This couple contacted me because they wanted a more holistic approach to their fertility situation - she instinctively felt as though something wasn't right, and they were reluctant to move towards IVF without taking a good look at everything first.
She was struggling with the following:
Secondary infertility (their first was conceived quickly and easily)
Low AMH (1.4 pmol/l) at the age of 32
A short menstrual cycle
An ectopic pregnancy around 9 months before, through which she lost one fallopian tube
She had seen a gynaecologist who offered clomid to support ovulation (though she was already confident that she ovulated), but also ran a blood test to check AMH. When they found out her AMH was so low, the doctor suggested she move straight to IVF.
At the time she came to me, she was on her third month of clomid. It hadn’t worked, and she opted to dive in with a 360` Fertility Review . . .
The key points from their Fertility Review:
- her cycle was usually around 21-23 days long, which is too short.
When a cycle is this short, it is important to identify when ovulation happens so that we can make sure the luteal phase is long enough - so I asked her to BBT chart, and suggested that we kick off with some regular acupuncture to improve her cycle length.
- her period flowed for less than 3 days, which is on the short side.
This raises questions about whether her uterine lining would thicken enough, whether blood flow to the uterus was sufficient. I suggested she see Gill Hind, the visceral osteopath that I work alongside as Gill frequently works wonders for clients with issues with either heavy or light menstrual flow. This is also super-important in secondary infertility cases, after a c-section or where someone has been through an ectopic.
- she reported breast tenderness, mood swings, PMT and sugar craving.
These symptoms, and the way they came and went relative to the time of cycle suggested she was having issues with hormone regulation (especially tired around ovulation, ). I recommended regular acupuncture to support hormone regulation which would reduce these symptoms.
- microbiome issues were likely to be in the picture.
She had a c-section delivery at the end of her first pregnancy which can allow pathogens to enter the system. She had been through an ectopic pregnancy which is associated with a higher chance of there being an infection present. I recommended a ScreenMe test to take a closer look at her microbiome.
- there was not enough information about her hormone profile, her thyroid function, or ferritin (a key marker of deficiency).
All of these markers are important for fertility, but especially important in a case where low AMH is a feature. I helped her to organise which tests to run and when.
- her immune system was on its knees, she rolled from one minor bug to another.
Implantation and early pregnancy lean heavily on an immune system, so if the immune system is struggling, it can significantly impact fertility. Acupuncture can be really helpful in this kind of situation, but we also needed to check her ferritin and vitamin D levels.
- her digestion was in need of support, she had issues with loose stools, constipation, bloating and indigestion.
She needed some encouragement to help her to make the changes she needed to make to her diet - there was a lack of plant-based foods, too much sugar, too much caffeine. Again, acupuncture can help with digestion, and the visceral work that Gill does is also hugely beneficial. I also suggested a good prebiotic powder to support healthier bowel transit.
- sleep was poor, and in response to that, she was fuelling her day with caffeine. I suggested cutting the caffeine intake right down, and regular acupuncture to support improved quality and quantity of sleep. Poor sleep is associated with lower AMH, so this was important.
- the potential for male fertility issues to be a contributing factor had not been explored.
Even with all the things going on on her side, we still needed a semen analysis (male issues cannot be ignored, even for secondary infertility - at least 40% of secondary infertility cases will involve male infertility).
Then we got to work . . .
When we started to work together, she was constantly unwell with coughs, colds, eye infections, headaches etc. Her energy was very flat, she was constantly tired and craving sugar, her acupuncture pulses were very faint and lacking in substance and energy. From an acupuncturists perspective, there were signs of Blood Deficiency, and Spleen deficiency, Liver Stagnation and Kidney yin and yang deficiency. Her feet were cold, her lower tummy was cold and her pulses very faint and lacking in energy.
She saw Gill, my visceral osteopath colleague for an assessment and treatment. There was work to be done on the c-section scar, on the positioning of the uterus and the blood supply to and from the uterus and ovaries.
We started with acupuncture near the end of her cycle, so there was little scope to delay that first period, but ovulation shifted on the following month by a couple of days and her cycle length went from from 21 days to 25 days and continued to improve steadily from there.
BBT chart data clearly showed a short luteal phase of 9-10 days, so we were able to arrange for her to be prescribed progesterone support.
In my opinion, Cyclogest is rarely enough to ‘fix’ infertility, as a short luteal suggests poor follicle health, poor hormone production and regulation, or both. A short luteal phase needs to be tackled holistically - by all means use cyclogest to lengthen and stabilise the luteal phase, but back that up by working with acupuncture to lengthen the follicular phase which would suggest improved follicle and egg quality.
The advanced thyroid function test showed thyroid function was OK, and antibodies were low, but the test revealed low Vitamin D level, low folate, and low-ish iron reserves. All this was tackled head on as all of these can impact egg quality and fertility and raise the risk of early loss.
I needed a better look at her hormone profile, so we ran a hormone blood test which showed a very low level of SHBG which suggests that insulin resistance would be an issue for her - and unregulated blood sugar causes inflammation which impacts egg quality and fertility. She took this on board and shifted her diet towards the Blood Sugar diet. If we had needed to, this is something I would have brought a functional nutritionist in for, but in this case she did an amazing job with no need for extra support. Sticking to a blood sugar diet helped her to reduce her sugar craving, reduced her brain fog and helped to stabilise her mood - and she noticed that she was quietly losing a few pounds a week as her insulin regulation came back into line which really helped her to keep up the good work!
We ran ScreenMe Vaginal microbiome test. The results from this test showed a complex bacterial picture with a high level of a handful of pathogenic bacteria including strep B and a moderate level of several other known pathogens such as prevotella bivia and enterococcus faecalis. We arranged for her to see a specialist pharmacist who has excellent knowledge of the microbiome and its impact on fertility and pregnancy. He prescribed antibiotics for her and we followed that with probiotic support.
Three months later, things were all falling into place nicely. She was no longer rolling from bug to bug, her energy levels were much better, her digestion had settled down, her sleep improved, and the signs and symptoms of poor hormone regulation had disappeared - and she started to radiate with good energy. She ovulated on day 16 of her fourth cycle with me, and conceived - the baby was in the right place, and had a strong heartbeat when she went for a viability scan. She has just had a 10 week scan and everything is looking peachy.
So what was it that made the difference??
If you want to know what it was that made the difference, I can’t tell you. That’s the nature of holistic fertility support - it’s a broad brush approach, because that’s what works.
I doubt we would have had success if we had only run a microbiome test and not been able to get expert advice regarding the results.
I doubt we would have had success if we only sorted out the luteal phase issue.
If we had not run the full hormone panel, would she have been so focused on improving her insulin regulation system?
Had she not come for regular acupuncture, would we have changed the timing of ovulation so quickly and easily, which in turn would have meant ovulating with a stronger, healthier egg by the time she had cleared up the infection?
Had she not seen Gill, would her ovaries and uterus been so hospitable, would she have been physically ready for pregnancy after having been through an emergency C-section and an ectopic pregnancy?
Had she not trusted us, and taken such an active role in helping support the work we were doing in clinic, would we have got there? She ran every test I recommended, took all the advice on board and did everything we asked of her.
If someone has had an ectopic pregnancy, statistically they are likely to have another. This is because infection is often at the root of an ectopic pregnancy, but to find these infections you have to run the right tests. While I am unable to say for sure what was the most significant change we made, I am confident that if she had listened to her consultant and pushed on into IVF, it wouldn’t have ended well. And once you have found, and cleared an infection, your risk of a repeat ectopic pregnancy are so much smaller.
I am confident that if she had gone through IVF with AMH of 1.4 pmol/l, the odds would have been stacked against her. Even if a transfer had worked, the chances of the pregnancy lasting would have been slim if she hadn't cleared the microbiome before transfer, and hadn't spent the time improving her cycle holistically beforehand. It was far more sensible to work out why she wasn’t conceiving, and to remove as many of those blocks as we could find.
This is what we do.
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