Infertility is fundamentally the inability to conceive a baby, including the inability of a male to provide normal sperms and the state of a female who is unable to carry a pregnancy to full term []. The causes of infertility include specific male causes, specific female causes, combined and unexplained infertility (Fig. 2, ). On the male side, low semen count and quality due to endocrine problems, drugs, radiation, infection, hormone imbalance, and blockage of the man’s duct system are the common causes. On the female side, egg released not at the optimum time for fertilization, problems of releasing eggs, structural problems in the Fallopian tube, endometriosis, pelvic inflammatory disease, age-related factors, imbalanced hormones and uterine problems are the common causes of infertility. Genetic factors, DNA damages, diabetes mellitus, thyroid disorders, adrenal disease, hypothalamic-pituitary factors, environmental factors (such as toxins, physical and chemical agents and smoking) can cause infertility on either sex. In addition, approximately one in five couples will experience unexplained infertility despite completing a full infertility work-up. One in six couples in Australia and New Zealand suffers infertility []. Worldwide, 3-7% of all couples have an unresolved problem of infertility and 12-28% of all couples experience this problem for at least one year . The infertility is highly related to the age. The older the age, the more problems on the fertility (Fig. 3, []).
Depending on the causes, infertility can be treated with psychological adjustment [], medicine (Clomid, Pergonal, Follistim, Metformin, Parlodel, etc.) [], surgery (Fallopian tube sterilization reversal, hydrosalpinx removal, testicular sperm aspiration, vasectomy reversal, etc.) [], artificial insemination, or assisted reproductive technology (conception cap, semen collectors, intracervical and intrauterine inseminations, In-vitro fertilization and donor insemination, etc.) . Many times these treatments are combined. One thing is very important for the infertility treatment: when starting the treatment to adjust the molecular metabolisms and functions, the organic diseases of infertility must be excluded.
There is a long recorded history of Traditional Chinese Medicine (TCM) being used in the treatment of infertility. In fact, records indicating herbal treatment of infertility and miscarriage date back to 200 A.D., including mention of formulas that are still used for those same purposes today []. Since the most situations of infertility are due to the imbalances of the molecular metabolisms and functions, while TCM has advantages at the regulations of functional balances individually, TCM shows many benefits in the treatment of infertility. TCM believes that women infertility is due to the lack of innate endowment, excessive intercourse, deficiency of kidney essence, deficiency of Chong and Ren channels; or deficiency of kidney yin, deficiency and cold of the uterus; or body weak, deficiency of Yin and blood, lack of nourishing womb and pulse; or sluggish emotion, stagnation of liver Qi, dissonance of Qi and blood; or obesity, excessive eating and rich fatty diet, Yang deficiency of spleen and kidney, the development of phlegm dampness, block of Qi, block of Chong and Ren channels; or blood stasis and condensation, accumulation of diseases in womb []. The followings are the common types of infertility and treatment for women in the clinics :
- Kidney Yang deficiency: Infertility for a long time, delayed menstruation, low volume of menstrual flow with light color, or oligomenorrhea, amenorrhea; dark and gloomy complexion, lumbar soreness and leg weakness, sexual apathy, clear urine in large amounts, watery stool, pale tongue with white coating, deep and slow pulse. Treatment: Warming kidney and nourishing liver; Regulating and reinforcing Chong and Ren channels. Formula: Yu Lin Zhu (毓麟珠, from “Jingyue Encyclopedia”《景岳全书》) plus Zi He Che (紫河车), Dan shen (丹参) and Xiang Fu (香附).
- Liver depression: Infertility for years, irregular menstrual cycle, abdominal pain during the period with clogged flow, less volume, dark color, and small blood clots, premenstrual breast distending pain, depression, irritability. Normal or dark red tongue with thin and white coating, stringy-taut pulse. Treatment: Soothing the liver and alleviating the depression; Nourishing blood and strengthening spleen. Formula: Kai Yu Zhong Yu Tang (开郁种玉汤, from Fu Qingzhu’s Obstetrics and Gynecology, 《傅青主女科》).
- Phlegm dampness: Inability to conceive a baby for a long time, fat body shape, delayed period or even amenorrhea, increased and thick leucorrhea, pale complexion, dizziness, palpitations, chest distress, nausea. White and greasy tongue coating, slippery pulse. Treatment: Drying damp and eliminating phlegm; Regulating Qi and menstruation. Formula: Qi Gong Wan (启宫丸, experienced formula) plus Shi Chang Pu (石菖蒲).
- Blood stasis: Infertility for a long time, delayed and hypo menorrhea, black and purple blood with clots, or dysmenorrhea, recurrent pain refused to press in the outer part of the lower abdomen. Dark purple tongue or purple dots on the side of the tongue, thready and stringy pulse string. Treatment: promoting blood circulation and removing blood stasis, regulating the menstruation. Formula: Shao Fu Zhu Yu Tang (少腹逐瘀汤, from “Correction on the Errors of Medical Works” 《医林改错》).
- Kidney Yin deficiency: Infertility for a long time, preceded and hypo menorrhea, red without clot, or normal menstruation but with extreme weight loss, soreness and weakness of waist and legs, dizziness, palpitation and insomnia, temperament, dry mouth, burning sensation of five centers, afternoon low-grade fever. Reddish tongue with less coating, thready and rapid pulse. Treatment: Nourishing yin and enriching blood; Regulating Chong channel and replenishing vital essence. Formula: Yang Jing Zhong Yu Tang (养精种玉汤, from Fu Qingzhu’s Obstetrics and Gynecology,《傅青主女科》) plus Nu Zhen Zi (女贞子), Han Lian Cao (旱莲草).
For male infertility, TCM believes that kidney stores essence and control reproduction; It is the material basis of human growth, development and reproduction. The imbalance of kidney Yin and Yang, especially the kidney deficiency, is one of the main pathological mechanisms of sterility. The other mechanisms include deficiency of Qi and blood, Qi stagnation and blood stasis, damp heat of essence room, liver depression and blood stasis, and so on. The followings are the common types of infertility and treatment for women in the clinics []:
- Kidney deficiency of Yang: Infertility after marriage, low sexual desire, impotence with erectile dysfunction, or a weak erection, chilly seminal fluid, low sperm count with low motility; usually accompanied by lower back pain and knee weakness, psychological fatigue, limb chills, clear urine in large amounts, pale tongue, thin white fur, deep and thready pulse. Treatment can be chosen with Jin Kui Shen Qi Wan (可选用金匮肾气丸), Qiang Shen Pian (强肾片), Ginseng and deer velvet pill (人参鹿茸丸).
- Kidney deficiency of Yin: Infertility after marriage, spermatorrhea, premature ejaculation, scarce semen; often associated with lower backache and leg weakness, dizziness, tinnitus, feverishness in palms and soles, dry mouth, insomnia, forgetfulness, red tongue with less coating, thready and rapid pulse. Treatment can be chosen with Wu Zi Yan Zong Wan (五子衍宗丸), and Liu Wei Di Huang Wan (六味地黄丸).
- Deficiency of both Qi and blood: Infertility after marriage, low sexual desire, thin semen, low sperm count with a low survival rate, pale or sallow complexion, body weakness, lack of Qi and no desire to speak, dizziness, pale tongue with thin and white coating, thin and weak pulse. Treatment can be chosen with Shi Quan Da Bu Wan (十全大补丸), Ren Shen Gui Pi Wan (人参归脾丸).
- Damp-heat and blood-stasis obstruction: hypochondriac pain and bitter taste in the mouth, agitated, irritable, moist and hyperhidrosis at scrotum, pruritus vulvae, urethral secretion, decreased libido, impotence, premature ejaculation, excessive dead sperm or non-liquefaction, scanty and brownish urine, red tongue, yellow greasy moss, stringy and rapid pulse. Treatment should be done by clearing heat and removing dampness, with Cheng’s Bi Xie Fen Qing Decoction with addition or subtraction.
- Stagnation of Qi and blood stasis: abdominal and perineal pain, seminal vesicle thickening, dragging and distending discomfort on testicle, dark purple tongue, thready and unsmooth pulse. The treatment choice can be promoting blood circulation to dispel blood stasis; dredging the meridians and producing essence by Xue Fu Zhu Yu containing Tao Hong Si Wu Tang (血府逐瘀含桃红四物汤) with addition or subtraction.
Note: Chapter 21 of the Jin Gui Yao Lue (Essential prescriptions of the Golden Cabinet – 金 匱要略) is dedicated to Women’s Miscellaneous Disease and one particular formula Wen Jing Tang (温经汤) stands out: Line 22.9: … [this formula] also governs women’s lesser abdominal cold and chronic failure to conceive; it also helps to eliminate blood from flooding or excessive menstrual bleeding or failure of the menses to arrive [at their proper] time.
Fertility is a complicated procedure of sperms and ova reactions, including spermatogenesis and oogenesis, transportation of gametes, fertilization and fetal development in the precisely regulated molecular environments through the whole procedure. Any imbalance of these molecules may lead to the infertility [, ]. The recent medical sciences demonstrate that TCM formulas regulate the body molecular balances and lead to the recovery of diseases [, ]. One study showed that the management of female infertility with Chinese Herbal Medicine can improve pregnancy rates 2-fold within a 4 month period compared with Western Medical fertility drug therapy or IVF []. In addition to the treatments of infertility with western medicine, TCM plays a very important role in helping many many couples to realize their dreams to have a baby.
 Infertility with age: http://blog.wenxuecity.com/myblog/58246/201311/339.html
 Alice Domar et al: Understanding the perceptions of and emotional barriers to infertility treatment: a survey in four European countries. Hum. Reprod., Apr 2012; 27: 1073 – 1079.
 TCM treatment history: http://www.naturalnews.com/035436_Chinese_medicine_infertility_treatment.html
 TCM treatment of male infertility: http://wenku.baidu.com/view/e493c589d0d233d4b14e690d.html
 B Dousset et al: Seminal cytokine concentrations (IL-1beta, IL-2, IL-6, sR IL-2, sR IL- 6), semen parameters and blood hormonal status in male infertility. Hum. Reprod., Jul 1997; 12: 1476 – 1479.
 Antonio Cianci et al: Relationship between tumour necrosis factor and sex steroid concentrations in the follicular fluid of women with immunological infertility. Hum. Reprod., Feb 1996; 11: 265 – 268.
 Fritz Wieser et al: Evolution of medical treatment for endometriosis: back to the roots? Hum. Reprod. Update, Sep 2007; 13: 487 – 499.
 Zhenzhen Zhang et al: Therapeutic Potential of Wenshen Xiaozheng Tang, a Traditional Chinese Medicine Prescription, for Treating Endometriosis. Reproductive Sciences, Oct 2013; 20: 1215 – 1223.
 Ried K, Stuart K.: Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: a systematic review. Complement Ther Med. 2011 Dec;19(6):319-31. doi: 10.1016/j.ctim.2011.09.003. Epub 2011 Oct 5.