1 Hallam Institution of TCM in Sheffield UK, Sheffield, United Kingdom. Email: [email protected]
2 The Princess Alexandra Hospital NHS Trust, Harlow, United Kingdom.
3 St Mary’s Hospital Paddington, London, United Kingdom.
4 Institute of Pharmaceutical Science, King’s College, London, United Kingdom.
Int Rev Neurobiol. 2017;135:297-311. doi: 10.1016/bs.irn.2017.02.014. Epub 2017 Apr 12.
Male infertility normally refers a male’s inability to cause pregnancy in a fertile female partner after 1 year of unprotected intercourse. Male infertility in recent years has been attracting increasing interest from public due to the evidence in decline in semen quality. There are many factors contributing to the male infertility including abnormal spermatogenesis; reproductive tract anomalies or obstruction; inadequate sexual and ejaculatory functions; and impaired sperm motility, imbalance in hormone levels, and immune system dysfunction. Although conventional treatments such as medication, surgical operation, and advanced techniques have helped many male with infertility cause pregnancy in their female partners, effectiveness is not satisfactory and associated with adverse effects. Chinese herbal medicine (CHM) has been used to improve male infertility in China for a very long time and has now been increasingly popular in Western countries for treating infertility. In this chapter we summarized recent development in basic research and clinical studies of CHM in treating male infertility.
It has showed that CHM improved sperm motility and quality, increased sperm count and rebalanced inadequate hormone levels, and adjusted immune functions leading to the increased number of fertility.
Further, CHM in combination with conventional therapies improved efficacy of conventional treatments. More studies are needed to indentify the new drugs from CHM and ensure safety, efficacy, and consistency of CHM.
This study did not use acupuncture or herbs, but it is interested to include it here as a way of managing early pregnancy in women who have had previous miscarriages. There is currently no known prevention therapy for unexplained recurrent miscarriage, but this study showed that emotional support and close supervision helped improve outcomes in subsequent pregnancies.
One hundred and thirty three couples were investigated at a recurrent miscarriage clinic. In their next pregnancy 42 women (Group 1) with unexplained recurrent miscarriage were managed with a programme of formal emotional support and close supervision at an early pregnancy clinic. Two women were seen in 2 pregnancies (44 supervised pregnancies); 86% (38 of 44) of these pregnancies were successful. Four of the 6 miscarriages had an identifiable causal factor. Nine women (Group 2), also with unexplained recurrent miscarriage, acted as a control group. After initial investigation they were reassured and returned to the care of their family practitioner and did not receive formal supportive care in their subsequent pregnancy; 33% (3 of 9) of these pregnancies were successful (p = 0.005; Fishers Exact Test). Whilst acknowledging that there is a significant spontaneous cure rate in this condition, emotional support seems to be important in the prevention of unexplained recurrent miscarriage, giving results as good as any currently accepted therapy.
Lian Fang et al, Zhong Xi Yi He Xue Bao 2009 Feb;15(1):42-46 Chinese Journal of Integrated Medicine
A chinese herb formula for endometriosis was given to women with long term infertility and endometriosis before and during an IVF cycle and various ovarian parameters were compared with a group of women with endometriosis who embarked on IVF directly without taking the herbs. The group who took the herbs produced more eggs and had a higher fertilisation rate (although a difference in pregnancy rate was not reported). Additionally the follicles of the women who took the herbs showed a reduced level of inflammatory cytokines compared to the women in the control group.
To observe the effect of Quyu Jiedu Granules (QJG) on the microenvironment of ova in patients with endometriosis (EM).
Twenty EM patients who received in vitro fertilization and embryo transfer (IVF-ET) were randomized equally into a treated group and a control group.Further, 20 patients who received IVF-ET due to oviduct factors were enrolled into a non-endometriosis group.The dosage of gonadotrophic hormone used, the number of ova attained, fertilization rate and clinical pregnancy rate were all observed, and the levels of tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) in follicular fluid as well as their mRNA expressions in ovarian granular cells were detected by RT-PCR on the very day of ovum attainment.
The ova attainment (13.80±6.87) and fertilization rate (0.69±0.31) in the treated group were all higher than the corresponding values in the control group (9.80±5.32 and 0.47±0.22); the follicular fluid contents of TNF-α and IL-6 in the treated group were 1.38±0.21 ng/mL and 130.56±12.81 pg/mL, respectively, which were lower than those in the control group (1.98±0.34 ng/mL and 146.83±17.65 pg/mL, respectively). Further, the treated group showed much lower mRNA expressions of TNF-α and IL-6 in ovarian granular cells.
The elevation of TNF-α and IL-6 contents in follicular fluid and their mRNA expressions in ovarian granular cells are possibly related to the low quality of ova in EM; QJG might raise the ova quality by reducing TNF-α and IL-6 levels to improve the living micro-environment for the ova.
Fu Yu and Xia Tian, Shanghai Jnl Acup Moxa, 2005, Vol 3 Shanghai Journal of Acupuncture and Moxibustion
This is just one trial of many carried out in China which looks at the clinical effectiveness of treatment of endometriosis with acupuncture and Chinese herbs. The investigators report that symptoms and signs of the disease are treated effectively without side effects.
To compare the clinical efficacy of combined acupuncture and herbs with danazol for treatment of endometriosis.
Seventy-eight patients were randomly divided into a combined acupuncture and herbs treatment group (40 cases) and a Westerm medicine control group (38 cases). Observation was made of changes in clinical symptoms, signs, serum CA 125, β-EP, PGE 2 and PGF 2α, and adverse reaction to the medicine in the two group.
The overall efficacy was similar in the two groups, but the effects on lumbosacral pain, anal downbearing distention, irregular menstruation and infertility were significantly better in the treatment group than in the control group(P < 0.05), and in the treatment group serum CA 125, PGE 2 and PGF 2α were significantly lower and serum β-EP was significanly higher after treatment than before (P < 0.05).
Combined use of acupuncture and herbs has a marked effect on endometriosis and the adverse reaction is lower than the control group.
Lim CED et al, Aust J Acupunct Chin Med 2009;4(2):12-17. Australian Journal Acupuncture and Chinese Medicine
Those of us who have experience in treating endometriosis with Chinese medicine are familiar with the benefits it brings patients in terms of reduced pain and possibly increased rates of conception. This pilot study, a collaboration between Guangzhou Medical University in China and RMIT university in Melbourne, is particularly interesting to us since it measured objective parameters such as immune factors (antigens and antibodies) shown to be abnormally raised in patients with endometriosis. A course of treatment with Chinese herbs not only improved pain but significantly reduced the levels of these immune factors. This is one way that Chinese medicine may improve fertility in endometriosis.
Secondary dysmenorrhoea associated with endometriosis affects many women and is the leading cause of work and school absenteeism, with considerable impact on quality of life. This study evaluates the possible role of Chinese medicinal herbs in relieving the menstrual pain associated with endometriosis.
A prospective clinical observational pilot study involving twenty-five patients with endometriosis with Chinese medical diagnosis of stagnation of qi and blood who were recruited at the Guangdong Women’s and Children’s Hospital during the period of January 2004 to December 2006 to participate in a three-month Chinese medicinal herbs study.
Sixteen patients reported nil dysmenorrhoea during the treatment period. The mean CA125 at the study entry was 59.67 ±28.32 u/ml, compared to 34.83 ±16.34 u/ml post-treatment. The positive EMAb before the commencement of treatment was noted in 22 of 25 cases (88%), while 5 of 25 cases (20%) remained positive after treatment.
Short-term administration of Chinese medicinal herbs may be effective in alleviating secondary dysmenorrhoea associated with endometriosis in qi and blood stagnation pattern. It may provide an alternative treatment option for the management of pelvic pain associated with endometriosis and further research in the area is required.