This was a particularly complicated client, who I found immensely challenging to work with, due to her medical history and lifestyle. We achieved a natural pregnancy without any medical intervention, which was a first for this client, but it sadly ended in miscarriage. I felt her lifestyle was adversely influencing her fertility but my client continued drinking heavily, she was convinced this did not need to change. I think she needed to address her childhood (alcoholic father) and reflect on her psychological wellbeing and issues around childhood (& having a baby) given her own precarious upbringing. Personally I learnt a lot about my role as practitioner from working with this woman and though very hard at the time, I took giant steps forward in my understanding of the complexity of fertility and dealing with the psyche.
Florence aged 38 had been trying to conceive for 3 years before she started treatment with me. Her story so far was:
- Diagnosed with Polycystic Ovary Syndrome (PCOS). Noted high ratio of LH to FSH of 2:1, irregular cycle between 31-41 days.
- Used fertility and diabetes medications (clomid and metformin) and conceived. Down’s Syndrome, foetus terminated.
- IVF fresh cycle– suffered hyperstimulation – fluid retention requiring drainage, nausea, and shortness of breath. Miscarried at 6 weeks
- IVF Frozen transfer – missed miscarriage at 9-10 weeks. Required Dilation & Curettage (D&C), infection resulted requiring being admitted to A&E. Required another D&C.
She was still taking metformin and had been for two years by the time of her consultation with me. Her lifestyle showed her and her partner to be drinking a lot of alcohol. Florence had a stressful job and had suffered from depression in the past. She mentioned every cycle testing early for pregnancy and if negative, going on a drinking binge to cope with her disappointment.
Chinese Medicine intervention
When we started acupuncture, Florence’s cycle was 41 days. This was a complicated picture from the Chinese Medicine viewpoint. She showed an excess pathology created by her past history, but underlying this was a deficiency. In particular her ‘Blood deficiency’ was creating stagnation in the uterus and psychological distress (anxiety and depression). The stagnation was creating heat and she had a tendency to cystitis and thrush.
The client was keen to get try another three months of clomid and then IVF, as medicated intervention resulted in her at least getting pregnant; even though non were successful. However it was difficult for her to understand that the lead up to getting pregnant – the quality of both the eggs and sperm and how the embryo implants will determine whether the pregnancy is successful and result in a healthy baby. She did agree though to allow three months treatment to improve her egg quality and then review. I emphasised the need for her to make changes during this time to enhance the nutritional and hormonal environment in which her eggs were developing.
We started acupuncture initially at twice weekly sessions. Lifestyle advice was given to reduce heat in the body. This focussed mostly on her high consumption of alcohol which was at 30 units each week (NICE recommend 2 units per week for women trying to get pregnant and 14 units is maximum for women) and reducing her coffee. Also her stress levels were high. We talked about techniques to reduce this stress. She was reluctant to reduce her alcohol initially due to a number of social events and she had tried techniques like mindfulness without success, she preferred to do strenuous exercise.
I questioned whether she needed to take metformin as she was not taking clomid and had no insulin issues. Her fertility consultant confirmed this was not necessary, so she stopped the medication. Around this time a death in the family caused her alcohol consumption to increase. She sought psychological help from a counsellor and coach.
Her cycle responded well to the twice-weekly treatment and her first full cycle with acupuncture was 31 days. The treatment frequency was reduced to nearly weekly and she had two subsequent cycles of 37 and 33 days. A blood test then revealed the ratio of LH and FSH was now a healthy 1:1. The acupuncture needed to address the imbalance in her “Liver” and I kept encouraging her to reduce her alcohol consumption, which she finally started to do.
Pregnancy and miscarriage
The next cycle resulted in a pregnancy. This caused her immense worry. She wanted to keep doing her strenuous exercise, though agreed to moderate it slightly. We discussed how adrenaline and cortisol competes with progesterone and so the importance of not overdoing her exercise and reducing her stress. Unfortunately her work became very stressful. She agreed to weekly sessions to help maintain her pregnancy and these were concerned with helping blood flow to the uterus and trying to reduce her anxiety and stress. But her finances meant she could not receive the treatment we had planned. A scan at 6 weeks showed a heartbeat but she developed spotting and cramps afterwards. At just over 7 weeks another scan revealed the foetus had sadly died.