- Irregular menstruation
- Amenorrhea
- Dysmenorrhea
- Galactorrhea
- Distending pain in the breast
- Aches in the waist
Primary Infertility
When a female is unable to ever bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth she would be classified as having primary infertility. Thus women whose pregnancy spontaneously miscarries, or whose pregnancy results in a stillborn child, without ever having had a live birth would present with primary infertility.
Secondary Infertility
When a female is unable to bear a child, either due to the inability to become pregnant or the inability to carry a pregnancy to a live birth following a previous pregnancy or a previous ability to carry a pregnancy to live birth, she would be classified as having secondary infertility. Thus those who repeatedly spontaneously miscarry or whose pregnancy results in a stillbirth, or following a previous pregnancy or a previous ability to do so, are then not unable to carry a pregnancy to a live birth would present with secondarily infertile.
Acupuncture Overview
The treatment of infertility with acupuncture dates back 5,000 years. These ancient, time-tested techniques improve fertility rates and support a female’s whole body, unlocking unlimited potential for health, healing, and childbearing.
When Qi (also called Life Energy) and blood are circulating freely throughout the body, every cell, tissue, and organ is properly nourished and functioning well. When this occurs, a female's health and fertility are increased.
According to the theories of acupuncture, infertility is caused by an imbalance of Qi and blood affecting one or more of the Organ Systems.
However, the three main organ systems related to female reproduction in Chinese medicine are the kidneys, spleen, and liver.
The tian GUI or heavenly water
The female’s physiological changes in seven-year increments the waxing and waning of something called the tian gui or heavenly water. The heavenly water refers to the kidney essence in its role in creating menstruation. Therefore, menarche is called “the arrival of the tian gui”, while menopause is called “the cessation of the tian gui.” For example, at 14 years of age, a girl’s kidney essence has developed and, therefore, her menstruation starts and she can conceive. At 21, her kidney essence has optimized and she is ready for conception. At 35, a female’s kidney essence has begun to wane, and by age 42, it is rapidly diminishing. At 49 years of age, the female’s kidney essence is now depleted, and, therefore, her menstruation stops and she can no longer conceive.
This classical theory describes the normal physiology of a female’s hormonal cycle throughout her life. Due to the cultural difference and the improvement in both nutrition and living environment, modern women in developed countries, on average start their puberty 1-3 years earlier and enter their menopause 2-3 years later than those living in ancient times. Despite this slight difference between ancient and modern-day women, the basic ideas about the physiology of female menstruation are still an important guide to modern traditional Chinese medical diagnosis and its treatment of gynecological diseases.
Pathology of Infertility
Western medical pathologies of female reproduction
Several primary pathological conditions may interfere with a female’s ability to achieve pregnancy:
1. Ovarian factors
At around 41 years of age, the function of a female’s ovaries starts to decline. (Although this is a natural stage of a female’s development, to achieve pregnancy, it is considered pathology here.) This decline results in the production of lesser-quality eggs. Fertilization of these eggs is more difficult and, generally, they do not develop as well after fertilization. When the ovaries decline in function, follicle-stimulating hormone (FSH) levels increase to induce ovulation. FSH levels above 10 indicate that ovarian function has declined, making pregnancy more difficult to achieve. Even when pregnancy does occur it is usually more difficult for the female to carry the embryo to term, and miscarriage often results. In addition, estrogen and progesterone levels decrease, causing a thinning of the endometrium. All of these factors affect the implantation of the embryo.
Another condition of the ovaries is the occasional or total failure to ovulate. This may be due to hormonal changes causing irregular menstruation, amenorrhea, or heavy uterine bleeding. This condition may also be due to polycystic ovaries.
The treatment for these conditions focuses on regulating the menses, balancing hormone levels, and if needed, treating poly-cysts and endometriosis. Once this is achieved, fertility is greatly increased.
2. Fallopian tube factors
The fallopian tubes may become blocked due to infection or endometriosis causing adhesions. As a result, the sperm is unable to fertilize the egg.
3. Uterine factors
Uterine fibroid distorts the uterine cavity or blocks the interstitial parts of the tubes, thus preventing the embryo from moving to the uterus. Another problem arises when the uterus is too small for the embryo to grow and develop.
4. Cervical factors
Cervical or vaginal infection can cause excessive discharge or mucus, which may kill or inhibit the advance of the sperm. This may be due to the presence of antibodies.
Female pathology according to TCM
In order for fertilization to occur, the yin, yang, Qi, and blood of the kidneys all need to be perfectly balanced. When one or more of these elements is out of balance, a disharmony results and infertility may occur. When diagnosing infertility, it is important to differentiate clearly between cases of Deficiency and cases of Excess. The following patterns relate to the uterus and the thoroughfare and controlling vessels, which include the ovaries and fallopian tubes.
1. Deficiency patterns
1.1 Blood & yin Deficiency
If the liver blood and kidney yin are deficient, the essence will not be sufficient to nourish the uterus and the thoroughfare and controlling vessels. This condition may bring about various problems with the eggs, such as the inability of the egg to be fertilized, the fertilized egg not being able to implant itself and grow, or the lack of any egg.
1.2 Qi & yang Deficiency
When there is a Deficiency of the Qi and yang of the spleen and kidneys, there is inadequate energy to transform and activate the uterus and the thoroughfare and controlling vessels, also leading to the inability of the egg to be fertilized or for the fertilized egg to implant itself and grow.
2. Excess patterns
There is some connection between Western medical pathology and Chinese medical pathology, which are listed below.
The Pathology of Infertility
| Deficiency of Kidney Yin OR Deficiency of Blood OR Deficiency of Kidney Yang OR Deficiency of Qi | No Ovulation Small Uterus Thin Endometrium Poor Quality of Eggs Poor Quantity of Follicles Low Estradiol Low Progesterone High FSH |
| Qi Stagnation OR Blood Stasis OR Phlegm Damp Obstruction | Fallopian Tube Block Uterine Fibroid Ovarian Cystitis Endometriosis Adhesions Stress |
| Damp Heat OR Toxins OR Blood Stasis | Cervical Infection Vaginal Infection Pelvic Infection Fallopian Tube Infection |
Kidney yang deficiency causes infertility with loss of libido, delayed, and decreased menstruation with pale menses:
Main Symptoms
Infertility, Loss of libido, Delayed menses, Decreased menses, Pale menses, Infrequent menses, Amenorrhea may be present, Aches and weakness of waist and legs, Dusky complexion, Loose stools, Abundant clear urination.
Cause of disease
- Kidney yang becomes deficient due to:
- Inadequate prenatal endowment
- Excessive sexual activity
- Deficient kidney yang fails to warm and nourish the uterine meridians. Hence Ren Mo and Chong Mo become deficient.
- The essence than cannot gel and form into a fetus.
- When the kidney yang is deficient, the fire of vital gate declines and is unable to propel Qi and move water.
- Cold and humidity gels in Chong and Ren Mo and causes blockage there
- Humidity fills the uterine meridians so that essence cannot gel and form into a fetus.
Treatment principles
- Warm the kidney
- Generate blood
- Nourish Chong and Ren Mo
- Resolve infertility.
Kidney yin deficiency
Kidney yin deficiency causes infertility with early & decreased menses with emaciation & 5-palm heat:
Main Symptoms
Infertility, Early menses, Decreased menses, Emaciation, Dizziness, Blurred vision, Palpitation, Insomnia, Five palm heat, Low-grade fever in the afternoon
Cause of disease
- The deficiency of kidney yin allows yang Qi to be overactive.
- Increased yang Qi raises internal heat. This internal heat goes to Ren and Chong Mo.
- This internal heat disturbs Ren and Chong Mo and the sea of blood so that essence cannot gel and form into a fetus.
- Excessive sexual activity can consume essence and blood causing deficiency of kidney yin. This causes infertility.
- An inadequate prenatal endowment may also cause kidney yin deficiency and consequent infertility.
Treatment principles
- Nourish the kidney yin
- Produce blood
- Regulate Ren and Chong Mo
- Augment essence
- Resolve infertility
Stagnation of liver Qi
Stagnation of liver Qi may cause infertility with premenstrual breast distension, decreased and dark-colored menses containing clots or irregular menses:
Main Symptoms:
Infertility, Premenstrual breast distension, decreased and dark-colored menses containing clots, Irregular menses
Other symptoms:
Restlessness, Anger
Cause of disease
- Pent up emotion may cause stagnation of liver Qi.
- Liver Qi stagnation impairs liver function. This causes disharmony of Qi & Blood. Chong & Ren Mo cannot support each other. Essence cannot gel and form into a fetus. This causes infertility.
Treatment principles:
- Release stagnation
- Unblock the liver
- Regulate menses
- Resolve infertility
Accumulation of internal humid phlegm due to deficiency of spleen
Accumulation of internal humid phlegm due to deficiency of the spleen causes infertility with delayed menses or amenorrhea, leucorrhea, and weight gain:
Main Symptoms:
Infertility, Delayed menses, Amenorrhea - copious and viscid vaginal discharge, Obesity, A pale complexion, Dizziness, Chest tightness, No appetite, Nausea
Cause of disease:
- Excess consumption of fatty and spicy foods causes humidity and Phlegm, which accumulate in the interior and obstruct Qi movement.
- Reduced Qi movement causes loss of control of Ren and Chong Mo.
- There is an overflow of fat in the uterine channels.
- It impairs the uterine function.
- The essence cannot gel and form into a fetus.
- Improper diet disturbs the spleen. The deficiency of the spleen causes internal humidity and phlegm. This humidity and phlegm go downwards to the warmer and block the uterine channels. This also prevents essence from getting and forming into a fetus.
Treatment principles
- Dry humidity
- Resolve phlegm
- Mobilize Qi
- Regularize menses
- Resolve infertility
Stasis of blood in the uterus
Stasis of blood in the uterus causes infertility with delayed and decreased menses or dysmenorrhea, dark purple menstrual blood with clots:
Main Symptoms:
Infertility, Delayed menses with decreased menses, Dysmenorrhea, Menses is of dark purple color with clots, Abdominal pain
Cause of disease
- The body’s defensive Qi system is weakened by:
- Excessive sexual activities
- Exposure to cold and water during menses
- Postpartum bleeding
- External pathogens attack the body more frequently.
- When the external pathogens intermix with blood, it causes stasis of blood.
- When the stasis of blood blocks the uterine channels, the essence cannot get and form a fetus. This causes infertility.
Treatment principles
- Mobilize blood
- Remove stasis
- Regulate menses
- Promote conception
Case Studies
Case 1 Female 32.
Background:
- Terminated pregnancy
- One IVF Failed
Western Diagnosis:
- Primary Infertility
- 12th-day Endometrium 3.5 mm.
- Poor blood flow in Uterine Artery
Tongue Observation:
- Pale Especially on sides
- Quivering
Pulse Reading
- Excess of Yin Wind
- Deficiency of Damp and Cold Qi
- Fullness of Kidney
Treatment Principle:
- Subdue Wind
- Promote Blood
- Resolve infertility
- Nourish the kidney essence
Treatment Protocol
Group1:
SP-3, Sp-6, K-3, K-7, ST-27, ST-36, REN-6, REN-12,
Ear: Shenmen, Uterus, Point 0
Group2:
Liv-8, Sp-6, K-3, BL-17, BL-18, BL-20, BL-23 Needling with reinforcing method.
Liv3, GB-20, DU-16, DU20
Needling with reducing method.
Group 3:
K-3, K-6, GB-39, REN-4, DU-4, DU-14, DU-20, BL-11, BL-15, BL-23
Needling with reinforcing method.
Result:
- 12th day Endometrium 8.5 mm.
- Good blood flow in Uterine Artery
Embryo Transfer completed successfully
Case 2 Female 43.
Background: Six IVF Failed
Tongue Observation: Short, Red, No coating
Treatment Principle:
- Nourish the kidney yin
- Promote Blood
- Resolve infertility
- Nourish the kidney essence
Treatment Protocol
Group1:
Ear: Shenmen, Uterus, Point 0, Kidney.
K-3, K-6, K-9, K-10, SP-6, REN-1, REN-4, BL-23 Needling with reinforcing method.
Group 2:
K-3, K-6, GB-39, REN-4, DU-4, DU-14, DU-20, BL-11, BL-15, BL-23 Needling with reinforcing method.
Result:
- Embryo Transfer completed successfully
- Completed the full term.
Case 3 Female 37.
Background:
- One IUI failed
- One IVF failed
Western Diagnosis:
- Fallopian Tube Block
Tongue Observation:
- Purple on sides
- Slightly Swollen
Treatment Principle:
- Remove Stagnation
- Promote Blood
- Resolve infertility
Treatment Protocol
Group1:
LIV-3, LIV-13, LIV-14, GB-34, TW-6, P-6, REN-6, SP-10, BL-17, BL-18
Needling with reducing method.
Ear: Shenmen, Uterus, Point 0, Liver, Spleen.
Group 2:
SP-3, SP-6, ST-36, REN-12, BL-20, BL-21
Needling with a reinforcing method.
Result:
- Conceived normally.
- Completed the full term.
Summary
Thus Acupuncture can
- Help to increase blood flow to the uterus, which improves the chances of an ovum implanting on the uterine wall.
- Reduce anxiety, stress, and the hormones that are secreted during stressful situations. (Such stressful situations can significantly decrease fertility).
- Normalize hormone and endocrine systems that regulate ovulation, especially in women with the polycystic ovarian syndrome.
- Positively affect the hypothalamic-pituitary-ovarian axis, which plays a key role in the fertility process.
- Regulate menstrual cycle
- Relaxing the uterus and increasing blood flow allows for the successful implant of an embryo within the uterine lining.
- Acupuncture and Chinese medicine can raise the fertility potential for women by affecting the quality, quantity, balance, and flow of Qi and blood.
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