Unexplained Infertility
September 4th, 2009 by Jill Blakeway, M.S. L. Ac.
Patients who have been diagnosed with unexplained infertility often find it a great relief that their seemingly random collection of symptoms make sense from a Chinese medicine perspective. They have usually undertaken a battery of tests by the time they visit us at the YinOva Center and their first question is, “If nothing is wrong, why am I not getting pregnant?”
Chinese diagnosis is based on identifying patterns of disharmony so an acupuncturist will look for signs that have meaning when seen in relation to each other. Two of the most common patterns in women with unexplained infertility are Liver Qi Stagnation and Kidney Yang Deficiency. In our book, Making Babies: A Proven Three Month Program for Maximum Fertility, Dr. David and I called these the Stuck Type and the Tired Type. You can identify your type by taking this quiz on the book’s website.
The Stuck Type describes someone who manifests stress physically. Often they have tension headaches or nervous stomachs, which are 
signs that they have become tight like a pressure cooker and qi is not flowing smoothly. This lack of flow can lead to unsmooth hormone transitions resulting in symptoms such as PMS. At the YinOva Center we give these patients a very well known Chinese formula called Xiao Yao Wan and treat them with weekly acupuncture to move qi. We know they are getting better when they no longer have PMS and many of them then go on to get pregnant.
The Tired Type describes someone who has metabolic issues that effect their reproductive hormones. They usually complain of fatigue, feeling cold and weight gain. At the YinOva Center we put them on a warming herbal formula and suggest they eat warming foods. We give them weekly acupuncture often with moxibustion, a warming herb. We know that they are getting better when they tell us they have more energy and that their hands and feet are not cold anymore. At that point many of them go on to get pregnant.
Both these types can result in problems that can be identified by conventional medicine. Women who are the Stuck Type can have elevated prolactin levels and women who are the Tired Type can have low thyroid hormone. However in many cases the imbalance is sub-clinical and not picked up by medical testing. That is a great reason to seek out an acupuncturist and herbalist in order to correct patterns of disharmony that may be minor but are subtly impeding your fertility.
Fragile X is a genetic disorder and is the most common cause of inherited mental impairment and cognitive problems including some forms of autism. It is caused by a mutation of the FMR1 gene on the X chromosome. The mutation turns off the production of the FMR1 protein which in turn affects brain development. People with Fragile X suffer from mental impairment which can take the form of anything from very minor learning difficulties to severe cognitive problems. They may be hyperactive or over sensitive to stimuli and they may have short attention spans. Physically people with Fragile X may have a long narrow face, prominent ears, enlarged testicles and loose joints. Approximately 1 in 2000 boys suffer some kind of mental impairment due to Fragile X. The disorder also affects girls but the incidence is lower and the symptoms tend to be milder. This is because girls have 2 copies of the X chromosome whereas boys only have one. This means that girls have 2 copies of the FMR1 gene so if one is mutated a girl has another copy of the gene to fall back on. Boys only have one X chromosome.
Fragile X syndrome is carried on the X chromosome. Since men (XY) and women (XX) each have at least one X chromosome, both parents can be carriers.
If a mother is the carrier, she can pass the gene defect to either her sons or her daughters, since she contributes an X chromosome to each. If, as a woman, you are a carrier you have a 50% chance of passing the gene on because you have two X chromosomes and only one of them is affected. So if you are a carrier you may not pass on the defect at all or you may just pass on the premutation or your child could inherit the full syndrome. Sons who have fragile X are at high risk of intellectual disability but daughters who receive the fragile X gene may appear normal because the have two X chromosomes and only one is affected.
A simple blood test can establish if you are a carrier of Fragile X and the degree to which this mutation is likely to cause problems for your child. Geneticists classify the gene mutation into three categories based on the number of repeats of a pattern of DNA called CGG repeats. Individuals with less than 60 CGG repeats have a normal gene. Individuals with 60-200 CGG repeats have a premutation which means they do have a small risk of their child suffering from Fragile X syndrome and that risk is directly related to the number of CGG repeats. Parents with over 200 repeats have a full mutation which causes fragile X syndrome.
As for my patient. She fell into the middle ground in that she had the premutation and so was at a small risk of passing on Fragile X. Fortunately we live in a time when we have access to good genetic testing and advice. Her doctor was able to reassure her that, because the number of CGG repeats was low her risk of passing this disorder on to her child was minimal. An amniocentesis at 16 weeks was able to confirm her doctor’s prediction and she was relieved to hear that her baby was just fine.
when she had a thought. She facebooked me to suggest that we start collecting fertility-friendly recipes and publishing them here on the blog. I loved the idea and thought her first two recipe suggestions were great. I’m growing cucumbers in my garden so her creamy cucumber soup sounds wonderful and her second recipe for a spicy lentil soup is a fabulous hot weather idea.
2 T. butter
Saute ginger, garlic, lemongrass, onion, and optional jalapeno in olive oil, until fragrant (leave the ginger & lemongrass large enough so that you can remove the pieces from the soup later). Add water, coconut milk, red lentils and salt. Cook until lentils are tender, about 40 minutes. Remove lemongrass & ginger pieces. Add cilantro, scallions, spinach and cook until spinach is wilted (but don’t overcook!). Add salt and lime juice to taste. Yummy!
In the new tome 
In our new book 
Clinical research seems to suggest it does. One German study took 160 women undergoing IVF and split them into two groups. One group combined acupuncture with IVF and one group did not. Interestingly the group that did the acupuncture had a 50% better outcome than the group that did IVF alone. You can read a BBC article about this study 
Whilst acupuncture works for some people straight away, it doesn’t necessarily work over night and the effects tend to be cumulative so, ideally, we would like to see our patients once a week in the two months leading up to IVF. If this isn’t possible, it’s still worth you coming in to see us when you start your IVF cycle. We see our patients twice a week when they are taking the follicle stimulating drugs and we like to schedule a treatment before egg retrieval as well as another before embryo transfer. Finally we ask our patients to come in for treatment 24 – 48 hours after embryo transfer so that we can do an acupuncture treatment to prevent uterine spasm.
The quick answer is no. Very occasionally, here at the YinOva Center, we do prescribe herbs for a patient going through IVF if she has a history of poor response to the stimulating drugs and if her doctor agrees. However, for most people the herbs can make your response to stimulating drugs unpredictable and we have found that most reproductive endocrinologists would prefer you not to combine them with IVF treatment.