Pregnancy Support for Women Over 40

A discussion of the challenges, treatments, and formulas to improve outcomes.

Not every woman is ready or able to have a baby during her prime reproductive years. Real considerations that affect her decision to have a child are her career, support system, relationship status, and financial ability to raise that child. If any of these are lacking, she may delay having a child. Some women don’t even realize that they want a baby until their 40s and they hope that time has not run out.

A woman is most fertile until her early 30’s when egg quality starts to decline. The decline accelerates after age 35, and by age 40, her chances of becoming pregnant naturally are about 5% each month. That is unless she uses acupuncture and Chinese herbs to improve her odds.

It may take several months, but as long as she still has a regular cycle and there are healthy sperm and eggs, pregnancy is possible. However, if there is a blockage in her uterus or fallopian tubes, or an issue with her partner’s sperm, a reproductive endocrinologist (RE), or fertility doctor must be seen. In fact, by age 40, it is ideal for a woman to see both an RE and a fertility acupuncturist/herbalist to make sure that she doesn’t waste any precious months by trying to conceive with an undiagnosed issue. Regarding fertility issues, eastern and western medicine work together very well.

Why does fertility decline as women age? A baby girl is born with 1-2 million eggs, which decline by about 11,000 per month before puberty. By the time she enters puberty, she has about 300,000 eggs left and at the end of her reproductive years, 30-40 years later, she runs out of eggs.

By age 40, a woman’s Anti-Mullerian Hormone (AMH) levels, which is a measure of the number of eggs left but, importantly, NOT the quality of them, have declined significantly. Acupuncture and Chinese herbs that nourish Blood and Yin and astringe Jing can help increase AMH levels. A patent formula I use clinically for this is Fu Ke Zhong Zi Wan It is used for preventing early miscarriage as well. Individual herbs to increase AMH levels include Bai shao, Du zhong, Gou qi zi (which can be eaten as a snack), and He shou wu, among others.

Follicle-stimulating hormone (FSH) levels begin to rise as a woman’s body attempts to stimulate the ovaries to produce more eggs, even though fewer are available. A higher FSH indicates lower egg quality. FSH can be lowered using Chinese herbs, specifically Yin tonics. An excellent formula for lowering FSH due to Yin Deficiency is Liu Wei Di Huang Wan. If she also exhibits heat signs at night, I prescribe Zhi Bai Di Huang Wan, or Er Xian Wan, if she is very hot and also has Yang deficiency.

By age 40, some of the remaining eggs will have abnormal chromosomes, and there isn’t anything that can be done to improve those. It takes 120 days for a primordial follicle to become an egg that is ready to ovulate, so regular weekly or bi-weekly acupuncture that affects the ovaries, in addition to taking the appropriate herbs for her diagnosis, will encourage the folliculogenesis of healthy eggs. Pregnancy near and after 40 can be achieved, but it takes time (3-6 months), weekly acupuncture, and daily doses of Chinese herbs that are properly prescribed for the woman’s TCM pattern diagnosis.

Case Studies

The following two case studies are chapters from my book, “Waiting on Pins and Needles”, about treating infertility in older women with acupuncture and Chinese herbs.

Case study #1: Xiaomin

Xiaomin, a 38-year-old software engineer came to see me, nervous because her biological clock was ticking. She said the sound was deafening! One of the best parts of my job is getting to know my patients. I ask them all kinds of questions because I love hearing their personal stories. Things, like, where did you grow up? What does your husband or partner do? I find people to be endlessly fascinating.

Xiaomin was all business, so it took time to draw her out, but eventually, I made some headway. She already had one child, a 6 ½-month-old son, and she wanted a sibling for her baby boy. She came to see me with low expectations but with the hope that I could work some magic. She was seeing a reproductive endocrinologist (RE) in Denver to be evaluated for in-vitro fertilization (IVF), and her numbers didn’t look good. In fact, they were in a range that would prompt most IVF clinics to turn her away. Her follicle-stimulating hormone (FSH), which measures the health and approximate age of the egg, was 17 IU/mL. The ideal FSH level for IVF is below 10 IU/ml. Her anti-Müllerian hormone (AMH), which measures the quantity of eggs left in the ovaries, was very low at 0.15ng/ml. Most clinics prefer an AMH level between 1 and 3ng/ml. The number of resting ovarian follicles on day three of a woman’s cycle gives the IVF clinic an idea of how well a patient will respond to stimulation medications. An ideal resting follicle count is between 15-20. She had only two resting follicles as seen on an ultrasound. Most IVF clinics won’t even consider doing an IVF when a patient has numbers like hers.

Xiaomin also had endometriosis which caused painful periods, so painful, in fact, that she’d take painkillers just to make it through the day. While we were waiting to see if she could improve her situation with acupuncture and herbs to be considered for IVF, I put her on blood-moving herbs to resolve the cramps and chose the formula Tong Jing Wan. These herbs break up Blood Stagnation that causes pain during menstruation. Picture a garden: if a gardener plants seeds in clumpy soil, they are less likely to grow or to grow well. Blood-moving Chinese herbs “aerate” the soil, making a healthy bed in which the seeds can implant. She reported only a little pain during her next menstrual cycle, and, for the first time, she didn’t need painkillers.

Xiaomin wanted to do everything to make her IVF dream happen, so she saw me for treatments twice a week. To boost the health of her eggs, I used points over her sacrum (UB 31, UB 32, UB 33, UB 34) to move and tonify blood flow in her eggs and uterus. She continued this for three months and took the Tong Jing Wan I prescribed. She reported less pain, a brighter red flow, and a healthier flow with each period. Her uterus “garden” was getting healthier and more receptive to an embryo!

Four months after she started acupuncture treatments, Xiaomin’s levels were tested again. Her FSH decreased from 17 to 14, her AMH increased from 0.15 to 0.4, and her ultrasound showed she had five resting follicles, up from two. Her numbers looked promising but weren’t quite there yet. Looking back, I should have also recommended a Yin tonic like Liu Wei Di Huang Wan to decrease her FSH even further. She was approved for IVF, and to be honest, I was surprised the clinic made this decision. Even though her numbers had improved, they were still not optimal. The clinic must have felt like she would succeed if they were willing to put her through an IVF procedure. Nonetheless, I was there to support my patient no matter what. I remained cautiously optimistic.

Xiaomin started IVF medications five months after starting acupuncture. She continued to see me twice a week. Most people come in twice a week for the four weeks leading up to the embryo transfer, but Xiaomin had been coming in twice a week for four months.

She produced five mature eggs, four of which fertilized. This was truly an amazing result, considering that usually only half of the retrieved eggs fertilize in most IVFs. The RE transferred one embryo into her uterus, which successfully burrowed in and implanted.

Xiaomin delivered a healthy baby boy and was grateful that she had decided to pair Eastern and Western medicine to enhance her fertility and make her dream of expanding her family possible. I’m certain her frequent acupuncture treatments plus herbs, and her intense commitment made all the difference.

Case study #2: Mary

At 41, Mary came to see me, discouraged about her dream to have a third child and worn out from trying. In the 15 months before she came in for treatment, she had endured first trimester miscarriages at six, nine, seven and five weeks, respectively. She already had two healthy boys, aged six and three, so we knew she was able to get pregnant and carry a healthy baby to term. She had explored the possibility of low progesterone levels, which she thought could be causing the early miscarriages, but her progesterone level during her last pregnancy was 24 ng/ml, which is excellent. Normal levels average 12-20 ng/ml, so that didn’t seem to be the problem. Her periods were very light, indicating that she may not have enough uterine lining for an embryo to attach to.

Mary adhered to a mostly vegan diet but did eat an occasional egg. She worried about her low body weight, so I suggested that she add humanely raised meat if she could tolerate it. Despite her commitment to veganism, she was open to my recommendation, given that she really wanted another child. She was supplementing her vegan diet with cod liver oil and vitamin B-12, which can be hard to get in a vegan diet.

Mary lived four hours away in the mountains, so a weekly in-person appointment wasn’t realistic, especially with young kids. We worked together over the phone and via email. I sent her Blood, Jing and Yang tonifying Chinese herbs customized just for her. A similar Mayway patent formula is Ten Flavor Teapills. Another option if the patient is not as cold internally is Women’s Precious or Nu Ke Ba Zhen Wan.

Things weren’t moving as quickly as we had hoped, so she agreed to come in for weekly acupuncture sessions for one month, then once a month after that. She added buffalo to her diet, which is rich in iron, and is good for building blood as well.

During one of our sessions, Mary revealed she still had the placenta from her pregnancy with one of her sons in the deep freezer. Mary was planning to plant it under a tree, as some indigenous cultures do, including Native Americans and the Maori of New Zealand. In these cultures, placenta burial symbolizes the baby’s link to the earth. In addition, planting a small tree that was “born” in the same year as your child is a lovely way to mark your child’s growth. In traditional Chinese medicine, the placenta (Zi he che, placenta hominis) has been used for hundreds of years as a supplement for patients who are deficient in Jing and Blood. Jing is the measure of one’s overall strength and vitality. Blood in Chinese medicine is more than just the fluid that runs through your veins and flows during menstruation. Blood is used by all of the organ systems. Blood deficiency is characterized by pallor, fatigue, dizziness, poor memory and concentration, dry skin and hair, brittle nails, and a light menstrual flow. It is interesting to note how these symptoms correlate to symptoms of dietary iron deficiency, which can happen on a vegetarian diet even if one is as careful as Mary.

It is certainly not my intention to offend vegetarians and vegans by recommending meat consumption. But it’s important to note that traditional Chinese medicine recommends everything in moderation, including meat. To help Mary get pregnant, she needed to build up her Blood and Jing, and eating meat was the quickest way to do that.

Jing can be compared to the genetic endowment one receives from their parents. Women who are Jing deficient often feel cold, weak, have issues with their teeth and bones, and with their fertility. As we age, our Jing reserves decline and do so more rapidly if we don’t stay healthy and take good care of ourselves. Some women are born with low stores of Jing, but this wasn’t the case with Mary. She easily had two children into her late 30s.

Because of Mary’s thin uterine lining at the age of 42 and the effects of being a long-time vegan I suggested that she consume her placenta. Before you get too grossed out, you should know that placentas are an amazing source of nutrition, especially for someone like Mary who was very Jing deficient. At least it would be her own child’s placenta, and not that of an anonymous donor—right?

Placentophagy advocates refer to the Compendium of Materia Medica, a comprehensive medical text of traditional Chinese medicine from the 16th century, as evidence of the long history of postpartum practice and the placenta’s medicinal properties. Zi he che, the Chinese term for dried human placenta, has historically been used for treating various ailments, including fatigue and postpartum anxiety, and depression. There is some debate in the Western world about the safety and efficacy of consuming placenta, as it filters out toxins before they reach the baby. Selenium, cadmium, mercury, and lead, as well as bacteria have been identified in post-term placental tissues.1 I don’t recommend it to everyone, just those who are quite deficient.

I shared with Mary that I had consumed my placenta after my daughter’s birth. Initially, I resisted the idea because it sounded gross, but I knew from my education how valuable it was. My acupuncturist, Kristie, recommended I do so, as my children were only 18 months apart, and I hadn’t had much time to recover from the first pregnancy. The thought of stir-frying it with onions sounded revolting, like a more disgusting version of liver and onions. She assured me that there was no stir-frying involved! She was so insistent that I do it, that she offered to process my placenta for me.

My husband and I told our midwife of our plans, and since the hospital wasn’t open-minded about releasing placentas to patients, she had a plan. During my daughter’s delivery, our midwife quickly handed the placenta in a bucket to Scott. He sneaked the contraband out of the hospital and into the back of his Jeep. My daughter was born on a winter’s night, which worked to our advantage. The placenta sat in the Jeep overnight and was frozen by morning. The next day, Scott drove it to Kristie who washed it and dehydrated it in her oven while her dogs, intoxicated by the smell, whined, and stared at the oven, hoping the treat was for them. She then ground it into a powder and put it into capsules for me to take, three pills two times a day. I have never felt better than when I was consuming those pills! They were such a tonic to my system, I felt like I was running on rocket fuel.

When I finished with the pills, I was sorry they were gone. They made me feel amazing! I was infused with energy and was much less anxious than I had been during the postpartum period with my son. I wanted more but wasn’t willing to consume anyone else’s placenta, even if it was in capsules. The recovery from my second delivery was relatively easy, and I had enough energy to handle a baby and a 19-month-old toddler.

Upon hearing my anecdote and understanding that it would really help her, Mary was open to the idea, especially since she hadn’t buried it yet. I told her there were many options for consuming the placenta, including putting fresh placenta in a smoothie, like one of my patients had tried. Mary said that a placenta smoothie sounded awful. So, she opted for having it processed by a midwife into capsules, which she took daily. Her cycle quickly became redder and heavier.

After 13 months of meeting with me weekly and then monthly, five months after including meat in her diet, and four months after consuming her placenta, Mary became pregnant with a baby girl! She was 43. Mary had an easy, full-term pregnancy, and Emmy is now a healthy 13-year-old who adores her two older brothers.