CASE STUDIES
Case Number 8: Joan
Joan was a 38 year-old woman who worked for a bank as a loan originator. She and her husband had been trying to conceive for two years. When she came to me, she had three failed attempts at in vitro fertilization (IVF). Prior to IVF, she also had two intrauterine inseminations (IUIs). Only one to three follicles were produced in her previous IVF cycles. Her day-three FSH level was 14, and an estradiol level of less than 30 suggested decreased ovarian reserve. Tests indicated that her husband's sperm was normal. When she first came in, Joan complained of fatigue, poor sleep, tinnitus, low sex drive, vaginal dryness, emotional depression, discomfort in her lower abdomen, and severe cramps at the beginning of her menstrual cycles. Her cycle varied between 23-28 days. The Chinese medicine pattern diagnosis for Joan's condition was Kidney Yin deficiency and Liver Qi stagnation.
The two principal approaches I used in this case were: a special needling technique called "surround needling" on an abdominal acupuncture point; and administration of the herbal formula Gui Shao Di Huang Tang with modifications for each stage of the menstrual cycle.
The principal goal in this case was to treat infertility by regulating the menstrual cycle. This approach divides the menstrual cycle into four phases: the menstruation phase; the post-menstruation phase; the inter-menstruation phase; and the pre-menstruation phase. Physiologically, during the menstruation phase (about 5 days) the blood is moving, for which it relies on the free flow of Liver qi and Liver blood, so this phase is a period of yang turning to yin. During the post-menstruation phase (about 7 days), blood and yin are recovering from depletion, so this phase is a period of growing yin and declining yang. During the inter-menstruation phase (about 7 days), the blood and yin gradually fill up, so this phase is a period of keeping balance between yin and yang. During the pre-menstruation phase (about 7 days), yang qi rises and Liver qi moves in preparation for the menses. This mobilization of Liver-qi is essential to move Liver blood during menses, so this phase is a period of growing yang and declining yin.
Because the menstrual cycle is so dynamic, the acupuncture points and herbal prescription used to treat it need to be modified to suit the energetic pattern of each stage. In the menstruation phase, the treatment strategy is to invigorate the blood and resolve stasis. In the post-menstruation phase, the treatment strategy is to tonify blood and nourish Kidney yin. During the inter-menstruation phase the indicated treatment is to tonify blood and nourish Kidney essence; and in the pre-menstruation phase we move Liver qi stagnation and activate blood circulation.
Using this nuanced acupuncture and herbal medicine approach, I treated Joan through three menstrual cycles. She received two acupuncture treatments per week, and drank a raw-herb tea twice a day. Originally, Joan intended to try IVF again after her menstrual cycle was regulated, but she got pregnant on her own. She gave birth to a healthy baby girl.
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