Case Report: Acupuncture in Infertile Women of Advanced Reproductive Age with Low AMH

Abstract

Low AMH Anti-Müllerian Hormone (AMH) is a hormone produced by the granulosa cells in ovarian follicles. It indicates the presence of a woman's eggs. The more eggs a woman has the more granulosa cells she has and the higher her AMH. Lower AMH shows low egg supplying which is associated with infertility. According to the American College of Obstetricians and Gynecologists (ACOG) [3], the production of AMH is reflective of the ovarian reserve. A low AMH level (< 0.5-1.1 ng/ml, Bologna criteria) points to a diminished ovarian reserve (DOR) or low egg count, which is linked to fertility. Consequently, low AMH can predict poor response in controlled ovarian stimulation [4]. According to traditional Chinese medicine (TCM), DOR is caused by four factors: the imbalance of qi, blood and body fluid; the dysfunction of the channels Chong and Ren; and the dysfunction of Zangfu/viscera such as kidney, spleen and stomach qi deficiency; and liver qi stagnation. TCM Etiology and Pathogenesis In traditional Chinese medicine, the book "The Inner Classic of the Yellow Emperor: Simple Question; The Universal Truth" mentioned a physiological law called "Seven Women and Eight Men". It means that the rhythm of life of women is related to seven, while the rhythm of life of men is related to eight. "In general, the reproductive physiology of woman is such that at seven years of age, her kidneys' energy is strong. At fourteen years, Tian Gui, or fertility essence is mature, the Ren/conception and Chong/vital channels are flourishing, menstruation begins, and conception is possible. At twenty-one years, the kidney energy is strong and healthy, the wisdom teeth appear, and the body is vital and flourishing. At twenty-eight years, the bones and tendons are well-developed and the hair and secondary sex characteristics are complete. This is the height of female development. At thirty-five years the Yangming/ stomach and large intestine channels that govern the major facial muscles begin to deplete, the muscles begin to atrophy, facial wrinkles appear, and the hair begins to thin. At forty-two all three yang channels-Taiyang, Shaoyang and Yangming are exhausted, the face is wrinkled, and the hair begins to turn gray. At forty-nine years the Ren and Chong channel are completely empty, and the Tian Gui has dried up. Hence, the flow of the menses ceases and the woman is no longer able to conceive." Abstract Female reproductive aging is a common cause of infertility in women in their late 30s and 40s [1] Because female fertility begins to decline in women of advanced reproductive age (≥ 35 years old), advanced reproductive age (ARA) is a risk factor for female infertility, pregnancy loss, fetal anomalies, stillbirth, and obstetric complications [2]. This article reviews on 10 clinical cases of Canadian women who are infertile due to advanced reproductive age with low AMH level (<1 ng/ml), and, who, after several failed IUI or IVF cycles, were treated with acupuncture for 3 to 6 months. All 10 women had spontaneous pregnancies and live births. Acupuncture is effective for patients of advanced reproductive aged with low AMH who did not respond to IUI or IVF protocol. Method: based on weekly treatments, the 12 course-treatment of acupuncture focussed on invigorating kidney qi and nourishing the spleen and stomach in order to increase the probability of the outcomes of pregnancy and live birth by regulating menstruation and ovulation, and improving egg quality.