PCOS: Tackled by Acupuncture and herbal medicine

PCOS: Tackled by Acupuncture and herbal medicine


PCOS: Tackled by Acupuncture and herbal medicine

Mike Berkley,

The health implications of Polycystic Ovary Syndrome (PCOS) stretch far beyond fertility and conception. Indeed, the third ESHRE/ASRM consensus, following agreements on diagnosis in 2004 and treatment in 2008, considered the wide-ranging ‘health aspects’ of PCOS, notably insulin resistance and other metabolic disorders, type 2 diabetes, cardiovascular diseases and cancers. Among the ‘pregnancy complications’ were gestational diabetes, pre-eclampsia and the birth of small-for-gestational age babies.

Just last year the largest study in the literature to date in assessing PCOS as a risk factor for the metabolic complications of pregnancy confirmed that women with PCOS are indeed at a two-fold higher risk of developing gestational diabetes than women without PCOS, at a 50% increased risk of developing gestational hypertension, and a 30% increased risk of pre-eclampsia.

Acupuncture and herbal medicine, via their regulatory functions on the endocrine and metabolic pathways may be helpful in reducing the possibility or the severity of gestational diabetes, pre-eclampsia and gestational diabetes.

The results come from an analysis of the largest inpatient cohort in the USA (the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database) in which deliveries to women with diagnosed PCOS between 2004 and 2014 (14,882 patients) were compared with a non-PCOS reference group of more than 9 million deliveries. While the results appear to echo those of earlier, and smaller studies, the authors state that this study avoids much of the formers’ heterogeneity and confounding from inadequate statistical power. Thus, in their opinion these earlier studies (even a large meta-analysis from 2019) were unable to isolate PCOS as an independent risk factor for all metabolic complications of pregnancy.

First, in terms of metabolic characteristics, the study showed that pregnant women with PCOS were at baseline more obese than controls (22.3% vs. 3.5%), had greater prevalence of chronic hypertension (8.4% vs. 1.8%) and had more pregestational diabetes (4.1% vs. 0.9%). All these differences were statistically significant. There was also a higher rate if IVF conception in the PCOS women (2.4% vs. 0.1%) and more multiple pregnancies (5.9% vs. 1.5%), which seemed largely explained by IVF.

Acupuncture and herbal medicine, via their regulatory functions on the endocrine and metabolic pathways are often helpful in assisting in weight-loss.

However, in all pregnancies the women with PCOS were more likely to develop gestational diabetes, pregnancy-associated hypertension, and pre-eclampsia than controls. The adjustments controlled for age, income level, obesity, smoking and chronic disease. The study also controlled for ‘insurance type’, which was significantly different between the two groups and may explain a possibility of underdiagnosis in women belonging to lower socioeconomic groups and receiving their care through Medicaid.

Acupuncture and herbal medicine, via their regulatory functions on the endocrine and metabolic pathways are often helpful in reducing the possibility, or the severity of gestational diabetes, pre-eclampsia and pregnancy-associated hypertension.


The adjustments proved important in the findings, indicating, for example, that the two-fold added risk of gestational diabetes was independently associated with PCOS and not confounded by obesity (or other confounding factors). The author’s conclude,

“Most studies and meta-analyses suggest between a 2.5- to 4-fold increased risk of GDM in the PCOS population, with significant uncertainty about whether or not the attributable risk is from PCOS alone, or if it is related to obesity.’

Acupuncture and herbal medicine are valuable interventions when trying to reduce what is in excess and support that which is deficient.

For example, excess may be viewed as gestational diabetes, pre-eclampsia and gestational diabetes, whereas deficiency may be seen as having reduced or stunted-activity of estrogen in the follicles due to excess androgens. By increasing that which is deficient (estrogen, or estrogen activity), this will then create a more balanced ratio between estrogen and follicular androgen. This can translate into better egg quality in the PCOS patient.


Mike Berkley, is Founder and Director at The Berkley Center for Reproductive Wellness in New York.






Your Fertility Questions Answered By Experts

Your Fertility Questions Answered By Experts

Fertially: Not just another fertility platform


Andrew Coutts


With so much information already available online you might ask whether there is room for one more platform.

The first conversation I have with anyone looking for answers to their fertility issues online is not about their ‘problem’ or about solutions to it. It is about how frustrating it is trying to find an answer at all, or at least an answer they can confidently assume is honest, transparent and correct.

There are growing numbers of forums, patient support platforms, and influencers offering general and bespoke advice on every aspect of fertility you can think of. But, who should we believe, who should we trust?

I am sure that most of us involved with providing patient care, support, and signposting do so from a deep conviction of wanting to help others. This might be based on our own personal experience, a professional interest or simply because we are paid to provide the best possible advice. In areas of life which have been addressed online (which is basically all areas of life) there will always be those trying to exploit the vulnerable and the fertility world is no different. In my experience however, the fertility community although not immune to this, is, on the whole, a trustworthy one. BUT, whilst we can say with some confidence the majority of information from trustworthy sources is accurate to a point it can sometimes be misleading or open to interpretation.

Any searches we perform online, any articles we read, and any forums we join therefore need to be viewed and considered with a certain degree of care. Whether we are comparing success rates, reading patient reviews or choosing treatment providers we have to be mindful that the information provided by a particular source might be open to interpretation and we should always, always, seek to compare, or confirm with others, before we decide on a particular course of action.

I was recently approached to consider the merits of a new initiative called FertiAlly.com, a simple (aren’t all the best ideas based on a simple proposition?) platform which provides straightforward answers offered by experts to straightforward questions posed by patients. I liked the idea so much I got involved in spreading the word. I like the simplicity of the concept where fertility experts are asked the questions that are really important to patients and their responses are captured on video and posted online for all to access freely. And, with a nod to honesty, transparency and an acknowledgement that we are dealing with complicated issues there are sometimes different answers given by different experts to the same question! Doesn’t this add to the confusion, I hear you ask. No, I don’t think it does, it is reassuring in many respects that questions posed by patients prompt reaction, differences of opinion and generate discussion. In many respects this is how we all learn, and I firmly believe that anyone who has questions about their fertility health or are considering treatment options should participate and listen to debates and answers created by fellow patients.


This is where the unique nature of the FertiAlly platform sits. It simply allows patients to drive the conversation rather than being directed or led by professionals.

By driving the dialogue, it is the patient that will ultimately benefit by getting the answers that are important to them and which will enable them to make fully informed decisions about the direction their fertility treatment, care and support should take.

Although still in its infancy, FertiAlly has quickly built up a bank of almost 70 worldwide fertility experts spanning different specialisms.

Patients can also contribute to the development of the newly launched European Fertility Society (EFS), an independent, not for profit organisation set up to safeguard and promote the interests of both patients and treatment providers. For each answer published on the fertially website a donation of 5 Euros will be made to the EFS.

I began this article by talking about the multitude of platforms that you can access for information and help on every aspect of (in)fertility and this number appears to be growing on daily basis. The FertiAlly platform should not however be simply disregarded as the next in a very long line, it is far more than that.

Check out the FertiaAlly YouTube channel for yourself.



What awaits the traveller?

What awaits the traveller?



Malaysia’s role in health tourism: What can the patient expect?



Andrew Coutts takes a look at what awaits the healthcare traveller in Malaysia.


The Malaysian Government identified the growth potential of medical tourism in the late 1990’s and took the strategic decision to pool the collective strengths of the private and public sectors to harness the country’s medical tourism industry. It was a decision which proved to be extremely productive.

 The unique private/public collaboration which saw health tourism promoted by the Government and fuelled by the corporate sector provided tourists with the stamp of regulatory approval in terms of quality, safety standards and medical related legislation. This endorsement combined with significant investment powered the development of the sector until it was so rudely disrupted in early 2020 by the Coronavirus pandemic. Up until March 2020 health tourism in Malaysia had seen monumental year on year increases in terms of both the numbers of patients travelling for medical treatment and income generated by the activity. Between 2011 and 2018 the number of healthcare travellers’ who visited Malaysia more than doubled from 643,000 to nearly 1.3 million.

Central to the exponential growth of medical tourism has been the considerable influence and work of the Malaysia Healthcare Travel Council (MHTC), the Malaysian government’s medical tourism arm. MHTC grasped the notion early on that branding is the key to effective marketing and with this in mind, it has developed a unique brand which has become synonymous with a portfolio of services designed to promote and support the ‘whole’ patient experience. Recognising that the medical procedure only forms part of this experience MHTC facilitates the overall patient journey in aspects of accessing information, the most appropriate treatment options for the patient, whilst collaborating with the country’s hotel, travel and leisure sectors to create a memorable truly Malaysian experience. A package of care which has ticked a number of boxes: facilitating the most appropriate treatment options for the patient whilst stimulating the country’s hotel, travel and leisure sectors.

MHTC’s work has also benefitted from the resources it has had at its disposal. The country is blessed with a wealth of available and skilled medical and technical expertise, political and economic stability, excellent infrastructure and transport links and a tourism sector with an exceptional track record in attracting visitors in their millions from all over the world.



What Can Patient’s Expect?


 The country offers healthcare, accommodation, entertainment and travel at very competitive prices. Tourist resorts sit in a tropical climate, ideal for rest and recuperation and there is no need for visitors to obtain a visa for stays less than 90 days in general. The vast majority of care providers speak English and there are no waiting lists for whichever medical treatment you require.

Many of the country’s 200 private hospitals provide excellent rehabilitation and wellness facilities to ensure travellers can access help and support for recovery purposes and each is recognised by internationally accredited bodies including the Joint Commission International (JCI) and the International Society for Quality in Health Care (ISQua) reflecting their commitment to high-quality care.

 This commitment to upholding the highest standards of care and service has consistently attracted external recognition in the form of both travel and healthcare awards. The country has been awarded the “Best Healthcare In The World” category in the International Living Annual Global Retirement Index in four out of the previous five years. At the most recent ‘International Medical Travel Journal Awards’ the country’s total belief in patient-centred philosophy was acknowledged by the awarding of 9 out of the total of 15 honours announced; a feat not matched by any other country in the world.




The Future of Health Tourism in Malaysia


 MHTC recently staged the fifth annual, ‘insigHT’, the region’s medical travel market intelligence conference. This virtual event staged during the Coronavirus pandemic brought together leaders from worldwide medical tourism hubs to discuss the future of the sector.

 As borders begin to open and patients prepare to travel once more in 2021 flexibility, innovation and collaboration were identified as the key drivers for renewal and growth. Malaysia hopes that the blueprint for private and public sector collaboration it initiated in the late 1990’s to promote good health will now enable it to achieve a far quicker recovery than in countries less prepared. The conference acknowledged that the pandemic has also accelerated the need for healthcare to embrace Innovation and digitalisation and harness available technology to assist communication between patient and provider.

The future may not be as certain as it was at the beginning of 2020 but you can be assured that Malaysia with a track record stretching over twenty years is very well placed to harness existing technology and ensure that patients remain at the very centre of the medical and tourism service it provides. 

The Covid-19 pandemic in Malaysia and its response

The Covid-19 pandemic in Malaysia and its response

The Covid-19 pandemic in Malaysia and its response


In a first of a series of articles on Malaysia and its role in world health tourism, Andrew Coutts looks at Malaysia’s response to the Coronavirus Pandemic.

Malaysia’s response to the outbreak of the Coronavirus disease was swift and effective. Coherent and collective action from individuals, policy makers and practitioners very early into the pandemic proved to be a key factor in the country, with its population of 31 million people, limiting both cases and deaths whilst supporting and then promoting individuals and the economy at large.

The country acted quickly following the first COVID-19 case outside China which was reported in Thailand on 13 January 2020, establishing an effective screening process at all airports. This was followed shortly after by an initial financial stimulus package over nearly £4 billion and a subsequent £46 billion ‘PRIHATIN’ package to aid micro, small, and medium-sized enterprises for employee retention.

Financial packages were further supported by federal measures such as the Movement Control Order enforced in March 2020, and widely adopted media campaigns promoting the hashtag #stayhome, did much to reduce both the unessential movement of peoples and infections. Cross sector collaboration was exemplified by large numbers of Non-Governmental Organizations assisting in the production of personal protective equipment as well as support from both conventional and Islamic insurance sectors who established a multi-million pound fund to assist with COVID-19 testing.

In the early days of the pandemic most companies had their employees working from home; Non-Governmental Organisations took on the immense role of helping to provide food and shelter for the homeless and all educational institutions, schools, and higher education institutions closed their doors to face to face teaching.

The country reported its first COVID-19-positive case on 25 January 2020 and by mid-April the figure had risen to almost 4,500 with 70 deaths; significant numbers but substantially lower than other countries that were following a similar timeline trajectory. These included the U.S. which had recorded 502,876 cases with 80,747 deaths and the U.K. with 73,758 recorded cases and 8,958 deaths.

In part the successful management of the pandemic at its early stage was due to the way that the Malaysian Prime Minister’s Department (Economy), Health Ministry, Finance Ministry and the National Security Council were able to adapt to a very fluid situation. Health screening at all points of entry into the country and the Movement Control Order were enlisted rapidly but so too was the establishment of cross sector collaborations aimed at supporting the growing health needs through financial and logistical assistance.

The Malaysia Health Coalition, established by the collaboration of 38 medical societies was a perfect example of this which supported the effort of the Ministry of Health to ensure the transparent flow of accurate health information.

A dedicated COVID-19 Fund was also launched to assist patients who had been directly affected by quarantine procedures and those without an income received a daily subsistence sum whilst either being treated or in quarantine.

The Ministry of Health also converted the country’s largest convention centre into a 604 bed field hospital and made provision for conversion of indoor stadiums and public halls should they be required; there was also a commitment from 3,000 retired nurses who were prepared to return to work voluntarily.

As a result of early federal intervention; the mobilisation of private and public sectors and most importantly a population who were prepared to follow the rules regarding essential regulations such as the wearing of face coverings and social distancing, Malaysia fought and continues to fight COVID-19 as effectively as an other nation in the world.

At the time of writing, the country was ranked 64th in the world based on the number of positive cases of COVID-19.

As we all look to the future with renewed optimism that a number of vaccines may be effective to stimulate immunity from COVID-19, policy makers and practitioners are moving from a position of maintenance and defence to growth and redevelopment. The redevelopment is perhaps nowhere more apparent than in the field of healthcare tourism.

The recent Governmental change in Malaysia has established an Economic Action Council to target economic regrowth. The Ministry of Health has benefitted to the tune of £110 million from the fund and almost £6.5 million has been set aside for work undertaken by the Malaysia Healthcare Tourism Council (MHTC), an increase of 40%.

The confidence placed in the work of MHTC by the Malaysian Government is both testimony to the work undertaken by the Council to date which has seen the country become one of the leading destinations for medical tourism in the world and its perceived ability to act as a catalyst for economic growth as the world reopens for business. A point not lost on MHTC’s chief executive officer, Sherene Azli who said following the recent fund announcement,

“The increase in federal support will further optimise the healthcare travel industry for economic revitalisation and has the ability to contribute up to RM10 billion (£1.9 billion) to the economy as the industry recovers.”

Over the coming months we will examine how Malaysia has taken the niche mantle of health tourism, developed it, and enabled it to become one of the country’s major assets. An asset which has been on pause for much of 2020 but will surely emerge just as strong in 2021.

Assisted fertility can be stressful and disarming

Assisted fertility can be stressful and disarming


Assisted fertility can be stressful and disarming. Since day one, we have strived to elevate the patient experience by creating a humanizing and caring environment”

Dr. Marjorie Dixon, CEO and Medical Director of Anova Fertility & Reproductive Health

It is easy and understandable to dwell on some of the tough realities of the moment, but we want to share some positivity during the UK’s annual Fertility Week, organised by Fertility Network UK. We did not need to look any further than the inspirational Dr. Marjorie Dixon, the founder of IFC’s Canadian partner Anova Fertility & Reproductive Health, to provide a breath of fresh air.

Q. Anova has grown into one of Canada’s leading next generation clinics in four short years; what motivated you to start it?

I returned to Canada after a certified fellowship in the U.S. and became disillusioned with what I saw to be the care options available to Canadians. When I asked why we were doing things a certain way, I was told that change was just about impossible. This is the worst kind of response I could have been given as it merely inspired me to go after change. There’s nothing worse for a Type A, analytically-driven, scientific person to be told “this is the way it is’. I built a team of inspirational achievers who shared my goal and we went for it.

On one side, from a more technical perspective, I knew that we could do better by building a centre that invested in the latest science and technology. I am so proud of our lab and people, we have a state of the art facility and it is the magic behind the success rates that we have at Anova.

From another perspective, I wanted to address that fertility clinics are often primarily geared towards heterosexual couples who are struggling with infertility. As an LGBTQ+ community member myself, and the mother of three IVF children, I recognized that there is a gap in access to care but also information since I experienced it personally. I made it part of Anova’s mission to make the path to parenthood as clear and supportive as possible for everyone, as love is love and everyone has the right to a family.

Q. So what is your goal?

Our goal is to improve the experience of reproduction — to improve the journey regardless of family status and sexual identity. To make family accessible to everyone, because we have the ability and training to do so. It’s in our mission statement: To provide individual care for patients of every age and situation.

I acknowledge that assisted fertility is stressful and disarming. I had IVF and I remember every single treatment. So we design the rooms differently. We host support groups because there is power in social interactions with others going through the same thing. I believe that the experience of fertility care is just as important as the science.

Q. It is personal then?

Of course, my experience as a patient shaped my thinking. As a black, female, LGBTQI+ I am familiar with what it means to be marginalized. I also know first-hand how stressful the fertility journey can be so wanted above all to offer patient-focused fertility care under one roof. The journey of fertility can be disarming on the best of days, and alienating, so we were determined to offer wrap around care in one physical location, undertaken by a compassionate and empathetic team.

The fertility journey is the ultimate equalizer. If you take a look around our clinic, we have every type of person coming through our doors, and they sit together with one goal in common: a legacy of their own, a family of their own.

This desire is wholeheartedly supported and shared by Anova’s entire team.


Q: What’s next for you, and for Anova Fertility?

We have had success, growth, and provided improved access to care. But there is still so much to do. I don’t think it ends. I believe we need to find champions to create a movement of improved access to every member of the community regardless of gender or sexual orientation. I envision a clinic that focuses on reproductive health, family planning and sexual wellbeing. This includes education and involving our patients in the decisions about their care in each stage of their journey. Every person is unique, and so should be their fertility plan.

Hopefully, the legacy we leave through Anova Fertility is one of sustainable change in medicine. I am so blessed to do what I do every single day. It is immensely rewarding to make babies, with lots of love and a some science.





Are we beginning to feel the strain of too many webinars?

Are we beginning to feel the strain of too many webinars?

Are we beginning to feel the strain of too many webinars?

Andrew Coutts


Pre Covid-19 there were only a few opportunities to jump online onto a presentation or discussion about fertility. Some of the forward thinking and marketing driven treatment providers were ahead of the game and were already sharing webinars featuring patient testimonials, clinic walk throughs and expert talks before the first Coronavirus infection. A few of the more active Insta Influencers had spotted the potential of the online ‘Live’ and were using it to share education, offer advice or to merely promote themselves. For most of the time, it worked.

Then in the early spring of 2020 Covid-19 started creeping and within a relatively short period it had lept on societies across the globe, pausing, cancelling and shutting down everything in its way. The fertility field was no exception, clinics closed, treatments were cancelled, hopes were put on hold.

Like many other countries the UK went, after polite consideration, into full lockdown in March 2020. There was general consensus that staying away from each other was the right thing to do so as a nation we took our ball and went inside. And, we rolled slowly forward.

Like every other field of activity, the fertility community took a breath, stepped back but then thought, what next?. Our biological clocks didn’t stop for Covid-19 and as each day and month passed the ticking got a little louder. Patients sought assurances, answers. Professionals did their best to comfort but the virus caused uncertainty and this uncertainty which began as a ripple, then raged across the tightly knitted fertility community.

Trying to conceive and failing is one of the most stressful emotions you can experience and historically it was an emotion that wasn’t shared, even among close family and friends. I brushed against the fertility field as a patient twenty years ago and ten years later as a professional. In that time there was a noticeable shift in the way individuals and society viewed infertility. As more of us were becoming affected by it, the more fertility stepped out of the shadows. In short, fertility joined the mainstream.

A new profession was born. ‘Fertility Specialist’ became a title not solely owned by the medical doctor; now it began to be adopted by a new crowd of individuals and agencies offering emotional support, coaching and even fertility travel, my own area of interest. This groundswell of people queing up to share information and advice on every aspect of infertility meant that in many ways the fertility patient too, became a Fertility Specialist. Infertility had arrived and we were at last beginning to talk about it.

Then, bang. Coronavirus reared its ugly head and started to have a real impact on people’s ability to access time limited fertility treatment. Older patients wondered if they were going to be ‘too old’ to get their treatment – Even (good) private clinics now have an upper age limit for patients – others were anxious about their ‘frozen’ embryos stored in laboratories and others speculated whether treatment would actually start again.

 The fertility community was crying out for a ‘cure’ like the rest of society. Their cure however didn’t come in a syringe, it emerged in the form of the Webinar. After weeks of uncertainty the webinar became the school yard for adults interested in fertility, an online haven for ideas, rants, frustrations, tears but also for reassurance, comfort and support.

My inbox and social media platforms bulged daily with invites to Insta Lives, Zooms, and Teams sent from all over the world. Speaking as a ‘Boomer’ I was blown away, telemedicine had suddenly come of age and patients were beginning to benefit from online services that hadn’t existed six months previously. Clinics and clinicians were talking to patients in their own homes; patients were talking to each other in safe, private environments and couples were ordering products designed to offer the promise of parenthood.

Webinars were running headlong towards the sombre spectre of Covid-19 and there was a great sense of togetherness and community. Some great examples of education and support were provided; myivfanswers.com launched over 250 videos and webinars that brought together ‘proper’ fertility specialists from all over the world. Closer to home, ‘The Man cave’ Instagram webinars offered the inspirational and honest thoughts of a male fertility patient.

Six months after the first wave of fertility webinars there appears to be no wane in the number of webinars and videos going live. A recent conversation with a colleague, and the reason behind this article, got me thinking, are we beginning to feel the strain of too many webinars? My eyes glazed when he calmly announced that he had spoken at 42 webinars in the previous three weeks, quite a feat at two a day. I wondered what there was left to say.

As the levels of compliance that were upheld by so many in March begin to fray in the face of lockdown yo yo I wonder if the fertility community too has also become tired of the webinar. I have randomly begun to surf Lives and videos and notice invariably there might be 3 people watching, I imagine the presenters disappointment as three become two as I leave.

And as we huncker down for what is likely to be a long winter it will be interesting to see if the fertility webinar can regain and maintain its popularity or whether like Covid it will slowly take a step back into the shadows.

Whilst we wait, my first webinar, ‘It Doesn’t Stop at the Pot’, a male only discussion on male fertility diagnosis and treatment is going live on Wednesday 4 November, to mark the UK’s Fertility Week. I have decided to play rather than to shout from the touchline. Hopefully we will attract a good crowd.

Andrew Coutts is the Chief Executive of the International Fertility Company and a PhD Research student at the Centre for Reproduction Research at the Du Montfort University.