst the yin of the body may be in natural treatment.14 A value of 12 or over will usually prevent decline due to aging, the empty heat acts as a stimulant treatment from beginning.
to the pituitary gland, causing it to release more FSH than necessary. In such cases, far from being non‑responsive, the ovary reacts appropriately to the Journal of Chinese Medicine • Number 91 • October 2009 The treatment of Elevated FSH Levels with Chinese Medicine high FSH level by working harder and faster, leading to This pattern often manifests as a significant instability in early egg maturation and ovulation. the basal body temperature.
• Herbal formula: Mu Dan Pi (Moutan Cortex) 12g, Di Gu • Herbal formula: Dang Gui (Angelicae sinensis Radix) 9g, Pi (Cortex Lycii Chinensis Radicis) 9g, Bai Shao (Paeoniae Bai Shao (Paeoniae Radix alba) 9g, Fu Ling (Poria) 6g, Radix alba) 9g , Sheng Di Huang (Rehmanniae Radix) Bai Zhu (Atractylodis macrocephalae Rhizoma) 6g, Chai 9g, Fu Ling (Poria) 6g, Xuan shen (Radix Scrophulariae) Hu (Bupleuri Radix) 6g, Bo He (Menthae haplocalycis 6g, E Jiao (Asini Corii Colla) 6g, Nu Zhen Zi (Ligustri Herba) 3g, Mu Dan Pi (Moutan Cortex) 9g, Shan Zhi Zi lucidi Fructus) 6g, Han Lian Cao (Ecliptae Herba) 6g, (Gardeniae Fructus) 6g, Xiang Fu (Cyperi Rhizoma) 6g, Qing Hao (Artemisiae annuae Herba) 6g, Huang Bai Ye Jiao Teng (Polygoni Multiflori Caulis) 9g, Bai He (Lilii (Phellodendri Cortex) 6g.
Bulbus) 9g, Fu Xiao Mai (Tritici Fructus Levis) 9g, Zhi • Patent formulas: Zhi bai di huang san (Anemarrhena, Gan Cao (Glycyrrhizae Radix preparata) 3g.
Phellodendron and Rehmannia Pill), qing jing san (Clear • Patent formula: Jia wei xiao yao san (Augmented Rambling the Menses Powder), tian wang bu xin dan (Emperor of Heaven's Special Pill to Tonify the Heart) • Acupuncture points: Neiguan P‑6, Yintang (M‑HN‑3), • Acupuncture points: Lieque LU‑7 and Zhaohai KID‑6, Taichong LIV‑3, Shenmen HE‑7, Zhongji REN‑3, Zusanli Guanyuan REN‑4, Sanyinjiao SP‑6, Yinxi HE‑6 and ST‑36, Sanyinjiao SP‑6, Hegu L.I.‑4.
Fuliu KID‑7, Rangu KID‑2.
Liver blood deficiency leading to yin deficiency Signs and symptoms: Elevated FSH, early ovulation, Signs and symptoms: Elevated FSH, a scanty or pale red irritability, hot flushes, night sweats, headaches and an menstrual flow, a thin endometrial lining, low blood excessive menstrual flow. Tongue: Red, raised sides. pressure, dizziness, insomnia, poor memory and a dull Pulse: Rapid and wiry.
complexion. Tongue: Pale and thin. Pulse: Choppy This pattern is essentially a more severe version of the This pattern is more common than the previous one in previous pathology.
women under the age of 30 who present with elevated • Herbal formula: Mu Dan Pi (Moutan Cortex) 9g, Di Gu Pi FSH. Patients often feel they are leading a very healthy (Cortex Lycii Chinensis Radicis) 9g, Bai Shao (Paeoniae life, but are frequently underweight and over‑exercising.
Radix alba) 12g, Qing Hao (Artemisiae annuae Herba) • Herbal formula: Dang Gui (Angelicae sinensis Radix) 9g, Sheng Di Huang (Rehmanniae Radix) 12g, Huang 12g, Sheng Di Huang (Rehmanniae Radix) 9g, Bai Shao Bai (Phellodendri Cortex) 6g, Fu Ling (Poria) 6g, Shan (Paeoniae Radix alba) 12g, Chuan Xiong (Chuanxiong Zhi Zi (Gardeniae Fructus) 6g.
Rhizoma) 6g, Shu Di Huang (Rehmanniae Radix • Patent formula: Jia wei xiao yao san (Augmented Rambling preparata) 12g, Shan Zhu Yu (Corni Fructus) 9g, Fu Ling (Poria) 6g, Ze Xie (Alismatis Rhizoma) 6g, Mu Dan • Acupuncture points: Taichong LIV‑3, Xingjian LIV‑2, Pi (Moutan Cortex) 12g, Shan Yao (Dioscoreae Rhizoma) Guanyuan REN‑4, Sanyinjiao SP‑6, Quchi L.I.‑11. 9g, Sha Yuan Zi (Astralagi complanati Semen) 6g. • Patent formulas: Gui shao di huang tang (Angelica Blood stagnation Paeonia Rehmannia Decoction) or liu wei di huang san Signs and symptoms: Painful periods, dark and clotted (Six‑Ingredient Powder with Rehmannia) and si wu tang menstrual flow, pain at ovulation, menstrual spotting (Four Substance Decoction) combined.
before or after the period, a history of endometriosis, • Acupuncture points: Lieque LU‑7 and Zhaohai KID‑6, fibroids and adhesions. Tongue: Purple body, dark Zusanli ST‑36, Guanyuan REN‑4, Sanyinjiao SP‑6, sublingual veins. Pulse: Wiry.
Ququan LIV‑8, Pishu BL‑20, Qichong ST‑30.
In the case of blood stagnation causing high FSH, the functioning of the ovary has been compromised by the Liver and Heart qi stagnation surrounding blood stagnation. It may be the case that Signs and symptoms: Elevated FSH, emotional instability, endometriosis, adhesions or surgical scar tissue are anger, anxiety, sawtooth‑shaped basal body temperature preventing the ovary from functioning fully, and the (BBT) chart18 during the follicular phase of the cycle and pituitary gland responds by appropriately releasing more premenstrual breast distention. Tongue: Raised red sides FSH to stimulate it. Treatment to facilitate the free flow and tip. Pulse: Rapid and wiry. of blood and qi in the surrounding area will improve the In the case of Liver and Heart qi stagnation, the heat functioning of the ovary and lower the level of FSH.
generated from stagnation causes the pituitary to release • Herbal formula: Sheng Di Huang (Rehmanniae Radix) more FSH than necessary. Because of the person's 12g, Dang Gui (Angelicae sinensis Radix) 12g, Chi Shao fluctuating emotional state, this heat is more intermittent (Paeoniae Radix rubra) 12g, Chuan Xiong (Chuanxiong than that caused by yin deficiency and so it is possible, but Rhizoma) 8g, Tao Ren (Persicae Semen) 6g, Hong Hua less likely, that there will be a shortened follicular phase. (Carthami Flos) 6g, Dan Shen (Salviae miltiorrhizae The treatment of Elevated FSH Levels with Chinese Medicine Journal of Chinese Medicine • Number 91 • October 2009 Radix) 6g, Yan Hu Suo (Corydalis Rhizoma) 4g.
a window of opportunity to allow patients access to • Patent formulae: Tao hong si wu tang (Four‑Substance treatment that might otherwise be refused. That said, Decoction with Safflower and Peach Pit), gui zhi fu ling clearly the role of Kidney deficiency should not be ignored san (Cinammon Twig and Poria Powder).
and in cases where the practitioner judges that there is • Acupuncture points: Gongsun SP‑4 and Neiguan P‑6, enough time, treatment can and should be focused here.
Xuehai SP‑10, Taichong LIV‑3, Sanyinjiao SP‑6, Siman KID‑14, Shuidao ST‑28.
Treatment considerationsPatients with high FSH levels involving empty heat usually Kidney yang deficiency and dampness respond well to TCM treatment. Particularly where the Signs and symptoms: Possible diagnosis of polycystic empty heat has caused a shortened follicular phase, ovarian syndrome (PCOS), elevated LH, delayed treatment can see a quick and dramatic reduction in FSH menstruation, scanty menstrual flow, dragging pain levels. Full heat caused by Liver and Heart qi stagnation can relieved by heat, anovulation, water retention, weight also be cleared relatively quickly. If the patient continues gain, abdominal bloating, fatigue, vaginal discharge, with a stressful lifestyle, however, or if anxiety about dizziness and a feeling of heaviness. Tongue: Pale and conceiving continually dominates their thoughts, then the swollen with a sticky coating. Pulse: Slow, deep, weak and stagnation and subsequent heat can quickly return. Prior to slightly slippery.
considering IVF treatment, many patients will have taken In this pattern the ovary is less responsive due to the Clomid (clomiphene), a drug with a heating, yin‑consuming yang deficiency, and its functioning is further impaired action that can exacerbate many of the pathologies listed by any surrounding dampness. Again, the pituitary above. Unless the drug has been used for six months or gland responds appropriately by raising the FSH to push more, however, its effects are likely to be short‑term and the ovary harder. Improved functioning of the ovaries easily remedied. Although TCM theory states that full heat following correct treatment to tonify Kidney yang and is frequently due to poor diet and lifestyle, this is rarely the resolve damp will see the FSH reduce.
case amongst this client group. The majority of patients • Herbal formula: Shu Di Huang (Rehmanniae Radix have usually already taken a proactive stance to improve preparata) 12g, Rou Cong Rong (Herba Cistanches) their chances of conception by cutting out alcohol, caffeine 12g, Huang Jing (Polygonati Rhizoma) 9g, Bu Gu and other toxins from their diet. They will often be leading Zhi (Psoraleae Fructus) 8g, Chuan Shan Jia (Manitis very healthy lives, taking appropriate exercise and eating Squama) 8g, Gui Zhi (Cinnamomi Ramulus) 6g, Zao good diets. Some patients will, however, have to find ways Jiao Ci (Gleditsiae Spina) 8g, Zhe Bei Mu (Fritillariae to reduce work and life stress as much as they can.
thunbergii Bulbus) 8g.
While some degree of Kidney deficiency can be assumed • Patent formula: You gui wan (Restore the right in all patients over 35, and will therefore be present in the pill) combined with either cang fu dao tan wan majority of patients coming for treatment of high FSH (Atractylodes‑Cyperus Conducting Phlegm Pill) or gui levels, it is important to diagnose whether the elevated zhi fuling san (Cinammon Twig and Poria Powder).
FSH is the result of an actual pathology or merely the • Acupuncture points: Lieque LU‑7 and Zhaohai KID‑6,, natural consequence of aging. In many situations this Zusanli ST‑36, Sanyinjiao SP‑6, Taixi KID‑3, Pishu BL‑20, can be difficult to identify; the patient may present with Shenshu BL‑23, Yinlingquan SP‑9, Shuidao ST‑28.
a treatable pathology that appears to be the cause, but the appropriate treatment sees no FSH reduction. With Other pathologies are possible, but rare, and patients are an accurate diagnosis and the appropriate treatment, usually found to present with some combination of the a reduction in FSH levels should be seen within three patterns above. menstrual cycles, although some fluctuation in FSH For all of the patterns above, the treatment principles for readings may still occur. both acupuncture and herbal medicine should emphasise This can be a difficult area in which to work because the clearing of excess ‑ particularly clearing heat and patients will frequently have been rejected from Western moving blood ‑ rather than tonifying the Kidney. With the fertility clinics, sometimes told bluntly that they should exception of patients under 35, where age and timescales give up hope of conceiving, or else advised that they are unlikely to be such a pressing issue, nourishing the should pursue the route of using donor eggs if they Kidney can be an unduly lengthy process. If the practitioner wish to conceive. With anxiety levels high and their sets out to fight against a naturally declining Kidney TCM prognosis apparently directly opposed to that of energy, it may be that time runs out and menopause starts their Western clinic, great scepticism and impatience before the Kidney has been sufficiently strengthened. are commonly encountered and require careful patient Although apparently constituting symptomatic treatment, management. This is actually the most difficult part of concentrating on clearing heat can provide a quick and treatment, especially because patients may present with effective method to lower FSH levels and thus provide a clearly identifiable pathology that could be the cause of Journal of Chinese Medicine • Number 91 • October 2009 The treatment of Elevated FSH Levels with Chinese Medicine their elevated FSH level, without this guaranteeing If the practitioner sets out to fight against a naturally
that their ovarian function and egg quality have not
already been irreversibly reduced by age, disease declining Kidney energy, it may be that time runs
or trauma. Frequent basal FSH testing can provide out and menopause starts before the Kidney has
good feedback on patient improvement, but can also
unfortunately create extra pressure and anxiety in been sufficiently strengthened.
the patient. This anxiety, also seen in some patients
who monitor their BBT daily in order to track their only had a short window of opportunity, so instead
cycle, can potentially be more detrimental to their of waiting to see if she could conceive naturally she
condition than the advantages gained from collecting opted for IVF treatment, which was agreed by her
the information. Therefore as well as deciding upon a clinic due to her new low FSH level. The treatment
diagnosis and a prognosis, the practitioner must also was successful and she subsequently gave birth to a
make a judgement on how to monitor the progress little boy. Two years later D conceived naturally and
of their patient appropriately. This type of clinical gave birth to her second child.
judgment necessarily comes, however, from clinical
experience rather than textual explanation.
Case study 2R was 40 when she first came to the clinic. Her most Case studies
recent FSH level had been 15 IU/L, and this had The following are three examples from the author's previously fluctuated on a monthly basis between 13 clinical practice. The first is more unusual ‑ it describes and 18 IU/L. She had previously attempted an IVF the fairly dramatic changes experienced by a young cycle, but had responded so poorly ‑ producing only woman with relatively severe pathology ‑ and is two follicles ‑ that the cycle had been abandoned. The included here simply to show what is possible with IVF clinic in question subsequently refused further TCM treatment. The other cases illustrate pathologies treatment. Her menstrual cycle was short, and she that are more commonly seen and treated in the tended to ovulate on day nine. In addition to this clinic. her period and cervical mucus were scanty and her anxiety levels were extremely high. Her diagnosis was of Kidney yin deficiency with empty heat, with D was 28 years old and had been diagnosed with Heart and Liver qi stagnation. She was prescribed a premature ovarian failure on the basis of a single FSH modification of zhi bai di huang san (Anemarrhena, reading of 45 IU/L. She had been told that she could Phellodendron and Rehmannia Powder) with Yuan not have IVF treatment. She had previously been Zhi (Polygalae Radix), He Huan Pi (Albiziae Cortex) diagnosed with endometriosis ‑ her periods were and Xiang Fu (Cyperi Rhizoma) added.
painful, dark and clotted, and she was anovulatory. Within two cycles her FSH level had decreased to Her tongue had dark sublingual veins and purple below 10 IU/L, and she was feeling much calmer. She patches on the tongue body. then approached another IVF clinic who accepted her In the case of this patient the functioning of the as a patient, and treatment was started the following ovaries had been impaired by blood stagnation month. She produced five follicles, four of which (manifesting as endometriosis) and the FSH level fertilised and three were transferred. All of the had risen as the pituitary pushed harder to overcome embryos produced were considered to be of a good this situation. She was treated with a variation of gui grade. She fell pregnant and gave birth to a healthy zhi fu ling san (Cinammon Twig and Poria Powder) baby boy. As soon as her first child had been born, she in the second half of her cycle and liu wei di huang returned for acupuncture and herbal treatment, and san (Six‑Ingredient Powder with Rehmannia) with subsequently had a further successful IVF treatment additional blood tonics and blood movers in the first which resulted in the birth of her second child.
half. Acupuncture treatment focused on moving qi and blood throughout her cycle, with treatments Case study 3timed during her period, and at the time we thought C was 42 when she came to the clinic. She had no ovulation ought to happen. Acupuncture points known gynaecological problems and was hoping to included Gongsun SP‑4 with Neiguan P‑6, Xuehai have IVF treatment (using donor sperm, as she did SP‑10, Taichong LIV‑3, Diji SP‑8, Siman KID‑14 and not have a current partner). At this point her FSH was Hegu L.I.‑4. Within three cycles, her period became tested and found to be 33 IU/L, and she was informed much improved in terms of pain and flow. Her fourth that donor eggs were her only option. Her cycle was cycle after beginning treatment was ovulatory, and a 24 days and her period was heavy and bright red. In day two FSH test measured 11.2 IU/L. D felt that she addition she suffered from night sweats and recurrent The treatment of Elevated FSH Levels with Chinese Medicine Journal of Chinese Medicine • Number 91 • October 2009 bouts of cystitis. The diagnosis was Kidney yin deficiency previously elevated FSH level was not truly representative with empty heat, and by her own choice she was treated of their suitability for Western fertility treatment, and thus using just acupuncture. allow them access to ART treatment that would otherwise Within two cycles her night sweats had stopped, the be denied. cystitis had improved and her third menstrual cycle after With little Western scientific agreement and even less commencing acupuncture had lengthened to 27 days. TCM literature regarding this subject, this article is based
Acupuncture points used included Lieque LU‑7 (right) mostly on the clinical experience of the author, and as
and Zhaohai KID‑6 (left), Zusanli ST‑36, Sanyinjiao such it is meant as a guide for practitioners rather than
SP‑6, Taixi KID‑3 and Shaofu HE‑8. Her FSH reading a definitive text. It is hoped that this information will
on the following menstrual cycle was 8.5 IU/L and the stimulate further research and discussion in this area.
clinic reluctantly agreed to try an IVF cycle with her. She
continued to have acupuncture throughout her treatment, Daniel Elliott is an acupuncturist and herbalist working with
and produced six follicles, four of which fertilised and led gynaecological and fertility issues. He is Clinical Director of the
to a healthy pregnancy and the birth of a baby girl.
London Acupuncture Clinic (, a multi‑practitioner clinic which specialises in the treatment of It is important to be clear that in all of these cases, the infertility and gynaecological issues.
reduction in FSH and subsequent pregnancy did not necessarily mean that there had been a reversal of the aging process or an improvement in egg quality. Such Street, London, W1T 4EU, cases rather demonstrate the inaccuracy in diagnosis accessed June 2009 1 Scott RT, Toner JP, Muasher and prognosis made by the Western fertility clinics that SJ, Oehninger S, Robinson S, 8 Most commonly in an injectable form, such as Gonal‑F, Puregon, test these patients. While some patients may feel that Rosenwaks Z. (1989). "Follicle stimulating hormone levels on Menopur or Fostimon.
acupuncture and herbal medicine have miraculous effects cycle day 3 are predictive of in 9 Abdalla, H and Thum MY in turning back their ‘fertility clocks', it is actually the vitro fertilization outcome", (2004). "An elevated FSH Fertil Steril 51:651–4 reflects a quantitive rather effectiveness of TCM diagnosis and prognosis rather than 2 Toner JP, Philput CB, Jones than a qualitative decline of the the treatment itself that allows for success in this area. In GS, Muasher SJ. (1991). "Basal ovarian reserve" Hum Reprod other words, it is not that TCM treatment is so all‑powerful follicle‑stimulating hormone that it can help any woman conceive irrespective of age level is a better predictor of in 10 Sharif K and Afnan M (2003). vitro fertilization performance "The IVF league tables: time for and health, but it is rather the diagnostic framework of than age", Fertil Steril 55:784– a reality check", Hum Reprod. Chinese medicine that is so valuable and enables TCM clinicians to clearly see (and treat) the pathological 3 Barnhart K, Osheroff J. (1999) 11 Visser JA, de Jong FH, Laven "We are overinterpreting the JS, Themmen AP (2006). processes responsible for driving up the FSH levels; predictive value of serum "Anti‑Mullerian hormone: in such cases it becomes clear that the Western medical follicle‑stimulating hormone a new marker for ovarian diagnosis or prognosis was incorrect. Thus patients may levels", Fertil Steril 72: 8–9. function", Reproduction 131:1–9. frequently be told that their chances of conception are less 4 Ilse A.J. van Rooij, Evelyn 12 Singer T, Barad D, Weghofer A, than one per cent, yet clinical experience amongst TCM Broekmans, Caspar W.N. Gleicher N (2009). "Correlation practitioners show radically higher success rates than this. Looman, J.Dik F. Habbema, of antimullerian hormone and te Velde Egbert R. (2004). baseline follicle‑stimulating This is also demonstrated by the high IVF success rates "High follicle‑stimulating hormone levels", Fert Steril achieved by clinics that do not use elevated FSH levels as hormone levels should the sole reason for refusing treatment.
not necessarily lead to the 13 Practice Committee of exclusion of subfertile patients the American Society for from treatment", Fertil Steril Reproductive Medicine (2006). "Optimal evaluation of the While Western fertility clinics continue to debate the 5 Esposito MA, Coutifaris infertile female", Fertil Steril C, Barnhart KT. (2002). "A actual significance of FSH levels, TCM practitioners have moderately elevated day 3 14 Broekmans FJ, Kwee J, Hendriks an excellent opportunity to provide effective treatment to FSH concentration has limited DJ, Mol BW, Lambalk CB 2006). patients who would otherwise be unable to access ART. predictive value, especially in "A systematic review of tests younger women", Hum Reprod predicting ovarian reserve and With links still being made amongst fertility specialists IVF outcome", Hum Reprod between FSH levels and ovarian function, egg quality and 6 R. Scott Jr., K. Elkind‑Hirsch, menopause, it is important that patients understand that a A. Styne‑Gross, K. Miller, 15 Khalifa E, Toner JP, Muasher SJ, J. Frattarelli (2008). "The reduction in this hormone level following TCM treatment Acosta AA (1992). "Significance predictive value for in vitro of basal follicle‑stimulating does not necessarily mean that time has been turned back, fertility delivery rates is greatly hormone levels in women with and that little or nothing may have happened to improve impacted by the method used one ovary in a program of in to select the threshold between vitro fertilization", Fertil Steril the quality of the eggs produced. TCM treatment can, normal and elevated basal 57:835–9 [Erratum in: Fertil however, improve ovarian function and regulate pituitary follicle‑stimulating hormone", Steril 58:458.]. Fertil Steril 89:868‑878 output, which may in turn increase the patient's fertility. It 16 Lambalk CB, de Koning CH 7 Figures as used by The Doctors may also, as is often the case, demonstrate that a patient's (1998). "Interpretation of Laboratory (TDL), 60 Whitfield elevated FSH in the regular Journal of Chinese Medicine • Number 91 • October 2009 The treatment of Elevated FSH Levels with Chinese Medicine Diploma in tui na
We will be running a second one-year tui na (Chinese menstrual cycle". Maturitas made by BBT charts, matching therapeutic massage) diploma course with a start date of them with specific TCM 15 January 2010. Attendance will be twice a month on Fridays. 17 The term treatable here syndromes. This has been The course is divided into three modules, each lasting four perhaps requires some documented Virginia Wood in explanation. The point being a previous issue of this journal months. For further details and an application form please made is that for some women [Wood, V (1999). "Infertility email Silvia Hovancova, the course registrar
who attend TCM clinics, a and the Use of Basal Body high FSH level is neither Temperature in Diagnosis and treatable nor pathological, Treatment", Journal of Chinese CPD events
but is rather a normal aspect Medicine 61:33‑41] for acupuncturists/CHM practitioners of getting older. As such it Jill Glover
does not require intervention Understanding IVF
with acupuncture or herbal medicine ‑ and even with such Martin Powell
intervention it is unlikely to Neuromuscular taping for acupuncturists
change the woman's ability to produce mature follicles or Basic 29 Oct 2009 Advanced 19 Nov 2009
conceive. This article focuses Charlie Buck
on ‘pathologically high' Understanding herb pairing dynamics 26 Nov 2009
FSH, which is, by definition, treatable.
Needling skills 27 Nov 2009
18 Measuring the basal body Bill Ryan
temperature (BBT) has The art of feeling qi 7Ð8 Dec 2009
traditionally been used as a method of contraception; the The art of projecting qi 10 Dec 2009
temperature rise caused by Find out more about these and other events or register online an increase in progesterone levels after ovulation provides at or cal Silvia on 0118 950 8880
a guide of when a woman is fertile. TCM fertility Doctors College of Integrated
in China have developed methods of diagnosis that include the different patterns 19 Castle Street Reading Berkshire RG1 7SB
t 0118 950 8880 e [email protected]
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The beginner's guide to pinhole photography

Copyright ©1999 by Jim Shull All photographs by the author. All rights reserved. Amherst Media, Inc. Buffalo, N.Y. 14226 Fax: 716-874-4508 Publisher: Craig Alesse Senior Editor/Project Manager: Richard Lynch Associate Editor: Michelle Perkins ISBN: 0-936262-70-2 Library of Congress Card Catalog Number: 98-71750 Printed in the United States of America.

Medicines partnership of australia

Medicines Partnership of Australia Packaging and labelling of pharmaceuticals and consumer safety – a survey of the literature Elizabeth de Somer, Ivan Trofimov Medicines Australia Ltd Introduction Inadequate and ambiguous packaging and label ing of medications is widely perceived as a