Mike Berkley

23/04/2018

Spence: Hello, everyone, welcome to the Conception Channel podcast, brought to you by the Being Fertile Program and the Yinstill Reproductive Wellness. I am your host, Spence Pentland, and today, I’m excited to be here with a very special guest, Mike Berkley from New York. Welcome to the show, Mike.

Mike: Well, thank you very much, it’s great to be here, Spence.

Spence: Excellent. I’m excited about today’s chat. Mike is going to help us go through common conditions that people are faced with when struggling with fertility and frame them from a biomedical standpoint, the diagnosis, mechanisms behind the disease and treatment, and then, we’ll look at the same thing through TCM lenses or Traditional Chinese Medicine lenses, so you can kind of get an understanding by the end of this podcast the condition that you might be faced with and how both Western physicians, your family doctor, IVF specialist and a TCM reproductive health specialist would approach your case and help support you. We’ll get into some highlights, you know, times maybe when surgery might be an important thing to choose and when IVF or PGS, these things are wise to recommend, and then when TCM is strong and lifestyle components really play a role. So, without further ado, we’re going to jump right in, Mike, if you want to give people a little bit of a background, that would be great, so they have some idea. I mean, Mike’s been doing this for over 20 years, working with women and couples trying to start their families in New York. And he’s close with many of the REs or fertility specialists in and around Manhattan, I know that. He’s contributed so much to our profession, the Traditional Chinese Medicine profession with his knowledge and forward movement with being the first or the pioneer that really focuses his medical practice in the reproductive health side of things. Mike, I’ll tee that up for you, but now, you give people a little background.

Mike: So, it’s great to be here, thank you so much for having me as a guest, I’m honored. I think you really said it all, I’ve been in practice for 21 years, really the first practitioner in the U.S. to specialize as an acupuncturist in treatment of fertility disorders. Acupuncturists generally treat everything, you know, from headaches to neck pain to fertility. I just decided to go into fertility and kind of do that, and that’s what I’ve been doing for a long time. I guess my  

philosophy of conception and those who are facing fertility challenges, that it takes a village. And that patients shouldn’t just see reproductive endocrinologist because they can’t really improve egg quality or lining quality or sperm quality, we can often, not always. And as well, they shouldn’t just be seen by an acupuncturist because an acupuncturist can’t do hysterosalpingogram or fluid ultrasound or if necessary an IVF, so therefore, it behooves the patient to create a team of support personnel, meaning reproductive endocrinologists, acupuncturists, herbalists, psychologists if necessary. So, my feeling is it takes a village, and that’s a very important way to go.

Spence: Awesome. I couldn’t agree more. I just moved to a new town and I’m amassing my medical referral village for the women and men that I see for reproductive health concerns. I just met with a pelvic floor physiotherapist and a psychologist last week and RE here in town is absolutely fantastic, so it’s exciting to create that village. I agree, everyone has their specialty, and today, it’s TCM or Traditional Chinese Medicine, which is an acupuncture, which is Mike’s as well and my specialty here. We are going to dive right into specific conditions and work through them one by one. If you ever have questions, we’re going to leave Mike’s contact, because we’re here to help support in any way we can. But to start with Mike, do you mind jumping right in?

Mike: No, no, I’m happy to.

Spence: Awesome. So, for advanced maternal, and I am going to couple that together with a quality just because that is what every woman will hear, you know, especially when they see reproductive endocrinologists or their IVF doc or fertility specialist. From a Western medical standpoint, can you kind of talk through what the diagnosis and mechanism behind that they’d be facing when they walk in there?

Mike: There’s a bell curve. People can see me?

Spence: Yeah.

Mike: Let’s just say it starts here and then it goes over here. Here’s 13-years old and here’s you know 50, 52 to 54-years old. And then it is this curve on top, and on top is 34-years old. You

start menstruating here at 13-years old, this is textbook, some people start at 10, some people start at 16, but it’s just a textbook. So, they start menstruating at 13, you can start getting into menopause at 52, and then on the top of the bell curve is 34-years old. So, from 13 to 34 is the most fecund time in a woman’s life. Fecund, meaning the ability to conceive in any given month. And from 34 to 52, the ability to conceive starts to diminish. It doesn’t diminish in a straight line, so the listening audience, you don’t have to worry for 35 or 36-years old. But it starts to just diminish like this, and so, what happens physiologically is that a woman loses a thousand and one eggs every month from the time she starts menstruating. Thousand eggs just die every month, and one egg is ovulated. And so, over a woman’s lifetime, she’s typically going to ovulate 500 times, plus or minus a little bit depending upon a person. Obviously, once a woman gets into 35, 36, 40, 42, she’s in this state that reproductive endocrinologists call advanced maternal age, because once you’re past 34, 35 you’re still a young woman, but you’re in the category of advanced maternal age. And what does that really mean? It means that, and by the way this statement is not universal, it means what I’m about to say is applicable to many women though not all women, so it means that when women are past 35-years old and they’re trying to get pregnant and they cannot, you’re trying to get pregnant in the natural form, using intercourse, timed intercourse, and they cannot. Why not, why can’t they get pregnant? Well, typically, there are many reasons why they can’t, but we’re going to stay in the conversation, in the category of advanced maternal age. So, what happens is the woman has fewer eggs and therefore there’s a reduced potential for a sperm to penetrate an egg because there aren’t as many eggs left. Second of all, there’s something that covers an egg, which is called the Zona pellucida. And the Zona pellucida gets more — what’s the right word — it gets more durable, it gets harder substance as a woman ages. And that means that a sperm may have a difficult time penetrating the egg, getting through the zona because it’s a little harder now. So, that’s over here. And over here, as a woman gets older, her eggs are likely to become more and more aneuploid, which means chromosomally abnormal. It doesn’t mean she won’t conceive because she HAS eggs, she probably has some normal eggs, but what happens to a woman who’s older, I’ll give you an example using money. Let’s say a woman’s wearing a pair of jeans and she’s 19 years old, she has 90 dimes and 10 pennies in her pocket. I’m speaking from America, so I don’t know if you guys use dimes and pennies is the same in Canada.

Spence: No more pennies.

Mike: Okay. So, she reaches into her pocket and every time she pulls out a coin, it’s a dime, because she has 90 dimes and 10 pennies. Very rare that she pulls out a penny. But as a woman gets older, it gets reversed, she has far more pennies than dimes. Every time she reaches into her pocket, she pulls out a penny. That penny is a bad egg. So, what you have is a case with fewer eggs and fewer good eggs. So, from the perspective of Traditional Chinese Medicine, well, I think I’m going to talk about Chinese medicine in the context of Western medicine, and you’ll see where I’m going with it. When that woman with diminished ovarian reserve and poor egg quality goes to reproductive endocrinologist, she’s done several intrauterine inseminations, they haven’t worked, the doctors are spineless doing IVF, they do the IVF, it doesn’t work – why not? Because the reproductive endocrinologist is only able to use what the couple presents with, so when the doctor retrieves eggs and fertilizes them with the sperm, if the eggs are not good, the woman’s not going to get pregnant or she’s going to get pregnant and she’s going to miscarry, or she may get pregnant and there may be some abnormality, for example Down syndrome. And then she has a choice to make as to how she’s going to proceed, whether if she’s going to abort or carry to term. And so, how now, because there’s no answer in Western medicine for improving egg quality, sperm quality, lining quality, you know, we’ll talk about lining later, but what our Western docs do for lining, they do transvaginal viagra, and you know, it helps a little, it doesn’t really help a lot. It’s a band-aid approach. But getting back to the egg quality, I read recently, sometime last week that eggs, this isn’t a Western Medical Journal, eggs actually need nourishment. Now I don’t know why that’s such a big new concept, but they said eggs need nourishment, so what does that mean? I mean, you’re not feeding your eggs a hamburger, you know, what does it mean to nourish your eggs? Well, it means that you have to feed more of the stuff that your eggs are already getting. For example, let’s say that I eat a steak three times a week, well, I can’t be eating that much steak. It’s not going to satisfy me, I need a bigger piece of steak. So, when you’re nourishing an egg, what does that mean? It means that blood from your heart beating, the circulation that’s manifest in the human body, it’s delivering blood all over from your eyebrow to your pinky to your nose to your ovaries, and why is blood flow to the ovaries important? Because blood carries FSH and LH from the brain, it carries electrolytes, it carries nutrients from the food that we eat, it carries oxygen from that which we inhale, and also blood is like a taxicab. It takes all these good things to the eggs and it drops them off, and what does it pick up? It picks up dead cells, which are called ‘debris’, because all the time our  

cells are dying and being regenerated. But sometimes, these dead cells can call what’s called reactive oxidative species of free radicals and that’s quite damaging to eggs and the whole ovarian milieu, and so, not only just the blood flow carries the good things, the things that I mentioned to the ovaries and the follicles and the eggs inside of the follicles, but it helps get rid of the debris, the dead cells. Now, that’s happening every single minute that a woman takes an inhalation. I mean, as long as the woman’s alive that’s happening. Why? Because our heart is beating and stimulating blood flow through the system. But what acupuncture and herbal medicine do is they improve and enhance hemodynamics. One proof, I’ll prove it to you. Let me just clarify, so what does that mean, hemodynamics? It simply means improved blood flow, that’s really all it means. Any acupuncturist can say anything, any physician can say anything, but here’s the proof. If you take woman and you perform, I can’t do it, it’s out of my scope, but if a medical doctor does a transvaginal ultrasound with a color Doppler, see ladies, every time you have an ultrasound, you can see the information on the screen, it’s all gray, black and white, but there’s another type of ultrasound that uses the color Doppler and you can see color on the screen instead of just gray. So, you take a woman, you do a transvaginal ultrasound and it gives you a number, which is called the Uterine Artery Impedance Index, and let’s say, the higher the number, the less blood flow there is. And so what happens is you do acupuncture on this woman. And, by the way, this has been done. I mean, you can look it up, google it, you do acupuncture on woman, ten minutes later, you do another transvaginal ultrasound with a color Doppler, you’ll see tremendous blood flow and perfusion, all kinds of blood flowing to the uterus and manifest in the uterus. Why is that a good thing? Well number one, you’re increasing blood flow to the uterus so you’re going to help with implantation issues and number two — and that’s what’s not so important, because most infertility is not about implantation failure even though sometimes it is the case, but certainly that blood flow is being fed to the ovaries as well – why? Because this is one artery called a uterine artery and that feeds the uterus, but at the end of that uterine artery, are these branches to the ovaries and feed the ovaries. So, the woman under the care of acupuncture and certain herbs will get a greater delivery of oxygen, nutrients, hormones, electrolytes and a greater excretion of dead cells. So, you’re taking a garden, you’re adding more water, taking out the weeds, cutting down the trees and a blocking this one, what do you expect as a result to happen? The garden is going to flourish and it’s beautiful. So, that’s how acupuncture helps to improve egg quality and improve uterine lining issues.

Spence: Beautiful. As you said, from backing up, I love that analogy. The first teacher I ever had in Chinese medicine used the analogy, in Chinese medicine, you’re a gardener trying to balance all the various natural phenomena like heat and cold and wet and dry, and you know otherwise you go to med school, you will become a mechanic more and view the body as some of its parts, not in a holistic perspective. For egg quality realistically, so many women that have difficult responses, or when they’re over a certain age, will just get that diagnosis from their physician usually, right?

Mike: Yes.

Spence: Poor egg quality, especially if they’ve had difficulty responding to an IVF. You mentioned Viagra, maybe one way to bring – is there any other Western medical treatments that you see commonly used?

Mike: Well, they used viagra too, and so sometimes what happens is, okay, a reproductive endocrinologist wants to see a woman with an endometrial thickness of 10 millimeters before they do a transfer. Now, there are many documented pregnancies on 7 and 8 millimeters, there are documented pregnancies on 6 millimeters, I don’t think there are any documented pregnancies on 5 millimeters. So, if a woman has got a 6 millimeter lining, first of all, many times, nobody knows why that is, but what the doctors will do is they’ll give her transvaginal Viagra. And, you know, viagra brings blood to the area. I think it helps minimally, and by the way, I don’t want to give the impression because it would be the wrong impression, that if a woman has a 6-millimeter lining and you do acupuncture on her and give her herbs that you’re going to necessarily get her to a 10-millimeter lining – that’s completely nonsense. But you might get it from a 6 to an 8, you might get it from a 6 to a 7. And so I think that the difference between acupuncture and viagra is that viagra is more of a band-aid approach. It’s bringing more blood flow and so is the acupuncture, but remember, the acupuncture is trying to facilitate the energetics and the activity of the whole organism, the whole body, to create an environment where blood flow is a naturally enhanced thing, or where the enhancement of blood flow occurs naturally. And listen, there’s nothing wrong with taking Advil for a headache, I have nothing against Viagra, but I think, you take viagra and the effect lasts for three days and then it goes away again. When I treat patients, I’m treating them twice a week until they get pregnant and twice a week for 13 weeks after they get pregnant. So, if I’m

working on them for a lining issue, they’re coming in twice a week, they’re lining is going to be improved at the time they get a transfer.

Spence: I’ve seen if it’s in a frozen embryo cycle or something as well, estrogen or estradiol might be used to help with the lining, suppositories, but from a Traditional Chinese Medical perspective –

Mike: I’m sorry, let me just interrupt you for a second, I apologize. This is important. Sometimes, the lining is not as thick as one would like it to be because estrogen receptor sites are down regulated, and so you can give a patient all the viagra you want and all the estrogen you want and it will not help. When you use acupuncture and herbs, and again I want to state clearly, I’m not one of these people that think that acupuncture and herbs are the answer, they are not, they are part of the answer. But the point is that if you have down regulation of estrogen receptors, acupuncture and herbs may be more efficacious than viagra or 81mg a day of aspirin or estrogen because acupuncture is working at a deeper internal level than just using 2mg a day of estrogen.

Spence: So then the acupuncture may be facilitating more than meets the eye, like the thickness of the lining may be just a piece of the pitcher and there may be more that we’re not seeing. You might have a millimeter lining and that’s fine, but if you’re utilizing acupuncture, there may be more to it. And often when you work with an acupuncturist, they may talk a little bit about diet and some other things in your life that maybe inhibit proper formation or just function of the overall organism and digestion so the blood is properly getting, you know, manufactured, etc.

Mike: I have to tell you… let’s see how to present this. I have to tell you that I’m at odds with many acupuncturists, and they know that, and that’s fine, because I’m not necessarily right. They could be right, I could be wrong. I don’t hold much value, I don’t think there’s much value in dietary recommendations and lifestyle recommendations unless there’s a value. And what I mean by that is if you have a woman who comes in, she’s 35 years old and she works out three days a week and she lives pretty well, but she eats bacon, lettuce and tomato sandwich or a hamburger twice a week, I’m not going to tell her not to do that. It’s fine. Now, if I have a patient who’s obese and smokes cigarettes, I’m going to tell that she needs to change her diet and her lifestyle, but I don’t think every single patient is a necessary recipient of

lifestyle and dietary counseling.

Spence: Agreed.

Mike: I think being sedentary is a big issue. People sit down all day, they sleep all night and what does that mean, what does that cause? It causes impedance in the blood flow, because activity stimulates the blood flow. I think that women should exercise, either yoga or hard core exercise, it doesn’t matter; however, make sure not to lose too much weight because you need to have some weight to be fecund. Anyway, I’m sorry if I digressed.

Spence: No, that’s perfect. I mean, I think that speaks really well to, you know, you’ve got experience in reproductive medicine, and I think that is why it’s important to seek out an acupuncturist or Chinese medicine practitioner that does, because certain conditions as well require maybe more lifestyle change than others. One of the cardinal components of Traditional Chinese Medicine should be an individualized approach as what you’re saying. There’s no protocol here, it’s like, not everyone should be on a damn Keto diet or anything. Every woman and man should be looked at individually and approached in that way and that is important to understand about Chinese medicine, so thank you for highlighting that. What’s the famous saying, ten people with the same condition can receive different treatment…

Mike: One disease…

Spence: Many treatments.

Mike: Yeah. One treatment, many diseases.

Spence: Exactly. There may be some diet lifestyle components, that’s great for advanced maternal age – do you mind if we move forward into something that’s quite different actually at least in my experience and I’m curious to see what you have to say, and it’s something that I see more of than almost anything else in my practice is unexplained infertility.

Mike: Sure

Spence: So, Western medical standpoint – how can you come to this diagnosis or lack thereof, I’m not sure how to put it?

Mike: So, what happens is a 30-year old patient is trying to conceive using timed intercourse, and she’s trying to conceive for two years and she can’t. So, she goes to a reproductive endocrinologist and the doctor checks the husband’s sperm and the sperm is fine, and he checks the woman out fully and she’s fine. So, that’s one unexplained infertility. Infertility is defined as the inability to conceive after 12 months of trying, and so she’s in the game for two years, she hasn’t been pregnant and there’s nothing wrong with her. And she can’t get pregnant, so that’s unexplained infertility. I want to say a few things about that. Remember that we’re in 2018 right now, and we think, the educated intelligent people, we think that medicine is cutting-edge, but I put to you for your consideration that most medicine is not cutting-edge and we’re in 2018. What’s medicine going to look like in 2028? What’s it going to look like in 2050? The diagnostics that we have today, or that Western physicians have today, are only as good as the diagnostics that they have today. So, I’ll give you a perfect example: a woman is going to do an IVF transfer and she does a pre-implantation genetic diagnosis on her embryo and it’s a beautiful embryo, with no inclusions and a little fragmentation, it’s just a beautiful embryo. And they transfer the embryo and she doesn’t get pregnant – why not? I don’t know. I don’t know. And neither does the reproductive endocrinologist – now, why don’t they know? They don’t know because their diagnostic tools, of which there are many and many good ones, but their diagnostic tools are limited. And next year and in ten years, they’ll be less limited. So, that’s the Western perspective of unexplained infertility. We don’t know what the heck is going on and we’re going to just keep doing IVF until it works. In TCM, there is really no nomenclature, there’s no word, there’s no concept of unexplained. In Traditional Chinese Medicine, every pathology, it is always explainable, and why is that? It’s always explainable because we diagnose patients differently than Western medical physicians do. We diagnose by asking a lot of questions, feeling the pulse, looking at the tongue. And so what happens in Chinese medicine is we asked a lot of questions about everything: is there shortness of breath, what’s your urination like, what’s your defecation like, what’s your stress level like, do you love your job, do you hate your job, what’s your sex life like, what do you eat, we ask everything. I literally probably asked a hundred questions during an intake. And then what happens is you take these questions, and I’m just being, you know, I’m making an analogy, you take these questions and you paste them on the wall and you start to like see connections

between a lot of things. And then you draw a line to all these connections and then guess what? You come up with a diagnosis and then you treat according to your treatment principle. You have a diagnosis and you have a treatment principle, which is your map to treat, your guidelines to how you treat and then you treat. Now, the patients listening to this podcast may say, oh, well, I don’t get it, it doesn’t make sense, etc, etc. And I would say to that patient, you’re right, I wouldn’t get it either and it wouldn’t make sense to me either. But what the patient has to understand is, that there’s more than one language in the world. Some people speak English, some people speak French, some people Chinese, Russian, Japanese, there’s different ways to communicate and different ways to approach a medical dilemma, a medical challenge. Western medicine is one way to approach it. Let me just let the listening audience know something: that three-quarters of the world, three-quarters of the inhabitants of this planet, three-quarters currently today use Chinese medicine. They don’t use any other type of medicine except Western medicine. For example, the oldest medicine in the world ever is Ayurvedic medicine that’s ten thousand years old, but it’s really only used, it’s 99% used in India, but traditional Chinese medicine is used all over the world .

So, why am I saying this? Because if it wasn’t beneficial, if it wasn’t working, it wouldn’t be used by three-quarters of the world’s population. And so listeners who have doubt, I just want to tell you this, you’ve done your five or six IUIs, and you’ve done your three IVF, try something new.

Spence: You know, what you just brought up is why I chose to study Chinese medicine, because I’m like, even a culture like the Chinese that are so infused with tradition in their culture wouldn’t bang their heads against the wall for 2,000 years if it was something that isn’t effective. And it wouldn’t have spread to every corner of the globe. There’s Chinatown’s and herbal shops and acupuncturists everywhere. That’s such a great point. So, the guideline or the map that we use to identify what to do with patients or our system of diagnostics we call patterns, pattern identification. I love using that word with patients because it seems to resonate known as void of pattern or patterns because we’re alive and breathing. If you’re an adult, there’s certain things that are going to be going on, if you’re a child there’s going to be certain things. If you’re an elite athlete, there’s going to be certain conditions you’re going to be battling more than someone who’s in a corporate job office.

Mike: There is no such thing as homeostasis. Homeostasis means perfect health. There’s no

such thing as homeostasis. Homeostasis is a theorem. That’s it. So, everybody has a pattern, you are right.

Spence: Any traditional Chinese medicine practitioner will find out what your goals are, and in reproductive medicine it’s most often a baby. We need to find out what would need to happen for you to bring you closer to the balance that has seen to be most often effective over time, over the millennia to restore fecundity or to restore fertility, and we move toward that. It doesn’t mean that that’s exactly where every woman’s going to need to be but we move toward that. Depending on the patterns you have in life, it might be a different journey there.

Mike: Absolutely.

Spence: Okay, unexplained – that was great. So, could we move into PCOS or polycystic ovary syndrome, another very different clinical picture?

Mike: PCOS is an interesting thing. I guess for those of you have it, you already know what it is. For those of you who don’t have it, and want to know what it is, it’s where a woman – well, actually it’s quite confusing and may require some explanation. I’ll just start at the basics and then I’ll contradict myself. Let’s do it this way, polycystic ovarian syndrome indicates a group of women that don’t ovulate, that are anovulatory. And there are other women that don’t have polycystic ovarian syndrome, they also don’t ovulate, but they don’t ovulate for different reasons. So, what happens in the PCOS patient is there is something in the brain called luteinizing hormone, otherwise known as LH, and it’s pulsatile. It just goes up and then it goes down, and an hour later, it goes up and it goes down. Every hour, it goes up. So, women with PCOS, their pulsatility of the LH happens quicker than the hour. I don’t know the time, but let’s just make believe it happens every 20 minutes. So, they’re constantly getting this high level of FSH, which is luteinizing these follicles. But the follicles could be 6-8 or 6-9mm. When a follicle is matured and a woman ovulates, it’s 20mm follicle on a natural level. So, these are 6-8mm follicles where luteinization helps the LH goes up and then the woman ovulates. But what happens is, because her eggs are very small, the LH goes up, but she doesn’t ovulate. So, this is called Luteinized Unruptured Follicle Syndrome, otherwise known as LUFS. So, she develops all these cysts in her ovaries and it’s a very big and complex disorder. So, not only does she have cysts on the ovaries, but frequently the PCOS patient has  

hyperinsulinemia, elevated testosterone levels, that can be hirsutism, which means hair, a lot of hair on the face, the breasts, the thighs, the stomach, acne. PCOS, it’s a spectrum disorder. There are some PCOS patients that ovulate every month and it’s totally fine. That’s over here. And over here, these women have clitoromegaly, they lose their hair, their breasts diminish, they look like men, they have beards almost. I mean, they’re never going to get pregnant and that’s all the way on the other end of the spectrum. I’ve never seen a patient like that in 21 years, but the typical PCOS patient is anovulatory. The typical course of treatment for that patient is to give her Clomid, there’s many ways to do it but you can give her Clomid and intercourse or you can give her Clomid and insemination and see if that works.

Spence: Clomid is a Western medical prescription.

Mike: Yeah. Clomid is a Clomiphene Citrate, it basically makes the woman ovulate. The other thing I wanted to say is that women with PCOS frequently, not always, have elevated testosterone levels. And testosterone is an anti-estrogen, and estrogen does two things in a woman. First of all, the follicles emit estrogen, but interestingly estrogen also nourishes the follicles, and so in the ovarian milieu, in the ovarian environment, you have some estrogen, you also have a little bit of testosterone, androgen, which gets converted into estrogen, but what happens in the PCOS patients, they have too much testosterone and it’s an anti-estrogen, and what does that mean? It means that the eggs are not getting nourished enough from the estrogen because they’re being kind of blockaded or overcome by the testosterone. What happens in fact is that PCOS patients are twice as likely to miscarry as the non-PCOS population, because by the sheer fact that you have PCOS, it means you have poor egg quality unless your testosterone levels are normal. But if your testosterone is high, you automatically have poor egg quality. And now the interesting thing about PCOS, the other interesting thing among many, many different things, but 50% of the PCOS population are obese and 50% are normal morphic, which means they have a normal regular average body. And the women that are obese are more problematic than the women that are normal morphic because obesity can also trigger the excretion of additional testosterone. So, these women — I don’t know the word there, they have a lot of testosterone, and that’s a problem. Again, with acupuncture and herbs, so these women are amenorrheic very frequent, they don’t even have a period. The main goal in this patient is not to get a pregnant, because you’re never going to get a pregnant, what you have to do is you have to regulate the period, because when the period is regulated, then the

ovulation is regular, and that she can go to work. Here’s I guess what I want to say, which is really about keeping it real for me. If I met a woman on the street who had PCOS and she didn’t ovulate and she wanted to get pregnant, you know what I would tell her to do? I’d tell her go to the doctor and take Clomid, and of course, to do a couple of IUIs. It’s easy, why should she come to an acupuncturist twice a week and spend a lot of money on acupuncture, on herbs. Listen, it’s like this, when I have a headache, I don’t have some acupuncture needles, I take two Advil and I relax, my headache is cured. When you have a PCOS patient that doesn’t respond or is called refractory, they don’t respond to the Clomid or to Letrozole, which is another type of medication or even IVF – why not, why aren’t they responding? Well, they’re ovulating because they’re taking Clomid or they’re taking Gonadotropin, injectable medication. You know they’re ovulating – so why aren’t they getting pregnant? Again, because of the egg quality. So, it’s the same case as I mentioned before, except it’s a little different: if the patient is really just under your care, your job, our job is to help regulate the period, which automatically regulates the ovulatory cycle or ovulation. And, in addition to doing that, driving blood flows to the ovaries, follicles and eggs so you can improve the egg quality.

Spence: Right. Polycystic ovary syndrome, it’s that metabolic storm, which is code for everything’s kind of out of balance, hormonal, for the most part insulin levels and cortisol levels, FSH, LH, which you’re explaining.

Mike: One other important thing, I just want to mention really quick, which is really interesting. I don’t mean to make it too confusing, remember in the beginning, I was a little bit confused because I didn’t know where to start, but I do know where to finish. There are many PCOS patients that do not have polycystic ovaries. So, when you have polycystic ovaries, that’s a physical finding, but you can have PCOS in the absence of physical findings because you can have what’s called ‘biologic PCOS’, which means that your LH is three times higher than your FSH and you have hirsutism, an elevated testosterone, elevated insulin, but your ovaries look normal, but you still have PCOS.

Spence: And that often may be the atypical PCOS , normal morphic, which you refer to, not the obese patient. One caveat I do want to say is that in my experience with, if it is something that people want to address and there may be younger and they realize a few things like there may be a genetic component, which they might pass down to their offspring, and you know

the chance of miscarriage like you said is higher as well, if they do want to come and work with traditional Chinese medicine for some time or even with themselves diet lifestyle, it’s like a type-2 diabetes scenario. It’s a condition that’s quite treatable but it requires a lot of commitment in time – is that your experience as well?

Mike: Absolutely. One of the differences between Western medicine and Chinese medicine is that in a certain sense Western medicine, and listen I always tell people without Western medicine we’d all be dead, I’m a huge proponent, I’m a huge fan of Western medicine, I go to a doctor, okay? So, I’m not knocking that, but — I think I lost my train of thought, I’m sorry. In any event, there’s nothing much that a doctor can do except make you ovulate and do an IUI and IVF. Under the care of acupuncture herbs, you can perhaps potentially, not infrequently, menstruate regularly, ovulate regularly, and probably even more important than that is improve the egg quality.

Spence: And adjust maybe the underlying mechanism that is adjusted at least to a point where you change the trajectory of the woman’s health that over time maybe insulin sensitivity returns and testosterone levels maybe come down. It’s like the management of that. I’ve used the type-2 diabetes because it’s a very similar condition. The first thing that I think is important for PCOS patients to understand if they do want to stick in that natural realm and they’re not listening, you know, when someone says, well, just take Clomid, do an IUI, there’s going to be some time and commitment involved.

Mike: Oh. that’s what I wanted to say. Western doctors, Western medicine spoiled patients, and what I mean by that is you go on prescription, and that’s the level of your commitment. That’s it. You get the script, you get an exam, and then you just take the medicine and you’re fine or you’re not fine. But in Chinese medicine, you have to commit to going once or twice a week, sometimes for a year, sometimes for three months, sometimes for three weeks, depending upon what you’re treating. But it requires participation on the part of the patient. And look, don’t be lazy if you want to get in shape, you got to get yourself to the gym. You know, if you want to learn how to play the piano, you’ve got to practice every day. If you want to get better, sometimes it requires your participation. That’s the train of thought that I lost and you brought it back.

Spence: Cool, just that commitment level for PCOS is important. Let’s dive into endometriosis  

quickly, diagnosis, Western medical treatments, and how TCM would reframe and try to treat that if it can or can’t?

Mike: Endometriosis is a fascinating subject, so first of all, it’s an autoimmune disorder, and I have a lot to talk about but I’ll try to keep it succinct. First of all, it’s an autoimmune disorder, right away, immediately, any woman who is trying to get pregnant with endometriosis, you should do a reproductive Immunophenotyping panel, which is a panel that determines if the woman has any other autoimmune issues, including those that can cause blood clotting. And that’s very important to note because there are many autoimmune issues, there are many times that women will have autoimmune markers but they don’t express the autoimmune disease. For example Lupus Anticoagulant, this is a type of blood clotting, a type of Thrombophilic disorder, a blood clotting disorder that can cause blood clotting in the uterus, and this will cause second or third trimester miscarriage, it can cause stillbirths, and even sometimes, it is not often, it can cause infertility. And the woman will have no signs or symptoms at all, and yet, it can mitigate her chances to get pregnant, it can activate natural killer cells, protein C, protein S, there’s many different autoimmune issues that that can mitigate one’s ability to get pregnant. And if a person has endometriosis, then they may have other things that should be looked for. So, that’s a very important point. Now, the other thing is, there are some reproductive medical doctors that don’t believe that autoimmune issues can mitigate fertility, and there’s a whole other group of reproductive endocrinologists said that they do believe in that. And my suggestion is, do the tests, because what have you got to lose, you’re going to spend some money and get the test. I’m not asking you to get open-heart surgery, get the test. It’s a blood draw. And if you have these things, why not treat them? If you haven’t treated them before, you treat them and then what happens is you get pregnant, you have a baby. Anyway, getting back to endometriosis, it’s an autoimmune disease, and by definition endometriosis means the endometriotic tissue belongs where? It belongs in the endometrium, the top layer of the uterus. And so by definition, endometriosis means ectopic deposition of endometrial tissue, meaning, endometrial tissue is in your nose, in your lungs, in your uterus, is in the cul-de-sac, in your bladder and your rectum, it can be all over the place. And what happens is these deposits of endometrial tissue respond to hormones, estrogen and progesterone, and just like when a woman is menstruating, these depositions of endometrial tissue, in a sense, they are menstruating too. They bleed, they cause scar tissue, they invaginate the tissue meaning, they dig into the tissue, they contact nerves, it can be

extraordinarily painful. The other interesting thing is that the mean time to diagnosis for endometriosis is 11.6 years. Women can be 30 years old, have by the way unexplained infertility. Because sometimes frequently, endometriosis is completely asymptomatic, a woman can have stage 4 endometriosis, endometriosis is all over the place and have not one single symptom. Conversely, if you took a pin and just hit it on a piece of paper, made that very little dot, she can have that much endometriosis and has severe, debilitating, agonizing pain every month, premenstrual symptoms. So, first of all, let’s go back – as an acupuncturist, what should we be asking every patient that comes in? Well, this is what we should be asking: when you’re menstruating, do you have severe, debilitating, pelvic pain? Yes/No. When you’re menstruating and you move your bowels, when you’re menstruating and you move your bowels, do you have rectal pain? Yes/No. Do you have severe debilitating pain when you’re ovulating, when you’re vaginally lubricated and you’re having intercourse, do you have pain with deep penetration? Now, if the patient answers yes to two times out of those four or five questions, I send it over to a laparoscopic surgeon for an evaluation. There are two ways to diagnose endometriosis. One is a lucky sway and one is not so lucky. The lucky way is you get an ultrasound and you see an endometrioma, which is a tumor made of endometriotic issue on an ovary. So, bang, we see it on an ultrasound, we know the patient has endometriosis, but what if she has a couple of these symptoms but you do an ultrasound and you don’t see anything? Well, that doesn’t matter, because she can have endometriosis in the cul-de-sac, which is around the rectal area, you’re not going to see that under the transvaginal ultrasound. In fact, a very good doctor who’s checking for endometriosis will do a rectal exam, a digital rectal exam. Many doctors, if not most, don’t do that to women who they suspect has endometriosis. Why do you do that? Because the cul-de-sac is an area, if I remember correct, anatomically between the uterus and the rectum. It is down near the rectal area. So, there can be endometriosis there. That’s why she has pain when she’s menstruating, when she defecates. If you do a digital palpation up there, and a patient that has endometriosis in the cul-de-sac, she’s going to scream. So, it’s a very difficult disorder. Now, let’s talk about how to treat it. Once you send the patient for a diagnostic workup to a laparoscopic surgeon and the surgeon finds that she has endometriosis, one has to realize that a laparoscopy is both diagnostic as well as therapeutic. Once the doctor’s in there and they see it, they’re going to go ahead and operate. They’re going to reset all that endometriosis. Oh, by the way, let me step back for a second. I had a conversation with a reproductive endocrinologist recently who I respect and I like very much, he’s a dear friend of mine, he’s a very smart doctor, he says to me that

endometriosis doesn’t cause infertility unless it causes tubal damage, and I completely disagreed with him and told him that. Why does then endometriosis in the absence of tubal damage cause infertility? For many reasons. First of all, it actually affects the uterus even though endometriosis by definition is a disease that happens outside of the uterus – how does it happen? Because there’s endometriotic depositions secrete something called ‘proinflammatory cytokines’. For lack of a better explanation, these are inflammatory products that find their way where? They find their way into the uterine cavity, so you know, the testicles are one degree less in temperature than the rest of the body. That’s why the testicles are outside of the body. I don’t know the temperature of the uterus, but the uterus must have a static temperature or a temperature range, so when you have proinflammatory cytokines in the uterus, it’s heat, it’s inflamed and it’s not a proper environment for reproduction and she’s not going to get pregnant. Now, where can acupuncture get involved in treating the endometriosis patient? Is there a place for acupuncture and the endometriosis patient? The answer is yes. Now, two minutes ago, I said we can’t treat it. So, I’m going to just take that clay and reshape it a little bit. You send the patient for laparoscopic resection and she does that, she’s fine. You still must do acupuncture on her and use herbs to clear heat and I don’t want to get too technical in Chinese medicine, you want to use the anti-inflammatory herbs – why? The doctor already took out the endometriosis. Here’s why: because endometriotic tissue can be purple, brown, black, red, but guess what, some endometriotic tissue looks as normal as normal tissue. Even when a woman has a laparoscopic surgery, there’s probably a 95% chance that she still has some endometriosis in the body but the doctor can’t visualize it. I always assume that she does, and I don’t give her very cold herbs because I don’t want to mess up the stomach and it can cause all these things, but I give her some cooling herbs and I use certain acupuncture points. I don’t want to get too technical, gallbladder 43, liver 2, spleen 10, liver 8, these things that can clear heat from the body. So, my proposition to acupuncture says, treat the patient for endometriosis after she’s had a laparoscopic resection.

Spence: Well, in a lot of other ways, there’d be an opportunity to optimize the fertility in that patient as well, because they’re also told as soon as they have that laparoscopy that the next three to six months are a fertile window for them, so they’re excited and hopeful and ready to come for acupuncture probably anyway. That’s fantastic.

Mike: Just for the patients to remember is speak to the doctor about a reproductive

Immunophenotype panel. Why? Because you can have all kinds of things that are undiagnosed. You’re still not getting pregnant because you have other things that haven’t been diagnosed.

Spence: Usually where there’s one autoimmune, there’s a bread trap.

Mike: It is very frequent.

Spence: I know you could go on about endometriosis for a long time, but I want to skip quickly into a recurrent pregnancy loss or miscarriage. There’s not a lot out there for but maybe a good segue is the autoimmune paneling as well, ‘m not sure what your thoughts are there.

Mike: Chronic recurrent miscarriage can be caused by many things, it can be caused by undiagnosed disease, for example endometriosis, or you know let’s take a polycystic ovarian patient who, she does ovulate but the eggs are no good so she has a chemical pregnancy. She constantly miscarries.

Spence: Advanced maternal age.

Mike: Advanced maternal age, which basically translates into egg equality, again, so she’s miscarrying. Sometimes, it’s implantation failure, sometimes, it’s very interesting, there’s cross talk between an embryo and the lining, they talk to each other. They have to talk to each other just like you and I are talking to each other. There has to be a mechanism for communication. Right now, we’re doing this on computer, we could do it on the telephone, we could do it in person, but if we’re just not connected, we can’t talk to each other. So, it’s the same thing with the uterus and the embryo. Sometimes, the uterus, the urine lining is not in sync with the embryo, and so this may require an in vitro fertilization because you have to transfer the embryo at a certain specific time when the uterus is receptive, and there can be uterine problems, there can be Asherman syndrome, which means you have scar tissue in the uterus. That’s something that’s not an acupuncture issue, that’s a surgery. The good news about Asherman syndrome is that 99% of the time, it makes the uterus fine and you’re going to be okay. But let’s talk about a chronic recurrent miscarriage as a result of poor egg quality, it just  

goes back to the very beginning of our conversation – we have to improve the egg quality. And by the way, we keep talking about egg quality. The egg quality could be fine, it could be sperm quality. And listen, an embryo takes two things, sperm and an egg, and then they make an embryo. Unless the sperm is great and unless the egg is great, you’ll get an embryo but it won’t be a good embryo, and so you’ll have a chemical pregnancy, you’ll miscarry at four weeks or six weeks or that kind of thing. And this is why by the way I will never treat a woman ever unless her husband has had a semen analysis, or unless promised to get one..

Spence: With recurrent loss or just fertility period?

Mike: No, with infertility case. I will never treat them unless they get a semen analysis because, listen, it could be either that they both have pathological presentations that can be worked on or it could be that the woman is totally fine, and it’s the guy. That’s a very important thing for acupuncturists to know as well as for patients to know.

Spence: I give an Amen to sperm quality and miscarriage or fertility in general, but there’s still such debate of how much sperm contributes to fertility period, and unfortunately, men aren’t going to carry the pregnancy so they’re further shuffled aside as well as being very little treatment from biomedical technology for sperm or pharmaceuticals, so they’re shuffled aside again more there. That is a place where acupuncturists have a lot that they could contribute.

Mike: Men with sperm anomalies, they do well with acupuncture and herbs unless they don’t. Meaning, they have very serious issues, they have a Microdeletion of the Y chromosome or they have a severe Varicocele, or tubal vasectomy, these kinds of things. Those are quite difficult cases, sometimes impossible cases. But if you get a guy with no history of testicular trauma or surgery, and those are usually idiopathic, those are usually a no known cause, the guy just has very low sperm count, or another big thing in men is Sperm DNA Fragmentation. What happens as a result of that is it can’t penetrate the egg, so what doctors do, they do ICSI, Intracytoplasmic Sperm Injection with the injected sperm into the egg. But my feeling about that is if the sperm has DNA fragmentation, and so you’re injecting a poor quality sperm into the egg maybe she gets pregnant, has a great baby, but maybe she doesn’t, because you’re forcing a square into a circle. Men with DNA fragmentation are very good candidates for acupuncture.

Spence: That’s a great segue. I want to wrap it all together, I mean, there’s other things we could chat about a little bit more in depth, but IVF or assisted reproductive technologies, IVF, ICSI and the like – what conditions the reproductive health conditions respond well to IVF treatment, and what places that we were just talking, like the male factor, would acupuncture Chinese medicine really be able to contribute and help support or be an alternative?

Mike: So, you’re asking me, just to make sure I understand, which female cohort would do well with IVF and which male cohort would do good with acupuncture?

Spence: I just stay with the female to start. We kind of touched on the male side, that’s maybe a separate topic anyway.

Mike: Okay. Here’s the thing, a woman needs to have an embryo in the uterus and the embryo needs to invade the uterus, which is called implantation, and sometimes it just doesn’t happen because for whatever reason the sperm doesn’t penetrate the egg and all of us back it up, let’s back it up all together. The woman has scar tubes, scarring on the fallopian tubes. She’s never going to get pregnant, she has to do IVF. So, that’s a perfect reason to do IVF. Scar tubes. Let’s say a man has very low sperm count, let’s say a guy has 3,000 sperm. He can’t get her pregnant by ejaculating into her, so you take one of those sperm and you create an embryo. You mix the sperm with the egg and you create an embryo – that’s a perfect reason to do IVF. Now, there are other reasons to do IVF. In these unexplained cases, sometimes you retrieve an egg, fertilized it, take the embryo and put it in, and she gets pregnant. Even the PCOS patients, many of them do well and have babies with IVF. Look, I think IVF is a very good tool, there’s been about 4 million babies born as a result of IVF, 4 million babies! That’s nothing to sneeze at. I think IVF is a good thing for patients that can’t get pregnant but I do think it should be a stepwise approach. If you’re not getting pregnant, get worked up, get evaluated, find out what the underlying pathology is. You have scarred tubes, the husband’s sperm is no good, the lining is 4mm, find out what the issue is, then go in and start with IUIs. Unless the husband has a very low sperm, but if the sperm is decent, do IUIs, do four or five of them. And then, if that doesn’t work, try an IVF. I think IVF is good for any patient that’s not getting pregnant, and I believe in IVF and I believe in IUIs. So the patient may say, the person watching this may say, then why should I get involved in acupuncture? Because what if the IVF constantly

doesn’t work, which is very frequently the case. Why isn’t it working? It’s not working because you have bad egg quality or bad sperm quality or bad uterine lining quality and the physician can do nothing for you, but we can. And so that’s why it takes the village.

Spence: Awesome. I love that. I think that’s a great place to wrap it up, Mike. It’s true, it’s why there’s the village. You have become really great friends with REIs in my hometown, and it’s great to live in a time where at least some of the ego is being taken out of medicine and we’re working toward the common good of the patient and that’s happening like wildfire in reproductive medicine. Because of people like you, and I know this is a quick hour –

Mike: Thank you.

Spence: Thank you, Mike. This is a quick hour, but we could go on and on, maybe we’ll split these topics up a little bit more so people can get a little bit more in depth about Chinese medicine and have a little bit more of an idea, because it is that unknown, it is a little bit weird and it’s different. Just it’s not what we’re used to for the most part, but for the sake of everyone listening today, I trust that you got some great pearls and a deeper respect for acupuncturists.

Mike: May I say one more thing to the listening audience, ladies and gentlemen just remember what I’m going to say, this could be the most important thing that I’ve said. Acupuncture and herbs will not ever hurt you, they will only help you or they won’t, but they’ll never hurt you. So, there’s nothing to fear. That’s the last reason that you should not come in.

Spence: So, if there’s a possibility to help?

Mike: Indeed.

Spence: Awesome. Well, Mike, we will be back, I am sure. I always enjoy our time and I know we’re going to hang out here this weekend. I’m excited that you will be on the west coast soon.

Mike: Hey, can I give my email website?

Spence: It will all be in the show notes, but yeah, please, how can people get a hold of you? For the listeners, some people might just be listening. berkleycenter.com.

Spence: And email, they can get it from the website. So, check out, you know, Mike’s been in Manhattan forever, and he is the man that really pioneered and built the Trojan horse, I think I’ve used that analogy today, I don’t know, but keep up the good work, Mike. We look forward to having you on the show again, and good luck to everyone listening and watching on your journey.