Understanding AMH

AMH blood test.

If you are trying to conceive and gone down the “infertility road” a little way, then you may well have had your AMH levels checked. Many will call this your “ovarian reserve”, but as we explore further, it really isn’t that simple.

AMH stands for Anti-Mullerian Hormone. This hormone is produced by the granulosa cells, which are specific cells within a developing follicle.

Follicles take around 100 days to develop, and this must happen at a nice slow pace in order to reach ovulation. AMH is produced to prevent these delicate “pre-antral” follicles from being stimulated by Follicle Stimulating Hormone (FSH) too early. [Pre-antral means they they have left the “storage cupboard” but are now at the stage before they reach the final menstrual month where they will be competing for ovulation.]

The larger the follicles get, the more AMH they produce, until they are ready to be stimulated by FSH within the menstrual month.

Therefore, AMH levels can be used as an indicator of the number of antral or developing follicles you might have. However, this is not as simple as it sounds. It is not an indicator of dormant eggs you still have in “storage” i.e. total ovarian reserve.

In theory, if your AMH is low, this could mean that you don’t have many antral follicles coming up along the “production line”, and thus not producing as much AMH, but those that you do have could be a good size and of good quality. In contrast, you might have lots of antral follicles but not of a good size and not developing particularly well, and thus not producing much AMH.

So really, AMH is not a good indicator for determining your complete ovarian reserve. What it is useful for is for IVF clinics to gauge an idea of how many follicles they might be able to work with during an IVF cycle. But without considering other factors, a fully rounded picture cannot be seen.

Other factors to consider

Age is the main factor when looking at fertility. There will be a slow and natural decrease in AMH as we get older.

If you are a younger woman with low AMH for your age group, there are other factors to consider including vitamin and mineral deficiencies, blood flow to the pelvis, inflammation and autoimmune responses, contraceptive drugs, smoking/vaping, sleep quality, stress, infections. All of these factors can have a significant impact on the ovarian environment, and with improvements in place, AMH can rise.

My advice would be not to get fixated on AMH levels, and certainly do not look at them in isolation. Take a good look at both your own and your partner’s overall health and lifestyle, get support from an holistic practitioner. Take time to make improvements to your diet and lifestyle (remember the 100 days) to do everything in your power to improve that internal environment within which eggs are recruited and developed, within which sperm are created, and the uterine terrain in which they come together to create new life.

Other useful information

Listen to this episode of Hannah Pearn’s podcast, talking about Low AMH and what it really means for your fertility

This is a great E-book if you want to know the answers to all the burning questions you have about low AMH: https://www.explaininginfertility.com/courses/LowAMH-ebook

This was a large study which measured AMH levels in a group of 1015 women who had no known fertility issues and who all had a proven level of fertility (conceived a child within 12 months of trying and carried to full term). Almost without exception, this presented those with low AMH were more likely to conceive. Thus, this research shows that it is possible to be naturally fertile with low AMH. https://pubmed.ncbi.nlm.nih.gov/24716733/

Does ICSI have all the answers?

Since the advent of ICSI (Intracytoplasmic Sperm Injection) problems with male factor in infertility can be addressed and bypassed with this procedure. The ICSI procedure allows particular sperm to be selected for use and manually injected into the egg by the embryologist using a microscopic needle.

But does ICSI always give us the best outcomes?

If the quality of sperm is sub-optimal, the question one has to ask is what impact will this have on the ongoing pregnancy and health of the child going forward?

In Traditional Chinese Medicine (TCM) our Jing is the substance we inherit from our parents at the moment of conception. Our Jing fuels our growth and development not just through conception and prenatal growth, but all through our lives from infancy to puberty, adulthood and beyond. Jing dictates our constitution and vitality as we move and age through life.

So if we completely disregard the quality of the sperm in favour of the ICSI procedure, what impact will have on the health of the life created? If a sperm is unable to penetrate an egg on its own, what does that say about the underlying Qi of that sperm?

So although ISCI is a wonderful and exceptional advancement in fertility medicine and assisted reproductive techniques, I do believe it should be firmly balanced with other perspectives of male health and vitality.

Sperm are continually created within the body, so taking a break for around 3 months before the next round of IVF is an optimal amount of time to put lifestyle changes in place. Dietary, lifestyle and nutritional changes can have a huge impact on sperm quality.[1] Taking this time and making this effort to improve the underlying Qi and Jing that is passed onto the next generation is fundamentally important. Things to consider:

  • Stop smoking/vaping;
  • Reduced consumption of refined sugars, processed foods,
  • Reduced consumption of alcohol;
  • Increased consumption of a wide variety of vegetables and fruit;
  • Take regular exercise;
  • Increased water intake;
  • Reduce the use of plastics for cooking and water/food storage (switch to glass)
  • Supplement with a good quality preconception multivitamin to include zinc, selenium, omega 3 fatty acids, antioxidants;
  • Reduce stress (look at meditation, reflexology, acupuncture, spending time in nature);
  • Keep mobile phone away from body [2];
  • Ejaculate frequently [3].

Other options to explore before diving straight into IVF/ICSI:

  • Having a full examination to rule out varicocele, hydrocele and other physical abnormalities;
  • Bloods taken for a full hormone profile;
  • Checking the microbiome to rule out any infection which might be causing levels of damage to the sperm.

“Mounting evidence suggests that the gut microbiome plays a key role in normal spermatogenesis and can be negatively impacted by diet and environmental perturbations.” [3]

Of course, every couple is individual, and factors such as age, for example, will also determine your route to IVF and ICSI.

If you are looking for fertility support in Lancashire please get in touch.

If you would like support through your fertility/IVF/ICSI journey with acupuncture please get in touch.

References

[1] https://pubmed.ncbi.nlm.nih.gov/32397485/

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7848840/

[3] https://rbej.biomedcentral.com/articles/10.1186/1477-7827-10-115

[4] https://www.fertstertreviews.org/article/S2666-5719(23)00001-4/fulltext

Fertility and Constipation

Woman experiencing constipation whilst trying to conceive.

If you suffer with regular constipation, and are trying to conceive, then improving your bowel movements can make a huge difference to how you feel and improve your chances of conception.

When we don’t release our waste at least daily, we are storing lots of debris and toxins within the body. We are also compromising our main detox pathway, and this means that new waste cannot be released by the body, leaving us feeling bloated and sluggish, and disrupting chances of conception.

If you are on a lot of medication, for pain for example, then this can also contribute to constipation.

If you find that your faeces is sticky and you are having to wipe a lot to get clean after using the toilet, then you could be at risk of trans-locating bacteria from the bowel into the vagina, causing vaginal dysbiosis: upset with the vaginal biome. If this happens then the vagina is not an environment that is friendly to sperm, and won’t be conducive to conception, as well as potential additional symptoms such as vaginal pain and itching, creating distress and anxiety.

The bowel is the body’s main detox pathway for oestrogen. Excess oestrogen is bound up in the liver and then released into the bowel for excretion. If it is not excreted regularly then this means that excess oestrogen is remaining inside the body, causing imbalance and disharmony. Furthermore, if you have gut dysbiosis, this can signal to the bowel to reabsorb the oestrogen coming from the liver, and send it back into circulation again. This then creates an oestrogen dominant state within the body.

General lifestyle tips for relieving constipation and improving the consistency of the stool is to increase your consumption of vegetables and fruit, and to increase your water intake. Please also see my other blog post on constipation in general, and for self-help tips.

If you are looking for fertility support in Lancashire please get in touch.

If you are experiencing issues like this, or other issues relating to fertility support, please get in touch with me for an appointment.

IVF: Why days 3-5 are key

Embryo forming.

When going through IVF, and in particular ICSI (Intracytoplasmic Sperm Injection), its super important to pay as much attention to male factor as it is female.

Usually when using ICSI there is an issue with sperm, and its ability to penetrate the egg for fertilisation. This might be due to poor morphology or low sperm count for example. Or perhaps you have tried IVF before and the eggs failed to fertilise naturally. ICSI allows the sperm to be injected directly into the egg by an embryologist.

Some might say that the ability of the sperm to penetrate the egg is no longer important as this penetration is bypassed by the injection technique.

However, just because the sperm is manually injected into the egg, doesn’t mean that its role is then finished!

As the embryo starts to develop, the egg’s energy is solely used to power cellular division, up to around day 3. From day 3-5, the male chromosomes start to contribute to the development of the embryo.

If you have experienced embryos that have arrested in development at this stage, it is a clear message that what’s actually underneath isn’t healthy enough, the genetic material isn’t viable enough, what’s happening with the male Qi is not good enough for the sperm to power through an embryo development.

Taking time for the man to work on and improve his health and lifestyle for the next 3 cycles before going for another round of IVF is super important and really effective.

Allowing a couple 3 months to prepare for conception, whether that be naturally or through IVF is really good advice. It takes around 100 days for an egg to mature, and the same amount of time for health improvements and lifestyle changes to be reflected in sperm.

Taking the time to really focus on your health and prepare properly really is key when you are trying to conceive.

Book in for acupuncture with me today and start your journey feeling fully supported and empowered through your fertility journey.

If you are looking for fertility support in Lancashire please get in touch.

Let’s talk about periods

Did you know that a true menstrual period only comes if ovulation occurred. This means that if you are on the oral contraceptive pill (OCP) and have “periods”, these are really withdrawal bleeds and not true menstrual periods. This is because the OCP prevents you from ovulating.

If you are trying to conceive then it is wise to give your body time to readjust from stopping OCP and get back to a normal cycle.

Period Flow

The flow of your period should be tracked on the day that menstrual blood starts flowing properly (this would be marked as day 1). Often light spotting can occur beforehand so only class day 1 of your period when it gets going properly.

A normal, healthy period would be 3-5 days of bleeding and have a clear end. A regular flow is normal.

Heavy flow and flooding are something to be flagged. This would be more than 5-7 days of bleeding, or if you are having to change sanitary products more than every 2-3 hours. These issues might indicate issues such as thyroid imbalances, fibroid, low iron.

Likewise, very light pink blood for less than 3 days is also something to be flagged. This might be a sign of low oestrogen levels.

Period Pain

Woman feeling emotional and in pain during menstruation.

Rate your pain levels on a scale of 0-10. Mild cramping when your period starts is normal. Anything more should be flagged. Does it stop you from going to work? Do you need to take pain killers? Do you need to use a hot water bottle? Anything more than a 1 on the scale indicates a red flag. Where is the pain in your body? e.g. headaches, abdominal pain, breast pain, lower-back pain? These can all be clues and could indicate imbalances that can be addressed.

Period Frequency

Cycle length (day 1 to the next day 1) should be 24-35 days in length. There should be a clear start and end to the period.

If you have spotting before or afterwards this is something to be noted. Similarly, the colour of the blood should be a healthy red colour with no clots. If it is pink, dark red, purple, or black, then these are all flags to be noted.

Acupuncture

After discussing all of the above in a consultation, acupuncture can help rebalance the body with certain point prescriptions based on your symptoms. Alongside regular acupuncture, lifestyle changes and wellbeing techniques can also be adopted to optimise health and chances of conception.

There are lots of things to think about and consider with fertility awareness. Education is key and having knowledgeable support from an acupuncturist or reflexologist can be invaluable.

If you are looking for fertility support in Lancashire please get in touch.

Molecular Hydrogen

Hydrogen is the smallest molecule in the universe. It has only 2 atoms, and binds with oxygen to give us water – H2+0.

Molecular hydrogen is the name given to hydrogen that is released into water to give it highly antioxidant properties. There are over 1000 published studies now providing evidence that hydrogen-rich water has many health-giving and therapeutic effects.

Why is water good for you?

If we consider that, as humans, we are made up of approximately 70% water, we should really make clean, living, health-giving water and hydration our number one priority when it comes to health and nutrition.

Tap water is not the same as filtered water

Tap water is drinkable but it is full of various extras such as the growing concern around micro-plastics, chlorine, fluoride, pharmaceutical residues and hormones. Because of these, as well as poor water structure, the tap water consumed does not effectively hydrate the body and penetrate deep into the cells where it is needed. It is a bit like watering a dried up pot plant: most of the water runs straight through into the saucer.

By releasing molecular hydrogen into clean, filtered and restructured water, we are left with water that is highly bioavailable and hydrates the body much quicker and effectively that regular tap water.

How do I get molecular hydrogen into my water?

There are various ways you can get molecular hydrogen into your water. The system I use at home (and have done so since 2021 – I never promote anything I do not use myself) is the Energy Plus Undersink Filter System from Water for Health.

This is a 4 stage filtration process which sits neatly under the sink. The first two filters remove debris and particulate, and other contaminants such as chlorine and fluoride. The third filter uses bioceramics to mineralise the water to give it good structure. It then finally passes through the fourth filter which uses a magnesium substrate to release molecular hydrogen into the water.

Which water filter is best?

A water filter of this nature is my preferred way to filter water, over reverse osmosis (ro) and distilling. This is mainly down to the fact that both of these methods remove absolutely everything from the water, including the good stuff – the minerals – which not only provide all the trace elements your body needs, but also provide a basic structure to the water. So if you do choose “ro” or distilling then make sure you re-mineralise the water before drinking.

For further information please see my affiliate link here. There are currently over 1000 published studies available on the benefits of molecular hydrogen.

Water droplets suspended in mid air.

Stress is a thief

Woman feeling stressed.

Stress is bandied about a lot across the internet and social media. But lets cut to the chase.

When you are chronically stressed (and this can be any type of stress, worry or fear because the body treats it all the same; as a threat) then your adrenal glands will secrete more of the hormone cortisol in order to keep you safe.

However, cortisol is made up of various ingredients, one of which is pregnenolone. This is where the steal happens. Pregnenolone is a key building block for the sex hormones: oestrogen, progesterone and testosterone. When the body is stressed, it believes it is under threat, and the priority is survival. So of course, the body will prioritise using the ingredients to create cortisol, the stress hormone, over using it to create our sex hormones. Because if your cycle is irregular, or you have unusual mid-cycle bleeding for example, these are not life-threatening. But the body will interpret any stress as life threatening, so other processes of less importance will be “put on the back-burner”.

So if you are having fertility issues of any kind, identifying areas of stress in your life can be a pivotal starting point. Really take some time reviewing your daily activities and routines and see where things could be improved. Spend some time sitting quietly and try not to think about anything. If this is difficult, write down the thoughts or worries that keep reappearing. Other things to consider:

  • Meditation or some sort of spiritual connection
  • Reflexology and/or acupuncture, massage
  • Gentle exercise allowing time for recovery afterwards
  • Setting time aside to do the things you love to do

If you are looking for fertility support in Lancashire please call/email me directly to have a chat and book in.

Buns won’t bake in a cold oven

Pregnant woman, happily holding her womb.

We’ve all heard the old saying “she’s got a bun in the oven”; a simple analogy of stating that someone is pregnant. But actually, this saying is true more than you might think. If you want to bake a bun, the oven must be warm right? The warmth gives all the ingredients the energy to transform together to create the desired outcome: a well-formed bun. This is all true for making babies. The environment in which the baby is conceived and implanted, and then subsequently grown and developed, needs to be one of which is warm.

One of the main areas I look at when seeing fertility clients is their tummy. I look at what they are wearing and whether they feel warm enough. Many women will wear cropped tops, or short tops that sit on the waist. Underwear may also be low sitting, which means the abdominal and lower back area where the uterus sits is not kept layered up and is prone to invasion of cold. Do you remember your mum or your gran telling you to wear a vest and tuck it into your knickers? This is absolutely sound advice for getting and staying pregnant!

Invasion of cold can also come from things like going outside with wet hair, no scarf, no coat, or sitting on cold surfaces. I’m not talking about doing it once, but repeatedly as a habit. Exposing our bodies regularly to cold exposure without warming up properly afterwards can lead to a manifestation of cold in the body. It is well known that going out in the autumn and winter with wet hair and no scarf can lead to us “catching a chill”, and this is the same for the abdominal area, which can lead to (or be a contributing factor of) fertility issues.

When the body is cold, the flow of Qi and Blood slows down. Our bodily fluids need energy from warmth to keep flowing freely and smoothly throughout the body. If the abdomen is on the cold side, this means that Qi and Blood are not flowing freely to and from the uterus, creating stagnation and leading to stasis.

Losing some weight around the middle can help a lot to increase warmth and disperse cold from this area. If you are looking at IVF you will know that there is usually advice as to the recommended BMI they recommend before starting your IVF journey. Lots of studies have also been done around obesity and pregnancy rates, indicating that a smaller waist can contribute to higher pregnancy rates.

When fertility clients come into see me, I will often ask to look at their tongue as well as palpate their tummy. The colour of the tongue can tell us a lot about what might be going on in the body from an acupuncture point of view. If the tongue shows me a blueish tinge then cold will be contributing factor to address.

Other signs of cold, or of Blood Stasis can be seen in menstrual blood, so if you are wanting to get pregnant then it is worth taking a note of your menstrual blood as well as monitoring your cycles. Look at the colour of the menstrual blood; it is bright red, or pink/orange, or dark red or purplish? What are the size of clots (if any) and the colour of those clots? Do you experience any cramping, bloating and pain before and during your period?

General things you can do to help dispel cold and warm up the abdominal area are:

  • Use a hot water bottle on your tummy or lower back regularly – if you’re sitting at your desk for a while use one then, or when relaxing on the sofa, or in bed at night.
  • Moxa patches are a great way to penetrate warmth and dispel cold. These are available in clinic. They simply attach to your tummy or lower back and will stay warm for 12-16 hours.
  • Incorporate herbs and spices into your diet. Things like ginger, garlic, cinnamon, mint, turmeric are all great for dispelling and dispersing stasis in the body and getting things warmed up and moving. Ginger & Turmeric Tea is a good way of doing this.
  • Get regular acupuncture to support your fertility journey.

If you are looking for fertility support in Lancashire please call/email me directly to have a chat and book in.

The Internal Seasons

I’ve had this blog idea on my “to-do” list for ages, but I’ve not been inspired to write it until today. Do you ever have that? Where something is there to be done but you’re just not inspired to do it until one day, ping! the inspiration comes.

This blog is about outlining the menstrual cycle from a TCM (Traditional Chinese Medicine) point of view, and how are cycles are similar to the seasons. By becoming more aware of our internal cycles we can really look after ourselves in understanding when times of rest, nourishment and calm are needed (Winter) and when times of high energy can bring us productivity and rejuvenation (Spring and Summer). And those times of preparation (Autumn). A bringing together of the physical and the mental/emotional.

However I feel that there is more to this blog than I originally thought. This is because it is becoming more and more apparent to me that we are not just similar to the seasons, we ARE the seasons. We don’t just live here on this planet, we ARE part of the fabric of creation itself. There is no coincidence that our cycles move in time with the moon; that the tides are pushed and pulled by the forces of the lunar cycle, that so many animals, sea creatures and insects follow the phases of the moon for their own reproduction. Everything in nature includes us. There is no separation. When we talk about “connecting with nature” I think what we are actually doing is “reconnecting with who we are”. We are nature. We don’t walk in nature, or spend time in nature; we ARE nature. This is why these times make us feel so good, because there is a sense of coming home, of becoming one, of belonging, of lessening the grips of the idea that we are seperate from the world and from each other. I find I have more and more of these moments of inner knowing, connectedness and understanding of life, and this is the first time I have been able to grab it and get it down into words.

When we discuss the theory of TCM we often mention the seasons and the weather when we talk about particular energies and meridians. TCM philosophy really harnesses the idea of connectedness with our environment and with nature. I really appreciate this concept in my own understandings of life and of health and wellbeing. I also like the idea of likening the menstrual cycle to the ebb and flow of the tides; the tides of Yin and Yang. Understanding these tides and the transitional points between the two can offer huge benefits of understanding to support one’s own monthly cycles:

Phase 1 (days 1-5) is about Blood as we menstruate, it is a restful Yin phase focusing on nourishing ourselves and taking care of ourselves. Honour this time and avoid sexual intercourse and strenuous exercise. The external pathogenic factor of Cold can penetrate particularly at this time so take note of this in the activities you pursue. Remember that Blood is flowing downwards so sanitary items such as tampons obstruct this downward movement. Better to use pads or a menstrual cup.

Phase 2 (days 6-13) is focusing on Yin as increased amounts of oestrogen cause the lining of the uterus to thicken. Eating protein and mineral-rich foods in this phase will help to replenish Blood and Yin. This phase is building towards Yang.

Day 14 is when ovulation happens, and some cramping or spotting can occur as the body prepares to move from Yin to Yang. Get to know your cycles and allow your body and mind space to transition.

Phase 3 (days 15-21) is very Yang focussed; the body is building and nourishing the uterus ready for implantation if fertilization occurs, or shedding the lining if it doesn’t. This segment of the cycle is very energetic. Remember to support yourself during this energetic time with nutrient dense foods and adequate hydration.

Phase 4 (days 22-28) focusses on Qi. As oestrogen levels drop, serotonin levels can also drop and this can affect our mood and emotions. PMS can occur, tears, frustration, anger, as well as physical symptoms such as bloating or breast tenderness. All of these symptoms are based on the lack of free flowing Qi and result in Qi stagnation. So this segment of the cycle it is important to eat clean, take gentle exercise and avoid stimulants in order to support the Liver energy to keep Qi gently flowing freely. It might be a time where you might want to reach for those sugary snacks, so try to substitute those with better choices. We can also choose to eat warming foods because Qi needs heat to keep the fluids moving. Avoiding cold foods and drinks, and exposure to cold weather, swimming and sitting on cold surfaces can all help to support this phase of the cycle.

If you are looking for fertility support in Lancashire please get in touch.

Understanding puberty in girls from a TCM perspective

We can all remember the struggles of our teenage years; problems such as acne, the start of our periods, breasts forming, getting used to wearing bras, peer pressure, increasing levels of school work and home work, not being able to get out of bed in the mornings.

As a parent, I want my own daughters to have an easier time than I did. As a therapist, I am more aware of the strains put upon children and teenagers, and how this can effect them physically, psychologically and emotionally.

In my previous blog post, I explained in general terms about our Kidney energy being responsible for our growth and development, and reproductive health. If we experience a painful puberty it is likely that we will experience a more difficult menopause. We also want to optimise fertility, pregnancy and childbirth in between these two milestones, as well as general health and wellness, and they are all interlinked.

The following behaviours can have a significant impact on a young woman’s health:

  1. Early sexual activity. This can have an impact on uterine health at such a vulnerable time, causing imbalances such as blood stasis.
  2. Excessive physical work and exercise, During puberty, this may cause weakness and deficiency in the developing body (Spleen and Kidney), which in turn can lead to stagnation. Of course this depends on the individual constitution, but it is important to be aware of as a parent.
  3. Exposure to external cold. Young women are vulnerable to invasion of external cold, particularly during puberty. Social pressure to wear clothes that reveal the lower back and abdomen, going out without a coat and scarf, prioritising their physical appearance over their well-being can leave them prone to being attacked by the external pathogen of cold. If cold attacks the uterus, it will contract and cause stagnation.
  4. The use of tampons blocks the natural downward flow of blood and can cause stagnation. There are also many other health risks associated with tampons including the exposure to environmental oestrogens which is covered in a different blog post.
  5. Emotional stress and anxiety will have a massive impact on energy levels, depleting the Kidneys and creating excess Heart energy. If it is held onto then this can cause stagnation.

Taking care during this sensitive time will have a massive impact on our young women’s health as they get older. Common problems such as period pain, irregular periods, heavy/scanty periods, infertility, endometriosis, anxiety and depression, fatigue can all be improved through gentle communication, education and sensitivity around these issues at a young age.

If you are interested in receiving some acupuncture or reflexology sessions please contact me directly for an initial chat.

If you are looking for fertility support in Lancashire please get in touch.

Jackie Marsden is a Reflexologist, Acupuncturist and Foot Reading Practitioner, based at Elder Cottage Clinic, Warton, Preston, PR4. She is a full member of the Association of Reflexologists.