Female Infertility Flashcards
What is true infertility (vs. subinfertility)?
The complete absence of eggs or sperm production.
Western medicine approaches to infertility:
Medication to stimulate ovulation
IUI
IVF with/without ICSI
Various surgical options.
TCM categories of subfertility:
Kidney Xu
Heart and LQS
Blood Stagnation
Phlegm damp accumulation
Which condition underlies all subfertility conditions?
Kidney Yin Xu
Ovulation is a functional issue if:
1) There are no periods
2) They are very irregular
3) There is no clear biphasic pattern on the BBT
4) Blood tests show an irregularity with estrogen/progesterone levels.
Ovulation is happening poorly but incompletely if:
1) BBT only shows a small rise in temp
2) The temp rise is very short-lived
3) Blood tests mid-cycle show low progesterone.
4) There is spotting in the luteal phase.
Two conditions combined that cause all problems with ovulation:
Kidney Yin Xu and Heart Qi Stagnation.
Reasons to suspect problems with implantation:
1) There is poor, lacklustre ovulation
2) There are physical barriers to implantation
3) The uterine lining is inadequate, i.e., very scanty, dark, or clotted period.
4) Everything else has been eliminated but pregnancy is still not happening.
Embryo implantation problems condition:
Kidney Yang Xu
Most common cause of infertility is:
Kidney Yin Xu
Kidney Xu Symptoms:
Poor stamina Low reserves of energy LBP and weakness difficulty urinating (esp. daytime frequency) nocturnal enuresis slight incontinence dark circles under eyes
Kidney Jing Xu can be diagnosed if any of the following are present
1) Obvious developmental disorders to reproductive organs
2) Reduced development of secondary sex organs, e.i. breast development.
3) Underfunctioning ovaries; even if they look normal sometimes the only way to diagnose reduced function is the ovarian inability to respond to infertility drugs.
Kidney Jing Xu P and T:
P: weak and thready
T: pale usually
Kidney Yin Xu Symptoms:
Restlessness Anxiety Poor sleep quality flushed easily copious thirst dry skin and hair Thin and wiry complexion scanty periods (like blood xu) bright red periods (yin xu heat)
How does Kidney Yin Xu affect the cycle?
Unstable follicular phase that is typically longer that usual (13-14 days before ovulation)
Yin xu heat can cause early ovulation of immature egg (short follicular cycle)
Vaginal dryness and scanty mucous production
Too acidic fertile mucous (sperm can’t survive in it)
Kidney Yin Xu T and P:
P: weak, especially on deep level. May give impression of floating due to emptiness at deep level. Rapid from false heat.
T: Dry, often small and thin. Red and peeled coating.
Kidney Yang Xu causes:
Injury by cold Overstrain Long term yin xu Long term qi xu Long term Heart or Liver qi stagnation
Kidney Yang Xu Symptoms:
Puffiness Overweight Lethargy Low libido Low motivation Lumbar ache, worse in cold weather Dysmenorrhea not unusual, no warm to drive blood causing stagnation
Kidney Yang Xu affect on cycle:
Low BBT esp in luteal phase
Luteal phase may be short
Ovulation may be muted, but not delayed.
Kidney Yang Xu T and P:
T: pale and swollen
P: Slow and deep
Kidney Yin and Yang Xu preconditions:
Women in their late 30s+
Few if any symptoms of Kidney Yin Xu
Have no physical obstruction for fertility (ex. blocked tubes, low sperm count)
Most reliable tool for KD Yang and Yin Xu?
BBT - because Yang and Yin cancel each other out and symptoms can be unclear.
Kidney Yang/Yin Xu impact on cycle:
Slow start to luteal phase and possibly delayed ovulation.
No obvious fertile window.
Temp to take a long time to rise and may not rise significantly at all.
Kd Yang/Yin Xu P and T:
P: Thready, slow, and weak
T: Pale and swollen or red and dry
What controls ovulation:
Heart Qi
What is the connection to the Heart and Uterus called, and which points access it:
Bao Mai: Chong accesses it.
P6, SP4 (chong), R14 + R4 (heart and SI mu connect Ht and Uterus), Ht5, Ht7, Bld15.
When should Heart Qi Stagnation be considered?
History of sudden shock, emotional trauma, or extreme anxiety
Heart Qi Stagnation Symptoms:
Palpations
Anxiety
Insomnia
Hysteria/neurosis (Ht fire from chronic conditions)
Shen disturbance in eyes
Over/under production of FSH, or LH with low estrogen
Heart Qi Stagnation affect on the cycle:
Unsteady BBT with significant peaks and troughs in follicular pahse
Heart Qi Stagnation P and T:
P: choppy or tight
T: red tip
How does Phlegm damp affect fertility?
Physical obstruction of the ovaries, fallopian tubes, or endometrium
How does phlegm damp present in the body?
Cysts
Congestion
Tumours
How does Phlegm damp affect the cycle and BBT?
If PD is obstructing ovulation the BBT will have a delayed peak
If PD is caused by KD Yang Xu not managing fluid, BBT will show very slight temp rise post ovulation.
BBT will have indistinct evidence of the normal biphasic pattern
Leukorrhea (no stretchy fertile mucus bc glands are obstructed)
Mucusy period
Phlegm Damp P and T:
P: Slippery and full if overall condition. If the PD is in one small place (ex. a tube) the pulse won’t change. If it is caused by something else like Kg Yan Xu or LQS, the pulse reflects the root.
T: thick or greasy coat, maybe only on lower jiao
Overall principle for acupuncture for fertility
Achieve harmony between Yin and Yang.
Best way to influence ovulation and the luteal phase:
Work during the follicular phase (build up yin before yang)
Treatment principles and points for Phase 1: Menses
Open the uterus, encourage smooth and strong downward flow: P6 + Sp4, P5
Move Blood and regulate chong: Kd14
Cool blood if yin xu heat evident: Sp10
Remove obstruction to blood flow: Sp8
Regulate and move qi in uterus/lower jiao: BL25, 30, 32
Moderate descending action: CV6
Phase 1 + 2: Balance Ren and Chong vessels:
R7, Kd5, 8, 13
Phase 1 + 2: Stimulate Chong vessel activity:
Sp4, St 30
Phase 1 + 2: Encourage blood production points:
St36, Lv3, Sp10
Phase 1 + 2: Emphasize Kidney yin development:
Kd3, 5, 6, Sp6, Bl23, R4
Phase 1 + 2: Influence Kd Jing points:
St27, Kd12
Phase 1 + 2: Resolve phlegm damp points:
R9, Sp9, Sp5, Gb26
Phase 1 + 2: Harmonise the Shen points:
Ht5, 7, Pc6
Phase 1 + 2: Move LQS points:
Lv3, 5
Phase 1 + 2: Cool heart/liver fire points (if necessary):
Ht5, 8, P7, Lv2
Phase 3 (ovulation): Regulate qi in the LJ, esp ovaries and fallopian tubes points:
Kd13, 14, Sp13, St28, 29
Phase 3: Move qi in the liver channel points:
Lv3, 5
Phase 3: Regulate and promote blood and qi circulation (yin and yang):
Kd5, 8, Sp8, Sp6
Phase 3: Strengthen the Kidney qi:
Kd4
Dramatic peaks and falls of estrogen can cause:
Mid-cycle bleeding
Inadequate progesterone in TCM =
Kidney Yang Xu
Methods to boost yang:
A) Tonify kidney yin
B) Promoting Qi
C) Nourishing blood
What is the lowest SAFE point to use in early pregnancy?
R6
Which points are important for a few days post ovulation to encourage implantation?
Lower Ren points.
How do we ensure good mobility and clear passage of the embryo through the fallopian tube?
By promoting qi in the first week after ovulation.
Qi xu and Kidney yang xu symptoms:
Kidney and Spleen symptoms: fluid retention, loose stool, abnormal uterine bleeding, difficult urination
Why is nourishing blood necessary to boost yang?
1) Chong (sea of blood) is closely related to the kidneys
2) Related to yin/yang, blood/qi
3) Successful implantation requires abundant, receptive and nourishing endometrium (blood).
Patterns of infertility
Kidney Yin Xu Kidney Yang Xu Liver and Heart Qi stagnation Jing Xu Blood stasis Phlegm damp accumulation
