Ancient wisdom in today’s fertility research
In our information age, it’s not uncommon to develop a habit of dismissing anything that isn’t supported by multiple recent and statistically significant RCTs and meta-analyses as hogwash, pseudoscience, or baseless. And while there is merit in this high standard for evidence (in many cases, it’s justified), we still must be prepared to acknowledge that research is really only as good as the humans, budgets, biases, and organizations completing it.
I believe in the possibility of holding two beliefs at one time: respect for the utility of modern scientific literature, and respect for the thousands of years of ancient wisdom that isn't as represented in the pages of PubMed. However it is so gratifying to see peer-reviewed research that does support ancient remedies. It can help put our analytical minds at ease, and inspire us to comfortably lean back into the healing modalities of our ancestors.
I am not promoting any specific modality, treatment, or way of thinking over another. My intent is to provide you with the scientific side of these practices for you to make the best decisions for yourself. Today’s blog highlights 3 facets of ancient wisdom that our modern culture has found scientific support for, and how we can use these age-old concepts to serve our health today.
Kidney essence for egg & uterine support
In Traditional Chinese Medicine (TCM) balanced qi (pronounced “chi) or vital life force, is the secret to living free of mental or physical illness or ailments. Qi is the energy present in all things and is always in flux: dynamic and transforming. When our qi is harmonious, we are at our healthiest state. When qi is deficient, depleted, or out of balance - identifying the root cause will restore balance in the body. There is also the concept of yin and yang, the necessary duality of opposing forces. For fertility health specifically, TCM calls attention to the kidneys as the origin of yin-yang of the organs and the source of life of the human body. We all have a certain amount of kidney essence, but when it is out of balance (either an imbalance in kidney yin or kidney yang), it can result in delayed periods, non-ovulation or scanty menstruation, amenorrhea or infertility.
A core tenant of TCM is that outside factors can affect balance in the body, so many of those issues can be attributed to causes we know about: under-nourishment, over-exercising, poor sleep, poor diet quality, and chronic stress. TCM says that nourishing kidney yin (essence) can regulate periods, restore normal levels of FSH, support estrogen production to thicken the uterine lining, and develop healthy follicles and eggs, and healthy sperm production for men. Strengthening kidney yang can support progesterone levels and promote fertilization and implantation.
One experiment of this 2023 randomized double-blind placebo-controlled trial looked at 80 women with low fertility (determined by “diminished ovarian reserve,” a combination of low AMH, low FSH, and low follicle count) and kidney essence deficiency (determined by TCM standards). One group received a treatment of Chinese herb granules known to support healthy kidney essence, and the other group received a placebo. Ovarian cell quality was analyzed after the intervention, as well as fertilization rates, embryo quality, and pregnancy rates between the Chinese herb and placebo groups. They found that compared to the control group, the fertilization rate in the treatment group was higher, and the difference was statistically significant. In terms of the high-quality embryo rate and the clinical pregnancy rate, the outcome of the treatment group was improved to some extent, but there was no statistically significant difference between the 2 groups.
This 2022 RCT clinical study looked at 60 individuals with an infertility and kidney deficiency (TCM definition). Half were given a Chinese medicine decoction, and the other half were given an estradiol table (control). The endometrial thickness of the two groups increased significantly after both treatments, and the endometrial volume in the Chinese decoction group was significantly higher than that in the treatment group. This improvement in uterine blood flow and endometrial thickness is associated with higher implantation and pregnancy rates.
This 2021 systematic review and meta-analysis evaluated the efficacy and safety of traditional Chinese medicine (TCM) therapy of tonifying kidney and activating blood circulation based on the theory of “kidney deficiency and blood stasis” for the treatment of immune infertility. “Immune infertility” refers to one or both partners having an antisperm immune reaction capable of impairing fertility, and accounts for around 10-20% of infertility cases. They found that therapy based on the theory of kidney deficiency and blood stasis could significantly improve the total effective rate, negative antibody conversion rate, and pregnancy rate with fewer adverse effects, yet more high-quality RCTs are needed to confirm these findings.
Yoga poses for menstrual pain relief & ART success
“Yoga” is the Sanskrit word for the connection of the mind, body, emotions, logic, and attention to action. In the West, we tend to lose reverence for this ancient practice by delegating it to post-exercise stretches or a rest-day’s movement. But truly yoga is a serious art of resilience, discipline, effort, and non-attachment. When done purposefully, yoga brings profound psychobiological and neuroendocrine benefits to the table.
These effects were seen in the following studies that showed how certain yoga poses (specifically cat-cow, fish, child’s, cobra, and plank pose) can ease PMS symptoms after only a short period of time. While these poses absolutely support our musculoskeletal structure, the positive outcomes from these studies are also due to the impact of mindfulness on our biology. Yoga’s focus on posture and breathing deeply benefits our nervous system, and we know an at-ease parasympathetic response is paramount for healthy fertility.
This 2020 randomized trial included 72 women with PMS symptoms and divided them into two groups. 1 group was assigned to 30 minutes of aerobic exercise on a treadmill, and the other group was assigned to 10 minutes of Kapalbharti Pranayam (which includes automatic inhalation with short and forceful exhalations), 20 minutes of yoga, plus 10 minutes of Shavasana for 15 days. The results showed that both aerobic exercise and yoga movements significantly reduced pain intensity and PMS symptoms, but that yoga is more effective in relieving the symptoms of PMS than aerobic exercise.
Primary dysmenorrhea (cramping before a menstrual period) is very common, so this 2011 RCT also sought to determine the effectiveness of yoga in relieving that pain. They included 92 women with painful menstrual cycles, and assigned one group to yoga during their post-ovulatory (luteal) phase for 3 menstrual cycles. The other group served as a control, so they were not assigned to any new activity. The results showed that compared with the control group, there was a significant difference in the pain intensity and pain duration in the experimental (yoga) group, which supports the role of yoga poses as a safe and simple treatment for primary dysmenorrhea.
The effects of yoga stretch even further than menstrual relief, as this literature review found that yoga can help couples overcome infertility and increase assisted reproductive technology (ART) success rate by improving the physiological and psychological states of both men and women. This review looked at couples experiencing infertility across 87 publications who were given a yoga-based intervention. They found that yoga has beneficial effects on fertility by increasing ART success; helping decrease depression, anxiety, and stress; reducing the rate of assisted vaginal delivery; and improving fetal outcomes.
Morning sun for hormone balance
The recent biohacking trend to get morning sunlight in your eyeballs within 1 hour of waking can seem like a renewed, modern appreciation for our life-giving sun. It’s completely understandable why we’ve lost a bit of touch with our sun, as our days no longer start and end by its rising and setting.
The reason why “sunlight before noon” is so intriguing from a research standpoint is that every cell in our body has an internal clock. Sunlight triggers the release of around 50% more circulating cortisol, epinephrine and dopamine (all important hormones), and makes it happen early enough to facilitate healthy sleep at night when the levels drop. And some very interesting research has linked the effect of sunlight in the morning to regulating our circadian hormones (no surprise there), but also in quite surprising aspects of fertility like stimulating ovulation and increasing FSH and LH (reproductive hormones)!
This very cool 2007 randomized controlled crossover (and counterbalanced) study had a small sample size of 22 women, and exposed them to either dim light or bright light in the morning, each day for a week straight. They took blood samples before and after the light exposures. The study showed that prolactin, LH, and FSH secretions, and ovarian follicle growth and the likelihood of ovulation are all increased following a week of morning bright light exposure compared with dim light administered to the same women, in the follicular phase of their cycles.
A 2020 review went into mechanistic detail on how exactly our circadian rhythms, hormones, and fertility are connected. It’s well-established that female fertility hormones are on a 24-hour rhythm (as well as a monthly rhythm of course), regulated by CLOCK genes - meaning all our cells have this internal timekeeping ability. The review concludes that chrono-therapeutical strategies that reset or modify the biological clock may help counteract pathological symptoms of infertility. Knowing that morning sunlight stimulates this daily hormone rhythm, light before noon is a very reasonable (and free) version of fertility-boosting chronotherapy.
Light timing’s effect on the menstrual cycle is explored in detail in this 2023 review, and some of the most compelling evidence consistently shows that longer photoperiods (environmental sunlight) increase ovarian function, while shorter photoperiods decrease ovarian function. Healthy sleep-wake cycles (encouraged by morning sunlight exposure) also correspond to better evening melatonin stimulation, and melatonin has been found to have antioxidant effect on egg quality. As a fun side note, this paper also looked into the research on lunar cycles and menstrual cycle timing. As much as I’d love to say the menstrual cycle has a direct connection to the lunar cycle, the evidence is inconclusive (though I was surprised by the amount of studies that looked into this connection!)
The takeaway
It’s wonderful to see concepts we innately know are healing and beneficial supported by the peer-reviewed evidence our modern culture reveres. Here’s a quick summary on how to bring these concepts into your life:
Prioritize getting a 10-20 minute sun-session in before noon (without sunglasses!)
Try incorporating a yoga practice or two into your week, especially if you are someone who suffers from pre-menstrual pain.
Find a TCM practitioner near you if you’re interested in getting to your root causes. If that’s not available to you, I really enjoy (and am a customer of) the company Elix, which will tailor a herbal TCM formula to your specific hormonal needs.
Written by Michelle Cawley, MS. 6/6/23
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REFERENCES
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