IVF has taken us as far as it can with embryo quality now that screening of embryos with PGS is becoming routine. Yet only half of chromosomally normal embryos implant to become a viable pregnancy. Our attention must turn towards the uterus and the receptivity of its lining, the endometrium. Chinese medicine may be able to lead the way with helpful interventions to improve the quality of the lining.

1. A good looking uterine lining!
What is a good looking lining?
Why do I want one?
How do I get one?

2. Where to next? - The hidden frontier
PGD tested embryos still only have a 50% chance of creating a
viable pregnancy. That is why we are must now focus more on
the uterine lining, its receptivity, blood flow and implantation
sites. How can we improve those?

3. Looking inside the uterus
(saline infusion hysteroscopy)
A Abdel-Gadir, www.gynaecologist4u.com
The smooth edges
indicate that there are
no polyps or fibroids.
.

4. A good looking uterine lining looks a
bit like this

5. Or this

6. Actually, like this
A Abdel-Gadir, www.gynaecologist4u.coml
The endometrium appears as a single thin line immediately
after menstruation. This then expands under the influence of
oestrogen in the follicular phase of the cycle to the typical
trilaminar appearance.

7. Or this, can you see the 3 layers?
A Abdel-Gadir, www.gynaecologist4u.com
Studies of women having frozen embryo transfers show that
this triple-line pattern is more often present in those who
successfully conceive.

8. And it is good and thick and juicy
A Abdel-Gadir, www.gynaecologist4u.com/
Studies suggest that a uterine lining thickness of 6 mm
or less results in fewer pregnancies. Ideally it will be 8-
10 mm before implantation.

9. An implantation site
Errol R. Norwitz, et al NEJM 2001 345: 19,1400-1408
Cytokines (immune factors), integrins (adhesion molecules)
and pinopodes (attachment structures) are among just
some of the important components in the lining which
make up an implantation site.

10. Blood flow to the lining is important
A Abdel-Gadir, www.gynaecologist4u.com
Women with good endometrial blood flow were often found
to have better outcomes during IVF cycles.

11. Blood flow and implantation
A Abdel-Gadir, www.gynaecologist4u.com
Some studies show that when good blood flow is visible on
ultrasound in the endometrial and sub-endometrial regions,
implantation and pregnancy rates can be significantly higher.

12. Electro-acupuncture increases flow of
blood in the uterine arteries.
http://acupuncturepregnancy.com.au/reduction-of-blood-flow-impedance-in-the-uterine-
arteries-of-infertile-women-with-electro-acupuncture/

13. Why is all this important?
• Its really important if you are trying to conceive
whether naturally or with IVF
A good uterine lining means ….....
• Embryo implantation rates are better
• You are more likely to have healthy
placenta
• And bottom line, you more likely to have
a baby

14. And cutting to the chase…..here’s how you can
improve your lining before trying to conceive or
attempting an IVF cycle
1. Check for polyps and if you’ve had a previous miscarriage,
retained products. Some fibroids may need removing
2. Ensure hormone levels are advantageous for implantation
(especially important in IVF cycles)
3. A complete and thorough menstrual discharge in the
previous cycle helps build a new lining (use herbs for this)
4. Have electro stimulation on specific acupuncture points at
specific times.
5. Use certain well known herb formulas to improve
implantation.

15. What should you do?
• Ask the radiographer if there are any polyps,
retained products, impeding fibroids or
structural abnormalities that need surgery.
• Make sure your menstrual flow is fresh red,
not clotty, flows smoothly and is completely
discharged – use Chinese herbs to help this.
• Talk to your Chinese medicine doctor about
the use of electro-acupuncture and certain
herbal formulae to improve the uterine lining.

16. What is electro-stimulation of
acupuncture points?
Fine needles are gently inserted into acupuncture points on
the abdomen and legs, or TENS pads are placed on these
points, and a mild current is passed through them so a pulse
can be felt.

17. How do we know it works?
• Several studies in China, using electro-stimulation
of acupuncture points have shown increased
implantation and pregnancy rates in IVF patients.
• One of these studies looked at the effect of
electro-stimulation of acupuncture points on the
pregnancy rate after frozen embryo transfer and
noted that the uterine lining of the women who
had the treatment was much improved in
structure and quality. This correlated with
significantly higher implantation rates and birth
rates.
• http://acupuncturepregnancy.com.au/category/research-and-
reviews/acupuncture-herbs-and-ivf-other-publications/

18. What did they do?
• For the 3 menstrual cycles
before the frozen embryo
transfer, these women had
treatment using acupuncture
points on the abdomen and
legs. They came 4-6 times a
month, especially in the first
half of the month when the
uterine lining is being prepared.

19. Zi Shen Yutai Pills
http://acupuncturepregnancy.com.au/category/research-and-
reviews/acupuncture-herbs-and-ivf-other-publications/
This formula, which has been
used for hundreds of years in
China to help prevent
miscarriage has been shown
to improve implantation rates
in IVF patients. The
mechanism appears to be
improving uterine receptivity
by upregulation of integrins
and other markers.

20. What we offer in our clinic
• We advise all our patients who are preparing for
an embryo transfer to take the time to prepare
the endometrium as well as possible before
hand.
• This means a good diet, avoiding toxic
substances, having stable and balanced
hormones and qi (this helps to balance the
immune system) and priming the uterine lining
with acupuncture treatment, and in some cases
herbs.
http://acupuncturepregnancy.com.au/acupuncture-for-frozen-embryo-
transfer/

21. For information on other treatment
programmes and clinical trials please see
http://acupuncturepregnancy.com.au