Female infertility and its treatment
Female infertility accounts for approximately 65% of cases of inability to conceive.
Many women have menstrual disorders that can make natural fertility difficult. At the Natural Fertility Clinic we use both acupuncture and Chinese Herbal medicine to treat menstrual disorders. Successful treatment of the primary disorder can then lead to conception and pregnancy.
The following conditions commonly interfere with natural fertility:
- Ovulatory dysfunction and polycystic ovaries
- Tubal dysfunction
- Unexplained or Functional infertility
(1) Ovulatory dysfunction & polycystic ovaries
Ovulatory dysfunction occurs frequently in women with polycystic ovaries [PCO], commonly manifesting as irregular menstrual bleeding (oligomenorrhea) or no bleeding at all (amenorrhea). A woman may not ovulate very well with poor progesterone output from the ovaries (luteal phase defect), leading to a delay in endometrial development. Irregular or no ovulation or weak hormone output from the ovaries will impair natural fertility.
Biomedical treatment of ovulatory dysfunction depends on the underlying reason but is commonly treated with clomiphene citrate to stimulate ovulation. In luteal insufficiency, the luteal phase is supported with a progesterone suppository. Side effects of clomiphene citrate include flushes (10%), abdominal distension (6%), breast tenderness (2%), nausea (3%), visual symptoms (1-2%) and headaches (1-2%). Women with complete ovulation failure can, with the correct treatment, expect a virtually normal chance of conceiving. Women with oligomenorrhea have a less good chance of conceiving because of the underlying pathologies of PCO.
Chinese medicine can be equally effective in treating ovulatory dysfunction as biomedicine. Extensive studies around the world show that:
- Chinese herbal medicine restores ovarian function effectively and promptly. It offers a valuable option for treating infertility in patients with premature ovarian failure and/or raised FSH and LH levels, as well as treating patients with polycystic ovarian syndrome. Many studies demonstrate that the correct application of herbs can restore a regular cycle with a good biphasic basal body temperature and an efficient luteal phase.
- Acupuncture can be equally effective as clomiphene citrate in the treatment of ovulatory dysfunction without causing any side effects. Studies suggest that acupuncture adjusts FSH and LH and normalize oestrogen and progesterone levels, thus regulating ovulation.
At the Natural Fertility Clinic we ask our female patients to monitor their ovulation by recording their basal body temperature (BBT). An increase of the basal body temperature of about 0.4-0.5Ëš suggests impending ovulation; a maintained higher temperature characterises the post-ovulatory period. The BBT chart helps us to understand the activity of the hormones that regulate the female cycle, and also guide our selection of acupuncture points and herbs. Improvement of the BBT curve during treatment is a way of monitoring treatment.
(2) Tubal dysfunction
The fallopian tubes play an essential role in fertility. They catch the egg as it is released by the ovary, then hold and nourish it whilst it fuses with the sperm. The embryo is then transported along the tube within 2-3 days, until the raised progesterone prepared a thick uterine lining for the embryo to implant into.
The fallopian tubes can become physically damaged by certain disorders or can simply loose its functional integrity, impairing natural fertility.
- Physical defects of the fallopian tubes may be associated with a history of pelvic inflammatory disease, endometriosis, use of intrauterine device, ruptured appendix, with lower abdominal surgery, or an ectopic pregnancy. Scarring occurs along the inner walls of the tubes, disrupting the natural function of the cells lining the tubes, or obstructing the passage completely.
- Functional defects of the tubes may be due to either muscle tension of the tubes or due to mucus accumulation. Progesterone should clear the secretions within the tube and should also relax its muscles to allow easy passage of the pre-embryo into the uterus.
If the tubes are not damaged too much along their length, microsurgery is a good treatment option, especially if combined with Chinese herbal medicine. A study in China examining best treatments for damaged and obstructed tubes found that combining Chinese medicine to surgical procedures enhances the clinical outcome and thus the chances of pregnancy. If there is extensive damage to the tubes, IVF becomes the only option.
Chinese medicine alone works best in functional disorders of the tube:
- Spasms and tension in the tubes can cause a functional blockage. A functional blockage can prevent the sperm reaching the egg or stop the fertilised egg reaching the uterus at the right time.
- Excessive secretions can block the tubes. Secretions are designed to lubricate the tube and nourish egg and embryo. In a pathological situation, fluids are either over-produced or cannot drain efficiently due to an obstruction of the tube itself or due to a deficient rise of progesterone.
The treatment with Chinese medicine may incorporate acupuncture treatment on the lower abdomen to relax the fallopian tubes, and/ or an herbal prescription to clear away any excessive fluid, or to raise the body's own progesterone levels.
Endometriosis is a common menstrual disorder manifesting with a wide range of symptoms such as painful periods, spotting before periods, pain during intercourse, and infertility. The disease is defined by the presence of endometrial (uterine) tissue outside the uterus, which can respond to the cyclic hormones involved in the menstrual cycle to cause bleeding and pain.
Endometriosis impairs natural fertility for a variety of reasons. It can physically obstruct ovulation and the transportation along the tube. The presence of endometrial tissue also activates immune cells (macrophages) which attack sperm cells and release substances (cytokines) that are toxic to sperm and embryo. Endometriosis is also associated with a higher incidence of ovulatory disturbance, leading to unruptured follicles and/ or low progesterone levels in the luteal phase, the latter leading to a non-receptive uterine wall (endometrium).
Western medicines treatment of endometriosis in women who try to become pregnant is limited. Surgical removal of the endometrial tissue is used to debulk severe endometriosis. The chances of conception after surgical interference are about 50% after 2-3 years. It is however difficult to remove all the tissue, and some small unpigmented lesions may be left that still produce secretions that interfere with normal fertility. Hormonal medication is often used to suppress the menstrual cycle for 3 to 9 months to “starve' the endometrial tissue into disappearing. Artificial fertilisation is also used to circumnavigate the damaged areas.
Chinese medicine approaches this multifarious disorder in a different way. Apart from treating the outmost manifestation (the congealed blood at places other than the uterus), we try to establish the underlying reason for why this disorder develops. This is different in each patient.
Studies in China confirm that the treatment of endometriosis with Chinese herbal medicine can substantially diminish the pain as well as the size of ectopic mass or cysts. Research into the mechanism shows that Chinese herbal medicine improves the microcirculation of the lower abdomen as well as modulating the immunologic disturbances associated with endometriosis. Reproductive function is preserved or even increased with Chinese herbal medicine.
(4) Unexplained or Functional infertility
About 25% of couples experience infertility and no clear biomedical cause can be established. To enhance ovulation, women are frequently given clomiphene citrate for 3-4 menstrual cycles, coupled with gonadotrophins to trigger ovulation. If that approach fails, intrauterine insemination is often performed. The monthly probability of pregnancy is 10-15%, slightly lower than the probability of pregnancy in fertile couples (20-25%). If no pregnancy occurs after 3-4 cycles, ART is recommended.
When we do a Chinese medicine diagnosis with unexplained infertility, we very often find a physiological (Chinese medical) reason for this sub fertility, for example we may make a diagnosis of “deficient blood' leading to a thin endometrial lining that could not sustain a pregnancy; or “blood stasis' in the uterus that interferes with the pelvic circulation, or 'deficiency of kidney yang which leads to a low body temperature. Treatment of such mild disharmonies with acupuncture and Chinese Herbal medicine can often lead to the desired outcome of achieving a pregnancy. Sometimes women are clearly run-down and did not realise so, and treatment is aimed at re-building her strength so that her body can then maintain a pregnancy.