Energetic Impact of ART Drugs (Assisted Reproductive Technologies)
Seminar in London at Royal College of Physicians on December 7th, 2006.
It was great to meet you all. Some old friends (well not too old!) and all practitioners keen to share information. Hopefully, we can support each other in the practice of Chinese medicine. The application of Chinese medicine to overcoming difficulty in getting pregnant is a popular subject and one which, I am sure, will be in great demand. Something like 1 in 6 couples have difficulty getting pregnant in these modern times.
After the talk, I was acutely aware that the emphasis is often on the woman. In my own practice, I ask to see both partners and treat accordingly. In my experience, a mixture of imbalances in the male and female are common.
It was good to debate the energetics of prescribed drugs. There is a lot of experience in the Chinese medicine community and the more we share them, the more we can determine how drugs act and how we can alleviate their adverse effects.
I have included information in my book, The Prescribed Drug Guide, about the energetics of prescribed drugs including several cases.
To this end, I am going to set up an on-line discussion group which will be open to practitioners to talk about prescribed drugs, describe their experiences in treating people who take them, share thoughts and ideas about their actions. Please watch this space!
I inadvertently deleted the information about metformin (Glucophage), the diabetes mellitus drug which is used for polycystic ovarian syndrome. This will be added to the information below in the next day or so. Also, the case history that I discussed in the lecture will be posted here.
.Please feel free to contact me for any questions or further details.
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Introduction
Chinese medicine gives us the philosophical basis to understand the inner environment of the human body. It gives us the tools to help balance and harmonise so that people can be healthy and achieve their full potential as human beings. In these modern times, there is so much choice available – different activities, foods and medicines. All of these affect us and the people we see. How can we understand these influences in terms of Qi and Blood, Yin and Yang so that we can appropriately guide people toward health and well-being?
The power of Chinese medicine lies in the diagnosis. This points directly to what needs to be given attention to aid healing. The treatment principles and the consequent treatment are the means by which people can change their health and, hopefully, attain a greater level of health and well-being.
I have a particular interest in understanding the effects of prescribed medication on people as they are commonly used and frequently powerful. Just as we need to consider how the ingestion of large quantities of cold beer may affect someone with Spleen Qi Deficiency or with DampCold Accumulation, we also need to consider how medications such as female sex hormones, antibiotics or betablockers may affect people.
So, how to understand the energetic actions of prescribed drugs? We can gather information from various sources:
Take them - the energetics of Chinese herbs have been closely studied for centuries and on the basis of personal experience. Masters of Qi Gong and meditation would take herbs and understand how they affect Qi and Blood, which organs they affect, what is their taste and Qi, e.g. hot or cold, and how they interact with normal physiological functions. We could do the same with prescribed drugs. Energetics of herbs - we can compare some prescribed drugs with a related herb. For example, ephedra (Ma Huang) is where ephedrine is derived from. This, and related drugs such as salbutamol (Ventolin), are used in the treatment of asthma and wheezing diseases. Therefore, we can deduce the actions of these drugs as being related to those of ephedra (Ma Huang) Published effects of drugs - each pharmaceutical company publishes information about each drug they manufacture, its uses, contraindications, precautions and effects. This can be a useful resource when trying to determine how drugs affect the person. Such information must never be taken as the final word but they are a guide. Patient testimony and clinical experience - when we treat people, they tell us how drugs affect them, what symptoms they produce and what happens to symptoms that are purportedly treated by them. This is a rich source of information which can inform and guide our practice.
Energetic effects of drugs
From our perspective of Chinese medicine practitioners, we do not need to understand the energetics of drugs to the same degree as with Chinese herbs. We are not going to be using drugs as part of a herbal formula. However, it would be useful to know:
Hot or cold?
Organs affected
Symptoms produced
We also need access to a source of information about the names of drugs so that we can study them and communicate with patients and other health-care practitioners.
The main point about prescribed drugs and clinical practice is that they are given according to the principles of Western medicine. They take no account of individual energetic patterns or underlying disharmonies as we do in Chinese medicine. Therefore, whether a drug is energetically hot or cold is irrelevant to its prescribed. It is given for a specific, usually single, symptom. We know from our knowledge of Chinese medicine that the person's Yin and Yang, Qi and Blood are key to their well-being. If, for example, a person is Yang or Qi Deficient, they need to be warmed and tonified. If they receive cold substances or prescribed drugs with a cold quality, they will be adversely affected. Conversely, the prescription of a drug which is warming is likely to make them feel subjectively better - at least in the short term. If a person is Yin or Blood Deficient, they need to nourish their Yin and Blood and perhaps also be cooled. If they take a hot drug, they will feel markedly worse. If they take a drug which is cooling in nature, they will feel subjectively better, again in the short term.
Therefore, with such an understanding of the energetics of drugs we can see how people react differently to their medication. We can also predict who will feel subjectively better and who will feel subjectively worse. We can also amend our treatment principles to take account of their effect. For example, if a person with Yin Deficiency is taking a hot drug, we need to spend more time and effort in supporting Yin and Blood as well as clearing Heat. If a person is taking a cold drug, we need to be aware of supporting Spleen Qi and also any Qi or Yang Deficiency in a specific organ.
Specific drugs
We can, therefore, study each drug in turn which is used in 'fertility' treatments or assisted reproduction. I have classified them according to their effect in heating or cooling as that seems a simple way of determining their actions.
Hot drugs (particularly those affecting hypothalamus and pituitary)
How is this Heat affecting the woman? Do you need to Clear Heat and Cool the Blood?
Consider supporting Yin and Blood as this is the Material basis for pregnancy.
Stagnation syndromes such as Liver Qi Stagnation are common as a consequence of the heating and drying action of these drugs.
Longer term you may see Blood Stagnation - see effects such as ovarian cysts.
The drugs below all manipulate hypothalamic or pituitary hormones.
Generic name - follicle stimulating hormone (FSH)
Trade name - Puregon
Uses - directly induce ovulation. causes the development of multiple follicles and is used in in vitro fertilization and stimulated intrauterine insemination. FSH should only be used by a reproductive endocrinologist as patients must be monitored and dosages adjusted based upon each patient's response
Effects - mild to moderate ovarian enlargement; fever with chills, musculoskeletal aches, joint pains, malaise, headache, fatigue, breast tenderness, dry skin, hair loss, hives, bleeding into the peritoneal cavity
Generic name - leuprorelin acetate
Trade name - Prostap SR
Uses - Endometriosis, advanced prostatic cancer, uterine fibroids,
Effects - headaches, insomnia, hot flushes, dizziness, oedema, weight changes, decreased libido, fatigue, nausea, vomiting, diarrhoea, abdominal pain, muscle and joint pains, visual disturbances, pins and needles, palpitations, blood pressure changes, depression, low white blood cell count, pulmonary embolism, impotence, breast enlargement in men, sweating, vaginal dryness, diminished bone density, hair loss, breast tenderness, breast enlargement
Generic name - ganirelix
Trade name - Antagon, Orgalutran. Cetrotide (cetrorelix) is a relation.
Uses - GnRH antagonist used in 'fertility' treatments
Effects - abdominal pain, foetal death, headache, ovarian hyperstimulation syndrome, vaginal bleeding, nausea, possible congenital abnormalities including hydrocephalus, hernias, kidney problems
Generic name - leuprolide acetate
Trade name - Lupron, Prostap
Uses - GnRH agonist. It causes dramatic reductions in estrogen, FSH, and LH levels and simulates the menopause. It is used to treat endometriosis because endometrial cells are dependent upon estrogen for growth and survival. It is also used to "down-regulate" patients undergoing IVF.
Effects - palpitations, fainting, dry mouth, thirst, appetite changes, anxiety, personality disorder, memory disturbances, delusions, bleeding into the skin, hair loss, painful urination, breast milk production, visual disturbances, enlarged lymph glands
Generic name - buserelin
Trade name - Suprefact, Synarel
Uses - GnRH agonist - inhibits the production of GnRH. Used in the treatment of advanced prostatic cancer, endometriosis, infertility.
Effects - hot flushes, mood swings, reduced libido, impotence, nausea, breast tenderness, breast enlargement, weight gain, tiredness.
Generic name - nafarelin
Trade name - Synarel
Uses - GnRH agonist - inhibits the production of GnRH. Used in the treatment of advanced prostatic cancer, endometriosis, infertility.
Effects - hot flushes, decrease in libido, headache, vaginal dryness, emotional upsets, acne, muscle pain, reduction in breast size, reduction in bone density
Generic name - letrozole
Trade name - Femara
Uses - breast cancer. Letrozole inhibits oestrogen synthesis. This results in development of follicles without the risk of multiple ovulation and ovarian hyperstimulation syndrome. Letrozole is quickly broken down and, therefore, is quickly cleared from the body. Therefore, there is a reduced chance of adversely affecting the endometrium and cervical mucus (see clomiphene).
Effects - hot flushes, joint pains, night sweats, weight gain, nausea, tiredness, weakness, oedema, muscle pains, bone fractures, vaginal bleeding, headache, vaginal irritation, vomiting, dizziness, lightheadedness, osteoporosis, constipation, uterine cancer, heart attack, stroke, angina, clotting, cancer
Generic name - clomiphene
Trade name - Clomid, Serophene
Uses - most commonly used 'fertility' drug, since the 1960's. Blocks oestrogen receptors on the hypothalamus causing them to “think” there is oestrogen deficiency. Hence the hypothalamus releases gonadotrophin-releasing hormone (GnRH) which causes the pituitary gland to release follicle stimulating hormone (FSH) and luteinizing hormone (LH) which causes the growth of the follicles. Makes cervical mucus thick and may also make the endometrium less receptive. It is widely overused and is rarely successful if pregnancy has not been achieved within 3-6 cycles. Not to be used for more than 12 months (6 months in some countries) because of the increased risk of ovarian cancer. 20% fail to respond.
Effects - hot flushes, nausea, mood changes, headaches, flashes of light or abdominal discomfort, breast tenderness, insomnia, increased urination, acne spots, weight gain, ovarian enlargement, lower abdominal discomfort and bloating, visual symptoms including blurred vision, lights, floaters, waves, photophobia, double vision, headache, abnormal uterine bleeding, intermenstrual bleeding, heavy periods
Generic name - tamoxifen
Trade name - Nolvadex
Uses - chemically and functionally similar to clomiphene. Breast cancer. As with clomiphene, ovulation can be induced in some patients (65-75%). Pregnancy is established in 30-35%.
Effects - 10% risk of twins, 1% of triplets. Flushes, no periods, scanty periods, bone pain, nausea, cough, oedema, fatigue, musculoskeletal pain, ovarian cysts, depression, abdominal cramps, anorexia, uterine cancer, stroke, pulmonary embolism
Generic name - anastrazole
Trade name - Arimidex
Uses - breast cancer
Effects - similar to tamoxifen which it often replaces now in the treatment of breast cancer. weakness, back pain, headache, abdominal pain, accidental injury, flu-like illness, chest pain, high blood pressure, nausea, constipation, diarrhea, indigestion, anaemia, oedema, weight gain, raised cholesterol levels, osteoporosis, bone fracture, bone pain, joint pain, muscle pain, depression, insomnia, dizziness, anxiety, pins and needles, sore throat, cough, breathlessness, siinusitis, bronchitis, rash, sweating, cataract, vaginal discharge, urinary tract infection, breast pain, breast cancer, inflammation of vulva and/or vagina, vaginal bleeding
Generic name - hMG - human menopausal gonadotrophin Trade name - Pergonal, Humegon, Menopur
Uses - contains both FSH and LH hormones. It is a purified extract from the urine of postmenopausal women. It stimulates the ovaries to produce multiple follicles.
Effects - multiple pregnancies in about 20% of treatment cycles. Of those, 33% are triplets or more. The MHRA in the United Kingdom has advised that no medical products using urine sourced in a country that has reported cases of human variant CJD (the human form of mad cow disease) be used in the UK, ovarian hyperstimulation syndrome
Generic name - luteinising hormone (LH)
Trade name - Luveris
Uses - stimulates follicle development
Effects - nausea, abdominal pain, pelvic pain, ovarian cyst, breast pain, headache, sleepiness, ovarian overstimulation, blood in peritoneum, ectopic pregnancy
Generic name - human chorionic gonadotrophin (hCG)
Trade name - Urinary hCG: Profasi, Pregnyl. Recombinant hCG: Ovidrel, Ovitrelle
Uses - infertility, delayed puberty, hypogonadism. It is a highly purified extract from the urine of pregnant women. The MHRA in the United Kingdom has advised that no medical products using urine sourced in a country that has reported cases of human variant CJD (the human form of mad cow disease) be used in the UK.
Effects - oedema, headache, tiredness, mood changes, breast enlargement in men, acne, thrombosis, ovarian hyperstimulation
Corticosteroids
Generic name - various but prednislone is a common one
Trade name - various but Medrone and Deltacortril are common ones
Uses - corticosteroids, powerful anti-inflammatory drugs that work at the level of the hypothalamic pituitary adrenal axis and lower the body's immune response. Low dose corticosteroid therapy may be used in females who have an over production of male hormones (androgens) such as testosterone. Sometimes steroid therapy is used when antisperm antibodies are produced by the female; however, intrauterine insemination is usually a better alternative. Corticosteriods may also be used when the male produces antibodies to his own sperm. Corticosteroids are often given to recipients of embryos that have undergone assisted hatching or ICSI to prevent any potential immune response caused by the procedures.
Effects - increased appetite, bursts of energy, insomnia, mania, psychosis, oedema, osteoporosis
Cold drugs
Cold substances damage Qi and Yang. In stronger patients you may see more of a Full picture but frequently there is Qi and/or Yang Deficiency. Damp Accumulation is a frequent occurrence also.
It is helpful to warm and tonify Qi and Yang and resolve Damp.
In the case of antibiotics, these clear Heat and Dry Damp and are significantly colder than many other drugs. They produce marked Spleen Qi Deficiency with Damp Accumulation. In the case of pathogenic influences, the use of antibiotics can lead to syndromes such as EPF remaining or Heat Lurking in the Interior.
Oestrogen
Generic name - various, oestradiol is a common one
Trade name - various, Progynova is a common one
Uses - oestrogen, a female sex hormone. Different formulations are used for contraception, acne in females, replacement around the menopause
Effects - abnormal vaginal bleeding, painful bleeding, changed vaginal secretion, premenstrual-like syndrome, breast tenderness, enlargement or pain, increased size of uterine fibroids, vaginal thrush, changes in cervical erosion, breast secretion, indigestion, abdominal bloating, flatulence, nausea, vomiting, abdominal pain, gall bladder disease, rashes, itching, eczema, nettle rash, acne, hirsutism, hair loss, erythema nodosum, erythema multiforme, headache, migraine, dizziness, anxiety/depressive symptoms, fatigue, palpitations, hypertension, thrombophlebitis, oedema, muscle cramps, leg pains, weight gain, increased appetite, changes in libido, nose bleeds, visual disturbances, intolerance to contact lenses, painful urination, abnormal movements, breast cancer
Progesterone
Generic name - progesterone (medroxyprogesterone is another presentation)
Trade name - various but Cyclogest is a common one
Uses - supports the growth and development of the endometrium
Effects - nausea, headache, insomnia, nervousness, sleepiness, depression, dizziness, rashes, nettle rash, itching, acne, breast tenderness
Antibiotics
Generic name - various
Trade name - various
Uses - antibiotics, treat reproductive organ infections in the male and female
Effects - tiredness, diarrhoea, indigestion, nausea, vomiting, vaginal discharge
Recommendations
Discuss what is appropriate with the couple themselves, e.g. Has the sperm been checked before any other treatment or invasive investigations, have the fallopian tubes been checked before any ovulation stimulation, have ethical or moral issues been addressed or discussed?
Education, education, education
of ourselves in conventional treatments and our own practice
of couples in choices, pros and cons of conventional treatments
of conventional doctors in benefits of Chinese medicine.
When working with couples – think about what will benefit them
When working with other healthcare professionals – think about how to work with them
