Female Subfertility

In traditional Chinese medicine, all aspects of female reproduction – the organs, the glands and their secretions, and the psyche – are described in terms of ‘Kidney’ function, ‘Heart’ function and the ‘Uterus’.

2000 years ago doctors in China referred to ‘Kidney Jing’ to talk about fertility – this is what modern Western medical science refers to as the gametes or eggs or sperm themselves. ‘Kidney Yin’ and ‘Kidney Yang’ include the influence of the hormones which regulate the different parts of the cycle.

In Chinese medicine, the ‘Heart’ encompasses the mind, as well the activity of the hypothalamus and pituitary, which controls the whole cycle. The ‘Uterus’ describes the arena where all of this happens. It includes all the reproductive organs – uterus, ovaries, fallopian tubes and cervix. The meridians or channels are the means of communication between the Heart, the Uterus and the Kidneys.

At a subfertility clinic in the West, we may describe female subfertility using labels like fallopian tube blockage, polycystic ovaries, inadequate luteal phase, infrequent ovulation etc. Although these labels don’t always translate directly into specific Chinese medical categories of subfertility, the symptom pictures they manifest can be analysed and categorised to fit a Chinese medical diagnostic pattern.

The main patterns considered are:

  • Kidney Yang Deficiency. There may be: a prolonged menstrual cycle, scanty or heavy period, backache, dizziness, feeling cold, depression, frequent urination.
  • Kidney Yin Deficiency. There may be: long-term subfertility, early periods, scanty periods with light-coloured blood, night sweats, dizziness, tinnitus.
  • Blood Deficiency. There may be: scanty periods, pale blood, delayed cycle, tiredness, depression, dizziness, pale complexion.
  • Cold in the uterus. There may be: delayed cycle, scanty period, small clots, painful periods, better with heat, feeling colder during her period, pale face, sore back.
  • Dampness in the Lower Jiao (abdomen). There may be: irregular periods, a delayed cycle, mid-cycle pain, vaginal discharge, long-term subfertility, adhesions, obesity, a feeling of heaviness of the body.
  • Blood-Heat. There may be: early periods (i.e. a short cycle), heavy flow, feeling hot during period, thirst, mental restlessness.
  • Stasis of Blood. There may be: irregular and painful periods, dark blood with clots, irritability, abdominal pain.

As mentioned, from a Chinese medicine viewpoint, there are a lot of reasons why a woman might have difficulty conceiving. As part of the acupuncture treatment, her lifestyle will be considered as well as every aspect of her monthly cycle, i.e. regularity, blood flow, pain levels and any premenstrual syndrome.

As the Kidneys are said to dominate reproduction, the treatment of Kidney Yin and Yang underpins all acupuncture treatments for subfertility. Alongside this aspect of strengthening the Kidneys, acupuncture treatment can also help clear “blockages” from the uterine area, facilitate movement in the fallopian tubes, strengthen and nourish the Uterus Blood, as well as calm the mind.

Randomised trials in China have demonstrated significantly better pregnancy rates for acupuncture than medication (Yang 2005, Chen 2007, Song 2008), but these studies may not be of a high quality. In the West, clinical trials on acupuncture for natural fertility (i.e. not as an adjunct to assisted conception) are almost non-existent, though there is a small amount of positive evidence (Gerhard 1992, Stener-Victorin 2000, 2008, 2010).
Research has established plausible mechanisms to explain how acupuncture may benefit fertility:

  • regulating fertility hormones – stress and other factors can disrupt the function of the hypothalamic pituitary-ovarian axis (HPOA), causing hormonal imbalances that can negatively impact fertility. Acupuncture has been shown to affect hormone levels by promoting the release of beta-endorphin in the brain, which affects the release of gonadotrophin releasing hormone by the hypothalamus, follicle stimulating hormone from the pituitary gland, and oestrogen and progesterone levels from the ovary (Ng 2008, Huang 2008, Lim 2010, Stener-Victorin 2010).
  • increasing blood flow to the reproductive organs – stress also stimulates the sympathetic nervous system, which causes constriction of ovarian arteries. Acupuncture inhibits this sympathetic activity, improving blood flow to the ovaries (Stener-Victorin 2006, Lim 2010), enhancing the environment in which ovarian follicles develop. It also increases blood flow to the uterus (Stener- Victorin 1996, Huang 2008), improving the thickness of the endometrial lining and increasing the chances of embryo implantation.
  • counteracting the effects of polycystic ovarian syndrome (PCOS) – PCOS is one of the most common causes of female infertility. By reducing sympathetic nerve activity and balancing hormone levels, acupuncture has been shown to reduce the number of ovarian cysts, stimulate ovulation, enhance blastocyst implantation and regulate the menstrual cycle in women with PCOS (Stener-Victorin 2000, 2008, 2009, Zhang 2009). It may also help to control secondary effects such as obesity and anorexia (Lim 2010).