Nowadays, there has been more attention brought upon the issue of declining birth rates, which even the more populated Asian countries are starting to experience. Alongside the increasing (average) age of marriage and infertility from socioeconomic factors, the rate of infertility is also increasing. In the past 20 years, the infertility rate has increased from 3% to about 10%. This rate is starting to be on par with the United States and other countries, whose fertility rates average around 10-15%.
Generally speaking, when I introduce my infertility treatments to my (Western) patients, I tell them that the medicine I use is well standardized among infertility treatments in China. Many of these patients only started trying Chinese medicine after Western medical treatment has not worked. The great success rate has caused the usage of Chinese medicine to increase in countries such as Japan, South Korea, and other Asian and Western countries. Chinese medicine gynecological prescriptions are useful in regulating menstruation, and there has been a gradual awareness of the effectiveness of acupuncture in the US fertility clinics as well.
Hormonal and endocrine disorders is a good fit to be treated by traditional Chinese medicine. Typically Western medicine reported about 10% of infertility cases have unexplained causes. If oriental medicine is used, physical, stress factors and/or other lifestyle issues can be identified and resolved. Utilizing treatments from both Western and Chinese medicine, the chance of a successful pregnancy can go from ~50% to ~85%.
1. Communication between the patient and the doctors has a great impact on results
A major infertility factors is obstructions to ovulation, but ovulation issues are hard to detect, so many do not realize that they have this issue. Many women just record when they have menstruation every month, and have intercourse in the middle of the menstruation cycle. Even leukorrhea date is hard to pinpoint by some patients as a question brought up during a consultation. This way there is no precise planning of three valid intercourses during each cycle. We practitioners often found out that, the success of self monitored pregnancy preparation depends largely on the patient's basic medical knowledge.
The other group of patients after finding an infertility doctor, normally undergo the treatment with the doctor. The patient's ability to evaluate and communicate with the doctor again directly impacts the results.
As an example, I heard two kinds of typical cases reported by various of patients that used Chinese infertility medicine, who claimed that the traditional Chinese medicine treatment methods were inadequate. One patient saw a doctor, and decided to switch to another doctor after a few months of no progress. She ended up seeing more than a dozen over the course of 5 or 6 years. The other patient did not want to change doctors, and she has been treated by the same doctor for two or three years without satisfactory results.
Often, these patients have incomplete records on Chinese medicine diagnosis and treatment. They may be able to find sporadic herbal medicine prescriptions, with no original pulse diagnosis or consultation record. If the patient changes doctors, they often lose precious time having to restart from beginning.
The holistic fertility treatment process usually are conducted on a weekly schedule. On every visit, the traditional Chinese medicine doctor takes the pulse, and ask the patient updates on their symptoms. The subjective chief complaints will change in the matter of weeks. For example, dysmenorrhea is not known until the next cycle of period. Cold hands and feet will gradually change over the course of a few weeks or more. In comparison, the objective hormone test (by blood) an OB orders is often conducted once every six months. These feedback cycles are too long to be used to adjust weekly treatment plan.
Luckily, we have a great tool to use, that is, daily BBT measurements at home. The effectiveness of TCM methods can be updated weekly with feedback. It is similar to measuring fingertip blood sugar at home for diabetes and measuring glycosylated hemoglobin every six months in the lab. The combination of the two contains both short-term and long-term data. What's more, the BBT test is painless and free, there is no reason not to do it.
Toni Weschler, the author of the best-selling book Taking Charge of Your Fertility, has a wonderful suggestion, letting your partner conduct the BBT test to improve communication, understanding, and bonding among the couple.
2. Understanding how the BBT test is used in TCM diagnosis and infertility treatment
The chart below showcases a visual of the menstrual cycle in Western medicine:
A. Follicular phase: From the first day of menstruation to ovulation (Day 1 - Day 12), body temperature is on the low phase line, which mainly reflects the level of estrogen. Egg production and growth occur during this period. The graphic above shows that ovulation occurs on day 12 of the cycle.
B. Luteal phase: The body temperature rises after ovulation, (Day 13 - 26) is on the high phase line, which mainly reflects the level of progesterone.
Let us take a closer look at the theory of traditional Chinese medicine gynecology. Here I will go over the "heart-kidney-uterus axis" theory and seven-segment cycle adjustment method, developed by Prof. Xia Guicheng, a master of Chinese medicine. You will appreciated the subdivision and refinements on top of the Follicular/Luteal phases.
a. The menstrual period itself is generally 3 - 7 days. The blood volume, color, and blood clot during the menstrual period are important indicators of her fertility.
b. The beginning of the follicular phase is called the early post-menstrual period, which generally refers to 3-5 days after menstruation is cleared, but some can reach 7 days or longer. Normally the vagina is dry and the estrogen level is low. According to Chinese medicine, it is the early stage of Yin growth, which corresponds to the stage of nourishing Yin and nourishing blood in treatment.
c. The middle post-menstrual period refers to the 3-5 days, or even up to 7 days, after the early post-menstrual period. The main sign is a small amount of discharge, usually a thin or slightly viscous secretion fluid. At this time, the strength of Yin reaches a medium level, which is also accompanied by the process of disappearing Yang. If there is too little leucorrhea than normal, the strength of Yin is not enough. At this time, besides nourishing Yin and nourishing blood, medicines that support both Yin and Yang should be added.
d. The ending post-menstrual period occurs 2-3 days before the ovulation period, mainly with a lot of vaginal discharge, thin and sticky egg-white like. One of the physiological changes is that Yin growth maxed, with the estrogen level being around a medium or high level. The second is that the growth of Yin requires the advancement of Yang. Generally, the method of simultaneous advancement of Yin and Yang is used. If there is excess Yin, Western medicine may detect that there is too much estrogen. In traditional Chinese medicine, it is regulated by nourishing Yin and reducing fire. In addition to regulating the Yin and Yang of the Kidney, it is sometimes combined with regulating the Liver and Spleen.
e. The ovulation period is the period of Yin to Yang transformation. On BBT, we observe the transition from the low-temperature phase to the high-temperature phase. Smooth ovulation requires a good “Chong Ren (冲任)”, Qi and blood activities at the uterus. Those with deficiencies should focus on activating blood circulation. According to individual circumstances, methods such as resolving phlegm, clearing heat, and removing dampness are added. If the treatment falls with an active IVF cycle, be careful not to induce ovulation.
f. The premenstrual period is the period from ovulation to the menstrual period. Generally, in the high-temperature phase of BBT for 6 to 7 days, the Yang growth reaches the peak, in the first half of the prmenstrual period. In this period, if the Yang growth is unfavorable, it is usually reflected in the slow rise of the BBT high-temperature phase. Sometimes the high-temperature phase is low and short, or the high-temperature phase is unstable. Insufficient Yang, in addition to the cause of Yang itself, are generally related to the insufficiency of Yin. Another abnormal condition is that there is excess Yang growth, excess Yang water, and BBT high-temperature phase is too high and too long. In Western medicine, the observed luteinized lesions and luteal atrophy, are related to this. TCM treatment is mainly to release heat, restore Yin, to clear the meridians and activate blood.
g. The second half of the premenstrual period refers to the 6-7 days before the menstrual period. Physiologically, Yang water drops and Yang Qi replaces it, and some premenstrual symptoms start to occur. If there is chest tightness and irritability, breast tenderness, and poor sleep at night, it is often accompanied by high BBT high temperature, or wavy ups and downs. If the Heart and Liver Fire is too strong, the treatment will emphasize "regulating Qi and regulating menstruation".
If the Spleen and Kidney are deficient, the high-temperature phase of BBT usually decreases slowly or is unstable, or low, or short, etc. It is also often accompanied by different degrees of spleen and stomach weakness symptoms, such as abdominal distension, gassy, loose stools, and fatigue. Treatment is based on "boosting Yang" and adding Qi-regulating drugs.
3. Examples of BBT exceptions
A. The BBT indicates that the follicular phase low temp curve is too high
This type of patient is often accompanied by feeling upset and irritable, facial acne, insomnia, and dreaminess. The TCM diagnosis is Yin deficiency and fire exuberance. It is common with high basal metabolism, hyperthyroidism, tachycardia, or endometriosis.
B. BBT shows a premature drop in body temperature during luteal phase high temp curve
Under normal circumstances, if you are not pregnant, the high-temperature phase of the luteal phase lasts until the day before your next menstrual period. If the body temperature drops prematurely during the luteal phase and the patient experiences premenstrual spotting, this may indicate a drop in progesterone levels. The TCM diagnosis is deficiency of Kidney Yang, and deficiency of Spleen that affects blood.
C. Complex cases
There are many combinations of the high-temperature phase and the low-temperature phase being too high or too low, respectively, and are too short or too long. In general, the post-menstrual period and the premenstrual period should be relatively balanced, with a half-month for Yin and a half-month for Yang. If the menstrual cycle is short, it may be shortening of the yin half-month and/or the shortening of the yang half-month. Similarly, the delay of menstruation, it involves the lengthening of the Yin or Yang half-month, which can be reflected on the BBT to guide the treatment.
There are also many complex cases of infertility in clinical practice. The high temperature phase of BBT is high in one menstrual cycle but low in the next month. Yang excess and Yang deficiency appear alternately, which may be related to many causes, the imbalance of Kidney Yin and Yang, or the disharmony of Liver and Spleen, or the imbalance of Qi and blood, etc. The treatment of such complex conditions really tests out the doctor's judgment and the ability to communicate with the patient. It is necessary not to over-treat in one direction, and not to waver repeatedly and make the patient lose faith in the treatment plan.
The treatment of infertility is first and foremost a field of gynecology, in which the knowledge of western medicine is not too complicated to be communicated to the patients. Once it involves traditional Chinese medicine treatment, the theory and practice of acupuncture and herbs can become more complicated. The fertility acupuncture part is very popular and acknowledged by many modern fertility clinics. The various typical conditions can be treated, will need to be extended in a separate article.
For premoms who are close to or over 40 years old, have been diagnosed with blockage, lesions, or have elevated abnormal hormone levels, the BBT measurement introduced in this article is a simple and efficient way to combine TCM diagnosis and treatment with a self-testing aid at home. It is the first step towards a success pregnancy.
Search App store for Easy@Home or Premom
On Home tab, record your BBT easily and share with your doctors. (You don't need to use a particular brand of thermometer in manual mode, but Easy@Home has pair mode for their own thermometers.)