Photobiomodulation and Fertility

Summary:

Low-Level Laser Therapy, also known as Photobiomodulation (PBM), is being explored as a potential treatment for female infertility. It helps fertility by improving blood circulation, to benefit the ovaries and the uterus, and improve endometrial thickness and oxidative stress. PBM also improves the energy integrity of the cells and provides more ATP (cellular energy) for the act of implantation. In the studies, PBM was seen to increase pregnancy and live births in 30-60% of the participants, who were all considered to be infertile and had attempted various Assisted Reproductive Technology (ART).

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The journey to parenthood can be filled with hope, anticipation, and sometimes, unexpected challenges. For many facing infertility, especially unexplained or age-related issues, the search for effective treatments goes beyond the conventional paths. Enter Low-Level Laser Therapy (LLLT), also known as Photobiomodulation (PBM), a therapy now being explored as a promising adjuvant in the fertility world. But how does it work, and is it truly helping women achieve their dream of a healthy pregnancy? Let's dive into what the latest research is uncovering.

Photobiomodulation is a non-invasive way to help treat a variety of different concerns. It is able to do this by supporting the mitochondria to create more ATP (energy of the cell), increasing blood flow, allowing for a thicker and healthier endometrium, and decreasing inflammation in the area being treated. This means that it can help with fertility in men and women. There have been a number of studies showing improvement in egg quality, as well as sperm quality and motility (how well they move, eg. in a straight line, circles, or not moving at all).

Endometrium:

For an embryo to implant successfully, the uterine lining - or endometrium - needs to be just right. In one study using PBM, found that it could enhance the thickness of the endometrium. The authors of this study suggest that PBM might even help extend the critical “Window of Implantation.” Giving the embryo a little bit more time to implant into the endometrium.

Blood flow:

Blood transports nutrients, oxygen, and beneficial signaling molecules throughout the body. It also helps to eliminate waste and brings that waste to our liver and kidneys to dispose of. PBM has been shown to have a significant positive effect on both local and systemic blood flow. Improved blood supply to the ovaries and uterus is vital for conception and supporting a healthy pregnancy.

Energizing cells:

The act of implantation is a very energy-intensive process, needing a lot of ATP. Age and other factors can impair mitochondrial function, affecting egg quality and energy production. PBM enhances mitochondrial activity, increasing ATP production and decreasing oxidative stress. This post in cellular energy is seen as foundational for reproductive health and early developmental stages, like blastocyst differentiation. Clinical protocols involving PBM often include treatment times around Assisted Reproductive Technology (ART) procedures, such as having treatments before embryo transfer.

Safety and Effectiveness:

The studies highlight positive results with PBM. One study of infertile women who had failed previous ART attempts reported successful pregnancy rates of over 22% when PBM, paired with the proximal priority technique, was applied. Another case series noted that all three cases of unexplained age-related infertility improved and all resulted in healthy live births following PBM treatments. Yet another study combining ART and PBM suggested a better pregnancy rate than ART alone in women under 45 years old.

Importantly, the 2024 case series reported no adverse effects from the PBM protocols used. The in vitro study even found that PBM had a protective effect on endometrial cells by upregulating a tumor suppressor gene (PTEN), suggesting safety at the cellular level. According to the studies, this innovative therapy supports implantation! It's being investigated and applied as a way to actively create conditions favorable for implantation.

Treatments:

Treatments can be PBM only or combined with acupuncture. PBM treatments can range from 30-45 minutes on their own, or 60-75 minutes when combined with acupuncture. For PBM, the light panels are placed on the lower back, followed by the lower abdomen. These panels are placed in one area and go through their cycle of red LED light, followed by infrared light, before being moved to the next area. After these panels are done, a laser probe is used to treat deeper and specific areas.

If there are immune or circulatory issues involved, the treatments may be longer, and can involve a technique called The Paroximal Priority Technique, where the laser probe is placed against the carotid artery at the neck (one at a time), to improve systemic circulation. The improvement in circulation can be quite pronounced, which will help with the development of the endometrium, and transportation of nutrients, and the elimination of waste.

If this is something that interests you, book in with Dr. Charmange at Vive Health.

~Dr. Charmagne

References:

Phypers R, Berisha-Muharremi V, Hanna R. The Efficacy of Multiwavelength Red and Near-Infrared Transdermal Photobiomodulation Light Therapy in Enhancing Female Fertility Outcomes and Improving Reproductive Health: A Prospective Case Series with 9-Month Follow-Up. J Clin Med. 2024 Nov 24;13(23):7101. doi: 10.3390/jcm13237101. PMID: 39685560; PMCID: PMC11642705.

Taniguchi Y, Ohshiro T, Ohshiro T, Sasaki K. ANALYSIS OF THE CURATIVE EFFECT OF GaAlAs DIODE LASER THERAPY IN FEMALE INFERTILITY. Laser Ther. 2010;19(4):257-261. Available from: www.jstage.jst.go.jp/browse/islsm1....

Ohshiro T. Personal overview of the application of lllt in severely infertile japanese females. Laser Ther. 2012;21(2):97-103. Available from: www.jstage.jst.go.jp/browse/islsm7....

El Faham D, Elnoury MA, Morsy MI, El Shaer MA, Nour Eldin GM, Azmy OM. Has the Time Come to Include Low-Level Laser Photobiomodulation as an Adjuvant Therapy in the Treatment of Impaired Endometrial Receptivity? Lasers Med Sci. 2018;33:1105–1114. doi:10.1007/s10103-018-2475-y.30.

Phypers R, Berisha-Muharremi V, Hanna R. The Efficacy of Multiwavelength Red and Near-Infrared Transdermal Photobiomodulation Light Therapy in Enhancing Female Fertility Outcomes and Improving Reproductive Health: A Prospective Case Series with 9-Month Follow-Up. J Clin Med. 2024;13(23):7101. doi:10.3390/jcm13237101.31....

Acupuncture and Fertility

Acupuncture has been used for thousands of years, first seen documented around 100 to 200 BC. Initially, sharpened stones or bones were used during treatments (News Medical Life Science), instead of the needles we now associate them with. Luckily, practitioners now use sterilized needles, of various widths and lengths. These needles are not coated with any medication and are single-use, and are disposed into a sharps container afterwards. All of the needles that I use are thinner than a needle that you get with injections. Some needles have a very thin layer of silicon around the shaft of the needle to help the practitioner insert the needle "faster and painlessly;" however, in my experience, it does not make much of a difference, unless you have fibromyalgia or another condition that makes you extremely sensitive to pain. Acupuncture is an incredibly safe therapy to use, whether it's for pain, improving fertility, relieving stress, regulating the nervous system, etc. when done by someone who has been trained properly. Treatments range from 30-45 minutes, depending on what is being addressed. 

Acupuncture is a useful therapy to use in conjunction with preconception care. Treatments have been known to decrease stress, and modulate the nervous system - which in turn can modulate hormones. There have been studies that have found that acupuncture, especially after in vitro Fertilization (IVF) increased rates of pregnancy, and delivery (Qian). Jungyoung found that acupuncture increased pregnancy, and ongoing pregnancy rates in women with Polycystic Ovarian Syndrome (PCOS). While Balk found that women undergoing IVF and receiving acupuncture, objectively felt less stress than women who did not have acupuncture. As a result, more women receiving acupuncture with their IVF became pregnant (64.7%), whereas 42.5% of the women not receiving acupuncture with their IVF became pregnant. 

Using acupuncture to help increase conception rates with or without IVF, is another tool in the toolbox that naturopathic doctors can use to help couples conceive. It helps increase blood flow (and therefore nutrition) to the uterus, improves egg quality, decreases uterine spasms, decreases stress, promotes relaxation. If you were looking for extra support throughout your journey, having a Naturopathic Doctor on your side would be a great addition to your health team. 

~ Dr. Charmagne

Preconception

Preconception is when couples start planning on having a baby, and preparing with what they think will improve their chance of conceiving. This period can be filled with stress and expectation - on yourself and your partner. This expectation can be counterproductive, and in some cases, cause quite a bit of tension. Know that you may not conceive the first time you try - and that is completely normal! Medically speaking, it's not considered infertility until you have tried for over 1 year - that being said, it wouldn't be considered infertility if you have only tried a handful of times within that 1 year.

Preconception is the perfect time to address diet and lifestyle changes with both partners. Lifestyle can heavily impact rates of fertility (to find out how you can improve your Foundation of Health, check our my series about it here). Being overweight, has a tendency to increase risk of malformation in the developing baby, and poses a greater risk for complications later on in pregnancy for Mama and babe (Zeynep), while decreasing sperm count, quality, and mobility in men (Ramaraju). The good news, is this is modifiable! Which means you have the power to change this factor! And what makes it even better, is the weight loss doesn't have to be dramatic - losing 5-10% can improve ovulation and fertility! Another lifestyle change that can have a huge impact of your fertility is quitting smoking. Smoking causes can increase infertility by 60%,  increase miscarriage, and risk of malformation in developing baby. 

Stress can be another influencing factor on fertility. If your mind and body is stressed, it isn't going to think you are safe to have a baby, and as a result, will suppress those functions until it thinks you are safe. Check out my other blog for tips and tricks to manage your stress. There's a high chance you may know someone, who wanted to have a baby, couldn't, and decided to adopt - just to conceive on their own shortly after. Yes, there can be a number of reasons why this happened; however, they also weren't putting that much pressure on themselves or their partners to conceive. 

It's nice to give your body 100 days to reboot from all of these changes. It takes at least 3 cycles for a woman to improve fertility and decrease risks, this is because the ova (eggs) are susceptible to damage 100 days before ovulation. As for men, it takes 72-116 days for sperm to mature, and during that time, they are also susceptible to damage. Rebooting your body during these 100 days is an amazing way to give your body the time it needs to optimize your fertility. During this time, be gentle with yourself, practise self-care via taking care of your body via healthy diet and activity, and any additional lifestyle changes you want to implement. You have enough pressures in your life, you don't have to add the stress about fertility on it as well. Practice this for 100 days, with no expectations, and be gentle with yourself.

There are also supplements and vitamins that you can take to improve fertility (eg. CoenzymeQ 10, and omega-3s); however, these basics are much more important, and in some cases, this is all couples need to conceive. If you have been working on this already, and are still having a difficult time. Book in with someone to help guid you, and who can make specific recommendations for you and your partner - because after all, it takes two to tango. Fertility isn't isolated to a single gender. 

Warmly, 

~ Dr. Charmagne