If you’re having difficulty falling pregnant or carrying to term, you’re not alone. One in six Australian couples experience problems or very lengthy delays in conceiving.
What is Infertility?
The infertility diagnosis is age and time-related:
For women under the age of 35, infertility is defined as the inability to conceive after one year of trying.
For women over the age of 35, infertility is defined as the inability to conceive after six months of trying.
Infertility is also diagnosed when a woman of any age is unable to carry a pregnancy to full term.
Types of Infertility
There are four broad categories of infertility: unexplained infertility, incomplete or subfertility, secondary infertility, and complete infertility. These are explained below.
1. Unexplained infertility
When no medical reason can be found for a couple’s inability to fall pregnant, the diagnosis is ‘unexplained infertility’. This is often a frustrating burden for couples and their fertility specialists. Without an apparent cause for infertility, there is no clear path of medical treatment, making unexplained fertility one of the most difficult types of infertility for western medical specialists to treat.
We regularly see women and couples diagnosed with unexplained infertility. We work with those seeking natural conception as well as those undertaking IVF. Chinese medicine has a great deal to offer patients with this often unsatisfactory diagnosis. By using different diagnostic techniques we are always able to identify the reason for your infertility.
2. Incomplete infertility (subfertility)
Subfertility refers to a lowered level of fertility, which means that without treatment, the time to conception will take longer, or may not occur at all. In general, most couples experiencing fertility issues come under this category. Problems tend to involve hormone imbalances or physical issues with the reproductive tract, or male factor infertility (e.g. low sperm count, or low morphology).
We routinely work with these women and couples to promote natural conception or assist with IVF methods.
3. Secondary infertility
This type of infertility refers to women who have previously given birth and who have problems falling pregnant again; or, it can refer to women who are having trouble carrying a pregnancy to full term.
Our work with women in this category includes those seeking help to conceive naturally, as well as those women undergoing IVF.
For those women who’ve previously miscarried, once conception has occurred, our treatment focus shifts to maintaining the pregnancy in order that the baby can be taken to full-term. As in all cases of infertility, herbal medicine is an important component of your treatment.
4. Complete infertility
Complete infertility, or sterility as it is otherwise known, is rare, and occurs when no viable eggs or no sperm are produced. This type of infertility requires medical intervention in order for pregnancy to occur.
In these cases we work in collaboration with western medical fertility specialists to improve the patient’s general health.
Causes of Infertility
We commonly see women with fertility problems due to a range of factors. Disturbances to ovulation, PCOS (Polycystic Ovarian Syndrome), uterine problems, endometriosis, fallopian tube damage, immune problems and advanced maternal age are all problems that our patients commonly present with. Some women have more than one obstacle to falling pregnant.
One of the most common causes of infertility, this is a group of disorders which has in common anovulation (lack of ovulation), infrequent ovulation, or ovulation occurring too early or too late within each cycle. Women may notice a lack of periods (amenorrhoea), short cycles, long cycles, changes to their period flow, or, confusingly, there may be no signs at all.
Hormone imbalances are usually the cause of ovulatory problems. Once the appropriate balance is restored, monthly ovulation begins again and the fertility problem is overcome.
Polycystic Ovarian Syndrome is now thought to be one of the most common causes of infertility amongst women of child-bearing age. Primarily a disorder of hormonal imbalance, PCOS diagnosis requires at least multiple cysts in the ovary and raised androgen levels. PCOS can also cause infrequent or absent periods, excess body weight, hirsutism (excess hair) and acne.
Acupuncture and herbal medicine can be very effective at rebalancing the disordered hormones, returning regularity to the cycle and promoting significantly increased fertility.
Any condition affecting the lining or shape of the uterine walls can affect fertility by interfering with the implantation and growth of the embryo. This includes fibroids and polyps (benign growth of tissue), a thin uterine lining which is inhospitable for implantation; abnormal or damaged uterine lining due to scar tissue or adhesions; and congenital malformation of the uterus.
While surgery is indicated for serious cases of uterine growths, , acupuncture and herbal medicine work very effectively in promoting blood flow to the abdomen and uterus to assist the body in overcoming mild to moderate cases of uterine growths and scarring. Thin uterine lining is a problem many women present with, which generally responds very favourably to our treatments.
Endometriosis is a condition in which functional uterine lining (endometrium) cells are found outside the uterus, most commonly in the pelvic and abdominal regions, or within the ovaries. These ‘out of place’ cells are controlled by the usual monthly hormonal changes that influence the endometrium, thus, with each period, they also bleed. This blood is unable to escape via the usual route outside the body.
Endometriosis can cause a wide range of symptoms, or be completely asymptomatic. Some women experience severe menstrual pain or abdominal pain throughout the cycle, heavy or irregular periods, mid-cycle or pre-menstrual spotting, and/or pain on intercourse.
Even severe cases of endometriosis can respond very well to acupuncture and herbal medicine treatments.
Fallopian Tube blockages
Damage to the fallopian tubes is often a result of previous abdominal surgery or infection, and prevents the passage of the egg from the ovary to the uterus. Stiffness and occlusion (closure) of the tubes can also occur due to stress, and excess fluids can cause congestion and tube blockage.
Acupuncture and herbal medicine can be very efficient at relaxing abdominal muscle tension and promote tube flexibility, or drying excess secretions blocking the tube. It is also possible to overcome structural damage due to surgery or other gynaecological complaints such as endometriosis to improve tube patency (openness).
Immunity comes into play during the conception process when the fertilized embryo attempts to implant. For some women who are having difficulty conceiving, recurrent miscarriage, or recurrent IVF cycle failures, it is believed that faulty communication occurs between the maternal immune cells and the embryo – with the result that the maternal cells identify the embryonic cells as being foreign and are to be destroyed.
Fertility problems relating to immunity can be overcome with acupuncture and herbal medicine therapy. We commonly find imbalances relating to internal ‘blood stasis’ and/ or ‘heat’ at fault in these cases. Once these underlying causes have been cleared conception and a full-term baby often results.
One of the most important factors in falling pregnant is the woman’s age. Female fertility can be seriously compromised up to a decade before the onset of menopause (the average age of menopause in Australia is 50-52 years).
Unlike men, who continuously produce sperm, women are born with all the eggs they will ever have. Each month, a number of eggs are lost during the menstrual cycle. This is because many eggs are prompted by hormonal signals to grow in each cycle, even though only one becomes the ‘dominant’ egg, which is then ovulated.
Since eggs can never be replaced, older women are at a distinct disadvantage when it comes to egg quantity.
Ovarian Reserve and Egg Quantity
Ovarian reserve is the term used to describe the number of eggs a woman has. The higher the ovarian reserve the better, as this means a woman has a more plentiful supply of eggs. A lower ovarian reserve means that there are fewer eggs. Generally speaking, women are most fertile in their early to mid-twenties when their ovarian reserve is the highest, and as it declines with age, so do does the fertility level. This decline begins in the mid-thirties when oestrogen levels begin to drop, and accelerates during the mid-40’s when a woman enters ‘pre-menopause’.
There are tests available to measure a woman’s ovarian reserve, most notably the Anti-mullerian Hormone test (AMH), which is often performed in conjunction with an ovarian ultrasound. While the trend is for older women to have a lower ovarian reserve, younger women can suffer prematurely lowered egg numbers.
It may be more useful therefore, for women of all ages, to think of the ovarian reserve and AMH test as being one good yardstick of ovarian functional time – hence the test’s nickname ‘Egg Timer Test’. The lower a woman’s reserve, the more important it is to try to conceive sooner rather than later.
It is important to keep in mind that ovarian reserve best describes the quantity of eggs, not the quality. It is thought that this may be one reason that a young woman with a high ovarian reserve may have difficulty falling pregnant, while an older woman with a lower ovarian reserve may not have difficulty in obtaining a viable pregnancy.
Many factors other than age can influence the quality of a woman’s eggs. Smoking, drinking too much alcohol or caffeine, nutritional status, environmental toxins, stress and lack of adequate sleep all have their role to play in harming egg health. As these are largely life-style related factors, women of all ages can greatly improve the quality of their eggs.
While it is important to understand that there is no treatment which can increase the number of eggs, and due to genetic inheritance some women can be born with poorer quality eggs, treatment with acupuncture and herbal medicine can have powerful effects on egg quality. This is achieved by delivering an adequate and enriched blood and ‘qi’ (energy) supply to the ovaries and developing follicles.