Ms. C, 36 years old adult career, has attempted pregnancy for 4 years without success. She was given contraceptive injection for 10 years and stopped it 4 years ago. Initially, she had very irregular menstrual circles, then it gradually got regular, but shorter: (6-7/21-23 with 2 days of period pain). After being checked in fertility clinic, she was found FSH33, and AMH1.7, so she was told that a normal IVF was not possible, but it might be possible for her to be given an IVF with the donor eggs. This news made her very disappointed, so they visited my clinic for help.
Clinical figures: short menstrual circles with long bleeding days: 6-7/ 21-23 with 2 days of period pain; nervousness, restlessness, headache, poor sleep, abdominal pain, very upset mood. Light red tongue with red at tip and sides, many cracks at the tongue; deep-wiry pulse.
Differentiation of TCM: Liver Qi stagnation with heat and blood stasis; and Kidney Yin Deficiency
Acupuncture:
Shenque: Moxi
Ren3 Zhongji, Ren6 Qihai, Ext 18 Zigong;
Du20 Baihui, Ext. Taiyang, Sp9 Yinlingquan, Sp6 Sanyinjiao;
Ki3 Taixi, Ki6 Zhaohai and Ki10 Rangu
Sj5 Waiguan, Gb41 Zulinqi,
Herbal medicine prescription:
Shudihuang (Radix Rhemanniae Glutinosae Praeparata) 30,
Danggui (Radix Angelicae Sinensis) 10,
Heshouwu (Radix Polygoni Multiflori)10,
Gouqizi (Fructus Lycii) 10,
Nvzhenzi (Fructus Ligustri Lucidi) 10,
Hanliancao (Herba Ecliptae Prostratae) 10,
Chaihu (Radix Bupleuri) 10,
Yujin (Tuber Curcumae) 10,
Zhike (Fructus Citri Aurantii)10,
Honghua (Flos Carthami Tinctorii) 10,
Shanyao (Radix Dioscoreae oppositae) 10,
Fuling (Sclerotium Poriae Cocos) 10,
Chishao (Radix Paeoniae Rubrae) 10
Before ovulation:
Zishiying (Fluoritum) 10, Huangbai (Cortex Phellodendri) 10, Zhimu (Radix Anemarrhenae Asphodeloidis) 10 are added into above prescription
Before period:
Aiye (Folium Artemisiae Argyi) 10, Tusizi (Semen Cuscutae Chinensis) 10-30, Xuduan (Radix Dipsaci Asperi) 10 are added into above prescription.
Above herbs are decocted as one dose for a day, 6 dose per week. I made some modification in each of her visit, according to her state.
Explanation
Due to longer time application of contraceptive injection, she appeared to have an early failure of her ovary reserve function. The sensitive hormonal figure-AMH is too low, and all other relevant reproductive hormonal figures are too high. This belong to Kidney deficiency, so Ren8 shenque, Ren3zhongji and Ren6qihai play the main effect; Ext18zigong is added to strengthen spleen and kidney, also stimulate ovaries; Sp9 yinlinquan and Sp6 sanyinjiao; and Ki10rangu, Ki6zhaohai,Ki3taixi reinforce spleen and kidney for feeding qi to fully support these meridians. Du20 baihui and Ext taiyang release the stagnated qi and relax mind, Sj5waiguan and Gb41 remove stagnated Qi from liver and throughout whole body.
Herbal prescription: Nvzhenzi(Fructus Ligustri Lucidi) and Hanliancao(Herba Ecliptae Prostratae), a famous classical formula for nourishing kidney yin and releasing empty heat from the lower burner; Shudihuang(Radix Rhemanniae Glutinosae Praeparata), Danggui(Radix Angelicae Sinensis) and Chishao(Radix Paeoniae Rubrae) raise qi and blood to feed ovaries; Gouqizi(Fructus Lycii) and Heshouwu (Radix Polygoni Multiflori)emphasize this effect; Chaihu(Radix Bupleuri), Zhike and Yujin(Tuber Curcumae) remove the stagnated Liver qi and excessive liver heat; Fuling(Sclerotium Poriae Cocos) and Shanyao(Radix Dioscoreae oppositae) reinforce spleen qi, but not too stronger in order to avoid qi’s stagnation. Honghua (Flos Carthami Tinctorii) push the blood stasis through. Zishiying(Fluoritum) is applied before ovulation for stimulating it; Huangbai (Cortex Phellodendri) and Zhimu (Radix Anemarrhenae Asphodeloidis) clear excessive heat and play a function similar to estrogen; Aiye (Folium Artemisiae Argyi), Tusizi(Semen Cuscutae Chinensis) and Xuduan(Radix Dipsaci Asperi) warm kidney and local yang and play a function similar to progesterone.
Outcome
After she received a regular TCM treatment over a year, she gradually got better in general, and her menstrual circles recovered to normal 4-5/28-30; the FSH and AMH of her went back to normal level. Infertility clinic accepted her for a normal IVF with her own egg.
She was retrieved 2 oocytes out for fertilization into embryo, which got transferred into her uterus easily after 4-5 days. She became pregnant soon and got a healthy baby girl in the full term of her pregnancy.
Analysis:
IVF is the typical type of ART which is suitable to most reproductive disorders from ladies. The infertility of this lady may be related with a longer time of contraceptive injection, so she had an early weakness of her ovaries. The sensitive hormonal item AMH is lower, FSH is higher, which explained why she had a shorter menstrual circle and shorter bleeding days during her period. She belongs to Liver heat and kidney Yin deficiency. So she is given acupuncture and moxibustion for stimulating her ovary function; and herbal medicine for strengthening kidney to complement a double Qi (vital energy) and Essences which can give significant promotion to her. Because she is still young, her ovary function did not completely collapse, which may only be manifesting a weaker appearance. So her condition significantly improved with TCM promotion, and ready for IVF.
Reference:
Dan Jiang, Tianjun Wang, Chapter 8: TCM’s promotion to Assisted Reproductive Technology (ART), Understanding, Managing and Treating Female Infertility with Traditional Chinese Medicine, Edited by Peilin Sun, Weixiang Wang, Shulan Tang, Dec 2018, Publisher: Singing Dragon.
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