Women who, during their reproductive age have been having regular unprotected intercourse or who have been trying for a second pregnancy for more than one or two years. In both cases, male partners have been confirmed as having normal specimens.

What is the definition?

Primary infertility Couples have never conceived at any stage

Secondary infertility Couples will have had a pregnancy, although not necessarily a successful one

Approximately 10% - 15% of reproductive age couples will experience difficulties in conceiving.

Diagnostic categories and distribution of couples with primary and secondary infertility

Diagnostic category Primary (%) Secondary (%)

Male 25 20

Ovulation 20 15

Tubal diseases 15 40

Endometriosis 10 5

Unexplained 30 20

Causes and Pathological Mechanisms in WM

30% (20-40%) anovulation, 30% female genital tract anatomic defects (#1 salpingitis, 25-50% tubal disease), antisperm Ab, 5-10% cervical factor, 10% unknown, 5-10% peritoneal factor, 3-10% luteal phase defect, combination

Causes and Pathological Mechanisms in TCM

The causes of female infertility are quite complex, but are mainly due to the deficiency of both kidney Yin and Yang, an insufficiency of both Qi and blood causing poor egg quality, or depression of the liver Qi causes anovulation. Phlegm may also have an effect as dampness and stasis of blood causes difficulty in implantation. Pelvic inflammation, endometriosis and endocrinal causes also often exist due to a combination of two or three of these causes.

Likely risk factors

Active or passive smoking is associated with delayed conception.
Alcohol use is also associated with increased risk for infertility in women.

Possible risk factors

Use of intrauterine device in nulliparous women associated with longer time to achieve conception after cessation of contraception than other contraceptive methods.
Decreased fertility with increased age.
Use of estrogen therapy to reduce adult height in tall girls associated with increased risk of infertility.
Inflammatory bowel disease might be associated with infertility
Female genital mutilation is associated with primary infertility.

Diagnosis

It is essential to establish the necessary diagnostic investigations such as ultrasound scans, tubal assessment, and laporoscopy and hormone assessment in order to determine the causes.

Testing to consider

Basal body temperature (BBT) charting
Hysterosalpingogram
Hormone tests

Syndrome differentiation in TCM

1. Deficiency of Kidney Yang

Symptoms and signs: Delayed menstruation; light-coloured bleed; watery discharges, low libido; cold sensation in the lower abdomen accompanied by gloomy complexion, soreness and weakness in the waist and knees, loose stools, copious urine in the night. Pale tongue with white coating; deep - thready pulse.

2. Deficiency of Kidney Yin

Symptoms and signs: Delayed menstruation; scanty and light-coloured menstruation; lack of mucus; low libido; sensation of weakness in the lower back; constipation; copious urine in the night. Pale tongue and lack of coating; deep, small pulse.

3. Insufficiency of both “Qi” and Blood

Symptoms and signs: Delayed menstruation; scanty and light-coloured menstruation; pale complexion; dizziness; tiredness. Slightly pale tongue and light coating; small pulse.

4. Depression of the liver – Qi

Symptoms and signs: Irregular and/or clotted menstruation; premenstrual distending pain over the nipples and breasts; oppressive sensation in the chest plus hypochondria, bloated stomach, headache, mental depression or restlessness, irritability. Pale tongue with light white coating. Wiry pulse.

5. Phlegm – dampness

Symptoms and signs: Delayed menstruation or even amenorrhea; heavy or sticky discharges; obesity; dizziness; chest distress; nausea; sleepy or tried. Pale tongue with white and greasy coating; slippery pulse.

6. Blood Stasis

Symptoms and signs: Scarce and purplish dark menses mixed with blood clots; abdominal pain aggravated by pressing; relief of pain after discharge of clots; purplish dark tongue with ecchymoses; wiry, slippery pulse.

Advice in lifestyle:

1. We recommend that the couple who try to conceive should avoid emotional upsets and stress due to previous failed experience of conception.

2. The couple need to avoid excessive sexual activities instead they should try baby-making sex during the optimum time and days of the month.

3. The couple should lead a relatively relaxed lifestyle with a relative balance between their work and appropriate rest.

4. The infertility could happen to both wife and husband, or wife only, or husband factors, so the biomedical diagnosis must be carried out before any treatment.

Author: Rachel Fang