Using Technology to Deploy Multivariate Interventions for Women with PCOS 2 Board Certified Reproductive Acupuncturist Former President of the American Board of Oriental Reproductive Medicine 15 years clinical experience Founder of one of the largest reproductive wellness centers in North America Clinical Wellness Director of RMA of Texas Founder/ CEO of Conceivable Kirsten Karchmer, M.Ed, M.S., L.Ac 3 4 5 Extensive clinical experience REs, OBs, L.Acs, Embryologist, Psychologist, Behavior Scientist Peer reviewed literature Human Reproduction, Fertility & Sterility Testing in over 7,000 cases Highly Successful Program 6 7 Ovulation regulation Decrease in PMS, cramping, hemorrhagic bleeding Decreased TTC Increased live birth rates/decreased miscarriage rates Weight loss Better hormone regulation Decrease in PCOS sxs Regular periods Better overall health Results that last beyond the intervention Improve outcomes of IUI/IVF Manage side effects of pharmaceuticals Increased agency for patients What are the goals? 8 How Do You Do It? Unique Dx Tools Diet Stress Management Lifestyle Coaching Western Medicine 9 Constitutional Diagnosing: Getting to the root of the matter 10 A Conceivable Cycle 28 day cycle No PMS Ovulation that occurs on CD14 with fertile CM 4 days of fresh red bleeding, soaking a tampon every 4 hours No clotting No spotting No cramping BBT averaging 97.2 in the follicular phase BBT averaging above 98.2 in the luteal phase 11 12 13 What Does A Conceivable Cycle Look Like? Regular: On average, women with irregular cycles had only the chance of getting pregnant each month as those with more normal cycles About 28 days long: Both shorter and longer cycles have been associated with reduced fertility, in some cases decreasing the chance of delivery by up to 50% Short cycles are especially detrimental to conception. In a series of studies from 1992 to 2003, researchers found that early ovulation resulted in a significant reduction (50- 75%) in clinical and viable pregnancy rates. However, when ovulation was regulated, pregnancy rates returned to normal levels. 14 What Does A Conceivable Cycle Look Like? A 4 day period: Bleeding that lasts too long, or not long enough, are both associated with a decreased chance to conceive each month, in some cases cutting chances to conceive in half Sufficient bleeding: Menstrual bleeding that is scanty, or excessive can indicate a lower chance to conceive each cycle PMS, pain, cramping and clotting are more than just uncomfortable symptoms. Theses symptoms may indicate larger problems like polyps, fibroids, endometriosis, or hormonal imbalances. In addition to being a drag, infertile women report these types of symptoms in much higher numbers than their fertile counterparts. 15 Diet Plant-based: Harvard scientists found that increasing the intake of animal protein, even by as little as one serving a day, resulted in a 32% higher likelihood of ovulatory infertility and researchers found that women who consumed plant proteins (instead of animal protein) for as little as 5% of their total daily calories had a 50% decrease in their risk of ovulatory infertility. Whole foods: Women with high glycemic loads, the result of a diet high in processed and refined foods, have been demonstrated to have nearly twice the risk of ovulatory infertility as women with low glycemic loads. Healthy fats: In one recent study, every 2% increase in calories consumed via unhealthy trans-fats increased the risk of ovulatory infertility by more than 70%. This is especially true when these trans-fats replaced fertility-friendly monounsaturated fats. 16 The Effects of Hydration on Reproduction Healthier cervical fluid: The more hydrated your cervical mucus is, the easier it is for sperm through it. Although a variety of factors determine cervical fluid viscosity, Lee et al. have found that sperm had the highest difficulty travelling through thick cervical mucus with low water content, regardless of when they are introduced. In other words, staying hydrated can improves the sperms ability to effectively fertilize the egg. Coffee: Women who consumed more than 100 mg of caffeine a day the equivalent of 1 cup of premium coffee were more likely to experience difficulty conceiving and higher rates of miscarriage during pregnancy, though the mechanism is still unknown.,, Sodas: According to the Harvard Nurses Health Study, women who consumed 2 or more sodas a day were up to 50% more likely to experience ovulatory infertility than women who drank less than 1 soda a week. Alcohol: Consumption of alcohol can causes increased time to conception, decreased probability of conception (by more than 50%), abnormal blast development, and decreased embryo implantation rate, thus increasing both the risks of spontaneous abortion and of fetal death. 17 Sleep Sleep. People experiencing either acute or prolonged sleep deprivation experience higher levels of the stress and elevated levels of associated stress hormones, such as cortisol, the following day. Elevated cortisol has also been associated with higher levels of early pregnancy loss. published by the National Academy of Sciences, pregnancies exposed to higher levels of cortisol were 2.7 times more likely to end in miscarriage. Sleep is essential for hormone regulation. Sleeping less than 7-8 hours per night has been associated with depressed leptin levels throughout the following day. Leptin is important because it influences important hormones for regulating the menstrual cycle. Furthermore, disturbances in leptin concentrations have been linked with poor egg quality and obesity which is also associated with ovulatory dysregulation 18 Weight Longer time to conception for obese women. A lower ongoing pregnancy rate the carrying of a fetus to term of 38.3% per cycle was found in overweight women compared to 45.5% per cycle in non-overweight women. The negative effects of obesity on female fertility have been shown to be reversible. Clark et al. found that after losing an average of 10.2 kg (22.5 lb) of body weight, 90% of previously anovulatory obese women began ovulating again. In other words, when obese women lost weight, their cycles began to return to normal. 19 20 Too Expensive Not Enough Time Not Scalable Technology The SolutionThe Problem 21 Women are already accustomed to interacting with their phone daily Provide education when and where the patient needs it Tracking increases engagement and compliance Supplements conventional treatment to improve outcomes Gives patients more of what they need Systematized patient info for better diagnosis, education, and engagement Why Technology? 22 Tracker apps are designed to help those who are FERTILE 23 Underlying Factors Herbal Formulas Diet Acupuncture Hydration Stress Managemen t Sleep Fertility Issues A wellness approach works! 24 Francisco Arredondo, MD Fertility & Reproductive Endocrinologist Highest pregnancy results for women in US 2011 The combination of a comprehensive, personalized wellness program with the best reproductive medicine provides my patients with the highest probability of conceiving and carrying a baby to full term.