Infertility Factors

Endometriosis is a condition where tissue similar to the lining of the uterus (the endometrial stroma and glands, which should only be located inside the uterus) is found elsewhere in the body.

Endometriosis lesions can be found anywhere in the pelvic cavity - on the ovaries, the fallopian tubes, and on the pelvic wall. Other common sites include the uterosacral ligaments, the cul-de-sac, the Pouch of Douglas, and in the rectal-vaginal septum.

In addition, it can be found in caesarian-section scars, laparoscopy or laparotomy scars, and on the bladder, bowel, intestines, colon, appendix, and rectum.

In rare cases, endometriosis has been found inside the vagina, inside the bladder, on the skin, even in the lung, spine, and brain.

The most common symptom of endometriosis is pelvic pain. The pain is often correlated to the menstrual cycle, but a woman with endometriosis may also experience pain that doesn't correlate to her cycle. For many women, the pain of endometriosis is so severe and debilitating that it impacts their lives in significant ways.

Endometriosis can also cause scar tissue and adhesions to develop that can distort a woman's internal anatomy. In advanced stages, internal organs may fuse together, causing a condition known as a "frozen pelvis."

Chinese medicine treats the western disease diagnosis of 'endometriosis' by reframing the signs and symptoms displayed by the client into traditional Chinese medical disease categories. The most common symptom associated with endometriosis is pain surrounding menstruation. The traditional Chinese medical disease category for pain during menstruation would be 'Painful Periods'. Another common symptom of endometriosis is the inability to conceive. This becomes reframed into the traditional Chinese medical disease category of 'Infertility'. There can also be erratic bleeding cycles, i.e. bleeding outside of the cycles, early spotting, spotting mid cycle, or spotting after the end of the cycle for several days. The traditional Chinese Medical disease category in these instances would be 'Erratic Menses'. There may also be profuse bleeding during the period (the bleeding is very heavy), this would fall under the category of 'Profuse Menstruation'. Therefore, the western medical diagnosis of 'endometriosis' can be reframed into at least 1-5 different traditional Chinese medical disease categories depending on the signs and symptoms displayed by the woman, mainly painful periods, infertility, and profuse menstruation. This is representative of how traditional Chinese medicine treats the individual person, not the disease.

The success of TCM treatment for those with Endometriosis is really dependant on the degree of compliance and commitment the client displays toward the requirements necessary for success. One must be willing to invest in themselves, make room for some lifestyle changes, modify their diet (sometimes drastically), undergo regular acupuncture treatment, religiously take the prescribed herbal formulas, and practice the intention required by the body mind and spirit to overcome a severe health condition. With time and diligence, 70-80% of women being treated with traditional Chinese medicine can expect to see significant reductions in their symptoms. 20% of women will get minimal to no results (as in every type of disease, there is always a small group of people who will not respond to the treatments, there is no explanation for this). Some women see results within just a few treatments, although, it should be noted that it is not unrealistic to expect six months to one-and-a-half years of treatment with traditional Chinese medicine to see results with lasting effect.

During treatment with traditional Chinese medicine, the woman's menstrual cycle can change, sometimes drastically. Some months it may look like things are heading in the right direction, and some months it may seem as though things are going backwards. The more severe the condition, the longer the body must take to heal. Many women that find no relief with traditional Chinese medicine have set unrealistic expectations, and quit before changes can occur. Treatment with traditional Chinese medicine is, in most cases, a more permanent fix, but, it must be remembered that it takes time for traditional Chinese medicine to make the adjustments and changes that must occur within the reproductive body tissue.

Diet Recomendations for Endometriosis

Women with Endometriosis should be particularly vigilant about increasing their consumption of kelp and wheat germ.

Endometriosis has been linked to thyroid dysfunction and kelp is particularly good for thyroid problems. The vitamin E in wheat germ improves the healing of scar tissue caused by internal endometrial bleeding. Women who suspect endometriosis should cut down on their yeast consumption, as yeast overgrowth has been recently implicated in endometriosis. Also, since yeast thrives on sugar, strictly avoid sugar, as well as any artificial sweeteners and dairy, though yogurt can be helpful for this problem.

In general, women with endometriosis should stick to a high-fibre, vegetarian based diet. Particularly, the elimination of fats from animal sources such as meat and dairy products is beneficial. Women with endometriosis should also particularly avoid caffeine and salt and should indulge in antioxidants such as sweet potatoes, yams, apricots, cantaloupes, carrots, spinach and broccoli, whole grains and beans for necessary B vitamins, and citrus fruits for bioflavonoids and natural vitamin C.

Unexplained infertility is the most frustrating diagnosis a woman can receive. Luckily, according to traditional Chinese medicine there is always an underlying cause and it will be found if you look deeply enough, and pay attention to what the body's messages are. It is as if the body-mind-spirit hides the expression of fertility when your life is out of balance.

There are many steps in the journey of fertility, and even a small misstep can make the difference between a happy mother and a woman faced with unexplained infertility. One hormone produced at the wrong time in the menstrual cycle, a tiny change in the pH of cervical mucus, or a millimeter less depth in the endometrial lining can be the deciding factor between a pregnancy and yet another period. Treatment

The first step is always to address the manifestation of the problem and determine the underlying pattern. In most cases of unexplained infertility, there is some sort of indication of where the problem lies-whether it be in symptoms involving the menstrual cycle, or feelings of hot or cold, lethargy or nervousness amongst others and when these imbalances are addressed, the reproductive system can begin to function normally again.

One of the best ways to discover subclinical fertility problems is to examine the different stages of a woman's menstrual cycle. Possible indications of fertility problems include menstrual irregularities such as:

• severe PMS

• premenstrual breast pain and headaches

• premenstrual low back pain, loose stools, acne

• heavy menstrual flow

• scanty menstrual flow

• clotty, dark menstrual blood

• menstrual pain

• short luteal phase

• long follicular phase

• short follicular phase

• inhibited ovulatory phase

These are all physical manifestations and important reflections of which aspects of the reproductive system are out of harmony. When we discover what energy imbalances cause the menstrual irregularities to appear, the infertility is no longer unexplained. And when we have an explanation, we have a diagnosis, a treatment, and a remedy.

Premature Ovarian Failure (POF) is essentially very early menopause, before a woman reaches the age of forty. Most women have hundreds of thousands of eggs at the time of their first period. By the time we hit menopause that supply of eggs has dwindled down to a handful.

This gradual loss of eggs during our fertile years is normal. However, in premature ovarian failure for some reason either the loss of eggs is accelerated or the follicles themselves become less responsive to hormonal stimulation (of course, these conditions contribute to each other). Unfortunately, POF is one of the more common conditions affecting a woman's fertility, occurring in one in every thousand women (0.10%) between the ages of fifteen and twenty-nine, and in one in every hundred women (1.0%) between the ages of thirty and thirty-nine.

Symptoms and Signs

Women with POF will have stopped menstruating altogether, or will have short cycles characterized by early (or no) ovulation. Sometimes periods do not occur at all, and menopausal symptoms-hot flashes, amenorrhea, and vaginal dryness-may appear suddenly over one to two months, or gradually over several years.

What is Happening?

As ovulation occurs increasingly early in women with POF, the cycle is often accompanied by elevations in FSH, a signal indicating that the ovaries are not responding to clues from the brain. This lack of communication causes hormonal "confusion." The hypothalamus gives the pituitary gland messages to try harder to stimulate the ovaries to respond. More FSH is produced to stimulate the ovaries, but the ovaries, whose receptors are down, have become less responsive to this message.

Western Medicine Diagnosis of POF

POF is an extremely frustrating diagnosis, as Western medicine cannot pinpoint its cause with any degree of accuracy. Some theories include chromosomal defects, damage from pelvic surgery, chemotherapy, radiation therapy, or pelvic inflammatory disease (PID). One promising avenue of investigation has to do with autoimmune disorders, where a person's immune system attacks the body's own tissues, including (in theory) the ovaries. Often a woman diagnosed with POF will have a concurrent diagnosis of conditions like autoimmune thyroiditis or Graves' disease, or Addison's disease (involving the adrenal glands).

Unfortunately, no matter what the cause of POF, Western medicine can do little to help it. Sometimes treating the associated autoimmune disorder (hypothyroidism, for example) will restore function to the ovaries, but this doesn't always work. If there is evidence of ovarian antibodies indicating an autoimmune disorder, high doses of steroids may be given in an attempt to restore ovarian function. However, the side effects of this treatment are severe. The treatment of choice for POF is usually estrogen replacement therapy (a version of HRT), which is not an option for women who are attempting to conceive because administration of estrogen feeds back to the hypothalamus that it doesn't need to prompt the pituitary to stimulate the ovaries to produce estrogen. The whole hormonal system then goes to sleep.

Women with POF who consult reproductive endocrinologists are usually given one option: IVF with donor eggs. While this might give a woman a baby, it does nothing to address the underlying failure of the ovaries and all of the menopausal symptoms that occur as a result. And since the average age of POF onset is 27-28, most women with POF would prefer a treatment that will restore their ovaries and hormonal system to full, functional health.

Treatment

According to the traditional Chinese female fertility model, the average age most women go into premature ovarian failure is precisely when they should achieve their reproductive prime. Something has halted this process. Sometimes it's physical. Often there is a deep seated emotional component. Yet, the remedy is, always, to gently restore all aspects of her body, mind, and soul. We must open up the communication between the hypothalamus, pituitary gland, and ovaries. This is not only a physical process, but one that evaluates all aspects of a woman's life that may be preventing this open communication.

Although treatment of POF may be challenging for the TCM practitioner, the results are extremely rewarding, because Chinese medicine is one of the most effective ways to address POF. TCM views most cases of POF as a combination of excess and deficiency patterns that cause the Penetrating and Conception meridians to become "empty." The lack of menstrual bleeding tells us that there is also a deficiency in Blood. Blood deficiency may be due to an obstruction, but in most POF cases it is due to deficient Blood production, usually from faltering Spleen energies or insufficient Kidney Yin. If a woman is experiencing short cycles, early ovulation, and heat signs like night sweats and hot flashes, there is also concurrent heat.

We view the condition of POF as a failure of communication: messages from the brain just aren't getting to the ovaries, and they cease their performance. As a result, the whole system increases its (Yang) energy to try to evoke a response from the ovaries, producing a frenetic cycle of stimulation with no effect. The result is depletion of Yin and deficiency Heat. Most POF cases we have treated have presented with a severe Kidney Yin deficiency, usually accompanied by (Liver or Heart) Blood deficiency, and Spleen Qi deficiency accompanied by deficient heat. It also is not unusual to see concurrent Kidney Yang deficiency.

A typical treatment will consist of the following recommendations.

• Dietary modifications from the Spleen-fortifying diet, avoiding wheat, refined carbohydrates, sugars, dairy, and most animal products. It's also wise to avoid hot, spicy foods if signs of internal heat are present. We want to calm the body down to make it less reactive. Dietary insults can set off aggravations in autoimmune conditions.

• Take herbs to fortify the spleen like Astragalus; herbs to nourish Yin and Blood like the formulas Liu Wei Di Huang Wan or Si Wu Tang, or the individual herbs Rehmannia, Angelica, White Peony, and Ophiopogon; and herbs to resolve Blood stasis and obstruction, like Persica, Moutan, and Red Peony.

• We stimulate the acupressure points to regulate the Penetrating (Chong) and Conception (Ren) meridians, and to supplement Yin and Blood. We employ techniques to improve blood flow to the pelvic organs and open up communication to the brain and pituitary gland.

Secondary infertility is defined as the ability to conceive one or more children, followed by the inability to conceive subsequent children. This particularly frustrating diagnosis is compounded by the emotional frustration of not knowing why a sibling isn't forthcoming and why your family isn't expanding according to your dreams..

Unlike those experiencing primary infertility (when a childless couple is unable to conceive), couples that are affected by secondary infertility are much less likely to get infertility treatment. This is usually due to the misconception that once you're fertile, you'll always be fertile. It is not uncommon for a couple to be told to just keep trying and that eventually it will happen. While this may be true in some cases, in many others, advice like this only adds to the frustration and heartache experienced by a couple having fertility problems.

Secondary infertility may happen at any time and the causes, where they have been pinpointed, are almost identical to those of primary infertility. The problem can lie with the woman's reproductive system; the man's reproductive system; or with both partners, as follows (RCOG, 2004):

• In 27% of cases an ovulatory problem in the woman is involved.

• In 14% of cases tubal damage in the woman is involved.

• In 19% of cases low sperm count or poor quality sperm is involved.

• In 39% of cases disorders in both the man and woman contribute.

This still leaves one third of cases in which the cause of infertility is not identified. This can be frustrating if you are desperate to find out why you cannot conceive. However, in cases of unexplained infertility there is still hope -- one to two thirds of couples with unexplained infertility will conceive within three years if they keep on trying.

Reasons for secondary infertility tend to be the same as reasons for primary infertility. Since you were last pregnant, you or your partner may have had an infection, gained some weight, or started eating fewer healthy foods. These seemingly small variances in your life can have large repercussions on your reproductive health. Additionally, if it has been a few years since you last had a child, your egg quality may have begun decreasing or your partner's sperm may not be what it once was. Abnormalities with sperm and ejaculate are frequently cited as causes of secondary infertility.