By Jake Paul Fratkin, OMD, LAc
Chinese medicine delineates several patterns in infertility. At its core, tonification of blood and kidneyqi is necessary in most cases. Further pattern differentiation can be made for deficiency of kidney yang, yin or jing; liver qi stagnation, blood stasis, or accumulation of phlegm and dampness.
In evaluating for patterns, paying close attention to the menstrual history offers the best clues. Irregular periods or premenstrual syndrome (irritability, breast distension, abdominal distension) indicate qi stagnation; dysmenorrhea indicates blood stasis or exogenous cold into the uterus; amenorrhea or light, scanty periods confirm blood deficiency; and obesity involves stagnation of phlegm and dampness.
Frequent miscarriage often accompanies infertility, and in modern medicine is correlated with low levels of progesterone. The Chinese blood and kidney builders suggested here can boost progesterone levels. Some women with frequent miscarriage will benefit by combining Chinese herbal formulas with bioidentical progesterone. The best way to determine progesterone levels is by lab testing. After the age of 39, however, the viability of the woman’s eggs come into question, and is a common reason for first-trimester miscarriage in older women. Chinese herbs cannot strengthen the life-force or integrity of the egg.
For fertility, the formulas described here boost blood and kidney qi. In cases with liver stagnation (irregularity, PMS), management requires addressing qi stagnation during the pre-menstrual phase, from ovulation until the first day of bleeding. A formula like Jia Wei Xiao Yao San is quite adequate. Then, a fertility blood tonic would be used at the end of menses until ovulation, or continued until the period starts. For cases with dysmenorrhea, it is important to use an appropriate formula starting either a day or so before cramping begins, or at least once cramping begins, and until cramping and clot expulsion is finished. Effective formulas include Tong Jing Wan or Shao Fu Zhu Yu Tang. In some patients, it may be necessary to work with three formulas: pre-menstrual, menstrual and post-menstrual.
Achieving a successful pregnancy may be quick, within one or two months, or prolonged over 6-8 months. The best sign of progress is that any menstrual problem becomes better and more normal. This particularly applies to irregular periods or amenorrhea. It is helpful to continue with blood tonics during the first trimester, to boost progesterone and prevent miscarriage. These formulas are also appropriate as post-partum tonics, and of course can be used for treating amenorrhea and irregular periods without fertility as a goal.