Written Lesson
Introduction to Herbs
Herbs are prescribed for enhancing fertility by a variety of complementary and integrative medicine practitioners. Those practicing functional medicine and western herbal medicine usually prescribe single herbs. Licensed acupuncturists who also have received training to practice Chinese herbal medicine prescribe herbal formulas. These formulas usually consist of 10-15 different ingredients selected from a large number (over 500) of different types of herbal, animal and mineral constituents of the Chinese pharmacopeia.
When designing a herbal formula for a patient a Chinese herbal medicine practitioner usually starts with a base formula. These base formulas have been used for specific conditions for 100s to 1000s of years, some dating back to the early use of classical Chinese medicine, and others more recently developed. Chinese herbal medicine has been used to treat gynecological conditions for many millennia and such practices are well documented. Therefore, the base formulas have a long history of usage and clinical practice assessment for effectiveness, safety and side effects. Base formulas are usually modified to suit the characteristics of individual patients by the addition or omission of individual ingredients. Formulas are also modified over time as a patient’s condition changes in response to treatment, and in relation to different times during the menstrual cycle and if pregnancy occurs.
Chinese herbal medicine is the most complex aspect of East Asian medicine and requires considerable additional training. Masters and doctoral degree programs that include herbal medicine are one-third longer, usually equating to an additional 1-2 years of education, as compared to acupuncture only programs. Accurate diagnosis is very important, as is the ability to modify formulas in relation to changes in a women’s fertility cycle. For this reason, choosing a practitioner carefully is important.
Your practitioner should be able to provide you with a list of the ingredients that are in your formula. Typically, ingredients are referred by both their Latin name and Chinese pin yin name. This information can be shared with your other healthcare providers.
Efficacy of Herbs
Many acupuncturists will prescribe and dispense herbs to address a patient’s fertility issues. There is a wide variety and combination of herbs that can be used and we may overgeneralize at times in this section.
Unfortunately, the quality of our data around the efficacy of herbs in conjunction with IVF is poor, even worse than our data around acupuncture and IVF. Today we have roughly 20 studies on the subject, but nearly all are small and suffer from major design flaws. Presuming this is the best data we have to work with, the meta-analysis below suggests that use of herbs improves pregnancy rates. However the authors urge “extreme caution” about reading too heavily into the results. We would not be surprised if this data proved wrong when more rigorously studied.
Safety of Herbs
We should point out most fertility doctors prohibit their patients from using herbs leading up to an egg retrieval, or ahead of a programmed embryo transfer where estrogen or progesterone is used. The fear is that using herbs in conjunction with these medications, or around the time of anesthesia, could result in a bleeding issue or have an impact on the drug’s ability to work. We’ve yet to see the data that supports this fear.
When Cao looked through the safety record of the above-mentioned 20 trials, she noted patients taking herbs before or during IVF suffered no higher rates of miscarriage or OHSS than those who did not take herbs.
Finally, patients must be extremely careful taking herbs from an unvetted source. There is no regulation to ensure herbs given to patients have been properly grown or processed, especially if they are sourced from China. We suggest relying upon your acupuncturist for guidance.
Popular Herbs
There is a spectrum of herbs acupuncturists can prescribe and the reality is we see a lot of trial and error in the process. All the same, below are four herbs that are frequently used. While many have a plausible case to be helpful, almost none have hard data that demonstrates they improve live birth rates in humans. We believe this is a result of omission (nobody has studied this thoroughly) rather than commission (the studies were done and turned out negative).
Vitex (Chaste Tree Berry)
Vitex is a popular herb for balancing the menstrual cycle and resolving PMS. It likely acts on the pituitary gland in the brain, increasing the strength of the Luteinizing Hormone (LH) surge, which triggers ovulation. This in turn can strengthen ovulation and progesterone production in the luteal phase (when your ovaries have released the eggs and the endometrium prepares to receive an embryo). It has also been shown to decrease abnormally high prolactin, thus improving hormone balance and ovarian function. This herb helps women with ovulation problems and women with luteal phase defect who have a short luteal phase or low progesterone production.
Maca (Lepidium Meyenii)
Maca has been used as a libido and fertility enhancing medicinal. It is indigenous to the Peruvian Andes and is a tuber (like a turnip). It acts as an adaptogen, helping the body cope during times of increased stress, but it may also affect androgens (testosterone) in both men and women. It is unclear if it affects actual levels of testosterone or just the receptor, but it has been shown in one very small study in males to improve semen parameters. Unfortunately, our only confirmatory data in females is limited to mice. In light of the effects on testosterone activity, however, this supplement may not be helpful for women with PCOS, which often is associated with elevated male sex hormones, like testosterone.
Cinnamon
Cinnamon may improve fertility in both men and women. In Chinese medicine, cinnamon bark (the spice) is used to warm the interior and nourish yang energy, which must be abundant for fertility. Our best data on the effect of cinnamon in males are encouraging (improvement in semen parameters) but are too early (in mice) to offer reassurance. Studies have also demonstrated that cinnamon affects blood sugar balance and the insulin response, so it may be helpful for metabolic syndrome and women with PCOS as well.
Tribulus terrestris
Tribulus may be helpful for both male and female fertility. In women with irregular ovulation, especially due to PCOS, Tribulus may help normalize the cycle and create predictable ovulation. One study showed it also increased conception rates (when both partners took it) in couples that had high levels of anti-sperm antibodies. That same study saw an improvement in the male’s sperm parameters, including motility, concentration and volume.
Zishen Yutai Pill
The Zishen Yutai Pill, also referred to as the Zi Shen Yu Tai Wan Pill or Zishen Guchong Pill, is a popular traditional Chinese medicine formulation widely utilized in ART treatments, primarily in China. This herbal remedy shows promising potential in supporting human reproductive health, including its application in in vitro fertilization embryo transfer and managing various reproductive disorders. A 2022 study by researchers based in China and at Yale University showed that the Zishen Yutai Pill increased the rate of live birth after fresh embryo transfer compared with placebo with no significant differences in the rate of pregnancy loss or in neonatal or maternal complications.
Pro Tips
While the data on herbal impact on success rates is encouraging, interpret it with caution.
Let your reproductive endocrinologist know if you are taking herbs. They may have concerns about its interaction with injectible hormones.
Let your acupuncturist know when and if you have begun injectible hormones.
Only take herbs provided to you by a trusted or vetted source. There is no regulatory oversight to ensure herbs have been safely processed.
Ensure your acupuncturist has the proper credentialing to prescribe herbs. You can read more about this in the next lesson.