Infertility Flashcards
What is the definition of Infertility
–inability to produce offspring in a woman who has been trying for two years (TCM)… (one year)–> Western Medicine
–who has a normal sexual life…
–and a partner who has normal reproductive function.
What is the cause of infertility?
*Constitutional weakness
–Weakness of Kidney Essence the basis for Heavenly
Water Tian Gui; a congenital weakness of pre-Heaven
Jing
- Overwork
- -Inadequate rest, poor diet depletes Kidney Yin
*Excessive physical work weakens SP/KD Yang
*Excessive sexual activity at an early age
–Before and during puberty up until age 18; weakens
Kidneys and damages the Ren and Chong Mai
- Invasion of Cold
- Diet
What is Jing?
*Jing is translated as “reproductive essence”
*Jing ripens as a young girl reaches puberty, filling the
Chong Mai with Blood, the Ren Mai with Qi and the
periods begin;
*Jing is important in all menstrual cycles that follow, plus
conception and pregnancy
*Jing gets used up with hundreds of menstrual cycles;
life itself exhausts Jing
What is Jing continued?
*Jing, Blood and Yin are consumed during pregnancy by
rapidly forming fetus
–Traditionally, Chinese families would wait five years
between pregnancies to replenish Jing
*Jing declines with age
What is Deficiency in Infertility?
DEFICIENCY
Lack of vital, essential substances: Blood and/or Essence
Tonify and nourish
INFERTILITY Deficiency patterns
KIDNEY YANG DEFICIENCY
KIDNEY YIN DEFICIENCY
BLOOD DEFICIENCY
Kidney Deficiency
Blood Deficiency
INFERTILITY Excess patterns
COLD in UTERUS DAMP in LOWER JIAO BLOOD HEAT STAGNATION of QI STASIS of BLOOD
Liver Constraint
Phlegm-Damp
Damp Heat
Blood Stasis
Prolonged menstrual cycle, period is scanty or heavy, backache, dizziness, feeling cold, depression, frequent urination
T: Pale, swollen, wet
P: Deep, weak
KIDNEY YANG DEFICIENCY
TX: Tonify and warm Kidney Yang, stoke Fire of Gate of Life, strengthen the Uterus
KD 13, KD 3, BL 23, BL 52, CV 4, GV 4, LU 7, KD 6, CV 8
Long term infertility, periods early, scanty, with light colored blood, 5 palm heat, night sweating, dizziness, tinnitus
T: Red without coating
P: Floating Empty or Rapid Fire
KIDNEY YIN DEFICIENCY
TX: Nourish Kidney Yin and Essence
CV 4, CV 7, KD 3, KD 13, SP 6, LU 7, KD 6, BL 52
Moxa on KD 3 only if Empty-heat not strong
Scanty periods, pale blood, delayed cycle, tiredness, depression, dizziness, pale complexion, blurred vision
T: Pale and thin
P: Choppy or Fine
BLOOD DEFICIENCY
TX: Nourish Blood and Essence, strengthen Liver and Kidneys
CV 4, ST 36, SP 6, KD 13, BL 20, BL 23, BL 17, moxa
Zi Gong: 3 cun lateral to CV 3
Irregular periods, delayed cycle, mid cycle pain, vaginal discharge, long term infertility, adhesions, obesity, feeling of heaviness
T: Sticky coat
P: Slippery
DAMPNESS IN LOWER JIAO
TX: Resolve Dampness, remove obstructions from Ren and Chong Mai
CV 3, ST 28, SP 9, SP 6, CV 9, LU 7, KD 6, ST 30, KD 14, BL 32
If Damp Heat in Lower Jiao: GB 41, TW 5, GB 26. For Fallopian tube obstruction: BL 32 - and CV 4 + with EA, patient on lying on side
Early periods (short cycle) up to twice a month, heavy flow, feeling hot during period, thirst, mental restlessness
T: Red
P: Rapid, overflowing
BLOOD HEAT
TX: Cool Blood, regulate periods
LI 11, SP 10, KD 2, LIV 3, SP 6, PC 3, BL 17, CV 4, LU 7, KD 6
Irregular periods, pre-menstrual tension, painful periods, breast distention, irritability
T: normal color or slightly Red on sides; if stagnation arises from Blood def.=pale sides
P: Wiry, or choppy if Blood def.
STAGNATION OF QI
TX: Move Qi, eliminate stagnation, pacify Liver, regulate periods
LIV 3, GB 34, TW 6, PC 6, CV 6, CV 4, KD 14, SP 4
Irregular and painful periods, dark blood with clots, irritability, manic behavior, mental restlessness, abdominal pain
T: Purple
P: Wiry or Choppy
STASIS OF BLOOD
TX: Invigorate Blood, eliminate stasis, pacify the Liver and the Chong Mai, regulate the periods
LIV 3, GB 34, BL 17, SP 10, SP 6, PC 6, SP 4, TW 6, CV 6, CV 4,
KD 14, ST 29, KD 6
With white vaginal discharge: BL 31
Blood stasis: CV 4
Abdominal pain: ST 30
SP 5, CV 3
GV 4, BL 23, CV 6, CV 3, LIV 11, KD 2, CV 4
Cold Uterus: Baomen L, Zihu R, 2 cun lateral to CV 4, KD 6
SP 6, SP 10, CV 6, GV 4, BL 23, CV 3, CV 4, LIV 11, KD 2, Baomen, Qimen 3 cun below navel, 3 cun lateral, moxa
LIV 8 if blood stasis, ST 36, Bl 67, LI 4, SP 6, CV 2 with 7-77 moxa cones
BL 32, KD 1, SP 5
Ancient Acupuncture Rx for Infertility
PROGNOSIS and PREVENTION
Conditions that will not respond to treatment with acupuncture and/or herbs:
- -Adhesions from TB of endometrium
- -Submucous myoma (if very large)
- -Congenital malformation or hypoplasia of uterus
- -Shistosomiasis
- -TB of the uterus
PROGNOSIS and PREVENTION
Blocked fallopian tubes; adhesions and inflammation
Treatment may take at least one year
Easiest pattern to treat
Blood deficiency
Most difficult pattern to treat
–Dampness, that often corresponds to polycystic
ovarian disease—a complex condition;
–irregularities of the hypothalamic-pituitary-ovarian axis
Western differentiation
- Primary: female partner has never conceived
- Secondary: when woman has had a pregnancy
- Incidence:
- -Hormonal factors of ovulation, 41%
- Failure to ovulate: 25%
- Irregular or absent menstruation: 80%
- -Fallopian tube abnormalities, 32%
- -Uterine factors, 16%
- -Cervical factors, 4.7%
- -No apparent cause, 5%
- Chinese medicine perspective:
- -Hormonal disturbances of ovulation
- Kidney or Blood deficiency
- -Fallopian tube abnormalities
- Blood stasis, Blood heat, or Dampness
HORMONAL FACTORS
Ovulatory Failure
-Hypothalamus: alteration of function affected by stress
-Pituitary: tumors may cause elevated levels of prolactin
-Ovary: absence of FSH receptors; FSH and follicle
interaction
Tubal abnormalities
–Salpingitis, from infections after abortion, delivery,
gonorrhea, chlamydia, tuberculosis, IUD’s, pelvic
peritonitis
Uterine Hormonal factors
uterine myomas if large enough
Cervical Hormonal factors
: cervical mucus unreceptive to sperm
General Hormonal factors
Hypothyroidism: lethargy, swelling of ankles, feeling cold, amenorrhea; Kidney Yang deficiency
Hyperthyroidism: Full condition, Blood heat affecting LIV & HT
Endometriosis: peri-tubal or peri-ovarian adhesions
MALE STERILITY Caused by
Deficient sperm count
Insufficient motility of the sperm
Poor morphology of the sperm
MALE STERILITY TCM perspective
Kidney deficiency
Damp Heat in genital system
Current WHO standards for assessing male infertility:
*Volume: more 1 ml
*Count: more than 20 million sperm per ml
*Motility: more than 50% moving vigorously and
purposefully
*Morphology: more than 14% normal forms
(no deformities of the head, mid-piece or tail)
Male Infertility patterns
*Deficiency of Essential Qi due to Congenital Deficiency
*Essential Qi Deficiency Cold due to Debilitation of Life
Gate Fire
*Phlegm Turbidity and Blood Stasis Obstructing Semen
*Damp-Heat Pouring Downward due to Improper Diet
*Liver Stagnation due to Emotional Disorders
*Qi and Blood Deficiency due to Prolonged Illness of
Taxation
Deficiency of Essential Qi due to
Congenital Deficiency
Kidney stores
Essence
Kidney governs
reproduction
Kidney stores Essence and governs reproduction
Essence can transform into Qi. When Kidney Qi becomes abundant, tian gui arrives to enter Chong and Ren Mai. Essence can mature only when these vessels become abundant:
- Menstruation in women - Seminal fluid production in men
Essential Qi Deficiency Cold due to Debilitation of Life Gate Fire
*Excessive sexual activity consumes essence and Qi,
even during adolescence. Over time this leads to
Kidney Qi deficiency and debilitation of life gate fire.
*Without warmth, essential Qi becomes Cold and
deficient
*Results in a decline of both sperm production and
sexual function
Phlegm Turbidity and Blood Stasis Obstructing Semen
*Excessive consumption of alcohol, greasy food
damages the SP & ST, especially in overweight and
obese
*Phlegm moves downward, inhibiting the production and
transformation of semen, and also obstruct its orifice
*Prolonged illness or physical injury that results in blood
stasis. Blood may block seminal vessel, semen
production decreases, ejaculation inhibited, seminal
fluid accumulates internally
Qi and Blood Deficiency due to Prolonged Illness of Taxation
*Qi and Blood may become deficient due to insufficient
Spleen Qi, SP & ST damage, constitutional deficiency or
poor recovery from illness
*Essence is derived from Blood
Damp-Heat Pouring Downward due to Improper Diet
*Excessive consumption of alcohol or greasy and spicy
foods damages SP and ST causing damp-heat and
phlegm that pours downward affecting the quality of
seminal fluid
Liver Stagnation due to Emotional Disorders
*Damage by the seven affects leads to Liver
Qi stagnation
*Early stages affect the Qi dynamic;
Later stages affect changes in essence and
blood because the viscera have been
affected
*Excessive sadness most often leads to sexual
dysfunction
*Sexual frustration is often followed by a
libidinal decline that can cause impotence
Pathogenesis
Deficiency, excess, cold, heat, phlegm, stasis or constraint, imbalance of Yin and Yang
most affected and is directly related to the functioning of the Liver, Spleen and Heart
KIDNEY
Essentially: infertility
results from Kidney Qi deficiency with a failure of Yin essence transformation
Treatment of Male Infertilty
- The key to male infertility lies in the Kidney
* Tonify Kidney, nourish Essence
Specific treatments may be applied to regulate
Kidney Yin and Yang, nourish Kidney Essence, and course the passage of Kidney Essence
Treatment continued:
Deficiency at the Root, Excess at the Branch
–Root Tx: Kidney and Spleen
–Branch Tx: Invigorate Blood, transform stasis, clear
heat, disinhibit dampness, transform phlegm
Male Immune Infertility
Tonify LIV & KD, invigorate blood, free the collaterals
- -BL 18, BL 23, LV 3
- -Modification: BL 15, BL 17, BL 22, HT 7
Abnormal Semen
Tonify KD and essence, regulate Yin and Yang
–CV 4, KD 12, SP 6
Low Sperm Count
Fortify SP, tonify KD, invigorate blood, dispel dampness
–BL 23, CV 4, BL 20, ST 36
Prognosis
*Male infertility should not be viewed as a single
condition, but rather as the manifestation of a number of
possible male reproductive system disorders—16
separate disorders, each with distinct differences in
etiology, pathogenesis and treatment.
*Proper identification of the disorder is critical
*Prognosis is good for men with normal testes and the
ability to generate sperm, and no structural disorders
Preventive Healthcare
*Smokers and drinkers have lower sperm count
–Nicotine shown to decrease sexual hormone secretion
–Alcohol can reduce seminal fluid by 50%
*Sleep at least 8 hours per day
*Proper Nutrition
–Zinc, copper, phosphorus, calcium, vitamins A & E
*Avoid lounging in hot baths, steam baths
–Particularly when planning pregnancy
–More than 30 minutes in hot water, 40ºC can lower
sperm counts
Preventive Healthcare
*Excessive sexual activity and interrupted intercourse
can both lead to congestion of urethra and prostate
gland.
*Standing for long periods of time causes local
congestion of the genital organs
*Psychological state is important in production of
seminal fluid
–Depression, anxiety show reduced sperm count
–Optimism improves reproductive health
*Particularly seminal fluid production
