Treating Infertility In Men And Women, From A TCM's Perspective
Getting Pregnant Is Not As Simple As It Seems
Infertility refers to the inability of a couple to conceive after a period of 12 months or more albeit regular, unprotected sex. For women, infertility includes an inability to maintain the pregnancy to a live birth. Infertility affects about 15% of the couples in Singapore. Depending on the underlying cause of infertility, treatments can vary considerably, from Assisted Reproductive Technology (ART), such as In Vitro Fertilization (IVF), to simply changing diet and lifestyle.
Studies indicate that for every 4 couples who are trying to conceive, one of them will conceive successfully within one month. This means that a couple has a 25% chance of conceiving each month. On average, about 85% of the couples will conceive within one year of regular, unprotected sex. The remaining 15% are either sub-fertile or infertile.
How TCM Classifies The Types Of Infertility
Traditional Chinese Medicine (TCM) treatment of infertility began as early as 2nd Century BC. Thereafter, numerous established TCM practitioners recorded and consolidated their knowledge and experiences of treating infertility with different medical approaches, supplementing and refining the theories based on observations in clinical practice. During that time, there were no blood tests or ultrasounds to evaluate fertility and assess the causes of infertility. TCM diagnosis and treatments of infertility were based upon syndrome differentiation, which is a detailed analysis of signs and symptoms using the four TCM diagnostic methods, namely observation, listening/smelling, questioning, and tongue & pulse assessment.
The "Kidney", "Liver" and "Spleen" System
Traditionally, TCM holds that Kidney, Liver and Spleen are closely related to fertility. It is essential to understand that TCM’s interpretation of Kidney, Liver and Spleen has a different meaning from that of the anatomic organs. Instead, TCM looks at the energetic functioning of the organ and its related meridian.
From TCM’s perspective:
Kidney is the main organ governing reproduction, and is related to conception and pregnancy. It houses congenital essence, which correlates to eggs and sperms.
Liver is related to sexual activities as its meridian circulates around the external genitalia. Its function includes regulating the movement of Qi (life energy) and storing Blood, making it the primary organ involved in a woman’s menstrual cycle.
Spleen is the organ that is in charge of digesting food, transforming the food into nutrients, and transporting the nutrients to various parts of your body. It is responsible for generating Blood and Qi (life energy) required to maintain a healthy reproductive system.
Imbalances in these organs may lead to stagnation of Qi and Blood, or obstruction by Phlegm and Dampness. Clinically, the diagnosis may be complex with a combination of two or more of the above disharmony patterns appearing at the same time.
Modernised TCM Care Integrates Western Medicine Perspective
With the advent of modern technologies, the integration of Western medicine fertility evaluation, which includes blood tests, urine tests, ultrasound scanning, semen analysis etc, help further refine TCM diagnosis and enhance the treatment outcomes.
From a Western Medicine point of view, infertility may be caused by:
1. Ovulation Disorder, which includes poor follicular development and the inability of the ovaries to release a mature egg (picture below shows normal follicular development and ovulation in a menstrual cycle if pregnancy does not occur).
The process of optimal follicular growth and subsequent ovulation depends on a complex interaction of hormones produced by the hypothalamus (a portion of the brain), the pituitary gland (a pea-sized gland at the base of the brain) and the ovaries. Conditions that cause disruption to this process include:
Premature Ovarian Failure
Hormonal Imbalances due to excessive physical or emotional stress, obesity or a very low body weight
Unexplained causes, which may be related to age, body weight, emotional factors, smoking, and alcohol consumption, etc
2. Egg Transport Dysfunction, whereby the fallopian tubes are blocked or damaged, preventing the sperm from meeting and fertilizing the egg, or blocking the passage of the fertilized egg to the uterus. This can be caused by:
Pelvic Inflammatory Disease
Previous surgery in the abdomen or pelvis
3. Implantation Failure, whereby the fertilized egg does not implant in the uterus, or get flushed out of the uterus before clinical detection of pregnancy. This may be due to:
Thin endometrial lining due to hormonal problems
Damaged endometrial lining due to infection
Uterine abnormalities, such as fibroids and congenital uterine malformations
1. Sperm Production Disorder, which includes low sperm count, decreased sperm motility and increased abnormal morphology.
2. Sperm Delivery Dysfunction, which includes sexual dysfunction that disallow proper ejaculation of sperm into the vagina, as well as damage to the epididymis and vas deferens blocking the sperms’ passage to the semen.
TCM practitioners recognize that the body conditions and disharmony patterns change over time, and regular reviews and adjustments of the treatment principles are often needed during the course of the treatment. At the same time, Western medical diagnoses can be viewed within the context of the TCM disharmony patterns.
Patient with poor follicular growth are more often diagnosed with Kidney Yin deficiency, Kidney Yang deficiency or Blood and Qi deficiency, while fallopian tube obstruction is almost always due to Blood Stasis & Qi Stagnation or Phlegm-Damp obstruction.
Acupuncture, Chinese herbal therapy, tui-na (Chinese ancient form of massage), lifestyle counselling and Qi-gong are often employed, singly or in conjunction with one another, to achieve and maintain healthy balance of Qi, Blood, Yin and Yang. The aim is to reduce or release excessive, and tonify deficiency.
These treatment techniques have been applied and refined for thousands of years to produce consistent result, and they often complement with the Western medicine approach of the condition.