Treating Infertility with Herbal Medicine

Herbal medicine has been used to treat internal disorders including infertility for thousands of years.

               

Practitioners of Chinese herbal medicine rarely use a single herb in treatment. Chinese herbs are formula based; many herbs are mixed together to create the perfect ‘concoction’ specifically designed for the individual patient.

Some formulae contain two herbs and some thirty or more herbs. Each herb has many functions. Each herb has its own flavor, nature, temperature and trophism.  Prescribing the right and the safe herbal medicinals requires training and clinical experience.  Herbal medicine is an extremely complex form of medicine which requires many years of arduous study and clinical experience to master. 

Self medicating with herbal medicine presents a dual dilemma. At best the herbs will be useless, as the key to correct formula prescription is an accurate differential diagnosis which can only be made by a licensed, board certified, experienced practitioner. At the worst case, self prescribing of herbal medicine may prove harmful or fatal.

A good example of this is Ma Huang/Ephedra.  Ma Huang is an herb prescribed on a daily basis by hundreds of TCM practitioners to thousands of patients safely. 

That several people have died as a result of taking Ma Huang has very little to do with the dangerous properties of the herb inasmuch as it has to do with individuals self-medicating.  Aspirin can prove fatal if taken by a hemophiliac.  This is not an indication that Aspirin should be banned or that it is a dangerous drug.   It is totally safe if used appropriately.

Herbal medicine is totally safe if prescribed by a knowledgeable expert. Not only is herbal medicine safe, it is highly effective in treating many pathologies without the concomitant harmful side-effects which often accompany pharmaceutical drugs.   There are greater than one million hospitalizations per year as a result of drug induced side-effects; not so with herbal medicine.

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Infertility

There are many causes of infertility which include but are not limited to elevated FSH levels, PCOS, endometriosis, luteal phase defect, hyperprolactinemia; pituitary adenoma, blocked tubes, uterine anomalies, sperm anomalies, stress, and, infertility which is diagnosed as idiopathic. 

Traditional Chinese Medicine has, for more than three thousand years, successfully treated infertility; and it still does so today.

Nancy is thirty-nine years old and she wants to compete as an Olympic triathalete; she is five feet in height and weighs three hundred and thirty pounds.  Can she compete?  Let’s see.  She asks her best friend, Alice, for a recommendation for a nutritionist. Alice raves about Teresa J., a fabulous nutritionist who “changed her life”. So Nancy makes an appointment with TJ and has a consultation. Nancy listens attentively to TJ, takes notes and leaves TJ’s office full of enthusiasm, commitment and motivation.

Starting the next day Nancy begins implementing the new dietary regimen which TJ has prescribed.  Next, Nancy joins a local health club, hires a personal trainer and works out three to four days per week.  Finally, Nancy joins a meditation group and meditates daily.

What happened?  In twelve months, Nancy lost one hundred and fifty pounds, put on solid muscle, developed a ‘six-pack’ abdomen and can run twenty-five miles per week. She is in the best condition of her life!  Can she now compete in the Olympics? Well, I’m afraid not. To be an Olympic athlete requires a life-time commitment of training and nutritional guidance.  Nancy has, however, become healthier, stronger and happier than ever before!   What if Nancy wanted to get her reproductive system in Olympic condition? 

The proper life-style counseling which includes nutritional changes and perhaps an exercise routine and acupuncture and herbal medicine can get a women’s reproductive system in the best possible condition that it can be in at the present moment.  Your TCM practitioner should be able not only to treat you with acupuncture and the appropriate herbal formula but should also give you guidance regarding diet, exercise and life-style changes which will positively impact your health.

Many women undergo three to five unsuccessful IVF procedures. Often these procedures are unsuccessful for the same reason that Nancy could not even begin to be athletic – overall poor health and specifically, poor reproductive health. 

Women who are over thirty years old need to get their reproductive system in the best condition possible to achieve pregnancy either naturally or via an A.R.T. procedure.

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As we grow older our circulation becomes less patent. In addition to the frequent complaint of cold hands and feet, another effect of inhibited blood flow is that the quantity of blood flow to the uterine lining, ovarian tubes and ovaries is less.  Acupuncture and herbal medicine have a stimulatory effect on the blood circulation.  An example of impeded blood circulation is blood clots in the menstruate. Though in and of itself, menstrual clotting may not be an issue, it does indicate a circulatory dysfunction which can be both a manifestation of an illness (circulatory inhibition) and the cause of an illness (blood stagnation [i.e., endometriosis], causing infertility).

Acupuncture and herbal medicine can be an important aspect of one’s healthcare routine, used to assist in achieving the goal of better health in general and better reproductive health in particular.

Under the care of a licensed and board certified acupuncturist/herbalist who is experienced in treating the infertile person there are no negative or dangerous side-effects associated with acupuncture or herbal medicine; there is only upside potential.   Using acupuncture and herbal medicine as part of the regimen to achieve a healthy reproductive system is a fertile idea.

Traditional Chinese Medicine

Although the goals of  Traditional Chinese Medicine (TCM) and allopathic medicine are the same, their ideas of etiology of disease, disease itself and the process used to regain health  are decidedly different.   The allopathic physician learns that disease must be cured by prescribing medicine which kills bacteria or renders a virus ineffective; at times surgical intervention is a necessity.

There is nothing inherently wrong with this approach. It often works.  The question worth exploring is why TCM succeeds when allopathic medicine fails? What is the mechanism of action of acupuncture and herbal medicine which results in palliation or cure that is not manifest in biomedicine?  It is through this exploration that the unique nature of TCM avails itself.

Though the goal of TCM is to cure a patient, the doctor of TCM attempts to do this not by treating the disease but rather by treating the whole person which takes into account the various attributes of an individual which, when combined, account for an individual being sick or healthy.  A person, according to the tenets of TCM is more than their pathology. To treat just the pathology may yield impressive though temporary results. 

People are not, according to TCM, represented solely by their illness, but by the accumulation of every human interaction engaged in from the moment of birth including the values of and the culture from which the individual develops. The emotional experiences, eating habits, work habits, work and living environment, personal habits and the social milieu are considerations which are important to fully comprehend for the deleterious effects they may have on the individual.

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Though the Western methodology of research of Chinese medicine has not, to date, been arrived at by the Western scientific community, the veracity and efficaciousness of this medical modality is nonetheless proved by its long history of continued success. More than a quarter of the world’s population regularly uses TCM as part of their health care regimen. Chinese medicine is the only form of classical medicine which is regularly and continuously used outside of its country of origin.

TCM is part science, empirical as that may be and part art. It’s practice is, to a greater or lesser degree interpreted and performed by based not only on the facts but also on the experience of the treating doctor. 

The experienced doctor must utilize his or her own interpretive skills, taking into consideration not only what the patient tells and shows, but also what they reveal without meaning too and, what they don’t express during the intake process. The empty spaces can contain more important information than the filled ones.  The tone of the voice, the complexion, the condition of the eyes, the facial expression, the overall demeanor, how one walks, sits, and stands are all observed and utilized by the doctor of Chinese medicine as part of the information required to arrive at a differential diagnosis.  In other words, even before the first words are spoken by the patient, the doctor already has some idea of who this person is.

The doctor must be able to note and sense inconsistencies in an individual that are expressed by the patient even without the patient being cognizant of the chasms which exist between what they verbally express and what their spiritual presentation divulges.

A great doctor is one who can process a mix of factual knowledge of medicine with a personal sensitivity based on experience.  The doctor of TCM specializes not just in inserting needles or prescribing herbal formulae but in being able to divine ‘hidden’ or subtle pathology which may not been seen or understood by practitioners of other types of medicine. In fact, a patient’s main complaint may be only one of several pathologies which are present though the patient herself is only aware of the one which is most important to her at the time of examination.  This ability of divination though quite difficult to master is ascertained without the benefit of modern technology; we rely on the  ‘Four Examinations’.

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This method of diagnosis dates back over three thousand years.  Observing, Listening and Smelling, Questioning and Palpating make up the ‘Four Examinations’. Listening and Smelling are considered to be one of the Four Examinations.  This method of diagnosis, though seemingly quite simple, is far from simplistic. It allows the astute practitioner to arrive at a differential diagnosis.  With the advent of technology, as amazing, necessary and beneficial as it is in relation to medical intervention, there seems to be a direct correlation between advancement in technological wonders with an increasing decrease in doctor sensitivity to the patient.  It is important to always remember that a patient is a person first!

Proper treatment in TCM is more than the elimination of pathological processes. In addition to attacking the pathological factor(s), it is the responsibility of the TCM doctor to support the individual in his or her goal of achieving overall total health which includes the physical-psycho-emotional and spiritual aspects of health.  This paradigmatic approach is an inexorable part of the process of healing. Without it, we are merely chasing the sickness and forgetting about the patient who, though a patient they may be must also be recognized first as a whole person, not just an embodiment of illness.

Pathologies are guests (and we hope temporary ones!) in a home which serves as a gracious host – our physical, emotional and spiritual selves.  TCM first is concerned with strengthening the immune function which includes homeostasis of the physical, emotional and spiritual attributes of the patient, so as to be able to assist the patient in his or her endeavor to do battle and destroy the enemy at the gates (or inside them).

Infertility and Acupuncture and Herbs

I was recently interviewed for Fran Meadosw wonderful blog. Here is the interview:




Do you have a personal experience that you would like to share with infertility?


When my wife and I were trying to conceive, we were not able to do so. I was not an acupuncturist at the time; I was a computer salesman. My wife went to Elaine Stern, a fantastic acupuncturist and herbalist for treatment. After three months of acupuncture and herbs, my wife became pregnant and subsequently gave birth to a healthy, beautiful baby boy. He’s still my baby even though he’s now eighteen years old!



Why did you choose the field of acupuncture and herbal medicine for reproductive disorders?


When I started out in acupuncture I treated pain. I had a woman come to my office for care. She wanted assistance in getting pregnant. I didn’t know what FSH or IUI or IVF meant. All I wanted to do was to treat her neck and back pain. I explained to this patient that I knew nothing about infertility or how to treat it. She had four IUI’s and two or three IVF’s; all resulting in negative outcomes. I promised her that I would do the research on how to treat infertility issues with acupuncture and herbs. Her issue was advanced maternal age. After two or three months of care with me, this patient became pregnant at forty-years of age and gave birth to a healthy, baby boy. I knew then that I was going to give up pain management and devote the rest of my professional life to learning Western and Chinese reproductive medicine so I could help couples start or grow their families.



Share with us how acupuncture and herbal medicine can help boost male fertility? Give us an example of treatments for a new male patient.


There are five key points to determining sperm health. The four most common parameters are volume which refers to the amount of sperm ejaculated, count, which refers to the amount of sperm in the ejaculate, morphology, which refers to the shape of the sperm and motility which refers to the ability of sperm to swim in a straight line. Other issues which are germane to sperm physiology are the amount of white blood cells in a given sample of sperm which may represent an infection, and sperm dna fragmentation which is the separation or breaking of DNA strands into pieces. A study showed a significant increase in miscarriage in patients with high DNA damage compared with those with low DNA damage.


Any deviation from the normal standards in these parameters can either lead to sub-fertility, infertility, or chronic miscarriage. Acupuncture and herbal medicine can often help to normalize sperms pathologies. Where there are genetic defects, for example a micro-deletion of the y chromosome which causes either reduced sperm (oligospermia) or no sperm (aspermia), acupuncture and herbal medicine cannot help. When there are structural abnormalities such as a congenital absence of the vas deferens acupuncture and herbs cannot help. Congenital bilateral absence of the vas deferens occurs in males when the tubes that carry sperm out of the testes (the vas deferens) fail to develop properly. Although the testes usually develop and function normally, sperm cannot be transported through the vas deferens to become part of semen. As a result, men with this condition are unable to father children (infertile) unless they use donor sperm. However, in the pathological states of low sperm count, poor motility, poor morphology, low volume and sperm dna fragmentation, with the cause being genetic or anatomical, acupuncture and herbs often help to remedy these pathological states.


The key effect of acupuncture and herbs on the health of sperm comes from their ability to increase blood flow to the testes and to increase the excretion of dead cellular debris from the testes. Blood carries nutrients, hormones, electrolytes and oxygen to the testes. This improves testicular function and health and often results in improved sperm parameters including count, volume, morphology, motility, and sperm dna fragmentation.


Sperm dna fragmentation is represented by percentages which look like this: 0-15% represent good fertility outcomes; 15-29% represents fair outcomes, and >29% represents infertility and/or chronic recurrent miscarriage. There are men who present with dna fragmentation levels above 50. Acupuncture and herbal medicine can often reduce sperm dna fragmentation levels to the normal range.

Do you work with both patients who are undergoing IUI or IVF as well as patients looking to go the more natural route?


Yes. Whether a patient is undergoing an IUI or IVF or trying to conceive naturally several things are required for pregnancy and live birth. They are: good eggs, good sperm, good endometrial quality and lack of a disease state that can mitigate fertility or contribute to miscarriage. No matter how many IUI’s or IVF’s are attempted, without high quality egg, sperm and lining and the absence of systemic pathology, either pregnancy will not occur or miscarriage will occur. The effect of acupuncture and herbal medicine for female factor infertility stemming from poor egg quality is the same as that for male factor which is to increase blood flow to the ovaries to facilitate the same effect as mentioned above. Acupuncture, via the release of beta-endorphins has a vasoldilatory effect and can frequently improve blood flow (hemodynamics) through the uterine artery which contributes to greater lining health. The uterine artery branches off and feeds the ovaries as well; this can often contribute to improved egg quality. Many diseases that can contribute to infertility and/or miscarriage should be treated with both Western and traditional Chinese medicine or, just Western medicine alone. Two examples are 1) hypothyroidism. Hypothyroidism can contribute to infertility. It is best treated by a Western reproductive endocrinologist with Synthroid. I see no place for acupuncture and herbs in this type of case. Another case where the patient may benefit from the intervention of both modalitities of care is endometriosis. For the purposes of this interview it is not possible to elucidate everything about endometriosis. Let’s just say that endometriosis is an inflammatory, autoimmune disease that affects fertility in many planes. The way endometriosis is addressed is typically via laparoscopic surgery. However, it is usually not possible to get all of the endometrial implants out during the surgery and the inclusion of herbal medicine can frequently reduce the remaining inflammatory state which can contribute to the facilitation of pregnancy and a live birth.


Regarding patients trying to conceive naturally, I won’t treat them unless they are seen and evaluated by a reproductive endocrinologist first. There is no way for me to determine if the patient has a uterine anomaly, blocked tubes, polycystic ovarian disease, endometriosis, autoimmune fertility dysregulators or male factor infertility. Therefore, treating a patient without them first having had an evaluation by a reproductive endocrinologist is irresponsible. Once the patient has had their evaluation, I can then determine if I think that they may benefit from acupuncture and herbs or, if they should have a surgery or if the reproductive endocrinologist, the patient and I should move forward in a team-oriented approach to care.


Tell us how most men that you treat react to starting a program of treatments for male factor?


Typically male patients are the most difficult to treat. As a result of the pressures on little boys to “take it like a man”, “be a man”, “be brave”, “don’t cry”, “don’t be a wimp”, etc, etc, men are less likely to seek care for any malady. Treatment flies in the face of their image of masculinity especially when it comes to treating sperm anomalies, as sperm, in many cases, for many men, represents their ‘manhood’. Another issue is that men complain that they “have no time for treatment” which, I suspect is a defense mechanism to avoid treatment due to the aforementioned reasons. It is too bad that many men have these insecurities. It is my view that these insecurities represent the damage that society has done to men based upon societies ill-informed definition of masculinity.

Have you experience men expressing themselves emotionally as most women do?

Never.

There is always a "great moment" - What is your moment when hearing of a pregnancy announcement and/or a successful birth under your care?


When my patient tells me that she is pregnant we often hug each other and cry together. This is a ‘great moment’!

Acupuncture After IVF?

Acupuncture should be continued after embryo transfer and confirmed pregnancy at the frequency of two times weekly for 13 weeks to help reduce the chances of 1st trimester miscarriage.

There are many causes of miscarriage. The most frequent cause is poor egg and/or sperm quality creating a chromosomally abnormal embryo. By order of natural selection and survival of the fittest, pregnancies that occur with these embryos frequently abort.

Another common cause of miscarriage is poor hemodynamics or blood flow. Strong blood flow is important throughout the entire pregnancy but poor blood flow at the beginning of a pregnancy often results in miscarriage as a result of initial lack of nutrient delivery to the implanted blastocyst and then, later on, lack of nutrient delivery to the placenta. Placentation typically occurs between weeks 5 and 9 during an on-going pregnancy.

The job of the placenta is two-fold: 1) to transport nourishment to the developing fetus; 2) to excrete waste matter from the developing fetus. If the placenta fails to maintain its functional integrity, a miscarriage will ensue. One of the reasons that placental demise occurs is because of poor blood-flow or inferior hemodynamics. Acupuncture improves blood-flow.

We know acupuncture improves blood-flow because when women have transvaginal ultrasound examinations with a color doppler before and after acupuncture treatment, there is frequently more blood available and visible at the level of the uterus after acupuncture intervention. A color doppler is a medical device which measures and visualizes blood flow.

The result of poor blood-flow to the placenta is intra-uterine-fetal-demise; the fetus stops developing and miscarriage manifests.

As 90 percent of miscarriages occur within the first trimester, I treat for 13 weeks or, one week past the first trimester to help ensure an on-going pregnancy. Of course there are 2nd and 3rd trimester miscarriages, but most miscarriages are first trimester events.

Based on the above data, it is, in my clinical estimation, important to continue to receive acupuncture after an embryo transfer and when pregnancy is confirmed to help reduce first trimester miscarriages.



@Mike Berkley, L.Ac.
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