Traditional Chinese Medicine for Infertility and Pregnancy
Traditional Chinese Medicine for Infertility and Pregnancy
Infertility, defined clinically as the failure to conceive after one year of unprotected intercourse or demographically as the inability to achieve a live birth, affects a large number of couples in Western societies. In Australia, 15% or 3 million couples currently deal with impaired fertility, which might be related to male or female factors or remains 'unexplained' in 28% of cases.
Most couples in Australia seeking treatment for infertility are referred by their General Practitioner to assisted reproductive technology (ART), including in vitro fertilization (IVF). However, of 70,500 ART cycles performed in Australia and New Zealand in 2009, only 17.2% led to live births. Moreover, ART treatment is costly for both government and individuals; in 2009, the Australian Government spent approximately A$250 million for ART services, and individual couples' out-of-pocket expenses were about A$3,000 for one IVF cycle costing A$7,000-8,000.
Despite infertility occurring relatively often in the population, it is experienced as a lonely road for individual couples. In addition to isolation, infertility challenges women's sense of identity, expectations of their life trajectory and their perceived value in society. This can lead to feelings of failure, guilt and shame. Women's sense of powerlessness can be exacerbated by the Western medical approach, through fragmented care, technical interventions and invasive procedures, and a lack of individualised continuous support.
Holistic approaches to infertility management, such as Traditional Chinese Medicine (TCM) might address some of the needs of women experiencing infertility, not met in the Western Medical approach. Traditional Chinese Medicine treatment encompasses herbal medicines, acupuncture and lifestyle counselling based on the individual's underlying TCM pattern diagnosis using tools such as pulse, tongue, general physical and emotional wellbeing, and menstrual history. In TCM, different conditions such as idiopathic infertility, polycystic ovaries, recurrent miscarriage or unexplained stillbirth, may have similar underlying TCM pattern (e.g. Kidney Yin Deficiency Heat), and treatment would therefore be approached with similar therapies.
Recent meta-analyses of randomised controlled trials of TCM herbal therapy for female infertility revealed a 2 to 3.5-fold higher likelihood of pregnancy within a 4-month treatment period compared with Western Medical drug therapy. In addition, a meta-analysis of cohort studies involving more than 600 women suggested a mean clinical pregnancy rate of 50% using Chinese herbal medicine. While complementary and alternative medicines are increasingly used for infertility in western countries, herbal medicines including TCM herbal treatment, are being used only by a small proportion of affected women, e.g. 5% of those surveyed at an infertility clinic in South Australia, 10% in the UK, 18% in the USA. In contrast to the better known and increasingly established use of acupuncture as an adjunct treatment to IVF, the level of communication about and awareness of holistic TCM therapy for fertility management is low, with most women hearing about TCM as an alternative and complementary treatment option only through word of mouth.
Our study is among the first to examine women's experience of holistic TCM therapy for infertility and viable pregnancy. In this paper, we expand on our previously reported findings describing women's experience of infertility and TCM treatment and outcomes, and explore specifically the quality of life, coping strategies and emotional and instrumental support needs of women with infertility or difficulty of viable pregnancy seeking TCM therapy.
Background
Infertility, defined clinically as the failure to conceive after one year of unprotected intercourse or demographically as the inability to achieve a live birth, affects a large number of couples in Western societies. In Australia, 15% or 3 million couples currently deal with impaired fertility, which might be related to male or female factors or remains 'unexplained' in 28% of cases.
Most couples in Australia seeking treatment for infertility are referred by their General Practitioner to assisted reproductive technology (ART), including in vitro fertilization (IVF). However, of 70,500 ART cycles performed in Australia and New Zealand in 2009, only 17.2% led to live births. Moreover, ART treatment is costly for both government and individuals; in 2009, the Australian Government spent approximately A$250 million for ART services, and individual couples' out-of-pocket expenses were about A$3,000 for one IVF cycle costing A$7,000-8,000.
Despite infertility occurring relatively often in the population, it is experienced as a lonely road for individual couples. In addition to isolation, infertility challenges women's sense of identity, expectations of their life trajectory and their perceived value in society. This can lead to feelings of failure, guilt and shame. Women's sense of powerlessness can be exacerbated by the Western medical approach, through fragmented care, technical interventions and invasive procedures, and a lack of individualised continuous support.
Holistic approaches to infertility management, such as Traditional Chinese Medicine (TCM) might address some of the needs of women experiencing infertility, not met in the Western Medical approach. Traditional Chinese Medicine treatment encompasses herbal medicines, acupuncture and lifestyle counselling based on the individual's underlying TCM pattern diagnosis using tools such as pulse, tongue, general physical and emotional wellbeing, and menstrual history. In TCM, different conditions such as idiopathic infertility, polycystic ovaries, recurrent miscarriage or unexplained stillbirth, may have similar underlying TCM pattern (e.g. Kidney Yin Deficiency Heat), and treatment would therefore be approached with similar therapies.
Recent meta-analyses of randomised controlled trials of TCM herbal therapy for female infertility revealed a 2 to 3.5-fold higher likelihood of pregnancy within a 4-month treatment period compared with Western Medical drug therapy. In addition, a meta-analysis of cohort studies involving more than 600 women suggested a mean clinical pregnancy rate of 50% using Chinese herbal medicine. While complementary and alternative medicines are increasingly used for infertility in western countries, herbal medicines including TCM herbal treatment, are being used only by a small proportion of affected women, e.g. 5% of those surveyed at an infertility clinic in South Australia, 10% in the UK, 18% in the USA. In contrast to the better known and increasingly established use of acupuncture as an adjunct treatment to IVF, the level of communication about and awareness of holistic TCM therapy for fertility management is low, with most women hearing about TCM as an alternative and complementary treatment option only through word of mouth.
Our study is among the first to examine women's experience of holistic TCM therapy for infertility and viable pregnancy. In this paper, we expand on our previously reported findings describing women's experience of infertility and TCM treatment and outcomes, and explore specifically the quality of life, coping strategies and emotional and instrumental support needs of women with infertility or difficulty of viable pregnancy seeking TCM therapy.
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