Infertility and Endometriosis

Please note: the May newsletter is the first in a special series on infertility and some common reproductive health issues that contribute to it. Although Guangli Xu treats patients for a wide variety of medical issues at the Acupuncture Clinic, over his 30 years of practice he has seen an increase in the number of patients seeking his help for fertility problems. More women than ever before are seeking the help of Traditional Chinese Medicine (TCM) to achieve pregnancy when conventional in vitro fertilization has failed. Stay tuned during the coming months for an extended discussion of infertility and its connection to multiple conditions, including endometriosis, polycystic ovary syndrome, endocrine disorders, and decreased ovarian function due to the natural course of aging. If you are considering medical help in getting pregnant, or if previous medical assistance has failed, TCM can be a powerful ally. Although no fertility treatment is guaranteed to be effective, Chinese medicine has demonstrated marked success in treating the underlying causes of infertility, and Guangli Xu is an expert in this area. We hope the information in this series will be helpful not only to those with fertility challenges but also to anyone impacted by some common and debilitating problems in women’s reproductive health. Click here to inform us of a particular topic or question you would like to see addressed during the course of this series.

For women facing the prospect of in vitro fertilization, or looking back on a round of unsuccessful treatment, the balance between hoping and guarding against hope becomes another difficulty to navigate. Some women experience the need for fertility assistance as a painful personal failure, blaming themselves for imbalances or limitations imposed by the stress of modern life, genetic and environmental medical conditions, and even the course of nature itself. While Western fertility treatment has helped thousands of women, the painstaking planning and constant vigilance it requires—not to mention the strict regimen of shots—can be as daunting as it is promising. For those women whose treatment is unsuccessful, the decision to discontinue medical assistance can bring deep feelings of frustration and loss. Gynecological, hormonal, and endocrine imbalances—and thus, fertility problems—can manifest at any point in a women’s reproductive years. This month, we will focus on a problem that affects women of all ages, endometriosis, and its impact on fertility.

Endometriosis is a very common condition, and even the highest accepted estimate for its frequency among American women (about 15%) is probably too low, as many women do not pursue a diagnosis for the severe pain it causes unless it is revealed as the underlying cause of their infertility. The cells forming endometrial tissue are normal—as long as they’re in their proper place. Their function is to line the uterus, where they are grown and shed each month (during menses) in response to hormonal stimulation. Endometriosis is a condition in which these uterine cells grow in other areas of the body, particularly in the pelvic area; the ovaries, bowel, rectum, and bladder are common sites. Just as normal endometrial tissue responds to the drop in estrogen prior to menses, atypical endometrial tissue growing outside the uterus also “sheds”; unlike normal endometrial tissue, however, it does not get released from the body through the pelvis. This abnormal bleeding accumulates into multiple cysts, which may grow very large, producing compression and adhesion on the ovaries, fallopian tubes, rectum, ligaments, and other areas around the pelvis. Although its severity and duration varies, pelvic pain—particularly during the period and intercourse—is one hallmark of this condition. Emotionally, women may experience apathy and even depression. Irregular menstruation often develops, and, not surprisingly, infertility. Endometriosis is considered incurable in Western medicine, where it is often understood to result from a hormonal imbalance best checked by medically induced amenorrhea (absence of the menstrual period in women of reproductive age). Protocols such as “continual” high-progesterone birth control pills, however, can end up contributing to a cascade of imbalances in the body, and must in any case be discontinued when pregnancy becomes the goal.

In TCM theory, endometriosis is caused by “blood stasis,” and is sometimes curable. In conditions of blood stasis, the body’s Qi, or energy flow, is unable to move the blood smoothly through its vessels; normal blood circulation is hindered when the small vessels cannot carry normal blood flow through the body, resulting in severe pain, particularly in the lower abdomen. TCM first treats this stasis with acupuncture, and then shrinks the scar tissue with herbs targeted to the individual patient. TCM classifies endometriosis into 4 clinical types, depending upon what specific imbalance combines with the blood stasis: Qi stagnation, cold accumulation, Qi deficiency, and heat formation. The theory of blood stasis, along with herbal remedies for its different types, was established by the famous doctor Wang Qingren nearly two hundred years ago. Such traditional formulas as shaofu zhuyu tang (literally “Driving Out Blood Stasis in the Lower Abdomen”), which contains the ingredients tan kuei (angelica), she chuang zi (cnidium), chi shao (peony root), and tao ren (persica) to increase warmth and circulation, have been perfected by modern Chinese doctors conducting clinical trials. In fact, during the last two decades many research articles have been published on TCM’s efficacy against endometriosis. The Shanghai College of Traditional Chinese Medicine Affiliated Hospital reported a successful treatment for endometriosis with the rhubarb formula Nei Yi Wan in 1991, in which 61 out of 76 cases—or 80%—were resolved.¹

In advanced cases of endometriosis, surgical removal of the growth becomes necessary. Surgery does not cure the condition, however, and TCM can greatly assist in alleviating persistent symptoms such as pain and bleeding. Electrical acupuncture is a popular treatment option for severe pain; moxibustion (topical herbal warming) is a good choice when there is blood stasis with cold accumulation. Such treatments offer an alternative to more invasive modern procedures, carry less risk than hormonal treatments and surgery, and are often more effective. Many women with endometriosis have found that, once that condition is effectively addressed, they regain their fertility in the balance. This makes sense, as the imbalance that gave rise to the endometriosis in the first place contributes to fertility problems, as well. As with in vitro fertilization, patience is a virtue during this treatment; but with gentle and persistent care, we have helped many women achieve their dream of pregnancy.

Acupuncture of Brookline has a history of success that we would be happy to share with you. Please feel free to ask questions via email or phone (617-731-0504). Visit http://www.acupunctureclinicforwomen.com for more information.

Guangli Xu, Lic. Ac.