Board Certified Reproductive Acupuncturist Former President of the American Board of Oriental Reproductive Medicine 15 years clinical experience Founder of one of the largest reproductive wellness centers in North America ID: 776637
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Slide1
Using Technology to Deploy Multivariate Interventions for Women with PCOS
Slide2Board Certified Reproductive AcupuncturistFormer President of the American Board of Oriental Reproductive Medicine15 years clinical experienceFounder of one of the largest reproductive wellness centers in North AmericaClinical Wellness Director of RMA of TexasFounder/ CEO of Conceivable
Kirsten Karchmer, M.Ed, M.S., L.Ac
Slide3Slide4Slide5Slide6Slide7Ovulation regulation
Decrease in PMS, cramping, hemorrhagic bleedingDecreased TTCIncreased live birth rates/decreased miscarriage ratesWeight lossBetter hormone regulationDecrease in PCOS sxsRegular periodsBetter overall healthResults that last beyond the interventionImprove outcomes of IUI/IVFManage side effects of pharmaceuticals Increased agency for patients
What are the goals
?
Slide8How Do You Do It?
Slide9Constitutional Diagnosing:
Getting to the root of the matter
Slide10A Conceivable Cycle
28 day cycle
No PMS
Ovulation that occurs on CD14 with fertile CM
4 days of fresh red bleeding, soaking a tampon every 4 hours
No clotting
No spotting
No cramping
BBT averaging 97.2 in the follicular phase
BBT averaging above 98.2 in the luteal phase
Slide11Slide12Slide13What Does A Conceivable Cycle Look Like?
Regular:
On average, women with irregular cycles had only ¼ the chance of getting pregnant each month as those with more normal cycles
About 28 days long:
Both shorter and longer cycles have been associated with reduced fertility, in some cases decreasing the chance of delivery by up to 50%
Short cycles
are especially detrimental to conception. In a series of studies from 1992 to 2003, researchers found that early ovulation resulted in a significant reduction (50-75%) in clinical and viable pregnancy rates. However, when ovulation was regulated, pregnancy rates returned to normal levels.
Slide14What Does A Conceivable Cycle Look Like?
A 4 day period:
Bleeding that lasts too long, or not long enough, are both associated with a decreased chance to conceive each month, in some cases cutting chances to conceive in half
Sufficient bleeding:
Menstrual bleeding that is scanty, or excessive can indicate a lower chance to conceive each cycle
PMS, pain, cramping and clotting
are more than just uncomfortable symptoms. Theses symptoms may indicate larger problems like polyps, fibroids, endometriosis, or hormonal imbalances. In addition to being a drag, infertile women report these types of symptoms in much higher numbers than their fertile counterparts.
Slide15Diet
P
lant
-
based:
Harvard scientists found that increasing the intake of animal protein, even by as little as one serving a day, resulted in a 32% higher likelihood of ovulatory
infertility and researchers
found that women who consumed plant proteins (instead of animal protein) for as little as 5% of their total daily calories had a 50% decrease in their risk of ovulatory infertility
.
Whole foods:
Women
with high glycemic loads, the result of a diet high
in processed
and refined foods, have been demonstrated
to
have nearly twice the risk of ovulatory infertility as women with low glycemic loads.
Healthy fats:
In
one recent study, every 2% increase in calories consumed via unhealthy trans-fats increased the risk of ovulatory infertility by more than 70%. This is especially true when these trans-fats replaced fertility-friendly monounsaturated fats
.
Slide16The Effects of
Hydration on Reproduction
Healthier
cervical
fluid:
The more hydrated your cervical mucus is, the easier it is for sperm through it. Although a variety of factors determine cervical fluid viscosity, Lee
et al
. have found that sperm had the highest difficulty travelling through thick cervical mucus with low water content, regardless of when they are introduced. In other words, staying hydrated can improves the sperms’ ability to effectively fertilize the egg.
Coffee:
Women who consumed more than 100 mg of caffeine a day – the equivalent of 1 cup of premium coffee – were more likely to experience difficulty conceiving and higher rates of miscarriage during pregnancy, though the mechanism is still unknown.
,
,
Sodas:
According to the Harvard Nurses’ Health Study, women who consumed 2 or more sodas a day were up to 50% more likely to experience ovulatory infertility than women who drank less than 1 soda a week
.
Alcohol:
Consumption of alcohol can
causes increased time to conception,
decreased probability of conception (by more than 50%), abnormal
blast development
, and decreased embryo implantation rate, thus increasing both the risks of spontaneous abortion and of fetal
death.
Slide17Sleep
Sleep.
People experiencing
either
acute or prolonged sleep deprivation experience higher levels of the stress and elevated levels of associated stress hormones, such as cortisol, the following day.
Elevated
cortisol
has
also been associated with higher levels of early pregnancy loss.
published
by the National Academy of Sciences, pregnancies exposed to higher levels of cortisol were 2.7 times more likely to end in miscarriage.
Sleep is essential for hormone regulation
. Sleeping less than 7-8 hours per night has been associated with depressed
leptin
levels throughout the following day.
Leptin
is important because it influences important hormones for regulating the menstrual cycle.
Furthermore
, disturbances in
leptin
concentrations have been linked with poor egg
quality and obesity which is also associated with ovulatory
dysregulation
Slide18Weight
Longer time to conception for obese women.
A lower ongoing pregnancy rate – the carrying of a fetus to term – of 38.3% per cycle was found in overweight women compared to 45.5% per cycle in non-overweight women
.
The negative effects of obesity on female fertility have been shown to be reversible. Clark
et al.
found that after losing an average of 10.2 kg (22.5
lb
) of body weight, 90% of previously
anovulatory
obese women began ovulating again
.
In other words, when obese women lost weight, their cycles began to return to normal.
Slide19Slide20Too Expensive
Not Enough Time
Not Scalable
Technology
The Solution
The Problem
Slide21Women are already accustomed to interacting with their phone daily
Provide education when and where the patient needs it
Tracking increases engagement and complianceSupplements conventional treatment to improve outcomesGives patients more of what they needSystematized patient info for better diagnosis, education, and engagement
Why Technology?
Slide22Tracker apps are designed to help those who are FERTILE
Slide23Underlying Factors
Herbal Formulas
Diet
Acupuncture
Hydration
Stress Management
Sleep
Fertility Issues
A wellness approach works!
Slide24Francisco Arredondo, MDFertility & Reproductive EndocrinologistHighest pregnancy results for women 36-38 in US 2011
“The combination of a comprehensive, personalized wellness program with the best reproductive medicine provides my patients with the highest probability of conceiving and carrying a baby to full term.”