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Case Studies Blog

ART Case4: TCM’s preparation before IVF for a lady with Amenorrhea in pre-Menopause stage



Mrs. S, a 49-year-old teacher, became pregnant when she was 23 years old but had an abortion at 6 weeks of pregnancy. She never managed to conceive after that and she started to worry about her reproductive capabilities when she was 40 years old. A gynecological investigation showed both fallopian tubes to be blocked, plus she failed IVF twice. She visited me when she was 49 years old after having missed two months of her menstruation. Due to her amenorrhea, the gynecologists refused another IVF. She also manifested exhaustion, hot flushes, depression, tinnitus, insomnia and other symptoms.


Her tongue was red and she had a wiry-thin pulse.


TCM differentiation:

Kidney yin deficiency, Liver qi stagnation and Spleen deficiency.

Treatment principle: To nourish Kidney yin, to move stagnant Liver qi and to reinforce Spleen qi.

Treatment given: Acupuncture: Moxibustion at Ren 8 shen que

Needles: Du 20 bai hui, Du 24 shen ting, Ren 4 guan yuan, Ren 6 qi hai, St 29 gui lai, LI 4 he gu, Liv 3 tai chong, Ki 3 tai xi, Ki 10 yin gu, Ki 2 ran gu, St 36 zu san li, Sp 6 san yin jiao.

Patent herbal medicines: Zhi Bai Di Huang Wan / Jia Wei Xiao Yao Wan.


Explanation:


She was given a typical supporting treatment, with the priority being the Kidney yin pattern. Zhi Bai Di Huang Wan reinforces Kidney yin and supports her estrogen levels whilst Jia Wei Xiao Yao Wan moves Liver qi stagnation and excessive heat from Liver and Kidney yin deficiency. Regular acupuncture stimulated her depleted menstrual function.


Outcome:


Once her periods returned she was given the ‘promoting the menstrual cycle treatment’ for half a year, after which she became pregnant following successful IVF. She conceived a healthy boy at the end of her term.


Analysis:

This patient had been 49 years old by the time she tried to conceive. Her hormonal levels had been in the final stages which meant she had amenorrhea for two months. After she was given acupuncture, which stimulated her reproductive organs, and herbal medicines, which had a stronger effect on reinforcing qi and yin in her Kidney and Spleen, her menstrual cycle returned. Her hormonal levels were probably still not high enough for a natural pregnancy, but she was accepted back by her gynecologists due to the menstrual cycle being regular again and IVF was given which proved successful in the end.



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.