MECHANICAL BARRIERS TO CONCEPTION:
TUBAL OBSTRUCTIONS, PELVIC ADHESIONS AND PELVIC IMFLAMMATORY DISEASE (PID)
Sometimes a woman can't get pregnant simply because the path from the ovary to the uterus is compromised. The ovary could be covered with adhesions that block the mature eggs from entering the pelvic cavity, the fallopian tube could be narrowed or even completely obstructed or perhaps the uterus is bound up with scar tissue that keeps it from holding the fertilized egg successfully. Blockages such as these may be caused by congenital defects, by scarring from past infections, by surgical procedures like tubal ligation, D&Cs, and so on.
Most fallopian tube obstructions produce no overt symptoms other than infertility. Adhesions and scar tissue may cause pain and limit mobility.
WESTERN MEDICAL TREATMENT
Most women discover blocked fallopian tubes only after experiencing infertility and as a result of one or more diagnostic procedures, including a hysterosalpingogram, where dye is injected into the uterus and examined via x-ray to see if it spills into the pelvic cavity, laparoscopy or laparotomy.
Treatment for tubal blockage is always some kind of surgery, either to remove or reduce the blockage or, in the most drastic cases, to excise the occluded part of the tube itself, which is followed by sewing the two healthy ends of the tube together. Advances in micro- and laser surgery are making success rates for tubal blockage treatment higher. If a woman still cannot get pregnant, however, the final treatment recommendation is IVF, which bypasses the blocked tube to allow for pregnancy.
Some blockages can be resolved through procedures or surgery. In other cases, surgery may produce only a relatively small improvement in fertility, if any. In the latter, IVF may be the best option.
DISCUSSION AND ROOT CAUSES
PELVIC INFLAMMATORY DISEASE
Pelvic Inflammatory Disease (PID) is one of the most heartbreaking causes of mechanical infertility because it can destroy a woman's fertility without warning, long before she is even considering getting pregnant. PID is usually the result of a bacterial infection that can involve the ovaries, fallopian tubes, uterus and cervix. The bacteria commonly enter the body through the vagina and cervix and spread from there throughout the pelvic cavity. More than one million women in the U.S., most of them in their teens and twenties, are diagnosed with acute pelvic inflammatory disease (PID) every year.
The best-known cause of PID is sexually-transmitted diseases, especially chlamydia and gonorrhea. PID can also result from using an interuterine device (IUD), complication from earlier pregnancy or infection following any surgery of the reproductive tract. Depending on the infectious organism and the severity of infection, the acute phase of the disease may be characterized by lower abdominal pain, fever, painful sexual intercourse, irregular bleeding and profuse vaginal discharge. As with any bacterial infection, signs such as these should be treated as quickly as possible with antibiotics. On the other hand, some PID infections, like chlamydia, may not have symptoms of any kind, yet can cause extensive damage to the reproductive organs, especially the fallopian tubes.
Most fertility problems associated with PID are not caused by active infection, but instead by scarring from past infections. Untreated, chronic PID creates a condition of long-standing inflammation within the pelvic cavity, and this sets up a reactionary environment within the reproductive organs, especially the fallopian tubes. If antibiotics are not prescribed or have not been effective, chronic scarring may result. If a woman suspects she has (or has had) PID, it's important to consult a Western medical doctor for a diagnosis and possible treatment with antibiotics.
FALLOPIAN TUBE OBSTRUCTION
One of the more common results of PID is fallopian tube obstruction. The fallopian tube is the "golden path" that the egg must travel to get from the ovary to the uterus. It is also the most common location for egg and sperm to meet and for fertilization to occur. The tubes contain two specialized kinds of cells: 1) those that produce mucus, glucose and other substances needed to nourish the egg both before and after fertilization, and 2) tiny hair-like structures that move the egg through the tube and into the uterus.
Unfortunately, the fallopian tubes are often the first locations attacked by the opportunistic bacteria coming from the uterus in the case of PID or other infection. And because they are such narrow structures, it doesn't take much to obstruct them. The tubes can become inflamed within, a condition called salpingitis. They may become filled with fluid (hydrosalpinx) or pus (pyrosalpinx), creating a bulge and/or possibly destroying the lining and musculature needed to nurture the egg and move it along. Some researchers suspect that the fluid from a hydrosalpinx can seep into the uterus and have an adverse effect on implantation.
The tubes may develop adhesions and thickened walls and close off completely. In that case, a woman's hormones can be fine, her eggs can mature and she can even release healthy eggs every month, but the sperm may not be able to reach them. If the tubes are open just enough to allow the sperm through, fertilization may occur in the fallopian tubes. Then, when the growing zygote is traveling through the tube to reach its destination in the uterus, it may get stuck and actually implant in the partially-obstructed tube itself, resulting in an ectopic pregnancy, which may cause further tubal damage and even loss. Women who have had this occur likely will never again become pregnant naturally.
Most mechanical infertility is due to adhesions and/or scar tissue found inside or outside the organs of the reproductive tract. Adhesions form naturally within the body as a healing response to tissue trauma. They may form after injury, such as a fall or physical or sexual abuse, inflammation or infection, such as that caused by endometriosis, yeast or bladder infections or PID, or surgery, such as a D&C, abortion, C-section or appendectomy.
The damaged connective tissue causes a series of vascular and cellular changes that alter the actual structure of the collagen fibers, contracting the tissue and causing cross-linking of the collagen fibers. This results in fibrinous changes known as adhesions. Wherever adhesions form, they act like glue on neighboring structures. Unfortunately, the female reproductive structure is so delicate that it does not take much "glue" to severely restrict its movement and function.
Adhesions may impair the mechanical functioning of the ovaries, the fallopian tubes and the passage between the two, blocking the ability of the egg to enter the uterus. When adhesions form within the uterus, they tend to make an inhospitable surface for implantation, often resulting in miscarriage or infertility. Adhesions on the outer surfaces of the organs can attach organs to each other or to neighboring structures, restricting their movement and their proper function.
Where adhesions are present, you can feel the restriction in the deeper tissues. Manual palpation helps to first detect the damaged tissue. Adhesions are usually discovered during a pelvic exam and confirmed by laparoscopy or laparotomy. Western medical treatment is inevitably surgical, and may or may not restore fertility. In some cases, adhesions are so extensive that they make pregnancy impossible.
EASTERN MEDICINE DIAGNOSES
PELVIC INFLAMMATORY DISEASE
When PID is in its acute form, it often produces a condition of damp heat in the body, accompanied by Blood stasis and stagnation. This is also a common pattern seen with fallopian tube obstruction, as we will discuss later. We begin by looking at the symptoms produced by PID. Since most cases of PID involve abnormal vaginal discharge, we focus on its quality and quantity. If the discharge is profuse and watery and without any smell or irritating sensation, it is categorized as being damp and cool in nature. This does not mean that the organism itself is "cold" per se, but that the response to it creates a pattern of cold. Any treatment needs to resolve dampness by drying and cold pathogens by warming. On the other hand, if the discharge is pussy and discolored, foul-smelling, irritating, itching or burning, it is characterized as a damp-heat pathogen. Again, it is our physiologic response to the organism that is "hot" in nature, not the pathogen itself.
Most fallopian tubal obstruction has Blood stasis as one of its underlying patterns.
PELVIC INFLAMMATORY DISEASE Since The Fertile Soul specializes in chronic infertility, it is rare for us to see clients with active PID-we usually see them only long after the damage has been done. However, there are ways The Fertile Soul program can treat both the symptoms and infection of active PID. In addition to treating the manifestation of the problem, we address the underlying imbalance.
While we balance the damp-cold or damp-heat conditions created by the body's response to the invading pathogens the inflammatory response may remain for some length of time after symptoms have resolved. In the same way a course of Western antibiotics usually must be continued for several days after symptoms of the underlying infection disappear, it is equally essential that a Fertile Soul natural treatment continues until the body's inflammatory response has quieted and the body's balance has been fully restored.
A primary means of treating excess discharge is through one of the Extraordinary meridians known as the Dai Mai, or Girdle meridian. The Nan Jing describes the Extraordinary meridians as a system of drainage ditches that tap into the main meridians and allow their excesses to discharge and run off. The Girdle meridian is described by the Su Wen to be like a belt that cannot be too tight or too loose. We drain excesses like profuse vaginal discharge through the Dai Mai. Although the Dai Mai does not have any points of its own, it taps into points on other meridians, like the Gallbladder and San Jiao, so treating points on these meridians will help clear the Dai Mai.
Other Fertile Soul treatments for excess vaginal discharge include herbal preparations to resolve the damp conditions and invigorate pelvic circulation, acupuncture and herbs to increase blood flow through the pelvic organs, exercises to open up pelvic circulation and deep tissue pelvic massage.
FALLOPIAN TUBE OBSTRUCTION
When the fallopian tubes are closed off, it takes powerful measures to open them. Chinese medicine employs a number of techniques to help remedy fallopian tube inflammation and obstruction. In China, herbal concoctions are sometimes injected directly into the uterus to eliminate tubal blockages, using similar principles as the Western hysterosalpingogram procedure. The herbs then flow to and through the fallopian tubes, bringing their healing effect directly to the site of obstruction.
The U.S. medical/legal system will not allow any procedure involving the internal delivery of herbs. Thus, herbs to invigorate the Blood, resolve stasis and diminish active inflammation are given orally. These herbs must be powerful in order to be capable of reaching the closed-off environment of the fallopian tubes. Chinese medicine calls this "resolving stasis in the network vessels", which lie between the major vessels and are thus harder to reach.
Our treatments may use resins like myrrh and frankincense, which are known for reaching the deepest network vessels to resolve Blood stasis. For conditions residing in the uterus or fallopian tubes, ingested herbs can find their way through the digestive system. Herbal enemas-decoctions taken rectally-or suppositories-herbal concentrates in a glycerin or cocoa butter base-may also be given, both of which bypass the need for harmonizing the herbal formula for digestion. There are also specific acupoints that can help resolve Blood stasis in the fallopian tubes.
In terms of lifestyle, cigarette smoking paralyzes the cilia, the small hairs in the fallopian tubes that help propel the eggs to the uterus. If you smoke, stop now. Deep kneading massage to the lower abdomen can apply enough friction to the fallopian tubes to manually resolve adhesions.
To decrease adhesions of the female reproductive tract, The Fertile Soul performs and teaches manual massage techniques. Applying a deep pressure, kneading and stretching the abdominal area can help break up scar tissue and slowly and gently pull adhesions apart. As the adhesions decrease, function improves. The massages often are given on points that are related to acupuncture and/or acupressure meridians.
ASSISTED REPRODUCTION CASE STUDIES CLINICAL STUDIES
PELVIC INFLAMMATORY DISEASE
A 1995 study in China described the treatment of 148 women between twenty-five and forty-six years of age with chronic pelvic inflammatory disease. Most of the women reported nagging lower abdominal pain, excessive vaginal discharge or menstrual irregularity, painful menstruation and exhibited a wiry pulse as their main symptoms. Their TCM patterns were diagnosed as 1) Liver depression, Spleen deficiency pattern, 2) Damp heat with stasis and 3) Cold, damp and stasis. They were treated for between 20 and 60 days with a combination of Xiao Yal San Jia Wei (Rambling Powder with Added Flavors) and Kang Fu Xiao Yan Shuan (Healthy Woman Disperse Inflammation Suppository). Other herbs were added based on individual patterns. Of the 148 women, 106 (72 percent) were considered cured after treatment. Their symptoms disappeared and gynecological and ultrasound examinations showed that adhesions had disappeared and enlargement and thickening of the uterus and fallopian tubes had returned to normal. Thirty-seven others (25 percent) experienced some improvement-their symptoms disappeared and adhesions were reduced, but there was still some uterine and fallopian tube enlargement and thickening. The total cure rate was around 97 percent.