Microsoft word - treatment of infertilit1.doc
TREATMENT OF INFERTILITY
An Integrative Approach
José Choy, MD; Natália R. Cordeiro, PhD.
Associação Portuguesa de Acupunctura e Disciplinas Associadas
Infertility is a new emerging problem in modern societies. Since II World War, History
has been changing the meaning of reproductive success, enhancing the value of
procreation in industrialized countries. Benediction
has taken the place of the old curse
Both Scientific Medicine and Traditional Chinese Medicine are effectively responding
to the new needs of nowadays families, using their own particular philosophical bases
In this paper the authors report their clinical experience of treating infertility using the
principles from the two sides of the border
, trying to promote an integrative perspective.
At last, reflecting about three case studies, they reach the conclusion that the problem
can be managed by the generalist TCM practitioner if clinical sense and sensibility are
Infertility seems to be a timeless problem, affecting mankind from the beginning of the
human origin. However, its value has been increased after the II World War by the huge
dimension of casualties and destruction occurred during the colossal conflict.
Contraceptive methods, all born in the XX century, have been giving, as well, their
contribution to the enhancing meaning of reproductive success, allowing couples an
The scientific approach has created new visions to this problem and also new solutions
supported by new coming technologies: the Assisted Reproduction Methods.
Accordingly, TCM is revealing ancient methods to the western world, showing and
Synergic convergence of this two approaches is emerging as a promising perspective.
The authors believe that in the west the future begins on the edge of this intimate
Industrial chemical pollution. Radiation. Reduced ozone layer can lead to increased
radiation exposure at ground level. Flying personnel are more exposed to cosmic
radiation and studies revealed the increased number of infertility and cancer cases in
Drugs such as cytostatics, antibiotics (quinolones, tetracycline, cloranfenicol), anabolic
Life style: Sexual activity is beginning earlier in life. The increasing partners number
and intercourse rate is promoting infertility causes such as immunity against sperm cells
and sperm compounds, mechanical resistance or obstruction due to infection, abortion,
and longer hormonal contraceptive intake.
Stress and restless life style as a consequence of the increasing professional and family
responsibility can reduce sexual intercourse frequency in regular couples, making
Automotive traveling, impact sports practice, can reduce the probability of uterine
implantation of new coming fertilized eggs.
Causes affecting male fertility: oligoastenospermia, azoospermia. Obstruction of sperm
conductive system caused by tuberculosis or venereal diseases. Functional
irregularities due to prostate surgery or backward ejaculation. Genetic irregularities
inhibiting the possibility of progeny. Chromosome dislocations and irregularities on
Causes affecting female fertility: Dysfunction on the axis Hypothalamus – Hypophysis
– Ovary, non ovulate cycles, amenorrhea. Fallopian tube obstruction or ablation .
Uterine adherences caused by tuberculosis or pelvic infection. Fallopian tube pregnancy
conditioning secondary infertility. Endometriosis. Antibodies against sperm. Genetic
irregularities which the woman might carry or irregularities on the meiosis of the
produced gametes, which are the same referred to man case.
DIFFERENT ASPECTS OF THE PROBLEM:
Primary infertility: Couples who had never had children until the moment they ask for
Secondary infertility: Couples who have already had at least one successful pregnancy
and now come to the fertility consultation due to the difficulty in getting another one.
The study and follow up of the latest unveils a third category for the problem: Sub –
fertility (or border line
infertility), that is to say, couples lightly affected, by general or
particular reasons encumbering the pregnancy (either it be the first or the latest),
nevertheless having a fine success potential when subjected to clinical help.
TECHNIQUES AND TECHNOLOGIES OF THE ASSISTED REPRODUCTION:
Study of the ovary cycle: daily registration of basal temperatures in order to determine
the ovulation moment. Image and coelioscopic study of the integrality of both male and
female reproductive system. Hormonal studies (determination of levels and sequences
of the outflow of FSH, LH, progesterone and estrogen, PRL).
Spermgram (counting of spermatozoids on sperm as well as the study of their
morphology, mobility and vitality). Post coital test in order to observe the behavior and
survival of spermatozoids inside female reproductive organs.
fecundation , followed by uterine implantation of embryos therefore obtained.
Causes for infertility according to TCM:
Kidney Qi deficiency (deficit
of Jing, Yin and/or Yang of Kidney)
All these causes might introduce mal function on women hormonal cycle progression,
causing interference in the epilogue ovulation cycle or damaging the uterine
The patient had an history of primary infertility with a 7 year long way of treatment at
Santa Maria Hospital Gynecological Department. By then, both functional and image
studies revealed no alterations. Unsuccessfully, she was twice submitted to ovulation
induction with clomifene, to ovules coeliscopic gathering, and finally, to embryos
implantation obtained by the in vitro
She express us anxiety and hopelessness.
She describes menstrual irregularities since puberty, menstrual cycles not only irregular
but also abundant, sometimes with coagulum.
Blood stasis and consequent mal function of the fulfillment and discharge of Chong
We prescribed the phyto formulas : Xiao Yao Tang and Ba Zhen Wan. Also
recommended acupuncture weekly sessions using the following acupoints: Ge Shu; Xue
Hai; Shen Shu; Jing Men; Zu San Li; Ben Shen; Wei Bao; Bai Hui; Yin Tang; Zhong
Managing to improve the blood circulation dissolve stasis, reinforcing the conversion of
Rong Qi both in Jing Qi and in blood, as well as to widen Chong Mai.
By the forth week in treatment, the menstrual flow and regularity are achieved.
On the sixth week of following up, she gets pregnant.
She comes to our generalist TCM consultation on 22nd September 2005, claiming severe
physical tiredness, emotional instability and loss of weight. Menstrual irregularities ,
non balanced, on the previous therapy, by contraceptive method.
She brought hormonal tests with no relevant data.
We recommended the phyto formula An Shen Wan and weekly acupuncture sessions:
Zu San Li ; Ben Shen; San Yin Jiao; Xue Hai; Fu Liu; Wei Bao; Bai Hui; Yin Tang;
Shan Zhong; Guan Yuan; Shen Men; Nei Guan; Ear Shen Men.
Managing to improve the circulation of Heart Qi dispelling the stasis, reinforcing the
blood circulation and conciliate the Shen.
She comes to our consultation in August 2004.
During the interview she describes pain on the left groin and an history of two
spontaneous abortions, on the 19th and 23rd week pregnancy.
Urinary incontinence caused by effort. Rheumatologic studies reveal anti bodies ANA
positive and synovitis of the left hip articulation.
Diminishing of Kidney QI with repercussion on Spleen Qi and Ren Mai, and secondly,
on Wei Qi, promoting a border line Wei Syndrome set.
We suggested the therapeutic support based on the phyto formulas Yin Yang Xue Qi
Da Bu Wan and Xiao Yao Tang, as well as weekly acupuncture sessions with the
Shen Shu; Jing Men; Wei Bao; San Yin Jiao; Ge Shu; Xue Mai; Bai Hui; Yin Tang;
The purpose was to fill in the Kidney Qi deficiency and ease its repercussion on the
Within a few weeks there was an improvement of the hip arthritis and of the urinary
In any of the three cases, the finest therapeutic response is rooted on a detailed and most
correct identification of the etiopathogeny under TCM criteria, but never disregarding
its framing in the Health Sciences set, for this attitude allows the practitioner to appraise
the condition of the problem and estimate its success probability if exclusively
submitted to the supporting ancestor methods. Far from interfering or getting in
conflict, the synergy of the two sources of knowledge is proving , each and every day,
to be having greater power in the defense of the patient’s best interest.
The growing search for TCM in western societies daily brings out new questions to the
practitioner’s office, challenging his knowledge and his response skills. New questions
do not necessarily demand for a specialized approach. As long as the evaluation criteria
be very strict in every case, the new problems can surely fit in the frame and be well
managed by the TCM generalist practitioner.
Treatment of Infertility with Chinese Medicine
; Jane Lyttleton; Churchill Livingstone;
Application of Traditional Chinese Medicine in the Treatment of Infertility
; Xu X.; Yin
H; Tang D; Zhang L; Gosden RG; The Jones Institute for Reproductive Medicine;
Department of Obstetrics and Gynaecology; Norfolk, USA; PubMed 2003 Nov;
Clinical Observation on Treatment of 2062 cases of Immune Infertility with Integration
of Traditional Chinese Medicine and Western Medicine
; Du Y; Zhao Y; Ma Y; Bai H;
Li X; Cellular and Molecular Immunology Laboratory; Henan University; Kaifeng
Henan; China; PubMed 2005 Dec; 25(4): 278-81.
Influence of Acupuncture on Pregnancy Rate in Patients Who Undergo Assisted
; Paulus WE; Zhang M; Strehler E; El-Danasouri I; Sterzig K;
Department of Reproductive Medicine; Christian Lauritzen Institut; Ulm; Germany.
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PROGESTERONE GENERAL DESCRIPTION Progesterone is a steroid hormone produced in the ovaries (corpus luteum) and adrenal glands. One of its Progesterone is also produced by the brain and peripheral nerves, and possibly other locations. Normally, women have much more progesterone at any given time, than estrogen. KNOWN FUNCTIONS OF PROGESTERONE 1. Balances the effects of estrogen