Treating Infertility through the Cycle with
Acupuncture and Chinese Medicine

There are a number of possible explanations as to why couples may experience difficulty conceiving. Traditional Chinese medicine including acupuncture can safely be used as a stand alone or integrative approach to infertility treatment, prior and also during pregnancy for miscarriage prevention and continued care. It is a non-invasive, natural and drug free treatment option with minimal side effects having the ability to take into consideration each individual’s signs and symptoms for a detailed differential diagnosis and pattern identification, enhancing fertility to treat both medically explained and unexplained infertility.

Traditional Chinese medicine fertility enhancement involves both partners, along with supporting or correcting the four phases of the woman’s monthly cycle.

As a health professional with a commitment to continued education development, regular consultation with leading fertility specialists and has years of clinical experience backed with a Bachelor of Applied Science (Traditional Chinese Medicine) from Western Sydney University; Australia and a Clinical Internship from Jiangsu Provincial Hospital Nanjing; China, Kaitlin is able to make parallels between identical processes viewed from different medical perspectives, utilizing the strengths that both Traditional Chinese Medicine and the western medical model has to offer.

The aim of fertility treatment is to substantially increase the likelihood of pregnancy and the intended outcome is pregnancy.

 

Menstrual Phase
The focus of treatment during the menstrual phase, is to clear any stagnation and prepare the endometrial lining. A healthy growth of new and productive endometrial lining in the following stage, relies on a smooth clean base.

Pooling of blood inside the uterus known as clotting, can sometimes be retained, whilst some or all is slowly expelled during menstrual bleeding. Blood stagnation impedes the quality, movement of qi and blood, and growth in the next stage. It’s clearance, is facilitated with acupuncture and Chinese medicine to ‘flush’ and set the uterus up for the regenerative process. Flushing encourages a complete discharge of the endometrium, even if there are no overt symptoms of blood stasis. It is of particular importance if there are signs of stagnation such as clotting, cramping or irregular bleeding. Chinese herbs used at this stage work to break up stagnation, reinforce the ability of the qi to expel the blood effectively and to support the production of blood after the loss during menstruation.

 

Follicular Phase
New follicles containing eggs, begin their growth on day one of the menstrual cycle. This is the commencement of the follicular phase, which ends at ovulation. Clinically however, support for this phase begins after the major menstrual blood flow is over, usually around day four.

Approximately two days following the onset of menstruation, the regeneration of the endometrium (or uterine lining) commences, even though menstrual bleeding still continues. This process involves tissue repair of the uterus where the lining has shed, along with the development of estrogen and progesterone receptors in the new tissue.

Estrogen is the dominant hormone during this phase. It is responsible for commanding the cervix to produce cervical fluid and, as the levels of estrogen in the body gradually rise, proliferation of the endometrium and its dense vascular network is stimulated.

Important endocrine glands in the brain called the hypothalamus and pituitary are responsible for influencing hormones that regulate the fertility process during the follicular phase. Together they interact, stimulating the pituitary to release FSH (follicle stimulating hormone) which, initiates the maturation process of ovarian follicles. One follicle will grow to become dominant and release its egg at ovulation. The hypothalamus responds to acupuncture signals transmitted from the distant sensory receptors (targeting with needles) via peripheral nerves and body fluid to enhance this process.

Your Chinese medicine practitioner will pay particular attention to this phase because it is the regulation of these hormones, which drive your menstrual cycle and are responsible for conceiving and retaining a developing fetus. It is the ‘setting up’ of a healthy endometrium, which provides the fundamental building blocks of a favorable environment for an embryo to implant and thrive later on. Your chance of conception is directly impacted by the production and communication among the elements of your hypothalamus/ pituitary/ adrenal axis (endocrine system).

Life during the fertility process of trying to conceive can be stressful and emotional taxing when month after month a couple is unable to conceive. Commonly the stress build up results in heat from stagnation, disturbing the steady building of yin and blood. This is often reflected in upward spikes in the body basal temperature. The stress hormone ‘cortisol’ is excreted via the adrenal gland – a part of the hypothalamus pituitary/ adrenal axis, which is just another important reason acupuncture has such a commanding influence on the success rate of positive fertility outcomes, as it significantly reduces stress levels.

Yin and/or blood deficiency is supported during this time in particular. A healthy state and strong building of yin during this phase, is again achieved by manipulating the release of the hormone estrogen and can be reflected in the amount and quality of cervical mucus. Cervical mucus is a key ingredient to aid conception and it’s monitoring will also give a general indication of good egg quality. If there is inadequate or a deficiency of yin and blood during this time, fertility will be affected manifesting with poor follicular development, thin endometrial lining or decreased cervical mucus.

Another concern is ‘Heat’ in the Chinese medicine diagnostic sense. Heat can damage yin levels by entering the blood, causing it to move recklessly at ovulation or menstruation. A measure of this invasion is reflected via temperature recording on a body basal temperature chart. Heat can cause follicles to grow too quickly resulting in poor egg quality, and may cause early ovulation and the shortening of the entire menstrual cycle.

The use of yin and blood tonic herbal formulas is particularly effective to correct this. Significant improvement shows with long or short follicular phases, cervical mucus production, menstrual blood quantity and quality improvement, and basal body temperature charts become more even. Correspondingly, ultrasounds and tests often show improvement in follicle and endometrial lining development.

 

Ovulatory Phase
When the main developing follicle becomes large enough and estrogen reaches a certain level, ovulation will occur.

Just prior to ovulation, the pituitary and hypothalamus governs the production and release of LH (luteinising hormone). This results in a ‘LH surge’ occurring approximately twenty-four hours prior to ovulation, and is indicative of the quick change from yin dominance in the follicular phase, to yang dominance in the luteal phase. It is this surge, which is often detected by an ovulation predictor kit. Temperatures will then stay relatively high throughout the second half of the cycle.

Ovulation itself depends on the yin and blood being at their fullest, to ensure a complete transformation of full yin to yang. An abundance of clear, watery, slippery, stretchy ovulatory cervical mucus secretions corresponds to yin being at it’s fullest and follicle growth is at its peak.

As the cycle changes to yang, activity and movement are expressed as the dominant egg bursts forth from the follicle. This process of ovulation is dependent on the strength and fullness of yin, the ability to mobilize yang, and the movement of qi and blood to facilitate transition.

When ovulation is early, delayed or even sporadic, specific treatment strategies during this stage are applied. Body basal chart recordings that reflect irregular biphasic patterns, long cycles or amenorrhea as common examples, may additionally require specific Chinese herbal medicine to address the particular problem.

Protecting the heart (and liver) is not only important during the trying to conceive process, but during this phase in particular. In Chinese medicine the heart is especially susceptible to emotional stimuli, which attacks the heart before moving onto associated organs. It looks after our mind (the Shen) and mental activity. More so, it is involved in ovulation through the bai mao channel pathway, which connects the heart and the uterus. The action of heart qi and blood, descend to the reproductive organs. The heart is placed under pressure, inadequate nourishment (to) occurs and facilitated movement is obstructed. The health of the Heart and Liver are of key importance, for the activity and vitality of transitions affecting the Uterus.

Ovulation and the shift to the luteal phase of the cycle can be affected by stagnation of qi, blood and/or phlegm. Pain at ovulation or inability to ovulate in a timely manner, may be an indication of problems with this transitional movement.

Chinese herbal medicine support during this mid-cycle phase works to invigorate the blood, encourage movement and removes stasis, while promoting a healthy yin foundation and the ability for yang to mobilize at ovulation. Problems with a slow to release egg from the ovary can be readily treated with acupuncture if this is occurring on a regular basis, along with herbs that specifically facilitate the release of the egg.

 

Luteal Phase
After the egg is released at ovulation, the sperm and egg travel to meet in the fallopian tubes, where a successful sperm will penetrate and fertilize the egg.

After ovulation occurs, an egg can be fertilized at it meets with the sperm in the fallopian tube within approximately twelve hours of its release (or ovulation). It continues to move to the uterus, to implant in the endometrial lining. Chinese medicine assists here to boost yang and support movement and activity for this action.

The corpus luteum is a term applied to the temporary endocrine gland, which develops in the ruptured ovarian follicle after maturation and discharge from the ovum.
The gland secretes progesterone, keeping the endometrium rich in hormones and nutrients, and maintaining a healthy environment for implantation. By recording body basal temperature during the luteal phase, presence of the key hormone progesterone is evident with higher temperature results.

The luteal phase is dominated by qi and yang, but is also dependent on a good foundation of yin and blood. In order for implantation to occur, the uterine lining must be healthy and receptive. The endometrium must be thick, moist, and rich in blood and nutrients, a very yin environment in which the fertilized egg burrows until it is completely buried by the end of the cycle.

Deficiencies arising during the luteal phase can manifest as many symptoms, most common are progesterone insufficiency, problems with implantation and the tendency to miscarriage. Consideration as a secondary treatment principal is the removal of symptomatic pre-menstrual stagnation, as a mutli-facet approach to removing any compounding infertility complications.

Chinese herbal medicine supports this phase beginning with herbs that promote progesterone production and synthesis by tonifying the yang and qi, whilst including herbs to support the yin and/or blood as well.

The inclusion of yin tonic herbs when treating the yang is common practice in Chinese medicine gynecology. Yin herbs are incorporated to support the foundation or root of the yang, and also to protect the yin from the warming nature of yang tonics.

During infertility treatment as discussed above, ideally the yin and blood were already well nourished in the follicular phase, and cleared of stasis in the menstrual phase. It is appropriate to continue this support of yin and blood during the luteal phase. Formulas can additionally be modified at this stage to move any Liver qi stagnation and calm the Shen.

 

References:

Righarts A., Dickson NP., Parkin L., Gillett W (2017). Australian and New Zealand Journal of Obstetrics and Gynaecology. Ovulation monitoring and fertility knowledge: Their relationship to fertility experience in a cross-sectional study. http://onlinelibrary.wiley.com/doi/10.1111/ajo.12606/full

Emily Evans-Hoeker, M.D.,^a David A. Pritchard, M.S.,^b D. Leann Long, M.S.,^b Amy H. Herring, Sc.D.,^b,c Joseph B. Stanford, M.D., M.S.P.H.,^a,c,d and Anne Z. Steiner, M.D., M.P.H.^a
Cervical Mucus monitoring prevalence and associated fecundability in woman trying to conceive. Fertil Steril. 2013 Oct; 100(4): 1033–1038.e1.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3787999/

Stener-Victorin E et al. Ovarian blood flow responses to electro-acupuncture stimulation at different frequencies and intensities in anesthetized rats.
Autonomic Neuroscience 2003, Vol 108, Issues 1-2, Pg 50-55 Autonomic Neuroscience.
https://www.ncbi.nlm.nih.gov/pubmed/14614964

Cochrane S., Smith C A., Possamai-Indesedy A., & Bensoussan  A.
Acupuncture and women’s health: an overview of the role of acupuncture and its clinical management in women’s reproductive health. Int J Womens Health. 2014; 6: 313–325.
Published online 2014 Mar 17. doi:  10.2147/IJWH.S38969

Lynch CD., Sundaram R., Maisog JM., Sweeney AM., Buck Louis GM (2014). Preconception stress increases the risk of infertility. Hum. Reprod; 29 (5): 1067-75.https://www.ncbi.nlm.nih.gov/pubmed/24664130

Zhou J., & Qu F. (2009). AfrJ TraditComplement Altern Med. 2009: 6(4): 494-517.
Treating Gynaecological Disorders with Traditional Chinese Medicine: A Review.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2816470/  

Wang S., ZhangJ.,Yang H.,Wang F.,& Li S(2015). Acupoint specificity on acupuncture regulation of hypothalamic- pituitary-adrenal cortex axis function. BMC Complementary and Alternative Medicine. https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/s12906-015-0625-4