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Sponsored by China Now

Jointly hosted by: - Ming-Ai (London) Institute- The Association of Traditional Chinese Medicine in the UK- The Good Earth Group

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This is the fifth of the 9-Series Traditional Chinese Medicine Workshop which is sponsored by "China Now 時代中國“.

The workshop content was prepared by the speaker who hold its ownership and copyright.

Ming-Ai (London) Institute accepts no liability for any damages or losses arising from the use of this document or its contents.

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TCM Treatment for Infertility By Dr Xiaoping Zhai

中醫藥與不孕症翟小萍醫師

128 Harley Street London W1G [email protected]

Thursday, 12 June 2008

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Introduction

• Background and view on integrated medicine

• Why they should be integrated

Thursday, 12 June 2008 Ming-Ai (London) Institute

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Aim of talk• General background and understanding

of infertility diagnosis• Simple treatment• Assisted conception or natural• Integrated approach• The future


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Definition

• Primary infertilityCouples who have not been able to conceive at any stage

• Secondary infertility Couple would have achieved a pregnancy but it was not successful


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Length of time trying to conceive

Of 100 couples trying to conceive naturally:

20 will conceive within one month 70 will conceive within six months85 will conceive within eighteen months95 will conceive within two years


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What is the Scale of fertility problems in the UK?

It is estimated that one in seven UK couples have difficulty conceiving, which is approximately 3.5 million people. Although the majority of these will become pregnant naturally given time, a significant minority will not. (HFEA)


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Assisted Fertility Treatment and its Success

• 28.1% for women under 35;• 21.9% for women aged 35-37;• 17.5% for women aged 38-39;• 10.4% for women aged 40-42;• 4.2% for women aged 43-44;• 1.4% for women aged over 44;

ICSI represents 44% of all IVF treatment in theUK. (HFEA)


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Disadvantages of assisted fertility treatment

• Expensive• Invasive• Low success rate

The single biggest risk from IVF treatment is multiple births, which carry potential health effects for both the mother and the unborn child

Thursday, 12 June 2008 Ming-Ai (London) InstituteThursday, 12 June 2008 Ming-Ai (London) InstituteThursday, 12 June 2008 Ming-Ai (London) Institute

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Normal FertilityLower part of the Brain

(pea-sized)

Hypothalamus(pituitary gland

Ovaries Testicles


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Normal Fertility

Sperm ImplantationFertilisation

Eggs Menstrual Cycle


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What could be wrong?• Ovulation• Tubal• Endometriosis• Recurrent Miscarriage• Unexplained• Male• Join


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The common causes of infertility(Female)

• Ovulation problems• Hormonal imbalances• Blocked fallopian tubes• Premature ovarian failure/Peri-menopause• Problem with the womb such as fibroids• Other


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Fallopian Tube(HSG or Laparoscopy)

• Sexually transmitted infection• Endometriosis• PID• Previous pelvic surgery


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Pelvic Ultrasound Scan

• Fibroids• Polyp• Physical abnormalities of the womb• Identify of information of PCO/PCOD


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Basic Hormone Tests

• FSH• LH• Oestradiol• Prolactin• Other…….


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The common causes of infertility(Male)

• Previous inflammation • Previous infection• Ejaculation problem• Inability to have an erection• Unexplained• Genetic


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Lifestyle Issues• Stress• Smoking• Weight• Alcohol• Diet • Occupation• Past illness and operation……


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Investigations (Male)Semen analysis:• Motility >50%• Morphology >15%• Number >20million/ml• Progression >3-4• Abnormal form 50%• Blood test, LH/FSH/Testosterone/Prolactin


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Acupuncture

• By stimulating the body channel to balance and improve the internal body’s networking system

• Manipulation of a needle in the skin and underlying muscles excites afferent nerve fibres

• We know that innervations of these nerve fibres can inhibit pain transmission and sympathetic outflow at both the spinal and central levels

• This can then help to modulate the endocrine system and elicit physiological response


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Herbal medicationIf there is heat, cool it;If there is cold, warm it;If there is dryness, moisten it;If there is dampness, dry it;If there is vacuity, supplement it andIf there is repletion, drain it. (Nei Jing)


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The new evidence

• Anti-Oestrogenic• Anti-Androgenic• Anti-Oxidant


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Endocrine activity responses

Oestrogenic Androgenic Anti-oestrogenic

Anti-androgenic

Individual herbs

Decoctions

2/37 0/37 29/37 9/37

0/7 0/7 7/7 0/37


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Anti-oxidant activityNo antioxidant

activityWeak

antioxidant activity

Moderate-strong

antioxidant activity

Individual herbs

4 8 25Decoctions 0 0 7


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Identifying the cause of female infertility (1)TCM patterns and Western diagnosis

PCOD/PCO:

Irregular menstrual cycle Over weightSleepy / needs a lot of sleepTirednessPoor appetitePale wet/white coat tongueSlippery / wiry pulse


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Endometriosis:

Painful periodsClotted bloodAbdominal painPurple body/spots tongueWiry pulse


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PID/tubal disease:

Abdominal distensionVaginal discharge Bitter tasteNauseaRed/rough tongue with sticky and yellow coatingSlippery/wiry/rapid pulse


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Identify the cause of female infertility (4)TCM patterns and Western diagnosis

Hormonal imbalances:

Elevated FSHEarly, light or irregular periodsNormal tongueLight coating, small or wiry pulse


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Other information which may help the diagnosis

• Previous pregnancy• Previous treatment information• Long term medication• Lifestyle• Other……?


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TCM treatment of male infertilityat The Zhai Clinic

• 6 males undergoing TCM treatment for male infertility

• Measured their sperm disomy levels before, during and after treatment


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0

20

40

60

80

100

120

A B C D E F

Patient

num

ber o

f spe

rm s

core

d

Sample 1

Sample 2

Sample 3

Sample 4

Sample 5

Sample 6

Sample 7

First bar (sample1) was taken before, or very early on in treatment, each following bar (samples 2 onwards) were subsequent times

Levels of chromosome abnormalities in the sperm of six patients


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Identifying the cause of male infertilityTCM patterns and Western diagnosis

• Infection• Lifestyle• Obstruction• Sexual problem• Genetic• Unexplained


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Many horses in the race – which one will win?

• Natural• IUI• IVF/ICSI• Egg donation• Sperm donation• Adoption


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Many horses in the race – which one will win?

‘Do not think of a single treatment cycle think of a package of treatment’

Mr. Michael Dooley132 Harley Street


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Traditional Chinese MedicineRole in :• Anovulation• Unexplained Infertility• Endometriosis• Miscarriage• Low sperm count• To assist assisted conception


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Purpose of TCM treatment• Clear obstruction• Balance body’s Yin – Yang• Regenerate blood supply to circulate within

the whole body and reproductive system

Eggs/Sperm qualityimplantation

Natural Pregnancy

Assisted Fertility Treatment


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Evidence that Chinese herbs contribute to fertility/healthy childbirth

• Reduction in sperm/egg chromosome abnormalities

• Strong anti-oxidant and anti-oestrogenic activity

Department of Biological SciencesBrunel/Kent University 2004


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• Referral– Self– GP and other practitioners– Consultants

• Initial assessment• Design Treatment Plan• Follow up• Communication with other practitioners

How I work...


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The initial assessment

• History - Duration of trying, pregnancy• Fallopian tubes• Scan• Hormone tests• Symptoms • Lifestyle• Semen analysis


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Pregnancy rates of 224 female patients1998-2000

Age (Years)

Number of

patients

Total Pregnancies Naturally Assisted

Live Birth

34 64 (29%) 55 (32%) 32 (32%) 23 (33%) 46 (84%)

35-39 88 (39%) 66 (39%) 38 (38%) 28 (41%) 52 (79%)

40-42 45 (20%) 30 (18%) 20 (20%) 10 (14%) 19 (63%)

43-44 21 (9%) 15 (9%) 8 (8%) 7 (10%) 10 (67%)

45-46 5 (2%) 3 (2%) 3 (3%) 2 (67%)

47-48 1 (0.4%) 1 (0.6%) 1 (1%) 1 (100%)

Total 224 170 (76%) 101 (59%) 69 (41%) 130 (77%)


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0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Diagnosis

Patients 41% 24% 18% 10% 7%

unexplained 92elevated FSH

54PCO/PCOD

40endometriosis

22tubal 16


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Pregancy achieved 170 (76%)

IUI 42%

frozen embryo replacement 7

4%

ICSI 1811%

IVF 4024%

Natural 10159%

Natural 101 ICSI 18 IVF 40 IUI 4 frozen embryo replacement 7


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0

20

40

60

80

100

Length of treatment with TCM

Patients 56 68 86 14

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The fundamental reproductive organs

• The kidney – foundation for growth and development before birth

• The liver – maintaining the harmony of movement and the free circulation of Qithroughout the body

• The spleen – foundation of life after birth, providing nourishment for growth.


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TCM diagnostic and TreatmentFemale (1)

Damp and Heat

Painful or heavy periodsUnpleasant dischargeBlood clotting during periodsNormal or red tongue Light moist or light yellow coatingDeep and wiry pulse or may be difficult to feel the pulse


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TCM diagnostic and Treatment(1)

Treatment PrincipleClearing the damp and heat, moving blood flow

Leading Prescription:Jia Wei Tao Hong Si Wu Tang


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TCM diagnostic and treatment Female (2)

Stagnation of Qi (Liver stasis)

Irregular periodsDiarrhoea or constipationDisturbed sleepNormal tongue and wiry pulse


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Treatment PrincipleShooting liver Qi, balance body Yin and Yang

Leading Prescription:Jia Wei Xiao Yao Wan


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Dampness

Pro-longed menstrual cycleDeep sleep or needs longer hours of sleepTirednessLoose or frequent bowel momentGreasy tongue or white thick coatingSmooth and fluent pulse


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Treatment PrincipleExpelling damp and restore blood flow

Leading Prescription:Qi Gong Wan


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TCM diagnostic and treatmentFemale (4)

Deficiency of Blood

• Irregular or light periods• Tiredness• Dizzy or and insomnia• Normal tongue, small or wiry pulse


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TCM diagnosis and treatment(4)

Treatment Principle: Nourishes and promote the Qi and Blood

Leading Prescription: Bu Xue Tiao Jing Tang


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Deficiency of Kidney Yin and Yang

Weak lower backLight periodsDiarrhoea or constipationNormal tongue, small or wiry pulse


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Treatment Principle:Improving kidney Yin and Yang

Leading Prescription:Jia Wei Liu Wei Di Huang Tang


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TCM diagnostic and TreatmentMale (1)

Damp and Heat

Low sperm count, low motility or highabnormal form TirednessFrequent or loose bowelsTesticles Itchy dampGreasy or coated tongue and fluent pulse


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Treatment Principle:Clearing the damp and restore the bloodFlow

Leading Prescription:Bi Xie Feng Qing Yin


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Deficiency of Kidney Yin and Yang

Low sperm count, low motility or highabnormal form Weak lower backacheUrination at nightNormal tongue, small or wiry pulse


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Treatment Principle:Improving kidney Yin and Yang

Leading Prescription:Jia Wei Liu Wei Di Huang Wan


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Advice on making lifestyle changes

• Eat well• Watch the weight• Stop smoking• Exercise• Drink wisely• Be active• Keep cool• Manage stress• Take folic acid• Check prescription drugs


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TCM – an option for infertile couples?

• Efficacy – high success rate• Safety – healthy pregnancy• Being natural • Less multiple rates• Low costs


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What more can be done?

• Scientific understanding• Well designed controlled study• High educational standard and training• Regulation of practitioners• Integration with Western Practitioners


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Integrated Approach


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PredictionThere will be some confirmations, whether the remedies are used on their own to improve natural fertility or as adjuvant in assisted conception protocols. Most likely desperate patients will continue to experiment with unproven products after failing with conventional Western medicine, or as a cheaper alternative.

Application of TCM in the treatment of infertilityHuman fertility (2003) 6, 161 - 168


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HRH Prince of WalesPresident BMA 1982-3

‘Today’s unorthodoxy is probably going to be tomorrow’s convention.’


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Case Study (1)

Years of trying: 5Female investigation: No abnormality

Past ICSI cycle: good numberof follicles, eggs, embryosPlan for 4th attempts at ICSIASAP

Years of trying: 5Male semen analysis:Count: < 1 millionMotility: < 5%Abnormal form: 100%Over weightWhite thick coatingFluent pulse


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Treatment PrincipleMrs B – Treatment Principle:Improving implantation

Leading Prescription: Tao Hong Si WuTang

Mr B – Treatment Principle:Clearing the damp and restoring the semenproduction

Leading Prescription: Bi Xie Fen Qing Yin


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Question?

• What was the treatment focus?

• Why do you think they can conceive?


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Case Study (2)Female: Male:

3 years trying OligozoospermiaPCOS < 1 millionPeriods: 60-90 days Slightly red tongueOver weight Slightly wiry pulseNormal tongueSmall pulse


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Treatment PrincipleFemaleTreatment Principle:Promote Qi and Blood and regulate menstrualcycleLeading Prescription: Tiao Jing Tang

MaleTreatment Principle: Tonify kidney YinLeading Prescription: Liu Wei Di Huang Tang


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Question?

• What was the treatment focus as a couple?

• Why did Mr J only have two months TCM treatment?


IntroductionAim of talkDefinition Length of time trying to conceiveWhat is the Scale of fertility problems in the UK?Assisted Fertility Treatment and its SuccessDisadvantages of assisted fertility treatmentNormal FertilityNormal FertilityWhat could be wrong?The common causes of infertility�(Female)Fallopian Tube�(HSG or Laparoscopy)Pelvic Ultrasound ScanBasic Hormone TestsThe common causes of infertility�(Male)Lifestyle IssuesInvestigations (Male)AcupunctureHerbal medicationThe new evidenceEndocrine activity responsesAnti-oxidant activityIdentifying the cause of female infertility (1)�TCM patterns and Western diagnosisIdentifying the cause of female infertility (2)�TCM patterns and Western diagnosis Identifying the cause of female infertility (3)�TCM patterns and Western diagnosis Identify the cause of female infertility (4)�TCM patterns and Western diagnosis Other information which may help the diagnosisTCM treatment of male infertility� at The Zhai Clinic Identifying the cause of male infertility�TCM patterns and Western diagnosisMany horses in the race – which one will win?Many horses in the race – which one will win?Traditional Chinese MedicinePurpose of TCM treatmentEvidence that Chinese herbs contribute to fertility/healthy childbirthHow I work...The initial assessmentThe fundamental reproductive organsTCM diagnostic and Treatment�Female (1)TCM diagnostic and Treatment�(1)TCM diagnostic and treatment �Female (2)TCM diagnostic and Treatment�(2)TCM diagnostic and treatment � Female (3)TCM diagnostic and Treatment�(3)TCM diagnostic and treatment�Female (4)TCM diagnosis and treatment�(4)TCM diagnostic and treatment �Female (5)TCM diagnostic and Treatment�(5)TCM diagnostic and Treatment�Male (1)TCM diagnostic and Treatment�Male (1)TCM diagnostic and Treatment�Male (2)TCM diagnostic and Treatment�Male (2)Advice on making lifestyle changesTCM – an option for infertile couples?What more can be done?Integrated ApproachPredictionHRH Prince of Wales�President BMA 1982-3Case Study (1)Treatment PrincipleQuestion?Case Study (2)Treatment PrincipleQuestion?

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