Chinese Herbal Treatments For Female InfertilityAdina Stanescu, R.TCMP April 1, 2012
Fertility support has become an important area of medical practice, as people in modern societies increasingly delay childbearing into their 30s and 40s, only to find it can be much more difficult to conceive at this age.
Over the last few years, several studies have shown acupuncture to be of benefit, especially when administered in conjunction with In Vitro Fertilization (IVF), and most patients and their conventional medical doctors are willing to include acupuncture in their fertility protocols. But what about the Chinese herbal treatment of infertility?
A recent study review published in the journal Complementary Therapies in Medicine* reached this conclusion: “Our review suggests that management of female infertility with Chinese Herbal Medicine can improve pregnancy rates two-fold within a four-month period compared with Western Medical fertility drug therapy or IVF. Assessment of the quality of the menstrual cycle, integral to Traditional Chinese Medicine (TCM) diagnosis, appears to be fundamental to successful treatment of female infertility.”
While acupuncture is quite effective at improving circulation of blood and energy to the uterus and ovaries, relieving stress, and optimizing the use of the resources that the body already possesses, it is less effective at supplementing the blood or vital essences. As we age, certain essential substances begin to decline, and this is responsible for the lessened fertility: blood quality and luxuriance, once abundant in our youth, lessens, making the period lighter; the “yin” fluids can decrease, causing dryness of skin, the hair or vagina; the vital essence, called “jing”, which is reflected in the amount of viable eggs (ovarian reserve) and the sperm count, starts to wane; the digestive system, which is responsible for nutrient assimilation and nourishment, weakens; the liver, which is responsible for breaking down excess hormones at the right time in the body, becomes sluggish, leading to hormonal imbalance or early perimenopause.
Over time, herbs can replenish and regulate all of these vital elements which, in turn, are the building blocks of the most important pre-requisite of good fertility: optimization of the menstrual cycle. Fu Qing Zhu, a TCM gynecology master from the Qing dynasty said: “when treating infertility, first regulate menstruation.” And this is where the herbal treatment of infertility begins.
The Ideal Cycle
To understand this, let’s paint a picture of the ideal menstrual cycle – 28 days between the start of periods; ovulation around day 14, without bleeding, breast pain or abdominal discomfort; period lasts four to six days, where the blood flow is abundant for at least three days, but not excessively heavy; absence of clots; absence of premenstrual symptoms, including acne breakouts. If a menstrual cycle presents in this way, it usually means that hormonal levels are balanced through the different phases of the cycle, the vital substances are plentiful, the uterus is unobstructed, and the body can support egg ripening, conception, implantation, and a full-term pregnancy.
A wonderful way to assess the cycle, as well as the progress of treatment, is with the aid of the Basal Body Temperature (BBT) chart. This simple, non-invasive method gives us a window through which to monitor how treatment is progressing, because the body’s resting metabolic temperature, taken first thing upon waking, will reflect the hormonal fluctuations of the cycle. Modern TCM doctors working with fertility have begun adding this useful tool to the traditional diagnosis of tongue and pulse reading and symptom assessment.
Once again, let’s take the “ideal” cycle as our goal, and see what it should look like on a BBT chart. The first image on the slideshow above shows the two-phase temperature curve of a healthy cycle: lower temperature during phase one, when the eggs are ripening, spiking at least 0.5 degrees Celsius at days 13-14 to support ovulation, and remaining high for phase two.
In phase two, the uterine lining continues to grow in order to host a possible pregnancy, and the temperature must remain steadily high in order to prevent miscarriage – akin to keeping the correct temperature in the oven. If pregnancy does not occur, the uterine lining sheds again during menstruation, the temperature drops and a new cycle begins anew. These two phases of the cycle can be considered in TCM terms as the yin phase (egg ripening) and yang phase (fertilization and implantation.) Regulating the cycle, so that it shows a clear two-phase pattern, is a priority of the herbal treatment.
The first phase of the cycle is called the follicular phase. It begins on day 1 of the period and lasts until day 14 of the cycle. It takes its name from the ovarian follicles that begins to grow and develop during this time. Ovarian follicles are little sacs that hold the woman’s eggs, and they are prompted into growth by a hormone called Follicle Stimulating Hormone (FSH), released by the pituitary gland. A woman is born with all the eggs she will ever have, which lie dormant until prompted to develop and mature during this phase of the cycle.
This is when the woman’s blood and yin energy need to nourish the growing follicles. When this phase of the cycle is problematic, the follicular phase becomes too short, and ovulation happens several days too early, as early as day 9 or even earlier, instead of day 14, as in the chart on this page shows. From a TCM perspective, this shows that there may not be enough richness to the blood or vital essence (jing) to support this follicular growth for long enough and to properly ripen the egg. This can be due to older age, long-term dietary deficiencies, or constitutional weakness. Additional symptoms of blood and yin deficiency may also be present, such as a pale or dry tongue, dry skin, scanty menstrual flow and dizziness.
Herbs used during this phase of the cycle include Angelica sinensis, Paeonia alba, Rehmannia glutinosa and the now-famous Goji berries. If symptoms of perimenopause threaten to appear, such as sweating or feeling hot at night, we add herbs such as Moutan bark and Anemarrhena root. After several cycles, we should see a lengthening of the follicular phase once again on the BBT chart (the seond image on the above slideshow). As well, the FSH count should fall back down to normal, having risen too high as the pituitary gland desperately tries to stimulate follicular development more and more to compensate for the sluggish response from the body.
At mid-cycle, around day 14, the yin begins its transformation into yang, reflected in the clear spike in temperature that should be seen on the BBT chart. The now mature follicle ruptures and releases the egg into the abdominal cavity, where it then travels into the Fallopian tube and further down into the uterus to await possible union with the sperm. The ovulatory phase is an important time for herbal therapy and acupuncture, and once again the woman’s symptoms and BBT chart offer us clues on how to proceed. If ovulation is accompanied by painful breasts or abdominal cramping, combined with changes in mood and a wiry, tense pulse, it means the liver is congested and is not breaking down the excess estrogen circulating in the body from the follicular phase. The BBT chart will show a too-slow rise to the higher temperature, occurring in small steps over several days instead of one, as the body struggles with the hormonal transformation.
We may use herbs that restore the smooth flow of energy to the pelvis and support the liver, such as Leonurus, Cyperus rhizome and Citrus viride. This will ensure that excess estrogen is broken down by the liver and that progesterone can take over as the dominant hormone for phase two, the luteal phase. We may also add a herbal combination known as the Two Immortals, which includes Epimedium and Curculiginis, two very important herbs for promoting ovulation and sparking the yang in order to push the temperature up decisively.
The luteal phase begins at ovulation and should last 14 days, until the end of the cycle. Progesterone is the dominant hormone of phase two of the cycle, and is responsible for maintaining a steadily high temperature during this phase, making the uterine lining receptive to implantation of the embryo, and preventing miscarriage once pregnancy occurs.
In infertility or recurrent miscarriage, the temperature is not able to spike quite high enough, nor remain high consistently, often showing a see-saw pattern where it continues to dip downward as in the third chart in the above slideshow demonstrates.
In TCM, this temperature pattern often correlates with a deficiency of yang, the life-giving “fire” aspect of the body. The tongue may be pale, puffy, with teethmarks and a wet coating. The woman may feel cold and have frequent urination. The herbal prescription will now include yang tonic herbs, which supplement this deficiency, or warm the uterus directly if the cold symptoms are pronounced. Such herbs include Dipsacus root, Cuscuta seed and Mugwort leaf. Incidentally, all three herbs also prevent miscarriage, and can safely be continued, and indeed are indicated, once conception takes place.
Additionally, continued treatment is directed at the liver if symptoms of Premenstrual Syndrome are a regular feature of the woman’s cycle, as this too indicates ongoing hormonal imbalance and obstruction of blood and energy to the uterus. One of the most important maxims of TCM is that where there is free flow, illness cannot arise.
As described above, an ideal period is mostly pain-free, with no clots, and flow that is neither too heavy nor too light. Clotted flow is very common, and many women think it is normal, but in fact it shows congealing of blood and poor blood flow to the uterus, either because of excess cold, exess heat, phlegm and mucus, or long- term stagnation of energy from stress and emotional frustration. Eliminating these clots is always a priority in the TCM treatment of infertility, or indeed for the treatment of any gynecological disorder. Blood-moving herbs such as Carthamus flower, Ligusticum rhizome, or Persica seed are used to break this stagnant accumulation and guide it out with the period. Initially this may result in more clots, but over the next few cycles it is gratifying to see that fresh red blood now flows smoothly and without pain.
Other Causes of Infertility
Fallopian tube blockage, endometriosis, and uterine fibroids are other examples of obstructive blockage of the reproductive organs which can interfere with all stages of conception and pregnancy. Their presence will call for a longer treatment time, as herbs will steadily work to chip away at the causative factors, generally a combination of dampness, phlegm and blood obstruction.
Working With ART
Many fertility patients will wish to pursue Assisted Reproductive Technologies (ART) alongside herbs and acupuncture to enhance their chances for success. Doctors are often reticent to have women taking herbs, but this fear has no basis, as herbs can only make their jobs easier by regulating and stabilizing the cycle. Modern medicine is often powerless to permanently treat hormonal and menstrual cycle imbalances. It can do so over the short term by giving hormone supplements, but this artificial manipulation of the cycle only yields results as long as the patient is on the drugs. In contrast, once herbal therapy has succeeded in normalizing the cycle, it will stay that way after the herbs are discontinued, and this will yield dividends over the long term. Additionally herbs can offset some of the side effects inherent in the fertility therapies of modern medicine.
Everyone has heard of women who finally conceived and carried to term once they lost all hope of ever being pregnant, and gave up trying. This reflects an unfortunate conundrum: the stress and tension engendered by months and years of trying and dashed hopes may become another factor causing the infertility. It is a physiological fact that when intense anxiety triggers the fight or flight response, the reproductive function all but shuts down as the body directs all resources to immediate survival.
Stress management thus becomes imperative during the fertility journey. One must find a balance between seeking a solution and running oneself ragged, physically and emotionally. Time must be set aside for doing nothing, resting, laughing, and engaging in pleasant activities that have nothing to do with “the goal.” This might even mean forsaking a mad dash to exercise class or the organic grocer in favour of utterly wasting time in front of the TV and some gentle stretching on the floor.
Reid K. Stuart. K. “Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: a systematic review” Complementary Therapies in Medicine 2011 Dec;19(6):319-31