Improving Fertility & Pregnancy in Advanced Maternal Age
It’s a fact that as a woman gets older her ability to procreate and produce offspring diminishes. Many would-be mothers have told me of their regret that they delayed having children due to the timing, their career, their partner, or life circumstances.
Here are the fertility rates categorized by age for women in the United States. As the chart illustrates, 40 years of age and above is considered an advanced maternal age, and a woman’s fertility decreases significantly by 35 and even more rapidly after the age of 40.
To add insult to injury, as women age they experience a decline in reproductive performance as they approach menopause. This decline in fertility is associated with a decline in the number of ovarian follicles. Although a human ovary has about 1 million oocytes or egg cells present at birth, only about 500 or about 0.05% of these eggs cells ovulate. As a woman ages, her decline in ovarian reserve happens at an increasingly rapid rate to near exhaustion by menopause.
Ovarian Egg Reserve
The biomarker for ovarian reserve is called Anti-Mullerian Hormone (AMH) which is used as a measure to assess a woman’s ovarian reserve. It is used as a predictor for ovarian response in IVF (in vitro fertilization) as well as to estimate a women’s remaining egg supply. Interestingly, we’ve been working with many patients with low AMH levels at Tao of Wellness and have seen their levels double or triple after treatment with Chinese medicine, indicating that it is possible to increase the total numbers of oocytes available for ovulation beyond the typical 500 eggs in a woman’s lifetime.
The Case of Low AMH
Debra is a 43-year-old successful partner at a law firm specializing in family law. She found true love at 40 and married her husband who is 7 years her senior and got down to making babies right away. In the first year, the new couple tried naturally as both were in good health. However, without success after the first year of trying, Debra underwent several IUIs and three IVFs—all of which failed. She was discouraged and in despair. While her hormone levels appeared within normal range, her AMH was 0.45 which meant her ovarian reserve was very low.
Debra was referred to me by her reproductive endocrinologist with whom we’ve shared many patients who have had happy outcomes. Our first visit was a telemedicine video call because Debra had moved to the east coast in order to be closer to her family during the pandemic, I explained that in spite of her low AMH numbers, we could work to improve and therefore increase her ovarian reserve. Understandably, Debra preferred her eggs over donor eggs. However, I explained to her that it wasn't just the number of eggs that is important but that the quality of eggs decreases with age so we would also need to improve her egg quality as well.
Egg Quality
The oocytes or egg cells inside a woman’s ovaries are “primordial” or immature eggs. As they ovulate, they go through a phase of cell division called meiosis. The curse of aging is that older eggs are more likely to have accumulated mutations or errors in their DNA during the process of cellular division, leading to genetically abnormal eggs. Western medicine believes that eggs that have been genetically degraded simply cannot be repaired or improved upon. Naturally, as women age, a greater percentage of their eggs become unviable. As the chart below shows, the quality of embryos produced from eggs of women decreases as they age.
In Chinese medicine, we believe that through diet, nutrition, Chinese herbal medicine, and acupuncture we can influence and improve the quality of the egg during the process of cellular division when an oocyte transforms during ovulation into a viable egg. My background in longevity and anti-aging research as well as my 36 years of clinical practice has convinced me that egg quality can indeed be improved and the opportunity for a successful pregnancy can be increased with the assistance that can be provided to a woman through Chinese medicine.
I told Debra that we needed three to six months to help her body restore and to see a meaningful increase in her ovarian reserve as shown in an increase in the levels of AMH as well as working to improve the quality of her eggs. Debra was naturally reluctant to begin treatment because she was worried about the pressure created by the ticking of her biological clock; and thought she was seeing her opportunity for becoming a mother with her own eggs evaporate. Even her current reproductive endocrinologist—the third one she had worked with —advised her to seek donor eggs.
1 Seasonal and Environmental Factors
Your external environment impacts your internal environment, influencing your health and wellbeing. The environment influences your mood, bodily function, and physical energy. Seasonal changes, weather, and time of day all play an important role in your health, and therefore your fertility. Engaging in activities that calm your spirit, simplify your lifestyle, put you in tune with nature, and protect your body from toxins will contribute to increased quality of life, which translates to enhanced fertility.
Reducing the use of chemically-laden beauty products, cookware, and pesticides, while surrounding yourself with a supportive and uplifting community will contribute to your wellness and fertility. I recommended that Debra go through an at-home detoxification process with a special dietary protocol that included fresh vegetable juices, broth, detox herbal tea, skin brushing to activate the lymphatic circulation, and soaking in a detox herbal bath nightly. (The Detox Kit is available at either the Tao of Wellness offices or online at taostar.com).
2 Nutrition for Fertility
Proper nutrition is an essential component in helping you increase fertility. Like a flower needs the sun, water, and healthy soil to thrive, we need the right nourishment to build a healthy foundation to conceive. Processed foods are not only detrimental to our health they also decrease the likelihood of fertility. The medical tradition of the Chinese—well-known as the most populous people in the world—has long considered certain foods valuable in increasing fertility. These foods include eggs, nuts, seeds, beans, legumes, and berries.
Since these foods are themselves capable of propagation when hatched or sprouted, they are said to be abundant in life-giving energy. These complete foods provide the essential amino acids that help form the building block of protein. They are also high in essential fatty acids (EFAs), critical for hormonal health, and chock full of antioxidants that prevent a premature decline in function and aging. I recommended that Debra read the Tao of Nutrition to harness the potent healing properties of special foods for fertility.
3 Fertility Herbs and Supplements
Chinese herbal medicine is one of the oldest, most systematized, and most researched natural healing systems in the world. Treating fertility with herbs is often used in Chinese medicine as a primary step. Chinese medicine recognizes that each individual has different requirements, and that is why it is best to work with a licensed traditional practitioner who can tailor the herbal formula to your specific needs. Our practitioners at the Tao of Wellness base their selection of herbal ingredients on our patient’s constitution, environment, and medical condition. Along with prescribing a customized herbal formula for Debra, I suggested that she take the herbal formula, Spark Female and recommended that her husband take Spark Male to support healthy male reproductive function.
In addition to herbs, certain supplements have been shown to be important in the process of conception and pregnancy. As mentioned earlier, antioxidants and EFAs are useful to reduce oxidative damage, particularly to fragile DNA. Omega-3 fatty acids manage inflammation so both Cell Protection and Omega Support were part of Debra’s supplement protocol.
4 Exercise and Rejuvenation Practices for Fertility
During my many years of clinical practice, I have studied the habits of centenarians and something they all had in common was that they led physically active lives. Many centenarians I encountered practiced the gentle mind-body exercises of tai chi and qi gong which have always been associated with health and longevity. These exercises are especially beneficial for decreasing stress and increasing fertility. By deliberately activating the flow of energy through the body and removing blockages, communication in body systems is restored and organ functions return to an optimal level. I recommended that Debra practice qi gong for fertility from a DVD at home. Meditation and visualization have also been shown to help balance sex hormones by lowering stress hormones like cortisol that upset the metabolic and hormonal systems, so I also asked Debra to meditate daily with my Calm Meditation.
5 Promote Pregnancy with Restoration, Spirituality, and Intimacy
Spiritual nourishment and stress management are just as important as what we feed our bodies. Inadequate rest, poor quality of sleep, and long working hours can all contribute to emotional instability. Your body detects that you are under a lot of stress and thus reduces your chance of becoming pregnant; it is your body’s protective mechanism since having a child requires a calm and healthy internal and external environment.
Sometimes, becoming too involved in your active pursuit of pregnancy can also induce stress. As a result, your relationship with a partner may develop friction, causing depression, frustration, and eventually an unsatisfying social life. It is important to give yourself the time to develop a closer sense of your inner self so that you can be clear in your purpose of motherhood. Inner understanding and personal strength will dispel conflict, helping you achieve the optimal state of health that is necessary for peak fertility so, after our biweekly telemedicine sessions, Debra really took my advice to heart and reconnected and fully embraced her Jewish roots and spirituality.
Debra’s Efforts Finally Yielded Fruit
Debra diligently followed the protocols that I prescribed for her. Since she was not living in Los Angeles she did not have the benefit of acupuncture which I am confident would have hastened the process. Nevertheless, after nearly five months she excitedly called to tell me that her pregnancy test was positive. In the meantime, her AMH had almost tripled from 0.45 to 1.10. I acknowledged her good news but told her to remain cautiously optimistic until she was further along in her pregnancy. Once she was pregnant I changed her protocol from optimizing ovulation and egg quality to one that emphasized the health of her uterine lining and hormonal optimization.
Ten months later, Debra delivered a healthy baby girl, naturally, and with her own egg.
Despite Tao of Wellness’ nearly 50 years of success stories in helping women and men achieve their dreams of becoming parents, our work is one of a fruitful partnership that involves many people including family members, friends, therapists, clergy, fertility doctors, and advanced technologies—everyone playing a part to help patients actualize their dreams. It takes a village!