How long should you wait between children?

A study conducted by the CDC found significantly higher numbers of adverse pregnancy outcomes when couples either did not wait long enough between children, or when they waited too long. The optimum time for the healthiest pregnancy was 18 – 23 months. In other words, infants CONCEIVED between 18 and 23 months had the lowest number of adverse outcomes…. I’d like to see a study on the optimum time for the psychological health of the parents 🙂

N Engl J Med. 1999 Feb 25;340(8):589-94.

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Assisted Reproductive Technology (IVF and IUI)

For almost 40 years now ART (Assisted Reproductive Technology) has been available in the United States. While the technology can be a game-changer for many couples, it’s incomplete. According to the most recent SART reports (from the CDC), the best ART outcomes (using In-Vitro Fertilization or “IVF”) have a success rate below 50%. Why is that? Why can you take a perfect embryo, transfer it into a perfect uterus and still end up without a pregnancy?

The reason is that reproduction isn’t the act of an embryo meeting a uterus. That is only one step in a complex process that involves every biological system in the body. Because of this, it is impossible to control it through external processes.

Consequently, the way to maximize one’s chances of ART success (such as IVF) is, perhaps paradoxically, not to focus on the reproductive system. What we need to do is make sure the orchestra of physiological systems within the body is operating harmoniously. But how do we do that? This is where Chinese medicine comes in.

Chinese medicine has developed complex diagnostic and treatment systems to identify where an imbalance is coming from and to either help eliminate it, or help the body address the imbalance to restore reproductive physiology. Because we look at the whole body, we’re able to complement IVF by addressing the portions of IVF that are not controlled by medication such as implantation and subsequent fetal development.

At the Lotus Center, we have a division that specializes in reproductive medicine and obstetrics, and has been helping IVF patients get pregnant and deliver healthy babies for over 20 years. Our acupuncturists are internationally recognized authorities both in Chinese reproductive medicine and in Functional medicine: having multiple peer-reviewed publications, including authoring the reproductive medicine chapter in one of the most highly regarded medical textbooks on Functional Medicine.

Natural Conception

Reproduction is a biological imperative and our bodies have evolved to survive and reproduce. As a result, the successful treatment of reproductive issues often has more to do with removing impediments to reproduction than directly facilitating conception.

This can be seen, for example, by the fact that the average in-vitro fertilization success rate is less than 50%, even in women under 35 years old. By the time a woman is 41, the success rate has dropped to less than 8%. IVF places a viable embryo into a presumably viable uterus and even with that degree of facilitation it fails the majority of the time. This is because most cases of infertility come from impediments that have not been identified and/or addressed. So where do these impediments come from? There are many including structural, physiological, energetic and emotional causes (for a much more extensive and technical discussion, please see the reproductive chapter we wrote for a medical textbook).

In our clinic, the first step in identifying impediments is conducting a thorough evaluation which includes both a history and physical examination. In a typical case, during the initial consultation we are able to identify the issues that are most likely impeding conception or the ability to maintain a pregnancy. Depending on the findings, we may recommend following up with specific labs. For a complete assessment, we recommend some basic imaging studies as well, in order to rule out tubal blockage or other factors that would make natural conception physically challenging.

For natural conception (or really for any type of fertility treatment) it is also important to assess the health of the male. Male-factor is known to contribute to 50% of infertility cases, yet men are often de-emphasized. If the semen parameters look adequate, then nothing is done other than a standardized vitamin/supplement prescription. This is a mistake. Men’s overall health and habits can have profound effects on a pregnancy. For example, while genetically abnormal embryos are usually blamed on poor egg quality, they are in fact mostly due to paternal factors, the biggest one being paternal age. But why does age do this? It’s because of damage accumulation which can be due to a wide variety of modifiable factors. Yet these don’t show up in a normal semen analysis. Paternal habits can also affect fertility and pregnancy. For example, alcohol consumption in men increases miscarriage rates in their partners. There are many other reasons why men should be just as involved in the fertility journey as women. The difference is once the woman is pregnant, male habits (other than being a source of stress for a spouse) tend to have minimal impact.

While the first phase of treatments is to remove impediments, once these are significantly dealt with, we then turn to actively facilitating conception. This involves protecting and rejuvenating the ovaries, optimizing reproductive blood flow and working on a variety of “anti-aging” techniques to both preserve and optimize fertility.

Pre-Conception

Approaching pregnancy is conceptually no different than approaching any other major life event. If you want to maximize your chances for a good outcome, then preparation is essential. But what does preparation mean in the context of pregnancy? In Chinese medicine, we divide pregnancy preparation into 3 major categories: preparation of the body, preparation of the mind/spirit and preparation of the environment.

Preparation of the body involves first identifying where your strengths and weaknesses are. People are often hyper-focused on the reproductive system, but this is a wrong understanding of physiology. Of course part of preparation includes an evaluation of the reproductive system, but you need to evaluate all of the systems in the body. Chinese medicine has evolved diagnostic techniques that, when mastered, enable a doctor to quickly hone in on problematic areas. Labs and imaging are complementary, and can be useful, but are not an adequate substitute for a skilled Chinese medicine diagnostician. We have seen this over and over: patients with piles of labs and imaging that weren’t able to identify the real problems.

Once any issues have been identified, of course they need to be corrected. Some issues can correct immediately and others take time. For example, certain kinds of oocyte (egg) quality issues can take over a year to improve, whereas other kinds can be corrected within a few weeks. Some issues are persistent and are difficult to completely cure, but can be controlled with regular treatments. Some examples include severe endometriosis, adenomyosis and certain reproductive infections. But the reproductive system itself is often not the most important part of preparation, rather it’s identifying problems in other organs or systems, since ALL of them are involved in reproduction.

The second area is to prepare the mind/spirit. The subconscious is real and can have profound and tangible influences on your life as a whole, let alone your ability to reproduce. There are many ways to work with your subconscious, but in preparation for having children, we have found many people have subconscious blocks with having children. For example, some people paradoxically are not ok with the idea of being a parent, or being pregnant. They may have deeper fears of body image or fear of loss. Some people who have had abortions in the past feel guilt and that they deserve to be infertile. There are a wide variety of problems that we may or may not realize we have, and if your subconscious doesn’t want you to be pregnant, it has a wide variety of tools at its disposal to keep that from happening.

Finally, preparing the environment is essential. This in Chinese medicine is referred to as “feng shui” which is the art of how energy flows. But energy flow isn’t just about taking a compass and putting a statue of a turtle in the corner of your house, it’s about identifying things that disrupt a good flow of energy which can include many types of things in your environment; be it noise pollution, air pollution, EMF pollution … or even people around you that exude a lot of negativity, including spouses! While we don’t have to resolve everything, creating a safe and comfortable environment can greatly promote fertility and proper fetal development.

Keep in mind that perfection is not required, but over the last 20 years we have seen these factors play decisive roles in couples who had not been able to conceive prior to making these changes.

Airi Watanabe

Airi Watanabe, MTOM, LAc, NCCAOM is a specialist in acupuncture and herbal medicine with a background in sports medicine. She received her bachelor’s degree in Exercise and Sport Science from Concordia University Irvine and her master’s degree in Traditional Oriental Medicine from Emperor’s College. She has extensive training in orthopedics. Before starting her journey in traditional oriental medicine, Airi worked as a sports trainer, touring with various famous bands in Japan. She is also a certified pilates instructor and is primarily interested in pain management and treating mobility disorders.

Being born and raised in Japan, Airi is bilingual in English and Japanese, and is part of the research team at the Lotus Center, translating articles on Japanese traditional medicine. When not seeing patients or researching, she enjoys watching anime and movies, bouldering, running and going to Japanese grocery stores.

幼少期よりダンスやスポーツに触れ、スポーツ医学に興味を持つ。日本で高校卒業後、アメリカに留学し、アーバインコンコーディア大学にてエクササイズ/スポーツサイエンス学部を卒業。日本に帰国し、アーティストグループのトレーナーとして働くかたわら、ピラティスインストラクターの資格を取得。またトレーナーとして様々な施術をするうちに、東洋医学に興味を持つようになり、アメリカにて東洋医学修士号（MTOM）を経て、カリフォルニア州鍼灸師免許（LAc）、米国東洋医学認定鍼灸師免許（NCCAOM）の資格を取得。LCIMでは鍼灸、およびハーブ（漢方）を用いて、身体の痛み、および運動障害を中心に、様々な治療を施す鍼灸師として活躍中。また、日本で独自に発展した漢方を中心とした東洋医学の文献を翻訳し、LCIMの鍼灸師たちの治療に取り入れるためのサポートをする。趣味はアニメや映画鑑賞、ボルダリング、ランニングやウォーキング。

Lotus Center for Integrative Medicine

How long should you wait between children?

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