Etiology
Female Infertility accounts for about 1/3 of infertility cases, another 1/3 male infertility and 1/3 combination female and male infertility. The definition of female infertility is inability to conceive after actively trying for more than 12 months without male fertility issues. The most common causes of female infertility are as follows:
Ovulation disorders
An ovulation disorder refers to any problem with ovulation whether a female ovulates infrequently or not at all. These problems can be caused by problems with the regulation and balance of sex hormones or by problems within the ovary itself. While other ovulation disorders exist, these are what we see most often:
o Polycystic Ovarian Syndrome (PCOS). In PCOS, changes occur in the hypothalamus, pituitary gland and ovaries, which causes imbalances of hormones, including sex hormones. This cause a rise in androgens (male hormones) which can reduce or stop ovulation. Because of the rise in male sex hormones, someone with PCOS will often also experience abnormal hair growth on face or body, and acne. PCOS also affects the glands that regulate insulin so other common symptoms are insulin resistance causing weight gain or trouble losing weight.
o Hypothalamic Dysfunction. There are two hormones that are responsible for stimulating ovulation each month, they are follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Throughout the menstrual, these hormones are released in a specific pattern which regulates when processes, like ovulation, occur. When these are not regulated properly, irregular or missed periods occur and thus irregular or missed ovulation. Hypothalamic dysfunction is often a result of too much physical or emotional stress, an excessively high or low body weight, or can also occur with recent changes (loss or gain) in weight.
o Premature Ovarian Failure (or insufficiency). This disorder is characterized by the ovaries being unable to produce and egg as well as a decrease in estrogen production (both occurring before 40 years of age). We often see this as a result of an autoimmune response (when the body attacks itself because of mistaking “self” for an intruder) secondary to an autoimmune disorder, trauma, or toxin exposure (like chemotherapy). This can appear with symptoms mimicking menopause, or could also produce minimal or no other symptoms.
Damage to Fallopian/Ovarian Tubes
Ovarian tubes can become damaged or blocked, which prevents sperm from reaching the egg or blocks the fertilized eggs’ pathway into the uterus. Causes can include:
o Pelvic Inflammatory Disease (PID), an infection of the uterus and/ ovarian tubes secondary sexually transmitted infections (STD/STI).
o Trauma to the abdomen or pelvis including surgery.
o Pelvic Tuberculosis (uncommon in US)
Uterine or Cervical Causes
Uterine or Cervical conditions can interfere with egg implantation or can increase risk of miscarriage. These include:
o Uterine Fibroids which are benign polyps or tumors that are very common in women, and often will not interfere with fertility. They can, however, block ovarian tubes, and prevent pregnancy.
o Endometriosis is a condition where uterine tissue implants itself elsewhere and grows, or overgrows. This “extra tissue” (or the surgical removal of it) can cause scarring which can block the ovarian tubes or disrupt implantation of the fertilized egg into the uterus. Females with endometriosis often have painful periods and irregular bleeding.
o Congenital Uterine Abnormalities such as an abnormal uterine shape.
o Cervical Stenosis which is a narrowing of the cervix, often inherited.
o Insufficiency of Cervical Mucus for successful transportation of the sperm.
Unexplained infertility
In some cases, a clear cause isn’t found. It could be a combination of several minor factors for both partners. Although it can be frustrating to not definitively know the cause, conception can still be possible and Chinese Medicine can often still help because we will look at the body holistically and not just for the diagnoses listed above.
Diagnosis
At least 12 months of active unprotected sex with the inability to conceive without male fertility issues present.
Chinese Medicine Treatment
Our clinic is focused on the treatment of female sexual dysfunction and infertility by increasing blood flow to the pelvic region to help repair trauma and promote the correct functions of the reproductive organs. We also use acupuncture and herbs to help regulate and balance hormones:
Acupuncture treatment: SP10, KID3, LV4, LI3, 4, LU7 PC7 ST36, UB62, GB34 (plus points for individual symptoms).
Ear Acupuncture: Internal Genital, External Genital, Libido, Shenmen, Kidney, Liver, Heart, Pituitary, Endocrine.
Herb treatment:
o Kidney Qi Deficiency: Low sex drive, frequent urination and/or incontinence, irregular or absent menses, fatigue. Herbal treatment: Zuo Gui Wan. With previous trauma to abdomen or pelvis, add Shao Fu Zhu Yu Tang.
o Kidney & Liver (and sometimes Heart) Yin Deficiency: Menopausal symptoms including hot flashes, night sweats, anxiety, and irregular periods. Herbal Treatment: Zhi Bai Di Huang Wan. With excess heat or toxin accumulation add Long Dan Xie Gan Tang.
o Blood and Qi Deficiency: Irregular and short periods, maybe a short cycle as well, signs of anemia including fatigue, dry hair, skin, and nails, and poor memory. Herbal Treatment: Dang Gui Shao Yao Tang, Gui Pi Tang.
o Blood Stagnation: Previous trauma or surgeries to abdomen or pelvic area, clots in menstrual blood, painful periods. Herbal Treatment: Shao Fu Zhu Yu Tang.