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On line course provided by Taught by Clara Cohen
FERTILITY & TCM
• FERTILITY AND TCM • THE PRACTITIONER’S ROLE• CAUSES OF INFERTILITY• RISK FACTORS• OBJECTIVES• UNDERSTANDING TESTS
FERTILITY & TCM
Conception in TCM
•Future Mother: conception depends on good Blood & Essence, strong KD & LV & healthy Ren & Chong meridians.
•Future Father: conception depends on good Essence.
•Future parents: Conception occurs between mother, father & the warm fire of Ming Men.
Fertility in TCM
• Regulate the menses• Always address the patient TCM
patterns• Regulate hormones: ask for test• Support for IUI, IVF, egg donor...• Nourish & move blood after the
patient ceases the BCP• Talk about lifestyle changes
The practitioner role
Fertility in TCM
• Educate the patients• The woman should keep track
of her period dates and also her Basal Body Temperature which should drop a day before ovulation and be at its highest during the 2 ovulation days.
The practitioner role
Fertility in TCM
• Educate the male patients• Intercourse every second
day is best.• Sperm regenerate every
48 hours. • Sperm lasts up to 5 days
in the uterus.
The practitioner role
Causes of female infertility
• Ovulation disorders, which hinder or prevent the ovaries from releasing eggs, such as polycystic ovary syndrome, excessive exercise, eating disorders, injury or tumors.
• Uterine or cervical abnormalities, including problems with the opening of the cervix or cervical mucus, or abnormalities in the shape or cavity of the uterus. Benign tumors in the wall of the uterus that are common in women (uterine fibroids) may interfere with implantation of the fertilized egg.
• Fallopian tube damage or blockage, which usually results from inflammation of the fallopian tube. This can result from pelvic inflammatory disease, usually caused by sexually transmitted infection, endometriosis or adhesions.
• Endometriosis, which occurs when endometrial tissue implants and grows outside of the uterus.
Cause: Infertility The Western World
Causes of female infertility
• Primary ovarian insufficiency, also called early menopause, when the ovaries stop working and menstruation ends before age 40.
• Pelvic adhesions, bands of scar tissue that bind organs after pelvic infection, appendicitis, or abdominal or pelvic surgery.
• Thyroid problems.
• Cancer and its treatment. Certain cancers — particularly female reproductive cancers — often severely impair female fertility. Both radiation and chemotherapy may affect a woman's ability to reproduce.
• Other conditions, amenorrhea, celiac disease, Cushing's disease, sickle cell disease, kidney disease or diabetes, can affect a woman's fertility. Also genetic abnormalities can make conception and pregnancy less likely.
• Some medications.
The Western WorldCause: Infertility
Causes of male infertility
• Abnormal sperm production or function due to various problems, such as undescended testicles, genetic defects, health problems including diabetes, prior infections such as mumps, trauma or prior surgeries on the testicles or inguinal region. Enlarged veins in the testes can increase blood flow and heat, affecting the number and shape of sperm.
• Problems with the delivery of sperm due to sexual issues, such as premature ejaculation, semen entering the bladder instead of emerging through the penis during orgasm (retrograde ejaculation), certain genetic diseases, such as cystic fibrosis, structural problems, such as blockage of the part of the testicle that contains sperm (epididymis), or damage or injury to the reproductive organs.
• Overexposure to certain chemicals and toxins, such as pesticides, radiation, tobacco smoke, alcohol, marijuana, and steroids (including testosterone), heat, such as in saunas or hot tubs, can elevate the testicular temperature, impairing sperm production.
• Damage related to cancer and its treatment, including radiation or chemotherapy. Cancer treatment can impair sperm production, sometimes severely.
The Western WorldCause: Infertility
• Cold: affect Chong & Ren causing infertility, menses & post delivery problems.
• Heat: affect LV causing heavy menses, irregular uterine bleeding and miscarriage.
Cause: Infertility The TCM World
• Overwork & excessive exercise (especially during puberty, pregnancy & menses): weakens SP, LV & KD
• Diet: weaken SP & ST • Traumatic injury: creates blood
stasis• Emotions: if not balance cause
infertility, irregular menses, miscarriage…
MenarcheMenarche
Cause: Infertility The TCM World
TMCTCTToo many children too close together
Fertility Risk Factors
Fertility
Age. Infertility in older women may be due to the number and quality of eggs as they age, or to health problems that may
interfere with fertility. Men over age 40 may be less fertile than
younger men are.
Risk Factors
Fertility
Tobacco use. A couple's chance of achieving a pregnancy is reduced if either partner uses tobacco. Smoking also reduces the possible benefit of fertility treatment. Miscarriages are more frequent in women who smoke. Smoking can increase the risk of erectile dysfunction and low sperm count in men.
Risk Factors
Fertility
Alcohol use. For women, there's no safe level of alcohol use during conception or pregnancy. Alcohol use increases the risk of birth defects, and it may also make it more difficult to become pregnant. For men, heavy alcohol use can decrease sperm count and motility.
Risk Factors
Fertility
Being overweight. Among American women, an inactive lifestyle and being overweight may increase the risk of infertility. In addition, a man's sperm count and testosterone levels may be affected if he is overweight.
Risk Factors
Fertility Risk Factors
Being underweight. Women at risk of fertility problems include those with eating disorders, such as anorexia or bulimia, and women who follow a very low calorie or restrictive diet.
Fertility Risk Factors
Exercise issues. Lack of or not enough exercise contributes to obesity, which increases the risk of infertility. Ovulation problems may be associated with frequent strenuous, intense exercise in women.
Fertility in TCM
Educate the patient on how long treatments need to be. It can, on an average take 3 months or more to get the results we want. Consistency is key!
First Step
Determine what the objective is: natural conception, support for IUI, IVF, egg donor, or prevention of miscarriage. Then establish a treatment plan.
Fertility
If the patient has been trying to conceive for 1year without success,
testing is required. 6 month if the patient
is over 35 yrs old.
Second Step
•Day 3 and 21•FSH •Progesterone•Estradiol•Prolactin
Understanding Tests
Woman
Fertility in Women
Day 3 - FSH
Understanding Tests
Follicle stimulating hormone (FSH) is the main hormone
involved in producing mature eggs in the ovaries.
Anything above 11 is high and will require help!
Day 3 - Estradiol
Elevated estrogen level can "mask" the potential for detecting low
ovarian reserve by suppressing FSH into the normal range.
Anything above 200 on day 3 is considered an issue
Fertility in Women
Fertility in Women Understanding Tests
High level of Prolactin inhibits FSH secretion
and can lead to irregular period or anovulation
Strenuous exercise, lack of sleep, PCOS, Hypothyroidism, and some foods and medications (especially
some anti-depressants and painkillers) can raise prolactin levels.
Prolactin above 25 is considered high
Day 3 - Prolactin
Day 21- Progesterone
Understanding Tests
Progesterone level will determine if ovulation has occurred 7 to 14 days prior
Anything above 30 means ovulation has occurred and the
corpus luteum is producing sufficient progesterone to induce
adequate secretory changes in the endometrium to assist
implantation.
Between 3-30 means ovulation has occurred but the level is probably not adequate to sustain endometrial growth for satisfactory implantation.
Less than 3 - no ovulation
Fertility in Women
Fertility in Men
•Sperm Count•Morphology•Motility
Understanding Tests
Man
26
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