Thursday, March 14, 2013

Book Review: Making Babies

Increasingly, couples are turning to Chinese medicine for fertility support.

There are many good books on the market on natural and medical approaches to fertility enhancement. Making Babies: A Proven 3-Month Program for Maximum Fertility takes an important place among them. This book is a fabulous resource for anyone wanting to learn more about the ways that Chinese medicine can support fertility. And for any couple (or individual) experiencing trouble conceiving, this book is a great first resource and wide-ranging storehouse of information related to getting pregnant. This book will empower couples and individuals to develop their own, personalized, pre-conception plan for optimizing health and fertility.

Making Babies is a truly complimentary -- East-West medicine -- team-effort. The book's authors are Dr. Sami S. David, MD, reproductive endocrinologist and pioneer in the field of Artificial Reproductive Technology (ART), and Jill Blakeway, Licensed Acupuncturist and Founder & Clinical Director of YinOva Center, an alternative health service for women in New York City.

Conception: As Naturally As Possible

Not only are David and Blakeway are committed to a complimentary approach to fertility enhancement. Their mission in Making Babies is to help women get pregnant as naturally as possible. Their goal is to help women/couples understand exactly what might be getting in the way of natural conception, and to utilize the least invasive combination of methods for fertility enhancement that are necessary. They draw on lifestyle and nutritional adjustments, exercise, self-massage & relaxation strategies, acupuncture, Chinese herbs, medical and surgical treatments.

Dr. David's professional story is interesting. In the early 1980s, he was the first doctor to successfully perform IVF (in-vitro fertilization) in the state of New York. Uncomfortable with the feeling of "playing God," however,  he reassessed his contribution to the field of reproductive endocrinology. While most of his professional colleagues went on to run IVF-centered practices, Dr. David turned his attention to less invasive medical and surgical treatment of infertility.

Dr. David and Ms. Blakeway acknowledge the important and valuable role of ART in helping millions of couples and individuals to conceive, and they are happy to refer patients to their colleauges who specialize in ART when necessary. However, they begin Making Babies by thoughtfully addressing their concerns regarding the overuse and risks of ART.

The book is full of interesting anecdotes of women who, after months or years of struggling with infertility, were directed toward IVF by a physician, or who experienced failed IVF attempts. David and Blakeway describe how many of these women subsequently went on to conceive naturally after receiving: 1) a clear diagnosis of the cause of their infertility and 2) a far less invasive medical intervention.

This paragraph, from Making Babies, nicely summarizes David's practice,

"I'm a surgeon, but I approach infertility medically, then surgically if necessary. I only take about 10% of my patients into the operating room. The way I see it, the less invasive a treatment is, the better (of course, it still has to work). I don't put anybody on fertility drugs unless I have to, which turns out to be less than half the time. And when I do prescribe fertility drugs, I use only one-quarter of the dose most IVF docs do. Some couples I see need drugs, but not fertility drugs -- they need antibiotics or steroids. Some benefit from simply taking over-the-counter cough medicine or plain old aspirin. Some of my patients simply need to douche with baking soda....... My preference is always for the gentlest option that will be effective.... Almost always, good medical detective work will uncover the cause of a patient's infertility and so reveal the appropriate solution. And despite what you'd think if you walked into just about any IVF clinic in this country, the solutions don't often involve major invasive interventions."

The Nuts & Bolts of Conception

The next section of Making Babies is a thorough, yet accessible, overview of the structures and functions of the male and female reproductive systems and the mechanisms of conception, followed by a discussion of several methods for women to monitor their fertility cycles.

The idea here is that women and couples should be as informed and knowledgable as possible, particularly when they interact with their medical providers. Furthermore, David and Blakeway keep emphasizing the importance of knowing and understanding the specific diagnosis underlying one's fertility challenges, so that the remedy can be as focused, effective and gentle as possible.

Next comes a discussion of lifestyle, dietary, nutritional, exercise and stress reduction practices for optimal fertility, accompanied by descriptions of how women might modify these practices according to the phase of their menstrual cycle. These recommendations are based in a combination of western naturopathic and traditional Chinese medicine systems.

A nice aspect of the book is that the educational pieces and recommendations are all presented gently, optimistically and, often with a good bit of welcome humor. David and Blakeway are very much in touch with and compassionate about real women's day-to-day lives.

The Five Fertility Types

This section is the heart of the Making Babies. And, its the part where Chinese medicine really makes its contribution. This is also my favorite part of the book.

In introducing this section, Jill Blakeway rightly points out that one of the advantages of traditional Chinese medicine over western medicine's "one size fits all" treatment approach is its highly developed system of differential diagnosis. Chinese medicine will not, for example, treat all cases of luteal phase disorder or ovarian cysts equally. Rather a Chinese medicine practitioner seeks to discern an underlying pattern of imbalance, unique in each patient's case, based on all available signs, symptoms, fertility charting, laboratory testing, etc. Treatment for each patient is unique and addresses that patient's specific pattern of imbalance.

The idea of Chinese medicine is to bring restore a patient's health by bring him/her into balance. Healthy people have healthy babies.

The Five Fertility Types, then, are the five most common Chinese medicine patterns that Blakeway finds in her infertility patients. Instead of using Chinese medicine terminology that is erudite and elusive to the lay person or western practitioner (think "Kidney Yang deficiency, Liver congestion Qi stagnation, damp phlem accumulation"), Blakeway has come up with five diagnostic labels:

1. Tired
2. Dry
3. Stuck
4. Pale
5. Waterlogged

As a Chinese medicine practitioner who likes to write for western audiences, I'm very impressed with how Blakeway handles this section. I love the clarity of her descriptions. For each of these types, she explains the signs and symptoms that typify the pattern, including hormonal imbalances and western diagnoses commonly associated with these patterns of imbalance. She shows how each pattern of imbalance relates to sub-optimal function of very specific aspects of reproductive function.

Blakeway highlights the importance of consulting with and coordinating with conventional medical practioners in the service of infertility patients. She seeks to put translate Chinese medicine diagnoses in the context of western medicine, framing them in terms of hormonal imbalances and explaining how acupuncture and herbs can help to level them out. In working with western doctors, Blakeway sets time limits and accessible goals to guage patient's progress. I.e. she likes to see very specific signs of hormones returning to balance as acupuncture and herbal treatment progresses through three consecutive menstrual cycles.

Common Fertility Problems and Their Solutions:

The next part of Making Babies is a thorough discussion of a full range of common fertility problems. These are divided into the categories of:

  • hormonal/endocrine imbalances
  • structural/anatomical issues
  • infections
  • immune system issues
  • general health issues (such as hypothyroid, anemia, diabetes, intestinal disorders, etc.)
For each common fertility problem, Blakeway and David discuss:
  • diagnostic methods, including how these should be timed in terms of a woman's menstrual cycles;
  • typically associated Chinese medicine diagnostic patterns;
  • solutions, including self-help tips, acupuncture and herbal treatment, medical or surgical intervention; along with
  • illustrative case studies of real-life patients and how they dealt with their fertility challeng and went on to have healthy babies.
Finally, David and Blakeway include a detailed discussion of a whole range of assisted reproductive techniques, including the role that Chinese medicine can play in supporting these techniques, when to use them, and how to make them as gentle as possible.

The Pre-mester: How to Use the Making Babies Program for your Fertility Type:

Making Babies culminates with an action plan. Patients are recommended to take three months in which to strengthen and rebalance their bodies using a range of recommendations in the areas of food, herbal teas (called "fertiliteas"), exercise, lifestyle, supplements, fertility strategies, medical assistance, acupuncture, and Chinese herbal medicine. The authors lay out five comprehensive prescriptions, one for each fertility type. They maintain that three months of following these guidelines, in a relaxed, non-rigid way, will effectively help many couples and individuals in overcoming barriers to fertility and along the way to successfully conceiving and making a healthy baby. This is in line with most systems of traditional medicine and healing, which recommend that couples set aside a period of time to boost their health before conceiving.

In closing:

Some of the things I love about this book are:
  • It's highly informativeand thorough. Key problems and solutions are discussed from various perspectives: Chinese medicine, western medicine, self-help.
  • It succeeds into making Chinese medicine concepts applicable by real-life people in critical, time-sensitive situations.
  • It empowers readers to interact with conventional and alternative medical providers from an informed perspective, laying the foundation for gentler, more effective outcomes.
  • It's real-life based, kind, friendly, optimistic, easy to read and implement.
I highly recommend this book to anyone thinking of getting pregnant, anyone running into trouble conceiving, or anyone simply looking for clearn, down-to-earth, writing on Traditional Chinese Medicine.

A Brief Illustration of one of the five Fertility Types:

Tired, for example, is the most common pattern in her infertility patients. Chinese medicine practioners would call tired "Yang Qi vacuity." Tired patients have sluggish metabolic symptoms. Hypothyroid condition is an example. The symptoms of tired patients reflect hormonal imbalances affecting the reproductive hormones, but also eoncompassing the thyroid, adrenal and pituitary glands. These imbalances impact metabolism, circulation, libido and, in turn, fertility. 

In Chinese medicine terms, Yang Qi has functions of transforming, transporting, warming, protecting and containing. Weakness of Yang Qi may manifest as an inability of the woman's body to transform and egg and sperm into a viable embryo, to transport the egg from through the fallopian tubes into the uterus, to create the right temperature environment in the uterus, to mount the appropriate immune response to protect the embryo, or to contain the growing embryo in the uterus. Chinese medicine treatment would seek to warm and augment Yang Qi in order to support a women's body in these specific functions.