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Fertility

Fertility Overview

In the United States, approximately 9 million people are currently having difficulty trying to conceive. There is a one in eight chance that either you or someone you know is affected by fertility problems.

For women under age 35, infertility is defined as the inability to conceive after one year of actively trying. For women age 35 and over, infertility is defined as the inability to conceive after six months of actively trying. Infertility also includes the inability to carry pregnancies to term (recurrent miscarriages).

Even when there are no diagnosed fertility issues, pregnancy does not always occur easily. For women under age 30 with no fertility problems, the chance of becoming pregnant in one cycle is 20-30% - on average, women in their 20s become pregnant every 3-4 cycles. For couples in their 30s without fertility problems, the average time it takes to become pregnant is 5-6 cycles. For women over 40 with no fertility problems, the chance of becoming pregnant in one cycle is approximately 5%. When fertility problems are added to this equation, months of trying to conceive can turn into years of frustration.

And women are not the only ones suffering from fertility issues - infertility is a couple’s issue. Recent research shows that 35-45% of all cases are due to female fertility problems, 15-35% are due to male fertility factors, 15-25% are a combination of male and female problems, and 10-20% of all cases are identified as unexplained.

How can Chinese Medicine Help with Fertility?

Traditional Chinese Medicine (TCM) has been used to treat fertility problems for over 3,000 years. TCM works to enhance fertility by restoring balance to the body and the internal systems responsible for regulating hormones. Researchers from Weill Cornell Medical Center in New York have concluded that acupuncture:

  • Increases blood flow to the uterus, thus thickening the uterine lining, which improves the chances of an ovum implanting on the uterine wall.
  • Reduces anxiety, stress, and hormones secreted during stressful situations - such as cortisol - which significantly decreases fertility (see section on Stress below).
  • Normalizes the systems that regulate ovulation, especially in women with Polycystic Ovarian Syndrome (PCOS).
  • Positively affects the hypothalamic-pituitary-ovarian axis, which plays a major role in fertility.
  • Regulates the menstrual cycles.

Several studies of Chinese herbal treatments to correct Luteal Phase Defect produced pregnancy rates from 33-56%, far greater than success rates achieved with Western medical treatments. In addition, studies show that acupuncture can improve the concentration, volume, and motility of sperm (see Male Fertility section below).

What Fertility Issues does Chinese Medicine Treat?

TCM can help with a wide range of fertility problems, including:

  • Advanced Maternal Age
  • Amenorrhea
  • Autoimmune conditions
  • Cervical mucus issues
  • Endocrine imbalances
  • Endometriosis
  • Elevated FSH
  • Fallopian tube blockage (mild to moderate)
  • Immunology factors
  • Luteal Phase Defect
  • Male factors
  • Menstrual irregularities
  • Ovarian cysts and Polycystic Ovarian Syndrome (PCOS)
  • Ovulation factors (including annovulation)
  • Pelvic Inflammatory Disease (PID)
  • Premature ovarian failure/poor ovarian reserve
  • Recurrent miscarriages
  • Stress
  • Thin uterine lining
  • Thyroid problems
  • Unexplained Infertility

How Does Stress Affect Fertility?

Our body's biochemical response to stress has a major effect on the reproductive system. Whether due to a major event or just the constant stressors of daily life, stress puts our body into "fight or flight" mode. This reaction to stress increases our levels of adrenaline, which inhibits our ability to use progesterone, one of the key hormones in reproduction. It increases levels of cortisol, which inhibits implantation of the fertilized egg. It also increases levels of prolactin, which inhibits fertility by decreasing or halting ovulation. Additionally, a hyper-stimulated nervous system sends blood away from the uterus and ovaries to the essential organs, thus lessening the overall function of our reproductive system.

In 2001, a study at the University of San Diego, California, examined the success rates of women undergoing Western fertility treatments. The study concluded the women with higher rates of stress were 93% less likely to become pregnant and achieve a live birth.

TCM is an effective way to reduce stress and rebalance the systems that stress affects. Acupuncture releases endorphins and serotonin, which have a calming effect on the body. These chemicals decrease the physical symptoms of stress by reducing heart rate, lowering blood pressure, and relaxing the muscles. Acupuncture also improves blood circulation throughout the body, which oxygenates tissues and cycles out cortisol and other damaging chemicals. Most importantly, acupuncture has been shown to rebalance the sympathetic nervous system and the endocrine system, thereby regulating the reproductive hormones that stress negatively affects.

When Should I Start Treatment?

When possible, its best to start treatment with TCM before you begin trying to conceive or undergo IUI or IVF. There are several reasons for this. One, studies show that it takes about 90 days to influence changes in a woman's menstrual cycle, such as improving ovulation and uterine lining, regulating hormones, regulating any problems with the actual cycle, and addressing situations such as PCOS or endometriosis. Two, it takes about 150 days for an egg to grow from a follicle in its resting state into a full-blown egg ready to be released (and follicles are selected from a pool of resting follicles almost a year before ovulation!).

However, most women don't find out about the benefits of TCM for fertility until they have already started trying to conceive or have started Western fertility treatments. In these cases, it's best to start treatment as soon as possible. It's never too late to start using TCM to improve your fertility.

How Long will I Need to Come for Treatments?

Because it takes 90-150 days to influence change in a woman's menstrual cycle, and because pregnancy does not normally occur in just one cycle of trying even under the best of circumstances (see Fertility Overview), the recommended course of treatment to achieve pregnancy is at least three to six months. This is a general time frame, however - some patients take less time to achieve pregnancy, and some take longer. Length of treatment and success varies for each individual and depends on the underlying fertility issue, among other factors. Success also depends on one's commitment to treatment - a patient who comes regularly for acupuncture, takes their herbs (if prescribed), follows the appropriate self-care measures at home, and makes diet and lifestyle changes will have a much better chance of becoming pregnant than a patient who does not take an active role in their treatment.

When you are trying to get pregnant, each passing month can seem like a wasted cycle, and three to six months or more can seem like a very long time. However, studies show that at least three months of preparation with TCM is optimal for a healthy pregnancy and baby. In TCM, no cycle is a "wasted" cycle. Each treatment strengthens your body and brings it closer to optimal reproductive health, a healthy pregnancy, and a healthy baby.

Do I Need to Take Herbs?

Herbal formulas are an important part of TCM fertility treatments. Herbs can help regulate the menstrual cycle and ovulation, thicken the uterine lining, regulate hormones, prevent certain types of miscarriage, and improve overall health. For these reasons, herbs are often recommended for fertility issues. However, some herbs may interfere with certain Western fertility medications and should be avoided. For this reason, herbal use is evaluated on a case-by-case basis. In addition, many Western fertility specialists do not want their patients taking any types of herbs during their medicated cycles. When this is the case, herbs are not prescribed, or are used only before Western medications are started.

How Does Chinese Medicine Work with IUI and IVF?

TCM is a wonderful and highly effective complement to your Western fertility treatments. Acupuncture reduces the stress associated with assisted reproductive technologies (ART), and therefore reduces the negative effects that stress has on the hormones related to reproduction. Acupuncture also strengthens and supports your body so that your Western fertility treatments are more effective. Most impressive are recent studies showing that acupuncture can significantly increase the success rates of ART. This is very important, as the success rates for ART are not generally high. For example, national data indicates that IVF works 33% of the time for women age 30 and under, 29% of the time for women in their mid-30s, and 5-15% of the time for women age 40. On average, women go through three to seven cycles of ART before they either conceive or stop trying. A women's response to ART depends on the state of her endocrine health in the months preceding ART, when follicles are developing in the ovary - this is why it is important to start your TCM treatments in advance of your Western treatments, if possible.

The most well known study of acupuncture and ART was a German study published in the April 2002 issue of Fertility and Sterility. This study showed that using acupuncture on the same day as IVF embryo transfer, both before and after the transfer, increased the success rate to 42.5% - the success rate for the group not receiving acupuncture was 26.3%. A more recent study conducted in Denmark in 2006 evaluated the effect of acupuncture on patients undergoing IVF with ICSI. Acupuncture was performed on the same day as embryo transfer, both before and after the transfer. The group receiving acupuncture had significantly higher conception and ongoing pregnancy rates, at 39%, than the group which did not receive acupuncture, whose success rate was 26%.

How Does Chinese Medicine Treat Male Fertility Issues?

Male factors account for approximately 40% of all fertility problems. One reason for this is that the average male sperm count has dropped significantly over the past few generations. For example, the average male sperm count dropped 45% between 1940 and 1990. Semen volume has also dropped, reducing the total number of sperm by 50%. The number of men with low sperm counts has tripled, while the number with high sperm counts has decreased. The reasons for declining sperm counts seems to be our increased exposure to environmental pollutants, increased use of recreational drugs and alcohol, and prescription medications, such as antibiotics. Studies show that although smokers generally have lower sperm counts and more abnormal sperm, once smoking is stopped sperm improve significantly within 6-12 months.

In a 2005 study published in Fertility and Sterility, acupuncture was shown to significantly improve several aspects of male fertility. The group that received acupuncture had a 50% improvement in sperm motility, while the group that did not receive acupuncture had only a 32% improvement. The number and percentage of healthy sperm also increased dramatically in the acupuncture group, increasing more than four-fold after 10 sessions of acupuncture. In addition, significant changes in sperm structure and quality were seen in the acupuncture group, with an increase from 22.5% normal shapes to 38.5% normal shapes.

Since new sperm generally take 72 days to form, treatment for male factors is usually recommended for a minimum of three months.

Is There Anything Else I can do to Improve my Fertility?

There are many things that you can do for yourself to improve your reproductive health. In fact, the more active role you take in improving your fertility, the better your chances are for achieving pregnancy. As part of your customized treatment plan, Dale will recommend dietary and lifestyle changes that can have a significant impact on your fertility. If appropriate, she will also teach you self-care measures, such as moxabustion, abdominal massage, and breathing techniques. Making the recommended diet and lifestyle changes and doing these self-care measures at home will compliment your TCM treatments and help bring your body back to optimal reproductive health.

Should I continue Treatment if I get Pregnant?

Fertility means more than achieving pregnancy - once pregnant, your body needs to be able to nurture and support a pregnancy for nine months. Acupuncture has been shown to increase the rate of ongoing pregnancies, especially for those undergoing ART. In addition, well-pregnancy care can help with the common complaints of pregnancy and ensure an easier labor and delivery.

Written by Cindi Ignatovsky, L.Ac. at www.healthinharmonytcm.com


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