Chinese Medicine and Fertility 1:
Chinese Medicine perspective on fertility
Registered Chinese Medicine Practitioner
PhD, Li Ka Shing Faculty of Medicine (HKU)
MChinMed Acupuncture, BChinMed (HKU)
WHO defined infertility as “the failure to achieve clinical pregnancy after 12 months or more of regular unprotected sexual intercourse”, and the condition affects an estimated 15% of couples globally, amounting to 48.5 million couples.  Despite female factors being more predominant, infertility is not solely a women’s problem. About 30% of infertility cases are caused by male factors alone, and up to 30% of cases involve problems with both partners.
Male infertility is mainly caused by the sub-optimal sperm parameters. It may be one or a combination of low sperm concentration, poor sperm motility, or abnormal morphology. Common factors identified in female infertility includes a) disruption of ovarian function, b) tubal or other blockage and c) sub-optimal uterine condition. Many researchers believe that the declining male fertility during this century is mainly caused by environmental pollution, while age and general health issues are the major underlying reasons for female infertility.
Age related infertility
Age-related infertility becomes more common as more women choose to wait until their 30s to begin their families. Although our life expectancy increase, the improved health in later life does not affect the natural age-related decline in fertility. Women’s fertility begins to drop in late 20s or early 30s and falls more rapidly after the age of 35. This is mainly attributed to the progressive decline of the number and quality of eggs. The age-related decline in fertility is also accompanied by asignificant increase in the rates of aneuploidy (the presence of an abnormal number of chromosomes in a cell) and spontaneous abortion. Various diseases and conditions like tubal disease, endometriosis and ovarian cysts also increase with age and adversely affect women’s ability to carry a pregnancy to term.
Facing fertility challenges, more couples in the recent years turn to complementary and alternative medicines for support of their natural conception and improving the outcome of their fertility treatment and/or mental health during fertility treatment. Among all alternative treatments, it is reported in a recent review that acupuncture has the highest level of evidence for its use in improving fertility outcomes.  In this blog, we will discuss and elaborate Traditional Chinese Medicine perspective on fertility and our approach in tackling the sub-fertility conditions. In the subsequent issues, we will further discuss how acupuncture, herbal medicine, and moxibustion help to increase the odds of natural conception, boost the general uterus health, and support the Assisted Reproductive Technology like IVF.
Source: https://www.fertilityiq.com/ivf-in-vitro fertilization/summary-of-the-ivf-process
Chinese Medicine view on infertility
Traditional Chinese Medicine stresses that humans are a part of nature, and are subject to natural law of balance and harmony. Life is sustained when the body's physical forms (yin) and its functions (yang) are dynamically balanced, which is also referred as the yin-yang balance. When it comes to reproduction, the kidney system in Chinese Medicine concept plays the most important role. The kidney yin essence govern the production of egg and sperm; the yang qi in the kidney provide the vital energy that move the sperm and egg and allow natural conception. Apart from the kidney system, the Chong and Ren meridians also play a part, as the Chong meridian regulate menstruation cycle and Ren median are involved in creating and sustaining a pregnancy. Hence, deficiencies of the kidney system, disharmonies found in Chong meridian, Ren meridians, or Qi and Blood could all have a negative impact on fertility.
According to Chinese Medicine classic The Yellow Emperor's Classic of Internal Medicine, Kidney Qi governs the growth and development of human beings, the rise and fall of Kidney Qi of women was described as a process that changes according to a seven- year interval. The Kidney Qi peaks at age 28 (the 4th seven-year period) for women, which also marked the most fertile period for women. In line with the modern medicine’s point of view, the fecundity rate dips progressively once the women reach the age of 35 (the 5th seven year period). Apart from the natural decline of fecundity rate due to age, all other causes of infertility have been summarized in another Chinese Medicine classic Essential Prescriptions from the Golden Cabinet into 3 areas
a) Deficiency syndrome （虛)
b) Accumulated coldness（積冷） &
c) Qi stagnation （結氣）
Deficiencies of kidney, liver and spleen system are most closely related to infertility. Kidney store the innate essence that govern fertility, the early depletion of the essence could lead to disorders like Primary Ovarian Insufficiency and irregular ovulation. The Yang qi in the kidney system provide energy for all reproduction related functions and help regulate the menstrual cycle while kidney yin regulates hormone and blood, both are essential to form a healthy uterine lining. Deficiency of Spleen and Liver system could lead to deficiency in overall Qi and Blood. These deficiencies could be congenital or acquired due to unhealthy environment and personal habits. Life stress and diseases could also induce the deficiencies.
Although body constitution and other innate reasons cause the coldness in the body, most of the coldness accumulated in the uterus system is acquired due to personal habits and environment exposures. Living in cold place, over exposed to air conditioning or frequent exposure to excessive dampness during menstrual cycle, fond of drinking ice-cold drinks could all lead to accumulating the coldness. Cold uterus not only causes the wrong temperature for the embryo to grow, like a seed growing in cold weather, but also inhibits uterine blood circulation.
Liver Qi is largely responsible for the movement of Qi through the entire body and the free flow of blood which nourish the body. Apart from physical reasons, life stress and emotional imbalance can cause stagnation of Qi in the liver system while the Qi stagnation can also induce emotional imbalance and stress, forming a vicious cycle. Obstruction of Liver Qi impede the free flow of blood to the uterus, limiting the lining (endometrium) formation. The obstruction could also lead to blood and phlegm stasis in the uterus and cause fibroids and cysts. Besides, obstruction of Qi flow in liver meridian could affect egg development in the ovaries and block the fallopian tubes.
Chinese Medicine approach in treating infertility
Traditional Chinese Medicine views health as a state of Yin and Yang balance and dynamic balance among all the visceral systems of the body. Fertility is a reflection of the rise of fall of Kidney Qi and also the general health of women. For a healthy woman, regular menstrual cycle should start at puberty and continue til a couple of years prior to menopause. During this period, women are fertile despite the fecundity rate may vary according to age and physical condition. Any irregularity in the menstrual cycle, including the pre-menstrual syndrome(PMS), menstrual or ovulation pain, and sub-optimal menstrual blood quality are all good indicators of women’s imbalance of the visceral systems and/or deficiency in Qi, blood, yin and yang.
To enhance natural fertility, Traditional Chinese Medicine puts a lot of emphasis in regulating women’s menstruation. In the long history of treating infertility, Chinese Medicine has accumulated a lot of experience in dealing with different causes and patterns of menstrual irregularity, including Amenorrhea (abnormal absence of menstruation); absence of ovulation, too long or too short of the cycle and irregular blood volume. Herbal medicine is normally used to tonify the kidney qi and any deficiency of the concerned visceral systems, replenish the essence and blood which are crucial in forming a healthy uterus lining, and nourish the Chong and Ren meridians so as to enhance the total health of the ovaries and uterus. When other pathogenic factors like accumulated phlegm and blood stasis exist, acupuncture and moxibustion is usually used to warm up the uterus system, remove the obstruction and move the qi flow in the related meridians. Physical, mental and emotional wellbeing all play an important role in boosting fertility. Acupuncture also serve to balance the emotion and reduce the anxiousness and stress of the patient, which will in turn enhance the treatments’ efficacy.
Chinese Medicine can also improve the sperm count and motility by boosting the overall health and enhancing the Qi and blood of the male. To enhance or modify the body constitution normally take 3-6 months. The improvement of the female will be reflected in the normalization of menstrual cycle together with an improvement on the general health. Patients who suffered from endometriosis may find the pain during ovulation or before menstruation greatly reduced, patients who suffered from PCOS may find their ovulation become more regular. For patient who choose not to take any herbal medicine, moxibustion will be used to warm up the uterus and ovaries, and enhancing the Qi and blood flow. In the next issue, we will discussed in further detail on how Chinese Medicine herbal medicine enhancing the natural fertility of women who suffered from various conditions.