Asheville NC Infertility Seminar, Victoria Koos Sept 20-21

[Guest guest]

Kingoff Acupuncture Presents

 

Female Fertility 101

 

Everything you wanted to know but were afraid to ask!

 

NCCAOM Approved for 14 CEU's ACHB # 685-007

 

$295.00 which includes an onsite lunch each day

 

 

Instructor: Victoria Koos, LAc, Dipl Ac, CH

 

(Speaker Profile at the end of this email)

 

Sept 20th – 21st, 2008

 

9:00am – 5:00pm

 

Holiday Inn Asheville Airport

550 New Airport Rd

Fletcher NC 2873

(Asheville NC)

 

(910) 791-3349

http://Tiny.cc/OMCEU <http://tiny.cc/OMCEU>

 

This course provides you with the information you've always wanted to know

but might have been afraid to ask for. This course begins at the beginning,

assuming only that you are familiar with Oriental Medicine, but not

necessarily reproductive medicine. Victoria Koos compares and contrasts the

western & eastern approach to aiding conception. You'll learn how your

patients can benefit from the best of both methods with minimal risks.

 

Your instructor, Victoria Koss, is the most sought after Oriental Medicine

Infertility specialist in Manhattan. In that very competitive market, she

has distinguished herself by producing results where mainstream and other

alternative methods have failed. Her seminar, while comprehensive, is very

accesible. You will be able to immediately apply in your clinic what you've

learned in this lecture.

 

 

Topics Covered in Fertility 101

 

The female endocrine system and fertility; estrogen, FSH, progesterone and a

detailed understanding of the menstrual cycle.

 

How to read a Basil Body Temperature Chart with case studies.

 

Short follicular phase, luteal phase defect, low progesterone, ovulation,

PCOS, anovulation etc…

 

Western diagnostic tests and how to use them to inform TCM treatment.

BBT, FSH, Progesterone, LH, estrogen, thyroid levels; when to take them and

what their values should be.

 

Age, ovarian reserve, and case studies of lowering FSH with herbs and

acupuncture

 

Age, ovarian reserve and responsibility.

 

How to know when a patient may be beyond treatment because of age or high

FSH.

 

Herbal formulas for balancing the menstrual cycle and boosting fertility.

 

Supplements, vitamins, western herbs and diet for boosting fertility.

 

PCOS:

 

What to look for: symptoms, indications, western tests.

 

Treatments: lifestyle changes, diet, metformin, herbs and acupuncture.

 

IVF acupuncture treatment during and after an IVF cycle

 

What the numbers mean during the cycle: dosages of ivf drugs, beta and

progesterone levels, ultrasounds and fetal heartbeat. Beta level, when it is

tested, when it is retested and what it means (ie what are the chances of

miscarriage) Lupron, Menapure and other IVF drugs, their side effects and

how to work with them.

 

Miscarriage

 

Statistics, indications, causes and treatments from an eastern and western

perspective.

Progesterone and miscarriage: cause or symptom? Beta levels and how to

understand what they mean for the survival of the embryo. Talking to

patients about miscarriage.

Thrombophillias, antiphospholipid antibodies, and blood clotting disorders.

 

What to look for, how to treat and when not to treat

 

How to become a specialist in Fertility.

 

 

 

*

 

Course Outline

* I. Female

A. The Menstrual Cycle

1. Key Events

Day 1-5 Progesterone/estrogen low causes period

Day 3 Pituitary makes FSH/LH to stimulate growth of follicles

Day 7 One follicle dominates

Day 7 -12 High Estrogen

Day 12-13 High Estrogen acts on pituitary causing LH surge (ovulation 12

hours)

Day 14 Ovulation (egg lives 24 hours)

Day 15-25 Corpus Luteum produces progesterone and estrogen

Day 25-28 Corpus Luteum dies, progesterone/estrogen drop causing endometrium

to deteriorate=pituitary starts making FSH/LH

(Follicular phase at least 11 days Luteal phase at least 11 days)

 

1. Western tests Day 3 test FSH/LH levels FSH should be <6 LH <7

Estradiol <50 (if elevated can mask true FSH level)

Anti-Mullerian Hormone (expressed by granulose cells in ovary and

controls formation of primary follicles by inhibiting follicular

recruitment

by FSH) day 3-5 <8.1 considered poor outcome

Day 21 progesterone 21

Hysterosalpingogram

AMH anti-mullerian hormone produced by egg follicles declines with age

less variability than FSH, can be taken anytime, earlier marker than FSH

Inhibin B

Antisperm antibodies/post coital testing

Prolactin

Antral follicles

DHEAS

Insulin resistance

Thyroid stimulating hormone T3 1.4-4.4 T4 .8-2.0

Clomiphene Citrate Challenge Test (CCCT) ((Day 3 bw E2 and FSH, Day

5-day 9 10 mg Clomid, Day 10 blood test FSH

Sperm analysis

2. TCM Phases of the Menstrual Cycle Follicular Blood and Yin (long

follicular cycle blood xu, short = heat)

Ovulation Yang/Phlegm

Luteal Yang

3. TCM treatments for phases of Menstrual Cycle Day 1-3 Blood Flow,

Regulate Qi and Bl yang switches to yin, chong empties, move blood

strongly), chong must empty so that lining can grow back in an orderly

fashion)

Day 4-12 Chong/bl/yin (post period, nourish yin, clear heat if

necessary, chong fills, nourish and invigorate blood)

Day 12-16 Ovulation, (keep Qi moving, reinforce yang, clear damp for

egg release, stabilize heart qi)

Day 16-28 Warm and Tonify yang

4. TCM Correlations with hormones

 

Estrogen yin, blood

Progesterone yang

LH yang/phlegm

FSH/AMH jing

Gametes jing

Pituitary/hypothalamus heart/shen/liver qi

All above is to be kept in mind with dominant conditions like yin xu, blood

stagnation etc…

 

B. Primary Fertility Signs; Basal Body Temperature, Cervical fluid, Position

of Cervix, Ovulation Predictor Kits

1.Waking temperature/Basal Body Temperature

 

1. Taking

2. Drawing the coverline Draw coverline 1/10th degree above the

highest temp

3. Rule of thumb/alcohol/illness

4. Reading the chart

 

- follicular phase v/s luteal phase

-follicular phase too short -temperature drops slowly

-follicular phase unstable

-luteal phase too short

-luteal phase too low

-luteal phase unstable/sawtooth

-yin or blood deficiency

-yang deficiency

-heart fire/liver qi

-saddle

-slow rise

-annovulatory cycles

-temperature rises one day after ovulation (ie; in most cases a rise in

temperature indicates that ovulation HAS ALREADY OCCURRED)

-luteal phase temp should not waver more than .2 deg

-follicular phase should not waver more than .5

-luteal phase rise at least .5 deg, can take 2 days

-sleeping in temperature goes up 1/10 deg per ½ hour

-long luteal phase >18 days J

 

 

1. Cervical Fluid (looking for " peak day " )

1. Different types of cervical fluid, ph, stickiness, spinnbarkeit,

ferning

2. Negative impacts on cervical fluid, western drugs

3. Positive impact

2. Cervical Position

1. Height, softness, opening (low closed firm v/s high open soft)

Soft, High, Open, Wet + SHOW

3. Ovulation Predictor Kits

 

a. When to test, smiley face, TIMING! 9,11,13

C. Causes of Infertility in women

1. PCOS

a. LH>FSH, string of pearls, obesity, hirstutism, ED (especially in

teens), amenorrhea or infrequent periods, BBT and how it will look, age of

onset

b. Yang/phlegm PCOS, v/s yin or blood xu PCOS

c. treatment herbs and acupuncture

2.Amenorrhea

a. Estrogen withdrawal bleeding

b. Estrogen breakthrough bleeding

c. PCOS

3.Endometriosis and other blood clotting disorders

a. Chocolate cysts seen with laparoscopy, severe cramping, dark clotty

periods, headaches during and around the cycle, varicose veins, distended

sublingual veins

-endometriosis attracts macrophages which can attack sperm or produce

cytokines which are toxic to sperm and embryo.

a. MTFR

b. Antiphospholipid Antibodies

-anticardiolipin antibodies,

d. levanox, heparin, baby aspirin, laparoscopy

4. Irregular menses

a PCOS

b hypothalamic pituitary pbx ie liver qi stagnation/ stress

c aging

5.Antisperm antibodies, activated macrophages

6. Age, Poor Ovarian Reserve, High FSH

a. increased chance of chromosomal abnormalities, miscarriage, poor

lining

b. strong decline in fertility after 38. 40 years old has as much as a 50%

mc rate

c. mitochondrial DNA, oxidative damage = lowered atp output= more

fragmentation.

7. Miscarriage

a. genetic disorders, poor embryo development, qi and blood deficiency,

blood clotting disorders, 1/3 of all pregnancies end in MC. Early testing

increases knowledge.

b. progesterone dilemma

c. blood clotting disorders see above

8. Unexplained Infertility (TCM favorite!)

a. liver qi stagnation

b. yin/blood def (+heat) age related, eating disorders, low carb diets,

c. blood stagnation

d. yang def (check thyroid)

e. phlegm

f. heart fire

 

Men

 

Motility, morphology and count

WHO 1999

Volume- at least one ml

Count >20 million per ml

Motility >50% moving purposefully

Forms < 85% abnormal forms

 

IVF Clinic:

 

Volume- at least one ml

Count- >48 million per mil

Motility > 63% moving purposefully

Forms <88% normal forms

Antisperm antibodies

9 to 36% of infertile men

70% of men who have had reproductive tract surgery

5% of infertile women

Spermatogenesis 3 months (72 days)

Stay away from hot tubs, bicycling, tight clothing, marijuana,

Arginine 4 grams per day

Yang/jing tonics help with motility, morphology and count (takes three

months)

Sperm agglutinizaion reacts well to zhi bai di huang wan

Naturopaths suggestions for sperm

 

Acupuncture for morphology

 

Ren 4, Bl 23, 32, lv 3, kid 3, st 36, sp 10, 6, st 29, ren 4

Study published in Fertility and Sterility 05 by J Pai

Significant improvement in sperm quality especially morphology

 

Herbs

 

Biphasic approach: During menses move blood (as long as not contraindicated

tao hong si wu tong) First half of cycle yin/blood tonics, second half of

cycle yang tonics and qi movers. Check out Jane's formulas.

 

For Yang Deficiency;

 

Yang tonics day 14 to day 18, progesterone cream, vitex (chaste tree berry)

Improving ovarian response/Lowering FSH

Increase ATP production in maternal mitochondira

 

Yin tonics

 

Reishi mushrooms (ling zhi) and cordyceps for lowering FSH all formulas all

the time

DNA damage

B vitamins (esp Niacin which is imp for energy production and DNA repair,

removes toxins from the body), folic acid, zinc, CoQ10

Omega Oils

DHEA

 

Western drugs

 

Clomid, contraindication, menapure where it comes from

Different types of ART especially IVF

Lupron headaches

Stims menopause

Progesterone headache, fatigue, pms

 

Facts about IVF and how to work with reproductive endocrinologists

 

Reading List

 

Taking Charge of Your Fertility by Toni Weschler

The Treatment of Infertility with Jane Lyttleton

Invitro Fertilization the ART of Making Babies Scher

 

 

Speaker Profile: Victoria Koos

Yin and Tonic Acupuncture PC

265 W 37th St Suite 640

New York, NY 10018

917.202.5356

www.YinandTonicAcupuncture.com <http://www.yinandtonicacupuncture.com/>

 

Victoria Koos has studied Western and Chinese medicine in the United States

as well as traditional healing in Mexico and India. She has clinical

experience practicing acupuncture at Saint Vincent's Hospital, the Hospital

for Joint Disease and in her private clinic. She works closely with several

reproductive endocrinologists and OB/GYNS in the New York area providing

acupuncture for patients undergoing ART &

<http://us.mc655.mail./mc/acupuncture_and_ivf_treatment.html>IVF<http:/\

/us.mc655.mail./mc/acupuncture_and_ivf_treatment.html>.

Victoria completed a rigorous four year Masters in Science and Traditional

Oriental Medicine (MTOM) program at Pacific College of Oriental Medicine in

New York. She believes that healers wear many masks and healing can take

many forms; her work is to incorporate all of these traditions into one

beautiful healing practice.

 

Victoria Koos is certified by the National Certification Commission of

Oriental Medicine in acupuncture and herbs. She is licensed to practice

acupuncture in New York State. She obtained her degree from Pacific College

of Oriental Medicine, graduating at the top of her class. Victoria Koos'

acupuncture clinic Yin and Tonic Acupuncture PC in Manhattan sees 40 to 60

fertility patients a week; some patients undergoing assisted reproductive

therapies like IVF, others trying to conceive naturally.

 

She is currently working with Continuum Reproductive Endocrinologists Dr.

Martin Keltz and Dr. Daniel Stein and the Department of Obstetrics and

Gynecology at St. Luke's Roosevelt Hospital Center on a study on the effect

of acupuncture on uterine profusion/endometrial lining.

 

Victoria recently participated in a round table discussion on secondary

infertility for PBS with:

Juila Indichova, author of *Inconceivable* and *The Fertile Female*,

Andrea Braverman, licensed psychiatrist, Reproductive Medicine Associates

and

Allison Styne-Gross Reproductive Endocrinologist, Reproductive Medicine

Associates.

The program discussed secondary infertility; causes, possible treatments

both western and eastern and the mind body perspective.

 

Victoria Koos is the fertility expert at www.realsavvymoms.com a resource

for women all over the country with fertility questions.

 

Before going into private practice Victoria practiced acupuncture at the

Hospital for Joint Disease working at the Initiative for Women with

Disabilities. She also practiced acupuncture at St. Vincent's Hospital

working with HIV positive patients.

Victoria has also been a licensed yoga instructor for ten years.

*

Education

*

Pacific College of Oriental Medicine: Bachelor in Professional

Studies/Master of Science in Traditional Oriental Medicine

North Carolina School of the Arts: Bachelor of Fine Arts

*

Licenses

*

 

Licensed Acupuncturist: State Acupuncture Board of New York

Diplomat in Acupuncture: National Certification Commission for Acupuncture

and Oriental Medicine

Diplomat in Chinese Herbology: National Certification Commission for

Acupuncture and Oriental Medicine

Certified in Clean Needle Technique

 

----------------------------

 

 

 

 

 

 

*Andrew L. Kingoff, L.Ac. MS, BS, BA*

**

*3407 Wrightsville Avenue

Wilmington NC 28403*

*(910) 791-3349*

 

www.KingoffAcupuncture.com <http://www.kingoffacupuncture.com/>

http://KingoffAcupuncture.Blogspot.com<http://kingoffacupuncture.blogspot.com/>

CEU Seminars: http://Tiny.cc/OMCEU <http://tiny.cc/OMCEU>

 

 

 

 

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