To a TCM practitioner, the tongue provides another glimpse into the overall state of an individual’s health. The tongue is the only visible internal muscle in the body. Its colour, size, and shape, as well as the thickness of the coating on it, reflect a lot about one’s health. Avery’s tongue was pale and swollen with teeth-marked edges, as if it was too big for her mouth. Increasing blood flow would make the tongue pinker, and increasing Qi (vital energy) would help the tongue hold its shape better.
To improve Avery’s blood and energy flow, we began weekly acupuncture treatments and Chinese herbal medicines. She began to make some lifestyle changes, which included eating warm, cooked foods and drinking warm drinks, in contrast with her usual fare of frozen berry smoothies and cold salads. According to TCM, when we eat cold food and drink, we use energy to heat it before we can digest it. If we want as much energy as possible to go toward reproduction, we must conserve our energy by eating warm and easy-to-digest foods. Refer to Chapter 1 for more information on eating for fertility.
Preparing the soil for the seed
Avery liked the idea of preparing her body (soil) before she planted the seed. Her plan was that if she did not get pregnant naturally in six months, she would consider IVF. She was not interested in a donor egg from a young woman.
She changed her habits, going to sleep an hour earlier and sleeping eight hours each night. Soon she had more energy and was less irritable. She began using menstrual pads instead of tampons, as in TCM we believe menstrual blood is meant to flow out unimpeded rather than being plugged up, which can cause stagnation over time.
Within two months, Avery reported that her periods had become pain free for the first time in her life. When her period came, she would have a day of disappointment and sadness but, because she was feeling better overall, she felt more in control of her health. She wasn’t focusing on her urgent need to be pregnant.
Feeling better physically allowed Avery to feel stronger emotionally, to process her feelings of sadness each month, often during our acupuncture sessions. Feeling better gave her hope that she was moving in the right direction by creating an internal environment that would welcome a child. She felt less desperate, more able to see what was possible rather than what her fertility doctor told her was not. As things improved, it made sense to work on her health for several months before trying IVF. After all, why plant the seed before the soil is ready?
Avery’s welcome surprise
At one of her appointments, Avery came in panicked. “Mary, I think something is wrong. My period is six days late. I’m never late.” I asked if she’d taken a pregnancy test and she said, “I’ve been putting it off because I don’t think I could be pregnant. My husband had a business trip and we were only able to do it once, four days before ovulation.”
I encouraged her to take the test. A week later, she announced her pregnancy with pride and joy and we altered our treatment strategy to support her pregnancy. She came in for treatments every week for the first trimester and monthly during her second trimester. At thirty-seven weeks, we resumed weekly treatments to help ripen Avery’s cervix in preparation for a natural delivery. She went into labour twelve hours after our acupuncture treatment, just two days past her due date. Baby Alexander was born naturally six hours later, a healthy eight pounds, ten ounces.
3
More Than Surviving
Although you may not always be able to avoid difficult situations, you can modify the extent to which you can suffer by how you choose to respond to the situation.
DALAI LAMA XIV, THE ART OF HAPPINESS
Cary: Depression and antidepressants
Cary, a physician, was approaching forty-three and had been trying to conceive for four years when her co-worker referred her to me. She had attempted IVF twice, at forty and forty-one, but her doctor had cancelled both attempts because the injectable hormone drugs had failed to stimulate an increase in egg production. On her third IVF attempt, her ovaries produced multiple follicles from which the doctor retrieved four eggs, but although one was fertilized, no pregnancy resulted.
She came in devastated that her lifelong dream of having a baby might never come true. She’d been with her first husband since she was twenty, but when she was thirty-two and finally ready to start a family, she caught him having an affair. More stress followed as Cary’s father divorced her mother, remarried, and then fell ill and died. Overwhelmed by emotional trauma, she began taking antidepressants and was still taking them when she first came to see me.
“I really wanted to be in love with someone and have a baby,” she told me. “So, I spent the next five years trying to find a partner, and didn’t care about anything else.” At thirty-eight, she met a man who wanted a baby, so they started trying. She loved him but didn’t care whether it lasted; she just wanted a baby. But when she hit forty, she realized they were incompatible. Instead of looking for a new partner, she bought a house with a swing set in the back yard and a park beyond, and assumed she’d raise a child alone.
Ironically, the moment she stopped looking for true love, it landed on her doorstep. At forty, she married her next-door neighbour, ten years her senior. Without wasting time, they sought the help of a fertility clinic. Based strictly on her age, the doctor said there was no time to waste.
The RE diagnosed poor ovarian reserve (POR). Although her follicle stimulating hormone (FSH), a key indicator of ovarian aging, was still within normal limits, he said the shells of her eggs were hard. He doubted sperm would be able to penetrate her eggs naturally, so she’d probably need IVF with donor eggs. Adding insult to injury, he told her to lose weight, as if a clause in some contract dictated she wouldn’t get pregnant unless she lost twenty pounds.
Like many of my patients, Cary came to me as a last resort, gravely disappointed that her life hadn’t fallen into place as planned. But throughout this long journey, she’d opened herself to exploring every possible way to become a mother, through birth or otherwise. It was then that I told her about a previous patient with a similar fertility profile, including low ovarian reserve, who’d conceived through IUI without fertility medication.
The panic factor
When fertility doctors provide women with statistics and numbers showing they’re reproductively old, even if they’re only thirty-five, they don’t intend to create panic, but this is often the effect. And if a woman is over forty and emotionally sensitive like Cary, they’re likely to feel defective, depressed, and out of control.
The doctors’ words cause women to fear they’re in a race against time to conceive, but really those words represent an educated guess; no doctor knows for sure what’s going to happen. For someone like Cary, who was anxious to begin with, the doctor’s words exacerbated her emotional state. She tried to get off antidepressants but ended up staying on them and seeing a psychiatrist to help her manage her anxiety and depression.
Antidepressants and conception
A small amount of prescription medication for an adult is a huge amount for a tiny developing fetus. But what do you do when you have severe, unmanageable anxiety and depression, and nothing short of medication helps? The only right answer is the one that’s right for you.
A 2015 study found that both continuous use of antidepressants and untreated major depression during pregnancy increase the incidence of premature delivery with all the potential accompanying health risks.1 But if you have major depression, going off antidepressants may pose a greater risk for your mental and physical well-being than staying on them, and may put your baby at risk once you are pregnant.
Concerned about fetal health risks, Cary tried to get off antidepressants prior to trying to conceive