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The Everywoman of Fertility Challenges

It does not do to dwell on dreams and forget to live.

J.K. ROWLING, HARRY POTTER AND THE SORCERER’S STONE

Avery: Poor ovarian reserve

Avery was a hard-working, goal-oriented woman. At thirty-six, having achieved partnership in her law firm, she focused on her goal of having two children before she reached forty. After two years of trying to conceive with her husband of seven years, they sought help from a fertility clinic. After undergoing IUI unsuccessfully, she attended my clinic feeling desperate and frustrated.

Avery’s first impression of my TCM clinic was that it was calm, restful, welcoming, and warm, in contrast to the necessarily sterile medical environment of the fertility clinic. She sat on my treatment table, commenting on the comfort of the pillows and sheets in contrast to the disposable paper at the medical clinic. When our conversation turned to her unsuccessful IUI, however, her tears began to flow.

I encounter this almost daily in my practice. The women who come to me feel more than devastated; they feel broken, as if their inability to have a child negates every area of their lives—lives in which they are not only competent but sometimes very accomplished. I provide a safe space for much-needed emotional release. I told Avery there was nothing I could say to ease her pain. There’s no other way to describe it except to say it’s unfair, and, well, it sucks.

I call this the mourning period, a time to grieve the loss of a wanted child. In Chinese medicine, we view this as a healthy and necessary emotional purge. It’s important and healthy to experience your emotions and get them out rather than trying to bottle them up inside and get on with your busy life.

The seven affects of emotions

In Chinese medicine, we recognize the need to experience the “seven affects” of emotions. It is a healthy and necessary part of the human experience to express joy, sorrow, worry, grief, fear, fright, and anger. When we harbour and suppress these feelings over a prolonged period without expressing or purging them, we give rise to disharmony, which affects our physical well-being, including our fertility.

Infertility myths

Before coming to my clinic, or going to a fertility clinic, Avery and her husband had tried to conceive on their own for twelve months. After six months of having sex three times a week without conceiving, Avery used an ovulation predictor kit (OPK) from the local pharmacy to time their intercourse during her peak ovulation times. She would pee on a urine stick every day from eight days after her menstrual period began; when a happy face appeared on the pee strip, it indicated her most fertile time (when her surging luteinizing hormone triggered the release of a mature egg from one of her ovaries). This peak indicated the small window of opportunity each month in which she might conceive, typically about six days.

Avery, an overachiever, said she and her husband would have intercourse daily, sometimes twice, to “get the job done.” She admitted their love-making had become mechanical, timed, and devoid of spontaneity. Instead of focusing on their connection and mutual enjoyment, she strategized the best sexual position to maximize conception; after he gave his “sperm donation,” she’d stick a pillow under her bum and lie on her back with her feet propped up against the wall. She’d stay in that position until morning, not even peeing before she slept so no semen would leak out.

Like most of my patients, Avery avidly read books and online information about enhancing chances of conception. Collecting information from so many, sometimes conflicting sources, leads many women to gather unhelpful advice that can even interfere with conception.

Holding your urine may seem like a good idea, but you run the risk of a urinary tract infection (UTI), especially if you are prone to them, as Avery was. Also, by “holding it in,” there is a natural tendency for the pelvic floor to tighten and constrict, which can be counterproductive to conception.

Moreover, it’s a myth that the sperm readily “leaks out.” Sperm are dynamic; it’s unavoidable that some get left behind, but the dynamic sperm quickly separate from the seminal fluid as they swim up to the fallopian tubes. Once there, they may sit for several days waiting to fertilize a matured egg as it descends from one of the ovaries.

The fertility clinic experience

After twelve months of trying on their own without success, Avery’s family doctor referred her to an RE at a fertility clinic in Toronto. Avery described the process as impersonal and stressful. At their first consultation, she and her husband gave blood samples and spoke briefly with the doctor before being ushered to separate rooms for preliminary tests.

Avery was shown to one room for a trans-vaginal ultrasound. The technician watched a monitor attached to the probe while moving it inside Avery’s vagina, looking inside her left and right ovaries for the developing antral follicles as well as examining the thickness of the uterine lining. This invasive process, which every fertility patient undergoes, can be very uncomfortable, but is necessary to determine the state of your fertility in that moment and therefore the likelihood of IVF success.

At the same time, Avery’s husband, Walter, was led to a small room just big enough for an armchair, a TV with a DVD player, and a small collection of X-rated movies and magazines. He was handed a plastic specimen cup and told to produce a sample. Fifteen minutes later, he handed his sperm sample to the nurse to be tested.

Avery and Walter then met briefly with the doctor, who described their next steps, and talked about statistics and probabilities. Typically, the fertility doctor shares Western medicine’s facts and perspectives about fertility, often without having seen their test results. For a woman who is already feeling emotional, vulnerable, and stressed, the process can feel dehumanizing.

In a nutshell, the doctor told Avery and her husband that, reproductively speaking, at thirty-eight, she was old. They should start right away with cycle monitoring, where the clinic would track her ovulation and they would be directed to have intercourse at the optimal times. Their chances would be moderately better if they came to the clinic for IUI. If that didn’t work for them after three tries, they could try IVF. But they should decide quickly because Avery’s eggs were “getting older by the day.” So she returned to the fertility clinic on the third day of her menstrual cycle and for many mornings thereafter for early morning cycle monitoring (CM).

Leading a busy life as a partner in a law firm and not wanting to be late for work, Avery would go to the fertility clinic before dawn each morning in an effort to put her name down first on the sign-up sheets at the reception counter. One list was to check the hormone levels in her blood, the second was to look at her developing follicles through trans-vaginal ultrasound, and the third was to meet with the doctor.

Somehow she never managed to be first. By 7 a.m. daily, the waiting room would be full of women seated quietly with their heads in a book or their cell phones, avoiding contact with each other. Avery preferred the anonymity, and dreaded the thought of running into someone she might know. A private person, she worried about admitting to someone she was having trouble conceiving.

Mentally prepare to go to a fertility clinic

If you are reading this book before your first visit to a fertility clinic, the information in the next section will help you prepare for it. If you have already been to a fertility clinic, and it was as difficult for you as it is for most women, this information might help you put your experiences into a different perspective.

Even if you don’t plan to go that route, you have no way of knowing whether your own pathway to pregnancy will end up taking you there. As a mother who didn’t plan to use a fertility clinic but ended up doing so, I can promise that you don’t always know where your fertility journey will take you. Although this section will equip you with information I give patients who come to me before attending a fertility appointment, it’s information you may find useful no matter where you are on your pathway.

An opportunity to gather information

I counsel my patients to view the fertility clinic as a step on their path, and I suggest you see it as an opportunity to gather medical information about your current baseline reproductive health. Along the way, remember you are always in charge. When it comes time to make decisions, pay attention to your intuition. Attending an appointment at a fertility clinic does not bind you to undergoing any kind of interventions.

Create a positive state of mind before attending your first appointment. Fertility doctors typically compare your test results against what they believe to be the “norm.” But you are a dynamic individual, capable of change, and your body has an innate way of healing itself. Use the tips and techniques you’ll learn in this book to take an active role in your reproductive health.

Please do not consider the fertility doctor’s diagnosis to be the final word. Their evaluation is an educated guess, an opinion based on statistical averages and numbers. Each woman is unique. Many babies are born despite unfavourable diagnoses from fertility specialists.

The clinic doctors may speak in generalizations. If you are over thirty-five, your fertility doctor may say you are reproductively old. If your tests indicate your eggs look less than stellar, remember that this test represents a moment in time. Eggs are cells that develop over the course of a year. From a TCM perspective, you can have a profound impact on your eggs’ health in their last ninety to 120 days, while they are growing and proliferating, by making positive changes in your life. Fertility doctors are not versed in TCM principles and do not view egg health as flexible, but as we’ll see in Chapter 5, egg health can change dramatically in a short period of time.

If you have already been to a fertility clinic

If you have already been to a fertility clinic and found it difficult, try to reframe your visit with these thoughts in mind: It was an opportunity to collect baseline information about your reproductive health. Your doctor’s opinion is just that—an opinion. You are not bound to follow any advice that makes you uncomfortable and you need to listen to your intuition in making decisions. Your visit may have left you feeling out of control, but you can take back control any time you choose. Your first step may be to try TCM as a way of getting a second opinion from a different perspective.

Epigenetics and environment

Before learning TCM, I studied sciences and was always looking for ways to demystify this ancient Chinese art. Even after I entered practice and was helping countless patients achieve their goals of better health and healthy babies, I continued to seek modern explanations for the centuries-old success of Chinese medicine.

Reading about quantum physics, which recognizes the energy fields or “Qi” that we study in Chinese medicine, excited me, but when I heard Dr. Bruce Lipton, a renowned cellular biologist, speak at an acupuncturists’ conference in 2004, his words and research resonated with me in a profound way. Dr. Lipton discussed the new science of epigenetics, a complex cellular science that says environment affects the health and well-being of our cells even more profoundly than genetics. Even our conscious and subconscious thoughts, beliefs, and emotions are part of our environment.

For me, Dr. Lipton’s work was the missing link, helping me understand why in TCM we focus on harmony and balance of body, mind, and spirit as the foundation of all health. Moreover, what we think, feel, and believe about our environment affects our health and, in this case, fertility.

Dr. Lipton says a “cell’s life is controlled by the physical and energetic environment and not by its genes.”1 In my TCM world, everything I do with my patients is intended to help them heal and balance their physical environment, using acupuncture, herbs, and diet to alter their energetic environment, encourage positive thinking, and pay attention to thoughts, feelings, and beliefs.

At the very foundation of fertility are two cells: the egg and the sperm. The largest cell in a woman’s body is her egg and smallest in a man’s body is his sperm. Everything I discuss in this book relates to how I help my patients create a nourishing, healthy, balanced environment in their bodies, minds, spirits, and surroundings to give their cells, especially their eggs and sperm, the best possible chance of developing into life.

Nature’s balance

Traditional Chinese medicine helps us understand how to restore and preserve balance in the body, mind, emotions, and spirit. Once balance is restored, and environment is optimized, many women in my practice achieve spontaneous conception. TCM stems from observing nature and viewing our bodies as microcosms of nature. We believe we must cultivate the earth before we plant the seed.

In nature, life erupts from fertile ground in supportive environments. In my clinic, we use TCM principles to create the ideal physical and energetic environment to increase the chance of conceiving a baby. In my experience, when the conditions are right in body, mind, emotion, and spirit, life happens spontaneously. When we go off course, our internal homeostasis becomes unbalanced. Some women’s bodies tell them of imbalance through frequent bouts with the flu, sore muscles, colds, or headaches. Other women’s bodies alert them of imbalance by presenting fertility challenges.

The work of the TCM practitioner, then, is to determine the causes of the imbalance and offer workable solutions to correct them and restore the body to a naturally healthy and balanced state that’s right for conception. TCM recognizes that our internal and external environments affect this balance. What we eat and drink; how we think, feel, and live our lives; and what we are exposed to in our environment all affect our overall well-being.

Western fertility clinics focus attention on gathering a patient’s medical history, blood tests, ultrasound results, and sperm analysis. Fertility doctors factor in a woman’s age to calculate her odds of having a healthy baby, and say they can improve those odds by using modern treatments and technologies. While some women have been told to reduce their stress and lose weight to increase their odds of conceiving, I have never heard of a patient whose RE told her to pay attention to the physical and energetic wellness of her internal environment because it would affect her eggs and her partner’s sperm.

For the first month after their initial visit to the fertility clinic, after having her cycle monitored, Avery and Walter had timed intercourse. It was more accurate than self-testing by peeing on a stick because the technician visually tracks the growth of the egg and follicle, and checks hormone levels via bloodwork. The nurse called, directing them to have sex as Avery would be ovulating within the next day or so.

Avery’s test results

Timed intercourse is the most basic intervention a fertility clinic offers. They administer no drugs, just monitor eggs and hormone levels so intercourse can coincide with ovulation. Unfortunately, Avery did not become pregnant this way. So a month after their first visit, Avery and Walter returned to meet with the doctor. The good news was that Walter’s sperm count was good: he had 100 million sperm per millilitre, well within the normal range of 20 to 300 million. Avery, however, was devastated to learn that, as a woman over age thirty-five, she had poor ovarian reserve (POR) and they would likely need greater intervention to achieve pregnancy.

Although the doctor said they could try a round of IUI, he warned them not to waste time and recommended they move straight to IVF before Avery “ran out of eggs.” Or perhaps, he suggested, they should use donor eggs from a younger woman, fertilized with Walter’s sperm. He offered these options while handing them a brochure for their donor egg program, which Avery interpreted as, “You are over the hill in terms of trying to get pregnant.”

Avery was in shock. She’d gone to the fertility clinic seeking hope and encouragement, and instead felt old, broken, and depressed. How could her eggs be too old when she had regular periods, was healthy, active, and looked younger than her age?

They decided to try an IUI cycle with a hormone medication called Letrozole to increase their odds of getting pregnant by releasing multiple eggs at ovulation. She produced two eggs, which the doctor said would double her chances of conceiving.

For two weeks after the insemination, Avery convinced herself she was going to have the baby of her dreams. After she went into the fertility clinic for an early-morning blood test, she waited anxiously by the phone for the results of the pregnancy test. Every passing minute felt like an eternity.

When she received the phone call that afternoon, the nurse apologized and told her the blood test had come back negative: she was not pregnant. She would need to return to the fertility clinic on the third day of her menstrual cycle to start cycle monitoring again. Instead, Avery came to my clinic.

What is poor ovarian reserve?

There are three main markers of poor ovarian reserve (POR):

•High follicle stimulating hormone (FSH). FSH is a hormone released by the pituitary gland (which is in the brain) to stimulate the growth and maturation of follicles and the eggs within them. Measuring a woman’s blood levels of FSH on day two or three of her menstrual cycle tests her ovarian function. If her FSH levels are above ten, it suggests she is approaching menopause because her ovaries are working harder to produce eggs. High FSH means the woman would respond poorly to IVF because FSH is the drug used to stimulate egg production.2

•If FSH is already high, adding more FSH will not help. Think of cooking with gas. You release gas to turn on the flame and start cooking. To a point, you can turn the gas higher to speed up the cooking. But after a certain point, more gas and a higher flame won’t help the cooking process; it will just burn the food. Similarly, in a woman’s body, adding more FSH will help stimulate egg production to a point, but after that point, it will actually make things worse.

•High FSH was once considered a key marker of POR, but we now know that FSH can go up and down over time, which makes it less reliable as a marker of infertility. That said, it is a reliable way to determine how women are likely to respond to FSH drugs. If FSH is normal, they’re likely to respond well; but a high FSH indicates a poor response to stimulation drugs for IVF since these drugs use FSH.

•Low anti-mullerian hormone (AMH). Until recently, women were thought to be born with their lifetime supply of ova (immature eggs), which secrete AMH. (Research has now shown egg precursor, or stem, cells in the walls of the ovaries of mice3 and women,4 dispelling this belief.) The amount of AMH in a woman’s blood, which remains constant throughout her menstrual cycle, is considered a good indicator of the quality and quantity of remaining eggs in her ovaries, and therefore a better measure of ovarian reserve than FSH.

•That said, AMH levels are considered controversial, because it’s unclear how accurate or cost-effective it can be at predicting live births or improving reproductive health care, and there’s a lack of international standards for interpreting test results accurately.5 And personally, I have witnessed some women’s AMH improve with treatment.

•Low antral follicle count (AFC). AFC is the number of follicles visible on day three of a trans-vaginal ultrasound. Each antral follicle contains one immature egg, which potentially develops and is released by the ovaries during ovulation. AFC indicates a woman’s ovarian reserve, expected response to ovarian stimulating drugs, and chance for successful pregnancy through IVF.

•For IVF, the more antral follicles visible to stimulate with hormones from the third day of menstruation, the greater the chances of having them all mature so they can be retrieved surgically through the vagina and become fertilized in a petri dish. More follicles mean potentially more embryos and a greater likelihood of conception.

What TCM thinks of your “old” eggs

When Avery started trying to have a family at thirty-six, like many women her age, she believed she had lots of time to have a child. She began worrying about her age when, at thirty-eight, she still hadn’t conceived. Unfortunately, her fertility doctor did not provide comfort or reassurance. When she came to see me, she was not only upset that she hadn’t conceived after her first IUI but was still troubled by the things her doctor said at their first appointment. She didn’t know how to get past the statistics the doctor had presented and she admitted to having negative thoughts and feelings that were interfering with her ability to stay positive.

Instead of talking about biological age as markers for fertility, in TCM we speak about fertility in terms of our vitality and energy. In the ancient practice of TCM, we believe we are born with a certain amount of energy, which we inherit from our parents. This finite amount of energy is referred to as Jing Qi (primordial, congenital, source energy, or Essence). In addition, we are able to tap into and produce energy through food and drink, which TCM refers to as Gu Qi (acquired nutritive energy). We also acquire energy from the air (oxygen) we breathe and metabolize it into usable energy for our bodies. This includes energy for procreation. While we can replenish the nutritive Gu Qi, our Jing Qi declines with age and living.

Women’s energetic life stages

Chinese medicine goes on to say that women and men have energetic stages in their lives. For women, these stages are in cycles of seven years (for men it’s eight):

•At seven, a girl’s Jing essence (her inherited energy) becomes bountiful and manifests in permanent teeth and healthy hair.

•At fourteen, she enters puberty as her essence fills her reproductive organs and menstruation begins.

•At twenty-eight, her sexual energy peaks.

•At thirty-five, her sexual essence begins to decline. Jing Qi energy is divided into different functions, which includes sexual energy/essence.

•At forty-nine, a woman’s reproductive essence becomes exhausted and menopause ensues.

According to Chinese medicine, a woman’s procreative energy is not accessible indefinitely, but neither does it end at thirty-five or forty years of age. We acknowledge the shift in her reproductive essence at age thirty-five but believe that a woman who lives in balance with nature in body, mind, and spirit can spontaneously conceive right up until the onset of menopause. My two grandmothers both had healthy babies at the age of forty-six.

TCM believes that, as we age, we deplete our Jing essence. The more we over-extend ourselves, the more we deplete this essence. Stress is a major cause of this depletion: working long hours for years on end is physically draining; hating your job and feeling unfulfilled is emotionally and spiritually draining.

Also in TCM theory, the fertility journey, if not approached in a balanced way, can deplete your energetic essence. Anyone who has faced fertility challenges will attest to how taxing they can be physically, emotionally, and spiritually. The key is to mitigate your stress and conserve your energy, including the sexual energy required to create life.

Achieving balance through TCM

After Avery and I talked about the different perspectives TCM and Western medicine have of reproductive health, we addressed the importance of creating balance in her world. That included processing and letting go of the things her fertility doctor told her to expect, or not expect. When a woman who is working hard at conceiving hears that, statistically, her efforts may be in vain, that kind of information can stick—especially when her fears are being confirmed by a doctor in a lab coat.

While Avery understood the TCM concept of energy and essence, she was still convinced she was going to have a challenge conceiving because her fertility doctor told her so. But because the environment in my clinic is so different from the fertility clinic, and my staff and I were welcoming, nurturing, and attentive, Avery began to open up to the possibility that the fertility doctor did not have the final word. I assured her that I would not make false promises, but that given her history and health, I believed she could become pregnant. Avery decided to work with me and my team for three to four months with a view to creating an environment in which she and her husband could make a baby.

Avery expressed to me in our initial meeting that she was worried she’d waited too long and on some level regretted pursuing financial stability, career, and partnership in her law firm. She wished they’d tried when they were younger instead of avoiding pregnancy so diligently. She was beating herself up for past choices. I encouraged her to let go of these negative thoughts, reminding her that they did not contribute to a healthy environment into which to welcome a baby.

Socio-economic trends

Having access to birth control for the past several decades has prevented women from having unplanned pregnancies, allowing young people to focus on education, career, and financial stability and delay marriage and childbirth. One study showed a thirty percent increase in women in the skilled work force from 1970 to 1990.6 Along with this, women are working more hours. There is also a self-incentive to delay marriage and childbirth because of the known “family gap” in the workplace, where a working mom generally receives less pay than a childless woman.7

In 1972, women comprised thirty-eight percent of the general workforce,8 and today it has increased to nearly half in the United States9 and Canada.10 Fifty-one percent of employed women work in management and professional positions,11 which tells me that as many women as men are in the workforce and as many working women as working men are in stressful, demanding jobs with long hours.

I will talk more about work stress in Chapter 6. The important point here is that there is no blame. In a world of rising living standards, modern women invest in and focus on their education and financial security. Focusing on the next promotion or achieving seniority can make it difficult to even contemplate finding a mate or making babies. Even in relationships, both partners generally work and, with busy schedules, often struggle to find time for intimacy. As a result, a woman’s natural maternal instincts can be set aside and suppressed as she is consumed by demands of work.

Survival mode kicks in

Avery and I discussed the years of stress she’d been under, first working toward partnership and then trying to conceive. That kind of stress can create disharmony and imbalance in the body. And being a high achiever, Avery’s workload and stress continued now that she had a financial stake in the firm.

She and her husband had started trying to have a baby immediately after she’d achieved partnership. They’d not prepared at all for a baby, other than not using protection. And each month when her period came, she shoved aside the emotional stress of not being pregnant, which in and of itself can be an emotional rollercoaster ride of hope and anticipation, followed by sadness and despair. This alone can be so overwhelming as to perpetuate long-term disharmony in the body.

According to TCM, when your body goes through cycle monitoring and even a single IUI cycle, as Avery’s did, your system becomes taxed. If you’ve already accumulated a lot of stress in your life, these procedures can send your system into survival mode, where your ovaries and uterus are almost dormant as your energy is diverted to support your brain, heart, and limbs. This does not mean your body is failing you, but that it is lovingly and protectively telling you, “Not yet. Let’s wait for a better time, when you are in a more balanced state physically, mentally, and emotionally, before becoming pregnant.”

After I explained to Avery the impact on her fertility of the years of stress she’d endured, she understood she was in a phase of reproductive dormancy. As a result, her blood tests and ultrasounds were less than optimal, which her RE interpreted as POR. I encouraged her to have faith that her body and her ovaries had an ability to shift, and that she was not necessarily going into menopause.

Straight talk about stress

Because Chinese medicine is holistic, a TCM practitioner will ask about all aspects of your life, including how much stress you’re dealing with, beyond the stress of trying to conceive. You probably think you’re aware of your stress levels at work, at home, and in your life in general. But unless you are already employing effective stress-relieving strategies, any kind of stress—even good stress—can create imbalance and affect the environment you’re creating for your unborn child.

In addition, women with fertility challenges may experience a very different type of stress. Please take a few minutes to ask yourself these questions and answer honestly to see how much of this stress you’re enduring:

•When was the last time you laughed and had a good time?

•Are you avoiding friends and family?

•How many people know you’re having some difficulty conceiving?

•Does your employer know you’re trying to conceive? Do they offer any kind of support? What about your colleagues?

•Are you and your partner enjoying sexual intimacy or are you feeling pressured to perform?

•Do you avoid friends or family who are currently pregnant or have babies?

•Do you feel upset when you randomly see pregnant women or women with babies?

•Do you become upset if you see parents who you think are not responding to their child’s needs as you think they should?

•Do you ask “Why them and not me?” or think “Everyone is getting pregnant except me?”

•Do you feel isolated and alone, thinking no one understands what you’re going through?

•Have work and trying to conceive become your full-time jobs, or are you doing other things so they don’t consume your life?

Unfortunately, when most women who come to my clinic answer these questions, they realize how isolated they feel and how consumed they’ve become with their fertility journey. Stress is part of living, but you can strategize to limit your stress where you can, create a supportive environment around yourself, seek ways to soften your reactions to stress, and make a positive difference in your own life.

Decreasing your stress levels

Acupuncture is one way to manage stress, but, realistically, you cannot do it every day. So what else can you do?

•Say “no.” You do not have to agree to every request someone makes of you. Learn to say “no” to organizing a work event, going to a baby shower, or spending time with family or friends who do not support you.

•When you can’t say “no,” such as when your stress involves caring for a sick parent or grieving the loss of a loved one, acknowledge it. Close your eyes and notice where your stress is sitting in your body. Consciously relax that part of your body. Stress in and of itself does not impede pregnancy. It’s how we respond to stress that may have a positive or negative impact on our body, mind, spirit, and ability to conceive.

•Connect with nature. Fresh air is healing. It can help you put things in perspective by seeing yourself as a small piece of the universe.

•Connect with your partner. Go for date nights. Keep intimacy alive. Remind yourselves why you became a couple.

•Go for walks. Moderate exercise helps work off stress hormones and replace them with feel-good hormones.

•Pick up a hobby. Find something you can be passionate about or something that just makes you smile, like pottery class, belly dancing, gardening, or crocheting.

•Create support. Talk to an understanding friend, join a fertility support group, or see a therapist who specializes in fertility. Do not rely on your partner’s support, because there is a limit to how much he can support and understand you, especially when he is mourning in his own way, a way that is likely very different than yours. It is too much to ask any one person to fulfill every one of your physical, mental, and emotional needs. That’s what friends and professionals are for.

•Assess whether you are a Type A personality, and realize you don’t have to do it all and do it right. Every day, patients ask me “What else can I do?” I usually say, “What can you let go of today or this week?”

•Take the herbal medicines your TCM suggests. These are time-tested to allow for the free flow of energy throughout your body and nourish, restore, and replenish your energy, blood, body fluids, and essence.

•Try meditation or hypnosis. This does not have to be a sit-down thing, unless you have a personality that finds stillness rejuvenating. If you are a Type A, the exercises in the next bullet might be better for you.

•Try mind-body exercise like Tai Chi, Qi Gong, yoga, and even walking or running moderately. Any exercise that combines breathing with movement and increases self-awareness can have a calming, meditative effect on your body, mind, and spirit.

•Clean up your diet. Eating organic foods and minimizing your exposure to toxins can decrease the physical stress on your body.

•Practice gratitude. Create a routine when you wake up, before you go to bed, or before meals, where you think about one thing you are grateful for. Allow your mind to focus on one positive thing in your life, even if it’s only for five minutes at a time. When I started working on this book, I created my social media Gratefulness Project, 365 Days of Keeping the Grass Greener on this Side, to create a supportive environment for my readers and reduce my own worries. I find myself happier, more content, and less likely to sweat the small stuff. Practising gratitude can help you mitigate your stress as you deal with your fertility challenges.

•Learn to mother yourself first. When you are in an airplane with a child sitting beside you and the oxygen mask comes down, you put it on yourself first to ensure you’ll be able to help your child. Mothering yourself means respecting and caring for yourself. In Avery’s case, this meant understanding her own limitations and learning when to say “no” or ask for help. It meant going to work and doing her job well and then going home and leaving work behind. It meant taking yoga classes and going for walks with her husband, eating organic, hormone-free, pesticide-free, antibiotic-free foods, and cutting out coffee and alcohol. And it meant recognizing how much to indulge her sweet tooth and when to stop.

•Remember, you are not your diagnosis. The fertility doctor’s words made Avery feel broken, but she was not broken. She didn’t need to feel imprisoned by her diagnosis, and neither do you. Instead, use your diagnosis as a jumping-off point, an opportunity to take care of yourself in ways you never have and see what happens.

The way TCM looks at your health

Avery reported herself to be healthy, active, and normal, with a regular menstrual cycle that was twenty-eight or twenty-nine days long. However, she experienced abdominal cramping and bloating, lower back pain, breast tenderness, lowered energy, and cravings for sweets for two days pre-menstrually and on the first day of her period. Even though these symptoms were normal for Avery, and typical for many women, they suggested an underlying imbalance as, according to TCM, menstruation should be uneventful and painless.

It’s not unusual for a TCM practitioner to spend one-and-a-half to two hours with a patient on their first visit and sixty minutes on subsequent visits. This is not about running up fees but taking time to listen, question, counsel, provide lifestyle advice, check in on them emotionally and physically, provide dietary advice, suggest herbal medicine, and treat overall health, not just reproductive health, since everything is interrelated.

At each of our sessions, Avery was surprised at how much time I spent with her, especially when I was coming up with her TCM diagnosis. Women continue to be surprised by the questions I ask and the depth and precision of information I gather. In addition to asking about her overall health history, bodily functions, and lifestyle habits, TCM practitioners learn to diagnose illness by palpating the radial artery pulse and looking at the tongue.

When a TCM practitioner feels the radial artery through their finger pads, they are paying attention to the rate and rhythm of the pulse, as well as its qualities. How the blood flows within the blood vessels, and how fast it flows, indicates the person’s health and vitality. Avery’s pulse was deficient and slightly choppy.

To a TCM practitioner, the tongue provides another glimpse into the overall state of an individual’s health. The tongue is the only visible internal muscle in the body. Its colour, size, and shape, as well as the thickness of the coating on it, reflect a lot about one’s health. Avery’s tongue was pale and swollen with teeth-marked edges, as if it was too big for her mouth. Increasing blood flow would make the tongue pinker, and increasing Qi (vital energy) would help the tongue hold its shape better.

To improve Avery’s blood and energy flow, we began weekly acupuncture treatments and Chinese herbal medicines. She began to make some lifestyle changes, which included eating warm, cooked foods and drinking warm drinks, in contrast with her usual fare of frozen berry smoothies and cold salads. According to TCM, when we eat cold food and drink, we use energy to heat it before we can digest it. If we want as much energy as possible to go toward reproduction, we must conserve our energy by eating warm and easy-to-digest foods. Refer to Chapter 1 for more information on eating for fertility.

Preparing the soil for the seed

Avery liked the idea of preparing her body (soil) before she planted the seed. Her plan was that if she did not get pregnant naturally in six months, she would consider IVF. She was not interested in a donor egg from a young woman.

She changed her habits, going to sleep an hour earlier and sleeping eight hours each night. Soon she had more energy and was less irritable. She began using menstrual pads instead of tampons, as in TCM we believe menstrual blood is meant to flow out unimpeded rather than being plugged up, which can cause stagnation over time.

Within two months, Avery reported that her periods had become pain free for the first time in her life. When her period came, she would have a day of disappointment and sadness but, because she was feeling better overall, she felt more in control of her health. She wasn’t focusing on her urgent need to be pregnant.

Feeling better physically allowed Avery to feel stronger emotionally, to process her feelings of sadness each month, often during our acupuncture sessions. Feeling better gave her hope that she was moving in the right direction by creating an internal environment that would welcome a child. She felt less desperate, more able to see what was possible rather than what her fertility doctor told her was not. As things improved, it made sense to work on her health for several months before trying IVF. After all, why plant the seed before the soil is ready?

Avery’s welcome surprise

At one of her appointments, Avery came in panicked. “Mary, I think something is wrong. My period is six days late. I’m never late.” I asked if she’d taken a pregnancy test and she said, “I’ve been putting it off because I don’t think I could be pregnant. My husband had a business trip and we were only able to do it once, four days before ovulation.”

I encouraged her to take the test. A week later, she announced her pregnancy with pride and joy and we altered our treatment strategy to support her pregnancy. She came in for treatments every week for the first trimester and monthly during her second trimester. At thirty-seven weeks, we resumed weekly treatments to help ripen Avery’s cervix in preparation for a natural delivery. She went into labour twelve hours after our acupuncture treatment, just two days past her due date. Baby Alexander was born naturally six hours later, a healthy eight pounds, ten ounces.

Pathways to Pregnancy

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