Melbourne Holistic Health Group

Published in Articles - Women's Health & Fertility on 01 November 2012 by Ruth Trickey

The team at MHHG has gained a solid reputation over the years for the effective treatment of infertile couples. An essential component has always been the strong collaboration that has developed between our group and some of Melbourne’s best-known fertility specialists. We are very proud of our reputation and are careful about the claims we make in relation to the effectiveness of complementary medicine. Unfortunately, in the wider complementary medicine community this is not always the case. We know of clinics who make claims of 80-90% success in the treatment of infertile couples, but as you will see later these claims are unlikely to be able to be substantiated. Similarly, we do not call ourselves ‘fertility experts’, because, even though we do know a great deal about the causes of and treatments for most causes of infertility, we believe that the term ‘expert’ is better applied to the medical specialists such as IVF specialists who have spent many, many years training to earn that title.

There are many variables and complexities to take into account when attempting to calculate pregnancy success rates. At MHHG we don’t feel we have the expertise to crunch the numbers and come up with anything that is meaningful to our patients. Indeed, the success for an individual couple will vary widely depending on these variables and so will the couple’s response to our treatments. Examples of factors likely to influence the success or otherwise of fertility treatments include the woman’s age (and to a lesser extent, the age of the male); months/years of unprotected sex without pregnancy; number of previous pregnancies; male factor infertility; number of unsuccessful IVF attempts; genetic factors; and gynaecological or medical conditions. We therefore talk with couples about what we might be able to do to improve on their current statistical chance of achieving a pregnancy; always keeping in mind that if a couple has say a <1% chance of conception, even a doubling or tripling of that figure still means the couple’s chances of a successful pregnancy remain extremely low.

What we can say with a reasonable level of certainty is that we can improve some of the confounding factors of persistent infertility, and by so doing; we can potentially improve a couple’s chance of a successful pregnancy. We have observed, for instance, that our treatments appear to reduce elevated FSH levels in some women, or improve ovulation frequency and regularity. We have also seen that fertilisation rates improve for some couples during IVF, resulting in better embryo numbers, and/or better quality embryos. We and some of the IVF specialists have observed improved response to IVF drugs with some of our treatments, a protocol that we reserve for women who are referred to as ‘IVF non-responders’. Even these changes might not be enough for a couple to achieve a pregnancy, but our successes are reliable enough for some IVF specialists to suggest that women with these or other types of fertility issues consult us for help.

This is anything but a simple or straightforward area of medicine – either to work in or to predict outcomes. We assess all of our couples on an individual case by case basis, taking into account all of their particular variables, then we assess our efficacy by evaluating the improvements for that particular couple before and after treatment. In the words of the scientific community, we use the couple as their own control and see if we can consistently improve those factors that are impeding that couples chances of a pregnancy. Although we might improve a couple’s chances of pregnancy from baseline, our discussion needs to always remain realistic and answer the question ‘Are our treatments providing a meaningful enough improvement for the couple to continue?’

What is meant by a ‘successful outcome’?

As a couple coming to a clinic for treatment of infertility you might quite rightly think that you would be guided in your decision to undertake this treatment on the basis of its proposed effectiveness. Additionally, you might think that it is an easy thing to post these types of figures on a website such as this. Other naturopathic clinics do it, you might reason, so why not MHHG?

Rather than pluck a figure from the air and apply this to all cases, our clinic has chosen to take a different stance. There are many websites, usually associated with large medical fertility clinics where it is possible to read about statistics for successful pregnancies associated with different complaints, at various ages and accounting for a number of other variables. We encourage patients to use these figures and then discuss the efficacy of our treatments in terms of their potential to increase their chances from their baseline. We feel that this gives couples a more realistic idea of what is possible.

The other aspect of ‘success statistics’ to clarify is what is meant by a positive pregnancy. Couples are only really interested in the statistics that indicate their chances of having a live, healthy babe in arms after a successful pregnancy, and so are we. However, we know that couples are inclined to ‘hear’ that the statistics are referring to a healthy babe even when a practitioner might be talking about something entirely different. For example, clinics can quote success figures based on the number of positive urine or blood tests their patients achieve (biochemical evidence of pregnancy); or from evidence of a heart beat at the 6-7 week ultrasound; or quote their live birth figures. Depending on which indicator is used, the figures of success will vary considerably. While the biochemical and ultrasound evidence of a pregnancy are important figures for clinicians to evaluate the success of various interventions, sadly many of these pregnancies fail and the biochemical pregnancy, in particular, is a very poor predictor of the live birth rate. Typically in Australia IVF clinics use either the positive heart beat at the 6-7 week ultrasound or numbers of successful live births.

Who comes to our clinic?

About half of the women who come to MHHG for naturopathic treatment for infertility have been referred to us by fertility specialists. Of the other couples, some might have been trying for some months to achieve a pregnancy and not getting anywhere, but not yet have any idea what is wrong; some might already be our patients with a well-established cause of potential infertility; and the remainder might come for preconception care. This latter group are, in the main, well and with no fertility issues, but want to maximise their chances of a successful and healthy pregnancy. So, even though their visit relates to fertility issues, at MHHG we do not recognise these couples as infertile and thus do not include their pregnancies in our reckoning of the success of infertility treatments at MHHG.

Referrals from IVF specialists

This group of women can and do have any type of underlying cause for infertility. Many are sent to us as a last resort. Often they are in their late 30’s or early 40’s, have had many unsuccessful IVF treatments or are not responding very well to these treatments in terms of egg pick-up numbers, or number or quality of embryo. They often have a very low statistical chance of pregnancy; usually below 5%, and we are very careful to ensure they continue to have realistic expectations of what our treatments can achieve.

Other common referrals are for first line treatment of PCOS or for women who have irregular or absent ovulation because conditions such as functional hypothalamic amenorrhoea or oligomenorrhoea. These women are often sent to us for naturopathic treatments in lieu of IVF because it is well known that diet and lifestyle changes will improve ovulation and pregnancy success. Typically we include herbal treatments as well, and provided we can re-establish ovulation, these women have very good chances of achieving a natural (non IVF or spontaneous) pregnancy.

We also treat women with premature menopause and premature ovarian failure with some success, but again, although our treatments seem increase the statistical chance of a successful pregnancy from baseline, we need to remain realistic. For instance, a 42 year old woman with evidence of impaired ovarian reserve has <2.5% chance of a successful pregnancy and nothing we could ever do will get those chances up to the 80-90% mark.

Couples who come to MHHG as the first option

Many couples feel more comfortable visiting a natural therapist about issues relating to fertility because they prefer low levels of intervention and want to achieve a natural or spontaneous pregnancy without drugs, surgery or IVF. In many cases this is achievable and the causes of pregnancy delay are easily overcome. Our priority is to define the cause because a diagnosis allows us to prescribe specific treatments directed at the underlying problem rather than giving a generalised infertility protocol used in many other clinics. It also allows us to give couples a realistic appraisal of the success of our management. We have a wide range of methods for determining the correct underlying cause/s. In some cases we are able to make a diagnosis in the clinic through, for example, accurate history-taking or through testing for ovulation; in other cases a diagnosis might require referral to a GP or fertility expert for blood tests or other types of examination.

Couples who come to MHHG with a well-established cause for infertility

In these cases, our focus is on the delivery of a specific treatment directed at improving the couple’s chances of achieving a pregnancy. We start with lowest levels of intervention first, typically diet and lifestyle, with an emphasis on using the smallest number of types of treatment to achieve a pregnancy. For example, a woman with PCOS might only be given dietary advice and an exercise regime to regulate ovulation. We would not ordinarily assume that we would need to start with every type of treatment such as herbs, lots of supplements and acupuncture so that this woman achieves a pregnancy. Part of the reason for this is that it can give the couple themselves the tools to tackle and overcome fertility issues that might arise in subsequent pregnancies before they have the need to see a professional. Other important reasons are cost and safety.

Related Articles:

• Polycystic Ovary Syndrome and Fertility by Ann-Maree Bortoli

 

</meta>