Chinese Medicine Treatment For Male Fertility And In-Vitro Fertilization

By: Keren Zelicha

Ilanit (30) and Asaf (37) are married and have been trying to conceive for about a year.

Upon investigation, it was found that Asaf is missing both Vas Deferens due to a mutation in Cystic fibrosis gene (CFTR). This condition prevents the transportation of the sperm which is produced in the testicles to come out with the semen during ejaculation. This absence of the sperm canal is known as congenital bilateral absence of the vas deferens (CBAVD). In these cases, fertility difficulties can occur due to azoospermia- the absence of sperm cells in semen analysis.

When this fact was discovered, Ilanit and Asaf were referred for in-vitro fertilization.  During this process, beyond ovarian stimulation and egg recruitment from Ilanit, Asaf would need to undergo sperm aspiration directly from the testicle in a procedure known as testicular sperm aspiration (TESA).  This procedure is conducted in men with azoospermia (a lack of sperm cells) as a result of a blocked vas deferens or due to its non-existence.  Following the TESA process, sperms undergo a preparatory process, at the end of which they can be used to fertilize the egg in the lab through micromanipulation (a process known as intracytoplasmic sperm injection (ICSI)).

Ilanit and Asaf came to see me after two failed IVF attempts.  They planned to combine a Chinese medicine approach with the Western protocol and hoped that this addition would improve their chances of conception.

Asaf’s Acupuncture Treatment before TESA  ( Testicular Sperm Aspiration)

Asaf had a history of back pain with occasional radiation to the sides of the right leg.  Hormonal blood tests were normal.  His tongue was geographic, many cracks were seen. No coating in the center with a sticky white coating in the upper burner.  Pulse was slightly wiry.

Asaf was diagnosed as suffering from kidney and stomach yin deficiency, spleen qi deficiency with dampness.

The frequency of acupuncture treatment was every other week, beginning one and a half months before the western protocol.  In addition, Asaf was requested to consume Vitamin E and co-enzyme Q10 200 mg/ day.  Care was taken to integrate fresh green vegetables, reduce animal proteins, and drink green tea + nettle tea into the weekly diet.

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Common acupuncture points:  Cv 6, Cv 4, Cv 12, St 29, Tw 5- Gb 41, Sp 9, Liv 3, Kid 7.

Cv 4 Guan Yuan, is a major acupuncture point for strengthening kidney qi, yin and yang.  The location on the Dan Tian along with the original qi moving between the kidneys allows it to treat a broad variety of fertility problems both in men and in women.  The absence of vas deferens is considered in Chinese medicine to constitute a symptom of kidney essence weakness.  In addition, Asaf’s was diagnosed as suffering from kidney and stomach yin deficiency.  Therefore, Cv 4 was selected since it has a broad variety of functions in supporting kidney essence, yin, and qi.  The acupuncture technique is important and its goal is attaining De qi sensation which descends downwards towards the genitalia.

Tw5 -Gb41 are intended to move qi, distribute heat, and treat problems in the lower burner.

Ilanit’s Acupuncture Treatment during IVF long Protocol

Ilanit has a regular 28- day cycle with bleeding for about a week, beginning with two days of light flow which grows stronger.  The color of the menstrual bleeding is fresh red, with few clots.  She experiences light period pain.  Some acne appears before her period and a little sensitivity in the lower abdomen.  Bowel movements are regular, with proper nutrition.  Hormonal profile is normal. Her tongue is red and cracked. A central crack from the kidney area to the tip of the tongue is clearly seen. The pulse is weak

Ilanit was diagnosed with kidney -heart yin deficiency and liver qi stagnation.

The IVF protocol chosen was a long protocol with daily injections of Decapeptyl (Triptorelin) beginning on Cycle Day 21.  After her period began, Ilanit was asked to begin injecting Gonal F 112.5 to encourage follicle development.

Ilanit’s treatments took place once a week and also began one and a half months prior to the start of the IVF protocol.

During the protocol, after about two weeks of Decapeptyl injections and 5 days of Gonal F 112.5, Ilanit mentioned that she was more tired than usual, was experiencing hot flashes and headaches, her pulse was soft, her tongue was red, cracked, with a light coating.  Acupuncture points selected were:  Kd 10, kd 3, Sp 6, Liv 3 (rt), Li 4 (Lf), Cv 4, Cv 6, St 28.

During this IVF treatment, 16 eggs were retrieved and 9 were fertilized.  One day before embryo transfer, acupuncture treatment was given, with the goal of moving qi and blood, strengthening qi and calming the mind:  Yin tang, Gv 23, St 36, Cv 6, Sp 6, Sp 10, Liv 2, Kd 3.

Two good embryos were transferred, and a week later, supportive treatment was given with the goal of regulating liver qi movement, calming the mind, strengthening kidney and spleen qi:  Liv 3 (Rt), Pc 6 (Lf), Kd 3,Kd 9, St 36, Yin Tang.

Beta testing was positive and later two heartbeats were observed!  The couple gave birth to two healthy children in Week 38 of pregnancy.

In my experience, we should begin the support with Chinese medicine even before starting the conventional IVF protocol in order to balance and prepare the body prior to hormonal treatment.  With fertility problems in which the reason is male fertility, we should recommend combined treatment of the man and woman.  Besides the fact that combined treatment can improve the odds of success for the treatment and the chances of conception, it also brings the couple together and turns the journey into one which is shared and equal.  The coping and the support network which the couple form together, reduces the difficulties and relationship stress which can be created during this period.

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