Infertility

What can cause infertility?

Infertility is really a bundle of diagnoses covering women who have difficulty conceiving. Conventional medicine identifies a considerable number of underlying problems:

1. Luteal phase defect
2. Hormonal and ovulation problems
3. Polycystic ovarian syndrome (PCOS)
4. High FSH and low AMH
5. Diminished ovarian reserve (DOR)
6. Premature ovarian failure (POF), or peri-menopause
7. Endometriosis and fibroids
8. Unexplained infertility
9. Immunologic reaction and recurrent miscarriage
10. Mechanical infertility — pelvic inflammatory disease and fallopian tube obstruction
11. Male factor infertility

Hormone imbalance can cause irregular or heavy periods, or stop them altogether. A blocked fallopian tube can prevent the egg meeting the sperm, and a partial blockage can result in an ectopic pregnancy. Polycystic ovaries can stop ovulation. An immune problem can cause the body to reject sperm and embryo. Endometriosis can cause severe period pain, obstruction and ovarian cysts. A very light period often reflects a womb lining too thin for an embryo to implant. Male factor infertility is usually a matter of semen and sperm disorders — abnormality, oligozoospermia, azoospermia, weak sperm vitality and so on.

Doctors will usually test the male partner's semen, take blood to check hormone levels, perform a pelvic ultrasound to look for fibroids, and use dye to check the fallopian tubes for blockages. In some cases everything comes back clear and the couple leave with a diagnosis of unexplained infertility. But everything that happens has a reason, so what lies behind these conditions? Here is how TCM sees it.

TCM philosophy of infertility

In TCM the body is an integral whole: its parts are inseparable in structure, connected and conditioned by one another in physiology, and acting on one another in illness. Reproductive and gynaecological health is not confined to the ovaries and womb. It is closely bound up with the kidney, spleen and liver, and the harmony between them is what makes conception possible. If any one is not functioning, fertility problems appear.

Kidney

The kidney is the origin of the congenital constitution. It stores the essence regarded as the origin of yin and yang in the organs and the source of life in the body, and that essence is the material foundation for growth, development and reproduction. When the kidney fails to store essence properly the result can be a delayed cycle, absence of ovulation, scanty menstruation, amenorrhea or infertility. Nourishing kidney yin can regulate the cycle, restore normal FSH levels, support oestrogen production to thicken the uterine lining, and develop healthy follicles and eggs — and healthy sperm in men. Strengthening kidney yang supports progesterone levels and promotes fertilisation and implantation.

Spleen

The spleen is the material basis of the acquired constitution — the foundation of life after birth, and the source of Qi and blood. It governs most of the body's energetic processes, transforms food into Qi, blood and other usable energy, and keeps blood within the vessels, so it must be working well for a healthy cycle. It is also associated with thyroid hormone and progesterone, with the circulatory and immune systems, and it dominates the luteal phase. When the spleen is not functioning, Qi and blood become insufficient and its commanding action weakens, producing early and heavy periods, a short luteal phase, prolonged bleeding or flooding — and eventually a poor blood supply to the reproductive system.

Liver

The liver governs the flow of Qi and the emotions. It stores blood and regulates the volume in circulation, which is believed to play a major part in ovulation, shifting blood from elsewhere in the body to the uterus. If the liver system is not running smoothly, neither is the hormonal system. Liver Qi dysfunction can bring distending pain in the chest, breasts or lower abdomen, an irregular cycle and low mood, or a flushed face, irritability, restlessness, PMT and menopausal symptoms. Persistent emotional disturbance in turn impairs the liver, producing stagnation of liver Qi or hyperactivity of liver yang, and with it heavy periods or a shortened cycle. Where liver blood cannot replenish the womb, scanty menstruation or amenorrhea may follow. Liver Qi stagnation allows oestrogen to build up, and the uterus itself can become hostile to implantation. Oestrogen dominance is implicated in endometriosis, fibroids and PCOS.

TCM treatment principles

The use of Chinese medicine in fertility can be traced in the medical literature back to the eleventh century. TCM recognises that a different energy dominates each phase of the menstrual cycle, so understanding the cycle and its yin-yang patterns is the key. Your prescription may therefore change from one stage of the cycle to the next.

Working alongside IVF and other assisted reproduction

IVF is an advanced technology that helps many couples achieve a pregnancy. The overall UK success rate for women under 35 is somewhere between 10% and 30%, and the process can be demanding and stressful. Part of the reason is that so many different problems can cause infertility, and IVF addresses only certain kinds. Proper preparation beforehand matters.

A woman's response to assisted reproduction depends on her endocrine status in the months before the procedure, while the follicles are developing. We therefore suggest beginning TCM preparation around three months ahead, particularly where hormonal, immunological, mechanical, age or implantation factors are involved. That usually allows enough time to restore a better balance before the cycle begins.

Many couples come to us while undergoing IVF, IUI or ICSI, and we have designed a course of acupuncture to support them before and during the programme. We ask for as much information as you can give us — your regime or treatment protocol, blood test and scan results, and your past medical and fertility history. Treatment alongside assisted reproduction aims to:

• support you physically and emotionally during and after the procedure, and ease some of the tension these treatments involve
• reduce some of the difficult side effects of the drugs, and improve the response to hormonal stimulation
• balance hormone levels
• increase blood supply to the uterus and ovaries and improve egg quality
• strengthen the endometrial lining
• calm the uterus in preparation for implantation
• reduce the risk of miscarriage where a pregnancy is achieved

Male infertility

Research suggests around half of infertility involves a male factor. Acupuncture can support a man in much the same way as a woman. TCM aims to increase blood flow and strengthen the function of the male reproductive organs, improving sperm quality and quantity. Where that succeeds, a couple may have a better chance of conceiving naturally with less risk of miscarriage, or may be able to attempt a less invasive and less expensive procedure such as IUI rather than ICSI.