Treating Infertility Issues with Acupuncture & Herbal Medicine
Over the past few decades, fertility rates have dropped in the “Western” world. The increasing inability to conceive has given rise to numerous treatment strategies.
While Western medicine advocates the use of In Vitro Fertilization (IVF), Intrauterine Insemination (IUI), hormonal therapy, donor sperm or egg transfers and other reproductive technologies, success rates are not always optimal and the treatments can be invasive. A growing number of doctors support the use of Traditional Chinese Medicine (TCM), specifically Acupuncture and Herbal Medicine, for treating infertility, as a stand-alone treatment or as a support to IVF.
For centuries, TCM practitioners have helped families to conceive by getting to the deeper, underlying root of the problem. Once the foundation of the body is healthy and Qi or life energy flows freely, the body is normally able to conceive. TCM explanations of health and disease are very different from those of “Western” medicine. “Balance” is the key word. For example, if the mother and father-to-be are generally healthy, are in balance physically and emotionally, and have normal functioning reproductive organs, both mother and father should be fertile.
Acupuncture is effective in restoring fertility by stimulating the flow of Qi or Life Energy along pathways called meridians. In addition, acupuncture increases blood flow to the reproductive organs and helps stabilize hormone levels. This improves ovarian function in women and sperm production in men.
To achieve better treatment results, acupuncture is often combined with Chinese herbal formulas. With the acupuncture/herbal combo it may take from 6 to 12 months to restore fertility. Patients also feel healthier due to their balanced physiological and emotional state.
What is infertility?
Doctors usually say that a couple is infertile if they have not conceived within two years, despite regular sexual intercourse. About 80% of heterosexual couples who have sex regularly (2 to 3 times a week) and who do not use contraception will get pregnant within a year. Of the other 20%, most become pregnant within two years of trying. Others may need medical assistance to conceive.
Women are more fertile between the ages of 20 and 25. From that time onwards their fertility starts to diminish slightly. From the age of 35 there is a marked decrease in fertility. The most significant drop in fertility is seen from the age of 38 to 40. Approximately 15 percent of couples are infertile. Male infertility plays a role in about half of these couples.
Causes of Infertility
Male infertility can be the result of low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm. Female infertility can result from irregular menstruation, blockages in the reproductive system caused by such conditions as endometriosis or ovarian cysts, and hormonal imbalances. Illnesses, injuries, chronic health problems, lifestyle choices and other factors can also play a role in infertility.
In general, treatments focus on building and balancing the flow of energy and alleviating any psychological issues which may be present. For women, much importance is placed on regulating the menstrual cycle with particular focus on the Kidney, Heart and Liver organ systems.
Before undergoing treatment there are some key things you can do to make it more likely you will conceive on your own:
- If you smoke, quit!
- Eat a healthy diet being careful to reduce intake of fatty foods, sugar, dairy products and refined foods. Focus on dark green vegetables, fruits, legumes, nuts and seeds. Organic produce it the preferred choice where possible.
- Avoid contact with environmental toxins
- Enjoy regular exercise
- Reduce alcoholic intake
- Reduce stress by practicing meditation and being physically active
- Practice intercourse around the woman’s ovulation cycle
Make sure your body is receptive to pregnancy: A receptive body is warm, enveloping, holding, and supportive. If you are constantly expending all of your energy working out or following the latest fad diet, there may not be enough energy left to support new life. In other words: everything in moderation. Also spending time with pregnant women and babies helps make you more receptive to pregnancy.
Don’t obsess: The more emphasis you put on the failure to conceive, the more stress and frustration you create. This in turn, may lead to more fertility hurdles. Having a neutral attitude toward the outcome of efforts to get pregnant and being more conscious of the process helps maintain balance and, ultimately, gives the desired results.
Avoid dampness: Dampness accumulates in our bodies and causes blockages in the form of cysts and fibroids that can make getting pregnant difficult. If you’re trying to become pregnant, eliminate damp foods like milk, cheese, yogurt, butter, ice cream, greasy foods, and alcohol. Wet clothing, humid environments, and moist basements should also be avoided.
Chart your cycle: Charting your basal body temperature to determine when you’re ovulating, whether ovulation occurs on the optimal day, and if your body is at a temperature conducive for fertility. Look for special basal thermometers at your local pharmacy. In addition, studies have found cervical secretion to be highly predictive of ovulation. With this method, note the presence or absence of cervical secretions. Check both at midday and early evening when you are less likely to have sex. Fertile cervical secretions are clear, wet, slippery, stretching and changing in quality. They are often compared to egg whites. Infertile secretions are unchanging and generally dry, sticky, cloudy, and do not stretch.
Ask your Doctor
If you have been trying unsuccessfully to get pregnant, you may wish to see a doctor to help identify any issues that may be hindering your ability to conceive. Depending on the results of the assessment, the Doctor may recommend fertility drugs sometimes in combination with the medical procedures listed below to give you the best possible outcome.
- Surgery: Surgery may be done to unblock fallopian tubes, retrieve eggs or sperm to be used in fertility treatments, or reverse sterilization surgery (like a vasectomy or tubal ligation).
- Intrauterine Insemination (IUI): A thin tube carries sperm directly into a woman's uterus through the vagina. Often, the woman must take fertility drugs to help her ovaries produce one or more eggs. This procedure can be done with sperm from a partner or donor when the male is infertile or when the female is single or has a same sex partner.
- Emybro Transfer: A doctor transfers one or more embryos into the woman’s uterus after in vitro fertilization (IVF). Frozen embryo transfer involves transferring an embryo that was frozen.
- In Vitro Fertilization (IVF): This process involves a number of steps that will let fertilization happen outside a woman's body. First, fertility drugs help the woman's ovaries to produce one or more eggs. Next, the woman has surgery to remove the eggs from her body. Inside a lab, the eggs are fertilized with sperm in a dish to produce one or more embryos. If successful, an embryo is transferred to the woman's uterus through a thin tube to achieve pregnancy. IVF is never the first step in the treatment of infertility. Instead, it's reserved for cases in which other methods such as fertility drugs, surgery, and artificial insemination haven't worked.
In 2010, 11,806 IVF treatments were performed at Canada's 28 IVF centres which resulted in 3,188 live births, a success rate of 27%. (Source: Canadian Assisted Reproductive Technologies Registry - CARTR)
The TCM Perspective
For centuries, TCM practitioners have helped families to conceive. Having a baby is a priority in the Chinese culture and the TCM system for treating infertility is based on the accumulated experience of both patient and doctor. Of all the alternative health systems, Traditional Chinese Medicine (TCM) appears to have the highest rate of success for infertility. TCM practitioners treat infertility by getting to the deeper, underlying root of the problem, instead of solely treating the most apparent problem.
The patient may choose to undergo solely TCM treatments for infertility or combine TCM treatment with other reproductive technologies.
1. Natural Birth with Traditional Chinese Medicine (TCM): Weekly acupuncture treatments and Chinese herbs (needed in 80% of cases) for a minimum of three months and for up to a year, are usually recommended. This treatment focuses on balancing the reproductive functions, stimulating natural ovulation, and increasing the chances of conception. In the pregnancy phase, weekly acupuncture and Chinese herbs are also advised for up to three months into the pregnancy.
2. TCM with In-Vitro Fertilization (IVF) or Intrauterine Insemination (IUI): The treatment plan involves three phases: pre-IVF or IUI, during IVF or IUI, and post- IVF or IUI.
In the pre-IVF or IUI phase, weekly acupuncture and Chinese herbs (needed in 50% of cases) are advised for at least three months (people over 40 or with low ovarian reserve may need them for a longer period of time). Treatment at the pre-stage is focused on improving general health, increasing blood supply to the reproductive organs, managing stress, improving the lining of the uterus, improving egg production and egg quality and eventually getting the body ready for the ART (Assisted Human Reproduction) procedure.
In the during-phase, acupuncture before and after IVF or IUI is needed. The goal is to help with the implantation.
In the post-IVF or IUI phase, weekly acupuncture and Chinese herbs (needed in 50% of cases) will be necessary for up to three months after the onset of pregnancy. This treatment aims at preventing a miscarriage and an ectopic pregnancy, as well as helping the developing foetus to grow well.
3. TCM for Male Patients: According to Dr. Michael A. Werner, a specialist in male infertility in New York State, male factor infertility contributes to about 60% of a couples’ infertility. Of those cases, 40% are primarily male and 20% are combined male and female factors.
When a couple is having trouble conceiving, it makes sense to not only evaluate and treat the woman but to assess the man as well. TCM treatment plans for this group require weekly acupuncture and Chinese herbs (needed in 80-90% of cases) for a minimum of three months. This treatment focuses primarily on improving the quality of the sperm.
TCM treatment effectiveness is cumulative; i.e., every time a patient undergoes a treatment, its effects accumulate to bring about a little more balance inside the body. Patients must accumulate sufficient treatments to balance the organs and the body. Once this occurs, the chances of conceiving are optimized.
TCM’s Treatment Approach to Infertility
Chinese medicine looks at infertility both from three perspectives:
1. Regulating the Menstrual Cycle
2. Balancing the Organ Systems
3. Managing Body Fluids
- Regulating the Menstrual Cycle
Classic Chinese medicine texts devoted to TCM gynecology emphasize regulation of the menstrual cycle as a means of improving internal balance and treating common and often complex women’s health complaints. In Chinese medicine, this is first accomplished with a detailed diagnosis of the patient’s individual pattern of disharmony. Once the pattern is determined, the patient is then treated according to her individual diagnosis as well as the phase of the menstrual cycle.
The menstrual cycle has 4 phases in Chinese medicine. Each of these phases requires different treatment methods (i.e. varying acupuncture points and herbs) according to what is happening in the body during the respective phase.
Phase 1: Menstrual Phase – Days 1 to 4
Day 1 of the cycle is generally the first day of significant menstrual bleeding, not just spotting. During menstruation, the endometrial lining of the uterus is shed. This phase is very important for the development of a thick endometrial layer, a necessary component of successful conception.
Treatment of infertility during the menstrual phase focuses on clearing any stagnation that may impede the quality and movement of qi and blood in the Follicular Phase. Clearing blood stasis facilitates the complete discharge of menstrual blood so that the new endometrial lining can grow on a smooth, clean base.
A typical base formula used during this stage is Tao Hong Si Wu Tang sometimes called Invigorate Blood and Stem the Flow.
Phase 2: Pre-ovulation or Follicular Phase – Days 5 to 11
The follicular phase begins on Day 1 of the menstrual cycle when new follicles, containing eggs, begin their growth. However clinically, the support of this phase generally begins after the major menstrual blood flow is over, usually around Day 4.
During this phase, estrogen continues to increase, signaling FSH (follicle stimulating hormone) to recruit follicles in preparation for ovulation. One of these follicles will grow to become the largest, or dominant follicle, and will release its egg at ovulation.
The regeneration of the endometrium, or uterine lining, begins about 2 days after the onset of menstruation, even though menstrual bleeding still continues. This process includes tissue repair of the uterus where the lining has shed as well as the development of estrogen and progesterone receptors in the new tissue.
As the levels of estrogen gradually rise, proliferation of the endometrium and its dense vascular network is stimulated, the endometrium continues to thicken and the cervix becomes rich with fertile mucus necessary to escort sperm through the cervix for fertilization of the released eggs.
Gui Shao Di Huang Wan sometimes called Nourish Ren and Chong Formula is a very effective formula for this stage to help regulate the length of the Follicular Phase, increase cervical mucus, improve the quality and quantity of menstrual blood, regulate basal body temperature, and improve development of follicle and endometrial lining.
This phase is very important in cases of infertility when there is a delayed ovulation, thin endometrium, decreased cervical mucus, and poor quality or number of eggs.
Phase 3: Ovulatory Phase – Days 11 to 15
When the main developing follicle becomes large enough and estrogen reaches a certain level, ovulation will occur. Prior to ovulation, the hypothalamus and pituitary gland again play a major role as LH (luteinizing hormone) is released. This causes the "LH surge" which occurs about 24 hours prior to ovulation and is detected by an ovulation predictor kit.
It is a dynamic time, one in which the menstrual energy transitions from the yin half of the cycle to the yang half. A strong movement of qi and blood allows for the transition to occur with subsequent expulsion of the egg from the follicle.
In a normal, healthy ovulation, the basal body temperature chart will show a quick rise in temperature with the LH surge, and temperatures will then stay relatively high throughout the second half of the cycle. This is indicative of the quick change from yin dominance in the follicular phase to yang dominance in the luteal phase. Ovulation itself depends on the yin and blood being at their fullest, and the ensuing transformation of full yin to yang.
Yin at its fullest corresponds to the secretion of ovulatory cervical mucus and peak follicular growth. As it changes to yang, activity and movement are expressed as the dominant egg bursts forth from the follicle. This process of ovulation is dependent on the strength and fullness of yin, the ability to mobilize yang, and the movement of qi and blood to facilitate transition.
The Heart is also involved in ovulation through the activity of the bao mai, the collateral connecting the Heart to the Uterus. The bao mai is one of the pathways by which the action of the Heart qi and blood descend to the reproductive organs, keeping them nourished and facilitating movement. The health of the Heart and Liver are key energies in the activity and vitality of transitions affecting the Uterus.
Ovulation and the transition to the luteal phase of the cycle can be inhibited by stagnation of qi, blood and/or phlegm. Pain at ovulation or inability to ovulate in a timely manner may be an indication of problems with this transitional movement.
Bu Shen Cu Pai Luan sometimes called Jade Moon Phase 3 is a commonly used formula for mid-cycle support. The formula invigorates the blood and removes stasis, while promoting a healthy yin foundation and the ability for yang to mobilize at ovulation. Herbs during this phase of the cycle are generally administered beginning about 3 days before ovulation, or when ovulation should ideally occur, until 2 days after ovulation.
Phase 4: Post-ovulation or Luteal Phase – Days 15 to 28
After the egg is released at ovulation, the sperm and egg travel to meet in the fallopian tubes, where a successful sperm will penetrate and fertilize the egg. The egg must be fertilized in the fallopian tubes within about 12 hours of ovulation, then it continues moving to the uterus to implant in the endometrial lining. Implantation begins about 7 days after ovulation. Strong yang is needed in this phase to support movement and activity.
After ovulation, the corpus luteum is formed at the site on the ovary wall where the follicle released its egg. This gland secretes progesterone keeping the endometrium rich in hormones and nutrients and maintaining a healthy environment for implantation. It also inhibits the development of new eggs. Progesterone is the key hormone in the luteal phase of the cycle and is evident in the higher basal body temperatures.
The luteal phase is dominated by qi and yang, but is also dependent on a good foundation of yin and blood. In order for implantation to occur, the uterine lining must be healthy and "receptive". The endometrium must be thick, moist, and rich in blood and nutrients, a very yin environment in which the fertilized egg burrows until it is completely buried by the end of the cycle.
Problems the luteal phase may lead to significant drops in basal body temperatures in the second half of the cycle, in progesterone insufficiency, problems with implantation, and the tendency to miscarriage.
Jian Gu Tang sometimes called Yuan Support Formula supports the luteal phase well by tonifying and invigorating the yang and the Spleen qi. The formula is often modified with herbs added to support the yin and blood, to move Liver qi stagnation, and calm the spirit.
- Balancing the Organ Systems
The main organ systems involved in infertility are the Kidneys, Liver, Heart and Spleen. The pathologies associated with these organ systems that can lead to infertility are:
1. Kidney Qi Deficiency
In Chinese medicine, the Kidney system provides the energy required for reproduction. If this energy is deficient either from overwork or other health issues, it may lead to a deficiency of the Conception and Penetrating Vessels which are central to providing the Uterus with Tian Gui (Menstrual Blood). The weakening of the menstrual Blood may cause the Uterus to become malnourished so that it cannot collect sperm and promote conception. The literal translation of Tian Gui is "heavenly water," and heavenly water mixed with sperm yields pregnancy.
There are two types of Kidney Deficiency:
- Kidney Yang Deficiency: In men, symptoms may include impotence and sensations of cold in the scrotum. In women, symptoms may include prolonged menstrual cycles with pale menstrual discharge or lack of menstruation.
- Kidney Yin Deficiency: In men, symptoms may include decreased ability to control ejaculation or abnormally protracted erections. In women, symptoms include short menstrual cycles with scanty menstrual discharge that is dark in color.
2. Liver Qi Stagnation
A major focus of infertility treatments is the regulation of the menstrual cycle and the treatment of any associated issues such as PMS or dysmenorrhoea. Therefore, regulation of the Liver system is an important aspect of treatment as the Liver system regulates the smooth flow of Qi and Blood.
Emotional health also depends on a smooth flow of Qi and Blood. In cases of emotional disturbances, especially frustration and anger, the Liver's regulating functions are impaired and a condition termed "Stagnation of Liver Qi" results. When internal Qi and Blood flow become disharmonious, the Conception and Penetrating meridians are affected and the menses will not come regularly resulting in fertility issues.
In men, symptoms may include sagging pain in the scrotum, inability to maintain an erection, and difficulty ejaculating. In women, symptoms may include irregular menstrual cycles with cramps, dark menstrual discharge with clots, and symptoms of premenstrual tension.
3. Heart Yang Deficiency
In addition to any previous psychological issues, many women undergoing western therapies experience stress - as well as hormonal imbalances - from the western procedures and the time commitments involved. Working to alleviate this stress and reducing the side effects of hormonal therapies is an important aspect of treatment.
The Heart is closely connected with the Uterus through the Uterus Vessel. This explains the profound influence of mental-emotional problems affecting the Heart on the Uterus. Normal menstruation and fertility depend on the state of the Kidney Essence and Heart Blood. If Heart Blood is deficient Heart Qi does not descend to the Uterus. If the Kidney Essence is deficient, menstruation does not occur. A deficiency in either Heart or Kidneys can therefore cause infertility or amenorrhoea.
There is also another important connection and that is via Blood. The Heart governs Blood and the Uterus stores Blood. Although the overwhelming majority of gynaecologists will emphasize the role of Liver Blood in relation to the Uterus, some put the accent on Heart Blood. According to this approach, tonifying the Heart will help Kidney Jing or Essential Energy produce menstrual Blood.
Managing Body Fluids
When Body Fluids are out of balance, especially Blood and Phlegm, it may lead to blockages in the Uterus from Blood Stasis, Blood Deficiency or accumulation of Dampness or Phlegm.
1. Blood Stasis
Damage to the Uterus during a previous delivery, invasion of Cold, long term illness and Qi deficiency are factors that affect the Blood flow and lead to Blood Stasis. If stagnated blood remains in the Uterus and impairs the Conception and Penetrating Vessels, a woman's menstruation can become irregular and conception may be difficult.
In men, there may be an enlargement of the veins of the scrotum or a history of hernia. In women, the menstrual cycle may be irregular and may contain a significant number of clots.
2. Blood Deficiency
Blood is the material basis for conception. When an individual has a constitutional weakness or dysfunction in the Spleen and Stomach, Blood production is affected. As a result, the Conception and Penetrating Meridians become deficient and dysfunctional and the Uterus is not nourished making it impossible for a woman to conceive.
3. Dampness and Phlegm
Improper dietary habits or Yang deficiency in the Kidney and Spleen lead to dysfunction in the water metabolism and cause accumulation of Dampness and Phlegm. When the body has too much Dampness and Phlegm, the movement of Qi is disturbed and the meridians around the Uterus are obstructed resulting in irregular menses and conception problems.
In men, there may be an accumulation of fluid in the scrotum. In women, there may be a large amount of vaginal discharge with no menses or a prolonged menstrual cycle.
4. Accumulation of Damp Heat
Improper sanitary habits in the perineum region may allow dampness and heat evils to invade the Uterus. When the Conception and Penetrating Meridians become obstructed, Blood and Qi supplies are interrupted. There will be difficulty in combining the congenital essences from both sexes to transmit into the embryo in the Uterus.
The main goals of treatment in TCM are as follows:
- Regulate menstruation
- Menses should become rich, red blood that is free of clots
- Menstrual issues such as PMS, breast distension, etc. should be alleviated
- Any psycho-emotional issues should be treated
- With regards to building energy, relaxing sleep and stress reduction should be promoted
- Any digestive issues should be treated
The benefits of TCM fertility treatments are as follows:
- Normalize the menstrual cycle
- Balance hormones
- Improve ovary or testicle health resulting in better egg or sperm quality
- Increase blood supply to the Uterus which helps build up the uterine lining
- Release the stress of infertility and its related treatments
- Reduce the risk of miscarriage and ectopic pregnancy
- Increase the success rates of IVF and IUI
Research on Positive effects of TCM for Infertility
A 2006 study published in the journal Fertility Sterility looked at 116 patients receiving acupuncture in the weeks following IVF compared with a group of 109 patients who received “placebo” acupuncture. Treatments were done immediately following embryo transfer and 3 days later. Clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4%) were significantly higher (virtually double) than in the placebo acupuncture group (15.6% and 13.8%).
One study, by Dr. Eric Manheimer of the University of Maryland School of Medicine, indicates that the use of acupuncture may increase the success of IVF therapy by as much as 65%. Additional studies in Europe and the US suggest that acupuncture treatment given on the day of implantation in IVF or IUI patients can improve the success rate.
Acupuncture also helps with men’s sperm count and sperm quality. In a study published in Fertility and Sterility in 2005, men who received acupuncture had fewer structural defects in sperm and an increase in the number of normal sperm than men who received no acupuncture.
Acupuncture also appears to facilitate natural birth. Scandinavian researchers studied 56 women at 39 weeks of pregnancy who were treated with 3 acupuncture treatments near their due dates to promote healthy labor. Compared with matched controls (women not receiving acupuncture treatment), women receiving acupuncture were more likely to labor spontaneously and less likely to undergo Caesarean sections.