What TCM thinks of your “old” eggs
When Avery started trying to have a family at thirty-six, like many women her age, she believed she had lots of time to have a child. She began worrying about her age when, at thirty-eight, she still hadn’t conceived. Unfortunately, her fertility doctor did not provide comfort or reassurance. When she came to see me, she was not only upset that she hadn’t conceived after her first IUI but was still troubled by the things her doctor said at their first appointment. She didn’t know how to get past the statistics the doctor had presented and she admitted to having negative thoughts and feelings that were interfering with her ability to stay positive.
Instead of talking about biological age as markers for fertility, in TCM we speak about fertility in terms of our vitality and energy. In the ancient practice of TCM, we believe we are born with a certain amount of energy, which we inherit from our parents. This finite amount of energy is referred to as Jing Qi (primordial, congenital, source energy, or Essence). In addition, we are able to tap into and produce energy through food and drink, which TCM refers to as Gu Qi (acquired nutritive energy). We also acquire energy from the air (oxygen) we breathe and metabolize it into usable energy for our bodies. This includes energy for procreation. While we can replenish the nutritive Gu Qi, our Jing Qi declines with age and living.
Women’s energetic life stages
Chinese medicine goes on to say that women and men have energetic stages in their lives. For women, these stages are in cycles of seven years (for men it’s eight):
•At seven, a girl’s Jing essence (her inherited energy) becomes bountiful and manifests in permanent teeth and healthy hair.
•At fourteen, she enters puberty as her essence fills her reproductive organs and menstruation begins.
•At twenty-eight, her sexual energy peaks.
•At thirty-five, her sexual essence begins to decline. Jing Qi energy is divided into different functions, which includes sexual energy/essence.
•At forty-nine, a woman’s reproductive essence becomes exhausted and menopause ensues.
According to Chinese medicine, a woman’s procreative energy is not accessible indefinitely, but neither does it end at thirty-five or forty years of age. We acknowledge the shift in her reproductive essence at age thirty-five but believe that a woman who lives in balance with nature in body, mind, and spirit can spontaneously conceive right up until the onset of menopause. My two grandmothers both had healthy babies at the age of forty-six.
TCM believes that, as we age, we deplete our Jing essence. The more we over-extend ourselves, the more we deplete this essence. Stress is a major cause of this depletion: working long hours for years on end is physically draining; hating your job and feeling unfulfilled is emotionally and spiritually draining.
Also in TCM theory, the fertility journey, if not approached in a balanced way, can deplete your energetic essence. Anyone who has faced fertility challenges will attest to how taxing they can be physically, emotionally, and spiritually. The key is to mitigate your stress and conserve your energy, including the sexual energy required to create life.
Achieving balance through TCM
After Avery and I talked about the different perspectives TCM and Western medicine have of reproductive health, we addressed the importance of creating balance in her world. That included processing and letting go of the things her fertility doctor told her to expect, or not expect. When a woman who is working hard at conceiving hears that, statistically, her efforts may be in vain, that kind of information can stick—especially when her fears are being confirmed by a doctor in a lab coat.
While Avery understood the TCM concept of energy and essence, she was still convinced she was going to have a challenge conceiving because her fertility doctor told her so. But because the environment in my clinic is so different from the fertility clinic, and my staff and I were welcoming, nurturing, and attentive, Avery began to open up to the possibility that the fertility doctor did not have the final word. I assured her that I would not make false promises, but that given her history and health, I believed she could become pregnant. Avery decided to work with me and my team for three to four months with a view to creating an environment in which she and her husband could make a baby.
Avery expressed to me in our initial meeting that she was worried she’d waited too long and on some level regretted pursuing financial stability, career, and partnership in her law firm. She wished they’d tried when they were younger instead of avoiding pregnancy so diligently. She was beating herself up for past choices. I encouraged her to let go of these negative thoughts, reminding her that they did not contribute to a healthy environment into which to welcome a baby.
Socio-economic trends
Having access to birth control for the past several decades has prevented women from having unplanned pregnancies, allowing young people to focus on education, career, and financial stability and delay marriage and childbirth. One study showed a thirty percent increase in women in the skilled work force from 1970 to 1990.6 Along with this, women are working more hours. There is also a self-incentive to delay marriage and childbirth because of the known “family gap” in the workplace, where a working mom generally receives less pay than a childless woman.7
In 1972, women comprised thirty-eight percent of the general workforce,8 and today it has increased to nearly half in the United States9 and Canada.10 Fifty-one percent of employed women work in management and professional positions,11 which tells me that as many women as men are in the workforce and as many working women as working men are in stressful, demanding jobs with long hours.
I will talk more about work stress in Chapter 6. The important point here is that there is no blame. In a world of rising living standards, modern women invest in and focus on their education and financial security. Focusing on the next promotion or achieving seniority can make it difficult to even contemplate finding a mate or making babies. Even in relationships, both partners generally work and, with busy schedules, often struggle to find time for intimacy. As a result, a woman’s natural maternal instincts can be set aside and suppressed as she is consumed by demands of work.
Survival mode kicks in
Avery and I discussed the years of stress she’d been under, first working toward partnership and then trying to conceive. That kind of stress can create disharmony and imbalance in the body. And being a high achiever, Avery’s workload and stress continued now that she had a financial stake in the firm.
She and her husband had started trying to have a baby immediately after she’d achieved partnership. They’d not prepared at all for a baby, other than not using protection. And each month when her period came, she shoved aside the emotional stress of not being pregnant, which in and of itself can be an emotional rollercoaster ride of hope and anticipation, followed by sadness and despair. This alone can be so overwhelming as to perpetuate long-term disharmony in the body.
According to TCM, when your body goes through cycle monitoring and even a single IUI cycle, as Avery’s did, your system becomes taxed. If you’ve already accumulated a lot of stress in your life, these procedures can send your system into survival mode, where your ovaries and uterus are almost dormant as your energy is diverted to support your brain, heart, and limbs. This does not mean your body is failing you, but that it is lovingly and protectively telling you, “Not yet. Let’s wait for a better time, when you are in a more balanced state physically, mentally, and emotionally, before becoming pregnant.”
After I explained to Avery the impact on her fertility of the years of stress she’d endured, she understood she was in a phase of reproductive dormancy. As a result, her blood tests and ultrasounds were less than optimal, which her RE interpreted as POR. I encouraged her to have faith that her body and her ovaries had an ability to shift, and that she was not necessarily going into menopause.