TCM and Infertility

Hello out there! I hope you all have been enjoying the week so far. I am going to be talking today about one of my favorite clinical specialities- fertility! This week is National Infertility Awareness Week (April 23-29), so I think it’s perfect timing to talk a little about infertility and what role Traditional Chinese Medicine can play in the fertility journey.

Although I am a primarily a general practitioner (meaning I see a little bit of everything in my practice), I do have a special place in my heart for working with fertility issues. Back when I was in school, I took additional classes on women’s health and infertility, and I also had the opportunity to work with a very well-known fertility expert as one of my clinical supervisors. Since being in practice, I have helped quite a few women with conceiving healthy babies, and it is always one of the most rewarding parts of my job.

Before we go any further, let’s talk about what I mean when I use the term “infertility.” This is generally defined in the medical world as a failure to conceive after 12 months of trying (this sometimes gets shortened to 6 months, depending on a number of factors, including age, relevant medical history, and how actively you are “trying” to conceive).

I work with women when they are still in this 6 or 12 month period of trying to conceive (I’ll use the abbreviation TTC for this phrase a lot), as well as with women for whom natural methods didn’t work. This means that they may be undergoing any number of medical interventions to help fertility, such as medication to stimulate ovulation, intrauterine insemination/IUI, or ARTs (Assisted Reproductive Technologies) such as IVF (In-Vitro Fertilization). Side note: the infertility world is bonkers for abbreviations…sometimes I look at my chart notes and basically see just a list of letters I’ve assembled. It takes a little while to become fluent in the fertility lingo, so I’ll try not to use too many more abbreviations than necessary.

The great thing about acupuncture is that we can help at pretty much any stage of the conception process. Sometimes if women have been trying but haven’t needed additional specialized support yet, I can do things like help regulate their menstrual cycle, monitor and assist in ovulation, and help them pinpoint the ideal time for sexual intercourse to maximize their chance of conception. This method is really fun because I get to help women become more aware of their cycles and become more in tune with their bodily rhythms. The sometimes odd part for people is that I’m going to talk to you a lot about your period, bodily fluids, and sex life. I am a professional and definitely keep things that way, but I also try and make this process not so scary and introduce a little light-hearted humor into the situation. One of the major stressors for women TTC is that the fun is taken out of your sex life- rather than just enjoying sex for the sake of sex, it often takes on this very clinical aspect (I’M OVULATING NOW, HONEY, SO WE’RE DOING THIS IN 5 MINUTES…THERE’S NO TIME FOR KISSING!!!). By helping increase awareness of what is going on in your body at any given point in your cycle, I can help women to feel a little more in control of the process and to get some support from an outside source in what can be a confusing and stressful time.

If a woman has any underlying condition like PCOS (polycystic ovarian syndrome), endometriosis, or hormone imbalances that might be causing difficulties conceiving, TCM can also help treat those conditions as well. Sometimes with these patients, I’ll ask that they stop TTC for a few months to focus on resolving some of the underlying issues to ensure that there is the best chance for success when active attempts at conception start up again.

If women are undergoing fertility treatments of any nature, there’s a lot that Chinese Medicine can do during that time as well. Depending on what medications/hormones/therapies the woman is undergoing, we can help to support that process along the way. This can mean things like helping to support ovulation for a healthy egg retrieval procedure, thickening the uterine lining for implantation, or helping to maintain an early pregnancy in a woman with a history of miscarriages.This can also mean helping to manage some of the unpleasant side effects the hormonal medications can induce and reducing stress/anxiety about the whole fertility process. The technology involved in the fertility process continues to absolutely astounds me- it’s an incredible advancement in medical science, but it can always be helped by additional support. Several of the fertility centers here in Connecticut recommend their patients get acupuncture because not only has it been shown to help increase success rates in IVF procedures, they have also seen the many benefits of TCM in their patients who get acupuncture. It’s also a really great insight into how acupuncture can work in ways that people don’t even realize. Sometimes acupuncture gets accused of only working through the placebo effect, but it’s hard to explain how the placebo effect can help make a woman’s endometrium thicker or help stimulate egg growth in an ovary that wasn’t working so well before (both are examples of things I have had patients report after acupuncture treatments).

I want to take a moment here and point out that I’ve been talking mostly about treating women for fertility issues. I want to make it very clear that women and men are just about equally affected by conditions that cause infertility. However, I largely only see women in clinical practice for fertility treatments…so I encourage all women to make sure their partners have been tested for any sperm issues (sometimes the little guys are terrible swimmers, there’s just not enough of them, or the sperm can be an abnormal shape that hinders their journey to the egg) and/or hormonal imbalances/deficiencies. The testing process for men is pretty simple, so it’s absolutely something that all couples struggling to conceive should make sure they investigate. Chinese Medicine can also help men with issues leading to infertility as well, although it can take a bit longer and usually involves herbal treatment in order to see positive changes in sperm counts and motility. I’ve also largely been talking about cis-gendered (meaning you identify as the biological sex you were born as) and heterosexual fertility issues here, simply because that it what I largely see in clinical practice. The LGBTQA fertility journey can also have some additional factors at play, and it is a topic I would definitely like to explore more for both my professional knowledge and patients’ benefit. I do encourage those couples to seek out a fertility center/doctor with experience helping this population to make sure you are getting the most supportive and comprehensive fertility care possible.

The last thing I want to talk about is how incredibly common fertility struggles are. 1 in 8 couples will struggle to conceive naturally. It is one of my eternal pet peeves how little infertility is addressed in the country. Women are often made to feel ashamed when they have trouble conceiving, and the physical/emotional/financial burden of the fertility journey is an incredibly tough one. Rarely do women feel they are able to talk freely about their struggles to get pregnant, express their frustration with family and friends around them who easily became pregnant, or share their experiences with miscarriages and failed fertility treatments. That’s part of the reason I write things like this- fertility struggles are very common, and couples undergoing these issues shouldn’t be afraid to discuss them. Additionally, I often recommend my fertility patients find some place where they can talk about what they are going through- either through individual or couples therapy, a support group, or an online community where they can freely express their emotions.

It can be difficult to know how to bring up and discuss fertility issues if you haven’t experienced them yourself. Many people sort of put their foot in their mouth, saying things like “Stop stressing about it and you’ll get pregnant- just relax,” or “Well, this miscarriage was meant to be, obviously there was something wrong,” or “Why don’t you just adopt?” I have never talked to a fertility patient who felt better after hearing one of these phrases, and often, they silently die a little inside due to comments like these. This is a really good list of 12 things not to say to someone trying to conceive and explains why some of those phrases might be really hurtful. Often, people say something just because they feel awkward or they want to “fix” a problem. We’ve all done it- I can guarantee even I have said something thoughtless at one point or another. It’s a learning process, but listening and asking what the person undergoing the fertility process needs is the best choice. Even saying “I don’t know what to say” is the best option sometimes. But don’t be afraid to hold space and support loved ones going through the fertility process- it can be a really isolating time for couples, and it makes a huge difference to know they have support coming from their family and friends.

So that about wraps things up on the baby-making front! Please feel free to ask any questions you might have about all of this, either in the comments or privately at acupoulin@gmail.com. And please don’t hesitate to share this post with anyone you think might be interested or might benefit from reading it. I hope you have found this helpful, and until next time, be well.

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Eating Seasonally: Spring Edition

Hello everyone! I hope that you all have been having a good week and are enjoying this beautiful spring weather as much as I am.

I’ve talked about the importance of eating seasonally on this blog several times before (see the winter edition and the summer edition here for a discussion on eating for both of those seasons along with some recipes). Today, especially with this being a week that involves some special meals prepared either for Passover or Easter, I thought it might be the perfect time to share a spring edition.

Eating seasonally is an important part of maintaining health according to Traditional Chinese Medicine. It helps our bodies and our digestive systems function at peak performance, and it also prevents troublesome health conditions from developing.

Spring in Chinese Medicine is associated with the organ of the Liver (and remember when I talk about the Liver, it doesn’t mean there’s actually anything wrong with the physical organ itself). In Chinese Medicine, the Liver is responsible for keeping your qi moving as it should. Just like little plant sprouts reaching up to the sun, spring is a good time for people to participate in activities that keep things moving and grooving. This can include things like stretching (the Liver controls the sinews and tendons, so stretching is especially important at this time of year), tai chi, and yoga. And if you’d like to pretend you’re actually a little plant reaching for the sun while you stretch, you do you and be the best little plant you can be!

The Liver is associated with the color green as well…perfect for spring! So eating foods that are green helps to nourish the body and keeps your qi happy and free-flowing. This brings us to one of my very favorite spring recipes. This is frequently on the menu for holidays and regular meals alike in my house. It makes a good amount of food, so even if you want to make up a batch on Sunday, you’ll have lots of delicious leftovers for the week ahead.

The recipe is originally from Ina Garten, whose Hampton lifestyle, adoring husband, and subtle sassiness all combine to make up one of my most favorite celebrities. You can easily make this without the potatoes if you are cutting down on carbs or sensitive to nightshade veggies, but, honestly, these potatoes are so good I can’t imagine it without them. Her original recipe also adds fennel when you add the beans and asparagus, but I personally find fennel gross so I leave it out. If you like fennel, however, roasting it is a delicious way to enjoy it.

Roasted Potatoes, Haricots Verts, and Asparagus

  • 1 pound fingerling or small potatoes
  • ⅓ cup good olive oil
  • 2 teaspoons Kosher salt
  • 1 teaspoon pepper
  • 1 pound French string beans (haricots verts), trimmed (These can occasionally be a little tricky to find, but I always can find them at either Stop & Shop or Trader Joe’s…if you can’t find them at your local store, regular green beans will work just fine)
  • 1 bunch thin asparagus, ends removed, cut diagonally into 3-inch pieces
  • Optional: 2 large fennel bulbs, cut into quarters and then again into long pieces
  • ¼ cup freshly grated Parmesan cheese
  1. Preheat your oven to 425˚.
  2. Slice the potatoes in half lengthwise, and spread them out on a baking sheet. Pour the olive oil over the potatoes, sprinkle them with the salt and pepper, and then toss until the potatoes are coated.
  3. Roast the potatoes for about 25 to 30 minutes, tossing once about halfway through cooking.
  4. Add the string beans and asparagus (and fennel) to the baking sheet, and toss with the potatoes. Roast for an additional 10 to 15 minutes, until the green vegetables are tender. I usually toss everything about halfway through this additional cooking time as well.
  5. Sprinkle Parmesan over all the vegetables and put back into the oven for a minute or two more, just to melt the cheese.
  6. Take the vegetables out of the oven, add a bit more salt and pepper to taste, and serve.

In TCM, asparagus are considered a sweet, bitter, and cooling food. They help clear heat and drain dampness, as well as moisten dryness (this seems counter-intuitive but often foods and herbs can have several important functions at once…dampness is a pathological state and draining it often requires the addition of something slightly moistening to prevent too much drying out). Green beans are a sweet and neutral food that help to nourish the Spleen and the Kidney. Fennel is a an ideal food for this time of year, helping to move Liver qi and strengthen the digestive system. Potatoes are also neutral and sweet, helping to tonify Qi. Putting all of these foods together creates a satisfying and nourishing meal that also helps clear a bit of heat that can develop when we move into warmer weather.

I hope everyone has a wonderful week, and until next time, be well!

Recipe originally from “Barefoot Contessa: Back to Basics” by Ina Garten

All individual food properties sourced from “The Tao of Healthy Eating,” by Bob Flaws