Infertility Q & A

Infertility is a condition of the reproductive system that impairs one of the body's most basic functions: conception. A couple is considered infertile if one of the following three conditions applies:

• If the female is under the age of 35: The couple has not conceived after 12 months of contraceptive-free intercourse.
• If the female is over the age of 35: The couple has not conceived after 6 months of contraceptive-free intercourse.
• The female is incapable of carrying a pregnancy to term.

Roughly one-third of infertility cases can be attributed to factors affecting the female and about one-third can be attributed to factors that affect the male. The remaining one-third of infertility cases is generally due to a combination of problems between both partners. However, among this last group, 20% of cases cannot be explained.

The most common causes of female infertility are as follows:

• Ovulation disorders due to irregular menstruation, amenorrhea, polycystic ovarian syndrome, or premature ovarian failure.
• Endocrine imbalances, such as elevated follicle-stimulating hormone (FSH), luteal phase defect, thyroid disease, or hyperprolactinemia.
• Blocked fallopian tubes, which can occur as a result of pelvic inflammatory disease, endometriosis, or having undergone an ectopic pregnancy.
• Cervical or uterine factors resulting from uterine fibroid tumors or surgical damage during treatment for cervical dysplasia.
• Immunological and inflammatory factors, both specific and non-specific. An example would be lupus, which is a chronic autoimmune disease that can affect various parts of the body.
• Congenital anomalies (birth defects) involving abnormal structure of the genital organs.

The most common causes of male infertility are as follows:

• Azoospermia, which refers to a complete absence of sperm cells in semen, accounts for 10% to 15% of all cases of male infertility. It may be caused by testicular failure or it may result from damage to some portion (e.g., the epididymis, vas deferens, or ejaculatory duct) of the reproductive delivery system. Obstructive azoospermia is caused by either congenital or acquired problems, the latter of which may be due to infection.
• Oligospermia, or abnormal sperm production, can be triggered by genetic factors, lifestyle choices (e.g., smoking, alcohol, and certain medications), varicocele (enlargement of the vein in the scrotum that drains the testicles), diabetes, kidney failure, childhood infections (e.g., mumps), and hormonal or chromosomal deficiencies (e.g., insufficient testosterone).
• In rare cases, infertility in men is caused by a genetic disease, such as cystic fibrosis or chromosomal abnormality.

In TCM, infertility is caused by an imbalance in blood and Qi affecting one or more of the organ systems. The three major organ systems involved in infertility are the kidney organ system, the spleen organ system, and the liver organ system.

The kidney controls the release of the ovum and also releases and stores a substance called Jing (body essence), which is necessary for a healthy body, mind, and pregnancy. If an imbalance exists within the kidneys, the body will be insufficiently supplied with Jing, resulting in infertility. If one consumes an excessive amount of cold foods or beverages, her kidney Yang will be deficient, and she will not be able to keep her uterus warm to help the embryo's implantation.

In the body, the spleen regulates an adequate amount of Qi, blood, and fluid supply that is necessary for a woman to have a normal menstrual cycle, a healthy pregnancy, and to be able to sustain a growing fetus. The spleen governs energy production, metabolism, and digestion. It also converts the nutrients and Qi into blood. Any disharmony within the spleen organ system can affect this delicate balance and lead to problems with fertility. A woman may either have Qi and blood deficiency, or excessive fluid that can block Qi and blood flow, thus causing a shortage of nutrient supply to the uterus.

Finally, the liver facilitates the smooth flow and distribution of blood and Qi. It is responsible for transformations in the body, including ovulation. Stagnation in either blood or Qi leads to depression, anxiety, and stress, all of which negatively affect fertility and lead to poor circulation.

There are 6 differentiations according to TCM: Kidney Yin Deficiency, Kidney Yang Deficiency, Spleen Qi and Blood Deficiency, Liver Qi Stagnation and Blood Stasis, Dampness, Cold uterus.

Western Medicine practitioners treat conditions according to the medical diagnosis. For infertility, assisted reproductive technology (ART) is generally offered as a solution. Examples of ART include intrauterine insemination (IUI), in-vitro fertilization (IVF), gamete intro-fallopian transfer (GIFT), and zygote intro-fallopian transfer (ZIFT). About 90% of infertility cases are treatable with medical and alternative therapies.

While Western Medicine treatments for infertility target the reproductive organs, acupuncture and TCM work to strengthen all systems within the body. Among the most positive aspects of acupuncture are the benefits it has on the hypothalamic-pituitary-ovarian axis, which plays a key role in fertility. Acupuncture helps to reduce anxiety, stress, and cortisol levels, and increases blood flow to the uterus and pelvic region, which in turn, improves the uterine lining and relaxes the uterine wall. This increases the chances of successful embryo implantation and fertilization. Finally, acupuncture and TCM also enhance the immune system and normalize all endocrine and hormonal systems that regulate ovulation and the menstrual cycle, which is especially important for women with polycystic ovarian syndrome. By exerting multiple effects on multiple systems and regions within the body, acupuncture and TCM restores health and balance to the mind, body, and spirit, which in turn enhances fertility in both men and women.

Free circulation of blood and Qi throughout the body ensures that every cell, tissue, and organ is properly nourished. Through procedures and treatment regimens that improve the quantity, quality, balance, and flow of blood and Qi, acupuncture and TCM ensure optimal functioning of all organs in the body, thus increasing health and fertility.

Acupuncture and TCM have been effective in treating infertility for four thousand years in China. Numerous studies in the past decade have shown that acupuncture also increases the success rate of conventional Western Medicine infertility treatments. In the April 2002 issue of Fertility and Sterility, a German study showed that using acupuncture pre-IVF and post-IVF increased the success rate by 42.5%, compared with only 26.3% for those who did not incorporate acupuncture into their treatment regimens.

Acupuncture and TCM offer several advantages in the treatment of infertility. They enable patients to conceive naturally with minimal side effects, thus allowing them to achieve pregnancy without compromising their health. When used in conjunction with ART procedures such as IVF, they help increase the success rate and reduce the side effects caused by drugs prescribed during ART. Acupuncture and TCM also have the added benefit of improving patients' overall physical and emotional well-being, thereby reducing the chances of ectopic pregnancies and spontaneous miscarriages.

We all know that seniors who continue to exercise are able to maintain greater level of strength, bone mass, and agility. People who have healthy diets and have active social lives are sharper and healthier, and retain his/her faculties at higher levels. Physical decline associated with aging has much less to do with biology and more to do with lack of physical activity, poor diet, and lack of stimulation. The same is true of our reproductive life spam which is only about 40 years (menarche 12-15 years old to menopause 46-55 years old ). A woman over 37 is defined as "senior reproductive age" who needs Ovarian Care. With acupuncture and TCM herb medicine, she may retain the benefit of having good blood flow in the reproductive region, regain balanced hormones, and non-responsive follicles resume normal communication to the Hypothalamus-pituitary-ovary-uterus axis again.

Yes. High FSH means sluggish ovaries. Ovaries may start becoming less responsive to FSH. When there is interruption along the Hypothalamus-Pituitary-Ovary-Uterus axis, the ovaries do not react without its normal signal from the pituitary gland, and the pituitary constantly secretes an excessive amount of FSH without any feedback from ovaries to make it stop. Acupuncture can help open up blocked channels and assist in restoring normal communication in each organ.

PCOS is medical disease defined as a disorder of ovulation, affecting the skin, hair, body, weight, reproductive system, endocrine system, pancreas, hypothalamus, pituitary gland, and adrenal glands. The primary indication of PCOS is having irregular or absent periods, often dating back to menarche. In some cases, women with PCOS can have very long cycles, do not ovulate, or ovulate later in the cycle, may have little bleeding or very heavy bleeding. Western medical doctors and scientists have been unable to explain the actual cause of PCOS, and thus have been unable to treat it effectively. Chinese medicine seeks to redress the entire hormonal secretion that produces the changes in a woman's ovaries seen in PCOS. The most common manifestation of PCOS is dampness or phlegm, which may be associated with Yang deficiency and obstruction. A study in Europe in the 1990s on anovulatory women with PCOS showed that electro-acupuncture restores ovulation in one-third of the test subjects. Acupuncture also reduces endocrine indicators of PCOS, including LH/FSH rations, mean testosterone concentrations, and beta-endorphin concentrations. Researchers theorized that this improvement was caused by an inhibition of hyperactivity in the sympathetic nervous system. In other words, acupuncture works to restore the entire sympathetic nervous system to health and balance. The result is normalization of the hormonal system directly tied to ovulation and reproduction. Then, the entire hormonal cascade allows an egg to develop and be released on schedule. To ensure follicles are healthy and capable of nurturing healthy eggs, it is important to have at least three regular ovulatory cycles before trying to get pregnant. Once the woman with PCOS has reestablished at least three cycles, her entire reproductive system will most likely function normally, and pregnancy may occur naturally.

POF is a condition that essentially means having a very early menopause, occurring before a woman reaches the age of forty. It is due to either the loss of accelerated eggs, or the follicles themselves become less responsive to hormonal stimulation. It is one of the more common conditions affecting a woman's fertility. Women with POF will have stopped menstruation altogether, or will have short cycles characterized by having early ovulation or no ovulation. The cycle is often accompanied by elevations in FSH, indicating that ovaries are not responding to any signals from hypothalamus. The lack of communication causes hormonal "confusion". The hypothalamus gives the pituitary gland messages to try harder to stimulate the ovaries. More FSH is produced to invigorate the ovaries, but the ovaries, whose receptors are down, have become less responsive to this message. Western medicine cannot pinpoint its cause and can do little to help it. Although treatment of POF may be challenging for the acupuncturist, it is also rewarding because Chinese Medicine offers one of the most effective ways to address POF. Based on TCM, most POF patients either have excessiveness or a deficiency causing meridian obstruction or the blood and essence depletion. In our practice, we individualize the treatment plan for each patient, either by decongesting or fortifying with acupuncture and herbal supplements depend on her specific condition. Therefore, it is possible for a woman with POF to have her biologic child. Of course, when a woman's ovaries reach her reproductive life span, there is nothing that can be done to reverse them.

In our practice, there are quite a few cases that patients with either fibroids or endometriosis become pregnant and have health babies. Both conditions are characterized by inappropriate tissue growth within the reproductive system in endometriosis. The endometrial cells migrate in the area outside the uterus in uterine fibroids. They are benign tumors found on the inner and outer wall of the uterus, or anywhere else in the pelvic cavity. They cause damage to the reproductive organs and prevent conception. In TCM, they are both considered a process of inhibited, stagnated pelvic blood flow. They form lumpy nodulations within the body caused by hardening static blood. TCM treatment involves acupuncture to open blocked Qi and blood pathway, invigorating the blood and eliminating blood stasis, clearing and softening the indurations. Thus, conception occurs when the body restores the free flow of energy and blood in the reproductive organs.

Treatment can start almost anytime, although 3-6 months of acupuncture and TCM usually provides maximum benefits. Any amount of treatment will help. Some patients become pregnant by natural means after undergoing acupuncture. Other patients undergoing ART turn to acupuncture and TCM to help them prepare physically and emotionally in the 3-6 months leading up to the time at which they begin receiving stimulation medication.

At Art of Wellness, treatment regimens are tailored to the specific needs of each individual patient. However, the general procedure for treatment of infertility with acupuncture and TCM involves the following components:

• Acupuncture treatments 1-2 times each week
• Herbal supplements taken 2-3 times daily (optional for patients under stimulation medication)
• Following specific dietary guidelines provided by the practitioners.
• Self-acupressure procedures taught by the practitioners.
• Tai-Chi, Qi Gong, Meditation, Yoga, and other exercises.
• Healthy lifestyle adjustments

The "Nei jing, Classical of Internal Medicine", was complied over 2,000 years ago and possibly the first document that described the dynamic relationship between health and the energies of food, which is known as Chinese dietary therapy. It emphasizes the connection between the human body and environment. What foods one should eat depends on the season, location, one's base constitution, emotional and spiritual health, daily work, and activity, as well as the food itself, in terms of color, taste, and energetic properties. Overall, organic and seasonal local-grown foods tend to be more nutrition-dense than conventional foods and will help enhance fertility.

In addition, be sure to eat white meats from poultry that are free-range and hormone-free. Vegetable products, such as sprouts, nuts, and seeds are a good source of vitamins and minerals. Complex carbohydrates (e.g., whole grains, such as brown rice, oats, quinoa, barley, and spelt) are another good source of nutrition. For further information, please read the article entitled "How to Enhance Your Fertility". Based on each individual's condition, there are specific dietary suggestions from the acupuncturist.

Supplements are by no means a substitute for natural sources of nutrition. However, the following supplements are our recommendation for increasing the chances of pregnancy:

• Natural, high-potency multivitamins and minerals containing 400-800 mcg of folic acid and iron.
• Deep sea fish oil, flax seed oil, or omega-3 fatty acids
• Pure royal jelly (1/4 tea spoon daily)or bee pollen
• Coenzyme Q-10 (75 to 100 mg for women and 200 mg for men with poor sperm production)
• Complex B vitamins daily
• Amino acids (L-arginine for women and L-carnitine for men)
• Zinc (15 mg for women and 100 mg for men)
• Selenium (20 mcg for women, and 150 mcg for men)

The foods that should be avoided by those suffering from infertility include but are not limited the following:

• Processed foods
• Foods containing preservatives and additives, such as food coloring, artificial sweeteners, and artificial flavoring
• Coffee
• Processed or refined sugars
• Cold and icy foods and drinks should be avoided, especially during menstruation
• Alcohol and drugs

In addition to the aforementioned foods, smoking should be avoided as should chemical and environmental toxins, such as aerosol cans, paints, glues, household cleaners, dyes, and pesticides.