Kristina’s Story: Eggs’ Quality and Long Dan Xie Gan Tang (龙胆泻肝汤)

Kristina, a 37-year-old woman, had been trying to conceive for 5 years. In October 2016, she came to see me after her first IVF cycle was canceled. Her AMH was 1.6 ng/ml in September. However, out of the five eggs retrieved, only four were fertilized, and just two progressed to the blastocyst stage before ceasing growth on the sixth day. Her doctor proposed an additional cycle, but it was canceled due to her antral follicle count being less than 4.

Kristina, who was 5’10’’ and weighed 130 lbs, typically had short menstrual cycles lasting from 23 to 24 days. Hair grew along the midline of her abdomen. She frequently felt fatigued and presented with a scarlet tongue with a thick greasy white coating. She had a history of chlamydia infection and salpingitis, with one blocked and liquid-filled fallopian tube and the other being sluggish. Her husband's sperm analyses revealed abnormalities, and he was advised against treatment as they had not conceived naturally and were pursuing IVF. Before commencing another IVF cycle, Kristina had her fallopian tubes removed.

(Note: Salpingitis is inflammation of the fallopian tubes, often caused by bacterial infections, including sexually transmitted diseases like gonorrhea and chlamydia. Salpingitis can lead to female infertility by damaging the fallopian tubes.)

Based on Kristina's symptoms, her pattern, according to Chinese medicine, indicated damp-heat in the liver meridian with kidney essence deficiency. We tailored her treatment with Long Dan Xie Gan Tang for clearing damp heat and alternated with Zuo Gui Yin for nourishing her kidneys. With our treatment, her menstrual cycle normalized to 28 days, and her AMH increased from 1.6 ng/ml to 3.1 ng/ml after 5 months. However, her damp-heat signs, such as a dark red tongue and greasy coating, continued to fluctuate, suggesting an unbalanced state.

Her doctor proceeded with IVF using the same protocol. Shortly after her period started, multiple antral follicles were observed, and she received 2 vials of menopure and 300 IU of follistim daily. Unfortunately, two dominant follicles outpaced the others, leading to the cancellation of the cycle on the fifth day of stimulation.

Recognizing that Kristina still exhibited signs of damp heat that could affect egg growth, she continued receiving Long Dan Xie Gan Tang for a month until the next IVF cycle commenced. Prior to starting the fourth IVF cycle, her damp-heat symptoms had nearly vanished.

On the second day of her period, an ultrasound revealed a total of 14 antral follicles, with nine on the right side and five on the left. Her doctor followed the same protocol, resulting in the retrieval of nine eggs, all of which were fertilized. Seven blastocysts were successfully frozen.

In Chinese medicine, the condition of damp heat likely corresponds to an autoimmune disorder and inflammation in Western medicine. Kristina's presentation of a dark red tongue indicating heat and a thick greasy coating signifying dampness supports the diagnosis of damp heat, particularly given her history of STI and salpingitis.

The presence of fewer antral follicles and shorter menstrual cycles pointed towards kidney essence deficiency. Chinese medicine posits that where there is "evil," there is deficiency in Qi, which reflects this case. Evil denotes invading etiologies or pathological changes, such as infection or inflammation. Kidney essence deficiency was attributed not only to age but also to the presence of damp heat. Although nourishing the kidneys may boost AMH levels by rescuing oocytes, the internal environment was not conducive for them to mature due to potential damage from increased natural killer cells. Imbalances in pro-inflammatory and anti-inflammatory factors could further complicate the situation.

In addition to growth factors, various immune factors, particularly cytokines, have an impact on ovarian steroidogenesis. Factors like interleukin-1, tumor necrosis factor, and interferon, found in human follicular fluids, generally inhibit gonadotropin stimulation of steroidogenesis. Damp heat, as a primary cause of inflammation, may impede follicular growth, explaining why the follicle count did not increase even after AMH levels rose to 3.1 ng/ml. Treatment for damp heat transformed the outcome by rebalancing the immune system with Long Dan Xie Gan Tang.

Long Dan Xie Gan Tang, a classical formula, has been proven to possess anti-inflammatory properties. This case serves as an additional testament to the positive impact of herbal medicine.

Words from the Author:

I have helped over a thousand of patients conceive in the past ten years. About half of them became pregnant naturally and others conceived with the help of IUI, IVF or medicine. Most of them have been very challenging cases, and I have learned much from them. I found out that many of my patients do not understand how to take care of their bodies. They don’t know when they’re ovulating, they don’t know what a normal period should look like, and most importantly, they don’t know how to be healthy and prevent infertility.  

Many people have heard that Chinese medicine might help their issues, but they don’t understand how it works because the terms used in traditional Chinese medicine (TCM) are abstract and unusual. Foreigners who do not have a basic knowledge of Asian culture and philosophy might find it difficult to grasp the nuances of Chinese medicine. As a result, TCM has not had as wide of an audience as it has the potential to have.

I have always wanted to share my work with anyone who isinterested in Chinese medicine, to explain how it can help heal different medical conditions.  Specifically, I wish to restore hope in those who were rejected by western medicine but still want their own child. To do so, I’ll start by telling you my patients’ stories. Much of my thinking is based on my observations and past experiences - they may not be verified by science yet, but I believe that will be proved in the future.

About the Author:

Jane Liu, graduated from Guangzhou University of Chinese Medicine in 1985,  is a clinical gynecological endocrinologist and also licensed acupuncturist and herbologist in Texas, USA.

Contact Address: Jade Clinic of Acupucture and Integrative Medicine, 6380 LBJ Freeway, Suite 180, Dallas, Texas, 75240,USA

Email: jadeclinicdallas@gmail.com