Some thoughts about stress, and how to manage it.

Just relax, Honey, and you will get pregnant.”

“You’re too stressed out to get pregnant!”

“You just need a vacation so you can get pregnant.” 

Any patient who has been dealing with infertility for any length of time has heard one, if not all, of the above. While the person saying this means well, he or she has no idea most of the time what a fertility patient may need or not need. All of these statements are, at least for most of my patients, annoying, frustrating,  downright offensive. If all you needed to do was relax, you probably would be pregnant by now, right? 

So, let’s take a minute and examine this whole stress thing. I believe that there is no question that stress, anxiety, and depression are part of any diagnosis of infertility. Just an infertility diagnosis is in and of itself a terrible stressor. It feels so unnatural, and many patients feel a total lack of control over their bodies. And then, to further complicate things, most patients know that stress is not good for them, so they stress over being too stressed. Nasty, vicious cycle. 

Basically, there are two kinds of stress, good and bad. The good kind, which pushes a person to achieve goals and meet deadlines, is obviously productive and helpful. We have all experienced this, and many of us thrive on a certain amount of productive stress. That is not the kind of stress we are discussing in this article. 

Bad stress, the villain, comes into play when the stressors in a person’s life begin to negatively affect the physiological and psychological function of the body, due to the “fight or flight” response. It is quite important that this type of stress be managed in the fertility patient, as it can have a very deleterious affect on fertility treatment outcomes. This applies to not only patients seeking natural fertility enhancement, as we see so frequently at Acupuncture Fertility Specialists, but also in patients undergoing more aggressive care such as IUI and IVF. Quite often, the patient feels like she has no control over her stress, cannot see a way in which to manage it, and feels like there is nothing she can do to help the situation. 

Stress has been shown to have a negative impact on IVF outcomes (1). It has been shown to have a negative impact on IUI outcomes (2), and has been linked to PCOS and other disorders of ovulation (3). Even in men during IVF, stress has been shown to have a negative impact on semen quality (4). Finally, when the patient does fall pregnant, stress contributes to increased miscarriage rates (2). Most of these responses are a result of elevated cortisol and/or adrenaline levels in the infertile patient (5). 

So, what’s a person to do? 

I’ve been an acupuncturist for a long time, and I will tell you that this stress issue is rampant in our culture. Infertility adds to the load, a lot, for sure. So I have looked for ways for my patients to manage their stress that are easy, fun, doable, and not too time consuming. The best I have found are as follows: 

1. Meditation. If you are a person who can sit still long enough, and empty your mind for 20-30 minutes, this is great. 

2. Exercise. In my clinic, we generally recommend 45 minutes of brisk walking 4-5 times per week. Also other forms of exercise can be used. Be careful not to over- exercise, as that can also be detrimental to your outcome. In Chinese medicine, we believe that too much sweating can deplete the body’s vital “yin” fluids which are essential for reproduction, so we discourage our patients from any activity, such as Bikram or hot Yoga which cause a rolling, heavy sweat. Other, cooler, forms of yoga can actually be very helpful in stress management. 

3. Tai Chi and/or Qi Gong. If you can find a class, this is great. Internet videos can help, too. Qi Gong would be the old school Asian way to really get relaxed and centered. I practice it myself! 

4. Rock in a rocking chair. My Chinese teacher taught me this, she said it is the American form of meditation, and I think she was right. Fifteen minutes daily of rocking, in a quiet setting, is easy, cheap, and feels fantastic. The rhythm of rocking becomes sort of mantric after a few minutes. 

5. And finally, of course, my personal favorite is acupuncture. Most patients I treat tell me how profoundly relaxing acupuncture is, how it is “better than a good massage,” in fact. Most of our patients fall asleep on the treatment table during their acupuncture sessions. Acupuncture in several clinical trials has been shown to improve IVF success by up to 17% (6). As a senior acupuncturist, I never treat a patient without addressing the stress factor at every visit. 

References: 

1) Ebbeson, S. et al. Human Reproduction 2009, 24, 9, 2173-2183.

2) Demyttenaere, K. et al. Journal Psychosom Obstet Gyn. 1988, 8, 175-181.

3) Kisdon, W. 2011 Australian Doctor, June 24.

4) Clarke, R et al, Human Reproduction, 1999, 14, 3, 753-758.

5) Gallinelli, A. et al. FertilSteril. 2001. 76, 1, 85-91

6) Paulus, W. et al. FertilSteril. 2002, 77, 4,

If you would like more information about this topic, or about acupuncture in general and how it might help you to conceive and have a healthy baby, please call (916) 789-1007. 

My Beginnings in Fertility Acupuncture

In about 1999, I had been doing general practice acupuncture for about 15 years when I got a call from a lady who was having trouble getting and staying pregnant. She was a patient at an IVF clinic in Colorado, had been diagnosed with thin endometrium, and she said that the IVF doctors there wanted her to have acupuncture as part of her IVF. She asked if I could treat her according to their guidelines, and I told her I would be happy to give it a try. 


Fast forward 3 months, and that same lady was standing in my waiting room, hugging me and sobbing with tears of overwhelming joy. She was pregnant! After years of trying, extreme expense, agonizing heartbreak, and failure after failure, she was pregnant! And, according to her, she owed it all to acupuncture! She went on to have a beautiful baby boy, and a couple more kids thereafter. 


I, of course, was pretty much blown away. It wasn’t that I underestimated the power of acupuncture, which I hadn’t, or that I wasn’t confident in success, which I was. It was that, while I had years of clinical experience and success, I had never had a patient so happy, so grateful, so thrilled. Tears of joy ran down both of our faces that day. 

Shortly thereafter, I started getting referrals from the IVF clinics in our area, mostly for treatment of thin endometrium or for endometriosis, both of which respond nicely to acupuncture treatment. After some time, I convinced the fertility doctors in the area to start sending other IVF patients to me. We developed treatments for diminished ovarian reserve, poor egg quality, and some general health and stress management treatments to enhance IVF success. In about 2006, a protocol was published in Fertility and Sterility known as the Paulus protocol. Paulus was clearly shown in a number of clinical trials to improve IVF success rates by somewhere between 17 and 21 percent, when done on the day of embryo transfer. Some studies, although maybe they were aberrant, showed as much as a 50 percent improvement. So, my staff and I started doing day of embryo transfer acupuncture. This, too, proved very successful. 


In my opinion, there is no more gratifying feeling in the world than when you can help a family grow. Think of it: the work we do in fertility acupuncture not only immediately affects our patients and their spouses or partners, but it affects their children, and their children, and their children for all generations of that family. It is profound. And it is profoundly, movingly, astoundingly gratifying. There’s no feeling better than when one of those patients brings her newborn in for the first time, and you hold it gently in your arms and see the little fingers and the little toes and smell that sweet new baby smell. There’s nothing in the world like seeing the look of love and satisfaction on the face of that new Mom or Dad. Nothing.


David D. Cherry, O.M.D., L.Ac.

A word about acupuncture, IVF, and early pregnancy care

Recently, a patient of mine was given a recommendation to discontinue her ongoing acupuncture treatment leading up to embryo transfer and during the 1st trimester of pregnancy. The patient was apparently told that she could be “over-stimulated” by acupuncture and to avoid it until after her first trimester. While we recognize that occasionally what patients hear and how they interpret it may be different, we did want to take an opportunity to clarify this point. 

To the best of our knowledge, there is no medical evidence that acupuncture has produced an “overstimulation” in a patient undergoing a frozen embryo transfer, or otherwise. 

I have used, and continue to use, the protocol established by Elisabet Stener-Victorin, et. al., in 1996 (Human Reproduction, Vol.11, No. 6., pp 1314-1317, 1996) prior to embryo transfer on most of our IVF patients. Since then, however, new studies have been conducted demonstrating the safety and efficacy of acupuncture during IVF and early pregnancy. While I continue to use the Stener-Vicotrin protocol, we have also incorporated the Credennda-Magarelli protocol as described by Paul Magarelli MD in 2008. In their study, Drs. Magarelli and Cridennda found an improvement in serum cortisol and prolactin levels, and a CPR of 51% as compared to 37% in the control group. Also, in that same study, there was 0% miscarriages in the acupuncture group and 6% miscarriages in the control group. (Fertility and Sterility Vol 92, No. 6, December 2009).

One of the most researched applications of acupuncture is on treating pregnancy related nausea ——Ezzo J, Streitberger K, Schneider A.  Cochrane Systematic Reviews Examine P6 Acupuncture-Point Stimulation for Nausea and Vomiting.  The Journal of Alternative and Complementary Medicine.  2006; 12(5): 489-495. 

S. deLacey in 2009 stated that “our findings suggest that acupuncture facilitated improvements with coping and self enhancement. Whilst confined confined to a small sample of women, [this study] confirms that acupuncture is indeed perceived by infertile women to have an impact on their health.”

I also recommend that patients get acupuncture, dietary counseling, and a prescription for Asian herbal medicine during the postpartum period, after they have delivered their baby. According to Chinese medical paradigm, the blood has been damaged at delivery and must be rebuilt in order for mom to regain her full health. Please contact me at (916) 789-1007 if you would like more information on this topic.