I know that there are probably a whole lot of people around who find the common elements of Eastern and Western medicine much less fascinating than I do. But for those of you who are intrigued by it, the fusion of the two in the treatment of infertility is, I think, especially fascinating. I am writing about the use of acupuncture and Traditional Chinese Medicine (TCM) as it relates to Modern Medicine’s understanding of how the body functions. One approach that can be used by a TCM practitioner (like me) is to help a woman’s body function at its best in the four phases of the menstrual cycle.
In the first part of the menstrual cycle, the lining of the uterus is discarded. When it is time for menses, the spiral shaped blood vessels in the endometrium constrict. This stops blood flow to the endometrium, and causes the tissue to atrophy and die from lack of blood. Then, the blood vessels puff back up and push the endometrium out, helping to expel the tissue.
The goal is to have a smooth and complete discharge of the lining. I support the body in doing this by moving the Qi energy and blood during menses. A new endometrium is important because that is the implantation site for the embryo. If there are problems with the menstrual cycle, they will be especially apparent in this part of the cycle. Herbs and acupuncture can help to flush the uterus.
Immediately after the period, during the second phase, the body’s goal is to build up blood. In TCM we say the Chong channel, which holds the blood, needs to be refilled. We also work to replenish the Yin. It is not easy to give a simple definition of Yin, but for the purposes of this article, think of it in terms of the fluids of the body, and of the first part of the menstrual cycle where estrogen is predominant and the body temperature is cooler. We need to support the body to help build a good uterine lining that is rich in nutrients so it is a healthy place for the embryo to attach. Nourishing the Yin also nourishes the follicle that develops into the egg. Phase two gets the egg and uterus ready so that everything that follows just falls into place.
From the Eastern standpoint, the uterus rebuilds endometrial tissue and the Chong channel by nourishing and invigorating the blood. Western medicine states that new tissue and blood vessels need estrogen to prime the endometrium. I support this phase by nourishing the Yin, and using blood regulators and blood tonics to help refill the Chong channel. Fertility is enhanced when the health of the egg and uterine lining are good. In this phase we also nourish Yin to help nourish the egg which is growing inside the follicle. FSH, follicle stimulating hormone, is one of the hormones naturally produced by the pituitary. If the body is working well, a number of follicles start growing, but one of them becomes dominant, responds the best, and grows the biggest. This follicle produces estrogen to stop the production of FSH by the pituitary so that all the other follicles that have started growing will die. The body produces just enough to keep the dominant follicle going, without keeping the others growing. If it takes too long for the egg to be ready and released from the follicle, it may be interpreted by a TCM practitioner as a deficiency in Kidney Yin and blood.
Phase three starts before ovulation and continues for a few days after ovulation. This is also the time that the cervix needs to be producing fertile mucous. During this phase, the egg and follicle (the egg is still inside the follicle) continue to mature so that a healthy egg is smoothly released. We also help the body get ready for the next stage, which is the Yang stage (think progesterone and higher body temperature).
Phase three is pretty exciting because a lot happens all at once. Yin and Blood need to be sufficient. The egg needs to be just ripe enough. If all that is moving along, then the Yin can switch to Yang. The correct signals need to be sent from the pituitary to the Uterus so the LH, luteinizing hormone, is at the proper level. In TCM, we see that the Liver Qi and Heart Qi are flowing properly.The egg is released from the ovaries in the damp mass called the cumulus, which has sticky cells around it and gets caught by the end of the fallopian tube. The secretions inside the tube are very important, and are related to estrogen and Yin levels. If they are not sufficient, the egg does not progress down the tube as it should, and could result in an ectopic pregnancy. But if all goes well, the egg meets the sperm at the very distal end of the tube, and fertilization occurs. The embryo starts to develop over the next few days. The secretions hold the embryo in place in the fallopian tube while it develops. In five or six days the secretions start to thin, with the help of Yang, so that the embryo can move into the uterus and find a place to implant.
Phase four is what happens after the egg is in the fallopian tube, and hopefully, after fertilization or conception. We want to keep the body warm so we boost the Kidney Yang. It is very important that the uterus is warm. During the fourth phase, the embryo is on its very last stage in the tubes and is getting ready to enter the uterus. The TCM practitioner makes sure the uterus is warm enough by promoting Yang. In Phase two, we nourished blood so that the embryo has enough nutrients for the embryo. From the TCM standpoint, Yang helps the body produce progesterone by helping the corpus luteum perform better. After the egg has escaped from the follicle, the emptied follicle forms the corpus luteum which produces progesterone to help the body maintain the pregnancy. In phase four, the purpose of the lining of the uterus is to produce more nutrients. The arteries grow more and twist, the glands become active. And this part of the story ends, hopefully, with the embryo finding a nice comfy spot on the uterine wall where it will settle in and attach to the nice, healthy, nutrient-rich endometrium.
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