Infertility is defined as being unable to conceive after having unprotected sex for 1 year. About 20% is due to the male factor and another 20% is attributed to the female factor.[1] Of the approximately 62 million American women of reproductive age in 2002, about 1.2 million (2%), had an infertility-related visit to the doctor within the previous year, and 10% visited the doctor for the same reason in the past. [2]
Causes of infertility(not limited to):
Ovulatory and hormonal disorders (including polycystic ovarian syndrome, prematue ovary failure).
Unexplained.
Endometriosis.
Blocked or damaged fallopian tubes (including previous infections of the reproductive organs, PID/STD, scars from previous surgery).
Male factor (including low sperm count, poor morphology and poor motility).
Factors that might increase the risk of infertility
Age - a woman’s chances of becoming pregnant decline dramatically with age.
Emotional factors, such as depression and stress.
Occupational and environmental risks, such as prolonged exposure to radiation, certain chemicals, high temperatures, microwave emissions, etc.
Alcohol intake and smoking.
Obesity or being underweight.
What are the conventional treatments for infertility?
Conventional western treatments for infertility include hormonal medication, surgical correction of anatomical defects, or artificial insemination. Other treatments include gamete intrafallopian transfer, intracytoplasmic sperm injection, in vitrofertilization, and zygote intrafallopian transfer. Although these can be successful, they are often invasive, time consuming and can be taxing on one's financial burdens. Therefore, any treatment that are cost-effective, noninvasive are viewed more highly in recent times. This includes natural TCM therapies such as herbal treatment and acupuncture.
What is TCM?
Traditional Chinese Medicine(TCM) has a long history of treating infertility in both women and men, and reports of successful cases have made a significant part of chinese gynecology/obstetrics textbooks.
Recently clinical research studies have further supported that Chinese medicine is a
useful tool for improving natural pregnancy and live birth rates by treating infertility in
both women and men. When used in conjunction with assisted reproductive technology,
TCM treatment increases the number of oocytes retrieved; improves the quality of eggs
and sperms; enhances the chances of clinical pregnancy and live birth rates; and
minimises the symptoms caused by IVF treatment.[8] Furthermore, TCM treatment reduces
the chances of miscarriages, and relieves some of the symptoms associated with
pregnancy with no adverse effects.
In TCM, infertility is caused by a disruption of vital balance and blockages in Qi(energy) and blood circulation flow. This causes a series of problems only known in TCM context, namely deficiency, stagnancy or heat syndrome(not exhaustive in terms of infertility) [3].
Our body needs a balance of Yin, Yang, Qi and Blood. A lack of any is known as Deficiency Syndrome. Deficiency or abundance of any will result in problems within the sexual and reproductive function both in men and women. Our diet and lifestyle play an important role in this maintaining this equilibrium.
When the flow of Qi and Blood is blocked due to various reasons, blood circulation to reproductive organs and tissues are restricted. This is known as stagnancy syndrome.
When there is inflammation in our pelvic regions, this can have an influence on semen quality and gynecological functions.
Can TCM help with my fertility issues?
The good news is, all three syndromes can be treated by TCM, either by acupuncture, herbs or moxibustion. [4] TCM sees each patient as a unique entity, and treatment is tailored to each individual. Side effects with TCM treatment is minimal. TCM treatment for infertility has a long history of more than 5000 years and in modern times, it has been incorporated together with Western Diagnosis. With the insertion of tiny sterile needles into acupoints located at specific parts of the body, hormonal and body functions can be regulated through the restoration of blood and qi circulation, removing stasis and stagnation. It has been found that with a combination of acupuncture and herbs, ovarian and follicular functions can be improved, as well as increasing blood flow to the endometrium [3] [5] [6].
TCM herbs and fertility with Science
The efficacy and safety of Chinese herbal medicine in the treatment of infertility were examined in recent clinical research studies.
In a controlled clinical study infertile patients were treated with Clomiphene either alone or in combination with herbal medicine, and were followed up for one year. Although no significant differences were found in ovulation rate, pregnant rate and miscarriage rate, the Chinese medicine group showed significant improvement in menstruation, follicle development, uterine blood supply, and endometrium thickness compared with the group treated with clomiphene alone. Patients in both groups showed similar minimal side effects which did not need medical intervention. The results indicate that herbal medicine is superior to Clomiphene in restoring regular menstruation, improving uterine blood circulation and may thus improve pregnancy rates[9].
Chinese herbal medicine was used to treat 76 infertile women with polycystic ovarian symdrome (PCOS) and 31 matched patients were treated with Clomiphene. The herbal group showed an improved menstruation with a pregnancy rate of 65.7% whereas the Clomiphene group did not show any effect on the menstruation. The pregnancy rate was only 25%[10].
Can TCM boost my chances with IVF?
The use of alternative medicine such as TCM and acupuncture as an adjuvant to conventional treatment in improving assisted reproductive technologies (ART) effectiveness is becoming more common. Since TCM was introduced to the West, the number of studies that investigate the effect of TCM herbal and acupuncture during ART is beginning to increase. Below I will explain how TCM actually helps with IVF.
1. Improve uterine blood flow
For successful in-vitro fertilisation (IVF) and embryo transfer (ET) to occur, optimal endometrial receptivity at the time of implantation is required. A study done over a period of four weeks showed that acupuncture exerted a general inhibiting effect on uterine sympathetic tone, which means it increased uterine blood flow and, hypothetically, endometrial receptivity. [7]
For my practice, I will administer electro-acupuncture(EA) treatment with needles inserted in acupoints found in abdominal areas and leg muscles. in the abdominal and leg muscles. When inserted needles are stimulated with low frequency EA prior to IVF treatment, uterine and ovarian blood flow can be improved with no adverse effects.
2. Pain relief during oocyte aspiration(egg retrival)
Patients usually experience pain during oocyte aspiration due to needle insertion through the vaginal wall and by mechanical stimulation of the ovary. It is often described as painful as menstruation cramps. Therefore, oocyte aspiration is usually done quickly with anesthesia.
EA was found to relieve pain and have fever negative side effects as compared to that beinginduced by a fast-acting opiate during oocyte retrieval.
3. Improves clinical pregnancy rate
A study has compared 80 women who received acupuncture on embryo transfer day and 80 women who didnt receive acupuncture and the authors have found that 42.5% achieved clinical pregnancy rate when compared to the control group(26.3%). [8]
In a randomized controlled double-blind cross-over study the efficacy of acupuncture as an adjunct to IVF was evaluated. A significantly lower amount of gonadotropins was required when IVF was combined with standard acupuncture. Most importantly a 70% pregnancy rate was achieved with standard acupuncture and IVF, compared to 25% pregnancy rate with IVF only[11].
In another larger clinical study, the acupuncture treatment significantly enhanced the pregnancy and live birth rates and decreased the ectopic pregnancy and miscarriage rates both in IVF poor responders (with elevated FSH and longer history of infertility) and in IVF patients with good prognosis[12].
4. Increases the number of oocytes
In a recent case study, infertile female patients undergoing IVF treatment were divided into two groups: (1) a treatment group with a minimum of two sessions of acupuncture 5 to 7 days prior to and on the day of embryo transfer, and (2) a control group without acupuncture treatment. Amazingly, it was reported that after only a few sessions of acupuncture, the treatment group showed an increased number of oocytes retrieved, and a significantly lower number of first trimester miscarriages, although both groups showed similar fertilization rates, pregnancy or implantation rates, and endometrial thickness on the day of HCG administration[13].
What about male infertility?
The efficacy of Chinese medicine in treating male infertility has also been demonstrated.
A general improvement of the number and quality of sperm, specifically in the ultrastructural integrity of spermatozoa after acupuncture treatment was reported by several authors[14][15].
In a prospective controlled and blind study, nineteen patients with semen abnormalities in concentration, morphology and/or progressive motility without apparent cause were randomized into two groups and submitted to acupuncture and moxa treatment at the therapeutic (Study Group) and the indifferent points (Control Group), respectively, for 10 weeks. The patients of the Study Group presented a significant increase in the percentage of normal-form sperm compared to the Control Group[16].
In a case study, effects of acupuncture on idiopathic male infertility were investigated. Twenty two patients with idiopathic male infertility who failed previous intracytoplasmic sperm injection (ICSI) treatment were treated with acupuncture twice weekly for 8 weeks before embarking on another ICSI treatment. Fast sperm motility was significantly improved, and the percentage of sperm with normal morphology significantly increased. Most importantly, the fertilization rates were significantly increased compared with the previous ICSI treatment [17].
Chinese herbal medicine was successfully used to treat infertile couples with anti-sperm antibody[18]. One hundred and three infertile male patients with positive anti-sperm antibody participated in a clinical trial and were randomly divided into 3 treatment groups: (1) herbal medicine and IUI, (2) herbal medicine alone, (3) IUI alone. The anti-sperm antibody became negative in over 76% of the herbal medicine group, along with a decreased number of CD4 lymphocytes. The pregnancy rate was significantly higher in the herbal medicine and IUI group compared with the other two (41.18% versus 20.59% and 11.43%)[19].
These results indicate that a combination of herbal medicine and IUI is effective in the treatment of infertility with positive anti-sperm antibody.
TCM in treating pregnancy discomforts and complications
Both acupuncture and herbal medicine have been demonstrated to safely relieve some pregnancy-related symptoms.
Seventy pregnant women with nausea and vomiting participated in a randomized double blinded controlled study and were randomly divided into two groups: (1) treatment with ginger (a commonly prescribed herb) and (2) control. During a 5-month period, it was shown that nausea vomiting episodes decreased significantly in the ginger group compared with the control group. No adverse effect of ginger on pregnancy outcome was detected[20].
Case studies showed that herbal medicine can be useful in the treatment of miscarriages.
Twenty patients with early symptoms of threatened miscarriage (such as vaginal bleeding, abdominal cramps) in the 7-8th week of gestation were treated with a classical herbal formula combined with psychological consultation. In 16 patients the symptoms disappeared, indicating the use of herbal medicine in threatened miscarriages [21].
In a further case study, forty patients with a history of recurrent miscarriage were treated with Chinese herbal medicine. Thirty six of them successfully continued the pregnancy over the first trimester which was the time miscarriages usually occurred[22].
Bottom Line
Acupuncture is considered a safe intervention, albeit in the hands of competent practitioners and its costs are lower than other treatments. Of course, more research is needed in this particular field and while others are already trying this safe intervention while waiting for other clinical trials' results, shouldn't you get started as well?
In my clinic, I do acupuncture and herbal consultation for regulation of menstrual cycles, infertility as well as a supplement to IVF cycles. Contact me if you need a consultation.
[1] Nordqvist C. Infertility in men and women; Medical News Today. MediLexicon, Intl. 2018.
[2] Centers for Disease Control and Prevention. Assisted Reproductive Technology. http://www.cdc.gov/ART/ [Jun 16;2008 ].
[3] Shi J. Boosting Fertility and Conception with Chinese Herbs. Acupuncture, and Diet. 2018.
[4] Dharmananda S. Chinese herbs and fertility. 1996
[5] Zhu J, Arsovska B, Sterjovska-Aleksovska A, Kozovska K. Acupuncture Treatment of Subfertility and Ovarian Endometrioma. Open Access Maced J Med Sci. 2018;6(3):519–522.https://doi.org/10.3889/oamjms.2018.128 PMid:29610611 PMCid:PMC5874376.
[6] Berkley M. Infertility And Acupuncture. 2016. www.americanpregnancy.org .
[7] Cacciatore B, Simberg N, Fusaro P, Tiitinen A. Transvaginal Doppler study of uterine artery blood flow in in vitro fertilization-embryo transfer cycles. Fertil Steril 1996;66(1):130-4.
[8] Stener-Victorin E, Waldenstrom U, Nilsson L, Wikland M, Janson PO. A prospective randomized study of electroacupuncture versus alfentanil as anaesthesia during oocyte aspiration in in-vitro fertilization. Hum Reprod 1999;14(10):2480-4.
[9] Xia YW, et al. Therapeutic effect of Chinese herbal medicines for nourishing blood and reinforcing shen in treating patients with anovulatory sterility of shendeficiency type and its influence on the hemodynamics in ovarian and uterine arteries. Chinese Journal of Integrated Traditional & Western Medicine 2004;24(4):299-302.
[10] Hua L, et al. Clinical study of yishen jianpi yangxue tongli therapy in treating polycystic ovary syndrome. Chinese Journal of Integrated Traditional & Western Medicine 2003;23(11):819-22.
[11] Quintero R, et al. A randomized, controlled, double-blind, cross-over study
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[12] Magarelli P.C., et al. Acupuncture and good prognosis IVF patients: Synergy.
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[13] Khorram N.M., et al. The effect of acupuncture on outcome of in vitro fertilization. Fertility and Sterility 2005;84: S364.
[14] Siterman S, et al. Does acupuncture treatment affect sperm density in males with
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[15] Pei J, et al. Quantitative evaluation of spermatozoa ultrastructure after acupuncture
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[16] Gurfinkel E, et al. Effects of acupuncture and moxa treatment in patients with
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[17] Zhang M, et al. Influence of acupuncture on idiopathic male infertility in assisted reproductive technology. Journal of Huazhong University of Science and Technology. Medical Sciences 2002;22(3):228-30.
[18] Liao DL, et al. Exploration on the relationship between positive antisperm antibody and nitric oxide level of infertile patients and on integrative Chinese and Western medicine treatment. Chinese Journal of Integrated Traditional & Western Medicine 2004; 24(4):306-8.
[19] Lian F et al Clinical observation on effect of zhenqi zhuanyin decoction combined with intrauterine insemination in treating spleen-kidney deficiency type patients of sterility with positive anti-sperm antibody. Chinese Journal of Integrated Traditional & Western Medicine 2002; 22(2):95-7.
[20] Vutyavanich T, et al. Ginger for nausea and vomiting in pregnancy: randomized, double-masked, placebo-controlled trial. Obstetrics & Gynecology 2001;97(4):577- 82.
[21] Sun F et al. Miscarriage prevention tea affects plasma beta-endorphin
concentrations in women with early threatened abortions. American Journal of
Chinese Medicine 1999;27(2):277-82.
[22] Sun F and Yu J. Effect of TCM on plasma beta-endorphin and placental endocrine
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