Infertility is typically defined as an inability to get pregnant after a year of unprotected intercourse. It is estimated that infertility affects one in seven couples in the UK and in America. Couples who experience difficulty in conception are estimated to be as high as 1 in 6, and among these infertile couples, female factors account for more than 60 to 70 percent, although the incidence of infertility varies considerably across the world. In fact, zero chance of conceiving only occurs if both tubes are completely blocked, or if there is a premature menopause in the female partner; or if there is complete lack of sperm in the male partner.
radiation, certain chemicals, high temperatures, microwave emissions, etc.
Some 10-15% of couples have difficulty conceiving at some pointin their reproductive lives and seek specialist fertility treatment.A commonly used option is in vitro fertilisation, which involvesretrieving a woman’s egg, fertilising the egg in the laboratory,and then transferring the embryo back into the woman’suterus through the cervix. This entire process is typicallyreferred to as an in vitro fertilisation "cycle" because itinvolves several procedures, typically over the course of abouttwo weeks, starting when a woman begins taking drugs to stimulateegg production.
Acupuncture has been shown in many clinical studies to improve fertilisation rate and pregnancy outcome [1] In a randomized controlled double-blind cross-over study the efficacy of acupuncture as an adjunct to IVF was evaluated. A significantly lower amount of gonadotropins was required when IVF was combined with standard acupuncture. Most importantly a 70% pregnancy rate was achieved with standard acupuncture and IVF, compared to 25% pregnancy rate with IVF only (Quintero R, et al. 2004 [2] In a recent case study, infertile female patients undergoing IVF treatment were divided into two groups:
(2) a control group without acupuncture treatment.
Amazingly, it was reported that after only a few sessions of acupuncture, the treatment group showed an increased number of oocytes retrieved, and a significantly lower number of first trimester miscarriages. Although both groups showed similar fertilisation rates, pregnancy or implantation rates, and endometrial thickness on the day of HCG administration (Khorram NM et al. 2005) [3]. In a similar but much bigger clinical trial (160 participants), acupuncture was given before and after embryo transfer in 80 patients and a similar-sized control group without any supportive therapy. The clinical pregnancy rate was 42.5% in the acupuncture group but only 26.3% in the control group, indicating the usefulness of acupuncture treatment for improving pregnancy rate after assisted reproductive technology (Paulus WE, et al 2002) [4] In another larger clinical study, the acupuncture treatment significantly enhanced the pregnancy and live birth rates and decreased the ectopic pregnancy and miscarriage rates both in IVF poor responders (with elevated FSH and longer history of infertility) and in IVF patients with good prognosis (Magarelli PC et al. 2004) [5][6] These data uniquely support a definitive role of acupuncture in IVF [7].
Discussion on how Traditional Chinese Medicine sees Infertility.
In Traditional Chinese medicine, the pattern diagnosis for female infertility and sub fertility can be based on Eight principles; Yin and Yang, Exterior and Interior, Cold and Heat, Deficiency and Excess, to determine the overall nature of the dysfunction.
When Yin and Yang are both harmonised in a woman’s body during her reproductive years, her Chong and Conception meridians will function properly and she will not have difficulty conceiving, because female infertility is almost always pertaining to Internal conditions.
Eight principles pattern differentiations for female infertility only leaves Yin verses Yang, Cold versus Heat and Deficiency versus Excess. Classical Chinese medicine identifies four different combinations for female infertility: Excess Cold, Deficiency Cold, Excess Heat and Deficiency Heat respectively.
Excess Heat may be seen in acute or chronic pelvic inflammation in
women. Furthermore, it is not uncommon that an infertile woman may demonstrate Excess and/or Heat and Deficiency and/or Cold.
Pattern diagnosis of internal organs is also important in evaluating female infertility. However, only three organs, the Kidney, the Liver and the Spleen, are most directly involved in female infertility
The Kidney is essential to female reproduction. The Kidney is the source of congenital Essence and the root of life.
It has two sides: Kidney Yin and Kidney Yang, which are the most important material and function of the female reproductive system. The Yin and Yang of the Kidney should not only be prosperous, but also harmonised. For Kidney syndrome, there are several pathological patterns: Kidney Yang deficiency, Kidney Yin deficiency with excess Yang, combination of both Kidney Yin and Yang deficiency, Kidney Qi deficiency, or Kidney Qi and Yin deficiency. Any of the above patterns may result in malnutrition of Chong and Conception meridians as well as in Qi and Blood stagnation, subsequently causing female infertility
The Liver stores Blood, regulates the normal flow of Qi and Blood, and coordinates the functions of the viscera. Emotional distress such as anger and depression impairs the Liver by stagnating the Liver Qi. Persistent Liver Qi stagnation will eventually result in Blood stagnation. Blood stagnation due to stagnation of Liver Qi may be one of the aetiologies of female infertility in Chinese medicine. Clinically, Liver Qi stagnation is so common that almost every infertile woman suffers from it in different degrees.
The Spleen is the source of acquired Essence as well as the source of Qi and Blood, supplying nutrients to the Five Viscera, the Six Hollow Organs and the female reproductive system. The Chong meridian also obtains Yuan Qi and Blood from Yang Ming Stomach meridian because they are connected to each other. When the Spleen and the Stomach are functioning properly, the Essence is sufficient, and then Qi and Blood will be abundant. Therefore, a healthy Spleen will sufficiently nourish the Chong and Conception meridians, ensuring the basic requirements for both conception and gestation.
If the Spleen is deficient, it cannot properly transport wastewater, resulting in Damp accumulation. Sooner or later, Excessive Damp will become Phlegm, which will subsequently obstruct the Chong and Conception meridians as well as the female pelvic organs — uterus, fallopian tubes and ovaries.
This process is the pathogenesis of uterine fibroids, endometriosis, polycystic ovaries, ovarian cysts and certain types of dysmenorrhea. Furthermore, because of the above process, the lack of acquired Essence may be the direct cause of female infertility.
Endometriosis or polycystic ovary fits in Blood stagnation and Phlegm, definitely indicating an Excess pattern. However the pulse, tongue and facial complexion of the patient with endometriosis or polycystic ovary may show Deficiency pattern as long as the patient’s conditions are deficient.
In addition to complete physical examinations, modern Bio Medicine employs
various special diagnostic techniques (sonogram, hysterosalpingogram, endoscopy and laboratory tests) to make a Bio medicine diagnosis for female infertility. The common causes of female infertility in modern Western medicine include simple ovulatory dysfunction, luteal deficiency, Fallopian tube obstruction, cervical factors, immunological factors, uterine fibroids, other intrauterine factors, endometriosis, and premature ovarian failure[1].
The failure to conceive for one to two years and then the biomedical world recommendation is to go on the IVF programme. This does not seem to address the problem of why the woman failed to conceive in the first place.
There seems to be an ever-increasing amount of women displaying uterine fibroids, endometriosis, polycystic ovaries, ovarian cysts, chronic fatigue, depression, stress and emotional dysfunctions.
It is difficult to find one answer but it seems to link to lifestyles, diet and stress disorders created by the Western world lifestyle of abundance.
During the treatment protocols TCM diagnosis was performed each time the patient presented herself for a treatment. The points were chosen from this daily diagnosis protocol. What presents itself on the day determines the point selection, this process is in keeping with true TCM philosophy. The only prescription points used were the first day of the period points protocol, which comes from the text in the Easy studies in needles and moxa Vol 1 by Zhen Jin Yi Xue[8] Below is a quote taken from the book.
Women not producing sons or daughters: disperse the energy of hegu (L1-4) through needles; disperse six times. Tonify the blood at sanyinjiao (SP-6) with needles; tonify nine times. In addition, on the day menses Is expected, moxa at zigong (M-CA-18). Increase the moxas and the person will become pregnant. There Is no case on earth where conception has not been achieved In this way. (YIX 1, 5r & 6r)
I have experienced great success with these points and this method for both brings on a heavy period to clear out the uterus and for rectifying blood stasis in the uterus and for ovulation day points to bring about a natural pregnancy. I admire the very bold statement at the end of the passage. If only it is that easy, but in saying that the success rate has been high.
Excerpt from the Classics
This excerpt from the Classics has been found to be extremely useful in formulating treatment strategies when the age of the patient is a factor in sub fertility difficulties.
The Yellow Emperor's Classic of Internal Medicine [7] has been the leading literature of Chinese medicine since it was first completed approximately 2,500 years ago.
This classic believes that female fertility is associated with the Kidney, the Conception meridian and the Chong meridian, which are necessary for female reproduction. It also describes that a woman's physiological changes take place every seven years.
At age 7, a girl has sufficient Qi in her Kidney. Her teeth begin to change and her hair grows longer.
At 14, her Conception meridian begins to circulate and her Chong meridian becomes strong. As Tian kui (‘Kind essence’ which controls the maturing and degeneration of the body) arrives and menstruation starts, conception is possible.
At 21, when her Kidney Qi has reached the highest peak, her wisdom teeth and body have fully developed.
At 28, her tendons and bones are strong, hair has reached full length, the body continues to flourish, and she remains in the most fertile period in her life.
At 35, her face begins to wrinkle and the hair thins when the energy in the Yang Ming meridian declines.
At 42, as the Qi and Blood decrease substantially in the three Yang meridians that branch to her face, her face looks more wrinkled and her hair begins to turn grey.
At 49, when her Conception and Chong meridians become deficient, her Tian kui exhausts, menstruation ceases, and fertility terminates.
In fact, due to the cultural differences and the improvement in both nutrition and living conditions, women today, on average, start puberty one to three years earlier and menopause two to three years later than those in ancient times. Generally, today’s female fertility initiates its downturn between the ages of 35 and 38, and undergoes a rapid decline between 43 and 46. Although there are minor differences between modern and ancient women, the basic ideas about the physiology of female reproduction in
The Yellow Emperor's Classic of Internal Medicine are still the important guidelines in today's diagnosis and treatment of female infertility in Chinese medicine. Any disturbances of the above physiological process may result in infertility.
References
2)Eric Manheimer BMJ, (Published 7 February 2008) doi: 10.1136/bmj.39471.430451.BE, Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis
3) Quintero R, et al. 2004;81:11-12.A randomized, controlled, double-blind, cross-over study
evaluating acupuncture as an adjunct to IVF. Fertility and Sterility
4) KhorramN.M., et al. 2005;84: S364.The effect of acupuncture on outcome of in vitro fertilization. Fertility and Sterility
5) Paulus WE, et al. 2002;77(4):721-4.Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertility & Sterility
6) Magarelli P.C., et al. 2004;82:S80-81.Acupuncture and good prognosis IVF patients: Synergy. Fertility and Sterility
7) Veith,1. 1972 The Yellow Emperor's Classic of Internal Medicine, University of California Press
8) Zhen Jiu Yi Xue, Published in I798 “Easy studies in Needles and moxa Vol 1 .3 volumes by Li Shou Xian,