It Takes Two

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The odds of getting pregnant seemed stacked against 37-year old Cathy Tan*.

When she first consulted Dr Ann Tan at the Women & Fetal Centre in Singapore, the consultant obstetrician/gynaecologist found fibroids, ovarian cysts and polyps in her uterus. Surgery to remove them also removed her right ovary, decreasing her chances of getting pregnant.

Cathy was also running out of time. Even with in vitro fertilization (IVF), the chances of conceiving was only between 20% and 30% past the 38-year mark.

Recovering from surgery, she began researching complementary traditional Chinese medicine (TCM) therapies, and when she began IVF treatment in 2011, decided to try them alongside conventional treatment. “The Chinese herbs I would be taking could only be good for my body, so why not try it?” she rationalized

Upon Dr Tan’s recommendation, she came under the care of Zhong Xi Ming, a senior physician with Eu Yan Sang in Singapore. The two worked hand in hand, combining the best of western fertility treatment with acupuncture and Chinese herbs to help Cathy become a mother.

It took three cycles, but Cathy gave birth to her first child, a boy, the same year. Two years and two TCM/IVF cycles later, she became the mother of another son.

Better together

Increasingly, medical doctors and TCM physicians are working together to help couples become parents. And with good reason.

A 2015 study by researchers from the Oregon College of Oriental Medicine, Oregon Health and Science University and the Northwest Center for Reproductive Sciences in Washington found that patients that complemented their IVF treatments with “whole-systems traditional Chinese medicine” had more live births (61.3%) than those who received only “usual” IVF care (48.2%). Whole-systems TCM includes acupuncture and Chinese herbal medicine as well as dietary and lifestyle recommendations.

Even those who received just acupuncture alongside usual IVF care recorded a higher proportion of live births (50.8%), the study found. The study looked at the results of 1,231 fresh cycles.

Another study led by cellular biologist Dr Shahar Lev-Ari, head of the integrative medicine unit of Tel Aviv University’s medical school in Israel found that TCM therapies gave a measurable boost to intrauterine insemination (IUI), with 65.5% of the test group conceiving, compared with 39.4% of the control group.

“I am open to recommending my patients to avail themselves to TCM alongside Artificial Reproductive Technology (ART),” Dr Tan says. “I have had positive experiences with my patients’ use of TCM, and many couples do it quietly anyway, so I prefer to be upfront and ask them about it.”

Physician Zhong recalls that when she first joined the Eu Yan Sang’s Reproductive Department more than a decade ago, she was unconvinced about the need for such a department, but people started streaming in.

Both Dr Tan and Ms Zong consider Cathy their “miracle” patient.

“It was a nice combination of work from Physician Zhong and myself to get the eggs out from someone who hardly produced any,” Dr Tan recalls. “And she wanted another and we both got stressed but she did it again!”

Well-timed therapies

Collaboration usually involves the two medical modalities taking precedence at different stages of the treatment plan, each referring patients to the other when necessary to ensure good quality eggs and sperm, successful implantation and a healthy, full-term pregnancy.

TCM plays a particularly active role in the preparatory and pre-implantation stages.

“Herbs and acupuncture can help to improve the womb lining, and enhance follicles so that the patient has a stable womb lining when the embryo is transferred to it,” says Physician Zhong. “Increasing the yang energy also helps to create a good uterine lining environment and increase the likelihood of successful embryo implantation. Factors such as a calm mind and a harmonious flow of qi and blood through the body also influence the blood circulation in the ovary and uterus, and have a positive effect on the success of IVF.”

Acupuncture, in particular, has become popular with women undergoing fertility treatment, with several studies supporting its benefits as complementary treatment for IVF. In 2002, 160 IVF patients at a German fertility clinic participated in a study on acupuncture. Half of them received acupuncture 25 minutes before and after embryo transfer, while the other half received no complementary therapy. All 160 had good quality embryos transferred. Thirty-four of the 80 women who received acupuncture got pregnant compared to 21 of the 80 women in the control group.

A journey requiring resilience

Although ongoing studies and growing anecdotal evidence offer hope to couples struggling to conceive, the journey to a successful pregnancy and birth can be an emotional rollercoaster, requiring great resilience.

“After my first failed IVF, I felt sad and thought that I was probably hopeless,” Cathy shares.

Also, “the most successful treatment is one where both partners are equally in tune to reach the goal of having a baby,” Dr Tan advises. “It’s always very difficult and stressful when one partner wants it more than the other. They must realize that it’s not a blame game; try to make the best out of what you both are as a couple.”

As always, work with a qualified TCM practitioner, and keep both your doctor and TCM practitioner informed of all treatments you are receiving.

(*Name has been changed to protect the patient’s privacy)

_{Studies cited/Sources:}
_{http://yourivfacupuncture.com/ya/wp-content/uploads/2010/04/Whole-systems-acupuncture-and-ivf-1.pdf}
_{http://www.israel21c.org/trouble-getting-pregnant-try-chinese-medicine/}
_{http://www.dailymail.co.uk/health/article-2084575/Traditional-Chinese-medicine-makes-fertility-treatments-effective.html}
_{http://yourivfacupuncture.com/what-is-the-process/research/medical-research-article-2/}

Get The Right Treatment

Of Birds & Bees

The Ticking Clock

Singapore’s Total Fertility Rate stands at an abysmal 1.2—way below what the population needs to replace itself. Some of that is the result of people choosing not to marry; some from couples having very few children—either by choice or because having children has proved difficult.

Dr Christopher Chen of the Christopher Chen Centre for Reproductive Medicine, comments, “If, despite regular intercourse every two to three days, pregnancy does not occur after six months to one year, then the couple may have fertility problems. The problems could be due to either the man or the woman, or combined.”

Age is a huge factor in fertility.

With couples marrying increasingly later and putting off having children— often to complete higher education and establish careers and finances— age-related fertility issues have become more common. “A woman’s fertility declines after the age of 25 initially slightly, but becomes quite precipitous after the age of 40. By the time she reaches 45, her prospect is very poor,” reveals Dr Chen. “Age also influences a man’s fertility. After the age of 50, there is a progressive decline in the man’s fertility and sexual performance.”

Adds Dr Ann Tan of the Women and Fetal Centre, “With increasing opportunities for more women to be educated and develop their careers, fertility has taken a back seat. In many women’s minds, it is something that can be summoned at will when they need it.”

That points to a host of lifestyle and societal factors that impact fertility. Education and career success sometimes take priority over having children. And, as Dr Tan points out, people often take their fertility for granted. A fast pace of life, stressful jobs and lack of work-life balance also take their toll.

As Dr Chen puts it, “Modern living has clearly had an impact on the fertility both of men and women, especially in a fast-moving, demanding and stressful environment such as Singapore, where many people work long hours and travel for business. The lack of opportunity for a couple to have intercourse amid their busy schedules has an impact on fertility and on general health.”

He continues, “Undoubtedly, mental, physical and emotional stresses have been found to impact fertility. In the man, it affects his sperm quality and count. In the woman, it can affect her ovulation. She may not ovulate over several periods of her cycles; she may produce poor quality eggs on account of these factors.”

Let’s Talk About Sex

Ultimately, for a couple to conceive a child, they need to have sex.

That’s stating the obvious, but it’s shocking how little sex many couples have. A range of factors contribute to this, of which lifestyle and stress are two large ones.

“Couples need to look realistically at improving their lifestyle to give them opportunities to relax and to have intercourse, especially during the woman’s fertile period,” suggests Dr Chen. “Modifying their work environment and changing jobs can be considered. Ultimately, couples need to make time to be together and to have more frequent intercourse. The best time for a couple to conceive is between Day 11 and Day 16 of a 28- to 30-day menstrual cycle.”

And what about the stress that trying to conceive a baby can in itself bring to a couple? “Making a baby should not be perceived as a chore,” advises Dr Chen. “Couples who take it easy in conceiving are more successful than those who try hard. Sex should not be regimented; it should be enjoyed. The couple should create a conducive environment for lovemaking and not just aimed at baby-making. The couple should combine the pleasure of sex and the pleasure of conception.”

The TCM Perspective

In traditional Chinese medicine (TCM) principles, the most important organs that govern the regulation of blood and qi and their related activities are the liver, spleen and kidneys. The spleen is the main ‘factory’ that produces blood and qi, while the liver is responsible for maintaining a smooth and even flow of these two important essences. According to Senior Physician Zhong Xi Ming from the Eu Yan Sang Premier TCM Centre, when it comes to fertility, “the kidneys play a big role in successful conception and normal reproduction.”

How does TCM manage this problem? The first method is via herbal prescriptions, which aims to nourish and balance the body, especially the reproductive system, liver, kidneys and spleen. Acupuncture can regulate the function of the relevant organs to strengthen and invigorate the whole body. Diet and exercise may also come into play.

The overarching principle of TCM when it comes to fertility is to “cultivate the soil before planting the seed,” as Senior Physician Zhong puts it. “We manage holistically, taking into account your physical, emotional and spiritual aspect.” This means TCM does not only focus on managing a particular fertility-related problem. “We also want to improve all systems of your body and mind,” she reveals. “If you are sleeping well, are full of vitality, have proper digestion and healthy sense of self, then all systems will work more efficiently, including your reproductive system.”

Acupuncture and Reproductive Health

Acupuncture treatment regulates the flow of qi and blood, tonifying where there is deficiency, draining where there is excess, and promoting free flow where there is stagnation. Researchers from New York’s Weill Cornell Medical Center reviewed existing studies and found that acupuncture helps…

Reduce stress hormones that interfere with ovulation
Normalise hormones that regulate ovulation so an egg is released
Increase blood flow to the uterus, improving the chances of a fertilised egg getting implanted
Improve ovulation cycles in women with polycystic ovary syndrome (PCOS), which makes getting pregnant difficult
Improve pregnancy rates in women undergoing in vitro fertilisation (IVF)

If you want to avoid taking fertility drugs, are not eligible for IVF, or want to improve the success rate of IVF, consider acupuncture and herbal medicine.

Beware These 6 Confinement Myths

In TCM, a woman loses large amounts of Qi and blood during childbirth, putting her body in a “cold” phase. This is why Chinese culture recommends a month-long period of “confinement” for the new mother. These weeks of rest and a modified diet are intended to restore the mother’s balance and return her to full health.

While certain confinement practices are common, it’s a bad idea to follow them blindly. Discover the truth behind the myths from a TCM perspective.

1. Myth: Do not drink plain water
This comes from the belief that drinking plain water causes water retention or will cool down the body too much.

The truth: There is no harm in drinking plain water. In fact, because new mothers tend to sweat heavily because of hormonal changes, they have all the more reason to drink water and keep hydrated. However, new mothers should be encouraged to drink warm water instead of cold water.

2. Myth: Consume alcohol
Drinking alcoholic beverages or eating dishes cooked with alcohol is thought to boost blood circulation and warm up the body.

The truth: It is correct that alcohol is used in TCM to expel cold and promote circulation. That said, new mothers should not regard alcohol as essential to their recovery. In fact, nursing mothers should avoid alcohol, since it can be passed on to their baby through breast milk.

3. Myth: Do not shower or wash one’s hair
Contact with water is thought to cause “wind” to enter the body and lead to headaches and rheumatism later in life. This taboo may have originated from northern China of the past. Since water quickly became freezing because of the cold weather, it was easy to catch a chill from bathing.

The truth: It is perfectly fine to continue one’s bathing habits. Besides maintaining personal comfort, regular bathing helps prevent skin and wound infections. However, the mother should not bathe with cold water. She should also dry her body immediately after bathing to prevent exposure to cold air.

4. Myth: Consume plenty of herbal supplements
Since childbirth drains a woman of Qi, it is recommended that she stock up on specific herbal soups and dishes that boost energy and blood.

The truth: Since every woman’s health profile is different, she may not benefit from the same remedies that help others. It is better to consult a qualified TCM physician for personalised advice and treatment.

That said, one dietary recommendation can be generalised to all new mothers. In TCM, it is best to avoid cooling foods during confinement. Eating such foods carry a risk of harming one’s Spleen and Stomach and hampering recovery. Foods to avoid include bamboo shoots, bananas, crabs and oysters.

5. Myth: Do not read or cry
Childbirth is thought to weaken the Liver, which is linked to the eyes. Therefore, one should avoid putting stress on the eyes by reading or crying. Otherwise, one might experience eye problems later in life.

The truth: There is no basis for the belief that reading or crying would lead to eye problems. However, TCM experts do hold that the large loss of blood during childbirth may weaken the eyes. This is because blood is related to the Liver, which is associated with the eyes. Regular consumption of Liver-protecting foods, such as Chinese Wolfberries, would help maintain eye health.

6. Myth: Wear warm clothing and do not use fans and air-conditioning
As with bathing, any exposure to cool air is said to cause “wind” to enter the body and lead to health problems later in life.

The truth: The key here is moderation. The new mother should do what makes her comfortable. In a hot and humid climate, fans and air conditioners may even be essential for preventing heat rash. However, the new mother should not let the fan or air-conditioner blow directly on her.

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