an ancient approach to a rising problem of INFERTILITY

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The benefits of Acupuncture and Traditional Chinese Medicine (TCM) in the treatment for infertility can be found in early Chinese medical literature dating back to 11AD. TCM sees the person as an integral mind/body organism. It endeavors to stimulate the body's natural healing potential by treating root causes. Each person is treated uniquely, according to her or his symptoms. Traditional Chinese herbal medicine used in the treatment of infertility by-passes undesirable side effects and accumulated toxicity caused from invasive procedures and drug therapies, known and unknown. In addition, it may be used to strengthen and balance one's general health so that In Vitro Fertilization (IVF), Intracytoplasmic Sperm Injection (ICSI), Gamete Intra-Fallopian Transfer (GIFT), Zygote Intra-Fallopian Transfer (ZIFT), and Tubal Embryo Transfer (TET) procedures are more effective. This "whole body" health approach provides a key to unlock unlimited potential in healing. Because this approach to healing stimulates overall health to positively enhance the reproductive system and reduce biological age, those near the age of 40 years old gain optimal benefits.

Many modern researchers have confirmed the ability of TCM to:

Regulate the menstrual cycle.
Invigorate sperm. Enhance sperm count and motility.
Enhance general health.
Reduce stress, control anxiety, enhance sleep and increase energy level.
Balance the endocrine system.
Improve blood flow in pelvic cavity.
Increase the chance of pregnancy for women undergoing in-vitro fertilization (IVF).
Western Medicine Pathology of Female Infertility
There are several pathological conditions that may interfere with a female's ability to conceive. Below is a list of the most common conditions for females in western pathology.

Ovarian factors
At the age of 41 the function of a woman's ovaries starts to decline. This decline results in inferior egg quality. Fertilization of these eggs is more difficult and, generally, they do not develop as well after fertilization. When the ovaries decline in function, follicle-stimulating hormone (FSH) levels increase in order to induce ovulation. When FSH levels reach above 10, ovarian function has declined, making pregnancy more difficult to achieve. Even when pregnancy does occur, it is usually more difficult for the woman to carry the embryo to term, resulting in miscarriage. In addition, estrogen and progesterone levels decrease, causing a thinning of the endometrial, which affects the implantation of the embryo.

Another problem of the ovaries is the occasional or complete failure to ovulate. This may be due to hormonal changes causing irregular menstruation, amenorrhea, or heavy uterine bleeding. Polycystic ovaries may be a cause of this condition. The treatment for these conditions focuses on regulating the menses, balancing hormone levels, and if needed, treating polycysts and endometriosis. When these issues are resolved, the chances for fertility are greatly increased.

Fallopian tube factors
If the fallopian tubes become obstructed due to infection or endometriosis, adhesions may develop. As a result of the obstruction, the sperm is unable to fertilize the egg.

Cervical factors
Due to the presence of antibodies in the vaginal discharge or mucus caused by a cervical or vaginal infection, the sperm may be killed or inhibited to advance towards the egg.

Uterine factors
Uterine fibroids distort the uterine cavity or block the interstitial parts of the tubes, thus preventing the embryo from moving to the uterus. Another problem arises when the uterus is too small for the embryo to grow and develop.

Chinese Medicine Pathology of Female Infertility
The different patterns considered for female and male pathology are based in the dualistic concept of Yin and Yang and the state of the vital substances (qi or "life force, blood or "xue" and body fluids "jin ye"). Any imbalance (deficiency vacuity or excess/repletion) of any of these entities (yin, yang, qi, blood and body fluids) can result in disease or dysfunction. These imbalances can be affected as well by any of the "six evils" or pathological energies. These evils are referred to as heat, cold, dampness, dryness, wind and summer heat.

A hot condition may be triggered by an excess, like damp heat, which corresponds to an infection. Likewise, there may also be deficiency presenting symptoms like night sweats or hot flashes.
A cold condition may also present with two patterns, excess or deficiency. This condition could cause dysmenorrhea with cold abdomen which makes the implantation of the egg very difficult.
A damp condition is referred to as fluid accumulation in the body. This condition can cause leucorrhea, ovarian cysts and vaginal discharge or infection.
A wind condition refers to external pathogens such as bacteria, virus or internal causes due to imbalances of the vital substances.
A dry condition means a deficiency of the body's fluids or yin causing a lack of vaginal fluids. This drying of vaginal fluids is a common problem for women experiencing menopause.
A summer heat condition is relevant only in the season of summer, when external damp heat enters the body because of environmental factors.
The Most Influential Meridians in Infertility Heart
The heart organ/meridian influences infertility in many ways, primarily because it governs the blood. It is also connected to the uterus, which is one of the extraordinary meridians. These extraordinary meridians play key roles in the support and nourishment of the reproductive system. And lastly, the heart-yang is a vital component to the formation of "heavenly Gui" or material substance of menstrual blood with the help of the Kidney essence. Abundance of essence is necessary for conception to occur; this is achieved by the harmonious relationship between the heart, uterus and kidneys.

Kidney
In Oriental medicine it is said that all chronic imbalances affect the kidney organ/meridian network. What this means is that if a person has a weak constitution i.e., is pale, feels cold is undernourished, etc., then this is a result of either prenatal (genetic) influences and or lifetime habits and illnesses. The way to change these conditions, is through treating the kidney with tools of acupuncture, herbs, diet, and exercise. Kidney influences bone and bone marrow and from the marrow blood is made. Blood nourishes qi and as a result, the cycle regenerates and builds. Essentially in Oriental Medicine it is said that the blood nourishes, the qi protects, and the kidney qi holds the fetus. If the Kidney is injured by cold there maybe an obstruction of the uterus. This may also be a cause of infertility. Some of the symptoms related to this organ are: fatigue, low libido, exhaustion due to overwork, low sperm count, soreness and weakness of back, hormonal imbalance (women over 40), hair loss, light periods, fear, depression.

Liver
The liver plays an important role in men as well as women. Liver is the organ that stores blood during the night and governs the free-coursing of qi throughout the whole body. If the qi stops or gets stagnated the blood also gets stagnated. This can cause ovarian cysts, endometriosis and uterine fibroids. Some of the symptoms that are related to this condition are: PMS, irritability, irregular periods, depression, painful periods, frustration, clots, unresolved anger and breast distension.

In men this condition can manifest as an obstruction of the ejaculatory ducts. Stress and anger could cause liver qi stagnation, therefore meditation and stress relief techniques are recommended, to sedate and calm the emotions. When the mind is calm, the liver qi flows.

Spleen
The spleen is the organ that transforms and transports the food and fluids. It is also where qi and blood originate. This is why the health of the spleen is so vital to the menstrual cycle. If the spleen is deficient there is not enough blood and women will experience delayed menstruation or amenorrhea.

In men, blood deficiency will greatly impact the production of sperm. If there is not enough sperm produced, the chances for conception are significantly reduced. Spleen also holds organs up and blood within the vessels. If this function of the spleen is deficient there will be uterine bleeding or organ prolapse.

Lungs
The lungs have only a minor influence on infertility. In fact, they are more related to the emotions, which in turn affects menstruation. When there is excessive sadness or grief, there is a depletion of Qi, which causes the menses to cease.

Stomach
The stomach is the source of Qi and blood. This has an influential effect on the digestive system which also includes the Small and Large Intestine channels. If there is an impairment of the Stomach, there will be a deficiency of Qi and Blood. This deficiency of Qi and Blood affects the heart (which governs blood) and the Spleen. As a result menstrual problems, especially scanty periods or amenorrhea, may occur.

The Extraordinary Vessels
The extraordinary meridians involved with infertility include the Uterus, Penetrating Vessel (Chong Mai), Directing Vessel (Ren Mai), Governing Vessel (Du Mai), Girdle Vessel (Dai Mai) and Yin Heel Vessel (Yin Qiao Mai).

Uterus
The uterus, in Chinese medicine, corresponds to the Lower Field of Elixir or Dan Tian. In men, this is where the sperm is housed, and in women where the uterus resides. The Uterus is considered an extraordinary meridian because it has the shape of a yang organ and the function of a yin organ. The shape of the Uterus is hollow, while the function is to store blood and nourish a fetus. It has a special relationship with the Kidneys via a meridian called the Uterus Channel (Bao Luo). The Uterus is also connected to the Heart via a channel called the Uterus Vessel (Bao Mai). The special connection between the Uterus, Kidneys and Heart creates a interdependency for certain female physiology to occur. For instance, there must be harmony within the three organs for normal menstruation and fertility. This is due to the dependency on the nourishment of 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. Therefore, a deficiency of either the Heart or the Kidneys can cause infertility or amenorrhea. Figure 1 shows the connection between the Uterus, Heart and Kidneys.

Figure 1 shows the connection between the Uterus, Heart and Kidneys.

Penetrating Vessel (Chong Mai)
The Chong Mai is considered the most important and possibly the original extraordinary vessel. It is call the "Sea of Blood", responsible for the Qi and Blood, and has a deep influence on menstruation. This vessel influences the supply and movement of Blood in the Uterus and controls menstruation in all aspects. If the Penetrating Vessel is empty there may be amenorrhea, scanty periods, or late periods. If stagnation occurs there can be dysmenorrhea.

Directing Vessel (Ren Mai)
The Directing Vessel is also related closely to the Uterus and to the entire female reproductive system including the internal and external genitalia. Any problems of the cervix, vagina or vulva are related to the Directing Vessel. This vessel is responsible for the Yin, Essence and fluids. Because this channel provides all of the Yin substances to the body, it has influence over all physiological processed and hormonal gateways, including puberty, conception, pregnancy, childbirth and menopause.

Governing Vessel (Du Mai)
The Governing Vessel begins at the space between the Kidneys, it also wraps around the vagina. Therefore when there are problems with the genitalia, this meridian is the best choice for treatment. This is also the most effective meridian to treat in the presence of Kidney Yang deficiency. The Governing Vessel represents the influence of the Fire of the Gate of Life (Ming Men) which must be strong and functional to support conception and fertility. The Governing and Directing Vessels are energetically equivalent to the hypothalamus-pituitary-ovarian function which is responsible for ovulation.

Girdle Vessel (Dai Mai)
The Girdle Vessel is also referred to as the belt channel. It encircles the waist and intersects the Kidney divergent channel. This channel encircles the leg channels, which corresponds to the flow of Liver Qi while also harmonizing the ascending and descending of both the Spleen and Kidney Qi. If this channel becomes weak and slack it may create Damp-heat as a result of chronic Spleen-Qi deficiency The damp-heat in turn results in leucorrhea.

Yin Heel Vessel (Yin Qiao Mai)
The Yin Qiao Mai influences the reproductive system and the lower abdomen in women. It is extremely effective in treating excess patterns of the Lower Burner such as abdominal masses, fibroids, difficult delivery and retention of placenta. Refer to Figure 2 for a flow chart of the most common causes of infertility in women according to Chinese medicine.

Refer to Figure 2 for a flow chart of the most common causes of infertility in women according to Chinese medicine.

The Most Common TCM Patterns in Female Infertility Vacuity patterns
Blood & Yin Vacuity — When the liver blood and kidney yin are vacuous, there is not sufficient essence to nourish the uterus the connecting meridians and vessels. This condition may contribute to various problems with the eggs, such as the inability of the egg to be fertilized, the fertilized egg not being able to implant itself and grow, or the lack of any eggs.

Qi & Yang Vacuity — When there is a vacuity of the qi and yang of the spleen and kidneys, there is not enough energy to transform and activate the uterus and the connecting meridians and vessels. This also creates an inability of the egg to be fertilized or for the fertilized egg to implant itself and grow.

Repletion patterns
Pathogenic factors such as cold, heat, phlegm, and dampness as well as stagnation of qi and stasis of blood have the effect of obstructing the uterus and blocking its channels. These factors create an excess in the body which causes blockage, and as a result fertilization cannot occur.

There is some connection between Western medical pathology and Chinese medical pathology. For example, absence or irregularity of ovulation, a small uterus, a thin endometrium, poor quality of eggs, poor quantity of follicles, low estradiol, low progesterone and high FSH often correspond mainly to the vacuity of kidney yin, kidney yang, or both but also correspond to qi and blood vacuity. Uterine myomas, ovarian cystitis, adhesions, endometriosis, and blockage of fallopian tubes often correspond to the Chinese medical pattern discrimination of qi stagnation and blood stasis with phlegm dampness. Cervical infection, vaginal infection, pelvic infection and fallopian tube infection often correspond to damp heat or toxins with blood stasis.

Western Medical Pathology of Male Infertility
Below is a list of the most common conditions for males in western pathology.

Testicular factors
Both testosterone and sperm are produced in the testicles. If a man has small testicles, he may produce poor quality sperm or have an insufficiency of testosterone.

1. Varicocele
A varicocele is an abnormally large and twisted (varicose) vein that drains blood from the testicle. It is common for this problem to prevent normal cooling of the testicle, thereby raising the testicular temperature. The inability to regulate the temperature inside the testicles may cause damage to the sperm.

2. Infection
Infections, including sexually transmitted diseased (STDs), mycoplasma, mumps, and glandular infections can all cause the sperm to become less motile.

3. Blockage of ejaculatory ducts
Some men are born with a blockage of the part of the testicle that contains sperm or ejaculatory ducts. This condition inhibits the transfer of sperm to the female. The vas deferens (the tube which carries the sperm), may also be surgically blocked.

4. Autoimmunity
This condition occurs when immune system antibodies target sperm and weaken or disable them. A semen analysis can determine which aspect of semen function is impaired. It provides information about sperm motility, morphology, liquefaction, count, and volume.

5. Motility
Motility is the sperm's ability to move rapidly towards the egg. If this movement is impeded, the sperm will have a decreased chance of reaching the egg for fertilization.

6. Liquefaction
Before ejaculation, the sperm are contained within the semen, which is thick and mucus-like. Upon ejaculation, the semen normally liquefies and becomes water-like to enable the sperm to swim towards the egg. Liquefaction should occur in less than 30 minutes to be considered normal. Poor liquefaction may result from enzyme deficiencies in the seminal plasma which, in turn, reflects an abnormality of the seminal vesicles.

7. Morphology
Referring to the shape and structure of the sperm, morphology may also be a factor in infertility. If it is abnormal, the sperm's ability to fertilize the egg may be impaired.

8. Count
Although it only takes one sperm to fertilize an egg, a sperm count that is less than 20 million sperm per milliliter of semen is considered low. Laboratory test results require 25-250m/ml.

9. Volume
To be considered normal, the amount of semen in one ejaculation should be at least six milliliters.

Chinese Medicine Pathology of Male Infertility
Here is a list of male pathology according to Chinese medicine;

Vacuity patterns Blood & Yin Vacuity
A liver blood-kidney yin vacuity can impair the ability of the essence to nourish the connecting meridians and vessels. This may result in small testicles, low sperm count or no sperm, low volume of semen, or abnormal liquefaction.

Qi Stagnation & Yang Vacuity
If there is a spleen qi-kidney yang vacuity, there is not sufficient qi to transform and activate the essence for the meridians and vessels. This condition may cause poor motility, impotence, no ejaculation, or a testosterone deficiency.

Repletion patterns Qi Stagnation & Blood Stasis
In this condition, qi stagnation and blood stasis can obstruct the meridians and vessels leading to poor morphology, varicocele, or blockage of the ejaculatory ducts.

Damp Heat
Excess damp heat evils can also damage the meridians and vessels, killing the sperm.

There are many parallels between Chinese and Western medical pathologies. What Western medicine considers failure to ejaculate, autoimmunity, small testicles, low testosterone levels, low semen volume, low sperm count, low quality sperm, or abnormal motility, Chinese medicine views as a vacuity of the kidneys or as a vacuity of qi and blood. Abnormal morphology, varicocele, or blockage of ejaculatory ducts corresponds to the Chinese medical differentiation of qi stagnation or blood stasis. Infections are typically caused by what Chinese medicine labels damp heat pathogens.

Combining East with West
The causes of difficult conception can vary from couple to couple. There are some situations where Chinese medicine cannot substitute for conventional fertility treatment, like in the case of structural problems. These situations are referred as dysfunctional infertility. Infertility due to hormonal problems, immune disorders, amenorrhea, irregular menstruation, stress and age related factors all fall into the category of functional infertility. For the woman with a structural problem, like blocked tubes, the most appropriate action is to combine Chinese medicine with fertilization procedures to better the odds of pregnancy.

TCM and IVF
Until recently, women have had no proven method to improve their odds with each IVF attempt. New hope has been provided by the encouraging results of a well-designed, German study on acupuncture-assisted reproduction therapy.

A study, published in the April, 2002 edition of the medical journal "Fertility and Sterility", found that acupuncture increases the chances of becoming pregnant for a significant number of women undergoing in-vitro fertilization (IVF). Researchers included 160 patients undergoing IVF for the study. The patients, who were all required to have good quality embryos, were evenly and randomly divided into two groups similar in age and diagnosis. When the patients were examined using ultrasound six weeks after their IVF procedures, the differences in pregnancy rates were notable. In the control group, 26% of the women became pregnant, (21 out of 80 patients). Of the patients who had received acupuncture treatments, 42% of the women became pregnant, (34 out of 80). The 160 participants were divided into two groups, each receiving a standard in-vitro procedure (IVF). One of the groups, however, received acupuncture before and after implantation.

The standard in-vitro group had a 26.3% pregnancy rate, while the acupuncture group showed a 42.5% success rate. Optimizing the Chances for Pregnancy
1. Timing and consistency of treatment, whether having acupuncture or just taking herbs, is of primary importance.

Consistency of treatment is most important for men since to raise sperm count and motility with herbs starts to take effect at the fourth month of treatment. It takes 70 days to generate new sperm.

Timing and consistency is also important for women as there are specific hormonal adjustments that can be made at each week of the cycle. Missing a week of treatment creates a missed opportunity to heal a particular segment of the four phase menstrual cycle. It takes a minimum of three consecutive cycles (12 treatments) to do the foundation work of regulation regardless of biological age. Most women can benefit from this type of concentrated foundational treatment every two years, even if they aren't trying to conceive. This preventative treatment should begin before a woman reaches 28 years old or earlier if birth control pills have been taken.

2. If a woman is nearing forty years old and has had either numerous fertility drugs (over 3 cycles), birth control pills, PMS, ART procedures, elevated FSH, polycystic ovaries, endometriosis, sperm antibodies, or a history of drug, alcohol, or smoking abuse, then it usually takes longer to balance her reproductive system. Likewise, if a man has a history of STDs, history of drug, alcohol, smoking, or sexual abuse, urinary tract infections, burning urination, chronic lower back pain, prostatitis, difficulty passing urine, or other urological health issues it takes longer to rejuvenate the reproductive function. The extent of rejuvenation is relative to the effort and inherent constitution of the individual. Daily training sessions with specific exercises usually provide tangible results when combined with weekly treatment, meditation and a reasonable diet.

The couple must expect to focus six to nine months before really expecting to evaluate results. There is no quick path when it comes to conception, full term pregnancy and recovery after delivery.

3. If a woman is in a state of high level wellness from conventional medicine's point of view (warm hands and feet and no PMS are just several indicators), and has a "normal" relatively low stress energy-abundant lifestyle, then it is appropriate to evaluate progress between the sixth and ninth month of consistent treatment.
4. Correct dietary and exercise habits are just as important for the expectant mother as for the father. Eating raw foods such as salads (cold nature food) is not the best diet for a person who has generally a low basal body temperature (BBT). Sometimes eating meat such as lamb (warming food) can help tonify a "cold" barren uterus. For male infertility as well as otherwise unexplained infertility, there are specific physical and mental exercises that may be learned by couples to generate the right environment necessary for conception.
General Treatment Protocols
Fertility treatments may vary from practitioner to practitioner, but on the average, an acupuncturist will recommend once or twice a week for at least three consecutive cycles (twelve weeks) before evaluating any progress.

Treatments will begin with a comprehensive consultation, in which details of menstrual cycle, medical history, lifestyle, nutrition and exercise habits are assessed.

Treatment will usually include acupuncture, customized herbal therapy, stress reduction and a reasonable diet. It is important to remember to be patient, give the treatment six to nine months before evaluating results.

Generally, acupuncturists use somewhere between three and 20 needles for treatment. Costs vary, based on location and practitioner's experience. Check with your insurance about coverage of acupuncture.

Legend for Chart:
A - Traditional Chinese Medicine
B - Western Medicine
A: Vacuity of Kidney Yin, Vacuity of Blood, Vacuity of
Kidney Yang, Vacuity of Qi
B: No Ovulation , Small Uterus, Thin Endometrium, Poor
Quality of Eggs, Poor Quantity of Follicles, Low Estradiol,
High FSH
A: Qi Stagnation, Blood Stasis, Phlegm Damp Obstruction
B: Fallopian Tube Blocked, Uterine Fibroid, Ovarian Cystitis,
Endometriosis, Adhesions, Stress
A: Damp Heat, Toxins, Blood Stasis
B: Cervical Infection, Vaginal Infection, Pelvic Infection,
Fallopian Tube Infection
Legend for Chart:
A - Traditional Chinese Medicine
B - Western Medicine
A: Vacuity of Kidney Yin
Vacuity of Qi and Blood
B: Sexual Issues, No ejaculate, Autoimmunity, Small Testicles,
Testosterone Vacuity, Low Semen Volume, Low Sperm, Abnormal Motiltiy
A: Qi Stagnation
Blood Stasis
B: Abnormal Morphology, Varicocele, Blockage of
Ejaculatory Ducts
A: Dampness and Heat
B: Infection
Bibliography 1.
The Infertility Book, A Comprehensive Medical and Emotional Guide, Harkness, Carla, 2nd edition 1992, Celestial Arts, P.O. Box 7327 Berkeley, California. (510) 845-8414

2. Infertility: A guide for the Childless Couple, Menning, Barbara Eck, New York, Prentice Hall rev. 1988.

3. You Can Have a Baby, Everything you need to know about Fertility, Bellina, Joseph H., M.D., Ph.D., Wilson, Josleen New York, Crown Publishers Inc.,1985.

4. Endometriosis & Infertility and Traditional Chinese Medicine, Flaws, Bob, CO, Blue Poppy Press, 1989

6. Endometriosis as Treated by Traditional Chinese Medicine, Cao Ling-xian & Tang Ji-fu,,trans. C,S,. Cheung, M.D., & Carolyn Atkinson, J. Amer. College of TCM. S. F., CA, Vol. 1, No. 1, 1983, p. 54-57.

7. A Woman's guide to Endometriosis, Older, Julia, Charles Scribner's Sons, NY, 1984.

8. Handbook of Chinese Herbs and Formulas, Vol. I & II, Him-che Yeung, Los Angeles, 1985

9. Chinese Herbal Patent Formulas, A Practical Guide, Jake Fratkin, Shya Publications, 1986

10. Chinese Tonic Herbs, Ron Teeguarden, Japan Publications, Inc. 1985

11. Wise Woman Herbal For the Childbearing Year, Weed, Susun, New York, Ash Tree Publishing, PO Box 64, Woodstock, NY 12498, 1986.

12. Infertility Statistics (source: Wayne Sinclair, M.D. & Richard W. Pressinger, (M.Ed.).

13. Acupuncture & CVF, Liang, OMD, Lifang, Colorado, Blue Poppy Press, 2003.

14. Obstetrics & Gynecology in Chinese Medicine, Maciocia, Giovanni, Harcurt Bruce and Company Limited, 1998.

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By Kelsey Fernandez, MSOM, L.Ac. and Alejandro Fernandez, MSOM, L.Ac.

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