An infertility clinic in China is worlds away from an infertility clinic in the West in just about every way but one: the desperation to have a child where nature has failed to provide. This human response is the same everywhere. The biological imperative to reproduce has no cultural boundaries.
The treatment offered by an infertility clinic in a traditional Chinese medicine (TCM) hospital of the early twenty-first century is basic and minimally-invasive: herbs are prescribed; acupuncture or Qi Gong exercises may be recommended; lifestyle or dietary changes are advised if necessary; pathology tests may be ordered for analysis of blood or semen; surgery may in some cases be recommended. The patient drinks a decoction of herbs twice every day (probably for several months), returns to the clinic weekly, fortnightly or monthly to see if the prescription needs changing and is encouraged to lead a healthy life.
The approach of the assisted reproduction technology (ART) or in vitro fertilization (IVF) clinic in the West, on the other hand, is more sophisticated and the procedures are quite involved. The specialist will prescribe drugs and perhaps perform surgery. He or she will rely on the expertise of nursing staff to administer injections and take blood samples, radiologists to perform ultrasounds, embryologists to monitor fertilization of the egg by the sperm and embryo development in the laboratory. The patient’s visits to the clinic are timed around the cycle and are quite frequent during the 4–6 week program, during which time they will receive medication, be monitored for their response and have procedures such as intrauterine insemination, egg collection or embryo transfer carried out.
From the perspective of the patient, the experience of infertility treatment with TCM or with IVF is altogether different; so is the philosophy of the medicine underpinning these treatments.
The China of today still has its soul deeply rooted in the traditions and beliefs of an era 2000 years ago – a reality that is evident not only in the philosophy and mores of its society but also in its medicine. The medical system that was developed at that time became the inspiration for many other medical systems in Asia. Traditional Chinese medicine is practised not just in China and other parts of Asia but also in the West, often as a complementary approach to the prevailing orthodox medical system.
Modern medicine as we know it has a relatively short history. Medical science has contributed hugely to our knowledge about the structure, function and diseases of the body and medical scientists have developed extraordinary technological systems used in diagnosis, surgery and the manipulation of body functions; nowhere more so than in ART. You might call these advances brilliant or terrifying, depending on your perspective. And TCM, you might call primitive or subtly sophisticated, again depending on your perspective.
The two medical systems have quite different strengths and weaknesses and when called on to address the same maladies, do so using different approaches. The two case histories above illustrate how TCM and Western medicine deal with infertility in startlingly different ways.
An old Chinese professor friend of mine once compared the two systems figuratively in the following scenario:
Imagine our patient is a round table, which in its diseased state, has grown sharp corners. It now looks like a square table – oh dear!
‘No problem at all, my dear table. We’ll have you round again in no time at all.’ Well, right he was, more or less. The operation was performed the very next day. The surgeon, wielding a saw, quickly removed the table’s corners. The procedure was quite painful but over and done with rapidly and efficiently. Unfortunately, he cut a little too close on the fourth corner and the table lost part of one of its legs. The top, however, while not entirely round and smooth, no longer had sharp corners.
‘Tut tut, how did this corner business come about?’ he would have enquired and then carefully and thoroughly felt the wood of the table’s corners, top and legs.
‘Yes,’ he might say quietly after some time, ‘I can help you to be a round table again.’ Then he would pull out a small file, apply it to one corner and begin to file. He would file and file. And even though it might be tedious and require a lot of patience on the part of both the table and the doctor, and it might take up to 1 year before the table would be truly its old round self again, eventually it would be beautifully smooth and strong and perfectly round again.
The side-effects of Western medicine – the rough contours and the damaged legs – are sometimes a high price to pay for immediately effective treatment. But this promise of a fast and effective result is what makes us choose this type of treatment so often, despite the risks.
Of course, if having ‘corners’ is a life-threatening situation, then fast and effective is exactly what we want. But where corners are not so critical, but are more of a threat to the quality of our life, then the slower and more subtle approach has its advantages.
Professor Robert Jansen, one of the world’s leading experts in the treatment of infertility, describes the strengths and pitfalls of Western medicine, thus, in his excellent book Getting Pregnant.1 (additions in parentheses are mine):
The slighter the variation from normal, the more trouble (Western) medicine has in correcting it. Returning a circumstance that’s a departure from normal back to towards normal is most likely to be successful when the departure from normal is major (such as pronounced corners on a round table). Because any medical or surgical intervention risks introducing disturbances attributable to the intervention (like damage to legs), the less the departure from normal the less likely the intervention will improve the situation and not make it worse.
And what Professor Jansen says is obviously true; we all know that Western medicine can perform what seem to be miracles, especially in the kinds of dire circumstances that leave us praying for such miracles. But in less critical situations, for example those that produce undesirable but not severe or life-threatening symptoms, then there is every likelihood that drugs and surgery will produce side-effects rather than miracles.
What needs to be added to Professor Jansen’s assessment of medical treatment is that in cases where the variation from normal is not so great, the slower and more ‘holistic’ forms of medicine often excel. If the table in our Chinese professor’s scenario had not developed such marked corners but just some irregularities in its contour, then the treatment with the file could have been effective and rapid. Or if the table had come for treatment as soon as the corners had started to form, the filing would have achieved satisfactory results in a short time.
Professor Jansen, going on to talk more specifically about fertility treatments, explains further (again, additions in parentheses are mine):
We can show in theory and in practice that the worse a diagnosed cause of infertility is, the better the chance of getting pregnant naturally will end up being after (Western medical) treatment – provided that the treatment corrects the problem properly and provided that the treatment does not, through side actions, interfere with any other aspects of reproduction.
Most of our (Western medical) treatments can have side-effects and these side-effects are more likely to tip the balance unfavorably when the condition being treated is relatively trivial. This principle is particularly prominent in reproductive medicine and surgery.
So, in infertility as in other specialities, it may be fair to say that using a Western treatment approach such as surgery and drugs, offers reasonable expectation of good results if the cause for infertility is rather severe, e.g., when there is blockage of the fallopian tubes, failure to ovulate or seriously inadequate sperm. In terms of our table analogy, these are very substantial corners made of hardwood that only a saw could have an effect on. Using a file in such cases might take a lifetime to make enough of a difference and, in the case of infertility, we do not have a lifetime to wait. Analyzing the genetic make-up of embryos where there is a family history of an inheritable disorder is another situation requiring the sort of treatment that only the ART clinic can provide.
However, more and more it seems that the saw is being used to fix very small corners or those made of soft wood. Our impatience and/or lack of knowledge of the subtle approaches of holistic medical traditions means that clinics specializing in ART are popping up in every city in the developed world (and some of the developing world) and doing very good business. But many of the infertile couples who receive treatment at these clinics could just as easily increase their chances of conception using the approaches offered by other less-invasive and risky medical systems.
The following chapters explain in detail how the medical system known as Traditional Chinese Medicine approaches the treatment of infertility; then, we revisit the IVF clinic and examine how both medical systems can work with each other to best benefit patients attempting to have a family.