Infertility in Women
Definition
Western
Generally, infertility is defined as not being able to conceive after inhabiting together for at least a year with unprotected sexual intercourse. Infertility is also further defined as not being able to conceive at all or not being able to conceive again after the first birth. Both the male and female play important roles in infertility, though in some cases, the cause remains unknown. Experiencing infertility can also bring on a range of painful emotions in one or both members of the couple.
Traditional Chinese Medicine (TCM)
In TCM, emotions play a crucial part in infertility in both men and women, especially to those medically unexplained cases. As the human body is a piece of holistic machinery, its physiological processes in the body are sometimes affected by the individual’s fluctuating emotions, such as chronic depression or low self-esteem. Even living in different environment may decrease the chance of success in conceiving, e.g. stressful working environment, relationship burdens or even changes in the climate. These factors can impact on the loss of certain essential fluids in the body, as well as affecting the energy levels in which the body processes rely on to stay at their tiptop conditions.
Classifications in TCM Context
Relating to the Kidney System
In TCM, the Kidney system is also involved in successful human reproduction, apart from its role in water metabolism. It governs two vital issues, mainly the materialised essence (i.e. sperm, egg and suspended bodily fluids), and the energy required for the respective cells to grow and develop into mature eggs to facilitate fertilisation when met with healthy sperms. In order for the foetus to grow into full term, a healthy uterus is crucial. Disturbances in the Kidney System may cause menstrual irregularities, hence affecting the release of potential eggs required for fertilisation. Common symptoms displayed include unable to conceive after years of unprotected intercourse, irregular menstruation, little or absence of pale-coloured menstrual discharge, lower back pain, weak knees, pale complexion, dizzy spells, ringing in the ears, fatigue, cold limbs, pale tongue and weak pulse.
Relating to the Liver System
The Liver System is important in supporting the blood production in the body, as well as ensuring the physiological development of the female reproductive organs. It also helps individuals cope with daily stress and keep it under control. When one overworks or constantly loses control of temper or emotions, the vital organs in the body will be thrown out of balance in attempt to cope with these unexpected changes. Common symptoms displayed include infertile for years with unexplained reasons, chest tightness, easily irritable or angry, unexpected mood swings, tender or painful breasts, pain experienced in lower abdominal region or sides of the body during menstruation or dark spots can be seen along sides of tongue.
Relating to the Spleen System
Healthy physiological functions of the Spleen System are brought upon by the types of food consumed and the way they are consumed. When the body is not able to absorb the essential nutrients as required for its growth, the functioning of the vital organs within the body would be greatly affected. Common symptoms displayed include infertile for years, lack of appetite, constantly feeling bloated in the abdominal region, occasional loose stools, fatigue, pale complexion, irregular or delayed menstruation, little or absence of pale-coloured menstrual discharge, pale tongue and weak pulse.
Causes & Risk Factors
Disorders in the Female Reproductive Organs
· Fail to release healthy mature eggs during ovulation
· Growths or masses [3] at inappropriate locations in female reproductive system
· Blockages of fallopian tubes [4] or changes in the shape of the uterus
· Hormonal imbalance triggered by the ovaries, e.g. PCOS [5], irregular periods
· Congenialities or genetic abnormalities [7]
Pathological Processes within the Female Reproductive Organs
· Includes inflammations observed at vagina, cervix, wall of uterus or pelvic region. These inflammatory processes may alter the structure of the uterine wall or causes blockages of the fallopian tubes, hence causing infertility.
· Endometriosis[6]is the process whereby there is abnormal growth of endometrial cells outside the uterus. Most commonly found on the ovaries, fallopian tubes, outer surfaces of the uterus, vagina, cervix, bladder or intestines.
· Polycystic Ovarian Syndrome (PCOS) [5] is a hormonal disorder wherewomen have the condition of having multiple small cysts in each of their ovaries. PCOS occurs when there is an imbalance of hormones in the female body and this is one of the most common causes of infertility in women. Symptoms may begin in adolescence with irregular menstruation. Women of all races may be affected.
Hereditary & Lifestyle Factors
· Weak immunity or unknown resistance during fertilisation
· Chronic obesity or being overweight [8]
· Malnutrition or severely under weight
· Late marriages or delayed pregnancy [17]
· Emotional factors [9-11], such as stress, depression or lack of self confidence
· Heavy use of alcohol, cigarettes or recreational and prescription drugs such as marijuana or cocaine
Treatments
Herbs commonly used in prescriptions:
1. Dang Gui – 当归
|
English/ Common name
|
Female Ginseng, Dongguai
|
|
Latin species
|
Angelica sinensis (Oliv.) Diels [12-14]
|
|
Park of plant used
|
Roots
|
|
Action/s
|
Helps to boost functions of blood, relieve menstrual related pain. Also used to ease constipation.
|
|
Precaution/s
|
People with chronic diarrhoea should consume with caution.
|
2. Ba Ji Tian – 巴戟天
|
English/ Common name
|
Morindae Officinalis Radix
|
|
Latin species
|
Morinda officinalis How [15-16]
|
|
Park of plant used
|
Roots
|
|
Action/s
|
Used in individuals suffering from infertility for a prolonged period of time, frequent or monthly discomforts, body pains or weak joints.
|
|
Precaution/s
|
Those who keep regular late nights or working night shifts are to be consumed with caution.
|
3. Shu Di Huang – 熟地黄
|
English/ Common name
|
Rehmanniae Radix Praeparata
|
|
Latin species
|
Rehmannia glutinosa Libosch. [18-19]
|
|
Park of plant used
|
Processed underground stems
|
|
Action/s
|
Helps to relieve accumulated heat from the body by boosting bodily fluids and immunity.
|
|
Precaution/s
|
For individuals with weak digestion, water retention, abdominal fullness or diarrhoea.
|
4. Huang Qi – 黄芪
|
English/ Common name
|
Chinese Astragalus
|
|
Latin species
|
Astragalus memeranaceus (Fisch.) Bge. var. mongholicus (Bge.) Hsiao or A. memeranaceus (Fisch.) Bge. [20-23]
|
|
Park of plant used
|
Roots
|
|
Action/s
|
Helps to boost immunity and aids digestion.
|
|
Precaution/s
|
No significant side effects. If unsure, consult a practitioner before consumption.
|
5. Nü Zhen Zi – 女贞子
|
English/ Common name
|
Ligustri Lucidi Fructus
|
|
Latin species
|
Ligustrum lucidum Ait. [24-25]
|
|
Park of plant used
|
Fruit
|
|
Action/s
|
Used to treat weak kidney or liver functions, dizzy spells, ringing in the ears, sore lower back, weak knees, premature hair greying, blurred vision, constant thirst, or hot flushes in the late afternoon or night.
|
|
Precaution/s
|
Individuals suffering from diarrhoea should consume with caution.
|
Test & Diagnosis
At Home
· Basal body temperature (BBT) can be measured using a thermometer to help predict the fertile days in the woman's monthly menstrual cycle, to help recognise the best timing for sexual activities.
· Self-examination of vaginal discharge can also be practiced to complement BBT in predicting the female’s fertile period. The discharge is clear, thin, slippery but sticky (can be stretched to about 2 to 3 inches long). This also indicates that ovulation is about to happen.
· Ovulation DIY Kits can be purchased conveniently at pharmacies or medical stores. These tests are able to detect increased levels of the luteinising hormone (LH) present in the urine which occurred 1-2 days before ovulation.
Laboratory Tests
· Blood tests to measure levels of various hormones (as below) to determine the actual cause/s of infertility:
- Luteinising hormone (LH)
- Follicle-stimulating hormone (FSH)
- Prolactin (PRL)
- Estradiol
- Progesterone
- Oestrogen
· Postcoital test is commonly used to observe the cervical mucus using microscopic observation which in turn detects its ability in filtering bacteria and enhancing the survival of the sperm cells.
· Imaging procedures
Commonly used to determine physical irregularities may prevent successful fertilisation or sustaining normal pregnancies. These include fibre-optic endoscopy, x-rays and ultrasound sonograms to visualise anatomic defects, abnormal growths, scarring or infections in the uterus.
Home Remedies
Dang Gui + Nü Zhen Zi + Huang Qi + choice of meat
a) Put all ingredients in a cooking pot and pour enough water to fill half the pot.
b) Bring to boil for 10 minutes.
c) Simmer for a further 40 minutes.
d) Remove from heat. Best serve warm.
References
|
7. Jin Liang Zhu, Olga Basso, Carsten Obel, Camilla Bille, Jørn Olsen. Infertility, infertility treatment, and congenital malformations: Danish national birth cohort. BMJ 2006;333(7570):pp679.
9. L. Schmidt, B.E. Holstein, U. Christensen, J. Boivin. Communication and coping as predictors of fertility problem stress: cohort study of 816 participants who did not achieve a delivery after 12 months of fertility treatment. Human Reproduction 2005 20(11):pp3248-3256.
10. Boivin, Jacky, Lancastle, Deborah. Medical waiting periods: imminence, emotions and coping. Women's Health (Jan 2010), 6(1): pp59-69.
13. Clara Circosta, Rita De Pasquale, Dora R. Palumbo, Stefania Samperi, Francesco Occhiuto. Estrogenic activity of standardized extract of Angelica sinensis.Phytotherapy Research (Aug 2006), 20(8), pp665-669.
15. Lian Fang, Wang Yu-dong, Zhang Ning. Progress in study on shen-invigorating herbs used in promoting follicular development. Chinese Journal of Integrative Medicine (2003), 9(1): pp76-78.
16. Jue Zhou, Fan Qu.Treating Gynaecological Disorders with Traditional Chinese Medicine: A Review. Afr J Tradit Complement Altern Med. 2009; 6(4): 494–517.
17. Inga Heese. The ‘egg factor’: Using Chinese herbal medicine to improve fertility in a 45-year old woman. Journal of Chinese Medicine (Oct 2006), 82:pp36-41.
19. WHO monographs on selected medicinal plants.Volume 3.Plants, Medicinal. 2. Angiosperms. 3. Medicine, Traditional. I. WHO Consultation on Selected Medicinal Plants (3rd: 2001: Ottawa, Ont.) II. World Health Organization. . Article can also be found at: http://apps.who.int/medicinedocs/index/assoc/s14213e/s14213e.pdf.
21. Sun Hao and Wang Zhaobao. Effects on exercise endurance capacity and antioxidant properties of astragalus membranaceus polysaccharides (APS). Journal of Medicinal Plants Research (May 2010), 4(10):pp982-986.
23. Chen KT, Su CH, Hsin LH, et al. Reducing fatigue of athletes following oral administration of huangqi jianzhong tang. Acta Pharmacol Sin 2002 Aug;23(8):pp757-61.
24. Yan Zhanga, Mansau Wongb, Chunfu Wu. Anti-osteoporotic Effects of Medicinal Herbs and their Mechanisms of Action. Asian Journal of Traditional Medicines, 2006, 1(3-4), pp1-7.
26. Xia Rong. Treating Infertility using TCM. 2005. Candid Creation Publishing LLP.
|