Planting the Seeds of Pregnancy: Chinese Medicine and Fertility
In today’s article, I’m speaking with two egg whisperers visiting with us from Seattle, Washington, Stephanie Gianarelli and Dr. Lora Shahine. Stephanie is a fertility acupuncturist at Acupuncture Northwest & Associates in downtown Seattle. Dr. Lora Shahine is a reproductive endocrinologist specializing in infertility and recurrent pregnancy loss at Pacific NW Fertility and IVF Specialists in Seattle. Together, they have written a book called Planting the Seeds of Pregnancy .
Dr. Aimee: Hi Stephanie and Lora! I love your book. It’s one of my favorite books about traditional Chinese medicine. We’re going to talk about TCM quite a bit tonight. How did you guys meet?
Dr. Lora Shahine: I started my practice here in Seattle about 10 years ago and Stephanie was one of the first people to refer a patient to me. I was a little bit familiar with acupuncture, I had done a little bit of research and some traditional Chinese medicine during my medical career, but I was blown away that an acupuncturist was referring to me, a western medicine provider, for fertility care. I called her up and we started a conversation, and we’ve been helping patients together ever since.
Dr. Aimee: That’s awesome. How did you guys come up with this book concept? I love the book, it’s so easy to read, it’s scientifically valid, you’ve basically fact checked every single thing in the book. It’s a great resource for patients who are interested in learning more about acupuncture and TCM and how it can help them in all aspects of their life. How did that come to be?
Stephanie Gianarelli: I just wanted to not have to tell my patients the same thing every day, and I wanted to have the research behind it so that they would believe me and do what I tell them!
Dr. Aimee: It is very nice when patients do believe you. I can imagine as an eastern medicine specialist sometimes people look at you like, “What?” I don’t necessarily believe in this stuff and I have patients sometimes use words — and I’m not trying to be rude or anything, so don’t get mad at me — things like, “That’s hocus pocus,” or, “I don’t believe in that.” So, I want to talk about the science behind TCM. But first, I loved your story about Megan. You wrote a beautiful introduction in your book. Can you tell us a little bit about Megan’s story?
Stephanie Gianarelli: The thing about Megan was she was one of my early stories. I specialized around 2002 and we got the most desperate patients at that point. We would have people with five failed IVFs and they just had nowhere else to turn, then they would come to us. She was one of those. She had a couple of failed IVFs and some miscarriages. She came to us with what are telltale signs to us, which are night sweats, irregular cycles.
Our goal in Chinese medicine is to get people as healthy as possible so that conception can happen naturally. Then if doesn’t, that’s where western medicine comes in. That’s why it’s such a beautiful combination. We like to lay the groundwork so that if western medicine is needed, they’re prepared. She was one of those early people. We have a lot of people coming now who say, “I want to start trying in three months. What do I do?” That’s a huge shift that we’ve seen over the past 15 years.
Dr. Aimee: Right. You mentioned being certified in 2002. Can you talk to me more about what that certification means? For patients out there that are thinking about seeing a fertility acupuncturist, help us understand.
Stephanie Gianarelli: There is a board certification called The American Board of Oriental Reproductive Medicine, although they are considering updating that name away from ‘Oriental.’ It is a nationally and internationally known certification, we have people from all over the world, because it’s the only specialization board certification that we have, I think on the planet.
Dr. Aimee: Should patients be looking out for that? Is that something that’s usually on a website or something a patient can ask the clinic they’re working with to see if that acupuncturist has that certification?
Stephanie Gianarelli: Absolutely. You can ask, but you can also go to the ABORM.org website and look it up, they have everybody who has been board certified on there.
Dr. Aimee: Oh, nice.
Stephanie Gianarelli: It really makes a difference. We’re all trained basically in Chinese medicine, but specializations in the west are somewhat new for acupuncture. What we do is not only know the fertility TCM piece, but we also know what the western medicine doctors are doing and we can talk to them and work with them, which I think is a crucial piece. It makes the patient feel like they’re on a team, they have a team behind them that they can work together and they’re not going behind their western medicine provider’s back to take their supplements, and it kind of calms the patient down.
Dr. Aimee: Right. I know you guys have a great relationship. Can you talk through that relationship and the communication that you guys have with one another and how important that is? Dr. Shahine, tell us about that.
Dr. Lora Shahine: Sure. Patients ask a lot, “Is there anything else I can do? What do you think about acupuncture? What do you think about eastern medicine as a way to enhance or improve my odds?” I have the conversation, I’m very open, and I talk about if you’re open to it, I think it may help and can absolutely be beneficial, but let’s talk about it.
If you’re going to look for an acupuncturist, this is what you need to look for. Just like in western medicine, not every doctor knows how to read an EKG or how to take care of orthopedic breaks. You should look for people in eastern medicine that specialize and really care about women’s health and fertility as the right person to look for.
Dr. Aimee: Right. I think one of the emailed questions that we got from a viewer of the show addresses that, so I’ll be asking that a little bit later. Let’s just go through some of the questions that I have for you guys that I think everyone can learn from.
One of the first questions is a question that I get all the time when I ask a patient to consider acupuncture. And I do ask all of my patients to consider it. How does TCM actually work? What is the science behind it, because I know there’s a science?
Stephanie Gianarelli: They’re still figuring it out.
Dr. Aimee: That’s what the smartest people actually say. It’s true.
Stephanie Gianarelli: They do know that it works. They’ve done functional MRIs of the brain while they’re putting vision points in the feet and the vision area of the brain lights up. So, they know it works, but they don’t know how it works yet. They will figure it out eventually.
One of the best hypotheses that I go with is you create a wound at the site of an acupuncture point and it marshals the body to heal itself. That works for pain. When we get into how it affects the central nervous system and the HPO axis, other things come into account, but that’s what they’re thinking. They’ll figure it out.
Dr. Aimee: The HPO axis, for viewers, if you don’t know, is just basically how your brain talks to your ovaries.
You mentioned in your book something about the four pillars. Can one of you talk to me a little bit more about what those are?
Stephanie Gianarelli: Yes. The four pillars of Chinese medicine are acupuncture, Chinese herbs, nutrition recommendations, and lifestyle suggestions. As I mentioned, we have a model of health, so we can’t just give them herbs and give them acupuncture and then have them go home to sit on the couch and eat Twinkies.
Dr. Aimee: That sounds pretty good, but yeah, you’re right, you can’t.
Stephanie Gianarelli: We want to make sure that they’re getting enough sleep and they’re eating well and how they’re dealing with stress. Our bodies are naturally programmed to deal with stress, it’s how we deal with it.
I like to remind patients that stressed out people get pregnant all the time. Stress affects everybody differently, and for some people it does affect their cycle. I have women come in and their cycle is regular, then they start trying to pregnant and suddenly their cycle becomes erratic. Those are the ones that I’m like maybe we can talk about stress reduction for you.
Dr. Lora Shahine: I love that Stephanie spends so much time really talking to the patients about nutrition and the importance of sleep. She spends so much more time and has so much more time to really see patients on a very regular basis, like once a week, to check in about those really important nutritional status, exercise, sleep, all these things that we know are important. It’s the reinforcement, like a coach.
Dr. Aimee: Another cheerleader on the squad, so to speak. My other question is what can a patient expect at their first visit? People ask me that all the time, so I’d love a blow by blow account of what happens when a patient walks into your clinic for the very first time.
Stephanie Gianarelli: Our intake form is at least eight pages long. I’d say most acupuncturist’s intake forms are, because with that model of health we look at all of these very disparate seeming symptoms and we put them into different organ systems so that we can figure out where the imbalance is, and that takes a time. Not only do you have to spend at least a half an hour filling out the paperwork, then you spend a full hour going through your history.
It will be a history like you haven’t probably given before, where you talk about your childhood, everything you eat, how you sleep, how your relationships are, what your work is like, do you like it and does it stress you out, and your physical health as well in a way that you probably haven’t answered, especially for a fertility doctor. At the end I’ll say, “Is there anything a little strange that you wouldn’t necessarily tell your MD? I want to know that, too.” Then they’ll tell me something strange that might make perfect sense in TCM.
Dr. Aimee: I’m kind of tempted to ask you what’s that something strange that you usually get, but I’ll just leave it there.
Stephanie Gianarelli: I do have a little example.
Dr. Aimee: Okay. Tell me.
Stephanie Gianarelli: Someone came in the other day and she said her thighs burn when she goes to bed, and to the touch, her husband feels it. She’s had acupuncture for like three weeks now and it’s almost gone.
After that hour long interrogation, then they get a half an hour acupuncture treatment, which is very relaxing. Then I’ll type up a treatment plan, which will include the four pillars and all of the different things that I want them to do.
I meet them where they are and then push them a little bit farther. Then I’ll work with Dr. Shahine or whoever they’re seeing to make sure that we’re all on the same page.
Dr. Aimee: Right. It’s not a one size fits all approach. It’s just like for Dr. Shahine and I when it comes to fertility treatment. Some patients come in once a week, some patients need to come in more. Everyone asks me what kind of time commitment it is and I tell them they basically have to see Stephanie first and then she’ll give her expert opinion based on what she studies about their body. Is that pretty accurate?
Stephanie Gianarelli: That’s true. People can come wherever they are in their western treatment. If they’re starting on IVF, we will just meet them where they are. The thing about Chinese medicine is dosage is an issue. They’re finding that more acupuncture, for example, is better. Nine to eleven electroacupuncture treatments before your retrieval or your transfer increases blood flow and increases outcomes, that has been proven.
An oogenesis cycle is three months, but people come in who are 40 and as you’re ready to do a retrieval on them, I’m not going to stop them. I may throw them on some CoQ10 and hope for the best. If it fails, then we’ll talk.
It’s really age-dependent if I tell them to stop. I will occasionally. A 30-year-old person who has fairly good numbers, I may say let’s just give it a couple of months, let’s get you ready, and then I’ll talk to you and you’ll say that’s all right. But I wouldn’t do that to a 42-year-old.
Dr. Aimee: You used a word that started with electro. Can you tell me a little bit about that? What does that mean?
Stephanie Gianarelli: Electroacupuncture is putting the acupuncture needles in, taking a TENS unit and hooking up the needles to the TENS unit, it just adds an added stimulation. Back before we had electricity, they would do that by hand, they would sit in the room with you and just twirl the needle for a long time.
Dr. Aimee: What kind of sensation would a patient have when they have a treatment like that?
Stephanie Gianarelli: That’s a good question. It’s a little buzzy in the beginning, it doesn’t hurt, and then it will fade out. I think the body just gives up telling the brain after a while.
Dr. Aimee: Got it. Thank you. You mentioned as part of the four pillars, and I imagine it’s not the kind of herbs that might come to a lot of people’s minds, but tell me about Chinese herbs. Who gets them, how much, how do you know when to give them, what part of the cycle they get what? Tell me about your prescription methods.
Stephanie Gianarelli: First of all, in China, if you’re a fertility TCM specialist, you’re an herbalist, you’re not an acupuncturist. Everybody really should be taking herbs if they’re doing fertility. That said, not everybody wants them, and we don’t want to do them during someone’s first or even second IVF cycle.
We will do them often, if they’re trying naturally, and then if they have a couple failed IVF cycles I’ll go to Lora and say, “We haven’t had a good response. Can we do Chinese herbs?” At that point, then we will if their RE (fertility doctor) is okay with that. It is important for us to keep the trust with the REs we work with.
Dr. Aimee: Why would you do them during the first cycle, what is the concern there?
Stephanie Gianarelli: There’s no concern, except we want to know how they respond to the medications and the MD wants to know how they respond to the medications. If I’m putting them on herbs, then we don’t really know what was the meds and what were the herbs.
Dr. Aimee: How do you know exactly what are in the herbs? Where do you get them from and how do you reassure your patients?
Stephanie Gianarelli: That’s a great question. I think the whole planet is getting fairly toxic at this point. I think our vegetables are as toxic as our herbs. We do source ours through Taiwan. A couple times a year we’ll have them send us reports on them, they do a certificate of authenticity.
They do that in the company and then as they come into the U.S., so we’ll get a couple of those just to make sure that everything is fine. We can tell them exactly which herb and which batch number we want, so they don’t just have the best ones on the ready. We’ll do that for patients if they want it, it’s really easy to do.
They probably have issues, just like everything we eat and are around, but from the certificates that we get, they’re not anything that we should be alarmed about. If we took them for years, maybe, just like anything else.
Dr. Aimee: Got it. I imagine the certificate speaks to things like heavy metal toxicity and stuff like that. Are they measuring that, is that what you were referring to?
Stephanie Gianarelli: Yes, that’s right.
Dr. Aimee: I just want to go to the questions that I’ve been emailed. I received a number of great questions from people from all over the globe, so I’m going to pull those up right now on my screen here and go ahead and start asking you.
One of the questions is, “I’ve been going to the same acupuncture clinic for two years now and normally see the same doctor each time. On occasion I see another doctor who places the needles in a completely different place than my regular doctor. Is that personal preference, just the difference of how they were schooled? And is it really a good idea to see more than one doctor or should we really be sticking to the same one?”
Stephanie Gianarelli: I think that’s probably a couple of questions. The first answer is I think probably it is training. We have differently trained people in our clinics, and they do treat people differently. Everybody seems to get really good results, especially if they’re fertility trained. I think it’s more important to make sure that you have an ABORM fertility trained acupuncturist.
I think it’s great to see different providers. I tell people in my practice to go see someone else. Not only because we’ll be able to talk about your case, hopefully we’ll be able to provide better care. We can get together and we’ve both seen the patient, and then we can help better.
Even if my colleagues don’t see a particular patient, I’ll go to them anyway and I’ll have to describe who they are and say, “What about this, what do you think,” especially if we have a difficult case. Sometimes it’s good, they’ll come back after seeing the other provider and say, “She said this. What do you think about that?” I think collaboration is a great idea. That’s how good western medicine happens as well.
Dr. Aimee: Awesome. The next question is, “What’s the equivalent of counseling or therapy in traditional Chinese medicine?”
Stephanie Gianarelli: In Chinese medicine, all of the emotions are doled out to the different organs. Fear is in the kidneys, anxiety is in the heart, and anger is in the liver. So, we end up talking a lot about people’s emotions and how it’s affecting them. It does not supplant a good therapist, but it can help discharge emotions, it’s very relaxing, it puts you into a meditative state.
For those reasons, people can think of it like a therapy session, but it’s not. Go to a good therapist. We actually have two in our office that are specialized in fertility.
Dr. Aimee: That’s really great, so it’s kind of like a one stop shop, if only you could get a pedicure at the same time.
Stephanie Gianarelli: Yes!
Dr. Lora Shahine: I just wanted to mention something. When I started working on the book with Stephanie and learning myself about traditional Chinese medicine, the language is very different. She talks about kidney deficiency being a part of infertility and your liver function and lungs.
I just would love for you to talk about that, because language is so important. When the acupuncturist starts talking about that, people can get uncomfortable, and that’s when we start getting the woo-woo, “What is going on?” I really like the language and its balance and I’m comfortable with it now, but can you explain what that means when you’re saying it?
Stephanie Gianarelli: Absolutely. I’ll make it somewhat brief, but the book does explain it really well if you want to have a more in-depth analysis of it. This is my spiel that I tell people every day.
Each of the organs do what they do in western medicine and then they have additional functions to take the rest of you into account in Chinese medicine. For example, the kidneys are in charge of all of your western functions, but they’re also holding your genetics and your qi bank account, how much energy you have. It’s almost like your ovarian reserve for your body.
Dr. Aimee: Or your mitochondria.
Dr. Lora Shahine: Yes. That’s right.
Stephanie Gianarelli: I tell people you have to do two things with your kidney energy, you need to make babies and you need to retire on it. Not only do you have to build it up to make babies, but you have to then build it back up after you have babies because it’s an expensive thing to do to the kidneys.
We can tell how people’s kidneys are doing, whether they have low back pain or night sweats or knee pain, so we can look at all these different symptoms and find out if they have kidney deficiency. The naturopaths would call it adrenal fatigue.
Dr. Lora Shahine: It’s all different language. I think we’re all kind of saying the same thing, it’s just western doctors say something and naturopaths say something different. Language is just important.
Dr. Aimee: I agree.
Dr. Lora Shahine: Just ask questions and understand what they’re really saying.
Dr. Aimee: I imagine that the age at first birth in Seattle is very similar to the Bay Area, where a lot of women aren’t starting to have their first pregnancy until they’re over 35 in many cases, and maybe sometimes even over 40, so egg quality is a really important issue that we always talk about. Can you tell me a little bit about how TCM can help with egg quality or improve it, and what does that take, what’s involved?
Stephanie Gianarelli: I was just speaking with Dr. Lee Hullender Rubin this morning, who is an excellent fertility acupuncturist researcher. I always call her before I go on these shows and ask what’s the latest research, what’s been going on. She was just at ASRM, the big national conference for fertility medicine last month, and she had a poster. The biggest thing that came out of her research that she did is that the 38+ women benefited from TCM significantly more than the under 38.
Dr. Aimee: Wow.
Stephanie Gianarelli: I think it’s because when we work on egg quality, we work on that kidney energy and that bank account, and getting the person as healthy as possible and increasing their mitochondrial function, too, I’m sure.
Dr. Aimee: That’s great.
Dr. Lora Shahine: Another really important research project that she did as well is showing that you can’t just do one acupuncture before your embryo transfer and think to yourself, “I’ve done acupuncture, I’ve done eastern medicine.” It really does take looking at the whole person, stress levels, and overall health and wellbeing, the whole package. It’s not just doing an embryo transfer.
Stephanie Gianarelli: And it’s hard to do research on that. It’s called whole systems TCM and it’s messy. You can’t do a randomized control trial with it.
Dr. Aimee: Someone would know if they had acupuncture needles in them.
Stephanie Gianarelli: Exactly. Not only do they know, but you also have to individualize it for them. One patient is going to have different supplements and herbs than another.
Dr. Aimee: Right. We talked about this a little but earlier, but I want to bring it up again about the whole three month prep. I hear that all the time. Is that really a thing that you have to do acupuncture for three months to really get the most benefit?
Stephanie Gianarelli: I was going to agree with you until you said the most benefit. Probably the most is true. What I tell people is you have to balance it out between your age, your numbers, and how much time we have. Because every month it could be that egg, so I don’t stop people unless they’re young and have endometriosis, something I can’t put them on really strong herbs in the luteal phase after ovulation.
I’ll stop a couple of those, but mostly I’ll let them keep going with whatever they’re doing and take whatever time I have. I will rarely stop someone from trying, because you might miss that egg.
Dr. Aimee: That’s true, we don’t want anyone to miss the golden egg. Dr. Shahine, how do you encourage acupuncture when patients are doing transfers? Does Stephanie come on-site or someone from another clinic? Can you tell me more about that?
Dr. Lora Shahine: We don’t have anybody on-site, but we’re in downtown Seattle, so Stephanie is really close and people can get to her really quickly.
Dr. Aimee: Great. Stephanie, what’s your preferred protocol for acupuncture around a transfer?
Stephanie Gianarelli: They start a couple months before. The research on day-of embryo transfer is not that great, it kind of goes up and down. If you can get in, even if it’s just three or four weeks before, then you can get in nine to 11 treatments, and then you can get the benefit.
It doesn’t have to be three months. Even working with men, in five weeks it has been shown that we can work on motility and count. So, we don’t need a full three months, but the sooner you figure out that you’re doing to acupuncture or you’re going to get pregnant, go see your acupuncturist.
Then on the day of I tell people to come in the day of, if you’d like, or come in the day before. We just adjust depending on when their transfer is. Now that they’re doing so many frozen embryo transfers on day five or day six, we do different points. Then we tell people to go home after their transfer and maybe come back the next day.
Dr. Aimee: Okay. How exactly can it help someone with an embryo transfer, what is the role that it plays?
Stephanie Gianarelli: We’ve had big hour-long discussions amongst ourselves about this with 150 fertility acupuncturists in a room. The research shows that it has to be done within 25 minutes. If you’re going to do that particular protocol, you almost have to be it on-site. Anything outside of that window is still beneficial, but you’re going to do something else, so you’re not going to stimulate the uterus as much as you would in that 25 minute window, especially with these day six embryos that they’re putting back now.
Dr. Lora Shahine: I think she was saying does it increase blood flow, what are the thoughts, etcetera.
Stephanie Gianarelli: Yes. And decreasing inflammation, I think.
Dr. Aimee: Perfect. I’ve had patients ask, and someone just asked this question a couple days ago for the show, about abdominal massage and compressing blood flow. That sounds kind of scary maybe to some people. Is that something that you offer or recommend? When do you do it? When do you decide it’s appropriate for a patient? Can you tell me a little bit about that?
Stephanie Gianarelli: Yes. We have a fertility abdominal massage person in our office and she’s amazing. You said two things. Compressing the femoral artery and backing up fresh arterial blood into the uterus and ovary area is one thing, and we teach that. If someone has a thin lining or they want to just do everything they can, I’ll show them how to do that and they can do it at home.
With abdominal massage, the person will go in and the massage therapist will figure out where everything is, where the uterus is placed, they can feel for adhesions and they can help break things up. Basically, they’re trying to mobilize the viscera, the organs, so that there isn’t any stagnation. That kind of speaks to Chinese medicine, which is stagnation causes problems, you want everything moving flow.
Dr. Aimee: I imagine it isn’t just a rub down or a pat, pat, rub, rub. I imagine it’s pretty deep and you’re not coming out of there feeling like you just went to a spa.
Stephanie Gianarelli: That’s right. They’ll go deep into the abdominal muscles and into the viscera and then on the back, but that’s as far as they’ll go.
Dr. Aimee: Got it. You talked about men. I actually recommend acupuncture to a lot of my male patients, and the reason is that we know stress plays a role in decreasing sperm quality, and acupuncture can reduce stress. Tell me about how you approach the male patient.
Stephanie Gianarelli: We’ll do the same things. We’ll do a traditional Chinese medicine diagnosis on them to figure out how to get them as healthy as possible. Chinese medicine is kind of simple in that way. It can get infinitely complicated in how you do it, but we all are looking for how are you out of balance and how can we fix that.
Dr. Aimee: Great. I think that closes out all of the questions that I’ve received for tonight. I love that you guys wrote this extremely good resource for people everywhere, it’s easy to read, scientifically valid, fact checked. You can also read about supplements. I love that there’s a section on things like melatonin and CoQ10 and how they can help.
Is there one last thing that you want to leave us with? I’ll let you each share that with us, if there’s one message that you want to give every visitor to this show tonight.
Dr. Lora Shahine: Sure. When people ask about acupuncture, I say explore it and think about it, and it may not be for you. I think it can be beneficial, but if you hate needles or it’s going to be very stressful to get to the appointments or financially burdensome, don’t feel like you are missing out completely.
Explore it and maybe try it, and you might find that it’s really beneficial. Just think about it. I don’t want people to carry around guilt like they’re missing out on something that they have to do or it’s not going to work.
Dr. Aimee: Right. Can I just ask one more question? That brought up a question. What if someone hates needles? What if I’m that person and I still want to see if acupuncture is for me, is there a workaround?
Stephanie Gianarelli: Well, some people do laser acupuncture, so no needles involved. And some people just come anyway.
Dr. Aimee: That’s awesome. Well worth it. Stephanie, do you have a message for patients out there who are trying so hard to have a baby?
Stephanie Gianarelli: Absolutely. I’m going to steal what Lora usually says. Keep trying, have hope.
One thing I tell people, I want to end with this really great story that’s in the book. A patient came up to me at the grocery store, she was pushing a grocery cart, she had this cute little baby in the basket. She comes up to me literally crying and said, “I’m so glad that it didn’t work out with my own eggs, because I got the perfect child for us.” That’s it.
Dr. Lora Shahine: If you want a family, if you want to be a mother or a father, there’s always a way.
Dr. Aimee: Absolutely. Thank you for joining us tonight. If you’re interested in watching any previous shows, you can go to the EggWhisperer.com website. If you’re interested in getting your levels checked and interpreted by me, you can go to the website for that as well.
Thank you for joining us tonight. Thank you, Lora and Stephanie. I look forward to seeing everyone next week. Have a great night. Bye.
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