The definition of Fertility and Infertility
Subfertility and infertility rates are high and according to the WHO, infertility affects millions of individuals and couples. It is estimated that approximately one in every six people of reproductive age experience infertility at some stage in their lifetime. Infertility is defined as 12 months of unprotected sex without falling pregnant. There is primary (when there never was a pregnancy) and secondary infertility (when there was at least one pregnancy). The types of reproduction system “defects” can be related to either sperm, the ovaries, the fallopian tubes, the uterus, or the endocrine system. Many factors can affect pregnancy rates. Whenever our patients are falling pregnant, especially, if they sincerely want a child, caring for them during their time of being pregnant is very important. In this article, we want to look at some herbal formulas to target infertility both male and female and explore pregnancy formulas.
Infertility and specialisation
As TCM practitioners, we feel inclined to help patients with both, subfertility issues and pregnancy-related complaints. TCM also offers one of the gentlest treatments in this situation with low rates of “side effects”. Perhaps this is one of the reasons for the high number of TCM “experts” in this area. However, not every woman wanting to fall pregnant can be helped, unfortunately, and so in my clinic, the first step is always assessing the risks and benefits of helping sub-fertile couples. I don’t think, it’s fair to create unrealistic expectations for our patients (and ourselves). As a Jing Fang practitioner, I usually don’t “specialise” in a particular area but I focus on balancing Yin and Yang. As a woman, I feel strongly inclined to want more individuals to fall pregnant and more importantly, have healthy pregnancies with live births.
PCOS, endometriosis and period pain (dysmenorrhea)
Looking back at some of my patients in this area, the tendency is to assist if there is Polycystic Ovary Syndrome (PCOS), endometriosis or primary/secondary dysmenorrhea, low sperm count or simply unexplained reasons for the lack of conception. I use formulas exclusively from the Shang Han Lun and the Jin Gui Yao Lue. I tend to assist women with acupuncture if they are undergoing ART (Assisted Reproductive Technologies) as their “fertility specialists” often don’t want them to have anything other than the drugs they prescribe, at least in Australia.
The following table is from Xu et al. (Application of traditional Chinese medicine in the treatment of infertility, 2003) which I have extended to match with a classical formula structure suggestion to address female infertility patterns:
Formulas for different patterns of female infertility
|Kidney Yin deficiency
|Anovulation Immunological infertility Luteal phase defect
|Malar flush, sweats, insomnia, dry throat, low grade fever
|Red, peeled, cracked
|Floating, empty, rapid
|Shen Qi Wan
|Kidney Yang deficiency
|Cold knees, weak legs, apathy, poor appetite
|Deep, weak, wet
|Zhen Wu Tang
|Liver blood deficiency
|Polycystic ovary syndrome
|Pale or transverse cracks on the sides
|Pale body, dry
|Dang Gui Jian Zhong Tang
|Liver blood stagnation
|Painful periods, dark and clotted blood, abdominal pain, and mass
|Purple body, spots
|Gui Zhi Fu Ling Wan Wen Jing Tang
|Damp-heat in the liver
|Genital infection Tubal factor infertility
|Fever, jaundice, bitter taste, nausea, vomiting, abdominal distension, vaginal discharge
|Red body, sticky yellow coat
|Slippery, wiry, rapid
|Huang Qin Tang
|Liver Qi stagnation
|Premenstrual syndrome (PMS)
|Depression, sighing, mood swings, painful periods, distension of the breasts
|Si Ni San Xiao Chai Hu Tang
|Cold stagnation of the liver channel
|Sexual arousal disorder
|Fullness and distension of the bladder
|Pale, wet, white coat
|Wiry, deep, slow
|Wu Zhu Yu Tang
|Deficient spleen Qi
|Dysfunctional uterine bleeding Uterine fibroids
|No appetite, tiredness, lassitude, blood in the urine, excessive menstrual flow
|Pale or transverse cracks on sides
|Huang Qi Jian Zhong Tang Li Zhong Wan
Formulas for different patterns of male infertility
The following table is from Xu et al. (2003) which I have extended to match with a classical formula structure suggestion to address male infertility:
|Deficient kidney essence
|Impotence Seminal plasma abnormalities
|Poor memory, loose teeth, hair loss, weakness of knees and legs Sexual dysfunction
|Floating, empty, leathery
|Tian Xiong San
|Deficient kidney Qi
|Azoospermia (absence of sperm when ejaculating) Oligozoospermia (low number of sperm in ejaculate) Asthenozoospermia (reduced sperm motility) Teratozoospermia (abnormal morphology of sperm)
|Soreness and weakness of the lumbar region, urinary incontinence, enuresis, nocturnal urination
|Pale, white coat
|Weak or thready
|Zhen Wu Tang Shen Qi Wan
|Liver blood stagnation
|Painful or irregular abdominal pain “mass” in the abdomen
|Purple body, spots
|Fu Ling Gan Cao Tang Gui Zhi Fu Ling Wan Dang Gui Si Ni Tang
|Damp-heat pouring downward
|Male accessory gland infection Immunological infertility
|Swelling and cramps in the perineum and lower abdomen, thirst, bitter taste in the mouth
|Azoospermia (absence of sperm when ejaculating) Oligozoospermia (low number of sperm in the ejaculate) Asthenozoospermia (reduced sperm motility) Teratozoospermia (abnormal morphology of sperm)
|String-like and slippery
|Huang Qin Tang
Treatment in pregnancy
I assist many women in pregnancy too. Generally, I see them once a month if their pregnancy is going well and I will treat them with acupuncture. However, if problems arise, I will also prescribe herbs. At first, I did not have the confidence to treat pregnant women with herbs, but I now prescribe herbs with high confidence. There is an entire chapter in the Jin Gui Yao Lue dedicated to problems during pregnancy (chapter 20). Those formulas worked for at least two millennia and I would use the basic structure of them (not all herbs are always available) and tailor them to the individual. I also advise women to have regular weekly acupuncture sessions starting from week 36 or 37 in preparation for labour.
Common Jin Gui Yao Lue formulas for pregnancy
|Chapter, line, and reference
|Bai Zhu San
|JG 20.10: For nourishing the foetus during pregnancy, Bai Zhu San governs. For toxic pain under the heart, augment Chuan Xiong to double.
|Dang Gui Bei Mu Ku Shen Wan
|JG 20.7: For difficult urination during pregnancy, with normal food and water intake, Dang Gui Ku Shen Wan governs.
|Dang Gui San
|JG 20.9: For pregnant women, it is indicated to often take Dang Gui San.
|Dang Gui Shao Yao San
|JG 22.17: For all types of abdominal pains in women, Dang Gui Shao Yao San governs. JG 20.5: For pregnant women, with twisting dull aches in the abdomen, Dang Gui Shao Yao San governs.
|Gui Zhi Fu Ling Wan
|JG 20.2: For women who have pre-existing mass disease, and the interruption of the period has not yet reached three months, after which there is incessant leakage, with foetal movement above the umbilicus, then it is damage to consolidated mass. When in pregnancy there is stirring at six months, and the three months prior to the pregnancy was uninhibited, then this is the foetus. If there is bleeding. If there is bleeding after the menses had stopped for three months it is due to bad blood. The reason why the bleeding does not stop is because the mass is not expelling. One should purge the masses, and Gui Zhi Fu Ling Wan governs.
Even when there is unexplained sub-fertility, there isn’t always success in helping these women become pregnant. It’s heartbreaking that especially in cases, where everything seems perfect, conception does not occur. It’s hard for us practitioners to admit that our treatments in that respect were not successful. It is difficult for women wanting to start a family or have another baby, not to be able to fulfil their wish. Things sometimes do not happen the way we would like or expect them. It’s wholesome to have that view on life in general.
Xu X, Yin H, Tang D, Zhang L, Gosden RG. Application of traditional Chinese medicine in the treatment of infertility. Human Fertility 2003; 6(4): 161-8.
Wiseman N, Willms S, Ye F. Jin Gui Yao Lue-essential prescriptions of the golden coffer. Summer: Paradigm Publications 2009