I stand in a hotel conference room with 15 other women simultaneously bending down to scoop up imaginary piles of dirt. In unison, we bring the make-believe soil to our pelvic regions and then, as instructed, reach up as high as possible to funnel energy from the skies through our heads and down to our uteruses.
"Collect the yin energies from earth and the yang energies from heaven, then blend them in your center, where all life begins," directs Randine Lewis, creator of the five-day alternative fertility retreat in which we are taking part.
This ancient Taoist moving meditation Lewis has us doing, part of a discipline called qi gong, is an integral part of our healing process, apparently, and so we wake to scoop and reach every morning at the crack of 7:30. Most of us can't really envision yin in the dirt or yang in the sky, but we try. Oh, man, do we try.
If someone had told me a year ago that I would soon combat my infertility by tossing myself headlong into an ancient Chinese regimen including herbs, acupuncture, daily meditation and sweeping changes in my diet, I would have wondered what kind of herb she was smoking.
But she would have laughed last. Because earlier this year, at the age of 37 and after 21/2 years of very conventional, very Western attempts to conceive, I threw myself into such a program.
And why not? Six months on fertility drugs, two inseminations and one $13,000 attempt at vitro fertilization (IVF) had all failed me -- or I them. I felt I had to try something else. In February, minutes after I realized the IVF hadn't worked, and knowing my husband and I would have a rough time financing a second round of treatment, I hit the Internet looking for an alternative.
Go East, Woman
I quickly stumbled on Lewis's book "The Infertility Cure: The Ancient Chinese Wellness Program for Getting Pregnant and Having Healthy Babies" (Little, Brown, 2004). Unlike lots of other books that champion this or that single regimen, this one combined a slew of alternative therapies: herbs, acupuncture, diet changes and mind/body work.
I ordered it and dove in, reading about how in 1991 Lewis -- who now holds advanced degrees in Oriental and alternative medicine -- had been a stressed-out medical student who couldn't get pregnant. Unwilling to go on fertility drugs, she read up on and tried herbs and acupuncture, adding stress reduction and a better diet. Three months later, bam, she was with child. Under her tutelage, Lewis says, some 1,000 women have followed suit.
The book got me wondering: Was there hope for me somewhere outside the IVF labs?
Figuring I had nothing to lose -- except $2,250, which is a whole lot less than what IVF costs -- I signed up for one of Lewis's "fertility-enhancing retreats" in the hills of western North Carolina. A month later, I stood -- along with 15 distraught, perplexed others -- in a dimly lit room slowly windmilling my arms every morning in an effort to "call to the unborn child." The rest of the days were spent sharing teary sagas and absorbing the details of how to incorporate traditional Chinese medicine (TCM, as it's called) and mind/body work into our lives.
Outside the Bottle
We are not alone -- the infertile 15 and me -- in looking to herbal medicine, acupuncture and mind/body exercises to battle our babylessness. Though there is scant scientific support outside of a few studies on acupuncture and fewer on herbs, a glance at any infertility bulletin board on the Web will show that interest is high. Some of us take a finger-wagging from our physicians, who are not sold on the tenets of ancient Chinese medicine. But we jump in feet first, often because there is nothing else left to try, or nothing else we can afford.
But still, I can't help but wonder what evidence exists for the therapies pulled together in Lewis's program. So once I returned from the retreat, I took a closer look.
The Eastern View Herbs, in use for infertility since 300 B.C., are said to harmonize the endocrine system, which regulates the menstrual cycle. If a woman has, say, low progesterone levels, a Western fertility doctor may prescribe progesterone; an herbalist will prescribe individualized blends of herbs intended to balance that person's entire endocrine system, causing the body to do a better job manufacturing its own progesterone in the right quantities.
After extensive interviews with Lewis before the retreat, I got my herb capsules in the mail -- one custom blend to take pre-ovulation, and another to take after ovulation. I choke down nine capsules a day, three with each meal.
The Western View Many doctors are leery.
"We are really very concerned about our patients' taking herbs," said Bob Stillman, medical director of Shady Grove Fertility, which recently began offering complementary medicine through its clinics but steers clear of herbs. Stillman, a reproductive endocrinologist, said he worries that even the herbalists themselves don't know much about the estrogenic properties in herbs, and too much estrogen in a woman's system may interfere with the drugs prescribed during an IVF cycle.
Others are less worried. "Most physicians don't know anything about herbs and are afraid they will have harmful effects, but that's just paranoid," said Adriane Fugh-Berman, associate professor of physiology and biophysics in Georgetown University's School of Medicine's complementary medicine program. Fugh-Berman, a general practitioner, says the strongest plant estrogen has less than 1 percent the potency of the estrogen produced in the body. Thus, she says, any estrogen derived from herbs is unlikely to have a deleterious effect.
But can herbs have a positive effect? "I think there's something there, but the evidence doesn't exist yet," said Fugh-Berman.
What the Studies Show In the West, large, controlled studies on herbs and infertility don't exist, and the few small studies that exist are hard to find. But in April, a Stanford University School of Medicine study published in the Journal of Reproductive Medicine showed that five of 15 study participants became pregnant after five months on the herb and dietary supplement mix FertilityBlend, which contains the herb chasteberry, the amino acid L-argenine and green tea as well as various vitamins. The study, while very small, was double-blind and placebo-controlled. It was, however, funded by the company that makes FertilityBlend.
In China, where the prescribing of herbs is far more common, studies are more numerous, though none are controlled in the Western sense. In an observational study published in 1994 in the Hubei Journal of Chinese Medicine, 248 of 401 women conceived after three months to one year of treatment with different herb preparations. There was no placebo group against which to compare results.
In another observational study, published in 1995 in Shanxi Chinese Medicine, 107 of 188 previously infertile women became pregnant after three months of herbs, while another 20 conceived after four to six months. Again, there was no placebo group.
Few studies have been done on the long-term safety of herbs.
The Eastern View The classical Chinese explanation goes like this: Channels of energy called meridians run in river-like patterns through the body, nourishing the tissues. Any obstruction in their movement is like a dam, disturbing energy flow and leading to dysfunction and possibly disease. Acupuncturists say that placing needles in specific points along the meridians can unblock the obstructions and reestablish the regular flow through the body.
Lewis points to small studies that say acupuncture can restore normalcy to the endocrine system, which regulates hormones necessary for reproduction. And, she adds, acupuncture has been shown to increase blood flow to the uterus and ovaries, which can bolster the quality of the eggs they produce as well as helping encourage an embryo to implant. She added that acupuncture can also trigger ovulation. Lewis gave me three acupuncture treatments at the retreat.
The Western View Many fertility doctors remain skeptical, including mine, Frank Chang. "It just doesn't translate into Western terms," said Chang, clinical associate professor of reproductive endocrinology at George Washington University School of Medicine and medical director of MidAtlantic Fertility Centers in Bethesda. "A lot of [belief in acupuncture] is empirical observations made over centuries. Most of us have a hard time making that leap of faith; we think in terms of specific physiological changes seen in controlled studies."
But Chang and many of his colleagues remain curious. This summer, he plans to ask patients to participate in a controlled study examining whether acupuncture improves IVF outcomes. Sponsored by the University of Maryland and conducted through Chang's clinic, the study will use sham acupuncture -- in which needles are inserted at non-acupuncture sites in the body -- as a control.
If the results show the ancient Chinese remedy to have significant merit, Chang says he's open to changing his mind and will suggest his patients consider it. In the meantime, he says his patients can feel free to go for the needles if they choose: "It can't hurt you in any way, and it might help. We just don't know."
What the Studies Show As with herbs, no large, controlled studies have been done on acupuncture and fertility in the United States.
In 2002, the U.S.-based journal Fertility and Sterility published results of a German study on IVF patients who received acupuncture treatments before and after embryos were transferred into the uterus. Almost half of the 80 women who got acupuncture conceived, compared with a 26 percent success rate in the control group, which got no acupuncture. That seems convincing, but the authors themselves said psychological or psychosomatic effects could not be ruled out, adding that they plan to do a future study using a placebo needle set as a control -- similar to Chang's upcoming study.
In 2002 researchers at Cornell University conducted a meta-analysis of the scant literature on acupuncture for fertility, concluding there was not yet sufficient evidence to gauge the method's merit.
In 1997 the National Institutes of Health (NIH) issued a consensus statement saying that acupuncture had shown promising results in treating adult post-operative and chemotherapy nausea and vomiting and in post-operative dental pain. But so far, no word from the NIH on acupuncture for infertility.
Zoe Brenner, a Bethesda acupuncturist who has worked with Harvard and the NIH on acupuncture projects, says large acupuncture studies don't get done because there's no big drug company money behind it as there is for, say, fertility drugs. Ditto for herbs. She thinks that shouldn't matter.
"Just because we don't have a study showing the efficacy doesn't mean it's not working," said Brenner.
* DIETARY CHANGES
The Eastern View Every diagnosis in traditional Chinese medicine is linked with foods that are said to be curative and others said to be detrimental. For instance, a person with "kidney yang deficiency" would be told to eat lightly sauteed vegetables instead of raw ones so that the patient doesn't waste the limited "heat" in his system by asking the body to heat raw food to body temperature.
Lewis says it's been shown that when an egg is three months from being ready to emerge through ovulation, it begins receiving nutrients from the body. In her view, some foods can help the egg along, while others can hinder it. Generally detrimental to the egg's formation, she says, are caffeine, alcohol, milk, sugar and refined or processed foods.
The bulk of one's diet, she says, should come instead from organic plant sources, as well as brown rice and breads made from sprouted wheat, and meats and fish free from antibiotics and hormones. Also, Lewis recommends various dietary supplements, depending on what underlying physiological patterns she detects in you. For me, she suggested fish oil, wheatgrass shots, a high-octane bee pollen called royal jelly, the antioxidant pycnogenol and a daily shot of wheatgrass juice.
The Western View Most fertility doctors don't think diet makes much of a difference. Chang concedes it's true that having too much or too little body fat can inhibit ovulation, and malnourishment can impede conception. Likewise, women with polycystic ovarian syndrome, an endocrine disorder, are usually put on a low-carb diet to manage their metabolism, which in turn stabilizes hormones. But should a woman of normal weight who already eats relatively healthfully (like me) make any changes? Chang says no, probably not.
What the Studies Show Fern Reiss, author of "The Infertility Diet: Get Pregnant and Prevent Miscarriage" (1999, Peanut Butter and Jelly Press), cites a 1994 Harvard Medical School study published in the American Journal of Epidemiology showing that milk consumption is associated with age-related fertility decline in women with a very common lactose intolerance. However, the authors of the observational study admitted they couldn't control for other factors that influence fertility, such as marriage customs, divorce rates, contraceptive use and individual wealth.
Reiss also notes a few small studies showing that foods rich in zinc (such as pumpkin seeds) aid in sperm health, and that yams support reproductive hormones in women, even increasing the incidence of multiple births in one small, observational study that was not controlled and has yet to be replicated. Reiss -- who credits her 1996 pregnancy to a diet she formulated, based on her research -- refers to 500 studies on food and fertility in her book.
The Mind/Body View Physical or psychological stress makes the heart race and blood pressure build as the body shunts blood from the internal organs to the eyes and musculoskeletal system to prepare to fight or fly from a perceived danger. Mary Jane White, a Houston-based psychotherapist trained by infertility and stress-reduction guru Alice Domar at the Harvard Mind/Body Medical Institute, says many people live their lives in this state, causing the endocrine and reproductive systems to end up with very little circulation. To reduce stress and restore physical balance and a sense of calm, White -- who works with Lewis in running the retreats -- recommends yoga, daily meditation and plenty of self-nurturing (three spa treatments are built into the cost of the retreat). In addition, Lewis suggests a half-hour of daily qi gong.
At the end of the retreat week, I find I'm talking more slowly, moving more languidly, and my body feels like a flaccid udon noodle (which I'm no longer allowed to eat).
The Standard Medical View Most fertility doctors support the use of relaxation techniques, at least to the extent that they help patients endure IVF, which can be very stressful.
"If you can help patients get through treatment by helping them relax, then they might be able to do more [rounds of IVF] and ultimately be successful," said Chang. But beyond that, doctors don't tend to put much credence in a causal connection between stress and infertility.
What the Studies Show In 2001, a University of California, San Diego, study published in Fertility and Sterility found that women who expressed very negative emotions prior to starting an IVF cycle were 93 percent less likely to have a baby than those who were very positive.
That followed an NIH-funded study in the same journal showing that more than half of 151 participants who were having trouble becoming pregnant enrolled in a mind/body program became pregnant after one year, compared with just 20 percent in a control group. About 20 such studies have been done, with most of them finding similar results.
Still, since many of these studies can't be controlled very efficiently, whether stress reduction and mind/body work helps couples become pregnant remains a matter of speculation.
Four months have passed since I attended the retreat. Lewis -- with whom I exchange e-mails about twice monthly -- concocts new herb mixtures for me every month. And on the recommendation of another retreat attendee, three times a month I see an acupuncturist who communicates with Lewis on my behalf. I can't say I do yoga or qi gong every day, but I try to work it in.
I'm off caffeine, alcohol (okay, I may have a glass of wine once a week or so), sweets (yeah, okay, dessert every once in a while) and processed food. I'm on all things organic (except when dining out), as well a host of supplements (I take those religiously.) I've inadvertently lost five pounds, dropping to 112 pounds, but I feel healthier and more robust than ever. And I now sleep like a coma patient at night.
No, I'm not pregnant (yet). But two months into all these changes, my cycles lengthened from an average of 25 days to 28 days, which can be an indication of healthier eggs and better hormonal balance.
My husband and I have discussed borrowing the money to try IVF one more time in September. But I can't help but hope we won't have to.
Suz Redfearn is a frequent contributor to the Health section.