Fertile Ground

Originally published in Seattle Magazine, (May 2007)

Seattle Magazine

I am sitting in a private room, my tongue sticking out, as two pairs of inquisitive eyes peer into my mouth. “Aah, yes …” acupuncturists Stephanie Gianarelli, L.Ac., and Margot Voorhies, L.Ac., say in unison, pulling back simultaneously. Then, they palpate my wrists-Voorhies on my left, Gianarelli on my right-and listen to my pulse.

After a thorough exam-which includes questions on subjects ranging from my dietary and lifestyle habits to my medical history-combined with the nonconclusive results of other fertility tests and my history of endometriosis and painful periods, these two deem me a perfect candidate for acupuncture and Maya abdominal massage.

My husband and I have been trying to conceive for more than two years without success. After countless doctor visits and enough invasive tests to put even the friskiest 16-year-old off intercourse, I decided to investigate alternative therapies. Bolstered by a recommendation from my primary care practitioner-along with success stories from friends and acquaintances who have tried alternative treatments-I made an appointment at Acupuncture Northwest & Associates, a downtown Seattle clinic that specializes in fertility treatments and women’s health, and where Gianarelli and Voorhies practice.

For many women, alternative therapies are a last resort-but things are changing. Charlotte York, the character played by Kristin Davis in Sex in the City who turned to acupuncture for help with fertility issues, was mirroring a burgeoning trend. “In the past, women who have tried everything else [came to see me],” says Voorhies. “But more and more patients are coming earlier on.”

As well, there’s growing acceptance of alternative treatments, especially acupuncture, by Western medicine. Voorhies says her clinic works with about 12 reproductive endocrinologists from three clinics in the Seattle area, and doctors often refer patients to them. Acupuncturist Johanna Flynn, L.Ac., who holds a master’s in Traditional Chinese Medicine (TCM) and has been on staff since 2004 at Seattle Reproductive Medicine, saw 900 patients in 2006-a twofold increase since she started.

Acupuncture is a component of TCM that looks at fertility through the lens of a patient’s life force, or chi. “[Chi is] the vital force that makes us alive and animates us,” explains Voorhies. “It runs through channels in the body and goes to all vital organs.” Many acupuncturists also use herbs, another TCM component, to support the healing power of acupuncture.

The fundamentals of infertility treatment are a standard part of acupuncture training, says Sue Yang-Eng, L.Ac., an assistant professor at Bastyr University’s School of Acupuncture and Oriental Medicine in Kenmore. Acupuncture students are required to take a series of courses that help them understand infertility from both Chinese and Western perspectives. In addition, fertility specialists like Voorhies pursue further studies and apprentice under experienced acupuncturists and herbalists in the United States and China.

TCM can support Western fertility treatments, such as in vitro fertilization (IVF), say Voorhies and Yang-Eng, or it can be used on its own when undetectable or undiagnosed factors are causing a couple to have difficulty conceiving naturally. Voorhies uses a combination of acupuncture, herbs, and nutritional and lifestyle suggestions. “In many cases, this assistance provides the fertile environment for conception to occur,” she says.

Several research studies support the use of acupuncture in conjunction with IVF. In a 2002 study involving 160 women (conducted by the Department of Reproductive Medicine at Christian-Lauritzen-Institut in Germany and the Department of Traditional Chinese Medicine at Tongji Hospital in China), the success rate of IVF increased from 26.3 percent in the control group to 42.5 percent in the group that received acupuncture. A 2004 study involving 114 women showed that combining the two techniques increased birth outcomes by 23 percent (conducted by the Reproductive Medicine & Fertility Center and East Winds Acupuncture, Inc., in Colorado Springs, Colorado).

Yang-Eng’s theory is that acupuncture and herbs aid the implantation of an embryo during IVF by enhancing the thickness of the endometrium and improving the quality of the uterine lining. “[Stimulating] specific acupuncture points and [using] Chinese herbs can help to influence progesterone and increase blood flow to the uterus.”

Gerard Letterie, M.D., a reproductive endocrinologist at the Northwest Center for Reproductive Sciences, agrees with Yang-Eng. “Patients in some studies seem to have better blood flow to the ovaries and the uterus and improved endometrium,” he says.

How acupuncture achieves this is unknown, says Letterie. “By Western medicine standards, the data collection and analysis isn’t what we would use in a traditional medical setting. But I think it fits nicely with what we’re trying to do.” And, he points out, acupuncture has been going on for centuries, and there is a basis of wisdom to it. “If a patient comes in and says, ‘I want to do something simple, potentially effective, clearly noninvasive, what do you think of acupuncture?’ I’d say, ‘Yes, totally.’ ”

Maya abdominal massage, like acupuncture, advocates that the body must be in balance to conceive and carry a baby to full term. The technique, which originates from the teachings and medicine of Central America’s indigenous Maya people, was introduced to the Western world in the 1990s by Dr. Rosita Arvigo, a naprapathic doctor from Chicago. Dr. Arvigo has spent decades studying with traditional healers and midwives in Central America, including Don Elijio Panti, a renowned Maya shaman (healer) from Belize. She developed the Arvigo technique of Maya abdominal massage, which combines anatomy, physiology, herbology and naprapathy (study of the ligaments, joints and muscles) with traditional healing and wisdom.

On her Web site, arvigomassage.com, Dr. Arvigo explains the noninvasive technique this way: Reproductive and abdominal organs-in particular the uterus-may have shifted (become tilted or prolapsed) due to weakened ligaments and muscles, thereby restricting the flow of blood, lymph and chi. Maya abdominal massage’s main focus is getting them in proper alignment.

The Maya therapist uses gentle scooping movements to massage the abdominal and pelvic areas, and may manipulate the hips and pelvis. It’s about as intense and just as soothing as a hot rocks massage at the spa.

“From our standpoint, when a uterus is out of position [many] conditions can occur,” says Danisha J. Christian, LMP, a fertility massage therapist who does Maya abdominal massage at Acupuncture Northwest & Associates. A tilted or prolapsed uterus can’t empty completely from menstruation, which, she says, can cause fibroids. The theory (though not documented by any Western studies) is that the blood can empty into the abdominal cavity and cause scarring, adhesions, cysts and masses.

Maya abdominal massage practitioners believe that manual manipulation of the uterus helps promote circulation so that hormones flow smoothly to the uterus, and ovaries receive fresh, oxygenated blood. The natural balance of the body is restored in the pelvic area and surrounding organs. Toxins are flushed, and nutrients that help tone tissue and balance hormones are restored to normal order, all of which are essential for healthy pregnancy, labor and delivery.

“We work on removing blockages in the body … break up scars and adhesions [that] your body processes,” says Christian. This helps diminish pathologies, including fibroids, endometriosis, and old adhesions from pelvic and abdominal surgeries and even cesarean delivery, she says.

Although the effectiveness of Maya abdominal massage has not been proven by Western standards, Dawn Schmidt, director of education at the Cortiva Institute-Brenneke School of Massage in Seattle, one of the most respected and innovative massage therapy training centers in the country, says anecdotal evidence supports the belief and experiences of both practitioners and clients. “It’s hard to refute when someone is saying, ‘This is what made the difference,’ when we know the client knows the best about her  body and the experience,” adds Schmidt.

At $60 to $100 a visit, acupuncture and abdominal massage are relatively inexpensive treatments compared with mainstream treatments such as IVF (costs span $10,000 to $20,000 a cycle and aren’t usually covered by insurance). And with insurance companies increasingly offering coverage for acupuncture and therapeutic massage, alternative fertility treatments may be covered under some plans.

In my fourth month of treatment with acupuncture and Maya massage, and my second cycle of trying to conceive (Voorhies and Christian advise three to six months of treatments), I am still waiting for the big blue cross to show up on my home pregnancy kit. But I find reason to be hopeful. Twelve pregnancies were recorded last November by Acupuncture Northwest & Associates in patients undergoing both acupuncture and abdominal massage. While my engineer husband searches for scientific evidence of a technique’s effectiveness, I hang my hopes on the baby photographs pinned to the walls of her office.

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