Female Factor Infertility

Infertility is the inability to conceive or carry a pregnancy to term after two years of regular, unprotected sexual intercourse. It is typically diagnosed after a couple has been trying to conceive for an extended period of time without success. In order for a diagnosis of infertility to be made, both partners must have normal reproductive function.

Causes

Infertility can be caused by constitutional weakness of the Kidney-Essence. This weakness may be inherited from the mother or may result from poor health or advanced age of the parents at the time of conception. When the Kidney essence is weak, the woman may be unable to conceive due to a lack of Tian Gui.

Infertility can be caused by various factors, including overwork and constitutional weakness of the Kidney-Essence. Overworking for long periods of time without sufficient rest and with an irregular diet can lead to Kidney-Yin deficiency. This deficiency can affect the menstrual cycle and the uterus, making it difficult for a woman to conceive.

Excessive physical work or strenuous exercise can also lead to Kidney-Yin deficiency. This can be especially harmful during puberty, when a girl's uterus is vulnerable. At this age, excessive physical work may take the form of playing too much sports, training excessively in ballet or gymnastics, or working on a farm. These activities can weaken the Spleen and Kidney-yang, leading to infertility.

Infertility can be caused by early sexual activity, which can weaken the kidneys and harm the directing and penetrating vessels. This damage may lead to infertility later in life.

Infertility in young women can often be caused by exposure to cold and dampness. During puberty, the uterus is particularly vulnerable to cold and dampness. If a girl is exposed to these conditions while exercising or playing sports, the cold can invade the uterus and obstruct the directing and penetrating vessels, preventing fertilization. This is a common cause of primary infertility in young women.

Infertility may be caused by an irregular diet leading to the accumulation of cold or dampness in the uterus, which can obstruct the uterus and prevent fertilization. This may be caused by exposure to cold and dampness during exercise or the consumption of cold, iced foods and drinks. Excessive consumption of greasy foods and dairy products can also lead to the formation of dampness in the lower burner, which can prevent fertilization. Dampness in the lower burner may turn into damp-phlegm, which can obstruct the uterus and fallopian tubes, causing infertility.

Pathology

In the case of empty conditions, infertility is due to a lack of essential substances such as blood and/or essence. The two main deficiencies are those of blood or of the kidneys (in their Yin or Yang aspect). When the Kidney essence is weak, the woman may be unable to conceive due to a lack of Tian Gui.

In the case of full conditions, fertilization cannot occur because pathogenic factors obstruct the uterus and the directing and penetrating vessels. These factors may include cold, blood-heat, dampness, stagnation of Qi, and stasis of blood and phlegm. Any of these factors can prevent fertilization, which is a delicate process that requires the perfect balance of Yin and Yang aspects of the essence.

In the treatment of infertility, it is important to monitor two key signs: the cervical secretion and the basal body temperature. The cervical secretion, which occurs just before ovulation, is a direct manifestation of Kidney-Essence. A deficiency of Kidney-Essence or a weakness in the proliferative phase of the menstrual cycle may be indicated by a lack of cervical secretion or a short duration of only one day. Monitoring the cervical secretion every month can provide useful information for the treatment of infertility.

Similarly, charting the basal body temperature (BBT) every month can help monitor the progress of treatment. A typical biphasic shape in the BBT chart may indicate improvement, while a flat chart may suggest a lack of progress. By tracking these signs, healthcare providers can gain valuable insights into the effectiveness of their treatment approach for infertility.

While it is not always possible to make direct connections between Western pathologies and Chinese medicine patterns, modern Chinese books and journals often attempt to do so. These connections can provide broad guidelines for treatment, but it is important to rely on a Chinese diagnosis and identification of patterns for the most effective treatment. According to these modern connections, absence or irregularity of ovulation may correspond to Kidney deficiency, blockage of the fallopian tubes to Damp-heat with possibly Toxic-heat and stasis of Blood, uterine myomas and endometriosis to stasis of Blood with possibly Phlegm, and pelvic adhesions to Dampness with stasis of blood.

Different patterns of disharmony may be associated with infertility, and the most common pattern is Kidney deficiency. However, the proportions of different patterns may vary depending on the specific population being studied. In a study of 257 cases of infertility, the most common pattern was Blood stasis, followed by Kidney-Yang deficiency and Spleen- and Kidney-Yang deficiency. It is important to rely on a Chinese diagnosis and identification of patterns for treatment, as statistical data may not be applicable to all populations.

Patterns of Disharmony

      The clinical manifestations of Spleen- and Kidney-Yang deficiency include: Prolonged menstrual cycle, the period could be either scanty or heavy, fatigue, abdominal distention, loose stools, pale complexion, cold limbs, pale tongue with a white and moist coating, and a weak and deep pulse. The treatment principle is to tonify the Spleen and Kidney-Yang, warm the uterus, and invigorate Blood.

      The clinical manifestations of Liver- and Kidney-Yin deficiency include: Irregular menstruation, the period could be either scanty or heavy, dizziness, tinnitus, dry mouth and throat, and a thin and rapid pulse. The tongue is reddish and without a coating. The treatment principle is to nourish Liver- and Kidney-Yin, and invigorate Blood.

      The clinical manifestations of Kidney-Yin deficiency with Empty-Heat include: Irregular menstruation, the period could be either scanty or heavy, hot flashes, night sweats, dizziness, tinnitus, dry mouth and throat, and a thin and rapid pulse. The tongue is reddish and without a coating. The treatment principle is to nourish Kidney-Yin, clear Empty-Heat, and cool the Blood.

      The clinical manifestations of Liver-qi stagnation include: Irregular menstruation, the period could be either scanty or heavy, abdominal pain, breast distention and pain, mood swings, and a wiry and rapid pulse. The tongue is purplish or reddish with a thin white coating. The treatment principle is to regulate Liver-qi, invigorate Blood, and regulate menstruation.

      The clinical manifestations of Blood stasis include: Irregular menstruation, the period could be either scanty or heavy, lower abdominal pain, breast distention and pain, dark purple or brown menstrual blood, and a choppy or wiry pulse. The tongue is purplish or dark. The treatment principle is to invigorate Blood, dissolve stasis, and regulate menstruation.

      The clinical manifestations of Damp-Phlegm include: Irregular menstruation, the period could be either scanty or heavy, abdominal distention, a feeling of fullness in the chest, and a slippery and slow pulse. The tongue is swollen and white and greasy. The treatment principle is to resolve Phlegm, regulate menstruation, and invigorate Blood.

      The clinical manifestations of Cold-Dampness include: Irregular menstruation, the period could be either scanty or heavy, abdominal pain and distention, a feeling of fullness in the chest and abdomen, pale complexion, and a deep and slow pulse. The tongue is pale and wet. The treatment principle is to drain dampness and warm the Uterus.