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December 17, 2018

How does Acupuncture Boost Pregnancy Success Rates

Are you wondering how does Fertility Acupuncture boost pregnancy success rates? You're not alone. Many of us, including myself, have gone through these exact same issues. I know what that stress and those worries and concerns are like.

When I was in my early 30's, after being married for quite a few years, I too was anxious to have a family. For myself, my biggest challenge was to understand how I could improve my own chances of conception as I was not able to get pregnant. If you're like me, you've tried every way possible to conceive prior to resorting to medical fertility treatments. I can smile about it now, but at the time I was trying all the recommendations on sexual intercourse positions and timing, taking half a dozen fertility supplements every day around the clock; doing yoga and meditation, going all organic and basically trying everything I read about or that was recommended.

After doing this for months and not conceiving, you're probably like me and feel this as an attack on your femininity. Fortunately, this problem ended after I had my first miscarriage following being pregnant for 2 months. It was a relief to know that I was able to get pregnant but it was also a blow as that miscarriage came after a few years of trying. Like all of us, I persevered and finally, with Chinese medicine treatment and improved nutrition through eating the right foods and proper supplementation, I was able to conceive again. I was 37 years old when my first child was born.

Later, I completed the training, studies and exams to become a Registered Acupuncturist and Traditional Chinese Medical Practitioner. One of the major rewards of my work is helping other women and couples conceive. I'm in a position to bring you the benefit of my own experiences as well as my professional knowledge in this area. I enjoy working with wannabe mothers (and fathers too) and knowing what it's like myself, I can promise you that I'll do my absolute best to help you conceive and support you through your pregnancy and post-delivery.

So just how does Fertility Acupuncture and Chinese Herbal Medicine help resolve infertility problems? Let's start by taking a look at conventional medical treatments for infertility, after which we'll dive into Fertility Acupuncture and Chinese Herbal Medicine. Just keep in mind this is an overview only. Every one of us is unique and in Traditional Chinese Medicine, there's no one treatment that suits every person. I treat every one of my patients as a unique individual with their own unique needs.

Many people believe to boost pregnancy success rates, western Medicine and IVF technology are the only solutions. What's the reality?

From the western medicine perspective, there can be many reasons that result in women having difficulty conceiving and following through with a successful pregnancy. Some of these may include:

  • Hormonal imbalances - for example, too high or low FSH, LH, Progesterone, Prolactin estrogens and androgens that cause an absence, irregularity or shortened/lengthened menstrual cycles.
  • Toxin overload, nutritional deficiency or insufficiency that lead to anovulation, thin uterine lining, premature ovarian aging and DNA damage to the eggs.
  • Existence of uterine fibroids and/or endometriosis that slow down and obstruct blood flow to the womb, inhibiting building a smooth healthy uterine lining for embryo implantation.
  • Having other health issues such as hypothyroidism, cholesterol abnormality, PCOS, type 2 diabetes, obesity, depression and chronic stress etc., any of which can be the cause of infertility.

Do any of the above issues describe your current situation? Not only will these issues continue to affect your ability to conceive, some of these problems can also cause chromosome abnormalities in the egg. These make developing viable embryos or become healthy babies a challenge.

What do western fertility clinics do for women to boost pregnancy success rates?

Prescription of fertility drugs to help stimulate egg production, followed by Intrauterine insemination (IUI) or IVF procedures:

Prescription of fertility drugs to help stimulate egg production

Western medical fertility clinics in general focus on using either IUI (Intrauterine Insemination) or  IVF (In Vitro Fertilization) regardless of the types of reproductive or health issues these "infertile" women are facing. Prior to carrying out these procedures, most women will be placed on pharmaceutical fertility drugs to stimulate ovulation, which assists with the timing of insemination.

Clomiphene Citric to stimulate egg maturation. What are the pros and cons?

The most commonly used drug that your fertility specialists or reproductive endocrinologist prescribe to “Infertile women” is Clomiphene citrate, an anti-estrogenic drug. This drug works by blocking estrogen receptors.

Although many women conceive by using this medication and / or with IVF and IUI, many of them need multiple treatment courses. Each course of treatment results in thinning of the uterine lining which may inhibit embryo implantation, decreased cervical mucus which causes difficulty for the sperm to reach the egg, and a long term depletion of estrogen receptors in the brain, which results in long-lasting hormonal imbalance, making conception and pregnancy difficult. Long term use of this drug also increases ovarian cancer risk.

I have treated many women who have previously received numerous IVF treatments. Most of them were prescribed Clomiphene. Some of these women had multiple failures of either IVF transfers (embryo implantation) or failure of the fertilized eggs to reach the blastocyst stage to form the embryo. Some of these woman, as a result of many courses of egg stimulation and hormone injections over the years, come to me with sudden weight gain, blurred vision, hot flushes, breast pain, abnormal vaginal bleeding, ovarian cysts, fibroids, and endometriosis in addition to “ female infertility”. Some of these problems further reduced their chances of conception, pregnancy and their ability to carry their babies to full term.

I've met some despairing patients, who, as a result of multiple years of failing IVF treatments, were finally rejected by their fertility clinics for further drug stimulation. Many of them were told by their fertility specialists to use donor eggs for the reason of poor egg quality. However, the reality is that after taking so many courses of fertility drugs to mature large quantities of eggs, these women's ovarian reserves had depleted too rapidly to produce viable eggs for either an IUI or an IVF procedure to be successful.

Letrozole prescription to stimulate egg maturation. What are the pros and cons?

Letrozole, also sold as Femara, is an anti-cancer drug that is prescribed by many Fertility Clinics. This drug can suppress estrogen production while inducing ovulation. Like Clomiphene, this drug may also increase your chances of conception.

So, while fertility drugs may help yield more eggs to fertilize, this process fails to improve egg quality and leaves the majority of women failing to become pregnant.

After many IVF failures, many of these women finally realize they have complicated their infertility problems - some may have no eggs for retrieval, while others experience health declines such as abnormal cholesterol, high blood pressure, presence of ovarian cysts which did not resolve, significant weight gain and mental taxation. Some of these women may give up, while others may look for alternative fertility treatments and overall health improvement.

One thing for you to realize is that women in their prime reproductive age range only have a 25% chance of pregnancy every month, even when perfectly timed with ovulation. If you've been having problems conceiving, while these assisted reproductive technology (ART) may improve your chances of conceiving considerably, they also increase the chances of you having a baby born with malformations.

Clinical data over the past few decades suggests that the use of either Clomiphene or Letrozole are linked to an increased risk of birth defects such as down syndrome, locomotor and congenital heart defects to newborn babies. When IVF and ICSI were used, the risk of birth defect rates, according to statistics, increased to 7% and 10% respectively.

And of course, when there is no conception or when miscarriage recurs, donor eggs are always an option suggested by their fertility clinics. Does this type of situation apply to you?

While IUI, IVF and ICSI may increase your probability of conceiving a baby, your own health, diet, stress and other personal factors determine your baby's health. An unhealthy baby can come from an unhealthy egg.

We’ll talk about what steps you can take to reduce these risks and increase your chances of successfully conceiving later in this post.

What do western fertility clinics do for men to boost pregnancy success rates?

What do western fertility clinics do for men experiencing infertility issues

Prescription of clomiphene citrate or ignore the male factor and advise couples to have an IVF immediately

While higher sperm count may increase the odds of conception, immobile sperm or poor sperm motility is one of the determining factors of a conception failure.

For conception to occur, sperm must be able to swim up to meet and fertilize the egg.

For male infertility, based on my experience, instead of identifying the cause of infertility to the patients, most fertility specialists ignore the male factors and present the IVF solution using Intracytoplasmic Sperm Injection (ICSI). Occasionally, I may encounter male patients bringing in their clomiphene citrate prescription.

How does clomiphene treat male infertility?

Clomiphene is a drug approved only for female infertility. Occasionally, it's sometimes prescribed "off-label" as an infertility treatment for men with low testosterone levels. The goal is to correct low testosterone production so that sperm count may increase gradually. However, male infertility can be a complicated issue. Is prescribing clomiphene the key to promote sperm health and a pregnancy success?

Male infertility can be caused by many other factors such as:

  • Injury to the testicles or testicular atrophy 
  • Aging
  • Overweight
  • Pituitary gland dysfunction
  • Exposure to higher than usual amounts of xenoestrogens
  • Existing health conditions such as diabetes, cystic fibrosis and some types of autoimmune disorder
  • Varicoceles (enlarged veins within the scrotum)
  • Genetic disorders
  • High intake of alcohol
  • Use of steroids, illegal drugs, cigarettes and marijuana etc.

Although Clomiphene citrate may increase testosterone, to see positive effects on sperm counts, infertile men must take this drug daily for at least 3 months.

It's worth noting that while Clomiphene Citrate can increase hormone production, too high testosterone can also suppress sperm production. Constant monitoring is required during drug intervention. If by the fourth month, sperm count remains low, IVF is still recommended by the fertility specialist. By then, approximately 3000-4000 eggs would have been lost by their female partner.

What's the most common side effects of Clomiphene citrate for men?

  • Tenderness of the breasts 
  • Irritability
  • Acne
  • Increased risk or accelerated growth of prostate cancer
  • Vision change due to swelling of the pituitary gland

In the case of an existing varicocele problem, I have seen fertility experts fail to take patients' existing health problems such as fatty liver, high abnormal cholesterol and abnormal liver enzyme issues into account before prescribing clomiphene citrate. The long term effect of taking clomiphene citrate while having the above issues can cause liver injury, which can be severe and even fatal.

How to increase fertility naturally?

Summarized, you need to spend time restoring your body's natural health and addressing factors that may be inhibiting your ability to get pregnant. While your western practitioners may take a straightforward approach using fertility medications to influence your hormone levels, they often don't address problems they can't identify medically, or solve unexplained infertility.

Fertility Acupuncture and Traditional Chinese Medicine on the other hand, takes a holistic approach to address the underlying causes of fertility issues.

How does Fertility Acupuncture boost pregnancy success rates?

Fertility Acupuncture has been used for thousands of years in China as a traditional medicine for treating various diseases including infertility. It has been widely used for the past few decades in many Asian and western countries. In fact, studies show that Fertility Acupuncture can increase the rates of pregnancy by up to 50%.

What makes Fertility Acupuncture so helpful in restoring female fertility?

acupuncture so helpful in restoring female fertility

1) Fertility Acupuncture treatments can help restore normal functioning of endocrine glands for women to achieve pregnancy success.

Our human body endows great capability to heal and return to normal equilibrium.

Fertility Acupuncture helps restore your endocrine gland function and balance hormones which are some of the critical elements needed to restore menstruation cycles, mature follicles, correct poor egg quality, induce ovulation, thicken uterine lining and support the growth of the fetus.

For example, an optimal level of Progesterone is essential to trigger ovulation, promote embryo implantation success and sustain a healthy pregnancy. Unfortunately, stress can deplete progesterone availability by stimulating the adrenal gland to convert progesterone to cortisol, one of the key stress hormones, to help fight stress.

High concentrations of cortisol during the first half of the cycle can lead to irregular menstruation, abnormal bleeding, painful periods, etc. In addition, high cortisol also causes weight gain, depression, anxiety and insomnia. All of these problems can lead to poor egg quality and absence of ovulation.

In the case of a successful conception, low levels of progesterone due to adrenal gland conversion into cortisol can lead to early miscarriage. In my clinical practice, I often encounter these wannabe moms who come for help due to frequent chemical pregnancy (pregnancy only sustained for a few days) or a miscarriage within 12 weeks.

Studies show that one of the important effects of Fertility Acupuncture is the improved performance of the adrenal gland. In one study, during a 4-week Fertility Acupuncture treatment cycle, participants consistently showed a gradually decreased level of plasma cortisol level after each acupuncture follow-up treatment.

Of course, other than to reduce stress levels, Fertility Acupuncture can also help regulate the pituitary gland directly to improve sex hormone production, balance hormone production and promote weight loss, all of which increase the success rate of pregnancy. 

What do you say about the effect of a Fertility Acupuncture session? Acupuncture treatment not only helps promote good quality eggs, and proper sex hormones; they also support the fetus's growth during pregnancy.

2) Fertility Acupuncture treatments help promote blood flow to female reproductive organs to remove toxins and increase endometrial lining thickness for a secure embryo implantation.

One of the causes of infertility diagnosed in Traditional Chinese Medicine (TCM) is blockage of blood circulation flow. When the free flow of blood is blocked, it can cause deficiency and stagnation syndromes.

Deficiency syndrome is the lack of nutritive blood to nourish the reproductive function in both men and women.

Stagnation syndrome is the disruption of free flow of blood circulation to the tissues in the reproductive organs.

Fertility Acupuncture treatment helps improve oxygenated blood flow of the ovarian artery to nourish the ovaries, fallopian tubes and the uterus so that hormone production can naturally be restored to support follicle growth. This improves nutrient flow to the eggs in the ovaries, and subsequently to the egg in the uterus. The supply of oxygen thru the ovarian artery helps repair DNA damage to the eggs. It also slows down aging of the eggs and the ovaries.

Fertility Acupuncture treatments and Chinese herbal medicine are proven helpful in improving both ovarian reserves, and in increasing the quality of oocytes. In several clinical studies as well as my own clinical experiences, Fertility Acupuncture treatments over the weeks prior to an IVF cycle showed a significant improvement of quality in the eggs retrieved for an In vitro fertilization process, resulting in much higher embryo transfer rates and a higher successful pregnancy outcome.

With increased blood flow, more nutrient and oxygen rich blood can reach the uterus to improve the uterine lining quality. This helps build a more evenly distributed endometrium for embryo implantation and fosters the healthy growth of the baby.

Chinese herbal medicine and nutritional supplementation can help correct nutritional deficiency issues of wannabe mothers. Nutritional deficiencies are one of the hidden issues causing premature ovarian aging and sub-fertile egg quality. These can be corrected prior to conception. Many times when nutritional deficiency problems are fixed, egg quality is improved, sometimes dramatically. When combining Fertility Acupuncture with herbal medicine, cysts, fibroid and endometriosis problems can also be resolved quicker. In my experience, the resolution of these problems often results in natural pregnancy, and the fetuses are able to develop to full term.

The existence of uterine fibroids, polycystic ovary syndrome (PCOS), endometriosis, sub-fertile eggs, a thin uterine lining and recurrent pregnancy loss should not be the obstacle that stops a couple from having their own children. The combination of Fertility Acupuncture and other complementary therapies such as fertility massage and nutritional therapy can help solve many of these issues which cause infertility and improve conception rates. Many clinical research studies as well as my clinical experiences using Chinese medicine treatment protocols and advanced nutrition have demonstrated the effectiveness in improving quality of the eggs and increased birth rates.

Here are some of the other benefits of acupuncture for Fertility. For example, 

  • Regulate reproductive endocrine system by balancing FSH, LH and testosterone levels
  • Improve ovarian reserve
  • Promote and regulate ovulation
  • Increase ovarian sensitivity to gonadotropins during an IVF cycle
  • Reduce side effects during fertility drug treatment
  • Prolong life span of the egg and embryo once conceived.
  • And much much more!

Does Fertility Acupuncture improve testosterone levels to increase sperm production?

Acupuncture improve testosterone levels to increase sperm production

It's estimated that around 15% of adult men suffer from male infertility.

Although many fertility experts claim that a single sperm is all it needs to create a baby, according to my experience, DNA fragmentation often exists in patients with abnormal sperm morphology and sperm motility issues. Sperm DNA fragmentation remains one of the biggest challenges for a couple to conceive a healthy baby.

Over the past 10+ years, I have treated many cases of men with zero percentage of normal sperm morphology. Some of these men have over 99% abnormal sperm with head, bodies and/or tail defects. This compounds the problem when the men already have a very low sperm count. Even with a "sperm wash", a process that is done to filter out the dead and abnormal sperm to improve sperm quality, medical technology is not advanced enough to help these couples to identify and select only the most viable and DNA-normal sperm for IVF and ICSI. For these men, the risk of creating a baby with a birth defect is much higher. As a result, babies born with birth defects due to IVF and ICSI procedures are a concern for prospective parents.

Fertility Acupuncture is one of the most effective treatment modalities available to help men overcome abnormal semen parameters. How does it work?

1. Fertility Acupuncture helps improve vital substance creation to help sperm regain motility and penetration.

Ancient Chinese medical philosophy believes that the human body is filled with an invisible life-giving force which we call “Qi”. When Qi flow is blocked due to a disease or injury. insertion of acupuncture needles in the surrounding area, or extremities can restore Qi flow. In TCM, we regard Qi as the commander of blood, directing blood to nourish tissues and organs.

Acupuncture points, in TCM, are recognized as the control points of Qi. They regulate Qi flow of the entire body. As a result, stimulation on certain acupuncture points not only promotes qi flow but also increases blood circulation. For this reason, some acupuncture points to treat infertility would be placed near the lower abdominal area and the lower back while other points would be placed on extremities to encourage proper qi and blood flow to the reproductive organs and genital area and resolve the underlying cause of infertility.

Idiopathic asthenozoospermia (iAZS) is characterized by reduced forward sperm motility. It is one of the major causes of infertility. There is no clear cause identified, therefore, there's no effective therapeutic drug treatment.

However, in a couple of recent animal studies using acupuncture, researchers were able to observe a significant increase in fructose formation in semen, the energy source for sperm motility. This is significant, as only motile sperm can swim up to meet and fertilize an egg if you want to have a natural pregnancy.

Using acupuncture to treat iAZS can be a promising complementary and alternative medicine (CAM) therapy for male infertility due to low sperm motility, and increases the successful pregnancy and birth rate.

2. Fertility Acupuncture treatments help decrease inflammation and subsequently lower scrotal skin temperature and results in higher viable sperm concentration and higher normal sperm morphology.

Inflammation is a body's natural response to injury, infection or to other unwanted substances such as toxins and plaque in the arteries. In the inflamed area, temperature often rises. Higher temperature is a mechanism to protect the body from pathogen attacks and to destroy unwanted substances.

Contrary to the rest of the body, men's sperm requires lower than normal body temperature to thrive. A rise in the body temperature often threatens sperm's survival and leads to cell death. Prolonged elevated scrotal skin temperature is widely accepted as a cause of impairment of healthy sperm production.

Studies show that infertile men with a low sperm count have consistently higher scrotal temperatures compared with fertile men.

While there are no drugs that can alter the temperature of the scrotum, one of the effects of acupuncture is lowering scrotal skin temperature. During 8-week acupuncture treatments, over 80% of the participants had increased sperm concentration.

3. Fertility Acupuncture helps reduce oxidative stress, hence reduces DNA fragmentation to the sperm

Oxidative stress is an imbalance between free radicals and antioxidants in our body. Oxidative stress can lead to inflammation and DNA damage. In TCM, we regard oxidative stress as pathogenic Qi, meaning that it can cause disease and dysfunction to tissue and organs. In cases of male infertility, oxidative stress leads to low sperm count, abnormal sperm morphology and impaired sperm motility.

As Acupuncture points are the control points of Qi, they can regulate Qi flow of the entire body. Stimulation on certain acupuncture points not only can bring healthy qi (the invisible life-giving force) to strengthen the weakened area or organs, in cases of excess pathogenic Qi (oxidative stress) accumulation, it disperses and resolves pathogenic Qi accumulation.

Studies show that regular acupuncture increases zinc (an antioxidant) flow to the reproductive organs and genital area. These studies showed that the presence of higher levels of Zinc offers oxidative stress protection to sperm, allowing sperm to regain its ability to penetrate and fertilize the egg.

Here are some other benefits of acupuncture to treat male infertility. For example,

  • Regulate reproductive endocrine system by balancing FSH, LH and testosterone levels
  • Increase Semen volume
  • Increase sperm production
  • Decrease anti-sperm antibody
  • Prolong life span of the sperm etc.

In case of infertility or reproductive health issues, when should Fertility Acupuncture begin?

If you have been diagnosed with "Unexplained infertility" or "Age-related" infertility, or have a "Poor ovarian reserve" or "low sperm count and quality", I would recommend you start taking regular Acupuncture treatments to boost your egg/sperm quality and reserve at least 3-4 months before trying any other fertility method such as IUI, IVF etc.

This is due to the fact that for "immature" sperm and follicles, it takes approximately 3 months to reach maturity.

In my clinical practice, many of my patients often experienced a significant increase in AMH (anti-mullein hormone) levels, which indicates increased ovarian reserve or increased healthy sperm count and quality after 3-4 months of acupuncture treatments. With providing nutritional guidance, I have found that most of my patients are able to develop and adhere to healthy eating and lifestyle habits. As a result, they have improved hormone production and many experience natural pregnancy. This complete lifestyle change provides positive effects on fertility and supports pregnant women in developing healthy newborn babies.

If you start early enough, then your chances of success increase significantly.

Interested in making an appointment but not sure what you'll get after the first session? Here is what you'd expect by the end of your first visit...

What would you expect when you come for your first visit?

What would you expect when you come for your first visit
  • Health status evaluation based on Traditional Chinese Medicine (TCM)
  • Health status evaluation based on nutritional assessment
  • Medical history review and risk factors for secondary infertility evaluation
  • Review of Fertility lab report and blood test report (if you have these available)
  • Fertility diet, fertility enhancing food recommendations and intake guidelines
  • Supplement recommendations
  • Lifestyle choice assessment and advice
  • TCM Fertility treatment plan and treatment recommendations
  • Initial treatment for infertility if time allows

Your initial visit with Bernadette is the most important step towards your conception and pregnancy success. This appointment often takes between 75 and 90 minutes to complete. At the end of the visit, you'll have a step by step guide to help pave your road to having an expanded family.

Bernadette Yu enjoys working with prospective mothers who are seeking to improve their probability of successfully conceiving a healthy baby and having a healthy pregnancy. Bernadette has great deal of experience working in conjunction with conventional medical male and female fertility treatment to improve the wannabe parents' outcome.

For further information on how combining Fertility Acupuncture treatment, Chinese Herbal Medicine, Dietary Therapy and Supplementation can help you to resolve infertility issues and how they can improve your chances of successfully conceiving when used alone or in conjunction with conventional medical treatment, please contact the author of this article, Bernadette Yu.

Bernadette has been practicing as a qualified fertility acupuncturist in Mississauga for more than 10 years and has assisted many couples in resolving their health problems that have resulted in infertility. Bernadette is also a Registered Holistic Nutritionist, and Traditional Chinese Medicine Practitioner in Mississauga. Bernadette has completed a rigorous 5-year hands-on Doctor of Traditional Chinese Medicine Training.  She is happy to help you expand your family with newborns. To discover how Bernadette Yu can help you conceive a healthy baby and support you or your spouse through pregnancy, please click the link below to schedule an appointment with her.


  1. 1
    Ovarian Stimulation, Intrauterine Insemination, Multiple Pregnancy and Major Congenital Malformations: A Systematic Review and Meta- Analysis- The ART_Rev Study.
  2. 2
    Potential Teratogenic Effects of Clomiphene Citrate.
  3. 3
    Clinical therapeutic effects of acupuncture combined with Chinese herbal medicine on infertility of polycystic ovary syndrome in the patients with ovulation induction with letrozole
  4. 4
    Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture.
  5. 5
    Successful acupuncture treatment of uterine myoma.
  6. 6
    Effects of transcutaneous electrical acupoint stimulation on ovarian reserve of patients with diminished ovarian reserve in in vitro fertilization and embryo transfer cycles.
  7. 7
    Impact of whole systems traditional Chinese medicine on in-vitro fertilization outcomes.
  8. 8
    Analysis on the traditional Chinese medicine syndromes of the patients with autoimmune thyroid diseases. Changes in the thyroid and immune functions in 109 cases
  9. 9
    The influence of acupuncture on the quality of life and the level of thyroid-stimulating hormone in patients presenting with subclinical hypothyroidism
  10. 10
    Acupuncture Treatment for Fertility
  11. 11
    Acupuncture for infertile women without undergoing assisted reproductive techniques (ART)
  12. 12
    Success of acupuncture treatment in patients with initially low sperm output is associated with a decrease in scrotal skin temperature
  13. 13
    The effects of acupuncture on pregnancy outcomes of in vitro fertilization: a systematic review and meta-analysis
  14. 14
    Traditional Chinese Medicine as a Remedy for Male Infertility: A Review
  15. 15
    Efficacy of electroacupuncture for the treatment of asthenozoospermia
  16. 16
    Premature ovarian failure of autoimmune etiology in 46XX patients: is there a hope?
  17. 17
    Positive Effect of Acupuncture and Cupping in Infertility Treatment
  18. 18
    Recurrent Pregnancy Loss and Traditional Chinese Medicine

Bernadette Yu

Bernadette Yu is an Ontario Registered Acupuncturist & Traditional Chinese Medicine Practitioner. She provides Acupuncture Treatment, Chinese Herbal Medicine Consultation and prescriptions, Nutritional Counselling and Bioenergetic testing services in a medical clinic in Mississauga, Ontario.

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