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Infertility is defined by the inability to conceive in a sexually active couple who are actively trying to get pregnant for one year or more. Both men and women have equal chances of being infertile.
For couples who are actively trying to conceive, there are many several forms of assisted reproductive technology (ART); such as Intrauterine insemination (IUI) and In Vitro Fertilization (IVF). It is often the last resort when other fertility techniques have failed. However, dealing with these fertility treatments are often stressful and expensive, with a lot of expectation placed on these treatments to succeed.
Contrary to popular belief, TCM is able to work hand-in-hand with modern medicine to improve the condition of your body and increase the success rate of IUI/ IVF, especially through acupuncture.
How can TCM help? Let us first take a look at some background information.
Conception is like gardening and there are 3 basic requirements for fertilisation to take place.
- Fertile, nutritious Soil (肥沃的土地) – a healthy developed uterus and endometrium lining, with no “weeds” like endometriosis or fibroids that can affect implantation and growth
- Seed (种子, Zhong Zi) – Healthy egg and sperm ( *种子必先育卵*)
- Time (对的时间点)– Sperm and egg need to meet at the correct time and location, i.e. during ovulation (usually day 12-16 of the period cycle)
Abundant Essence, Qi and blood are 3 essential substances that are vital to our health and fertility.
Age & Infertility
There is a correlation between a woman’s age and her ability to conceive. A woman’s best fertile years are in her 20s. Fertility gradually declines in the 30s, particularly more so after age 35.
The ancient Yellow Emperor’s Inner Canon 《黄帝内经:上古天真论》 book wrote:
帝曰：人年老而无子者，材力尽邪?将天数然也?
岐伯曰：女子七岁，肾气盛，齿更发长。
二七，而天癸至，任脉通，太冲脉盛，月事以时下，故有子。
三七，肾气平均，故真牙生而长极。
四七，筋骨坚，发长极，身体盛壮。
五七，陽明脉衰，面始焦，发始堕。
六七，三陽脉衰于上，面皆焦，发始白。
七七，任脉虚，太冲脉衰少，天癸竭，地道不通，故形坏而无子也。
The above summarises the growth and development, maturity, prime of life and then the ageing of a female.
Age | Signs1 |
Seven (1×7) | The milk teeth begin to change into permanent teeth and the hair grows thick and glossy. |
Fourteen (2×7) | The Ren Mai circulates abundantly and Chong Mai is prosperous. Puberty begins, and menstruation starts. |
Twenty One (3×7) | Her kidney qi reaches a balanced state, and all her teeth including the wisdom teeth are completely developed. |
Twenty Eight (4×7) | Her fertility is at optimal condition and has strong tendons and bones. |
Thirty Five (5×7) | Her peak condition declines gradually. The yang ming channel (which is in charge of blood and qi ) is depleted and her bloom gradually fades and her hair begins to fall. |
Forty Two (6×7) | Her three yang channels (tai yang, yang ming and shao yang) begin to decline. Her face starts to age more obviously (wither) and her hair starts to turn grey or white. |
Forty Nine (7×7) | Her menstruation ends, menopause arrives and she can no longer conceive naturally |
In addition, women are born with a fixed number of oocytes (eggs) inside their ovaries.1
Ageing naturally reduces a woman’s ovarian reserve. The quantity and quality of a woman’s ovarian reserve declines with age. At the start of puberty, there can be 300,000- 500,000 eggs and it reduces to about 25,000 at around the age of 37.
On the other hand, male infertility is responsible in up to 30 per cent of infertility. It can be caused by low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm.
- Sperm quality: low sperm count, poor sperm mobility, abnormally shaped sperm or no sperm present.
- Varicoceles (enlarged veins in the scrotum) can negatively impacts testicular sperm production
- Obstruction of the vas deferens or epididymis (the tubes that carry sperm). Blockages can be a result of infection such as traumatic injury or gonorrhoea.
The proportion of women aged 35 years and above who are intentionally delaying pregnancies has been rising in the past few years. Delayed pregnancies lead to an increased chance of infertility. The optimal age for childbearing is between 20 and 35.
For decades, the average marriage age has been in the 20s. However, it is becoming increasingly common for couples to get married in their 30s, as people are graduating and starting work later in life. This thus affects reproductive and fertility status.
Today, there is an increasing trend of couples seeking fertility treatments.
Intrauterine insemination (IUI) and In Vitro Fertilisation (IVF) are two common Assisted Reproductive Technology (ART) treatments.
IUI is a fertility treatment that involves placing sperm inside a woman’s uterus through a catheter by a gynaecologist to facilitate fertilisation. The goal is to improve the chances of fertilisation by increasing the number of sperm that reach the fallopian tubes during ovulation and thus increase the chances of pregnancy.
IVF refers to the fertilisation of an egg outside the body. During IVF, mature eggs are retrieved from ovaries and combined with sperm in the laboratory to achieve fertilisation. Then, the fertilised egg (embryo) or eggs (embryos) are transferred to the uterus.
Both are commonly used to improve the chances of pregnancy.
Reasons for choosing ART
- Hostile cervical mucus condition
- Ovulation disorder
- Fallopian tube blockage or damage
- Impaired sperm production or function (poor sperm motility, count or quality)
- Ejaculation dysfunction
- Unexplained infertility
How can Acupuncture aid in IUI and IVF?
Acupuncture is a readily accepted form of treatment for ART as there are no known contraindications with Western medicine.
Acupuncture can help to condition your body to be in its optimal state and hence increase the success rates with ART.
It is highly recommended to start the acupuncture treatment sessions 3 months before your IUI/IVF treatment commences. This is especially so for those who have low ovarian reserve or poor egg quality.
Acupuncture treatment can reduce the number of structural defects in the sperm and increase the quality, mobility and concentration of sperm with normal morphology during ejaculation3,4.
How often should one do acupuncture?
*1st Trimester Symptoms
- Fatigue
- Anxious
- Tender or swollen breasts
- Increased urination
- Increased cravings and aversions
- Heartburn
- Constipation – High levels of progesterone during pregnancy and taking iron supplements can result in constipation. Drink more fluids and include more fibre into your diet.
- Morning sickness: Nausea, with or without vomiting.
To help relieve nausea, avoid having an empty stomach. Eat in small amounts and slowly every 2 hours and drink plenty of fluids.
- Drink ginger tea.
- Massage PC-6 Nei Guan Acupoint for 2-5 mins..
How to locate:
Place 3 fingers from the crease line at the wrist area. The point is located in between the 2 tendons (palmaris longus and flexor carpi radialis).
How to massage:
- Massage the point with the tip of your thumb in a circular motion.
- While doing so, try engaging in deep breathing to reduce nausea.
- You may add a fresh slice of ginger above the acupoint and massage if the nausea is severe.
How to improve the sperm count and quality
1. Stop smoking
Tobacco smoke contains more than 4000 kinds of chemicals, including nicotine, tar, carbon monoxide, polycyclic aromatic hydrocarbon and heavy metals. Smoking is associated with dysfunction of spermatogenesis and impaired spermatozoa function5, leading to reduced semen quality including semen volume, sperm mobility, sperm density and normal morphology.
2. Stop habitual heavy alcohol consumption
Alcohol can affect sperm mobility and alter sperm count, shape and mobility. In men, heavy drinking can lower testosterone, follicle stimulating hormone, and luteinizing hormone levels and increase estrogen levels6. These hormone changes can reduce sperm production and development.
3. Have a healthy diet rich in fruits, vegetables and whole grains.
Do not be a picky eater. You may be lacking zinc, Vitamin B, C or E. Zinc deficiency impedes spermatogenesis and causes sperm abnormalities7. Zinc cannot be stored in the body and hence regular dietary intake is essential. Vitamin Cand E are essential antioxidants that protect the cells from damage from oxidative stress and free radicals.
Examples of food high in…. | ||
Zinc | Vitamin C | Vitamin E |
Oyster Beef Red meat Shiitake mushroom Whole grains Beans | Fruits and vegetables | |
Guava Orange Berries Papaya Sweet yellow pepper Thyme Brussel sprouts Parsley Kale | Almonds Avocado Mango Pumpkin Spinach Broccoli Almond Sunflower seeds | |
4. Avoid excessive heat
The normal physiological temperature of the human testis ranges between 32 and 35 °C. It is cooler than the core body temperature of 36.9°C. This is essential for optimal sperm production, maturity and function8. Hence, it is important to avoid potential heat exposure to the testicles such as prolonged hot baths, laptop, high-temperature work area and prolonged sitting. Avoid wearing tight pants too as it can affect the blood circulation to the testes.
Couples undergoing fertility treatments can experience immense amounts of stress, especially for the woman. IUI and especially IVF can be a long and stressful journey to manage alone.
Couples are usually encouraged to come for treatments together. Acupuncture sessions can provide immense support for a couple’s physical and mental wellbeing: it aids in improving energy levels, blood circulation, as well lowering stress levels. All this plays a part in increasing the success rates of conception.
Infertility can be a lonely journey, but you are not alone. If you wish to start your fertility planning journey, our physicians are here to help.
As there is no “one size fits all” treatment plan, a consultation with a physician is recommended to more accurately diagnose your body condition and constitution before proceeding with any treatment.
Note: Information provided is not a substitute for a physician or any form of medical care. Individual symptoms differ due to different body constitutions and diagnosis. One should consult a licensed TCM practitioner for accurate diagnosis and treatment.
Reference:
- Fu W. The Yellow Emperor’s Canon of Medicine: First complete summary of ancient chinese medicine. Chin Med Cult 2018;1:18-20
- https://www.healthline.com/health/womens-health/how-many-eggs-does-a-woman-have#eggs-at-puberty
- https://www.webmd.com/infertility-and-reproduction/news/20050803/acupuncture-may-improve-sperm-quality
- https://www.sciencedirect.com/science/article/pii/S2305050015000226
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4814952/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761906/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010824/
- https://www.clevelandclinic.org/reproductiveresearchcenter/docs/publications/93_Durairajanayagam_et_al_Heat_Stress.pdf
