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Expert Advice-Treatment of Infertility 2 in Traditional Chinese Medicine(TCM):
Infertlity 2
Chinese Medicine for Infertility (2)

Part I

If you lived in China right now, you would probably be hearing a lot of conversations about having a baby. In Chinese culture, the first year of a millennium has tremendous positive energy. Besides being the beginning of a millennium, the year 2000 is also the year of the Dragon, which is another token of good fortune. Consequently, lots of Chinese women have been anxious to get pregnant and have a “lucky baby.” It looks like it’s going to be a lucky year for several of my clients at TCM Health Center who come for infertility treatment. One of them delivered twin boys in January, and several more will have babies in the next few months. When infertility treatments are successful, it is one of my favorite things about practicing Chinese medicine.

A woman who came to my clinic for infertility, said, “I read that infertility rates are higher in this country than anywhere else in the world. Why is this so?” This is a very good question. The United States does have a high infertility rate-17 percent, and this rate continues going up.

If you were to look at the data about fertility across the world, you would find that the Chinese have the lowest infertility rate, less that 3 percent. What could make this kind of difference? Some people even think that the Chinese must be born with a stronger or better reproductive system than other people. This is not true. All people are born with the same potentials. Differences in fertility potentials depend to a large extent on environmental and cultural factors. If you visited any full-service hospital of Chinese medicine in China, you would find the infertility clinic to be one of the busiest places there. Most hospitals have two infertility clinics-one for men and one for women. Many doctors of traditional Chinese medicine (TCM) specialize in this area of practice. It’s not that the Chinese have fewer problems with infertility that Americans; it is my belief that, for a majority of infertility patients, Chinese medicine provides more effective approach than that the approach that has been taken in the West to address the problem.

From what my patients have told me, Western medicine tends to approach conception as a full-scale strategic battle, where the emphasis is on sperm, eggs, and reproductive organs. Often, the wants, needs, and even the overall health of the patient are secondary considerations. This process also tends to be very high-tech and expensive, prohibiting many people form even making the attempt. Chinese medicine assesses the state of health of an individual or a couple in a holistic way, taking everything about them into account, paying attention to what the typical diet is like, how much exercise or how much rest a person gets, etc.

TCM treatment for infertility is generally a combination of acupuncture treatments, Chinese herbs, and dietary medications. In some cases, where the Fallopian tubes are completely blocked by scar tissue, for example, surgery is the best treatment. But most cases, where conception is prevented by an underlying hormone imbalance, low sperm count, or endometriosis, Chinese medicine is generally extremely effective.

Infertility is a very complicated condition, and either or both partners may have several contributing factors. Western medicine diagnosed hormone deficiencies or imbalances, scarring from infections or sexually transmitted diseases, overgrowth of reproductive tissues,  and other factors as the causes of infertility. Chinese medicine has its own special vocabulary, and speaks of problems with the primary organ systems such as Kidney Yang deficiency or Liver Chi stagnation, or problems with a fundamental substance of the body, such as blood stagnation, or of pathological factors such as Phlegm accumulation or Damp Heat. These are all common conditions, but each person’s history and particular manifestation of his or her condition varies. In order to give readers a clearer idea of how Chinese medicine diagnoses and treats various infertility problems. I will present several case studies from my practice.

Part II

For many couples, infertility can become the central issue of their lives, both as individuals and as a couple. Just going through fertility testing can be expensive and time consuming. Techniques such as harvesting eggs or in vitro fertilization can raise the price of conception beyond the ability of many people to pay.

In the United States, where infertility rates are very high, conception is treated as a technical, science-based problem. In China, which has one of the lowest infertility rates in the world, the approach is more holistic. Patients are assessed in terms of their energy level, diet, rest, and exercise patterns, etc. In certain cases, such as blocked Fallopian tubes, surgery is the most effective treatment. But for a majority of patients with problems such as a hormone imbalance or low sperm count, Chinese medicine can be an effective way to bring the body back to balance. Traditional Chinese medicine (TCM) treatment          generally combines acupuncture, Chinese herbs, and diet modifications. This type of treatment requires that a patient be conscientious about getting acupuncture, taking herbs, and eating a proper diet.

Infertility is generally a complex problem, and may involve one or both partners who are trying to conceive. There are' no quick fixes and no guarantees but for many people, Chinese medicine has been an affordable, I present the cases of two of my male infertility patients.

When Mr. Green came to see me, he was a 49-year-old gentleman married for nine years. He had been diagnosed with a low sperm count and low sperm motility. He was given hormone treatments which not only didn't work, but which drastically changed his personality. He went from being quiet and laid-back to being aggressive, with violent thought patterns. After this experience, he was referred to me by his sister-in-law, who I had successfully treated for infertility.

According to his history and other signs, Mr. Green fell into the pattern of Kidney Yang deficiency. The Kidney is the organ which TCM considers to be primarily responsible for reproduction, growth, and aging. Yang is the male principle of the universe, which balances with Yin, the female principle. A man with Kidney Yang deficiency can certainly have a low sperm count, and there are often other problems as well, such as lack of sexual desire, impotence, and sexual dysfunction. In Mr. Green's case, treatment was aimed at restoring Yang and tonifying the Kidney.

Specific treatments will be different from person to person, but for Mr. Green I recommended two acupuncture treatments a week for six to seven weeks, and then weekly treatments after that for another two months. This was accompanied by the Chinese herbal formula JIN GUI SHEN QI WAN (kidney yang tonic) and several other herbs. Chinese herbs can be taken in capsule form or boiled in water to make an herbal tea.

In addition, I referred him to my associate, Dr. Xirong He, for moxibustion treatment. Moxa is dried, formed into cigar-shaped sticks, and burned over acupuncture points. Sometimes sections of the “cigar” are cut off, attached to the handle of an acupuncture needle and burned. Moxibustion treatment is not painful at all. It has a deeply warming affect, and most people feel much better after it is done. Unfortunately , moxibustion treatments are time-consuming and require good room ventilation, so a lot of practitioners are unwilling to do them.

Mr. Green was a wonderful patient. He took his herbs and got acupuncture treatment with complete dedication. In a three month follow-up check with his doctor, it was found that his sperm count and sperm motility were dramatically increased. Today, Mr. Green has a two-year-old daughter.

Mr. Anderson is an athletic, healthy young man in his late 20s. He and his wife came in together, and he seemed embarrassed to tell me his story. At the age of 15, he suffered a bad accident that severely injured his testicles. The ER doctor told his parents that the injury would cause scar tissue to form, and that his scar tissue might make it impossible for him to produce sperm normally.

After the accident, Mr. Anderson recovered completely and pretty much forgot about what the doctor had said. But, later after being married seven years, his wife began to wonder why she had not been able to get pregnant. A series of tests on Mr. Anderson showed that every category of sperm production was absolutely abnormal and that it would be almost impossible for him to impregnate his wife. There was no way of telling how much scar tissue had formed, and I was not very confident when I saw this test results. But in my experience, it is always worth trying the modalities of Chinese Medicine to see what will happen. We decided to work together for three months, using acupuncture, Chinese herbs, and dietary modification. Like Mr. Green, Mr. Anderson was a good patient, even though he wasn’t happy giving up some of his favorite foods. At the end of the three-month treatment period, he went back to his doctor to repeat the fertility testing. He called me from the doctor’s office, practically crying on the phone-every one of the tests were now within normal limits. The chances are now very good that Mr. and Mrs. Anderson will be able to conceive a child normally.

Part III

     In the last article, we talked about infertility in men.  Women with infertility generally present more complicated cases than men.  Traditional Chinese medicine (TCM) recognizes many different kinds of imbalances and deficiencies that can lead to infertility in females.  In the next few articles, I will talk specifically about female infertility and how to treat it by using Chinese herbs, acupuncture, and dietary modifications.  Because endometriosis is the leading cause of infertility in women, I will present two cases of endometriosis in this article and the next.

     Tanya is a 39-year-old woman who has suffered with infertility for five years.  After she had been married for several years she was ready to have baby, but she could not get pregnant.  She went to see a doctor, and was told that her infertility was related to endometriosis.  She tried all the conventional approaches to treating endometriosis with no results.  When she searched for information on the Internet, she discovered that acupuncture and Chinese herbs are widely used to treat endometriosis and infertility in Asia and have a very high success rate.  She also read several scientific studies on the subject.  She became very excited to think that there may be another way to get help, and she scheduled an appointment in my clinic.  I immediately started her on a program of raw herbs and twice-weekly acupuncture treatments.  Raw herbs means that you take dry herbs in their natural state, boil them, and drink the tea which results.  This is the most potent form of herbs in Chinese medicine, stronger than pills or capsules.  After four months of this treatment, Tanya got pregnant.  In a few months now, we will see her new baby.

     Endometriosis-related infertility is the commonest type that a practitioner will see.  A severe case of endometriosis, especially if multiple surgeries have been done, can be very difficult to treat.  Fortunately, Tanya responded after four months of treatment, and was able to conceive.  Sometimes the condition can be improved with Chinese medicine, but conception is still not possible.  In TCM, the signs and symptoms that a body exhibits in a state of disease or imbalance is called a pattern.  There are several patterns that can cause endometriosis, but most often we see women who have a pattern called Congealed Blood with Phlegm Accumulation.  Tanya had this pattern.  In basic terms, Chi and Blood are two fundamental substances of the body, and they travel around the body in a system of vessels.  Chi, or energy, travels in several systems of vessels called meridians.  Blood has its own vessel system, of course, but Blood can also travel in Chi meridians, as can Phlegm, which is a pathogenic substance.  When any substance becomes stuck or obstructed in a meridian, this always causes pain and dysfunction.  “Congealed Blood” is a condition where blood becomes stuck in a meridian.  When there are gynecological problems, the blood is usually stuck in the Liver meridian, which encircles the reproductive organs in men and women.  Phlegm is a substance which is created by an accumulation and concentration of dampness over a longer period of time.  When water is not metabolized well and there is water retention in the tissues; or when a person eats a lot of mucus-producing foods like dairy products, then the pathological factor of Phlegm will eventually result.  Phlegm can accumulate in any part of the body, but it often tends to sink into the lower parts of the body, obstructing the free flow of Chi and Blood.

     The treatment strategy in Tanya’s case was to open the blocked meridians and expel Phlegm.  Since diet has such a strong effect on our health, it is important to avoid foods that contribute to an imbalanced state.  Following a good diet makes the acupuncture and herbs more effective because you are strengthening your system with nutritious foods instead of depleting your system with foods that are unhealthy for you.  I asked Tanya to give up the foods that can contribute to phlegm and blockage, including cheese, ice cream, ice cold drinks, sugar, and a few others.  Some of these foods were favorites of hers, but she was willing to give the treatment her full cooperation.

     The first change that Tanya noticed after several weeks of bi-weekly treatments was that her menstrual pain decreased quite a bit.  Even if a woman is not trying to get pregnant, treatment for endometriosis can definitely reduce painful periods and improve quality of life.

     Not all cases of endometriosis are diagnosed as the Phlegm Accumulation pattern.  There are other patterns that can produce the painful congestion of endometriosis .  In the next article, I will discuss the Blood Stasis pattern.

Part IV

     In last month’s article, I began to discuss infertility in women, presenting a case of endometriosis-related infertility.  There can be a number of causes for infertility, but endometriosis is the most common cause in the U.S. and China.

     In Chinese medicine, diseases and imbalances are diagnosed as patterns.  A pattern is defined by the signs and symptoms that a person exhibits, and patients will often present more than one pattern.  In the case I discussed last month, the woman had a combined pattern of Congealed Blood (also called Blood Stasis) and Phlegm Accumulation, with the Phlegm Accumulation being the predominant issue.  Her Western-medicine diagnosis was endometriosis.  This month, I will talk about Jean.  Jean also has a Western-medicine diagnosis of endometriosis, but her predominant Chinese medicine pattern is Blood Stasis.

     Chinese medicine believes that Blood travels both in the blood vessels and also in the energy meridians of the body.  It sounds strange to say that blood can circulate in an energy meridian, but Blood has several aspects in Chinese medicine.  There is the physical aspect of blood – the blood that you see when you cut yourself – and this physical aspect only circulates in the blood vessels.  There is also the energetic, or functional aspect of blood, which can travel in both blood and energy vessels.  The functional aspect of Blood is as a primary Yin substance in the body.  Blood is called the “mother of Chi” because it moistens and nourishes every cell.  It also nourishes the feminine principle that exists in every human being.  Ideally, Blood circulates freely through the vessels and meridians, but sometimes it becomes stuck in the meridians of in the tissues, and this is called Congealed Blood or Blood Stasis.  A bruise is a superficial type of Blood Stasis involving the physical aspect of blood.  When Blood is stuck in the meridians, the main symptom people notice is pain, which is usually described as constant, fixed, stabbing pain.  When Blood is stuck in tissues, it often produces lumps, tumors, or masses, which can also be painful.  Endometriosis, uterine fibroids, and ovarian cysts are all examples of Blood Stasis in women.

     Jean is a thirty-five year old patient who originally came to see me for problems related to a car accident.  These injuries cleared up well with acupuncture and Chinese herbal treatment, and Jean began to talk about her infertility issues.  She has a successful career and has been happily married for nine years, but she and her husband are both eager to have children, and they have not been able to.  Jean felt enough pressure about this situation to visit a fertility clinic.  After some diagnostic tests, they told her that she had endometriosis, and that was probably the reason she had not been able to conceive.  The doctor at the clinic decided to try fertility drugs with Jean.  He believed that the endometriosis was a relatively mild condition, and that fertility drugs could override the endometriosis problem.  Unfortunately, the drugs did not work, and at this point, Jean was very hesitant to try this method of fertility treatment again.  She didn’t like the side effects from the drugs, and it is an expensive treatment with no guarantee of results.

     After I began to treat Jean’s Blood Stasis issue with acupuncture and Chinese herbs, her symptoms improved relatively fast.  The patient that I discussed last month, Tanya, had endometriosis based in a pattern of Phlegm Accumulation, and it took quite a while to resolve because it was a severe case.  But Jean’s Blood Stasis pattern was not as serious or as deep-seated.  Even though both of these cases are called endometriosis in Western medicine, they are seen as two different patterns in Chinese medicine, so the acupuncture points that I used and the herbal formulas that the two women took were quite different.  Jean’s response to treatment was wonderful – her pelvic discomfort lessened, and she became pregnant.  In a few months she will be a first-time mother.

     In China, where both Western-style and traditional Chinese medicine are practiced, gynecologists always recommend their infertility patients to try traditional Chinese medicine first.  It is far less invasive, and there is much less risk from herbal formulas than from potent drugs.

Part V

This series of articles is about the traditional Chinese medicine approach to infertility.  Chinese medicine sees people as a whole, taking lifestyle issues such as diet, exercise, and rest into account, and using acupuncture, herbs, and dietary modifications to rebalance the body’s energies.  When unhealthy patterns within the body are cleared up, and when depleted energy is restored, it is often possible for people to conceive.  Western medicine fertility therapy can be very effective, but the emphasis is on powerful drugs that override the body’s natural functioning.

In this article, I will discuss a common problem for older women who want to conceive:  Kidney-energy deficiency.  Pam came to see me when she was 43.  She and her husband had been trying to have a baby for several years, and she had taken fertility drugs without success.  Her doctor tried the highest dose possible of the fertility drug, but she only produced a few, unfertilizable eggs, and the doctor told her she might just be too old to have a child.  Pam and I decided to work together, because there was a chance that Chinese medicine could help her, although even in Chinese medicine theory, age is considered to be a significant factor in fertility.

In the ancient Chinese text, Yellow Emperor’s Classic of Medicine, it says “When the energy of all the organs is full, the excess energy stored in the kidney is excreted for the purpose of conception.  But [when] the organs have aged and their energies have become depleted, . . .the kidney reservoir becomes empty, marking the end of the power of conception.”  The Kidney is responsible for reproduction, growth, and aging.  When we are conceived, the Kidney Essences of our parents combine to produce a new being.  This is very similar to the Western idea of genetic inheritance.  When we are born, our basic, hereditary constitution is set, giving us our lifetime potential of physical development and aging.  The lifestyle we choose can affect this potential.  If we wear ourselves out with work or stress, or if we eat poor diets or abuse our bodies with alcohol, cigarettes, etc., we will “use up” our Kidney Essence at a rapid rate, and will therefore age more rapidly than if we follow a balanced and moderate lifestyle.

Pam was in relatively good health when she came to see me, but she was entering her pre-menopausal time, when the Kidney energy normally declines.  Becoming pregnant and carrying a baby to delivery is a very heavy demand on the Kidney’s resources, even for a young woman.  Because Pam saw this effort as her last chance to conceive, she was very dedicated to the treatment.  We started with acupuncture treatments every other day, and she cooked and drank a strong herbal formula on a daily basis.  At the same time, she continued to see her regular doctor, which I encouraged.  After several months of acupuncture and herbs, her doctor tried the fertility drug again, using only half the dose that he had last time, and they harvested twelve good eggs.  The doctor was surprised, and Pam was thrilled.  The only difference was Pam’s use of Chinese medicine.

It is standard practice to stop acupuncture and herbs once a pregnancy starts, as long as everything is going well.  Unfortunately, the first pregnancy did not go well:  the baby died a few weeks after it was implanted.  This often happens when a woman is older, or has deficient energy to start with – the uterus is too old to nourish the baby.  Pam resumed the acupuncture and herbs and tried again.  When she was pregnant the second time, we continued with the acupuncture and herbs until her fourth month in order to give her extra support and nourishment.  This time she had healthy twin boys.  They are seven months old now, and the parents are very happy.

Pam’s case shows a successful collaboration between Chinese medicine and Western medicine.  In my experience, women do extremely well using these two modalities in conjunction, especially if the Western approach has not worked.  Some women hesitate to try Chinese medicine because they think they will have to give up on their Western treatment.  In China, it is common to use traditional Chinese medicine in combination with Western medicine.  Doctors there have a good idea of what kind of medicine will work best for different conditions, and they use whichever one is most effective for the patient.  I hope that this will eventually be the trend in the American health care system, too.

Part VI

     The subject of infertility is complex.  There are many reasons why men and women can have difficulty conceiving a child, and there is usually more than one problem involved.  In previous articles on infertility, I have discussed male infertility, as well as endometriosis and age-related infertility in women.  This article presents two cases where the problem appears to be rooted in diet and/or stress.

     Western medicine tends to focus primarily on the reproductive organs and sex hormones of the infertile, using surgery and drugs to “correct” a dysfunction.  Traditional Chinese medicine (TCM) is holistic by nature, taking every aspect of a patient’s life into consideration.  When there is an internal imbalance, Chinese medicine examines the patient’s diet and lifestyle very seriously.  Any practitioner you see should be concerned with these issues, because they are basic to good health and well-being.

     When I first saw Tina, she was twenty-nine, and had been trying to get pregnant for six years.  She had tried in vitro fertilization many times with no success.  As a teenager, Tina had an eating disorder.  She didn’t get her first period until she was eighteen, and still suffers from irregular periods.  Interruption of the menstrual cycle is almost always a sign of stress.  Complete suspension of normal menstruation indicates a highly stressed body.  For a young woman, Tina had quite a few problems from a TCM point of view.  She was deficient in three fundamental body substances:  Chi, Yin, and Blood; and she also had a condition called Stagnant or Congealed Blood.  This congealed blood was blocking the flow of Chi/energy through the meridians (energy pathways).  In Tina, the Liver, Kidney, and Spleen meridians were affected.  It is a challenge to treat a case like Tina, because there is no one remedy that will treat all of her patterns.

     First, I decided to unblock the congealed blood from the energy meridians, using Chinese herbal formulas and acupuncture.  This is like taking a log jam out of a river so the water can flow easily again.  Once the energy pathways were open, we began to tonify the deficient blood, Chi, and Yin.  If you tried to tonify the deficiencies first, before clearing the obstruction, it would be like pouring more water in behind the log jam – there would be a flood, or energy would back up and make the problem worse.  This treatment strategy applies to other conditions where there is obstruction, like pain or depression.  Sometimes people will complain of having a bad reaction to acupuncture or Chinese herbs.  This might be because the practitioner tried to correct all the blockages and deficiencies at the same time, instead of taking them in order.

     For Tina’s combined problems, we used six different herbal formulas at various stages of treatment, and changed acupuncture points as needed.  After five months of treatment, Tina’s depleted body was restored enough for her to get pregnant naturally.  Her daughter is a year old now.

     Some infertility specialists believe that 30% of the infertility they see is related to stress.  This may be why infertility rates are higher among well-educated, professional women.  In China, it seems that housewives and women who live in villages are more fertile than urban, professional women.  There are many cases of infertility where there is no medical explanation.  Since I came to the United States I have seen a lot of workaholic women who eat very poorly, and they frequently have problems with infertility, endometriosis, PMS, and menstrual problems in general.

     Chris is a good example of the difficulties that a busy, stressful life can bring.  She is a 35-year-old woman, an attorney’s assistant, with a nine-year-old daughter.  She has been trying unsuccessfully to have another child for the last five or six years.  Her doctor did a lot of tests, but could find nothing wrong with Chris or her husband.  In Chinese medicine terms, Chris had the kind of deficiencies and imbalances that result from being overtired or overworked, and from eating an inadequate diet.  When I asked her to keep a food diary for a week so I could see how she ate, she said she was too embarrassed to write it down.  She generally ate a donut or cold cereal for breakfast, then skipped lunch or grabbed some fast food.  After work, she was too tired to cook, and ate more junk food for dinner.  She couldn’t remember the last time she cooked a meal.

     Acupuncture and herbs can help a lot in nourishing and balancing a woman’s body to increase her chances of getting pregnant, but there are no magic bullets or instant cures.  A woman with this kind of stress in her life also needs to make a lot of changes in her lifestyle, eating habits, exercise routine, etc.  I always tell my patients that I will have a hard time keeping them in good health if they work 80 hours per week, with no time to eat properly, get enough exercise, or even just relax.  Western medicine has also come to see that stress can trigger many health conditions such as heart attacks and ulcers.

     Chris decided it was time to reorganize her priorities, and she made a lot of changes in her lifestyle.  She joined a Tai Chi class, took long walks with her dog, and made a real effort to cook and eat a proper diet. All the efforts that she made to help herself made the acupuncture and herbs more effective to correct her imbalance and deficiency.  Within a year, she got pregnant.