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Acupuncture and Infertility in a Post 9/11 World
September 11, 2004
 
For some time I have been thinking about the growing number of women seeking acupuncture treatment at Turning Point for unexplained infertility. Since 9/11 this number has increased. Some of the increase is surely due to the recent publicity buzz in the media surrounding the use of acupuncture for fertility. Interest surged when a German study published in April 2002 (in Highlights in Fertility and Sterility Vol. 77, No. 4) demonstrated that acupuncture improved the outcome of IVF.  Read more about this study here.

But I think the increasing numbers of women having difficulty conceiving are responding to the toxic stress of living in an urban environment under siege. Indeed, my office manager Deborah Pannell, who herself had assistance in conceiving her son Josiah, now 16 months of age, told me having a baby in today's world is “a supreme act of hope.”

Contents:
1. Western Medical: Toxicity and Infertility
2. TCM: Causality and Treatment of Infertility
3. Integrative Approach to Infertility
4. Fertility Stories Wanted
5. Turning Point Acupuncture Notes


1. Western Medical: Toxicity and Infertility
The reason usually cited for the increase in infertile couples is delayed childbearing, especially as women seek to establish themselves in the workforce before having a family. Other factors include infection, pelvic masses, immunological problems and the like. However I see a more insidious trend: I think the increase in infertility today is an effect of the toxic environment of the late 20th century, and even more dramatically, of the early 21st century.

In Western Medicine we may view toxicity as the effects of environmental pollutants in our air and water, chemicals added to our foods including hormones in our meat, dairy and poultry, noise and light pollution, etc. These indeed pose serious health hazards. I believe, however, that the greatest toxin of all is stress.

The trauma of 9/11 cast the shadow of imminent terrorism that we live under now. It saddens me that three years have passed and the World has become an even more frightening place. The newsletter that I sent out immediately after the attack on the Towers about coping with trauma unfortunately applies equally well today.

Since the beginning of the war with Iraq, we city dwellers have lived under brightly colored (orange and red) alert levels indicating a threat that makes “normal living,” and in this I include reproduction, so difficult.
I maintain that this landscape of fear creates a toxic environment to live in.
As Bob Dylan, the troubadour of my generation wrote in Masters of War:
 
You've thrown the worst fear
That can ever be hurled
Fear to bring children into the world
For threatening my baby
Unborn and unnamed
You ain't worth the blood
That runs in your veins

(Copyright © 1963; renewed 1991 Special Rider Music)

 
In the 30 years I have been practicing medicine it has been common to see large numbers of women with all manner of disorders of the female reproductive system. Concurrently the incidence of breast cancer has approached epidemic proportions. Most of the medical community accepts this as the norm and proceeds to treat the symptoms of the affected organs: women have bad menstrual cramps and just need to take Motrin; PMS is normal and maybe an antidepressant will help; let's biopsy that breast lump; menopause is uncomfortable so take hormones or tough it out, etc.

One of the compelling reasons that I practice Chinese Medicine is that this array of pathology is not considered typical, but rather a sign of disturbance in the underlying life force energy (Qi) that is vital to address.

2.  TCM: Causality and Treatment of Infertility
Traditional Chinese Medicine (TCM) grew out of Taoism, a spiritual belief system that has its basis in the observation of Nature and Universal forces. In fact the yin yang symbol so often associated with TCM is a Taoist symbol. It represents the opposing forces in the Universe in harmony, that is, flowing one into the other. The early Taoist philosophers postulated that the processes that went on inside the body must be like Nature; “so within so without”. Farmers knew that if environmental conditions were just right, i.e., just enough sun, and enough rain, not too hot or cold or dry, then their crops will flourish. So too, if there is harmony and balance in the body, the individual will experience excellent health.

I digressed with this explanation because I think it suggests a clue to why treatment with TCM is so critical to personal well being in these times, especially for people trying to start a family. The concepts of wholeness, harmony and balance from Taoism that underlie TCM create a medicine that makes no distinction between physical, emotional or spiritual aspects of health. There is only one Qi. Disturbances in the Qi can be from an insufficient amount of Qi, a blockage of Qi, or an imbalance in the yin/yang balance of Qi. These disturbances can manifest as a physical symptom, mental disturbance and/or crisis of Faith.

For millennia the Chinese, propelled by the other great religion of China, Confucianism, have been interested in having healthy babies. An important tenet of Confucianism is the reciprocal love of parents and children and the practice of ancestor worship plays a significant role. Thus TCM treatment for fertility for men and women is well developed. Acupuncture is used to manipulate the flow of Qi, and Chinese herbs are incorporated to nourish, support and strengthen the Qi and the vital fluids (including blood), as well as the internal organs.

So, getting back to my thesis:
How does this atmosphere of fear impact reproduction?
In TCM all the internal organ systems are associated with an emotion. The kidney is the organ system affected by fear.

(Note: In TCM the name of an organ, e.g., kidney, refers to the organ and to the functions ascribed to it.)

Since the kidney organ system includes the kidney/adrenal axis, fear can deplete the kidney Qi in exactly the same way that it causes the adrenals to become drained by the continual excretion of adrenaline in a “fight or flight” mode to deal with ongoing emergency situations. In NYC we live a heightened state of adrenal overdrive, driven by fear mongering from politicians and the news media and exacerbated by caffeine. This is important because the role of the kidney organ system in fertility is critical: The kidney acts as our pilot light and is the source of generative energy. It is also the seat of ancestral energy, known as Jing: that part of the life force energy that defines the strength of our gene pool. Contemporary women with kidney depletion appear weak and pale and feel cold, especially in the extremities. The uterus is also cold by TCM definition and will not sustain a pregnancy. Frequent miscarriages ensue. Chinese herbs are essential here to warm and nourish the kidney.

And what is the impact of frustration, anger and depression on fertility?
In TCM it is the liver organ system that deals with this kind of stress, so common in daily life today.
 
Liver imbalance results in constrained energy (Qi) that causes blockages. Typically symptoms manifest in the pelvis and the breast. (The liver meridian runs right through the breast.) Frequently I see infertile women with a history of painful menstrual cramps, PMS symptoms including breast swelling, and irregular and/or painful menses.

If untreated over a long period of time blocked Qi coalesces into masses such as endometrioma, fibroid tumors, ovarian cysts, polyps and breast lumps. Women with these masses have a difficult time conceiving for obvious reasons.

However, even in the absence of such overt signs of blockage, it is increasingly common for a woman to be unable to conceive because there is energetic (Qi) blockage in the pelvis. These instances correspond to so-called unexplained infertility in Western Medicine: all the medical tests are normal including hormonal levels and structural integrity of the reproductive organs as seen on sonograms and hysterosalpingograms, but the woman is unable to conceive.

The kidney and liver organ disharmonies described above are gross simplifications. There are a host of TCM syndromes that correspond to difficulties with fertility by affecting different parts of the female reproductive cycle - production of the egg, fertilization of the egg and implantation of the fertilized egg in the uterus. These TCM syndromes include kidney yin and yang deficiency, blood deficiency, constrained liver Qi, phlegm-dampness, and blood stasis.

Similarly energy disturbances in men may result in poor sperm production, shape or motility. TCM seeks to address these problems with time-tested methodology using acupuncture and Chinese herbal formulas.

Dietary and life style changes are often indicated for both men and women.
If the woman has constrained liver Qi, for example, and we know the liver is the organ of detoxification, we suggest that she not drink alcohol. The liver is also the organ system in Chinese Medicine that deals with stress, so a meditative practice might be cultivated. Modern women tend to choose vigorous aerobic exercises that cause Qi depletion and undermine reproductive health. Many women seeking to improve their productive chances would do better with gentler practices including walking, yoga and especially Tai Qi and Qi Gong.

What about the spiritual aspect of TCM treatment?

Today the woman (man, couple) trying to conceive is under unprecedented psychic pressures. To me one of the most attractive aspects of TCM is the lack of mind/body spirit separation stemming from Taoism, as I described earlier. A disturbance in Qi or an organ system can manifest on many levels. For example, if the woman's spleen organ is damp, she may have digestive problems, or obsessive thinking. This phlegm-dampness in the pelvis will interfere with conception. It is exacerbated by worry and cold food.

As the TCM practitioner balances and treats the affected internal organ systems, we help the individual to be calm and centered. The recipient is the best he or she can be at any given moment. In this way one can live in our difficult environment and navigate the often arduous road that is infertility treatment.

TCM is about balance. People contemplating parenthood often live in a limbo between fear and hope. The spiritual Taoist origin of TCM, which grew out of observations of Nature, teaches us to trust in the natural order of the Universe. We are called upon to turn fear into faith and align our personal desire for a child with the Universal Qi.

Timing and treatment:
Chinese Medicine is tailored to each individual. How well a person responds depends on his/her condition when the treatment begins. A much depleted individual will take longer to respond. Getting pregnant is a complicated and multi-systemic issue. Since stress is an enormous factor in many cases of delayed fertility, cultivating patience and serenity is always helpful.

Many cycles may be needed to get results. In our experience women who may need more extensive treatment are over 40, have pelvic masses or a history of PID, PMS, or have undergone multiple hormonal therapies in the past or have used birth control pills extensively. A history of drug and /or alcohol abuse or smoking resulting in injury to the liver and lung organ systems can also interfere with success. I treated one woman in her early 40's for 1½ years before she conceived!

At TPA, office visits for women are usually scheduled weekly to correspond to the four stages of the menstrual cycle, but the periodicity is individualized to each woman's need. She can start at any point in her cycle. In the first part of the cycle (prior to ovulation) the treatment will be more intensive since the intention is to move a lot of Qi to open the pelvis. After ovulation, when there may be an implantation in progress, the treatment is gentle and supportive.
Men are also typically seen on a weekly basis.

Acupuncture treatment is calming and centering. At the very least this will help to navigate the challenging days ahead for those dealing with infertility.

Preventive Medicine:
Allow me to make a pitch to the modern urbanite woman for regular acupuncture maintenance treatment throughout her childbearing years (starting as young adults, if possible). As women we are lucky because we have a built in health barometer, i.e., our menstrual cycle. The menstrual period should be regular, painless, with free flowing bright red (no brown) blood, without clots and with no antecedent PMS. TCM can help to achieve this goal by treating the underlying Qi and thus promote fertility in the future.

3. Integrative Approach to Infertility:
At Turning Point Acupuncture we treat people facing infertility using TCM alone, or in combination with their concurrent Western Medical intervention, such as, IUI and IVF procedures.

The treatment at Turning Point Acupuncture combines acupuncture, Chinese herbal formulas, FIR infrared treatment, along with nutritional counseling, lifestyle suggestions, Chinese exercise (Qi Gong) instruction (or referral), homeopathic herbal formulas and stress reduction modalities, as indicated.

Regardless of whether we use TCM or Western Medicine or the combination of both, the miracle of creation of life is ultimately not in our power. We work together as patient and practitioner with the understanding we can only prepare the canvas for the masterpiece that may ensue.
 
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