Infertility and Acupuncture

Infertility is fundamentally the inability to conceive a baby. Infertility is a state of a female who is unable to carry a pregnancy to full term.


The worldwide study revealed the following facts:

  • Women become less fertile as they get older. For women aged 35, about 94 out of every 100 who have regular unprotected sexual intercourse get pregnant after three years of trying. For women aged 38, however, only 77 out of every 100 do so. The effect of age upon men’s fertility is less clear.
  • In people going forward for IVF, roughly half of fertility problems with a diagnosed cause are due to problems with the male, and about half due to problems with the female. However, about one in five cases of infertility has no clear diagnosed cause.
  • The male factor infertility accounts for 25% of infertile couples, while 25% remain unexplained. 50% are female causes with 25% being due to anovulation and 25% tubal problems/other.
The World Health Organization defines infertility as follows:

Infertility is “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.”

Other Symptoms:

  1. Irregular menstruation
  2. Amenorrhea
  3. Dysmenorrhea
  4. Galactorrhea
  5. Distending pain in breast
  6. Aches in the waist

Primary Infertility

When a female is unable to ever bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth she would be classified as having primary infertility. Thus women whose pregnancy spontaneously miscarries, or whose pregnancy results in a stillborn child, without ever having had a live birth would present with primary infertility.

Secondary Infertility

When a female is unable to bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth following either a previous pregnancy or a previous ability to carry a pregnancy to live birth, she would be classified as having secondary infertility. Thus those who repeatedly spontaneously miscarry or whose pregnancy results in a stillbirth, or following a previous pregnancy or a previous ability to do so, are then not unable to carry a pregnancy to a live birth would present with secondarily infertile.

TCM Overview

The treatment of infertility with acupuncture and Chinese medicine dates back 5,000 years. These ancient, time-tested techniques improve fertility rates and support a female’s whole body, unlocking unlimited potential for health, healing, and childbearing.

When Qi (also called Life Energy) and blood are circulating freely throughout the body, every cell, tissue, and organ is properly nourished and functioning well. When this occurs, a female’s health and fertility are increased.

According to the theories of acupuncture, infertility is caused by an imbalance of Qi and blood affecting one or more of the Organ Systems.

However, the three main organ systems related to female reproduction in Chinese medicine are the kidneys, spleen, and liver.

Ø  The kidneys

In addition to storing the essence, the kidneys have two aspects: kidney yin, which provides substance, and kidney yang, which provides the force. Both are very important factors of the female reproductive system. A Deficiency of kidney yin, resulting from overwork, a long, chronic disease, or too many children born too close together, leads to a drying up of yin and, therefore, the cessation of the menses. Kidney yang Deficiency may lead to the formation of cold, which obstructs the uterus and may cause infertility.

Kidney essence is the origin of menstrual blood, which has many functions in Chinese medicine. Blood flows throughout the body sending nutrients to every cell and supplying the female’s menstrual cycle. Once pregnancy has occurred, blood nourishes the embryo’s growth. When the child is born, blood turns into the mother’s milk and supplies the infant with nourishment.

Ø  The spleen

The spleen has several important functions. The spleen transforms and transports food and drink and sends the clear Qi out to the entire body and the turbid Qi down and out through the intestines. The spleen also forms blood, which is very important to a female’s menstrual cycle. If the spleen Qi is deficient, it is not able to make enough blood, and the female may experience delayed and/or scanty menstruation or amenorrhea. The spleen also has the function of holding the blood within the vessels. If the spleen fails to manage or contain the blood, there may be spotting or heavy uterine bleeding.

Ø  The liver

According to Chinese medical theory, the liver plays a very important role in the reproductive systems in both men and women. The liver governs the free coursing of Qi throughout the entire body and it stores blood at night. Since the Qi moves the blood, if the Qi stops, the blood stops. This means that, if the Qi becomes stagnant, the blood may eventually become static. Qi stagnation and blood stasis often go hand in hand and cause such problems as endometriosis, uterine fibroids, and ovarian cysts. Often, Qi stagnation and blood stasis may present with symptoms of abdominal pain, cramps, or irregular menstruation. In men, this blockage of Qi and blood may manifest as obstruction of the ejaculatory ducts. High levels of stress impede the free flow of Qi and, thus, often cause binding depression of liver Qi. If there is liver blood Deficiency, there may be scanty menstruation, dizziness, headaches, and problems with fertility.

Ø  The channels & network vessels

Each of the viscera and bowels of Chinese medicine has an associated channel (Jing) and various network vessels (Luo) that run along specific pathways on the body and can be accessed through the acupuncture points. These are referred to as the regular channels. In addition, the body has several extraordinary vessels that act as reservoirs to these regular channels. These extraordinary vessels can both hold replete Qi from the main channels as well as give Qi back to them as needed. In gynecology, two of the most important of these eight extraordinary vessels are the Ren and Chong vessels. The controlling vessel, also known as the “sea of yin,” helps regulate menstruation, fertility, conception, pregnancy, childbirth, and menopause. Often referred to as the “sea of blood,” the Chong vessel nourishes the blood and works in concert with the Ren vessel to regulate the uterus and menstruation. Both of these vessels derive their Qi from the kidneys and help circulate kidney essence throughout the body. The girdling vessel (Du Mai) is the only horizontal channel of the body. It influences the genitals and is thought to have a containing function, encircling the other channels.

The tian gui or heavenly water

The female’s physiological changes in seven-year increments the waxing and waning of something called the tian gui or heavenly water. The heavenly water refers to kidney essence in its role in creating the menstruate. Therefore, menarche is called “the arrival of the tian gui”, while menopause is called “the cessation of the tian gui.” For example, at 14 years of age, a girl’s kidney essence has developed and, therefore, her menstruation starts and she is able to conceive. At 21, her kidney essence has optimized and she is ready for conception. At 35, a female’s kidney essence has begun to wane, and by age 42, it is rapidly diminishing. At 49 years of age, the female’s kidney essence is now depleted, and, therefore, her menstruation stops and she can no longer conceive.

This classical theory describes the normal physiology of a female’s hormonal cycle throughout her life. Due to the cultural difference and the improvement in both nutrition and living environment, modern women in developed countries, on average start their puberty 1-3 years earlier and enter their menopause 2-3 years later than those living in ancient times. In spite of this slight difference between ancient and modern-day women, the basic ideas about the physiology of female menstruation are still an important guide to modern traditional Chinese medical diagnosis and its treatment of gynecological diseases.

Pathology of Infertility

Western medical pathologies of female reproduction

There are several primary pathological conditions that may interfere with a female’s ability to achieve pregnancy:

1. Ovarian factors

At around 41 years of age, the function of a female’s ovaries starts to decline. (Although this is a natural stage of a female’s development, for the purposes of achieving pregnancy, it is considered pathology here.) This decline results in the production of lesser quality eggs. 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. FSH levels above 10 indicate that the ovarian function has declined, making pregnancy more difficult to achieve. Even when pregnancy does occur it is usually more difficult for the female to carry the embryo to term, and miscarriage often results. In addition, estrogen and progesterone levels decrease, causing a thinning of the endometrium. All of these factors affect the implantation of the embryo.

Another condition of the ovaries is the occasional or total failure to ovulate. This may be due to hormonal changes causing irregular menstruation, amenorrhea, or heavy uterine bleeding. This condition may also be due to polycystic ovaries.

The treatment for these conditions focuses on regulating the menses, balancing hormone levels, and if needed, treating poly-cysts and endometriosis. Once this is achieved, fertility is greatly increased.

2. Fallopian tube factors

The fallopian tubes may become blocked due to infection or endometriosis causing adhesions. As a result, the sperm is unable to fertilize the egg.

3. Uterine factors

Uterine fibroid distorts the uterine cavity or blocks 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.

4. Cervical factors

Cervical or vaginal infection can cause excessive discharge or mucus, which may kill or inhibit the advance of the sperm. This may be due to the presence of antibodies.

 

Female pathology according to TCM

In order for fertilization to occur, the yin, yang, Qi, and blood of the kidneys all need to be perfectly balanced. When one or more of these elements is out of balance, a disharmony results and infertility may occur. When diagnosing infertility, it is important to differentiate clearly between cases of Deficiency and cases of Excess. The following patterns relate to the uterus and the thoroughfare and controlling vessels, which include the ovaries and fallopian tubes.

1. Deficiency patterns

1.1 Blood & yin Deficiency

If the liver blood and kidney yin are deficient, the essence will not be sufficient to nourish the uterus and the thoroughfare and controlling vessels. This condition may bring about 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 egg.

1.2 Qi & yang Deficiency

When there is a Deficiency of the Qi and yang of the spleen and kidneys, there is inadequate energy to transform and activate the uterus and the thoroughfare and controlling vessels, also leading to the inability of the egg to be fertilized or for the fertilized egg to implant itself and grow.

2. Excess 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. Because of this blockage, fertilization cannot occur.

There is some connection between Western medical pathology and Chinese medical pathology, which are listed below.

The Pathology of Infertility

Deficiency of Kidney Yin  OR

Deficiency of Blood OR

Deficiency of Kidney Yang  OR

Deficiency of Qi

No Ovulation

Small Uterus

Thin Endometrium

Poor Quality of Eggs

Poor Quantity of Follicles

Low Estradiol

Low Progesterone

High FSH

Qi Stagnation OR

Blood Stasis OR

Phlegm Damp Obstruction

Fallopian Tube Block

Uterine Fibroid

Ovarian Cystitis

Endometriosis

Adhesions

Stress

Damp Heat OR

Toxins OR

Blood Stasis

Cervical Infection

Vaginal Infection

Pelvic Infection

Fallopian Tube Infection

Patterns of infertility according to TCM

Kidney yang deficiency

Kidney yang deficiency causes infertility with loss of libido, delayed, and decreased menstruation with pale menses:

Main Symptoms

Infertility, Loss of libido, Delayed menses, Decreased menses, Pale menses, Infrequent menses, Amenorrhea may be present, Aches and weakness of waist and legs, Dusky complexion, Loose stools, Abundant clear urination.

Cause of disease

  1. Kidney yang becomes deficient due to:
  • Inadequate prenatal endowment
  • Excessive sexual activity
  1. Deficient kidney yang fails to warm and nourish the uterine meridians. Hence Ren Mo and Chong Mo become deficient.
  2. The essence than cannot gel and form into a fetus.
  3. When the kidney yang is deficient, the fire of vital gate declines and is unable to propel Qi and move water.
  4. Cold and humidity gels in Chong and Ren Mo and causes blockage there
  5. Humidity fills the uterine meridians so that essence cannot gel and form into a fetus.

Treatment principles

  1. Warm the kidney
  2. Generate blood
  3. Nourish Chong and Ren Mo
  4. Resolve infertility.

Kidney yin deficiency

Kidney yin deficiency causes infertility with early & decreased menses with emaciation & 5-palm heat:

Main Symptoms

Infertility, Early menses, Decreased menses, Emaciation, Dizziness, Blurred vision, Palpitation, Insomnia, Five palm heat, Low-grade fever in the afternoon

Cause of disease

  1. The deficiency of kidney yin allows yang Qi to be overactive.
  2. Increased yang Qi raises internal heat. This internal heat goes to Ren and Chong Mo.
  3. This internal heat disturbs Ren and Chong Mo and the sea of blood so that essence cannot gel and form into a fetus.
  4. Excessive sexual activity can consume essence and blood causing deficiency of kidney yin. This causes infertility.
  5. An inadequate prenatal endowment may also cause kidney yin deficiency and consequent infertility.

Treatment principles

  1. Nourish the kidney yin
  2. Produce blood
  3. Regulate Ren and Chong Mo
  4. Augment essence
  5. Resolve infertility

Stagnation of liver Qi

Stagnation of liver Qi may cause infertility with premenstrual breast distension, decreased and dark-colored menses containing clots or irregular menses:

Main Symptoms:

Infertility, Premenstrual breast distension, decreased and dark-colored menses containing clots, Irregular menses

Other symptoms:

Restlessness, Anger

Cause of disease

  1. Pent up emotion may cause stagnation of liver Qi.
  2. Liver Qi stagnation impairs liver function. This causes disharmony of Qi & Blood. Chong & Ren Mo cannot support each other. Essence cannot gel and form into a fetus. This causes infertility.

Treatment principles:

  1. Release stagnation
  2. Unblock the liver
  3. Regulate menses
  4. Resolve infertility

Accumulation of internal humid phlegm due to deficiency of spleen

Accumulation of internal humid phlegm due to deficiency of spleen causes infertility with delayed menses or amenorrhea, leucorrhea, and weight gain:

Main Symptoms:

Infertility, Delayed menses, Amenorrhea – copious and viscid vaginal discharge, Obesity, A pale complexion, Dizziness, Chest tightness, No appetite, Nausea

Cause of disease:

  1. Excess consumption of fatty and spicy foods causes humidity and Phlegm, which accumulate in the interior and obstructs Qi movement.
  2. Reduced Qi movement causes loss of control of Ren and Chong Mo.
  3. There is an overflow of fat in the uterine channels.
  4. It impairs the uterine function.
  5. The essence cannot gel and form into a fetus.
  6. Improper diet disturbs the spleen. The deficiency of spleen causes internal humidity and phlegm. This humidity and phlegm go downwards to the warmer and blocks the uterine channels. This also prevents essence from getting and forming into a fetus.

Treatment principles

  1. Dry humidity
  2. Resolve phlegm
  3. Mobilize Qi
  4. Regularize menses
  5. Resolve infertility

Stasis of blood in the uterus

Stasis of blood in the uterus causes infertility with delayed and decreased menses or dysmenorrhea, dark purple menstrual blood with clots:

Main Symptoms:

Infertility, Delayed menses with decreased menses, Dysmenorrhea, Menses is of dark purple color with clots, Abdominal pain

Cause of disease

  1. Body’s defensive Qi system is weakened by:
    • Excessive sexual activities
    • Exposure to cold and water during menses
    • Postpartum bleeding
  2. External pathogens attack the body more frequently.
  3. When the external pathogens intermix with blood, it causes stasis of blood.
  4. When the stasis of blood blocks the uterine channels, the essence cannot get and form a fetus. This causes infertility.

Treatment principles

  1. Mobilize blood
  2. Remove stasis
  3. Regulate menses
  4. Promote conception

 

Case Studies

Case 1 Female 32.

Background:

  • Terminated pregnancy
  • One IVF Failed

Western Diagnosis:

  • Primary Infertility
  • 12th-day Endometrium 3.5 mm.
  • Poor blood flow in Uterine Artery

Tongue Observation:

  • Pale Especially on sides
  • Quivering

Pulse Reading

  • Excess of Yin Wind
  • Deficiency of Damp and Cold Qi
  • Fullness of Kidney

Treatment Principle:

  • Subdue Wind
  • Promote Blood
  • Resolve infertility
  • Nourish the kidney essence

Treatment Protocol

Group1:

SP-3, Sp-6, K-3, K-7, ST-27, ST-36, REN-6, REN-12,

Ear: Shenmen, Uterus, Point 0

Group2:

Liv-8, Sp-6, K-3, BL-17, BL-18, BL-20, BL-23 Needling with reinforcing method.

Liv3, GB-20, DU-16, DU20

Needling with reducing method.

Group 3:

K-3, K-6, GB-39, REN-4, DU-4, DU-14, DU-20, BL-11, BL-15, BL-23

Needling with reinforcing method.

Result:

  • 12th day Endometrium 8.5 mm.
  • Good blood flow in Uterine Artery

Embryo Transfer completed successfully

PMA report

Qi

 

Case 2 Female 43.

Background: Six IVF Failed

Tongue Observation: Short, Red, No coating

Treatment Principle:

  • Nourish the kidney yin
  • Promote Blood
  • Resolve infertility
  • Nourish the kidney essence

Treatment Protocol

Group1:

Ear: Shenmen, Uterus, Point 0, Kidney.

K-3, K-6, K-9, K-10, SP-6, REN-1, REN-4, BL-23 Needling with reinforcing method.

Group 2:

K-3, K-6, GB-39, REN-4, DU-4, DU-14, DU-20, BL-11, BL-15, BL-23 Needling with reinforcing method.

Result:

  • Embryo Transfer completed successfully
  • Completed the full term.

 

Case 3 Female 37.

Background:

  • One IUI failed
  • One IVF failed

 Western Diagnosis:

  • Fallopian Tube Block

Tongue Observation:

  • Purple on sides
  • Slightly Swollen

Treatment Principle:

  • Remove Stagnation
  • Promote Blood
  • Resolve infertility

Treatment Protocol

Group1:

LIV-3, LIV-13, LIV-14, GB-34, TW-6, P-6, REN-6, SP-10, BL-17, BL-18

Needling with reducing method.

Ear: Shenmen, Uterus, Point 0, Liver, Spleen.

Group 2:

SP-3, SP-6, ST-36, REN-12, BL-20, BL-21

Needling with a reinforcing method.

Result:

  • Conceived normally.
  • Completed the full term.

Summary

Thus Acupuncture can

  • Help to increase blood flow to the uterus, which improves the chances of an ovum implanting on the uterine wall.
  • Reduce anxiety, stress, and the hormones that are secreted during stressful situations. (Such stressful situations can significantly decrease fertility).
  • Normalize hormone and endocrine systems that regulate ovulation, especially in women with the polycystic ovarian syndrome.
  • Positively affect the hypothalamic-pituitary-ovarian axis, which plays a key role in fertility
  • Regulate menstrual cycle
  • Relaxing the uterus and increasing blood flow allows for the successful implant of an embryo within the uterine lining.
  • Acupuncture and Chinese medicine can raise the fertility potential for women by affecting the quality, quantity, balance, and flow of Qi and blood.
– Dr. Shripad Chodankar

Leave a Reply

Your email address will not be published. Required fields are marked *