- Infertility in TCM
- TCM Treatment for Infertility
- Patient Resources
Infertility is defined as the inability to conceive after 12 months of active trying if the female is under the age of 34, or after 6 months of active trying if the female is over the age of 35 (declining egg quality of females over the age of 35 accounts for the age-based discrepancy as when to seek medical intervention). Females who are able to get pregnant but cannot carry a pregnancy to term (impaired fecundity) may also be considered infertile.
- Primary infertilityThe couple has never been able to conceive (approximately 40% of infertile couples)
- Secondary infertilityThe couple was able to conceive, whether the pregnancy was carried to term or resulted in a miscarriage (approximately 60% of infertile couples)
- Common Cause of Infertility
- Test and Diagnosis
- Infertility Treatment
It is estimated worldwide that one out of every seven couples has problems conceiving, including 7.3 million people in the United States. Infertility has several causes and is not only a problem of the female. According to the data collected in UK (2009), about 30% of all cases are due to female fertility problems, about 30% of all cases are due to male fertility factors, and about 10% of all cases are due to a combination of male and female problems. In about 25% of cases are categorized as unexplained infertility because the cause of infertility is not identified.
- Male Infertility
- Female Infertilit
- Unexplained Infertility
- Impaired shape and movement of spermSperm must be properly shaped and able to move rapidly and accurately toward the egg for fertilization to occur. If the shape and structure (morphology) of the sperm are abnormal or the movement (motility) is impaired, sperm may not be able to reach or penetrate the egg.
- Low sperm concentrationA normal sperm concentration is greater than or equal to 20 million sperm per milliliter of semen. A count of 10 million or fewer sperm per milliliter of semen indicates low sperm concentration (subfertility). A count of 40 million sperm or higher per milliliter of semen indicates increased fertility.
- VaricoceleVaricocele is a varicose vein in the scrotum. Because the excess blood that pools and backs up in the vein causes overheating, it can diminish the number and quality of sperm cells that are produced.
- Physical irregularitiesA blocked or missing vas deferens or epididymis is another potential cause of male infertility. This problem is usually indicated by a semen analysis in which the sperm count is very low or there are no sperm at all. As long as sperm is still being produced, however, it can be collected directly from the testicles for use during in vitro fertilization.
- Hormonal imbalanceA hormonal imbalance, caused by a gland malfunction, genetic condition, or unhealthy weight, can interfere with sperm production and cause male infertility. Blood tests are used to diagnose hormonal imbalances and treatment may involve medication or lifestyle changes.
- Environmental and lifestyle factorsBecause new sperm cells are constantly being produced, the number and quality of sperm are easily affected by environmental exposure and poor health choices. Smoking, heavy alcohol consumption, certain medications, exposure to toxins, and anything that causes prolonged overheating of the testicles can cause temporary male infertility.
For more information about Causes of Male Infertility, click here.
- Low ovarian reserve Unlike men, who continue to produce new sperm cells throughout their reproductive lives, women have a substantial but finite supply of eggs. Although only one or two eggs are released during any given cycle, several will begin to ripen, and those that are not released will disintegrate. Over time, a woman's egg supply gradually diminishes and may eventually reach a point where infertility is the result.
- Ovulation disordersIrregular or absent ovulation is a common cause of infertility. Disruption in the part of the brain that regulates ovulation can cause low levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Even slight irregularities in the hormone system can prevent the ovaries from releasing eggs (anovulation). Specific causes of hypothalamic-pituitary disorders that can result in anovulation include injury, tumors, excessive exercise and starvation.
- Polycystic ovarian syndrome (PCOS)PCOS is a common endocrine condition that causes infertility. Instead of developing a dominant follicle and releasing a mature egg each menstrual cycle, polycystic ovaries develop multiple follicles that do not produce any eggs. Women with PCOS generally have signs of excess male hormone production, are often overweight, and may develop insulin resistance.
- Premature ovarian failure (POF) / Elevated FSHPremature ovarian failure, also known as primary ovarian insufficiency, premature menopause, and hypergonadotropic hypogonadism, affects approximately 1-4% of the female population, and is defined as the loss of ovarian function before the age of 40. Women with POF typically experience amenorrhea (absence of menstruation), low levels of estrogen, and elevated levels of follicle-stimulating hormone (FSH). Elevated FSH levels impairs the maturation of eggs. Ovarian failure can be permanent in some cases, but is often intermittent, with up to a 60% rate of subsequent ovarian function.
- Luteal phase defectThe luteal phase is the second half of the menstrual cycle, between ovulation and menstruation. During this phase progesterone production is at its highest, and the uterine lining is preparing for embryonic implantation. The ideal length of the luteal phase is from 12 to 14 days. If the luteal phase lasts anything under 10 days it is considered a luteal phase defect, and it can affect a woman's ability to conceive and carry a pregnancy.
- Uterine irregularitiesAny irregularity of the uterus, including congenital malformations, adhesions, fibroids, or polyps, can potentially be a source of infertility or recurrent miscarriage.
- EndometriosisEndometriosis is a condition in which sections of the uterine lining, or endometrium, are attached to tissues outside of the uterine cavity. These endometrial lesions build up and break down each month, just as the normal uterine lining does. This causes inflammation, cysts, and severe menstrual pain. The connection between endometriosis and infertility is unclear, but treating the condition, usually through minimally invasive surgery, often improves a patient's chances of becoming pregnant.
- Fallopian tube damage or blockageFallopian tube damage usually results from inflammation of the fallopian tube (salpingitis). Chlamydia, a sexually transmitted disease, is the most frequent cause. Tubal inflammation may go unnoticed or may cause pain and fever. Tubal damage may result in a pregnancy in which the fertilized egg is unable to make its way through the fallopian tube to implant in the uterus (ectopic pregnancy). One episode of tubal infection may cause fertility difficulties. The risk of ectopic pregnancy increases with each occurrence of tubal infection.
For more information about Causes of Female infertility, click here.
Up to 30% of all cases of infertility in women and up to 25% in men are due to idiopathic or unexplained causes. Unexplained infertility is a diagnosis based on exclusion. If no medical reason is found with standard fertility tests, a patient will be diagnosed with unexplained infertility. Possible causes of unexplained infertility are:
- Timing issuesThe fertile window is defined as the days of the menstrual cycle during which intercourse is most likely to result in pregnancy. The sperm can survive up to 5-6 days in a woman's reproductive tract while the egg can survive for only about 24 hours after ovulation. Therefore, the fertile window extends for 6 days starting at 5 days before ovulation until the day of ovulation, but the most fertile days are just the 2 days before and the day of ovulation. However, the fertile window can be highly unpredictable. Studies have shown that even in women with regular menstrual cycles, ovulation can possibly happen any time, and no existing ovulation predicting tool is perfect.
- Immune problemsA person's immune system is designed to protect oneself from invading cells and organisms in order to prevent disease and infection. A female's immune system may recognize the partner's sperm cells or the zygote (fertilized egg) as foreign organisms and attack them, resulting in difficulty getting pregnant.
- Stress and Psychological factorsThe body's biochemical response to stress has a major effect on the reproductive system. Whether due to a major event or just the constant stressors of daily life, stress puts the body into "fight or flight" mode. Stress increases our levels of adrenaline, which inhibits the ability to use progesterone, one of the key hormones in reproduction. It increases levels of cortisol, which inhibits implantation of the fertilized egg. It also increases levels of prolactin, which inhibits fertility by decreasing or halting ovulation. Additionally, a hyper-stimulated nervous system sends blood away from the uterus and ovaries to the essential organs, thus lessening the overall function of our reproductive system.
In order to effectively treat fertility conditions, it is important to understand what causes infertility. A complete medical history and physical examination of both partners is essential. The following are the most commonly used steps that assist a clinician to reach a causal diagnosis in the infertility management.
- Tests for Male
- Tests for Female
- Physical examinationA basic physical examination involves the inspection of the male reproductive organs by a urologist or male infertility specialist. This includes examination of the male reproductive organs and questions concerning medical history, illnesses and disabilities, medications and sexual habits.
- Semen analysisOnce a semen sample has been collected, either in our office or at home, it will be examined for volume, color and consistency, as well as sperm count, motility, and morphology. Normal values are:
Since sperm quantity and quality can fluctuate, more than one semen analysis it is recommended for accurate assessment.
Ejaculatory volume: 1.5-5.0 cc
Sperm density: > 20 million/ml
Motility: > 60%
Forward progression: > 2, on a scale of 1-4
Morphology: > 60% normal forms (oval head and long tail)
No significant microscopic sperm clumping
No significant white or red blood cells
No increased thickening of the seminal fluid (hyperviscosity)
- Blood testsDepending on the results of the semen analysis, blood tests may also be conducted to check for hormonal imbalances or certain genetic conditions. The levels of testosterone, FSH (follicle stimulating hormone), LH (luteinizing hormone), prolactin, estradiol, and the thyroid hormones T-4 and T-3 is tested through the blood tests.
For more information about Tests of Male Infertility, click here.
- Hormonal evaluationHormone tests may be done to check levels of ovulatory hormones as well as other hormones in the system, such as estrogens, androgens, progesterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, testosterone and thyroid hormones.
- Pelvic examA physical exam to check for signs of infection as well as obvious physical abnormalities. Pretty much the standard feet-in-stirrups event.
- UltrasoundUltrasound is an effective fertility testing device and by far the least invasive method of assessing internal structures of the body. By using sound waves to create a picture, an ultrasound can confirm the size, shape, and position of the reproductive organs as well as indicate such problems as uterine fibroids, adhesions, or cysts.
- Hysterosaplingogram (HSG)Hysterosalpingography is an x-ray of the uterus and fallopian tubes involving the injection of contrast (dye) through the cervix. It is used to detect blockages in the fallopian tubes as well as a uterine septum or other abnormalities. It is also sometimes used in combination with a treatment procedure known as tubal cannulization.
- Post-coital test (PCT)PCT involves an assessment of the cervical mucus within a few hours of intercourse and within 48 hours of ovulation. A sample of cervical mucus is collected and examined for consistency and the presence of motile sperm.
- Endometrial biopsy (EMB)A sample of the uterine lining (endometrium) is obtained using a small catheter-like device inserted into the uterus through the cervical canal. The tissue sample obtained is sent for analysis to rule out infection or inflammation in the uterine lining and may help to determine if the lining is prepared for implantation.
- LaparoscopyLaparoscopy is used to look for the structural abnormalities of the exterior of the uterus, fallopian tubes, and ovaries, endometriosis and adhesions as well as possibly repair any problems found. The abdomen is inflated with carbon dioxide and a scope is inserted through a small incision below the navel. A second incision just above or below the pubic hairline is used to insert a tool to help manipulate the organs for better viewing with the scope.
- HysteroscopyHysteroscopy focuses on the interior of the uterus. The cervix is dilated just enough to insert a small scope used for viewing the inside of the uterus. Minor abnormalities can be fixed during this procedure, which can be done under local or general anesthesia. Often done in conjunction with a laparoscopy.
For more information about Tests of Female Infertility, click here.
Treatment of infertility depends on the cause, the age of the partners and many personal preferences. Having sexual intercourse at least 2 to 3 times a week, leading up to and through the expected time of ovulation, may improve fertility. Ovulation occurs about 2 weeks before the next period starts. Sperm survive in the female reproductive tract for up to 72 hours, and an egg can be fertilized for up to 24 hours after ovulation.
Underlying conditions contributing to infertility are sometimes addressed before beginning treatment, and are sometimes overridden by the treatment itself. Although some causes of infertility can't be corrected, majority of infertility cases are treatable with medical intervention. The use of medications, surgery or assisted reproductive technology such as IUI or IVF are the most commonly used therapies.
- Fertility Medications
- Corrective Surgeries
- Assisted Reproductive Technologies
Fertility medication are drugs which enhance reproductive fertility by stimulating the ovaries to produce eggs and preparing the body to receive an embryo. Fertility medications are a key part of treatment for many types of infertility including in vitro fertilization (IVF) and other assisted reproductive technologies.
- Clomiphene citrateClomiphene citrate (Clomid® or Serophene®) is an oral fertility medication that works by triggering the pituitary gland to release more FSH and LH, which stimulate the growth of an ovarian follicle containing an egg. This oral medication is often among the first used for ovulation induction.
- GonadotropinsGonadotropins (Bravelle®, Follistim®, Gonal-F®) are a class of injectable fertility drugs that directly stimulate the ovaries and commonly used for ovulation induction during in vitro fertilization. Gonadotropins are made from highly purified follicle stimulating hormone (FSH) and cause the ovaries to develop and mature multiple eggs at once.
- Human chorionic gonadotropin (hCG)hCG is a hormone that is normally released by the body after an embryo has implanted in the uterine lining. In female, hCG(Ovidrel®, Pregnyl®) is used to induce ovulation, usually after taking clomiphene citrate, menotropins or urofollitropins. It is also used to support the corpus luteum and keep progesterone levels elevated. In male, hCG is used to improve sperm count if the FSH, LH, and testosterone levels are low.
- Human menopausal gonadotropin (hMG)hMG (Repronex®, Menopur®) is an injectible fertility medication directly stimulates the ovaries to induce ovulation. It contains both follicle stimulating hormone (FSH) and luteinizing hormone (LH), and is used both in and out of the IVF settings.
For more information about Fertility Medications, click here.
- HysteroscopyHysteroscopy is utilized to diagnose and treat abnormalities within the uterus. Hysteroscopy can be used to remove uterine fibroids, polyps, scar tissue and uterine malformations or to treat abnormal bleeding and other reproductive conditions.
- LaparoscopyLaparoscopy is used to remove abnormal cyst or myomas, to excise endometriosis, or to treat an abnormal fallopian tube. The major benefit of laparoscopic surgery is that it only requires a few small incisions, which means less pain and external scarring and healing is faster than traditional open surgery.
- TuboplastyTuboplasty is a surgical operation to correct fallopian tube obstruction or adhesion.
For more information about Corrective Surgeries, click here.
Assisted reproductive technology (ART) is a general term referring to methods used to achieve pregnancy by artificial or partially artificial means. ART refers not only to IVF but also to several variations tailored to patients' unique conditions. These procedures are usually paired with more conventional therapies, such as fertility medications, to increase success rates.
The most common forms of ART include:
- In vitro fertilization (IVF)IVF is one of the most commonly used procedures. It involves retrieving mature eggs from a woman, fertilizing them with a man's sperm in a dish in a laboratory and implanting the embryos in the uterus 3 to 5 days after fertilization. IVF often is in cases of fallopian tube blockage, endometriosis, unexplained infertility, cervical factor infertility, male factor infertility and ovulation disorders. IVF increases the chances of having more than one baby at a time because multiple fertilized eggs are often implanted into the uterus so that there is a greater chance one will develop into a baby.
Standard IVF Process
Follicle Growth and Egg Collection
Based on each woman's age, natural hormone levels, and overall reproductive health, an individual protocol of fertility drugs will be administered to stimulate her ovaries to produce multiple follicles. When the follicles reach an optimum size, the eggs within are retrieved with a long thin needle guided through the vaginal wall, using ultrasound and a light anesthetic. The needle is inserted into each follicle and pulls the egg and the fluid into a collection tube. When one follicle is drained, the needle is gently repositioned to collect fluid from each adjacent follicle. This process is done for both ovaries. The follicular fluid is then given to the embryologist who examines it under a microscope to find the eggs.
Once the eggs are identified, they are mixed with several thousand sperm (previously obtained from the partner's or donor's sperm sample) in a dish with nutrient liquid and kept in an incubator overnight, and later examined under a microscope to identify which eggs have fertilized normally. When there is an abnormal sperm or egg factor (i.e. poor sperm motility, morphology, low concentration, or previously failed fertilization), egg fertilization can be achieved through intracytoplasmic sperm injection (ICSI). An extremely sharp glass needle is used to inject one normal appearing sperm directly into the center (cytoplasm) of the egg under the guidance of a specially fitted microscope.
Once the eggs are fertilized, they are carefully nurtured in the laboratory and they become embryos which are ready for transfer into the uterus on day 3 or 4. The embryologist loads the embryos into a very soft catheter along with a small volume of the culture media in which they are growing. The physician then inserts the catheter through the cervix and injects the embryos inside the uterine cavity during a speculum examination. The process is similar to an insemination, although it is done under abdominal ultrasound guidance in order to ensure that the catheter is in the proper position prior to transferring the embryos. The number of embryos transferred depends upon the age of the patient, the quality of the embryos and the stage of their development. Any remaining viable embryos that are not transferred into the woman's uterus during treatment may be frozen (cryopreserved) in small tubes and kept in storage in an embryo laboratory for future use.
Approximately 10 days after embryo transfer the first blood pregnancy testis performed and after another 2 weeks the first ultrasound will confirm the pregnancy.
- Intra-uterine insemination (IUI)Also called Artificial insemination (AI), IUI is the process by which washed sperm is deposited in a woman's uterus to facilitate fertilization of her egg. The goal of IUI is to increase the number of sperm reaching the fallopian tubes and subsequently increase the chance of fertilization. IUI procedure is simple and may be performed even if the woman is not receiving medication to improve her egg production. Many physicians will encourage women to take medications to stimulate the ovaries in order to increase egg production and, hopefully, the chance of achieving pregnancy.
Standard IUI Process
An ultrasound will be used during a woman's cycle to monitor the growth and size of her developing follicles. When the follicles reach an optimal size, the hormone human Chorionic Gonadotropin (hCG) is administered to stimulate the release of eggs from the follicles within 34-40 hours.
Meanwhile, the woman's partner will provide a semen sample which will be processed by the lab in order to separate the semen from the seminal fluid. A catheter is then used to inject the processed sperm directly into the uterus at the time of egg release. This process maximizes the number of sperm cells that are placed in the uterus and thus increases the possibility of conception. The IUI procedure is short, involves minimal discomfort, and is often a less-expensive alternative to in vitro fertilization (IVF).
The best candidates for IUI include those with the following characteristics:
- Women who are under the age of 40
- Women without blocked fallopian tubes
- Women who have a hostile cervical condition, like too thick cervical mucus
- Women requiring sperm donation
- Men who have mild sperm motility, count and morphology issues
- Men with sexual or erectile dysfunctions
- Intracytoplasmic sperm injection (ICSI)ICSI consists of a microscopic technique (micromanipulation) in which a single sperm is injected directly into an egg to achieve fertilization in conjunction with the standard IVF procedure. ICSI has been especially helpful in couples who have previously failed to achieve conception with standard techniques. For men with low sperm concentrations, ICSI dramatically improves the likelihood of fertilization.
For more information about ART, click here.
In the view of traditional Chinese medicine, human fertility relies on the normal functioning of the internal organs and the balance in the Yin, Yang, Qi, Blood of the body. When one or more of these elements is out of balance, a disharmony resulrs and infertility may occur.
- Fundamental Organs
- Etiology of Infertility
- Pattern Differentiation
In Chinese medicine, the Kidney, Liver, and Spleen play important role in human fertility. The infertility occurs when one or more organs are impaired.
As one should understand, the terms of the organs here are used primarily to classify a certain group of physiological functions, although they may or may not be physically consistent with the anatomic organs.
In TCM, the kidneys store the essence (Jing) and govern growth, development and reproduction. The essential Qi stored in the kidneys is derived from the reproductive essence of the parents, which is the primitive substance needed for the development of the embryo. From childhood, the essence in the kidneys gradually develops and reaches its fullness in puberty; men are able to produce sperm and women are able to ovulate. Thus the reproductive function reaches maturity. The kidneys play a major role over the urinary and reproductive systems, as well as in parts of the endocrine and nervous systems, more specifically egg and sperm production.
If the essence-storing function of the kidneys is disturbed, the growth, development and reproductive ability will be affected, possibly leading to infertility. The kidney's Yin and Yang should be mutually conditioned and interdependent in order to keep the dynamic balance inside the human body. If this balance is disturbed, certain symptoms can develop such as night sweats, cold limbs, breathlessness, exhaustion, frequent urination, impotence and premature ejaculation in men and infertility in women.
In TCM, the liver governs the smooth flow of vital energy within the human body. This key organ is considered to have the same functions and roles as those in Western medicine. The liver also maintains and stores blood, which is regarded as 'reproductive essence'. It regulates the amount of blood which the various parts of the body need, and therefore has a great influence over the menstrual cycles in women. The liver-blood together with the kidney's Jing essence and Qi energy, are the body fluid metabolism. The liver is also responsible for promoting a well-balanced circulation of the Qi energy in the body. It's this harmonious balance between the liver and the kidneys, which is believed to play a very important part in assisting successful ovulation and consequent conception.
Generally speaking, the liver Yin should control the liver Yang to prevent it from being hyperactive. If the liver Yin becomes insufficient and fails to restrain the liver Yang, the liver Yang’s hyperactivity then most commonly causes premenstrual tension, short temper and headaches. On the other hand, when the liver Qi is depressed, symptoms such as depression, sadness, sore breasts and diarrhoea will develop.
The spleen is where blood and Qi energy originate from, and is the foundation for life after birth. The spleen governs transportation and transformation and provides the necessary nourishment for healthy growth and also the main material foundation to transform Qi and blood. The spleen functions include digestion, absorption and distribution. Therefore, when there are problems with the functioning of the spleen, there will be damp and phlegm due to fluid retention. This can sometimes lead to obstructions within the abdominal environment and problems such as abdominal distension, diarrhoea and nutritional disturbance. This can further result in poor blood flow within the reproductive system, tubal obstructions and endometriosis. Consequently, the healthy development of the egg or sperm will be hindered.
Wind, cold, summer heat, damp, dryness and heat/fire are termed as the six types of environmental Qi in the nature. The normal six types of environmental Qi do not easily cause diseases; however, when the climate changes abnormally and abruptly or when the body resistance decreases, these six types of environmental Qi become pathogenic factors, collectively called 'six evils', which attack the human body and cause disease.
In TCM, the human mental and emotional activity are classified into seven categories: joy, anger, anxiety, preoccupation, sorrow, fear and fright. Under normal circumstances, they belong to the scope of physiological activities. However, if a persistent emotional state or sudden and intense traumatic mental injury occurs, it may cause dysfunctions in the Yin, Yang, Qi, Blood and internal organs, causing diseases. It is understood in TCM that extreme emotional changes can bring about different influences upon the internal organs. For example, anger injures the liver, joy injures the heart, preoccupation injures the spleen, sorrow injures the lungs, fear and fright injure the kidneys.
Commonly encountered emotionally caused symptoms include: insomnia or disturbed sleep, palpitations, depression, irritable bowel syndrome, a sensation of obstruction in the throat, and menstrual irregularities.
Eating irregularly, or eating the wrong amount of food affects the body's digestive ability and cause damage to the spleen and stomach. If the food can't be decomposed and transported and transformed, Spleen Qi deficiency can result.
Normal physical exercise is beneficial to the smooth, healthy running of the human body, increasing physical strength and preventing illness. However over-activity can consume and weaken the body's constitution and indirectly cause kidney deficiency.
In addition, prolonged or untreated illnesses can damage the Yin of the body and exhaust both essence and blood, leading to more severe and complicated disease.
In Chinese medicine, treatment for individual patient depends on the pattern differentiation based on the cause and the main symptoms of the illness. Patients diagnosed with same disease in Western medicine may have different patterns in TCM. Moreover, patients with same pattern differentiation in TCM may present with different signs and symptoms.
The following are the most common patterns for infertility. Patients are often diagnosed with more than one pattern.
- Male Infertility Patterns
- Female Infertility Patterns
- Blood and Yin deficiencyLiver Blood and Kidney Yin decifiency can impair the ability of the seence to nourish the reproductive organs. This may result in small testicles, low sperm count or no sperm, low volume of semenn, or abnormal liquefaction.
- Qi and Yang deficinecyIf there is Spleen Qi and Kidney Yang deficiency, there is not sufficinet Qi to transform and activate the esence for the reproductive organs. This condition may cause poor motility, impotence, no ejaculation, or atestosterone deficiency.
- Qi stagnation and Blood stasisImpaired flow of Qi and blood can obsturct the Chong and Ren channels, the channels govern and nourish the reproductive organs, leading to poor morphology, varicocele, or blockage of the ejaculatory ducts.
- Damp-HeatAccumulation of damp-heat from environment or inproper diet can obstruct the Chong and Ren channels and damage the reproductive organs. This condition can cause severe low sperm count, low sperm motility, high abnormal forms and seminal fluid infections.
Correlation between Chinese and Western medical pathologies
|Traditional Chinese Medicine
Deficiency of Kidney Yin
Deficinecy of Qi and Blood
Lack of ejaculation
Low semen volume
Low sperm count
Low sperm quality
Blockage of ejaculatory ducts
- Blood and Yin deficiencyIf the Liver Blood and Kidney Yin are decifient, the essence will not be sufficient to nourish the ovaries and uterus. This condition may bring about various problems with the eggs, such as lack of ovulation, inability of the egg to be fertilitzed, or inability of the fertilized eggs to be implanted in the uterus.
- Qi and Yang deficinecyWhen there is deficinecy of Qi and Yang of the spleen and kidneys, there is inadequate energu to transform and acivate the uterus and ovaries, leading to inability of the egg to be fertilized or inability of the fertilized eggs to be implanted in the uterus.
- Qi stagnation and Blood stasisImpaired flow of Qi and blood can obsturct the Chong and Ren channels, the channels govern and nourish the reproductive organs, leading to painful or irregular menstruation, mood swings, depression, uterine fibroids, or fallopian tube blockage.
- Cold, Heat, Phlegm, or Damp AccumulationAccumulation of pathogenic factors such as cold, heat, phlegm, dampmess, and damp-heat from environment or inproper diet can obstruct the Chong and Ren channels and damage the reproductive organs. Because of this blockage, fertilization cannot occur.
Correlation between Chinese and Western medical pathologies
|Traditional Chinese Medicine
Deficiency of Kidney Yin
Deficiency of Kidney Yang
Deficinecy of Qi
Lack of Ovulation
Poor quality of eggs
Poor quantility of follicles
Low estradiol level
Low progesterone level
High FSH or LH
|Fallopian tube obstruction
Fallopian tube infection
Traditional Chinese Medicine (TCM) has been used to treat both male and female fertility problems for over 2500 years in China and other Asian countries. In the recent decades, infertility treatment with TCM is getting popular in Europe and the USA because it is natural, least invasive, generally safe, effective, and less costly.
TCM can offer a path to follow for a healthier body and lifestyle approach and can aide couples conceive naturally, improve sperm quality and quantity, and also improve the chances of success on IVF implantation and conception with no or least side effects.
- Benefits of TCM Treatment
- Treatment Modalities
- Treatment Plan
Chinese medicine works to strengthen and balance all systems of the body whereas Western medicine concentrates on the health of reproductive organs.
Chinese medicine has a long history when it comes to enhancing fertility for both men and women. In fact, evidence that acupuncture and herbal medicine have been used to aid fertility can be found in early medical literature dating back to 3 A.D.. Fertility treatments were first recorded by Zhang Zhong Jing, a famous physician from the Han Dynasty (206 B.C. - 220 A.D.), in his discussion of diseases in women in the Jin Gui Yao Lue (Essentials of the Golden Cabinet).
Acupuncture and Chinese medicine work to enhance both male and female fertility by restoring health and balance to the body, mind and spirit. According to the principles of Oriental medicine, a person's health is determined by the harmony in Yin and Yang, quality of Qi, the vital life energy, and Blood circulating through the body. When Qi and blood are circulating properly and Yin and Yang are balanced, the body is properly nourished and functioning optimally which, in turn, enhances fertility.
Major Benefits of Acupuncture and Chinese Medicine
- Overcomes common fertility challenges, including:
- Advanced maternal age
- Autoimmune conditions
- Cervical mucus issues
- Endocrine imbalances
- Elevated FSH
- Fallopian tube blockage (mild to moderate)
- Immunology factors
- Luteal Phase Defect
- Male factors
- Menstrual irregularities
- Ovarian cysts and Polycystic Ovarian Syndrome (PCOS)
- Ovulation factors (including annovulation)
- Pelvic Inflammatory Disease (PID)
- Premature ovarian failure/poor ovarian reserve
- Recurrent miscarriages
- Thin uterine lining
- Thyroid problems
- Unexplained Infertility
- Increases chance of conceiving naturally
- Improves reproductive health and strengthens immune system
- Increases effectiveness of Western procedures, such as IVF and IUI
- Reduces side effects of fertility medications during Western procedures
- Increases libido
- Reduces chance of miscarriage
- Improves energy and balances emotions
- Diminishes morning sickness
- Shortens labor time
Post Partum Care
- Improves long-term reproductive health
- Decreases post partum depression
- Improves breast milk quality
Chinese Medicine and Assisted Reproductive Technologies
While assisting in achieving natural pregancy, traditional Chinese medicine is also very effective when combined with assisted reproductive technologies (ART), include IVF (in vitro fertilization) and IUI(intra uterine insemination).
There have been a multitude of research studies in the past decade showing how acupuncture and Chinese medicine increase the success rate of conventional infertility treatments. In the April 2002 issue of Fertility and Sterility, a German study showed that using acupuncture before and after IVF (in vitro fertilization) increased the success rate to 42.5% as opposed to a success rate of only 26.3% by those not using acupuncture.
In 2008, a research published in British Medical Journal (BMJ) confirmed that the effects of adjuvant acupuncture on in vitro fertilization are significant and clinically relevant. The results from seven studies on 1,366 women from four countries who were undergoing IVF showed a 65% increase in establishment of pregnancy, an 87% increase in continuing pregnancy, and a 91% increase in live births.
Chinese medicine provides safe and effective treatment for the majority of causes of male and female infertility. The use of Chinese medicine greatly improves the outcome of assisted reproductive technologies such as in vitro fertilization (IVF) and intrauterine insemination (IUI), while providing an alternative to these treatments for those who desire natural conception. A number of different treatment modalities are prescribed, depending on the specific presentation involved for each patient:
Acupuncture improves natural conception rates, as well as conception rates when used in conjunction with assisted reproduction. A 2002 study of fertility and sterility reported that acupuncture treatments performed before and after IVF transfer increased the success rate from 26.3% to 42.5%. Further research has shown that acupuncture during pregnancy improves the overall live birth rates, as well as the conception rates.
The effects of acupuncture for infertility include:
- Reduces stress levels.
Elevated stress can prohibit conception by blocking blood flow to the reproductive organs and causing an imbalance in hormonal production, thus resulting in irregular menstrual cycles, lack of ovulation, poor ovarian production, diminished egg quality, and poor sperm production and quality.
- Increase blood flow to the pelvic cavity and strengthen the function of the reproductive organs.
- In female, the increase in blood flow enhances egg quality, thickness of the endometrium (uterine lining), and implantation rates as well as reduces the chance of miscarriage.
- In male, the increase in blood flow helps the reproductive organs to generate more volume, count, and better morphology of the sperm.
- Balance the hypothalamus-pituitary-gonadal axis to regulate and improve the body’s natural hormonal production.
- Stimulate ovulation
- Decrease the side effects of fertility medications used with assisted reproduction.
- Strengthen the immune system to prevent immunological complications and decrease inflammation.
- Improve sperm production and quality to increase the fertilization rate of eggs and create better quality and quantity of embryos
For certain conditions, electro-acupuncture treatment can be used. Electro-acupuncture is the usage of electric impulse stimulation through the acupuncture needles in the affected areas and in utilized in more severe pain conditions as well as in anovulation and fallopian tubal blockages. It is also a pain-free treatment with minor vibration in the affected area.
As an additional therapy to the acupuncture treatment, moxibustion can be applied. Moxibustion is a procedure of burning a herb, Folium Artemisiae Vulgaris, commonly known as mugwart to create heat and therapeutic result on the affected areas. It is used to treat certain types of pelvic pain and infertility. Deep warmth is usually felt after moxibustion in the applied area. Moxibustion increases circulation thoughout the pelvic cavity and promotes healing and follicular development.
Chinese Herbal Medicine
Chinese herbal formulas are prescribed to help enhance egg quality and sperm parameters and to improve implantation rates and prevent miscarraige. They also normalize the function of the hypothalamus-pituitary-gonadal axis to regulate and improve the body's natural hormonal production. Chinese herbs are useful to control many of the underlying causes of infertility, including endometriosis, polycystic ovarian syndrome (PCOS), fibroids, follicle-stimulating hormone (FSH), poor egg quality, blocked fallopian tubes, and immune system imbalance.
Massage and Physical Therapy
Reproductive organ massage and physical therapy manipulate the fascia of the pelvic cavity to unblock any obstruction in the reproductive organs and improve the blood flow to these organs. Massage and physical therapy can be used to correct structural imbalances caused by fibroids, endometriosis, blocked fallopian tubes, scar tissue from prior surgeries, and adhesions from trauma or injury, restricting the function and mobility of the reproductive organs.
Nutritional and Dietary Therapy
Dietary guidance is customized for each patient based on the health of her or his kidney, liver, and spleen functions, which control our reproductive health and underlie our metabolic processes. Balanced diet can improve pregnancy rates and can be used by both male and female partners to enhance fertility. Numerous research articles have shown that the use of nutritional supplements prior to and during pregnancy improves the health of both mother and baby.
Meditation, Qi Gong, and yoga excercises are often useful for patients struggling with infertility as they reduce stress and cortisol levels and allow the body to prioritize reproduction.
Every treatment plan will be customized to address the individualized patient's needs. On your initial visit, your acupuncturist will discuss your fertility and menstrual history as well as other health issues and daily habits such as diet, sleep and exercise. Following the comprehensive intake, an acupuncture treatment will be given. Subsequent visits will include acupuncture, updates and check-ins on diet and lifestyle health as well as Chinese herbal medicine, uterine massage and relaxation exercises as needed.
Good candidates for Natural Conception Program are patients who have a functional, rather than structural reason for infertility. Infertility due to hormonal problems, immune disorders, amenorrhoea, irregular menstruation, frequent miscarriage, stress and age related factors all fall into the category of functional infertility and would be encouraged to seek relief from acupuncture and Chinese medicine.
Although stuructural fertility issues can be treated with acupuncture and Chinese medicine alone, patients may need to combine TCM treatment with assisted reproductive echnologies, such as IVF or IUI. Infertility due to endometriosis, fibroids, endometriosis, or fallopian tube blockage in female, and varicocele, undescended testicle, or obstruction of the vas deferens in male are considered structual fertility issues. Assisted Pregnancy Program would be recommended to the patients with these conditions.
- Natural Conception Program
- Assisted Pregnancy Program
- Fees and Forms
Acupuncture and Chinese medicine can be used as a natural approach to fertility without the use of Western medical interventions. Studies have shown that women and men receiving acupuncture along with Chinese herbal medicinals, appropriate nutrients, adequate exercise, and stress reduction techniques, improve their chances for developing healthier eggs and sperm.
Treatment plan will be designed after an initial consultation. A normal course of treatment will span 3-12 months. Althought there are cases of achieving pregnancy after 4-6 weeks of treatments, the minimun time period of 3 months are generally required because the eggs begin their maturation 90 days before they are chosen for ovulation and it takes about 90 days for the sperm to renew so it is during that 3 months when their health can be affected.
Phase I: Restoring the Balance
Treatments in first 3-6 months are aimed to improve egg quality in female and sperm count, motility, and morphology in male, by detoxicifying the body, regulating menstruation, reducing stress, correcting any hormonal imbalances or reproductive issues, and restoring the balance of Yin and Yang of the body. Underlying nfertility issues (such as PCOS, edometriosis, or fibroids) as well as otehr health problems(such as insomnia, emotional disturbance, or digestive issues) will be addressed during this time.
During Phase I, 1-2 acupuncture treatments per week and daily Chinese herbal medicine are recommended.
Phase II: Nourishing the Reproductive Organs
Once there is signs of improvement in fertility (i.e. regular menstruation, bright red blood flow without clots, minimal or no menstrual cramping and breast tenderness, better emotional balance, enriching sleep, and balanced hormone levels), the patient is ready to move onto next step. Treatments in next 3-6 months are focused on increasing blood flow to the reproductive organs to enhance the sperm count, motility, and morphology in male and to develope healthy uterine lining for better implantation in female. This is a time for patient to nourish the body system to improve fertility as well.
During Phase II, weekly or biweekly acupuncture treatments plus daily Chinese herbal medicine are recommended. Additional acupuncture treatment 5-7 days after ovulation to relax the uterus during implantation time are optimal.
Phase III: Managing the Pregnancy
Once conception occurs, third phase treatment starts to increase the probability of a full term pregnancy, manage the discomport from pregnancy (such as morning sickness, depression, hypertension), and decrease the possibility of miscarriage.
During Phase III, weekly acupuncture treatments throughout that delicate and important first trimester, and then monthly treatment throughout the rest of pregnancy are encouraged until it is time to start preparing for labour and delivery. Chinese herbal medicine may be prescribed dependting on the patient's condition.
Combining Assisted Reproductive Technologies (ART), such as fertility medications, IVF and IUI, with acupuncture and Chinese medicine has shown to dramatically increase the chances for conception. Applying TCM principles can support you physically and mentally before, during, and after the ART procedures. Acupuncture and Chinese herbal medicine can significantly improve the outcome of ART in 4 ways:
- Alleviate side effects of medical treatments and improve response to hormonal stimulation.
- Improve the blood flow to the uterus and ovaries
- Alleviate mental / emotional tension inherent in these extremely stressful procedures.
- Calm the uterus to prepare it for implantation.
Phase I: Pre-conception Care before ART
In order to maximize the success rate, it is highly advisable to have a consultation at least 3 months before an IVF / IUI procedure or medicated cycle. A women's body begins to recruit the eggs about 90 days before they are released, and it takes about 90 days for sperm to renew so it is a opportunity for you to nourish your body to improve egg quality, and strengthen your uterus by increasing blood flow to your uterus and ovaries, as well as enhancing sperm count, motility, and morphology. Acupuncture, Chinese herbal medicine, diet, lifestyle and exercise changes at least 3-6 months prior to ART procedure allows the oppotunity to optimize hormonal balance and regulate any menstrual disorders such as heavy or light periods, scanty cervical fluid, delayed ovulation, etc.
In Phase I, 1-2 acupuncture treatments per week for at least 3 months before ART procedure plus daily Chinese herbal medicine are recommended.
Phase II: Fertility Medication Cycle
The typical ART procedure starts with a regimen of fertility medications to stimulate the development of multiple follicles of the ovaries. Oral ovulatory stimulants Clomid or injectable gonadotropins (as more advanced reproductive therapies) are used to induce ovulationIn most patients.
Acupuncture and Chinese herbal medicine during medication phase of ART can help stimulate ovulation while neutralizing adverse effects (i.e. thinning or nonexistent cervical fluid, scantier periods, hot flushes, headaches, and mood swings) by balancing the hypothalamus-pituitary-ovarian axis to regulate and improve the body's natural hormonal production. Re-establishing the natural estrogen and FSH pathways is extremely important to the health of the eggs and plays a large role in sustaining future pregnancies achieved with IVF or IUI.
During Phase II, 1-2 acupuncture treatments per week during the Clomid or injectable medications and follicular development phase are recommended to enhance follicle growth, egg health and endometrial lining. Additional 1 acupuncture treatment 5-7 days after ovulation is also suggested to relax the uterus during implantation time.
- Women taking injectable medications are monitored with ultrasounds and blood work during the follicular phase of the cycle. This information will help the acupuncturist determine the exact timing and extent of the treatments necessary to enhance the cycle. If the patient is responding poorly to the medications, more acupuncture treatments can help boost follicular growth, likewise if the cycle is going well, less treatments may be advised.
- There is no evidance of negative interaction between Chinese herbs and fertility medications. In fact, Chinese herbal medicine can help stimulate ovulation, regulate hormone levels, and reduce the side effect of fertility medications. However, if your infertiliy doctor does not want you to take Chinese herbal medicine during medication cycle, all herbal formulas need to be stopped 2 weeks before their medications begin.
Phase III: IUI / IVF Cycle
Acupuncture and Chinese medicine can continue to support the quality of the endometrial lining and overall hormonal balance during IUI / IVF cycle. These positive effects are in part accomplished by keeping stress within lower limits. Increasing endorphins during acupuncture neutralizes the negative effects created by cortisol and other stress hormones. By promoting relaxation on both emotional and physiologic levels, you are giving your body the best opportunity to naturally take over and nourish a pregnancy.
For patients undergoing IUI:
- 1 acupuncture treatment on the day before and the day of IUI are highly recommended.
- Dailiy Chinese herbal medicine may be advisable.
For patients undergoing IVF:
- 1-2 acupuncture treatments per week and daily Chinese herbal medicine during the IVF cycle are recommended to enhance follicle growth, egg health and endometrial lining as well as promote general relaxation.
- Special acupuncture treatments on the day of egg retrieval are generally not necessary except in cases of elevated discomfort or stress.
- Acupuncture treatments the day before and the day of the embryo transfer are highly advisable to eliminate fallopian tube and uterine contractions and promote general relaxation.
- If possible, two treatments on embryo transfer day, one before and one directly after the embryo transfer, are desirable. According to a study conducted in 2006, on-site treatment at the fertility clinic both before and after the embryo transfer has been shown to improve success rates by 40%.
- If the on-site treatments at the fertility clinic are not available, one treatment at Acupuncture Wellness Center the day before and/or the day of embryo transfer are recommended to increase the success rate of IVF. Your acupuncturist can discuss what the best choice is for your case.
- One acupuncture treatment 5-7 days after the transfer to relax the uterus during implantation time is also recommended.
Discussion of fertility history and current needs will determine an individual treatment plan for each patient. Listed above is a general description of the kinds and types of treatments available to patients and may not be appropriate for every patient.
Costs and Insurance Coverage
- Initial consultation and treament$ 95
- Return visit treatment$ 75
- 5 treatment package$ 300
- 10 treatment package$ 550
- Embryo transfer treatment at fertility clinic$ 300
Chinese Herbal Medicine
- Chinese herbal formulas are customized for each patient and the price varies depending on the patient's condition, dosage, and form (pill, concentrated powder, or concentrated powder in capsules) of the formula.
Currently, most insurance companies in the state of Louisiana do not accept claims from licensed acupuncturists. At this time, insurance companies do not allow us to bill them for treatment reimbursement so payment is due at the time of treatment. Patients are encouraged to send in receipts to their insurance carrier to see if it may be applied to their deductible or considered part of a health savings account.
How to Make an Appointment
To make an appointment for your initial consultation at Mandeville Acupuncture Wellness Center, please call at 985-635-8846. We encourage you to set up your initial appointment as early in your fertility journey as possible but it is also never too late to add the benefits of our services to your plan.
You will want to fill out paperwork before you come to the appointment, please print out the forms below specific for male or female fertility. Bring any information you have easily available such as BBT charts, lab reports, etc.
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Chinese Medicine and Female Factor Infertility
Chinese Medicine and Male Factor Infertility
Chinese Medicine and ART
- Acupuncture in IVF linked to lower miscarriage and ectopic rates
- Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women
Lars Westergaard, Qunhui Mao, Marianne Krogslund, Steen Sandrini, Suzan Lenz, and Jørgen Grinsted
- Acupuncture treatment for infertile women undergoing intracytoplasmic sperm injection
Sandra Emmons and Phillip Patton
- Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilization
Eric Manheimer, Grant Zhang, Laurence Udoff, Aviad Haramati, Patricia Langenberg, Brian Berman, and Lex Bouter
- Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection
Stefan Dieterle, Gao Ying, Wolfgang Hatzmann, and Andreas Neuer
- Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy
Wolfgang Paulus, Mingmin Zhang, Erwin Strehler, Imam El-Danasouri, and Karl Sterzik
- Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer
Caroline Smith, Meaghan Coyle, and Robert Norman
- In vitro fertilization and acupuncture: clinical efficacy and mechanistic basis
Belinda Anderson, Florina Haimovici, Elizabeth Ginsburg, Danny Schust, and Peter Wayne
Improve your chances of conceiving
There are many lifestyle factors that can enhance your reproductive health. By both you and your partner taking a good look at your lifestyle, and being prepared to make some positive changes, you can dramatically increase your chances of conceiving.
- Calculating Ovulation
- Diet / Nutrition
- Lifestyle Modification
- Recommended Reading
Knowing the optimum fertility signs and times is the first step of improving the chance of conceiving. This sounds straight forward, but knowing exactly when you're ovulating, and recognizing the physical signs indicating when you're at the peak time to conceive are sometimes easily confused or missed.
- As long as your periods are regular, you can calculate that about 14 days after the first day of your period is the time when you are ovulating.
- Around the same time, the cervical mucus usually becomes very thin, clearer and more stretchy; almost like egg white in quality.
Charting Basal Body Temperature
Charting basal body temperature (BBT) is a good way of pinpointing your optimal fertility time. BBT can tell you when the ovulation occurred. After ovulation, the corpus luteum (the remains of the follicle that released an egg at ovulation) produces progesterone. Progesterone causes an increase in your body temperature that is observable when you measure your BBT with a BBT thermometer just upon waking in the morning. This increased progesterone after ovulation is what lets you see a thermal shift on your chart after ovulation.
BBT can also tell you how long the luteal phase is so you will know when to test for pregnancy, when you may be pregnant and also if it is sufficiently long to allow for a pregnancy to occur.
How to chart BBT
Charting your BBTs is really pretty easy. Basically, what you are doing is taking your temperature first thing each day and plotting the temperature on a chart. What you are looking for is to see a shift of at least 0.4 °F after ovulation making your chart biphasic (showing low temperatures before ovulation in the follicular phase, and higher ones after ovulation in the luteal phase). Be sure to use ovulation tests in conjunction with your basal charting to provide you with an accurate sense of your most fertile time of month.
- Take your temperature first thing in the morning before you get out of bed or even speak -- leave your thermometer at your bedside within easy reach so you don't have to move much to get it. If you use a glass thermometer, make sure you shake it down before going to bed.
- Try to take the temperature at as close to the same time each day as possible (set an alarm if you need to). Staying within a half hour either side of your average time is a good idea because your temp can vary with the time (i.e. if you usually take your temperature at 6 am, it is OK to take your BBT between 5:30-6:30, but the closer to 6 the better). The normal variation is by up to 0.2 °F per hour (lower if you take your temperature early, higher if you take it late).
- It is best to take your BBT after a minimum of 5 hours sleep, and at least 3 in a row is preferable.
- You can take your temperature orally, vaginally, or rectally (just stay with the same method for the entire cycle).
- You should try to place the thermometer the same way each day (same location of your mouth, same depth vaginally and rectally).
- Plot your temperature on your chart each day, but refrain from reading too much into it until the cycle is done.
- Some women, not all, have a temperature drop when they ovulate. If you see this drop, it is a good idea to have sexual intercouse in case you are ovulating.
- What you are looking for is a temperature shift of at least 0.4 °F over a 48-hour period to indicate ovulation. This shift should be above the highest temperatures in the previous six days, allowing one temperature to be thrown out as inaccurate (fluke, illness). Perhaps the best way to explain this is to show an example.
In the image above, the seven BBTs before ovulation are 97.2, 97.3, 97.8, 97.4, 97.2, 97.3, 97.0 then it jumps to 97.7 and then 98. Ovulation most likely occurred on the day 14 with the 97.0 and you can comfortably draw a coverline at 97.6. You just ignore the 97.8 on day 10.
- After you see a temperature shift for at least three days, or at the end of your cycle, you can draw a coverline between your follicular phase and luteal phase temperatures. With luck, it is easy to see a clear shift and draw your line between the highest follicular phase BBT and the lowest luteal phase BBT as in the sample above. The main reason for drawing this line is just to clearly delineate that your chart is biphasic.
- Look at the chart at the end of the month to analyze what happened.
- Chart for a few months and look for patterns.
- If your temperature stays up for 18 days or more after ovulation, you should test for pregnancy
One thing to note is that women with ovulatory cycles but with irregular cycle lengths, the greatest variation from cycle to cycle should be in the follicular phase. The luteal phase should be relatively constant (within 1-2 days). So if one has a cycle that ranges from 28-34 days, and a luteal phase of 14 days, ovulation would occur somewhere between days 14-20 (not the middle of a cycle, not day 14. This is the biggest mistake women with long cycles make when trying to conceive).
Charting Cervical Mucus and Cervical Position
If you want a clearer picture of your cycle, it is best to combine charting your BBT with charting your cervical mucus and perhaps also charting your cervical position.
There are several ways to chart your mucus, and you have to find the approach that is best for you. You can simply examine your toilet tissue after wiping. You will see more mucus after you have a bowel movement. Another way is to insert two fingers and gently take a little pinch of mucus from the cervix.
The easiest positions for most women would be sitting on the toilet, one foot up on the toilet or bathtub, or squatting. If you have trouble reaching, you can ask your partner to check for you. For most, the best position to do this would be for the woman to get on all fours on the bed, or chest down on a pillow, and let the partner insert fingers from behind.
How to chart Cervical Mucus
Mucus varies from dry, to sticky, to creamy, to egg-white before ovulation in most women.
- Dry is when there really isn't much mucus to get your fingers on.
- Sticky is when you get enough mucus for your fingers to feel sticky or tacky.
- Creamy might be whitish and feels somewhat like lotion when you rub your fingers together. This mucus can be fertile, but isn't always.
- Egg-white cervical mucus (EWCM) is called that because of its resemblance to raw egg whites. It is either clear or streaked and stretches an inch or more.
After ovulation it is normal to have some dry, sticky or creamy mucus, and some women have watery mucus or a little egg-white again right before their menses begins.
How to chart Cervical Position
If you are planning to chart cervical position in addition to BBTs and mucus, it makes sense to chart your mucus by feeling your cervix (or having your partner do it).
You cervix has a pattern each month. It should start out low, closed and firm. Around ovulation it shifts upward, gets softer and feels more open. The difference is slight -- like the difference between feeling your nose (firm) and feeling your lips (soft). It should only stay high for a day or two around ovulation and you may catch it in transition for a day on either side. The rest of the luteal phase (after ovulation) the cervix should be low. It is often soft right before menses. It tends to shift up if you are pregnant.
One caution is that you shouldn't read too much into cervical position alone since how full your bowels are can make a difference as to how high it feels.
* You can download our BBT Chart or chart your basal temperature online using a free service provided at Ovulation-Calculator.com or FertilityFriend.com. Online chart offers a number of advantages over traditional paper charting and helps to identify your ovulation date.
Part of the information on this page is from FertilityPlus.org
Good and nutritious diet is crucial in maintaining optimum health and well being.
Liquids in our diet play an equally important role in maintaining our health as foods do. Sugared drinks, including soft drinks, flavored waters, and fruit juices, raise the blood sugar levels and promote inflammation. Stick with water and unsweetened teas to quench your thirst throughout the day. Organic whole milk or almond milk is also a good choice for the protein and healthy fats we need. Caffeine is ok in moderation, but less than 300mg per day and use organic if possible.
Carbs themselves are not the bad for the body, but refined white carbs should be avoided. Choose breads and pastas that are made from whole grains or brown rice. Fruits and vegetables contain fibers. Low glycemic index diet is recommended to regulate insuline and other hormone levels. Women with PCOS will need to make even stricter changes to their carb intake to help manage their symptoms.
Protein makes up a very important part of our diet and we are often lacking in healthy forms of protein. To avoid meat that has been treated with hormones and antibiotics, buy your meat from a health food store or better yet, from a local farmer. Make it a goal to incorporate protein with every meal in the form of eggs, cheese, yogurt, beans, whole grains such as quinoa, nuts, fish and lean meats. Clod-water oily fish such as salmon, herring, mackerel, anchovies and sardines are good source of protein as well as omega-3 and omega-6 fatty acids.
A recent study published in Newsweek by Harvard identified the fertility benefits of having 1-2 whole milk servings per day. It is much better to sauté foods in saturated fats such as butter or even coconut oil because it has a higher tolerance for heat; when foods are cooked at very high temperatures, the fats are damaged and become unhealthy. Keep away from fried foods; even as little as one donut or one medium French fry serving affected fertility in the women surveyed. So bake, steam and gently sauté your foods for maximum fertility benefit. Remember its the type of fat, not the fat itself that you should avoid.
Vitamin A is essential for the production of female sex hormones. It has antioxidant qualities which protects cells against damage from free radicals in the body. It also is important for the developing embryo and affects the bones, eyes, hair, skin, soft tissue, teeth, soft tissue reproduction and repair, infection resistance, and purple spectrum for night vision. Eggs, yellow fruits and vegetables, whole milk and milk products, dark green leafy veggies, liver, and cod liver oil are vitamin A rich foods.
Vitamin B1 (Thiamin)
Vitamin B1 is needed for ovulation and implantation. It also affects the brain, ears, eyes, hair, heart, nervous system, appetite, blood building, carbohydrate metabolism, circulation, digestion, energy, growth, learning capacity, muscles of the heart, intestines, and stomach. Pineapple, molasses, brewer's yeast, whole grains, nuts, brown rice, organ and other meats, egg yolks, fish, poultry, legumes, and seeds are vitamin B1 rich foods.
Vitamin B2 (Riboflavin)
Deficiency in vitamin B2 is linked to sterility, miscarriage, and low birth weight. The liver uses B2 to clear away old used hormones (estrogen and progesterone). If these are not excreted, the body thinks there is enough and less production happens, resulting in hormone deficiencies. Vitamin B2 Also affects the eyes, hair nails, skin, soft body tissues, antibody and red blood cell formation, cell respiration, metabolism of carbohydrates, fats, and proteins. Dietary sources for vitamin B2 are: molasses, brewer's yeast, whole grains, nuts, brown rice, organ and other meats, egg yolks, fish, poultry, legumes, and seeds.
Vitamin B5 (Pantothenic acid)
Vitamin B5 is mportant for the fetal development, adrenal growth, digestive tract, nerves, skin, antibody formation, conversion of carbohydrates fats and proteins into energy, growth stimulation, and vitamin utilization. Dietary sources for vitamin B5 are: molasses, brewer's yeast, whole grains, nuts, brown rice, organ and other meats, egg yolks, fish, poultry, legumes, seeds, wheat germ, salmon, sweet potatoes, broccoli, oranges, cashews, pecans, and strawberries.
Vitamin B6 (Pyridoxine)
Together with zinc, vitamin B6 is essential for the formation of female sex hormones and the proper functioning of estrogen and progesterone. A deficiency causes the ovaries to shut down production of progesterone which leads to estrogen dominance. Vitamin B6 is used to treat luteal phase defects because of it encourages the production of progesterone. It also has shown to improve fertility rates if taken over a 6 month period. Molasses, brewer's yeast, whole grains, nuts, brown rice, organ and other meats, egg yolks, fish, poultry, legumes, seeds, and green leafy veggies are rich in vitamin B6.
Vitamin B9 (Folate / Folic acid)
Vitamin B9 should be taken for at least 3 months before conception, and 2 months after. It reduces the risk of neural-tube damage (brain and spinal cord) in the developing embryo. It is also used for the red blood cell formation, body growth and reproduction, hydrochloric acid production, and protein metabolism. Dark green leafy veggies, broccoli, organ meats, brewer's yeast, root vegetables, whole grains, oysters, salmon, milk, legumes, asparagus, oatmeal, dried figs, and avacados are rich in vitamin B9.
Folate and B12 are needed for the synthesis of DNA and RNA as well as blood cell formation, cell longevity, healthy nervous system, and the metabolism of fats, carbohydrates, and proteins. Dietary sources for vitamin B12 are: lamb, sardines, salmon, fermented foods that contain bacteria.
Vitamin C is an antioxidant that prevents damage from free radicals. It is also used for the bone and tooth formation, collagen production, iodine conservation, red blood cell formation, and prevention of hemorrhaging. Citrus fruits, rosehips, cherries, sprouted alfalfa seeds, cantaloupe, strawberries, broccoli, tomatoes, sweet peppers, black currants, mangos, grapes, kiwi fruit, pineapples, asparagus, peas, potatoes are good sources of vitamin C.
Taken with vitamin C, vitamin E may improve ovulation and uterine lining. Deficiency in vitamin E may cause miscarriage. Vitamin E is also used for slowing aging process and blood cholesterol reduction. Dietary sources are: cold pressed oils, wheat germ, organ meats, molasses, eggs, sweet potatoes, leafy veggies, nuts, seeds, whole grains, and avocados.
Iron helps prevent miscarriage. It also is important for the production of hemoglobin, and plays a role in stress and disease resistance. Organ meats, lean meat, eggs, fish, poultry, molasses, cherries, dried fruits, prunes, green leafy veggies, kelp, spinach, parsley, pumpkin seeds, sunflower seeds, broccoli, oatmeal, sardines, and nuts are good sources of iron.
Magnesium is used for the energy production, acid/alkaline balance, blood sugar metabolism, and metabolism of vitamin C and calcium. Dietary sources for magnesium are: kelp, green leafy veggies, tofu, legumes, rye, buckwheat, millet, molasses, brown rice, bananas, dried figs, dried apricots, nuts, barley, seafood, and whole grains.
Zinc is important for the cell division in the fetus, producing good quality eggs, and maintaining the menstrual cycle. It is also used for burn and wound healing, carbohydrate digestion, prostate gland function, reproductive organ growth and development, sex organ growth and maturity, phosphorus and protein metabolism. Lean meat, fish, seafood, chicken, eggs, pumpkin and sunflower seeds, rye, oats, whole grains, legumes, ginger, parsley, mushrooms, brewer's yeast, and wheat germ are rich in zinc.
Essential Fatty Acids
Essential fatty acids act as hormone regulators. Omega-3 DHA and Omega-6 arachidonic acid are important structural elements of the cell membranes, body tissue, and brain development in the fetus. They are also used for the prevention of the hardening of arteries and blood coagulation. Salmon, herring, mackerel, anchovies, sardines, flaxseed oil, chia, kiwi, black raspberry, hemp seeds, pumpkin seeds, safflower seeds, walnuts, pecans, hazel nuts, and olive oil are good sources of omega-3 and omega-6 fatty acids.
Cigarette smoke can dramatically affect both female and male fertility. Smoking has been associated with infertility and early menopause in women, as well as sperm problems in men. It also reduces the success of fertility treatment.
Increased consumption of caffeine has negative effect on estrogen production and/or metabolism and may cause tubal factor infertility, endometriosis, and spontaneous abortion. Generally said, caffeine in moderation (less than 300mg/d per day) is safe.
- Cup of coffee = 150-160 mg/d
- Cup of black tea = same as coffee
- Cup of green tea = 85-90 mg/d
- Can of soda= 35-45 mg/d
- Keep in mind that chocolate, specialty drinks and some OTC drugs also contain caffeine.
Unhealthy alcohol habits (binge and heavy drinking) are associated with many fertility problems, including menstrual disorders, spontaneous abortions and reduced fecundity. Risk might begin with as little as one drink per week but the stronger evidence is at four to eight drinks per week. If you are trying to conceive you should limit or avoid alcohol consumption.
Regular, moderate exercise of around 30 minutes a day will help to improve and maximise your fitness and keep you at a good weight. Exercising in an appropriate way can also improve the mental health by boosting the endorphin levels and decrease stress. Different types of exercise have different benefits, so it is important to choose the appropriate exercise that you can enjoy and get more benefit from.
Manage your stress level
Both emotional and physical stress can have a profound affect on fertility and pregnancy outcome. Infertility can also have an adverse effect on both our mental and physical well-being and leave us feeling even more helpless. Studies discovered that there is more anxiety and depression in infertile women than in those who are fertile. There is no separation between mind, body and spirit. Whatever treats the body helps the mind, and whatever heals the spirit will also help restore balance to the physical being.
Acupuncture, a holistic method, integrates the body and mind, and has been extremely effective in helping the body deal with stress as well as helping you get through each day with greater calm and balance. Meditation, reproductive Qi Gong exercise and fertility yoga are also powerful methods for improving your quality of life because they bring you to a deep peacefulness, which can help lower your levels of tension and anxiety over infertility.
Participate in a support group
The ability to share and express the many emotional peaks and valleys that you experiences during your fertility treatments can provide valuable peace of mind and a greater sense of control. A supportive group of like minded people will help reduce the stress which is important to creating a healthy environment for conception.