Fertility is defined as the number of live births in a population relative to its size (ABS cat.no.3301). In recent years, there has been a trend towards women delaying births within Australia. Delayed childbearing reduces overall fertility in several ways. Firstly, it reduces the period during which a woman can have children. Secondly, women who start having children later in life tend to have fewer children and thirdly women are faced with the increased risk of childlessness due to delaying childbirth. It is this last factor that has the most influence on women’s reproductive health.  The purpose of this paper is to explore the different options available to women who are defined as infertile. It will examine both Traditional Chinese Medicine (TCM) and Western Medicine approach in treating infertility.

The clinical definition of infertility is currently defined as one year of unwanted non-conception with unprotected intercourse in the fertile phase of the menstrual cycles (Evers, 2002). In Western Medicine, there are varying degrees of infertility.  Generally speaking, the majority of couples are sub- fertile. This means couples can produce eggs and sperm, however, have trouble conceiving due to disorders such as male factor, ovulatory & hormone imbalances, autoimmune diseases and problems of the reproductive tract.  Whilst, there have been reported cases of total infertility-i.e. no eggs or sperm production, these cases are considered rare.  Below, are the current infertility statistics in Australia.

Infertility statistics

• A One in six couple is infertile. In 40 per cent of cases the problem rests with the male, in 40 per cent with the female, ten per cent with both partners, and in a further ten per cent of cases, the cause is unknown.
• Fertility problems strike one in three women over 35.
• One in 25 males has a low sperm count and one in 35 is sterile.
• For healthy couples in there twenties having regular unprotected sex, the chance of becoming pregnant each month is 25 per cent.
• The chance of conceiving in an IVF cycle is on average around 20 per cent (but varies due to individual circumstances).
• More than one per cent of births in Australia involve the use of assisted reproductive technologies.

www.abc.net.au/health/library/stories/2007/05/20/1919840.htm

From the given data, it can be concluded that infertility affects both men and women. The risks of infertility are even higher for women wishing to child bear after there thirties, as the probabilities of conception decline with age. Faced with this predicament, couples must take serious steps when trying to successfully conceive.  Whilst, in vitro fertilization (IVF) is known to be the most successful of the infertility treatments it is normally the last resort for couples. The cost of IVF comes with a high price to pay both financially and emotionally. While IVF remains to be the only fertility therapy that can successfully bypass pelvic adhesion, male factor infertility and poor oocyte maturation etc.  Research indicates that majority of IVF cycles do not result in pregnancy and there is a need for multiple IVF cycles to reach the goal of pregnancy. Secondly, female patients tend to suffer from anxiety, stress and depression. (Anderson, J, et al, 2007, p.38). And it is for these reasons; many couples have turned to complementary and alternative medicine (CAM) to enhance the success of IVF treatment.

When we compare Western Medicine and Traditional Chinese Medicine (TCM) in the treatment of infertility there is quite a contrast between the two. Western Medicine has only been treating disease for a couple of hundred years, with Reproductive medicine as one of its newest sciences. The first “test” tube baby was born less than thirty years ago. Chinese Medicine on the other hand, has a long history of treating infertility in both men and women and reports of successful cases have made a significant part of Chinese gynaecology/obstetric textbooks. It is only over the recent years, that conclusions have been made regarding the utility of acupuncture and herbal medicine in conjunction with assisted reproductive technology.

Western Medicine tends to take a more mechanical view of the body, rather than viewing it as a whole integrated system.  The goal of Western Medicine in fertility works with an eye on numbers. The greater the quantity of eggs or sperm produced, the higher the chances are of a viable pregnancy. In contrast, TCM is holistic and cumulative; it practices into a unified medical system that can be integrated into Western Medicine. Recently, clinical research studies have supported that when TCM is used in conjunction with assisted reproductive technology it improves the fertilization rate and pregnancy outcome.

Acupuncture in combination with herbal medicine perform these functions by:

1. Acupuncture can increase blood flow to the reproductive organs, which dramatically improves a woman’s response to hormonal therapy.
2. Acupuncture has been shown to regulate hormone levels by moderating the release of beta endorphins levels in the brain, which improves the release of gonadotrophin releasing hormone by the hypothalamus, follicle stimulating hormone from the pituitary gland and oestrogen and progesterone levels from the ovary.
3. Acupuncture reduces stress and a hyperactive sympathetic nervous system response.
4. Acupuncture has been speculated to moderate cyclooxygenase and prostaglandin levels in the uterus, reducing uterine motility to improve implantation rates.
5.  Herbs nourish the blood, whilst acupuncture moves qi, which facilitates the movement of blood.  It has been claimed that some herbal formulas produce high clinical pregnancy rates as well as improve the general wellbeing of patients.

The following descriptions below will describe how acupuncture can integrate with Western Medicine. Each point relates directly to the one above.

1. There needs to be adequate blood flow to the developing ovarian follicle. This is essential to the initiation and maintenance of normal human pregnancy. Doppler ultrasound evaluation of uterine and ovarian blood flow has demonstrated that improved blood flow in either vascular system is associated with improved fertility outcomes. Women who respond poorly to ovarian stimulation for IVF have compromised blood flow to their ovarian follicles.
2. There are 4 phases in the menstrual cycle. During each phases various hormones are released. The most common cause of infertility is hormonal imbalance.
3. From a Western Medicine perspective, people who are under stress release the hormone cortisol in the brain. Cortisol alters the brain’s neurochemical balance thus changing hormone levels and disrupting the pituitary balance, which is the key to the reproductive cycle. Because of this delicate balance between the hypothalamus, pituitary and reproductive glands, stress is capable of preventing a woman from ovulating entirely.
4. For IVF transfers and implantations the endometrium needs to be of particular density and thickness for successful implantations and fertilization. The uterus therefore needs to be in a relaxed state.
5. The menses is based on the condition of blood.

It is in this field of Reproductive Medicine where we see the integration of western medicine and traditional Chinese medicine. Whilst, Western Medicine has its methodology and techniques when it comes to treating infertility. The brilliance of TCM is that it has had long history in the management of infertile patients and secondly its understanding to infertility relates and overlaps to the Western Medicine view.  This is evident in the literature discussed above. Overall, acupuncture and Herbal medicine provide very powerful tools in the world of infertility. And when combined clearly demonstrate improved fertility rates.

References

Anderson, J.,&  Haimovici, F. (2007). In Vitro Fertilization and Acupuncture Clinical Efficacy and Mechanistic Basis. Retrieved 6^th May, 2008, from: www.alternative-therapies-digital.com

Swan, N. (2008). Acupuncture helps IVF. Retrieved 6^th May, 2008, from: www.abc.net.au/health/minutes/stories/2008

McArthur, S. (2007). ABC Health and Wellbeing. Fact File. Infertility. Retrieved 6^th May, 2008,  from: www.abc.net.au/health/library/stories.

Gnoth, C., & Godehardt, E. (2005). Definition and prevalence of subfertility and infertility. Retrieved 6^th May, 2008, from: www.1093/humrep/deh870

Sedlmeier, S., & Wing, S. (2006). Measuring the effetiveness of Chinese Herbal Medicine in improving female fertility. Retrieved 6^th May, 2008, from: www.encyclopedia.com/doc

Bio, J. (2007). Fertility Research Delivers Healthy Results. Retrieved 6^th May, 2008, from: www.acupuncturehealingpoints.com

Australian Bureau of Statistics. (2005). Australian Social Trends, 2005. Retrieved 6^th May, 2008, from www.abs.gov.au/Ausstats/ABS@nsf.

Hugo, G. (2007). Recent trends in Australian Fertility. Retrieved 6^th May.

Lyttleton. J. (2007). Treatment of Infertility with Chinese Medicine. United Kingdom. Churchill Livingston.

Allison, A., & Wang, R. (2008). Auto-immune factors in infertility. The Lantern, 5(1), 26-34.