Causes of Infertility in Chinese Medicine for Women and Men
Addressing infertility begins with healthy lifestyle practices including diet, stress management, abundant sleep, and abstaining from alcohol for both men and women; even a seemingly unrelated lifestyle choice such as men smoking up to a year before conception can have a negative impact on sperm, and therefor a negative impact on fertility efforts. There are several common patterns that can cause infertility that can be caused by one, or several, TCM energetic organ systems:
Kidney Deficiency and Infertility
Deficiency is often a key culprit in infertility, especially for women trying to conceive in her 30’s and 40’s. The concept of deficiency is not something that is not recognized in Western medicine, and therefor not addressed. Kidney Deficiency and Essence Deficiency are some of the most common patterns seen for women struggling with infertility. In Chinese medicine, the Kidney energetic organ system is responsible for successful reproduction, among other things. Sufficient Kidney Energy is also necessary in the prevention of miscarriages. It is restored using Kidney Tonic Formulas that are nutritive and restorative for the Kidney energetic organ system according to Chinese medicine.
Blood is Yin, and abundant Blood is necessary for not only healthy conception, but a successful pregnancy resulting in a birth. Additionally, estrogen is considered a Yin substance so fertility issues that have an element of estrogen imbalances would fall under Yin Deficiency; nevertheless, nourishing Yin will not cause estrogen dominance or the overproduction of estrogen. Symptoms of Yin Deficiency would include poor or limited cervical fluids, afternoon sweats, night sweats, hot flashes, or unusual thirst.
In men, seminal fluids would relate to Yin substances; both low sperm counts and poor morphology would be associated with Yin Deficiency. An additional symptom for men would be a strong sex drive but premature ejaculation. Consider our Organic Yin Valley formula!
Conception requires that Yin is nourished so that the egg has a rich layer of nourishing Blood in which to implant. Yin-Yang theory dictates that Yin and Yang are in a constant interplay where Yin transforms to Yang, and Yang then transforms in to Yin; this is a universal law that transcends all truths and can be applied to any physical disease or imbalance. In the case of women's reproduction, ovulation is the point when Yin transforms into Yang: nourishing Kidney Yang during the week before the ideal ovulation time can be beneficial. Women with coldness, hypothyroidism, and a history of
miscarriage are symptoms of Kidney Yang Deficiency. Progesterone is a Yang substance, and is pivotal during the first 3 months of pregnancy according to western medicine; likewise, Kidney Yang is necessary to "hold" a pregnancy in TCM. Men experience Kidney Yang Deficiency often as a lack of sexual energy, the inability to maintain an erection, or poor sperm motility.
The Liver Energy is responsible for menstrual blood, and is one of the main underlying causes of infertility, and more specifically, stagnation of Qi and Blood of the uterus. While Liver Qi Stagnation does not always manifest as a mechanical block that can be diagnosed it is often a factor in fallopian tube blocks, endometriosis, or fibroids. It is important that the Liver energy is soothed, as hormonal balancing is generally attributed Liver/Kidney organ systems in TCM. Consider our organic Free and Easy Wanderer formula!
Liver Yin Deficiency
The Kidney energetic organ system is the root of Yin energy, and Liver Yin Deficiency is naturally associated with Kidney Yin Deficiency. The Liver is part of the Wood Element in Chinese medicine. The Wood Element allows for life to manifest and spring forward. Blood is a Yin substance; the Liver stores the Blood that nourishes the uterus, so having healthy fertilized eggs depends on an abundance of Liver Yin/Blood. Stress consumes Yin, and a major stressor for women can be emotional constraints including suppressing emotional growth.
For men, Liver energetic organ system blocks are quite common in cases of ED, ejaculation issues, or poor sperm quality as the Liver channel traverses the testicles (as do the Spleen and Kidney meridians). A free flow of Qi and Blood are vital in producing viable sperm. Often men are expected to "perform" sexually because of the timing factors involved with fertility treatments; stress caused by these demands are made more difficult with Liver Qi imbalances. Sometimes men with pent up stress from Liver Qi Stagnation have the need to ejaculate often.
Stagnant Qi and Blood of the Lower Jiao and Infertility
In Chinese medicine, there is a functional organ system called the Triple Burner, or more specifically, the Triple Jiao; it has no comparable organ in western medicine. The uterus is located in the Lower Jiao, and the energy can be disrupted by a stagnation of Qi and Blood. Moving Qi and Blood and breaking up stagnation is vital in promoting conception, but would be contraindicated in a pregnancy. The Lower Jiao would include the uterus and fallopian tubes. Consider our organic Stasis in the Lower Palace formula!
Dampness Creating Stagnation of the Lower Jiao and Infertility
Infertility can also be attributed to Internal Dampness, another underlying cause of stagnation of the Lower Jiao. Internal Dampness is not recognized or addressed with western medicine, but can be addressed utilizing Chinese medicinal herbs. This condition is often seen with fibroids, PCOS, and endometriosis in women. Consider our Organic Restore the Middle Way formula!
Men are also afflicted with Dampness in the Lower Jiao; prostate issues are often complicated with Internal Dampness.
Herbs that move Blood and Qi in the uterus are combined with Spleen Qi tonics; Internal Dampness is tenacious and can lengthen the period of herb use.
Damp-Heat and Infertility
When Internal Dampness (TCM) is left unresolved, longstanding stagnation of fluids tend to heat up. When fluids heat up, they become thicker and more viscous. Conception depends on the free flow of fluids; thick cervical fluids inhibit the free flow of sperm in to the uterus; thick fluids or phlegm would also block eggs moving through fallopian tubes. Progesterone supplementation causes Damp-Heat in the Lower Jiao. Damp-Heat is often seen in recurring vaginal infections; bacterial of fungal. Eventually, pathogenic Internal Phlegm can block the fallopian tubes completely; this often contributes to unexplained infertility. Consuming large amounts of sugar and sweet foods would contribute to this condition.
For men, Damp-Heat would be indicated with UTIs, STDs, and prostatitis.
Essence Deficiency and Infertility
- Poor egg quality
- Cannot ovulate
- Poor sperm count and quality. It is very Important to re-enforce Essence in older men trying to create a family
- Never had much of a sexual drive
- Abnormalities in sexual organ development
Related article explaining the concept of Essence or Jing in Chinese medical theory linked here
PCOS and Infertility
PCOS is one of the main causes of infertility. Related article explaining Chinese medicine and PCOS linked here.
Stress and Infertility
Stress is a major contributing factor with ALL imbalances and disease processes according to Chinese medicine. In regards to infertility, we produce larger amounts of cortisol than are optimally required. High levels of cortisol interfere with other essential hormones, and can result in insulin resistance, estrogen imbalance, progesterone deficiencies, and even testosterone fluctuations. Related article on managing stress with Chinese medicine linked here.
Immune Imbalances and Infertility
Autoimmune disorders can be a major underlying factor in infertility and normalizing the immune system is vital in successfully addressing infertility successfully. One possible way that an imbalances immune system can work against conception is when the body begins to identify the fertilized egg as a foreign pathogen and it is attacked by protective killer cells. Related article on immune normalizing strategies linked here.
Chinese Herbs for Improved Chances of Conception
Chinese medicine is successful in increasing a woman’s chance to conceive in several ways. First, ovulatory issues can also be addressed with Chinese medicinal herb formulas as they can balance hormones when ovarian failure is due to hormonal issues. Chinese herb formulas are especially helpful for older women who have mysterious unknown causes of infertility. Chinese herbs can also address structural issues leading to infertility such as scar tissue blockage in the fallopian tube, fibroids in the uterus, or endometriosis in women. For men, Chinese herbs are used to increase sperm counts and improve the motility of sperm for improved rates of conception.
There are a couple of advantages to using traditional Chinese herb medicine as an approach to improving fertility:
- Chinese herbal therapy stimulates the body’s natural healing potential by treating root causes rather than just the symptoms
- Chinese herbs decrease undesired side effects and accumulated toxicity
Why are herbs only taken in the 1st half of the cycle for women?
They actually can be used during the whole cycle if reliable birth control methods are being used. Herbs that move Blood and resolve Qi (chi) stagnation involved with infertility are taken during the first half of the menstrual cycle (follicular phase begins the 1st day of menstruation and ends after 14 days). Restricting herb use to the first half of the menstrual cycle is important for women trying to conceive, or who are not actively utilizing birth control and are self-prescribing. Because ovulation typically occurs in the middle of the cycle, there is a possibility that conception has taken place after the 14th day generally. Herbs that move Blood and Qi vigorously would be undesirable upon conception, but may be vital in preparing the uterus for conception. This is why herbs are not taken in the second half of the cycle for those actively trying to conceive. It must be noted that it would be better to use a barrier type birth control for 4-8 months full time to prepare the body not only to conceive, but to successfully carry to pregnancy full term. Taking the herbs half of the time will be less than half as effective.
Important: We recommend that women discontinue the use of herbs once they have become pregnant, unless under the care of a qualified herbalist (RH AHG) or an acupuncturist trained in herbs. It is best to take 4-8 months to prepare for pregnancy utilizing the herbs full time if at all possible while preventing conception; this can take some convincing for many, as many women feel that the clock is ticking, or they have grown impatient. However, most women who have trouble conceiving have some level of Kidney Deficiency, and are more susceptible to miscarriage. A miscarriage sets back progress tremendously and can have an emotional impact also. The disadvantage in attempting to reinforce the body while trying to become pregnant is that you lose the whole second half of the month for many treatment options and the progress is so much slower (likely up to a year). Being able to take herbs throughout the cycle for 6 or more months gives the mother to be the strength and organ balance to help hold a pregnancy.
Some Fertility Supplements and Infertility
Important supplement for both men and women:
- CoQ10 for egg maturation (Yang supplement-contraindicated with Yin Deficiency Heat)
- Omega 3 can be from flax seed or from fish oils (krill best)
- Vitamin D
Important supplements for women:
- Folic acid (women)
- Vitamin C helps to facility ovulation and is important for implantation
- L-arginine (Yang Hot supplement-contraindicated with Yin Deficient Heat)
- Beta Carotene
Important supplements for men:
- Vitamin E assists with the sperm penetrating the egg shell
ART and Chinese Herbal Therapy for Women-It is not either/or!
The goals in western medicine and Chinese medicine have different treatment goals and approaches when addressing conception. Chinese medicine is interested in promoting the quality of eggs, normalizing hormones, and nourishing the endometrial tissue; this is a process leading to a successful pregnancy and live birth. Western medicine is more focused on an event and the goal is to have a successful conception that hopefully leads to a successful pregnancy.
Because Chinese medicine focuses on nourishing and balancing the body, it is necessary to take time to facilitate these changes. The length of herbal therapy depends upon the level of imbalance and length of time that these imblances have been present. The fact that full blown infertility has developed tends to suggest long-standing chronic deficiencies and imbalances. Most women suffering with infertility require at least 6-8 months of herbal therapy to impact fertility outcomes.
Although the approach is different, the two work well together. Although a couple may determine that a natural conception may not be possible for them and intervention is necessary, having healthy sperm, healthy eggs, and a nourished womb is going to improve the chances of producing a live healthy baby; in this way, Chinese herbal therapy can be the difference between success and failure. Many couples looking to IVF or IUI are facing a closing window of opportunity due to age; therefore, making the best effort is vital, and taking some time to prepare is smart.
When women are working to stimulate with Clomidin or Femara, it is best to discontinue herbs for the 5 days of treatment unless under the care of a qualified Chinese medical practitioner trained in herbal medicine. The exception to this may be Liver soothing herbs as these fertility medications can tax the Liver; Clomidin specifically produces many uncomfortable symptoms of Liver Qi Stagnation and the addition of Free and Easy Wanderer can make the process less stressful with fewer symptoms.
BBT Charting and Chinese Medicine
Basil Body Temperature (BBT) charting can be an invaluable tool for women trying to conceive. These patterns are relative to optimal BBT's. As with all disease patterns and imbalances in Chinese medicine, a "pattern" of imbalance must be established pulling together many different symptoms; these correlations would only be one clue in determining underlying imbalances and the articles on organ level imbalances-TCM should be perused before coming to a conclusion.
Follicular Phase Imbalances and TCM
- Low temperature during follicular phase indicates Kidney Deficiency
- A long follicular phase can indicate Yin Deficiency, Yang Deficiency, Essence Deficiency or Blood Deficiency.
- A short follicular phase and/or incomplete follicular development can indicate Kidney Yin Deficiency and possibly Deficient Heat.
- High temperatures during the follicular phase can indicate Blood Stasis; an example would be endometriosis.
- Follicular phases that fluctuates and are unstable likely indicate Liver Qi Stagnation (likely contributing to Heart Blood Stagnation).
Luteal Phase Imbalances and TCM
- When temperatures are slow to rise during the luteal phase it indicates that Yin is not transforming into Yang during this important transition; this suggests simply Yang Deficiency, but could also indicate insufficient Yin. There could also be a lack of Spleen Qi available to help spark life and Qi is a Yang substance, as is progesterone.
- Short luteal phases with low temperatures are likely due to Kidney Yang Deficiency. In these situations, hypothyroidism may be suspected.
- If temperatures rise and fall throughout the luteal (sometimes referred to as saw tooth or saddle luteal imbalance) can be attributed to Kidney Yang Deficiency, Spleen Qi Deficiency, Liver Qi Stagnation, and/or Blood Stagnation; an example may include fibroids.
Ovulation Issues and Chinese Medicine
- Primary ovarian failure is an indication of Essence (or Jing) Deficiency; Essence can be re-enforced through herbal therapy.
- Premature menopause can indicate Kidney Yang Deficiency or Essence Deficiency.
- Women who exercise too heavily, have eating disorders, or who have experienced extreme stress can develop amenorrhea and hypothalamic anovulation; this is an indication of Blood Deficiency.
- After women discontinue the birth control pill, it may take up to a year to ovulate regularly again. In general, hormonal birth control pills cause Liver Qi Stagnation; herbs that soothe Liver Qi will help to speed this process up.
Four Phase Chinese Herbal Treatment for Infertility for Acupuncture Practitioners
Imbalances and deficiencies leading to infertility are typically issues that have been developing over many years and are not resolved quickly. Before practitioners utilize the Four Phase Method of treating infertility, it is very likely that tonic herb formulas will be used for 4-8 months to address root imbalances before this phase method will have a great impact. While we at Ageless Herbs do not advocate using herbs for self-treatment during pregnancy, this is an example of a strategy that your licensed acupuncture practitioner may implement.
Phase 1 Herbal Therapy Goals and Strategies
This would include the first day of menstruation generally through day 4. The goal is to insure that all impurities are cleared from the uterus and ready the uterine wall for implantation by clearing out all Blood and tissue.
Herbal strategies in Phase 1: Move Blood and break up stagnation; nourish Blood
Phase 2 Herbal Therapy Goals and Strategies
After menstruation the goal is to help build endometrium and ripen follicles. This would also be an important time to Calm the Mind.
Herbal strategy in Phase 2: Nourish Yin and Blood; calm the spirit
Phase 3 Herbal Therapy Goals and Strategies
During the few days of ovulation, the goal is to stimulate a productive ovulatory phase by encouraging the transformative phase from Yin to Yang, and facilitate the successful passage of the egg down the fallopian tube by clearing the passage of Phlegm.
Herbal strategy in Phase 3: Move Qi and regulate Blood; tonify Yang (lightly apply Yang tonic)
Phase 4 Herbal Therapy Goals and Strategies
The strategy after ovulation is to support an implantation by re-enforcing Kidney Yang and the ability to "hold" the pregnancy, and to regulate the Qi. This is a time that Deficient Heat is drained, but this can cause complications and would be better addressed before conception is attempted.
Herbal strategies in Phase 4: Support the Yang (progesterone is a Yang substance in TCM); calm the mind; and regulate Qi and Blood
*Phases 1-4: Nourish Essence
Miscarriage and Chinese Medicine
Repeated miscarriages will further deplete Kidney energies and cause deepening Blood Stagnation. Simply conceiving will not insure the birth of a live baby. It is very important that a woman has prepared her body for pregnancy before attempting the Four Phase Herbal Strategy with infertility. One of the most compelling arguments for taking the time to bring your body in to balance is that you will need a whole lot of energy to care for a baby and then run after a toddler. Often, the main focus with infertility is pregnancy; there is so much to consider beyond conception, and being healthy and vital so that you are able to properly care for your children should come first.
TCM Causes of Miscarriage
- Kidney Yang Deficiency
- Blood Stagnation in the Lower Jiao
- Spleen Qi Deficiency not "holding"
- Damp-Heat in the Lower Jiao
- Heat in the Blood
Women experience an emotional roller coaster ride when addressing infertility; there is often ongoing highs of hope, and lows of disappointment. This aspect of infertility causes emotional stress and Shen imbalances; it is important to calm the Mind and soothe the Heart in long-standing infertility.
TCM Research and Fertility
Modern researchers have confirmed Chinese medicine’s benefits in promoting fertility in the following areas:
- Regulating menstrual cycles
- Invigorate sperm. Enhance a man's sperm count, morphology and motility
- Enhancing general health and wellness
- Reducing stress, controlling anxiety, enhancing sleep and increasing energy level
- Balancing the endocrine system
- Improving blood flow in pelvic cavity
- Increasing the chance of pregnancy for women undergoing in-vitro fertilization (IVF)
Herbal medicine works more quickly for people who have a functional, rather than structural reason for infertility. Infertility due to hormonal problems, immune disorders, amenorrhea, irregular menstruation, stress and age related factors all fall into the category of functional infertility. Structural issues that are more difficult and/or time consuming to addressing naturally would include uterine fibroids, endometriosis, blocked fallopian tubes, and PCOS. Stress can dramatically decrease fertility in both men and women. Herbal therapy increases fertility by reducing stress and increasing the flow of Qi and Blood to the reproductive organs for both men and women.