Fertility and Pregnancy

Fertility and pregnancy 

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 male and female infertility and explore and discuss pregnancy formulas.

Infertility and specialisation

As Traditional Chinese Medicine (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. It is unfair 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 naturally inclined towards more individuals to fall pregnant and, more importantly, have healthy pregnancies with live births.

Factors to impact fertility: 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

TCM pattern Western Diagnosis Manifestations Tongue Pulse Formula
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 Amenorrhoea Cold knees, weak legs, apathy, poor appetite Pale, swollen Deep, weak, wet Zhen Wu Tang
Liver blood deficiency Polycystic ovary syndrome Pale or transverse cracks on the sides Pale body, dry Choppy, fine Dang Gui Jian Zhong Tang
Liver blood stagnation Endometriosis Painful periods, dark and clotted blood, abdominal pain, and mass Purple body, spots Wiry 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 Normal Wiry 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 Fine 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:

TCM pattern Western Diagnosis Manifestations Tongue Pulse Formula
Deficient kidney essence Impotence Seminal plasma abnormalities Poor memory, loose teeth, hair loss, weakness of knees and legs, Sexual dysfunction Red, peeled Floating, empty, leathery Tian Xiong San  
Deficient kidney Qi Azoospermia (absence of sperm when ejaculating) Oligozoospermia (low number of sperm in the 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 Varicocele Painful or irregular abdominal pain “mass” in the abdomen Purple body, spots Wiry 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

TCM treatments 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. An entire chapter in the Jin Gui Yao Lue is dedicated to pregnancy problems (chapter 20). Those formulas worked for at least two millennia, and I would use their basic structure (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

 

Name 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.

 

References

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

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