Immune Issues, Infertility and Chinese Medicine
First, I want to acknowledge my admiration and respect for a couple, my friends, and their struggle with fertility and immunity issues and their search for answers. I am inspired by their efforts to discuss this common concern and how Chinese medicine can help.
Immune related infertility must be looked at from at least four different angles.
- Is it a male or a female related issue? For instance is there clear evidence of Anti-sperm antibodies in the male partner, or is it the female body that is preventing the sperm from properly functioning.
- If it appears to be a female issue, is it because her body has an over-responsive immune system, or a defective one leading to an inappropriate immunological tolerance to the pregnancy?
- Are there genetic issues that are causing inappropriate clotting or blood flow restrictions?
- Are there other considerations that are coexisting with some minor immune issue that need to be addressed, such as hormonal imbalance or inflammation and fluid buildup that prevents pregnancy?
As a TCM practitioner dealing with fertility, I find myself constantly digging for real answers since many patients are left with either inaccurate information or no answers by their reproductive specialists. There is always an answer. Chinese medicine can explain many things well and importantly will have a treatment for it. However, we should understand it in scientifically quantifiable terms as well, so that we can improve our results. Because of modern ART treatments that circumvent some immune issues, most of these tests are not performed. It would also be a struggle to find an immune specialist who is an expert with fertility issues. Generally what happens is that individuals may do two, three or five IVFs before some more tests are carried out to consider immunity a factor.
The reality is that patients with immune issues are still able to get pregnant. This is because the immune issue may be a small factor, but a contributing matter nevertheless. Once the endocrine dyscrasia is rectified, they get pregnant. The other factor is stress that can be a mitigating concern that changes the immune response. However, this is at times overstated and mention of stress leads to more stress when focus should be elsewhere. Realistically, who doesn’t have stress dealing with “infertility problems”.
The newest models of immune response issues are related to T-regulatory cells (suppressor T-cells), sometimes combined or in conjunction with clotting factor issues. The basic theory is that the female body is unable to down-regulate the immune response that prevents her own immunity -such as the NK cells (Natural Killer cells)from attacking the embryo. Often what happens is that there is either no pregnancy or that the HCG levels stay low and slowly disappear soon after.
Another common issue is clotting factors such as anti-phosphalipid and factor V laiden test that demonstrate a chance of blood flow restriction which may lead to preeclampsia and pregnancy loss.
The current modern treatments are still limited and speculative, but show some promise. There is usually a combination of blood thinner such as lavonex, heparin or aspirin, with an immune suppressor such as Imuran, possibly combined with IVIG therapy. Sometimes steroids are given to suppress the immune system. The more complex treatments are only performed within very few treatment centres.
Lymphocyte Immunization Therapy (LIT) is a newer treatment carried out by some centres to hopefully regulate the immune system. This is done in conjunction with immune suppressors. As even normal couple have a limited yet plausible success rate with any ART treatment, the exact cause of failure or success to conceive after such treatments are always debatable. In light of the positive research demonstrating beneficial immune modulatory effects of LIT, the success credit can be assumed by the combined therapy which could include IVIG and immune suppressors such as steroids.
Now for the other causes of infertility due to anti-sperm antibodies, again, procedures such as IUI and IVF and ICSI presumably circumvent the obstacles to some degree. This is why a post coital test and similar tests are not commonly performed in most centres.
To complicate matters even further, a failure to implant can have too many causes, including the uterine lining being out of phase, low progesterone and even poor follicle maturity. Individuals who are suspected of having immune issues are often discovered to have other possible issues at the same time. It is likely, that the mechanisms which are causing the myriad of complications are multifaceted.
What can Chinese medicine do?
Chinese medicine is extremely effective for immune disorders. It is essentially able to down-regulate the immune system by rebalancing the “attacking” and the suppressive aspect of the immune response. This is why Chinese medicine can put even conditions such as psoriasis into regression. Surprisingly, immune related infertility is much more seriously considered in China in comparison to North America. Presumably, with a large population and an acceptable combination of medical modalities, basic immune disorders are more readily acknowledged.
How does Acupuncture and herbal medicine work?
The herbs and acu points are selected based on diagnosis and pattern differentiation according to Chinese Medicine, in combination with ones that are beneficial to the immune system. So in the system of Chinese medicine, we do not just go in and give herbs that are anti-inflammatory or suppress the immune system as that is not the general problem. In most cases, a part of the immune system is too weak to balance itself by down-regulating. Other times, the body is constrained due to stress and inflammatory factors which need to be rectified. In every case, the endocrine system is also supported to ensure that the reproductive system works optimally for pregnancy. For instance, acupuncture points such as LI11, Du14 and Sp10 have been studied for their effect to reduce fever and inflammation. Even cupping has demonstrated that it has the potential to reduce ESR as measurable in blood tests.
A patient who is diagnosed with unexplained infertility and after some treatments becomes pregnant may wonder if immune issues were a factor. Interestingly, the Chinese medicine differentiation based on presenting signs would have been the same and so the treatments would have been similar. This is the unique aspect of Chinese medicine, where two different individuals with two different conditions can be given a similar formula if they have a similar pattern presentation. On the other hand, two individuals with similar conditions may receive completely different treatments depending on their presenting signs and symptoms. However, if certain disorders are suspected, the treatments can be adjusted to address thoseissues more accurately.
The power of Chinese medicine is its restorative ability. It has the capability to strengthen “vital force” of the body to resist pathogens. This has been the cornerstone of Chinese medicine treatments for over two thousand years. It is important to recognize that a properly functioning immunity is dependent on many factors, including basic hormone levels.
Chinese medicine is an extremely sophisticated science. Treatments for infertility and gynecology have developed over hundreds of years. They are now being corroborated and constantly improved by modern experimentation and research studies. Immune issues are no exception to this rule. Modern diagnostics have only helped evaluate the conditions and focus the treatments to improve the outcome.