What is Infertility
Infertility refers to the failure of a couple to conceive after one year of actively trying, or after at least six months if the woman is age 35 or older. Female infertility accounts for roughly two-fifths of infertile cases, with male infertility accounting for another two-fifths. In the remaining cases, the reason is unknown or due to a combination of factors relating to both partners.
How Acupuncture and Chinese Herbs can help
Acupuncture can help treat infertility through a number of ways, including alleviating the negative effects of stress and restoring optimal hormonal balance. It can also help to increase blood flow to the uterus and ovaries, improve the thickness of the uterine lining, prevent unwanted uterine contractions, minimize the adverse effects of IVF treatment, bolster the immune system, reduce the chances of miscarriage, and improved the quality and quantity of fertile cervical mucus.
Common Causes of Infertility
The most common causes of infertility include ovulation problems, poor egg quality, endometriosis, polycystic ovarian syndrome, uterine/cervical abnormalities, premature ovarian failure, fallopian tube damage/blockage, and adhesions.
Endometriosis is a condition in which the endometrium (the lining of the uterus) grows outside the uterus. This occurs most commonly in the pelvic cavity (e.g. ovaries and fallopian tubes), ligaments supporting the uterus, perineum, and perimetrium (outer surface of the uterus). The misplaced endometrial tissue (endometriosis implants) also responds to oestrogen and follows a monthly cycle. They grow, break down and bleed with each menstrual cycle, but they cannot leave the body via menstruation. As a result, the monthly bleeding in this tissue leads to inflammation, scarring, adhesion and distortion of normal pelvic anatomy.
The most common symptoms of endometriosis include recurring pelvic pain, painful periods, infertility and painful sex. The symptoms tend to appear or get worse either during or immediately preceding menstruation.
Polycystic Ovarian Syndrome (PCOS)
PCOS is a complex hormonal disorder that occurs in females of reproductive age. It is a common condition and affects the normal functioning of the ovaries. The criteria for diagnosis include infrequent menstruation, increased levels of androgens (male sex hormones) and multiple ovarian cysts demonstrated on ultrasound.
PCOS generally presents with multiple small cysts around the edge of the ovaries. These cysts are immature follicles, containing eggs that haven't developed properly. Often these follicles are incapable of releasing an egg, meaning ovulation does not occur and thus infertility results. In women with PCOS, the ovaries commonly over produce androgens(male hormone) resulting in extra hair growth and/or acne. Many women with PCOS also have an increased risk of developing metabolic syndrome, type 2 diabetes and cardiovascular disease.
Pelvic Inflammatory Disease
Pelvic inflammatory disease (PID) refers to the infection and consequent inflammation of a woman's fallopian tubes, ovaries and/or endometrium. It is usually due to bacteria transmitted through sexual contact, which subsequently spreads upward from the cervix.
If not treated early, PID can lead to adhesions in and around the fallopian tubes, leading to infertility. The most common presentation is pelvic (lower abdominal) discomfort or pain. Other symptoms include abnormal vaginal bleeding, pain during sex, and abnormal vaginal discharge. Women with PID also are at higher risk of having an ectopic pregnancy.
Luteal phase defect (LPD)
The luteal phase is the time in a women's menstrual cycle between ovulation and the onset of the next menstrual period. During this time, your ovaries produce a hormone called progesterone. This hormone stimulates the uterine lining (endometrium) to grow thicker in preparation for possible pregnancy.
LPD may be due to insufficient secretion of progesterone from the ovaries(corpus luteum) or the endometrium not responding appropriately to progesterone stimulation. Therefore the endometrium does not grow properly, potentially preventing implantation of a fertilized egg. Characteristic symptoms of LPD may include increased frequency of periods, early miscarriage, difficulty falling pregnant, and spotting before periods.
Premature ovarian failure
Premature ovarian failure (POF) occurs when the ovaries cease functioning normally in women below 40. Typically a patient with POF will experience irregular periods associated with abnormally low levels of oestrogen and abnormally high levels of FSH (follicle stimulating hormone). It generally presents similarly to menopause with comparable signs and symptoms, the difference being in POF, woman can still have periods and fall pregnant. However their periods tend to be infrequent and irregular, and the chances of falling pregnant are significantly reduced.
Unfortunately for most women the cause is unknown. Some common causes include genetic and chromosomal defects, a past history of chemotherapy or radiation, autoimmune disorders and previous severe pelvic inflammatory disease (PID).
Other factors involved in causing infertility include:
- Other ovulation disorders (e.g. thyroid problems)
- Scarring and adhesions from prior surgery
- Problems with cervical mucus
- Drugs and medication including NSAIDs, chemotherapy, andantipsychotic medication
- Advanced maternal age
Understanding the menstrual cycle
A woman’s monthly cycle starts on the first day of the menstrual period and ends the day before the next period. On average, a woman’s cycle last 28 days. However, this can vary anywhere from 21 to 42 days due to natural variation in the duration of the follicular phase.
An understanding of the menstrual cycle is important for a number of important reasons:
- Gaining a better understanding of your menstrual cycle and knowing your ovulation date allows you to calculate your fertile days, thus optimising your chances of falling pregnant.
- The menstrual cycle entails complex changes that occur in your body due to the regular rise and fall of hormone levels. Thus your menstrual period provides a ìmonthly updateî on the hormonal conditions of your body. Changes to your periods, or irregular periods, are often the first signs of hormonal imbalance.
- The menstrual cycle is an important window into your overall state of health. It provides you with a snapshot of how well your body is functioning. Changes in menstrual cycle can often signify a number of other health conditions such as thyroid or metabolic disorder.
You can gain a significant amount of control over your health, fertility and reproductive planning simply by keeping track of your menstrual cycle.
The menstrual cycle is divided into three distinct phases: the follicular phase, ovulation and luteal phase.
The follicular phase starts on the first day of menstruation and ends with ovulation. It can vary considerably in length, depending on the time of ovulation. In the early follicular phase, after menstrual flow has ended, the lining of the uterus (endometrium) is at its thinnest and the levels of oestrogen and progesterone are low. This triggers the pituitary gland to release follicle-stimulating hormone (FSH). This hormone stimulates the ovaries to produce follicles. As they mature, oestrogen is produced, causing the lining of the uterus to thicken in preparation for the possible implantation of a fertilised egg. It also causes the cervical mucus to becomes clear, slippery and stretchy, resembling raw egg white (also referred to as 'fertile mucus').Usually, only one follicle (the primordial follicle) will mature into an egg, while the others disintegrate.
Ovulation is the release of a mature egg (ovum) from the dominant ovarian follicle. The peak of oestrogen that occurs at the end of the follicular phase triggers a sudden increase in another hormone called LH (luteinising hormone). The LH surge causes the mature follicle to release its egg from the ovary (ovulation). Oestrogen also peaks during this surge. Ovulation normally occurs 24 to 36 hours after the LH surge, which is why LH is a good predictor for peak fertility. Following ovulation the egg travels through the fallopian tube to the uterus. If fertilisation does not occur the egg will disintegrate within next 24 hours.
Ovulation occurs 12-16 days before the next period. This is what many refer to as the ìfertile timeî of a womanís cycle. Usually an egg only survives about 24 hours, but sperm can remain viable for up to five days. Pregnancy is therefore possible a few days prior to ovulation and 24 hours following ovulation.
This phase follows ovulation until the start of the next menstrual period. After the follicle releases its egg, the remaining elements form a corpus luteum. It has the primary function of releasing large amounts of progesterone as well as some oestrogen. These hormones contribute to the further thickening and maintenance of the endometrium in preparation for the implantation of a fertilised egg. Progesterone also causes the basal body temperature (BBT) of the body to rise slightly until the onset of the next period. This rise in temperature can be plotted on a graph to provide an approximate indication of when ovulation has occurred.
If fertilization takes places, the corpus luteum will carry on producing progesterone until about the 10th week of pregnancy, after which the placenta takes over production. However if fertilisation does not take place, the corpus luteum will break down after 12-14 days, leading to a subsequent decline in the levels of progesterone and estrogen. The decrease in these hormones causes the uterine lining to break down and menstruation to begin.
To increase your chance of pregnancy you need to know ways of finding out when you are ovulating:
Charting Your Menstrual Cycle
This is done by counting the number of days from the beginning of one menstrual cycle to the next. To determine when you ovulate, count back 14 days from Day 1 of your cycle. This method will not be completely accurate and may be a few days off, but it should give you an approximate idea as to when you are ovulating.
Basal Body Temperature (BBT)
When you ovulate, your basal body temperature will increase, typically between 0.5 and 1.6 degrees as a response to hormone level changes. Each morning, take your temperature and record it on an ovulation calendar. You are most fertile on the day of the temperature spike and on the few days before.
Cervical mucus can also provide clues as to your ovulation date. Cervical mucus changes throughout your cycle; during ovulation, the cervical mucus becomes thin, clear, and stretchy. When you can stretch it a few inches without breaking, you are likely ovulating.
Ovulation Predictor Kits
Ovulation kits are now widely available to help you determine when you are ovulating. These ovulation tests measure the amount of LH in your urine. These tests are fairly inexpensive and easy to use; simply place a special stick in your urine flow and wait for the results.