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Enhancing Implantation with Chinese Medicine

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For a pregnancy to occur, an embryo must burrow into a woman’s healthy, receptive uterine lining and connect to the blood supply. Her immune system must allow this invasion, and the blood flow to the developing fetus must flow well enough to sustain its development. An implantation “window” (the time when the lining is optimal for an embryo to attach itself) is present during a woman’s menstrual cycle about 6-10 days after ovulation. After an IVF transfer with a blastocyst, the window is the following 4 days. For many women, this may be a particularly anxious time and we often get asked what can be done during this time to increase the likelihood of a pregnancy. 

While it is helpful to care for your body and mind during this time, the most effective way to influence your implantation window is with early preparation, ideally in the months leading up to your transfer, IUI, or timed intercourse. This can include acupuncture and herbs, as well as diet and lifestyle adjustments to support a healthy uterine lining, hormone balance, and uterine circulation. Successful implantation is a complex event requiring many factors including expression of the correct receptors in the endometrium, good egg and sperm quality (creating a chromosomally normal embryo), adequate lining thickness and blood flow to the uterus, and a healthy immune system. 

Here are some ways to maximize the implantation window

Chinese Herbs

A recent study showed that a Chinese herbal formula (Traditional Chinese Medicine diagnosis-specific) taken in the menstrual cycles leading up to an IVF  and transfer may help support healthy endometrial receptivity by increasing the expression of DNMT1, a protein which may regulate the endometrial genes associated with implantation[1]. Some Chinese herbal formulas, especially when combined with acupuncture, may also help thicken the lining[2].

Acupuncture 

During the implantation window acupuncture treatment focuses on reducing factors that hinder implantation. This includes lowering stress by reducing the stress hormone cortisol and increasing endorphin levels, as well as preventing uterine contractions by maintaining relaxation of the smooth muscles of the uterus. In IVF embryo transfer cycles, some studies show that acupuncture treatments pre and post transfer help to encourage implantation. In a natural cycle, acupuncture not only supports healthy ovarian function and uterine lining, but may also help to relax the fine muscles of the fallopian tubes to assist movement of a developing embryo and prevent spasm. 

Lifestyle 

Avoid high impact, strenuous, intense cardio routines and opt for more moderate, low impact exercises such as yoga, walking, and jogging which relieve stress. For most women, it is ok to continue an exercise routine that your body is used to at this time, with reduced frequency or intensity but may be contraindicated in some (women with fresh embryo transfers).  Check with your doctor about what is right for you. 

Avoid hot baths, saunas, heating pads, and hot yoga, activities that may raise body temperature.  

Embrace your mindfulness practices and look to ways to promote relaxation such as meditation, acupuncture, and fertility massage.  

Laugh and enjoy! A study found that women who received entertainment from a comedic performer post transfer had higher rates of implantation[3].

Avoid taking NSAIDs such as Advil (Ibuprofen) at this time. Anti-inflammatories can interact with the receptivity of the uterine lining and are also problematic for embryos. Consider taking Tylenol (acetaminophen) for cramping instead[4].

Continue taking a prenatal with adequate folic acid (800-1000mcg) and supplement with vitamin D if levels are low[5][6].

Eat a variety of nutrient-rich foods to support healthy progesterone levels including organic and hormone free meat and fish and organic produce. Many women like to include pineapple fruit and its core around this time. There are no studies confirming that it is helpful for implantation, but since it is a delicious fruit, we say why not!  Try 1/5 of a pineapple a day including the core. 

 

What to Expect

Many women do not experience any signs or symptoms during the implantation phase, but some do. Possible symptoms include light spotting, cramping or pulling in the lower abdomen, and tender breasts.

Whether conception occurs or not, it is important to remember that this is the area of fertility that we cannot control yet. Embryo quality and the uterine lining health are typically the biggest determining factor for a successful implantation, not what one did or didn’t do during the implantation window.  If you are struggling with implantation or conception, consider consulting a fertility acupuncturist or Reproductive Endocrinologist.

 [1]Fang, L., Rui-Xia, W., Feng-Mei, M., Zhen-Gao, S., Li-Hong, W., & Lei, S. (2013). Effects of Chinese medicines for tonifying the kidney on DNMT1 protein expression in endometrium of infertile women during implantation period. Journal of alternative and complementary medicine (New York, N.Y.), 19(4), 353-9.

 [2]Guo J, Li D, Liu C, Ji X, Li R, Du X. Effects of Chinese herbs combined with in vitro fertilization and embryo transplantation on infertility: a clinical randomized controlled trial. J Tradit Chin Med. 2014 Jun;34(3):267-73.

 [3]Friedler, S., MD, Glasser, S., MA, Azani, L., MSc, Freedman, L., PhD, Raziel, A., MD, Strassburger, D., PhD, Lerner-Geva, L., MD, PhD. (n.d.). The effect of medical clowning on pregnancy rates after in ... Retrieved from https://www.fertstert.org/article/S0015-0282(10)02958-4/fulltext

 [4]De-Kun, L., PhD, Ferber, J., MPH, Odouli, R., MSPH, & Quesenberry, C., PhD. (2018, September). Use of nonsteroidal anti-inflammatory drugs during pregnancy and the risk of miscarriage. American Journal of Obstetrics and Gynecology. Doi: 10.1016/j.ajog.2018.06.002.Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29890124

 [5]Rudick, B.J., Ingles, S.A., Chung, K., Stanczyk, F.Z., Paulson, R.J., & Bendikson, K.A.(2014). Influence of vitamin D levels on in vitro fertilization outcomes in donor-recipient cycles. Fertility and Sterility, 101(2) 447-451. Doi:10.1016/j.fertstert.2013.10.008

 [6]Garbedian, K., Boggild, M., Moody, J., & Liu, K. E. (2013). Effect of vitamin D status on clinical pregnancy rates following in vitro fertilization. CMAJ Open, 1(2). doi:10.9778/cmajo.20120032


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