alternative medicine - what every ivf specialist needs to know

Doctors – Doctors – Scientists and/or Scientists and/or Healers ?Healers ?

Dr Anjali Malpani, MD www.drmalpani.com

Conventional v/s Conventional v/s Alternative Medicine – who Alternative Medicine – who Decides?Decides?MoneyColonisationHigh TechThese have made Western medicine occupy the premier position

Yoga, Ayurveda and Chinese medicine have a much longer tradition than modern medicine

In Germany homeopathy is mainstream medicine –not alternative!

Conventional v/s Alternative Conventional v/s Alternative MedicineMedicine

Doctors are Doctors are ScepticalScepticalLack of available scientific documentation and evidence

• No need to be critical and dismissive

• No need to look down upon these treatments just because there are no publications !

Wake up!Wake up!

40% of all infertile patients use some form of CAM

Doctors don’t know Doctors don’t know everythingeverythingDoctors need to be humble,keep an open mind and be willing to learn!

Jenner “discovered” vaccination by Jenner “discovered” vaccination by being willing to listen to cowgirls! being willing to listen to cowgirls!

Alternative medicine is Alternative medicine is usually self-prescribedusually self-prescribed

Why do patients look for alternatives in the first place ?

Because they are not happy with modern medicine !

Good doctors need to be empathetic and to acknowledge this fact

Scientists or Scientists or Healers?Healers?

“ART” specialists have lost the ART of Medicine

Alternative Alternative TherapyTherapy

Why ?When ?Who ?How ?

Why? Why? Holistic approachPersonalized touch Patients experience control over their situation- “doing something themselves”

Low costAvoid side effects of drugs

When?When?When they have been given the frustrating diagnosis of “unexplained infertility”

When they have failed standard fertility treatments

To maximize their chances of having a child

Cultural beliefs

How do they How do they work?work?Bringing the body back into balance?

Reducing stress level?Placebo effect?

Who Benefits?Who Benefits?

Unexplained infertilityOvulation disordersIVF waiting list “ treatment independent “ pregnancies

Integrative Integrative MedicineMedicineAlternative therapies are very often used in conjunction with conventional treatments

Prior to undergoing treatment

Patients will often not tell us that they are using CAM

Are scared that we will criticize or pooh-pooh these

Show Me The Show Me The Data!Data!

Western Medicine is evidence-based Medicine

Efficacy of a treatment has to be proven scientifically by convincing experts and scientific committees

The Randomized controlled trial (RCT) is considered the “gold standard” for evaluating the effects of interventions.

Why are there no Why are there no trials in alternative trials in alternative medicine ?medicine ?Too expensive, not enough funding

No money to be made by pharmaceutical companies

Drugs cannot be patentedDifficult to enroll patients for these trials

Difficult to conduct double blind trials

Lack of evidence of an effect

does not equal

evidence of the lack of an effect

Anecdotal Anecdotal successessuccessesStory of the old man and

the starfish

“Not everything which counts can be measured,

Not everything which we can measure is worth counting.”

Einstein

New trendNew trendPatients are doing research for themselves

Social networkingHealth 2.0 www.patientslikeme.com

Why are doctors Why are doctors sceptical?sceptical?Quackery flourishes as there is no formal training required and there is no monitoring of practitioners of alternative medicine.

Dubious?Dubious?That’s fine

We should be!

But we need to be equally skeptical about all medical interventions!

Modern medicine also uses Modern medicine also uses Untested and unproven Untested and unproven treatments!treatments!• DHEA as a miracle drug in the

treatment of poor responders; hype or hope? Human Reproduction. Kayhan and Urman

• Is recombinant FSH really better than urinary HMG ?

• Male infertility treated with hormones, vitamins,antiestrogens.

• Operative treatment of varicocoeles

• IVIG for treatment of repeated IVF failures

Evidence-Based Medicine Evidence-Based Medicine : can the evidence be : can the evidence be trusted?trusted?

Many well reported RCTs are designed to deceive by biased study designs!

Vested financial interests!

Manipulation of statistics to produce desired outcomes that are selectively reported.

Keep an open Keep an open mindmindRather than looking down upon alternative medicine treatments it is better to be accepting and be willing to learn from our patients

Different Methods of Different Methods of CAMCAM

Alternative Medical Systems• Ayurveda• Homeopathy• Naturopathy

Manipulative Bodybased Therapies

• Acupuncture• Massage • Chiropactry• Osteopathy

Mind body TherapiesYogaMeditationReikiHypnotherapyAroma Therapy

Diet based TherapiesChinese herbs Vitamin therapy

Commonest Commonest methodsmethodsAcupuncture

Chinese herbs

Yoga and Meditation

AcupunctureAcupuncture

Acupuncture – how Acupuncture – how does it act?does it act?

Acts centrally by increasing B-endorphin levels which in turn affect the HPO axis and GnRH secretion

Acts peripherally by increasing the uterine artery blood flow and hence improving endometrial thickness and implantation.

Chang and Rosenwaks –Fertility and Sterility Vol 78,No.6, Dec 2002

How does Yoga How does Yoga help?help?

Has a calming restorative effect on the mind and body

Reduces stress levels

Reduces depression

Feeling of control over one’s reproductive destiny

How does Yoga How does Yoga Help?Help?Improves strained relationships

Helps to cope anxiousness, nervousness, helplessness

Reduces emotional stress

One cannot control what’s happening to your body but you can control how you feel about it!

What is success?What is success?We need to redefine the term success

pregnancy? or patient wellbeing?

We need to acknowledge that CAM works!

How it works really does not matter

Information TherapyInformation Therapy

Better to be an agnostic rather than an atheist

It’s fine to say – We do not know!

Cannot be an expert on everything !

Patient – centered Patient – centered medicinemedicine

Putting Patients First !Respect patient’s desiresBest to offer all complementary therapies under one roof

Integrative medicine combines conventional medicine and CAM

Why lose your patients to another doctor ?

Best to keep an Best to keep an open mindopen mind

The “ label “ does not matter ! We need to do what’s best for our patients

This is not a competition. We are all on the same side!