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Complementary Medicine from a Reproductive Endocrinologist’s Point of View

January 26, 2005 - Wednesday
2:19 PM to 3:19 PM (EST)
Guest Speakers: David Barad, MD - The Center for Human Reproduction

Categories
Acupuncture • Complementary Medicine • Infertility • IVF • Miscarriage • Pregnancy

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Lori_Masi_-_AFA_Patient_Advocate	Hi All - I had alittle trouble getting online tonight - how is everyone?
Lisa_Rosenthal	Good evening and thanks for joining us this evening. Dr. Barad will be with us shortly.
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Lisa_Rosenthal	Welcome Dr. Barad, thanks for joining us this evening!
Dr._Barad	Thank you for inviting me
Stephen	Dr. Barad, can you explain what complementary medicine really is and what it includes
Dr._Barad	Well first lets correct my institutional afiliation listed above
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Lori_Masi_-_AFA_Patient_Advocate	Welcome Dr Barad and Everyone!!
Dr._Barad	I practice in New York at the Center for Human Reproduction
local	[332] Dr. Barad-Center for Human Reproduction in New York
Dr._Barad	Complementary medicine are various techniques and remedies that may be used in conjunction with western medical techniques.
Lori_Masi_-_AFA_Patient_Advocate	Welcome All! Please call the AFA Toll Free Support Line at 888-917-3777 for information, a referral in your area or just some good ol fashioned support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
Lisa_Rosenthal	Sorry Dr. Barad, it was supposed to have been fixed here as well. I will keep posting your information and I would like you to post your phone number as well so our participants can reach you.
Dr._Barad	Much of modern complimentary medicine is based upon traditional chinese medicine (TCM)
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local	[332] Dr. Barad-Center for Human Reproduction in New York
Dr._Barad	Thanks Lisa. Our office number in New York is 212 994-4400
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Dr._Barad	There is a growing community of practitioneers of TCM here in the New York area.
Cynthia	Traditional chinese medicine, how much of it is based on science that can be proven?
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Orly	Dr. Barad, are you trained in TCM? I'm in the NY area and would love to have an RE that is trained in other modalities.
local	[332] Dr. Barad-Center for Human Reproduction in New York
localhost	[2009] touser Please feel free to post questions for Dr. Barad. Keep in mind that you may need to repost them as the room is quite busy. You may want to save your questions in a word document instead of having to retype them.
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Dr._Barad	Sorry I got disconected
Dr._Barad	The real question is how TCM has been studied here in the west.
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Dr._Barad	WE have done a fairly poor job of testing it so far.
Cynthia	Are there any double blind studies that have been done?
Dr._Barad	Looking at the wetern literature there are only a few studies that show techniques like acupuncture have any effect on infertility.
Dr._Barad	But there are only a few well designed studies that have been carried out.
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Dr._Barad	Just because we don't have evidence telling us that something works, doesn't mean that it is not effective. We still have a lot of work to do to determine the role that TCM techniques might have
ama33	How does TCM work? What is based on? What does a traditional work-up look like?
Dr._Barad	The studies of acupuncture have focused on male fertility, ovulation induction and on improving pregnancy rates at embryo transfer.
Dr._Barad	I had a chance to meet with 150 TCM practitiopners recently to discuss just these issues.
Dr._Barad	It seems that the TCM approach is fairly foreign to those of us trained in the west.
Lori_Masi_-_AFA_Patient_Advocate	Welcome All! Please call the AFA Toll Free Support Line at 888-917-3777 for information, a referral in your area or just some good ol fashioned support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
Dr._Barad	The TCM practioners evaluate a patient looking for a ballance of Yin and Yang and evaluate Qi.
Lisa_Rosenthal	Dr. Barad, would you please explain Yin and Yang for us?
Dr._Barad	Based on that evaluation they look to restore ballance.
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Lisa_Rosenthal	Sorry that you are having such trouble, Dr. Barad!
local	[332] Dr. Barad-Center for Human Reproduction in New York
Dr._Barad	THe TCM practioners described it to me as representing something like "heat" and "cold"
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Sandy	How did you get interested in this, Doctor?
Dr._Barad	About 20% of the patients in our practice are chinese.
Dr._Barad	I have also had the pleasure of working together with some of the TCM pratitioners based in New York.
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Sandy	Can you tell us more about ying and yang?
Kath93Q	And qi?
Dr._Barad	I am willing to consider that these techniques may have something to offer, but at this point their efficacy is certainly not proven.
Dr._Barad	I am told the the Qi represent the energy flow through the body and that Yin and Yang represent the ballance of forces like hot and cold in the body.
Dr._Barad	If the TCM pracitioner beli9eves that there is not enough Yang (heat) then one might be given herbs that increase heat like ginseng or ginger
Janna	Are meridians discussed at all with TCM?
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Stephen	Do you advise patients to speak with a TCM practicier?
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Dr._Barad	Fertility patients are often under such stress.
local	[332] Dr. Barad-Center for Human Reproduction in New York
Dr._Barad	Many of my patients will ask for a referral to an acupunturist.
localhost	[2009] touser Please feel free to post questions for Dr. Barad. Keep in mind that you may need to repost them as the room is quite busy. You may want to save your questions in a word document instead of having to retype them.
localhost	[2009] touser The American Fertility Association has a set of message boards, several which are moderated by a physician daily. Please feel free to stop by and ask questions there as well! Also, "Connections" will meet every week for an online educational session. Please check the schedule on our home page.
Dr._Barad	We have patients who want ot have acupuncture before and after their embryo transfers.
Dr._Barad	SOme of the practiuoners are able to come to our office and provide this service.
ama33	That's exciting!
Dr._Barad	In many cases the patients find it takes some of the edge off.
Lori_Masi	Don’t Forget to please call the AFA Toll Free Support Line at 888-917-3777 for information, a referral in your area or support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
Dr._Barad	The practioners use acupoints that are supposed to provide relaxation as well as improve circulation to the uterus.
Janna	How do you find a TCM practioner, are they licensed, etc?
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Dr._Barad	THe theory is that this will improve the chances of implantation.
Lisa_Rosenthal	Welcome Bon128!
local	[332] Dr. Barad-Center for Human Reproduction in New York
Bon128	Ty Glad to be here, sorry I am late
Bon128	I know Dr. Barad, He's Great!
Lisa_Rosenthal	It's never too late, please feel free to post questions.
Dr._Barad	In New York they need to register like any other helath care provider.
Lisa_Rosenthal	Of course, he's great, otherwise why would we have him?
Dr._Barad
Bon128
Lisa_Rosenthal	Thank you so much, Dr. Barad, for giving of your time and expertise this evening. We appreciate it!
Dr._Barad	My pleasure.
Janna	These chats are great. Each one is better than the last
Dr._Barad	THere are practioners that are trained in the states and of course ther are those trained in CHina.
Sandy	Really unusual to be able to hear an RE discuss TCM, this is great.
Dr._Barad	My understanding is that TCM training in CHina can take up to 6 years.
Kath93Q	It's really hard to understand how it works and seems otherworldly. Any good reading that you might suggest to understand it better?
Dr._Barad	The is a single clinical trial of acupuncture and IVF published in 2002 out of germany by Dr. Paulus.
wannababy	Are you considering doing the training, Doctor?
Dr._Barad	In that study 160 women were randomly assigned to either acupuncture or non acupuncture at the time of their transfers.
Lisa_Rosenthal	Dr. Barad, wasn't there also a study released last spring from a RE practice out of Colorado and Arizona? They presented at a Pacific Coast meeting.
Dr._Barad	Well.... I'd love ot understand it better, but I think my time and training would be better spent helping the existing TCM practioners to find how they can fit into what we do already.
Dr._Barad	THe nature of complimentary medicine is that it is an adjucnt to what we already have.
Dr._Barad	TOgether the techniques may be more effective tha either are alone.
Dr._Barad	I hope to be able to collaborate with them to better evaluate what they do and its effectiveness.
Cynthia	So, there's accupuncture, TCM, anything else? homeopathy? flower essences? aromatherapy?
local	[332] Dr. Barad-Center for Human Reproduction in New York
localhost	[2009] touser The American Fertility Association has a set of message boards, several which are moderated by a physician daily. Please feel free to stop by and ask questions there as well! Also, "Connections" will meet every week for an online educational session. Please check the schedule on our home page.
Bon128	i definitely believe that, it seems lately, the success stories from using both techniques, seems to be doubling
Dr._Barad	Well, all of those techniques deserve careful evaluation. THe aromatherapy, as I understand it, is mostly a relaxatiuon technique.
Dr._Barad	I would be careful of anecdotal stories, but the message is that we should not ignore these techniques and in many cases they deserve to be more carefully evaluated.
Janna	Essential oils are supposed to have wonderful healing properties
local	[332] Dr. Barad-Center for Human Reproduction in New York
Dr._Barad	By the way ... NOt Huntington ... CHR New York 212 994 4400
Lori_Masi	Don’t Forget to please call the AFA Toll Free Support Line at 888-917-3777 for information, a referral in your area or support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
Lisa_Rosenthal	This is a case of computer versus mind, and I am losing out!
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Dr._Barad
Lisa_Rosenthal	Welcome Kate, please feel free to join in and ask questions of Dr. Barad.
Dr._Barad	Yes, but we must ask, what are we healingin this case.
Lisa_Rosenthal	Who practices in NY, at Center for Human Reproduction!!!
Dr._Barad
Dr._Barad	There is a growing body of literature about moind/body and infertility.
Dr._Barad	It seems to me that many of the aromtherapy, essential oil threatment and maybe even acupuncture could be working in anon-specific mind/ body axis
Kath93Q	How are these drugs that are used deemed safe? Are they overseen by the FDA?
Dr._Barad	CHinese herbal medicine is not overseen by the FDA.
Dr._Barad	TEchnically they are sold as "food" or in health stores as nutritional supplements.
Bon128	I personally believe that if you "believe" in something and relaxation is a part of it, how could it hurt, it could only help, infertility is very very stressful, at least for me it is
Dr._Barad	One of the problems with the herbal literature isn that there is no standardization even when we are studying the same herbs.
local	[332] Dr. Barad-Center for Human Reproduction in New York
Dr._Barad	I agree with you BON128
Bon128	Ty
Dr._Barad	On the other hand some herbs are fairly potent so it is imoprtant ot keep all your health care practioners in the loop about what you are taking.
Lisa_Rosenthal	It's interesting about "believing in something" especially when you think of the placebo effect. Often a "sugar" pill can be as effective as a standard medication.
local	[332] Dr. Barad-Center for Human Reproduction in New York
Dr._Barad	Placebo can be a very powerful drug...
kate	I'm currently on my 3rd cycle of Clomid 50mg. Round one was successful (progesterone levels were at 40 on day21). Round 2 was NOT successful in inducing ovulation. I am hopeful that round 3 will do the trick. If unsuccessful, what direction should I go in?
Lisa_Rosenthal	Ladies and gentlemen, the only way that I get such wonderful speakers on our online sessions is by promising them that they will be off promptly at 9. That leaves us a few minutes. Remember to check the site for the transcript of this session and past session. Also, Connections meets every week, check the schedule.
Dr._Barad	Just like baseball... three trys on one thing and then think of moving on.
Kath93Q	Thanks to Dr. Barad and Lisa for this very interesting session.
local	[332] Dr. Barad-Center for Human Reproduction in New York
Lori_Masi	Don’t Forget to please call the AFA Toll Free Support Line at 888-917-3777 for information, a referral in your area or support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
Stephen	Dr. Barad, please post your phone number again
Bon128	ty Dr. Barad
Dr._Barad	FOr a woman with anovulation and normal tubes and a husband with nornmal sperm the next step would be injectables with IUI.
Dr._Barad	212 994-4400
Dr._Barad	WE recently have been investigating the use of DHEA supplementation for women with decreased ovarian reserve.
Dr._Barad	Our preliminary results have been encouraging.
local	[332] Dr. Barad-Center for Human Reproduction in New York
Dr._Barad	WE are just launcing randomized clinical trial to see if the results really hold up to further testing.
Lisa_Rosenthal	Thank you so much for joining us this evening!
Lori_Masi	Thank you Dr Barad for such a wonderful and informative session! Good night to all and Don’t Forget to please call the AFA Toll Free Support Line at 888-917-3777 for information, a referral in your area or support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
Dr._Barad	We have found that a few months of DHEA can restore FSH levels and improve respnse to ovulation induction.
Bon128	i recently did IVF and had a chemical pg. I was just wondering if you could confirm this question? is a chemical pregnancy a good sign for a woman that she could conceive or does a chemical pg have no value?
Lisa_Rosenthal	Dr. Barad, you have been just wonderful, as always. I hope that you will join us again sometime soon.
Bon128	ooops guess i asked too late
Dr._Barad	Lisa... it has been my pleasure to be with you.
Kath93Q	Our pleasure, thanks so much to you both
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local	[332] Dr. Barad-Center for Human Reproduction in New York
Dr._Barad	kI have always felt that it is a good sign, thoughI know how disapointed you must be.
Bon128	thanks Dr. Barad I am glad to have an answer that question.. its been on my mind
Stephen	good night
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Bon128	i am over it now, going to try try again
Dr._Barad	Good night
ama33	nite, thanks
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Sandy	Great session!!!! More on CAM
Dr._Barad	Good idea... you can't succeed if you don't try.
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Lori_Masi	Don’t Forget to please call the AFA Toll Free Support Line at 888-917-3777 for information, a referral in your area or support. Looking forward to hearing from all of you! Lori Masi – AFA Patient Advocate
Dr._Barad	Sandy do you have a question
Dr._Barad	I guess she left
Lori_Masi	Dr Barad It is so kind of you to continue
Lisa_Rosenthal	I think that she just wants you to come back for another session!
Dr._Barad	OK...I would be happy to.
Lisa_Rosenthal	Maybe you should do a session at the conference on April 17th this year on CAM
Dr._Barad	Soundlike it might be fun.
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Lori_Masi	That sounds great!
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Bon128	Bye Dr. Barad, ty for your time, sorry i was so late, hope to catch you again
Dr._Barad	Bye Bon
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Orly	Bye
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Cynthia	Good night
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Lisa_Rosenthal	See you next week!!!!
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Dr._Barad	Good night
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