Fertility and Pregnancy

If you aren't pregnant yet and you've been trying for more than 6 months, acupuncture and herbal medicine can help. Our goal is for you to achieve and maintain a healthy pregnancy. Acupuncture and Chinese herbs are safe & effective ways to enhance natural fertility or to complement assisted reproductive therapies (ARTs).

Acupuncture can greatly increase your chances of a successful pregnancy*. If you wish to try getting pregnant naturally before trying high tech medical techniques such as IVF, IUI or ICSI, acupuncture and herbal medicine are the most popular natural tools available.

Using the diagnostic principles of TCM (traditional Chinese medicine), we determine the nature of the imbalance that is preventing conception. It takes three to six months to re-balance the system using acupuncture and herbs. We also offer nutritional guidance and lifestyle management techniques to help the process of harmonizing the mind and body. For women who are not getting pregnant naturally, the combination of modern science and ancient wisdom is the best way to achieve and maintain a healthy pregnancy. Procedures such as IVF and ICSI are modern science at its very best. When you combine this with acupuncture, herbal medicine, and healthful eating and lifestyle habits, you are going for it with the best selections available.

*A successful pregnancy refers to one that results in a baby.

How acupuncture and Chinese herbs increase pregnancy rates:

• 1. By improving the function of the ovaries to produce better quality eggs.
• 2. By helping regulate the hormone levels to help produce a larger number of follicles.
• 3. By increasing blood flow to the uterus, which in turn creates a thicker uterine lining. The result is better likelihood of implantation of the embryo in the uterus.
• 4. During implantation of the embryos, acupuncture and herbs can help prevent the uterus from contracting. This also prevents painful cramps.
• 5. By lessening the side effects of the drugs used in IVF, such as emotional instability, insomnia, palpitations, fatigue, etc.
• 6. Acupuncture and Chinese herbs can strongly strengthen the immune system.
• 7. By improving the quality and quantity of the semen to create better quality embryos.
• 8. By decreasing the chances of miscarriage. For women over 40 years old, pregnancies through IVF have an approximate 46% rate of miscarriage after six weeks. This percentage can be greatly reduced with the help of acupuncture and herbal medicine.

What are the reasons for infertility?
Infertility is medically defined as the inability to conceive after multiple sustained attempts of unprotected sex for at least 12 months. This condition has multiple causes, both male and female.

Surprisingly, the most common cause is related to male abnormalities as opposed to female. Semen analysis is the cornerstone for evaluation in male partners. It is a simple, non-invasive procedure that analyzes the semen for sperm count, motility, morphology, and other parameters.

What semen analysis determines

• » Motility is the sperm’s ability to move rapidly towards the egg. If this movement is impeded, the sperm will have a decreased chance of reaching the egg for fertilization. Lab tests indicate that at least 50% of sperm must be able to swim to be within the normal limits.


• » Morphology refers to the shape and structure of the sperm. If it is abnormal, the sperm’s ability to fertilize the egg may be impaired. Lab test results show that at least 50 – 70% of sperm must have a normal morphology to be considered in the normal range.


• » Liquefication of the semen should occur upon ejaculation to enable the sperm to swim towards the egg. Poor liquefication may result from enzyme deficiencies in the seminal plasma which, in turn, reflects an abnormality of the seminal vesicles. Liquefication should occur in less than 30 minutes to be considered normal.


• » Count of less than 20 million sperm per milliliter of semen is considered low. Lab tests results require 25-250 m/mL.


• » Volume, the amount of semen in one ejaculation, should be at least six milliliters.

What causes abnormal semen?

• » Testicular factors
  As testosterone and sperm are produced in the testicles, their health is very important and can affect fertility. Infections, including sexually transmitted diseases (STDs), mycoplasma, mumps, and glandular infections can call cause the sperm to become less motile.
  A varicocele is an abnormally large and twisted (varicose) vein that drains blood from the testicle. It may prevent normal cooling of the testicle, thereby raising the testicular temperature. This may cause damage to the sperm.
  Some men are born with a blockage of the part of the testicle that contains sperm or ejaculatory ducts. This condition inhibits them from transferring their sperm to the female. The vas deferens (the tube which carries the sperm), may also be surgically blocked.


• » Sexual factors
  General problems with sexual intercourse, such as erectile dysfunction (ED) and premature ejaculation, will impair delivery of sperm. These are treatable with both Western drugs and Chinese herbal medicine.


• » Autoimmunity
  This condition occurs when the immune system antibodies target sperm, weakening or disabling them. A semen analysis can determine which aspect of semen function is impaired.

How Chinese medicine can help male fertility
What traditional Western medicine would call sexual issues, failure to ejaculate, autoimmunity, small testicles, low testosterone levels, low semen volume, low sperm count, low quality sperm, or abnormal motility, Chinese medicine views as a deficiency of the kidneys or as a deficiency of qi, yang, blood, and/or yin. Abnormal morphology, varicocele, or blockage of ejaculatory ducts correspond to the Chinese medical differentiation of qi stagnation and/or blood stasis. Infections are typically caused by what Chinese medicine labels damp heat pathogens.

Chinese medical treatments for these conditions are specific acupuncture treatments, herbal formulas, dietary guidelines, and lifestyle recommendations.

What causes infertility in women?
There are several primary pathological conditions that may interfere with a female’s ability to achieve pregnancy.

• » Ovarian factors
  At around age 41, the function of a woman’s ovaries starts to decline. Although this is a natural stage in development, for the purposes of achieving a successful pregnancy, it needs to be treated. This decline results in the production of lesser quality eggs. Fertilization of these eggs is more difficult. Generally they do not develop as well after fertilization. When the ovaries decline in function, FSH (follicle-stimulating hormone) levels increase in order to induce ovulation. FSH levels above 10 indicate that the ovarian function has declined, making pregnancy more difficult to achieve. Even when pregnancy does occur, it is usually more difficult for the woman 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.
  
  In such cases a full endocrine work up needs to be done, to check hormone levels within the blood. If ovarian disease is suspected a pelvic ultrasound will be needed in addition to more specific and more invasive procedures to establish a specific ovarian cause.


• » 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. Scarring of the tubes due to surgery or pelvic inflammatory disease (PID) can lead to a blockage of the tubes, preventing a fertilized egg from implanting properly within the uterus. Diagnostic tests which are helpful in diagnosis, include a hysterosalpingogram and a laparoscopy. (see Fertility test section below).


• » Uterine factors
  Uterine (fibroid) myomas distort the uterine cavity or block the interstitial parts of the tubes, preventing the embryo from moving to the uterus. Another problem arises when the uterus is too small for the embryo to grow and develop. Endometritis, and endometriosis are different conditions, which affect the lining of the uterus. In these conditions scar tissue can form which can effect the implantation and thus be a cause for infertility. Ultrasound, hysterosalphingogram and laparoscopy can help detect these conditions too.


• » Cervical factors
  Cervical or vaginal infection can cause discharge or mucus which may kill or inhibit the advance of sperm. This may be due to the presence of antibodies. Inappropriate changes in the cervical mucus can lead to a hostile environment for the sperm. Cervical mucus incompatibility accounts for approximately 5% of female infertility.

How Chinese Medicine can help Female Infertility
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 excess.

If the liver blood and kidney yin are deficient, the woman’s essence will not be sufficient to nourish the uterus and ovaries. This condition brings 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 eggs.

When there is a deficiency of qi and yang of the spleen and kidneys, there is inadequate energy to transform and activate the uterus and ovaries, also leading to the inability of the egg to be fertilized or for the fertilized egg to implant itself and grow.

Pathogenic factors such as cold, heat, phlegm, and dampness as well as stagnation of qi and stasis of blood have the effect of obstructing the uterus and blocking its channels. Because of this blockage, fertilization cannot occur.

Absence or irregularity of ovulation, a small uterus, a thin endometrium, poor quality of the eggs, poor quality of the follicles, low estradiol, low progesterone, and high FSH, often correspond mainly to the deficiency of kidney yin, yang, or both but also correspond to qi and blood deficiency.

Uterine myomas (fibroids), ovarian cystitis, adhesions, endometriosis, and blockage of fallopian tubes often correspond to the Chinese medical pattern discrimination of qi stagnation and blood stasis with phlegm dampness. Cervical infection, vaginal infection, pelvic infection, and fallopian tube infection often correspond to damp heat or toxins with blood stasis.

Unexplained Infertility can be the most frustrating of all. Unexplained infertility accounts for 10 – 15% of all infertility cases. To understand how such cases can go unexplained, we need to understand how complicated conception really is. In order for conception to take place, a lot of things must occur correctly and in the right order.

• » A hormone that stimulates ovum production, FSH (follicle-stimulating hormone), must be made by the anterior pituitary gland and must be released properly.
• » The egg must contain the correct number of chromosomes, 46, and develop into a mature ovum.
• » A LH (Luteinizing hormone) surge must take place to stimulate the egg's final maturation.
• » Ovulation must occur, meaning that the follicle must rupture and release the egg into the fallopian tube.
• » The sperm must survive the travel from the vagina, enter the cervical mucus, enter the fallopian tube and fertilize the egg.
• » The fertilized egg must be able to divide until it is an early embryo.
• » The embryo must travel down the fallopian tube and implant onto the lining of the uterus (endometrium).
• » The endometrium must be properly formed and receptive. The lining should be at least 8 mm thick. 10 mm or more is preferable.

Another factor is the woman's age. Women aged 35 and over have a decreased chance of achieving a successful pregnancy naturally. The potential for unexplained infertility is increased even more in women who are 38 and older. This is due to poor egg quality and decreased egg quantity. Since there is no category for this naturally occurring process, when it is the culprit for the infertility, it is still considered unexplained infertility.

Being told that your cause of infertility is unknown can be a very disheartening and upsetting experience. Even though your fertility issues cannot be explained by modern medical science, it does not mean that you are destined to lead a childless life.

Traditional Chinese Medicine (acupuncture, Chinese herbal formulas, nutrition and lifestyle guidelines) regards the human body as an ecosystem that needs to be replenished and refreshed in order for health to be optimal and balanced. Western medicine views the body as a machine that is malfunctioning and needs repair. I highly recommend the book The Infertility Cure by Randine Lewis for a more thorough explanation of how Chinese medicine helps women and couples achieve the pregnancy and babies they want and deserve. There are dozens of stories in the book of real people who achieved pregnancy and gave birth to happy children with the help of acupuncture and Chinese medicine. I also recommend Acupuncture & IVF by Dr. Lifang Liang. Dr. Liang is Katherine’s gynecology professor and also her employer during her years of study at ACTCM in San Francisco.

The Bottom Line
Talk to your doctor, preferably your gynecologist or reproductive endocrinologist. Both male and female partners need to be evaluated to determine the proper course of treatment. By determining the cause of the infertility, different options can be explored specific to each individual couple.

Using ancient wisdom, modern knowledge, years of experience and a loving environment, the dream of becoming pregnant may soon become a reality.

Female Fertility Tests
Successful pregnancy requires the recruitment, development and ovulation of eggs that can be fertilized. If a woman is not ovulating, she is said to be anovulatory. See our Web page on amenorrhea for more information.

Predicting and Documenting Ovulation
The first fertility tests seek to document that successful ovulation is occurring. The patient may be asked to use a basal body temperature thermometer or an ovulation predictor kit (OPK) to chart her temperature throughout her cycle. The body temperature is measured each morning before getting out of bed and noted on the BBT chart.

Prior to ovulation, there is a small temperature increase indicating imminent ovulation and intercourse is timed around this period. The BBT is charted for several months making it possible to predict the time of ovulation in subsequent cycles. Because BBT charting is less than 50% accurate in documenting adequate ovulation, Dr. Mac prefers his patients no longer use this technique.

Most specialists prefer to use the urinary ovulation predictor kits to document ovulation because they are more accurate. The urine is tested daily around the time that ovulation is expected. A sharp rise in luteinizing hormone (LH) indicates that ovulation is imminent within 36 hours.

Purpose of Fertility Tests
Endocrine Profile (CD=cycle days 3 - 5) (Checks brain - thyroid - adrenal - ovary axis). When grouped together these tests (FSH, LH, E2 (estradiol), Prl (prolactin), DHEA-S, Testosterone, TSH) are called an endocrine profile. They are all normally occurring hormones.

When the levels are out of the normal ranges, interference with ovulation can occur. Follicle stimulating hormone (FSH) is produced by the pituitary gland and stimulates the ovary to produce estrogen (E2). Luteinizing hormone (LH) is also produced by the pituitary gland and induces the ovary to ovulate.

Prolactin (Prl) is also produced by the pituitary gland and may interfere with the mid cycle LH surge if prolactin levels are higher than normal. Dehydroepiandrosterone sulfate (DHEA-S) is a hormone produced by the adrenal gland. Its level allows us to determine whether or not the adrenal gland may be acting to suppress the ovulatory process.

Testosterone is an androgen (male-like hormone) that is produced by both the ovaries and the adrenals. Its production, along with DHEA-S, allows us to better identify if the ovaries or adrenal glands are in a resistant (suppressive) state. Thyroid stimulating hormone (TSH), yet another hormone produced by the pituitary gland, may increase prolactin production to higher than normal levels that act to interfere with ovulation.

Inhibin B
Inhibin B serum concentration provides a new measure of ovarian reserve. Ovarian reserve describes the ovaries' capacity to respond to gonadotropin (FSH & LH) stimulation by producing a sufficient number of good quality eggs capable of generating normal embryos.

Inhibin B concentrations drawn on cycle days 3 to 5 have been shown to predict response of the ovaries to ovulation induction medications. In addition, these levels have been used to predict the chance of miscarriage after becoming pregnant. These levels are recommended in any woman where ovarian reserve may be suspected to be low, i.e. age > 35, previous ovarian surgery, when premature ovarian failure is considered, etc.

Clomiphene challenge fertility test (CCT)
The clomiphene challenge test is a sensitive way to measure a woman's "ovarian reserve," or relatively speaking, whether she has fertilizable eggs left in her ovaries. It appears to be more sensitive than an endocrine profile since some women with normal profiles on day 2 or 3 may have an abnormal clomiphene challenge fertility test. It is most often used in women over the age of 35 to assure the patient that ovulation induction is worthwhile. Results of this test will help you and your physician evaluate your ovarian reserve and how aggressive you may need to be with regard to treatment.

Hysterosalpingogram (HSG)
Hysterosalpingogram is an x-ray of the uterus and tubes. It is an outpatient procedure that takes less than 30 minutes performed in the radiology department. A catheter is threaded through the cervix into the uterus and dye is injected to determine whether the fallopian tubes are open and to see if the shape of the uterine cavity is normal. This procedure causes moderate menstrual cramps and ibuprofen is recommended 1 hour prior to the procedure. Antibiotics are also recommended to decrease any risks of developing a uterine infection.

Urine LH "Ovulation Predictor" Kits
This pituitary hormone that triggers ovulation suddenly rises about 36 hours before ovulation and is easily measured in the urine. One can predict ovulation and plan intercourse, insemination, or post coital test based on this test.

Follicular Ultrasound
Follicles develop in a characteristic fashion prior to ovulation. After ovulation, the ruptured (ovulated) follicle becomes the corpus luteum that produces progesterone. The endometrial lining also develops gradually throughout the cycle. Watching the development and changes via ultrasound is a safe and simple method of determining ovulation and appropriate growth of the endometrial lining.

Ultrasound Fertility Tests
The pelvic ultrasound has many uses including assessing follicular development, measuring endometrial thickness, and diagnosing other abnormalities such as large uterine fibroids. Please see our Web page on "Ultrasound" for more information.

Cervical Mucus
The cervical mucus changes from scant, thick, sticky, and cloudy early in the cycle to plentiful, thin, clear, and stretchable just before and during ovulation. As estrogen levels increase mid cycle, the mucus changes. This allows for sperm to be easily transported to the fallopian tubes where fertilization takes place.

Post coital Test (PCT)
The PCT or "post-intercourse test" is done from 2 to 12 hours after intercourse within 2 days of predicted ovulation. Evaluation is made of both the mucus and the number of sperm that show progressive forward movement, thus examining simultaneously both female and male factors.

The post coital test (PCT) is a test performed on the cervical mucus after intercourse looking for sperm. In the post coital test, the couple has intercourse and the female then comes to the office within 2 to 12 hours. At the office, a speculum exam is performed where a sample of her vaginal and cervical fluid is examined.

The fluid will be analyzed and the quantity and quality of sperm will be determined. If numerous dead or nonmoving sperm are seen, it may be indicative of the presence of antisperm antibodies. The cervical mucus may also be too thick or there may not be enough mucus to transport sperm into the uterus.

This type of infertility is known as "cervical factor infertility" and is often treated using intrauterine insemination (IUI), which places sperm directly into the uterus.

Estradiol (E2)
Estradiol is an ovarian hormone secreted by the cells that surround the egg. This hormone helps develop the uterine lining during the first half of the cycle. It is also used to monitor the development and health of the developing egg (s).

Progesterone (P4)
Progesterone is an ovarian hormone secreted by the corpus luteum after ovulation. This hormone helps maintain the endometrial lining which is crucial for implantation of the embryo. Furthermore, it is vital in sustaining the early pregnancy for the first 7-9 weeks of gestation.

Endometrial Biopsy
The endometrial lining changes throughout the cycle from "proliferative" before ovulation to "secretory" after ovulation. This is necessary to allow implantation by the embryo. A biopsy allows one to assess if the proper amount of hormone (E2 and P4) was received by the lining by a certain day of the cycle. The physician may want to document that the endometrium is properly prepared to accept the developing embryo by ordering an endometrial biopsy. In this procedure, a small sample of the endometrium is taken and examined under a microscope. The depth of the endometrium can also be determined using transvaginal ultrasound. Progesterone levels are often measured before an endometrial biopsy to insure that successful ovulation has occurred.

Endometrial function test (EFT)
A family of cell-surface protein receptors appears on the endometrial lining of the uterus during "the window of implantation." This window often exists 8-10 days after a woman's urinary LH peak. The absence of certain proteins leads to poor implantation or lack of implantation in many cases. It is now been proven that implantation markers are necessary for proper development of the endometrial lining during a woman's menstrual cycle and for implantation.

Recently, many women with "unexplained infertility," "luteal phase defect," "endometriosis," or "hydrosalpinx (swollen tubes)" have been shown to have alterations in their endometrial lining function at the time of implantation. The lack of these implantation markers has been associated with each of these disease states. Biopsies of the uterine lining at appropriate times in the cycle can identify this type of abnormality. These biopsies collectively are termed the endometrial function tests.

Laparoscopy
The laparoscopy is a cornerstone infertility test where the physician can visually examine the internal "pelvic" organs. It is an outpatient surgical procedure performed to inspect the female for such infertility factors as endometriosis or pelvic scarring. Please see our page on "Laparoscopy" for an extensive discussion of this procedure.

Hysteroscopy
Hysteroscopy is a procedure in which a small camera is inserted through the vagina into the uterus. The structures such as fibroids can be seen. Please see our discussion on the hysteroscopy for more information.

Many other tests that may be ordered based upon each couples individual condition.

It is important to determine the nature of the problem so that a proper treatment plan may be implemented. Some people may choose biomedical therapies for reproduction such as follicle stimulating hormones, Donor Eggs, Donor Sperm, ICSI (Intra-Cytoplasmic Sperm Insemination), IUI (Intra Uterine Insemination), or IVF (In Vitro Fertilization).

Changing factors such as diet and lifestyle can greatly enhance sperm count in men as well as ovarian and uterine health in women. Be Well Healing Arts is committed to providing you with the most up to date information available, as well as solid theories from Eastern medicine that have worked for thousands of years, and still work today.

We encourage our patients to make an informed decision based on their personal feelings as well as the advice of their gynecologist and reproductive endocrinologist. Many patients do not, in fact, need biomedical treatment for fertility. Drinking herbal tea and receiving acupuncture treatments can often result in a naturally conceived, successful pregnancy.

Sources:

• » Houston Fertility Specialist
• » Fertility Expert
• » Lifang Liang