Dr Michael Monk - News Information

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New research shows simple mindbody techniques may help you get pregnant 9 June 2011

At last a clear connection between stress and your likelihood of getting pregnant has been demonstrated.

Using a biomarker for stress, researchers showed that women who had the highest levels of stress markers were less likely to get pregnant than women who had the lowest. Bad news?

That’s good news in the sense that there is much that you can do to help reduce stress to increase your chance.

At the same time as that piece of research was published in the prestigious medical journal Fertility & Sterility at the beginning of June, a new study by Dr Alice Domar was published in the same journal.

This showed that women who undertake a mindbody programme to reduce and manage stress during IVF were twice as likely to get pregnant as women who didn’t - 52% against 20%! Dr Alice Domar is one of the world’s leading authority’s on stress and infertility and I trained with her in Boston, Massachusetts, so I always prick up my ears when she publishes new studies.

This research confirms what we have always felt; you need to start mindbody approaches in advance of your IVF cycle to get the most benefit. The research showed that the success rate was no different between those who did mindbody and those who didn’t on the first cycle of IVF (probably because it takes time for mindbody effects to develop). On the second cycle of IVF, however, when you will have been practising your Mind Body techniques for some time, there is a huge difference in success rates - 52% against 20%.

Please go to www.drmonk.co.uk/infertility to find out more about we do based on Alice Domar’s research.

Sarah Monk

Newsletter April 2011

Survival Psychology

The film 127 Hours is currently on release. As you probably know it’s about a climber, Aron Ralston, whose arm was trapped by a rock and had to take the decision to cut his arm off to survive.

With this in mind, I was fascinated to read two articles about why some people die in disaster situations, and some can survive against impossible odds.

In the January edition of The Psychologist magazine, John Leach of the Centre for Human Cognition at the University of Oslo, looked at current thinking on survival psychology.

The received view is that this is a personality issue and some of us are more disposed to give up - we lack ‘the will to live’. He argues that this view is probably not true and by perpetuating it we also blind ourselves to other explanations - and the possibility of saving lives.

Studies suggest that (in cognitive terms) in the first three days of a disaster situation, it is our ‘executive function’ which is most compromised. This compromise reduces the ability to take initiative and produce pro-active behaviours. One of the key components of executive function is our ‘working memory’ and this also seems to be suspended in a crisis.

The result is that we lose the ability to sort things out on the hoof and we can’t access the stored information about how to deal with a crisis, even if we have had training.

Leach suggests one of the reasons why we may fail to activate our stored memory about what to do is that recovery of stored procedures may be ‘situation dependent’ when the capacity to reason things out is lost.

Here we get a clue about what might help us train people for disaster handling more effectively. Training should be practical and experiential and if possible in situ rather than relying on classroom teaching, reading manuals and watching videos.

The second article in the same journal looks at what is happening physiologically, and is very interesting in the light of the previous post about HEART BREATHING, the Relaxation Response and Yoga.

Researchers showed that people with high levels of a hormone called DHEA relative to levels of cortisol tend to be less traumatised in a disaster situation than those where cortisol is relatively higher, and on this basis they should be able to deal with the situation better. High levels of DHEA relative to cortisol are seen in people who practice Relaxation Response techniques such as Heart Breathing.

This must be a benefit from practising such techniques (hopefully we will never be in that situation), but it is an argument for teaching the techniques to the emergency services and armed forces and making the practise of it part of their every day routine.

Beyond the immediate crisis situation we know that people’s cognitive ability declines markedly and rapidly with the physiological changes caused by dehydration, lack of sleep, hypo/hyperthermia and falling blood glucose. Yet studies show that people fail to prepare adequately for disasters, for example if they live in disaster zones, either through denial, or lack of understanding, but that this attitude can seriously compromise their chance of survival.

From these two articles we can take the message that there are wide ranging benefits in

· being more chilled out generally;

· not underestimating potential threat;

· being prepared;

· and practising survival training in as realistic a situation as possible to take the strain off our thinking processes which are likely to collapse in the crisis.

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Evidence for the mind-body link continues to grow 2 February 2011

The physiological benefits of Yoga, where the Relaxation Response (Benson) is elicited along with stretching exercises, have been explored further recently. The findings were published in the prestigious Journal of Psychosomatic Medicine which you can access on line at http:/pni.osumc.edu/publications.html

A group of researchers at Ohio State University showed that women who practised Yoga regularly (they looked at Hatha Yoga) had lower levels of one of the bio-markers for inflammation, interleukin-6 (IL-6), in their bodies. They also had lower inflammatory responses to stress; stress produces an inflammatory response in the body.

So what this study showed was that not only did the Yoga women have fewer inflammatory ‘information substances’ or neuropeptides such as IL-6 caused by chronic stress, they also responded to stress with fewer inflammatory side-effects. A virtuous circle seems to be created.

What does this have to do with our long term health?

EVERYTHING.

Inflammation is one of the main predictors of death from all causes. This is because neuropeptides like IL-6 play a key part in our likelihood of developing type-2 diabetes, heart disease, arthritis, Alzheimer’s, osteoporosis and probably several cancers.

Yoga looks like a great way to protect ourselves, and the exercises help to keep us supple too, but not everyone can spare the time on a regular basis.

An alternative would be to learn “HEART BREATHING”, which can be quickly learned (usually within 1 or 2 sessions using our biofeedback software) and can be practised discreetly almost anywhere throughout the day when you have a few minutes to spare.

'An apple a day keeps the doctor away’ – a few breaths a day could do even better!

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More on Restless Legs 10 February 2010

There was an article by Lucy Atkins in yesterday's Guardian G2 section (www.guardian.co.uk) about the debilitating effects of RLS. I thought it was well written but she doesn't appear to be aware of the research study underway at the London College of Osteopathic Medicine. This is looking at the potential for a gentle non drug treatment approach to this disturbing and sometimes disabling condition. It seems to be difficult for many doctors to understand the idea that RLS may not be due to dopamine disturbances in the brain and that there may be other approaches which could be very successful.

The research is still going on and so the results that we have are at present very largely anecdotal, but they do look very encouraging. What we mean by anecdotal is that these results are based on reports of individual or small numbers of cases which all show the same trend, but the treatment approach has not been subjected to a rigorous scientific study where treatment is matched against 'non-treatment' to assess whether the response is merely due to chance or the placebo effect. This sort of formal controlled study is now being carried out.

A recent example from my own clinical experience is a patient that I hadn't seen for 2 years. Her main problem then was Restless Legs Syndrome which had been disturbing her and interfering with sleep for several years. I treated her this gentle manipulative approach just 3 times.

She was very much better following the first treatment and in hte next coupole of weeks had only one episode of disturbance, which was after a long haul flight. With the second and third treatments all symptoms of RLS disappeared. They haven't returned in 2 years.

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Isle of Man Syndrome? 1 October 2009

‘The Isle of Man syndrome’

You probably know the emblem of the Isle of Man? Three legs in armour and spurs joined together at the thigh which look as though they have been running for ever.

The emblem is a triskelion and is based on the coat of arms of the last Norse King of Mann. (A modified version of this coat of arms is still in use by his Norwegian descendants).

I always think that this should be the coat of arms of sufferers from ‘restless legs syndrome’ (RLS). It seems to capture so well the continuous movement forced upon these poor sufferers.

I have written extensively on this site about RLS, because it is a condition that can usually be helped and frequently cured by some simple, very gentle, manipulations. Usually only 4 or 5 treatments are necessary for lasting relief.

A pilot study some years ago at the London College of Osteopathic Medicine showed an extremely good response rate in patients and now they are running a much bigger trial with many more patients. The London College of Osteopathic Medicine ( www.lcom.org.uk ) has a sixty year history of training medical doctors to be osteopaths and has significant research experience. Any treatment given in the trial will be by a medical doctor who is also an osteopath.

They are looking for people to take part in the trial which is a completely drug free approach. This is being run in conjunction with the Ekbom Syndrome Association www.rlsuk-esa.org.uk.

Visit www.rlsuk-esa.org.uk/researchproject for more information.

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Two giddy ladies and one giddy man 22 January 2009

Labyrinthitis, vestibulitis, vertigo, dizziness, giddiness. Whatever you call it - whether you use medical terms or not - it isn't pleasant. The feeling that the room is spinning round, the feeling of nausea, you wish it would stop. Most doctors will tell you that it's due to a disturbance in the organ of balance in the middle ear, sometimes due to a virus.

This may be the case for some but there is a link between the neck and giddiness and dizziness which is not really recognised by mainstream doctors, although there is plenty of research literature on this subject, some of it going back to before the Second World War. Minor 'mechanical' disturbances or abnormal muscle tensions in the neck can disturb a person's sense of balance and may lead in turn to nausea and vomiting. Sometimes there is a history of a minor injury to the neck, not necessarily recent; sometimes the symptoms may start with a minor viral illness, but the giddiness just doesn't settle and may go on for months or even years.

It really is a disabling condition; over the years I have seen patients who were afraid to stand on a chair because they might fall off, and patients who had to come downstairs backwards, on hands and knees, because of giddiness.

Just recently I have seen three patients with labyrinthitis/vestibulitis who all had a similar problem in the neck, although each story was different.

Mrs A. (in her mid 40s) had had 'labyrinthitis' for 4 months following a mild viral cold and sore throat. She had a constant feeling of slight unsteadiness and was dizzy if she moved her head. She had some pain over the right side of her face and in the right ear. For 2 months she had also had moderately severe pain in her left arm spreading down to the hand. This was bad enough to wake her at night and force her to get out of bed and walk round the house.

Mrs B. had had Meniere's disease for 3 years. This is when the combination of dizziness, ringing in the ear and slight deafness occurs. Her right ear felt 'full' and 'under pressure' and was painful, and she couldn't lie on that side at night. For 9 months before I saw her she had had episodes of vomiting lasting 4-5 hours, and happening every few days. They were unpredictable, seemed to happen for no rhyme or reason, and were completely debilitating, wiping her out of action. Difficult with a young family to run.

Mr T. was a keen scuba diver but was being sick under water. He had always been aware of what he called motion sickness when he turned his head but this was new. It had started when he did a dive in very poor visibility and became disorientated - he wasn't sure which way was up and which was down. Suddenly he felt sick and then threw up into his face mask and breathing apparatus. This happened again on a couple of later dives. He now became very worried because this was obviously very dangerous under water, apart from being very unpleasant.

What was interesting was that all three of these patients had minor disturbances in the neck, all at the same level of the upper spine. Each of them showed a very good response to the gentlest of manipulations within a couple of sessions. Mr T. needed 2 treatments, Mrs A. had lost all her giddiness and pain in her face and arm by the third time I saw her, and Mrs B. also saw a huge improvement within 2 sessions, with some improvement in her tinnitus.

These are anecdotes about patients and are obviously not controlled studies. But if your giddiness just goes on and on, perhaps you need to get someone experienced in manipulative medicine to look at your neck.

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Stress doubles risk of stillbirth 2 June 2008

For a long time we have felt that one of the most important platforms of our treatment approach is the overall reduction in stress to help you get pregnant and to stay pregnant. This study is another piece of evidence in support of that.

A report in New Scientist (www.newscientist.com) last week drew attention to some recent evidence from work in Denmark which showed that stress almost doubles the risk of stillbirth. "We don't yet know for sure whether stress may directly cause stillbirth, but our results are enough for doctors and midwives to be concerned", said Kirsten Wisborg, one of the lead researchers.

One possibility is that stress hormones such as adrenaline might be reducing blood flow to the placenta, which could restrict oxygen supply to the foetus. This effect has been shown in monkeys. It has been recognised for some time that stress is linked to premature birth, high blood pressure and pre-eclampsia. There is also evidence of stress causing cognitive problems in children and increasing the risk of miscarriage.

The Danish study only measured the effect of recent increases in stress. Kirsten Wisborg pointed out that if chronic stress was taken into account then more of the stillbirths might have been linked to stress. Commenting on this study, Vivette Glover, a perinatal psychobiologist at Imperial College London said that people should start changing their behaviour now. "People looking affter pregnant women should pay much more attention to their emotional health and employers should be open to flexible working hours".

This is certainly another mechanism which would explain why both acupuncture and mindbody medicine can increase the number of successful pregnancies, and not just increase the likelihood of getting pregnant.

We aim to reduce stress before you embark on ART, to help you to manage stress during ART, and we give you the tools to continue managing that stress at home for life.

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Smoking and drinking damage sperm 4 April 2008

“Men should not smoke, drink, or take unnecessary drugs if they are planning to become fathers”. This is the message from the annual meeting of the American Association for the Advancement of Science, in Boston (reported in The Guardian February 19 2008 www.guardian.co.uk).

In the past it had been assumed that male exposure to toxins would have little or no effect on the children. Sadly there is increasing evidence of how wrong this idea is.

Toxins, from pesticides to prescription drugs and to wartime chemicals, have been shown to cause problems leading to miscarriage, low birth weight and an increase in the number of birth defects. In rats, some garden chemicals have been shown to cause damage to the prostate and kidney, and infertility, in up to 4 generations (i.e. also in the children, grandchildren and great grandchildren).

Alcohol in excess leads to a higher rate of sperm abnormalities, and caffeine too has been shown to disrupt DNA in sperm cells.

The good news is that damaged sperm cells are replaced with healthy cells, but this takes time – about 74 days, or 3 months. This means that if you go binge drinking at Christmas there may still be an effect on your sperm cells in the Spring.

So the message is "give it up early". Like any athlete you need to go into training. Make sure you stop in time.

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“Acupuncture may help increase IVF success rates by 65%” 26 February 2008

“Acupuncture may help increase IVF success rates by 65%” was the attention grabbing headline in The Guardian (www.guardian.co.uk) onFriday 8 February, which was reporting on an article published that week in the British Medical Journal (BMJ) .

Although it was good to see another article in a reputable medical journal coming down on the side of acupuncture, the results were not quite what you would be led to believe by the newspaper headlines.

There was indeed an increase of about 65% but this was in the odds ratio. This is not the same as the rate ratio.

The authors of the article, Manheimer and colleagues, explain in the BMJ, that this was “significant and clinically relevant”, which indeed it is. The article is well discussed by NHS Choices where it is pointed out that this means a confirmed pregnancy rate of 32% in the acupuncture + IVF group, compared with 27% in the IVF only group. So, although very worthwhile, this is not the huge increase implied by the headline.

We would also like to make the following points about the article in the BMJ

• Some newspapers have tended to present this as new research. In fact, this was not a new study but a meta-analysis, pooling together and examining previously published research to try to reach an overview. For several years now we have successfully based our acupuncture/mindbody integrated approach to infertility on research work, including some of the studies that Manheimer used for his meta-analysis, but also on other studies which go further than the narrow use of acupuncture taken in this study.
• Manheimer and his co authors looked at the effects of a single treatment just before embryo transfer (i.e. these women had already had down regulation, up regulation, egg collection, fertilisation and egg hatching). That there was a “significant and clinically relevant effect” is obviously good news, but this is a very limited way to use acupuncture.
• Some studies, for instance those by Magarelli and Cridennda , have shown that a course of acupuncture improves pregnancy rates for IVF by considerably more (up to 51%). They also raised success rates in women who are thought to be ‘poor’ candidates for IVF to the same level as ‘good’ candidates, by using acupuncture. In addition they showed a reduced risk of ectopic pregnancy and miscarriage in the group who had acupuncture. It has been shown that acupuncture has effects on the release of hormones which control ovulation, on ovarian function and on the lining of the womb, and all these effects have a part to play, but are probably dependent on repeated treatments over a short period of time.
• The authors of the BMJ study once again emphasised the safety of acupuncture in this context.

Can you do anything to get near to a true 65% success rate?

Mindbody medicine (MBM) produces rates approaching this figure, according to the research evidence. Mindbody medicine, which is the other part of our combined integrative approach, can lead to success rates even closer to this 65% level.

Dr Alice Domar, in Boston Massachusetts, showed that an astonishing 55% of women became pregnant after completing a mindbody programme, compared with only 20% in a control group. More surprising was the revelation that 42% of women became pregnant with just MBM and no IVF (although the numbers in this group did not reach statistical significance).

Alice Domar was recently awarded the special Founder's Award - The Barbara Eck Menning Award – by the National Infertiity Association of America for ‘demonstrating ‘leadership in the field of infertility or infertility resolution’.

Sarah trained with Alice Domar in Boston and is certified to teach her group programme. In addition, she offers a ‘one to one’ course, based on Domar’s groundbreaking work, which we combine with acupuncture in our integrated approach to helping you have a baby.

Sarah & Michael Monk

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