Thursday, February 23

Meanderings on Oocyte Quality and Qi

Several reproductive hormones are related to ovarian reserve and follicle depletion. Ovarian reserve is assessed by measuring FSH, inhibin b and AMH as well as visualizing antral follicle count (afc) via transvaginal ultrasound examination. AMH suppresses FSH.

Qi has six functions. They are: transforming, transporting, containing or holding, raising, protecting and warming.

Inhibin b is analogous to the holding aspect of qi. FSH is analogous to the transforming aspect of qi as FSH transforms germ cells into follicles and primordial follicles into pre antral follicles and pre antral follicles into antral follicles and antral follicles into a graafian follicle.

One may consider that yang qi is associated with action and/or metabolic function and thus I might equate LH as a surge of yang qi facilitating the action of ovulation.

Ovulation also reflects the raising function of qi in that if qi is sinking or deficient, ovulation will not occur. The raising aspect helps the egg to burst through the follicle. So we can see the symbiotic relationship between spleen qi and kidney yang in the action of ovulation.

As the follicular pool diminishes either as a natural occurrence of aging or due to genetic defect, FSH increases due to a diminishment of inhibin b. Inhibin b is produced in the granulose cells of the follicle.

Oocytes are one type of physical manifestation of congenital kidney essence. Congenital essence is nurtured and supported by acquired essence which is derived from gu qi. Gu qi is essence qi derived from the transportation and transformation of food which is accomplished via the joint action of the stomach and spleen.

Typically with depletion of the follicular pool comes reduction in oocyte quality with greater opportunities for chromosomal anomalies, i.e. trisomies, monosomies, etc. It is my contention that acupuncture and herbs cannot increase the follicular pool anymore than he shou wu can turn the hair black. As in any ancient system (martial arts for example) theory, speculation and myth must be separated from clinical reality. But, I do know from clinical experience that oocyte quality can be improved. This evidence is obtained from clinical pregnancies as a result of the utilization of acupuncture and herbs where pregnancy did not occur prior to intervention. This occurs within a cohort of patients without other mitigating factors, i.e., tubal damage, male factor, POF, etc.

Since oocytes are a physical manifestation of kidney essence and congenital essence is nurtured and nourished by acquired essence, it is always important to tonify spleen qi when trying to fortify the kidneys and benefit essence. To tonify essence alone using herbs such as ze he che, rou cong rong, shu di, lu rong, etc. is a mistake. Theses herbs must be a part of a formula that utilizes spleen qi tonics as well. This is known as treating ‘one step removed’. It’s similar to benefitting metal to augment water as opposed to treating ‘water’ directly. An interesting analogy is the concept of treating local, distal and adjacent points when treating with acupuncture; not just putting a needle in LI11 to treat elbow pain or stiffness. So, in a way, we must think about using local, adjacent and distal herbs conceptually. This makes for a more sophisticated, more balanced and more efficacious formula.

Qi tonifying herbs that go to the spleen and lungs are best to use as the lung is the mother of the kidney and the spleen tonifies the lungs and the spleen as mentioned previously creates acquired essence. Use herbs like shan yao, ren shen, dang shen, huang qi, etc.

Of course every case must be treated according to differential diagnosis and treatment principle. The above thoughts and ideas and merely those – thoughts and ideas on how the treatment of the kidney and spleen may in a sense, be appropriate in every case of advanced maternal age infertility where egg quality is suspect, regardless of the differential diagnosis. Another way to state this concept is: no matter what the differential diagnosis, treatment of the spleen and kidney should be included to improve oocyte quality.