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Case #3: Endometriosis and Infertility with IVF

37 year-old female, married 15 years   Office visit date: January 2003
Severe menstrual cramping 9 years
Tried for pregnancy 7 years
Western Diagnosis:  1) Endometriosis   2) Primary Infertility

The patient experienced severe menstrual cramping for 9 years.  She had tried to conceive for the last 7 years of that time. Over the 9 years, she had two laparoscopies and one open surgery. The right ovary was removed and the left ovary partially removed. The post-operative treatment was a six month courses of GnRH (gonadotropin releasing hormone), followed by a six-month course of progesterone and another six month course of GnRH.

After the first surgery and hormone therapy, the patient had two failed IUI’s (Intrauterine Insemination) in 1996 and 1997 and two failed IVF’s (In-vitro Fertilization) in 2000. With the two IVF’s, the patient’s ovary response to the medication was fairly good (about 13 to15 eggs, 6 to 9 embryos, 2 embryos transferred each cycle).  The problem was in implantation.

After the two failed IVF’s, the treatment for endometriosis was continued using the birth control pill coordinated with low-dose progesterone.  The patient’s menses became very irregular after the failed IVF while using the birth control pill.  Bleeding lasted from fifteen days to two months continuously.

The patient stopped using the birth control pill after six months and began a year-and-a-half course of Chinese herbal medicine.  The formula was designed to tonify Kidney and Liver and remove Blood Stasis. The patient felt better in general, with decreased cramping and increased energy.

In January 2003, the patient came to my office from Germany for fertility treatment one or two months before her third IVF attempt. The patient appeared thin and deficient.  She experienced sweating on the upper body, simultaneous cold and heat, stomach discomfort from cold food, lower back pain, fatigue and cramping during menses, frequent constipation, especially during the luteal phase of her cycle.  She had severe constipation when taking progesterone during the previous two IVF’s.

TCM Diagnosis: 1) Yin and Yang deficiency with deficient Heat and Cold (Spleen & Kidney Yang Qi, Liver Blood & Kidney Yin).  2) Blood Stasis in Chong Ren.

When I saw the patient, the Blood Stasis symptoms had greatly improved because she had been taking a Blood Stasis moving formula for the previous year and a half.  The Yin and Yang Deficiency and imbalance were still present. Therefore, I decided the treatment should mainly focus on tonifying and balancing the Yin and Yang, with moving the Qi and Blood as a secondary factor.

Since she was visiting from abroad for a short period, I gave her three acupuncture treatments over 10 days, plus herbal medicine.

The patient’s previous formula was geared 70-80 % to move Qi and Blood for the endometriosis with 20-30% to tonify Kidney.  In the new formula, I increased the Kidney tonic function and focus to mostly balance the Yin and Yang to create a better environment for the embryo to implant and grow.

Since the patient was only staying for ten days, we gave her four weeks of the final herbal formula to carry back to Gemany, and especially two weeks of herbs to use right after embryo transfer to help implantation through balancing the Yin and Yang of the body.

In three months, the patient was very happily called to report that she did get pregnant in her 3rd IVF and was 5 ½ weeks pregnant. The patient gave birth to a healthy baby girl. Next Page>

 

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