The excitement of seeing two pink lines or a plus sign on a pregnancy test is exhilarating when you are trying to conceive. And devastating if you lose that pregnancy, no matter when in your pregnancy it happens. Even before you know if you are having a boy or a girl, your mind runs with possibilities. What color eyes and hair will it have? Who in the family will it look like? What will their personality be like? The parents-to-be are already planning the life of their future child, figuring out their due date, coming up with names, and then…a devastating miscarriage.
Unfortunately, about 25% of all known pregnancies end in miscarriage, and the frequency goes up with age (both maternal and paternal).
Before trying again, there are many ways acupuncture and Chinese herbs can address underlying issues. Below are the most common causes of miscarriage according to traditional Chinese medicine theory and some recommended herbal treatments:
Spleen Qi Xu (deficiency)
Spleen Qi Xu (deficiency) can cause a variety of problems leading to early and even late term miscarriages. The Spleen “holds things in” the body. A weak Spleen can lead to Spleen Qi sinking which presents as very heavy periods, a short luteal phase, and incompetent cervix. Incompetent cervix is rare (1-2% of pregnancies), and results in a devastating loss if not caught early. It usually occurs in the 2nd trimester between weeks 14-24.
Miscarriages can also happen because of low progesterone values. Low progesterone values often correspond to a shortened luteal phase (shorter than 10 days). They are often caused by Spleen Qi and Yang deficiency; a lack of warmth and lifting of the Qi.
The Chinese formula Bu Zhong Yi Qi Wan (“Tonify the Middle and Benefit Qi” formula) is outstanding for all these issues. It lifts Spleen Qi and Yang and holds the Blood in the body. I have consistently seen it lengthen the luteal phase in women to a normal 14 days. It is safe in pregnancy, and I even prescribed it to a patient pregnant with twins who was experiencing a down bearing pressure in her pelvis. It was so effective in holding things in, that she had to stop taking it at week 38 because she wasn’t showing signs of going into labor.
Most Americans have a weak Spleen, so I recommend a Spleen friendly diet to every one of my patients. That is: no ice water or drinks and limited cold and raw foods. Diets with lots of raw vegetables and fruits are seen as healthy in America. Of course, fruits and vegetables are healthy, but TCM recommends cooking your vegetables and even fruit if your Spleen is really weak, like in a pie or compote.
Smoothies are a healthy way to get lots of fruits and vegetables into one’s diet. They are full of nutrition, but I recommend at least not adding ice, and defrosting frozen fruit before blending.
Kidney Yang Xu (deficiency)
Kidney Yang Xu (deficiency) can also look like low progesterone contributing to early miscarriages because of a lack of warmth holding the pregnancy in.
I recommend Jin Gui Shen Qi Wan (“Golden Cabinet Kidney Qi Pills”) until the patient becomes pregnant. Once she becomes pregnant, I have her discontinue it and start Fu Ke Zhong Zi Wan "Gynecological Plant Seed Pills”) which is designed to prevent miscarriage in early pregnancy, especially with Kidney deficiency.
Deficiency of the Kidney and Spleen can lead to inadequate Jing and Blood, causing sinking of Qi and disharmony of Chong and Ren vessels. In this case, the uterus will not be properly nourished, and miscarriage may occur.
Blood Stagnation (Xue Yu)
Blood Stagnation (Xue Yu) is another common cause of early miscarriage. This can be the result of a history of endometriosis, a clotting disorder such as Factor V Leiden, or an autoimmune disorder such as elevated antiphospholipid antibodies APA) or antinuclear antibodies (ANA). Women with the MTHFR gene mutation may also suffer early miscarriages due to tiny clots in the bloodstream that don’t harm the mother but may cut off the blood supply to the developing fetus or embryo.
Before pregnancy, I prescribe Tong Jing Wan ("Dysmenorrhea Pills”) for menstrual cramps or Shao Fu Zhu Yu Tang ("Drive Out Blood Stasis in the Lower Abdomen Pills”) if cramps are particularly terrible. The minute she learns she is pregnant, she must discontinue these formulas, though they are safe during the two-week wait.
Blood stagnation from clotting or autoimmune disorders is a difficult situation. I treat it before the patient gets pregnant again and refer out to a fertility doctor once she is pregnant. The fertility doctor may prescribe baby aspirin or an injectable blood thinner, depending on her condition.
Damp heat in the uterus
Damp heat in the uterus presents as endometritis, an infection of the uterus. Sometimes the infection is obvious as an abnormally smelling menstrual flow with clots or tissue in it. This can be cleared up with antibiotics or Chinese herbal formulas such as Chien Chin Chih Tai Wan (“Thousand Pieces of Gold Stop Leukorrhea Pills”) or Yu Dai Wan (“Heal Leukorrhea Pills”).
Physical causes of frequent miscarriage, which are not treatable with acupuncture and herbs, but which I would like to include are: uterine septum, uterine polyps, and fibroids. In these cases, if the embryo tries to implant on any of these inside the uterus, it will not be able to get enough blood flow to grow and will die.
Genetic issues are also a cause of frequent miscarriage. If the genetic abnormality is severe, the patient will need to undergo IVF and have the embryos tested to find some that are not affected by the condition.
Below are 2 case studies of treatment of multiple miscarriage from my book Waiting On Pins and Needles, a compilation of 25 stories of some of my patients’ journeys to motherhood.
Case Study: Kate
Kate first came to my office in 2015 at age 36. She had been pregnant once two and a half years before, and that had ended in miscarriage at 12 weeks. She had been unable to get pregnant since then. She was seeing the local Reproductive Endocrinologist (RE) to get some answers and she had discovered several issues that the RE resolved.
She had had her right fallopian tube removed in 2012 because she had a very large ovarian cyst that was attached to her fallopian tube. With only one tube, that lowered her chances of conception every month. In 2014 she had another surgery to remove endometriosis and a septum in her uterus. A septate uterus is a deformity of the uterus which happens before birth during fetal development. A membrane called a septum divides the uterus. This dividing septum is a fibrous band of tissue that doesn’t supply the necessary blood and nutrients to the developing embryo if the embryo implants onto the septum. Women with a septate uterus are at increased risk of miscarriage.
Kate was also diagnosed with endometriosis. With her RE she had tried four cycles of Clomid (Clomiphene- ovulation stimulant), Menopur (menotropin, a gonadotropin), and hCG (Human chorionic gonadotropin). Two of those were also Intrauterine Inseminations, and none of these interventions were successful. That’s when she decided to try fertility acupuncture.
Kate was very healthy, using a bicycle as her main mode of transportation, and she and her husband ate home cooked, garden grown food. She was normal weight and healthy other than some acne.
Four cycles of Clomid had heated her up internally, and she was waking at night with hot flashes. She had many signs of a methylation disorder, including infertility, miscarriage, septate uterus, blood stagnation (endometriosis), and a family history of anxiety, depression and cancer. A DNA ‘Methylation disorder’ refers to an imbalance in the methylation process, which is crucial for regulating gene expression, detoxification, and various metabolic functions in the body.
I initially treated her with blood moving herbs to help thin her blood a little and treat the underlying cause of the endometriosis. She was also having recurrent yeast infections since her endometriosis surgery, so I had her use an herbal douche to clear it up. It helped, but it wasn’t enough, so she took Diflucan (fluconazole, an antifungal which resolved the condition).
She consulted with me weekly for 3 months, and by July 2015, she was pregnant! She developed a rash on her chest as well as achy joints, both warning symptoms that she was having an immune reaction to the pregnancy. I put her on herbs to clear heat ie: to decrease inflammation and immune response. It seemed to help, since her rash and achy joints subsided. She continued to come in weekly. Her yeast infection returned, and she reported that she was having nausea and heartburn.
Her ultrasound showed a gestational sac and a yolk sac, but no heart flicker yet. It also showed 2 fluid pockets and a polyp. She began spotting brown blood. She had a rash in her belly button, and her throat was very sore, both signs of an immune reaction. I put her back on an immune formula.
Unfortunately, this pregnancy didn’t last. There was no heartbeat, and she ended up having a dilation and curettage (D&C). She continued to come in weekly, and I put her on herbs to heal her uterus, cool her down, and calm her spirit which was understandably upset. During the D&C, the RE found another piece of the septum in her uterus that hadn’t been completely removed. During her first period after the D&C, Kate had the worst cramping she had ever felt. The RE ran a panel of immune blood tests. They also ran a miscarriage panel and discovered that her beta-2-glycoprotein was slightly elevated. This indicated that her body makes antiphospholipid antibodies. Antiphospholipid antibodies (APA) are a group of immune proteins that the body produces against itself in an autoimmune response to phospholipids in cell walls. APAs increase the risk of excessive blood clotting which can cause a developing embryo to miscarry. APAs can also contribute to pre-eclampsia. Treatment of APAs to achieve a successful pregnancy is with injectable blood thinners once pregnant.
A hysteroscopy showed a tiny polyp, and indeed, a ridge where the septum had been removed. Surgery was scheduled. In the meantime, her husband had a double knee replacement. While she waited to be able to have the surgery or to be able to TTC (try to conceive) again, we continued to clear heat and move blood. She was hot at night and experiencing cramps with her cycle. I wanted to address these for her before she tried to conceive again. Kate was also struggling with continued yeast infections and was trying to get them under control. She exhibited signs of dampness (yeast) and heat (hot flashes, acne).
She ended up not having the surgery, and 11 months after starting treatment, and 8 months after her D&C, she was pregnant again. She miscarried almost immediately at less than 5 weeks pregnant. The RE recommended putting her on Lovenox (enoxaparin- an anti-coagulant) and baby aspirin to proactively treat the antiphospholipid antibody (APA) syndrome the next time she became pregnant.
She took 3 months off of TTC, and the first month she tried again, in July of 2016, she became pregnant again. She was immediately put on Lovenox injections and baby aspirin to prevent her from miscarrying again. Her hCG levels rose dramatically- quadrupling- from 33 to 112 to 433, indicating that she could be pregnant with more than one baby.
Kate started to feel viral symptoms again- a sore throat but no rash. Her first ultrasound at 6 weeks and 3 days showed no heartbeat. Her viral symptoms had already disappeared at 6 weeks and 1 day, which indicated to us that that is likely when she had lost the baby. The RE suggested genetic testing and to have the surgery to have the septum removed. Repeat blood work showed that her thyroid was in good shape with no anti-thyroid antibodies.
In addition to the surgery, Kate did a monitored, unmedicated cycle to see what her estrogen levels at ovulation were. She also had an endometrial biopsy to test for infection, as well as testing levels of estrogen and progesterone in the second half of her cycle. She continued to come in for acupuncture and took herbs.
All of her blood levels looked normal, and the biopsy showed no infection in her uterus. For the 4th time since starting acupuncture and herbs, 21 months after starting acupuncture treatment, and 4.5 years since her first pregnancy that ended at 12 weeks, she was pregnant again. Again she had cold/virus symptoms, so I again put her on herbs to calm her immune system down. She also used injectable Lovenox and baby aspirin orally. She had all the normal pregnancy symptoms of sore breasts, nausea and heartburn. Her hCG was very high, and her sore throat began to subside. At 6 weeks and 1 day, an ultrasound showed a heartbeat (!).
At her second ultrasound at 8.5 weeks, the baby looked good. She had no more cold symptoms, so she stopped the herbs. At 12 weeks everything looked great. At 13 weeks she caught an actual common cold, but it passed, and everything progressed normally.
Kate came back at 36 weeks to prepare for labor. Acupuncture is effective at relaxing the cervix and pelvic floor to help facilitate an easy delivery. Kate switched her blood thinner from Lovenox to heparin to prepare for delivery, as the effects of heparin are easier to reverse if she began to bleed too much during delivery. Jake was born on 9/12 at a healthy 6lbs and 4oz. She had an uncomfortable delivery as he was sunny side up (occiput posterior position), but everyone was healthy. Kate came back for treatment to improve her milk supply.
When Jake was 13 months old, Kate came back because she was thinking of trying for baby #2. She was 40 years old and wanted to get going before it was too late. Her pattern was similar to the first time she came in, so I put her on heat clearing herbs and blood movers to get her body more fertile again.
At age 40 and 3 months, she began TTC again. Her husband had another knee replacement, as the first one needed repeating. This delayed her ability to try for several months, as his body had been under great stress from surgery and also needed to get the anesthesia out of its system. In the meantime, we worked on clearing heat and moving blood again and getting her body in shape for a (hopefully) successful pregnancy.
Nine months after starting acupuncture again, Kate was pregnant again! She immediately went on blood thinners. Unfortunately, the pregnancy didn’t work out. Kate was now 41, increasing her odds of miscarriage, not to mention her past history of frequent miscarriage due to antiphospholipid syndrome.
One month later, her husband showed up on my table for treatment. Peter didn’t have any apparent issues with sperm, but he was 47 years old, and they both decided to give this last try everything they had. Recent research shows that even after three weeks of treatment there are statistically significant improvements in sperm count and quality. Women only release one (sometimes two) eggs every month, where men make an average of 40 million to 300 million sperm in each ejaculation daily.
The average man makes 1000-1500 sperm with every heartbeat, which can lead to some issues with quality. Since cell division happens so fast, there is room for error, such as double headed or double tailed sperm, sperm with oddly shaped heads, etc. Because men make so many so quickly, the potential for positive change with treatment is also great, and it also happens quickly.
Peter was a real trooper, as acupuncture wasn’t his favorite thing. But he loves his wife, and he really wanted another child, so he came in weekly. He also quit smoking, no small feat, because quitting smoking greatly improves sperm health. I would guess that men comprise about 5% of my patients, so he was in the top percentage.
Kate came in again weekly, and her hopes seemed down. It seemed that she wondered if it was a waste of time.
Four months after she came back, and 3 months after her husband came in for acupuncture, at age 41 ½, her SIXTH pregnancy since coming to see me for 5 years, Kate was pregnant again, and this one lasted. She delivered another healthy baby boy.
Case Study: My Personal Story
My ex-husband and I got pregnant the first time we tried. I was 31. I miscarried at barely 5 weeks. We got pregnant again on the very next ovulation, and I miscarried again at barely 5 weeks.
I took herbs, got acupuncture, and we tried again, and I got pregnant very quickly with fraternal twins! So exciting. I did not expect twins, but I was so excited!
The first one's heart stopped beating at 6 weeks, and the second one's stopped at about 7 weeks. I had a D&C, and couldn't get pregnant again for 9 more months. These were the longest and most miserable 9 months of my life.
At that time I threw myself into figuring out how to fix this with acupuncture and Chinese herbs. I also saw my own acupuncturist. I started taking a prenatal vitamin with folate instead of folic acid, because I have 2 copies of the MTHFR (methylenetetrahydrofolate reductase) gene mutation. Whether or not the MTHFR gene mutation affects miscarriage is up for debate in the fertility world. However, I took my functional medicine MD’s advice and switched to a prenatal with folate instead of folic acid. In my clinical practice, I often see that if women who have had multiple miscarriages switch to folate, they often go on to have a successful pregnancy. Is it the folate or the acupuncture? Without a research study it would be hard to tell, but it certainly doesn’t hurt anything to switch to folate, as those babies also don’t have neural tube defects. I always put patients on the dosage of folate that the RE suggests.
During this waiting period, I also started doing all the things I’d ever wanted to do that would be challenging to do if I was pregnant or had a newborn. I traveled to Iceland for a week where I saw whales, hiked on a glacier, rode Icelandic horses, and soaked in the Blue Lagoon. I learned to play the cello, something I had always wanted to do. I trained for and competed in a sprint (mini) triathlon. I was signed up to do another triathlon in Glenwood Springs, CO when I found out I was pregnant again. I had the happy task of writing to the race organizer to see if I could cancel my registration and get a refund because I was PREGNANT. She refunded me and congratulated me.
This pregnancy stuck, and our son Calvin was born in 2003. It was an easy pregnancy, but I ended up having a C-section. I was pretty upset about not having the natural, drug-free delivery I was hoping for, but I was grateful to have a healthy beautiful baby (C-section babies are very pretty, since their heads aren’t squished from coming out of the birth canal). And just like my struggle with fertility, it has helped me understand my patients’ experiences better.
When Calvin was only 9 months old, I was nursing him, and he pulled his head back and looked at me with baby horror on his face. I’ll never forget that look. He refused to nurse after that. I was very confused, but pumped for him, at 40oz per day (my super power). Luckily, he was happy to take my milk from the bottle. Slowly, my supply dwindled to the point where, 2 months later, I could only pump about 4 oz a day. I was confused and sad until I started to feel nauseous in the morning, and finally figured out what was going on. I was pregnant again! He must have tasted the difference in my milk that pregnancy hormones cause, and knew I was pregnant before I did. He is still a picky eater...
With my history, I was certain this pregnancy (my 5th) wouldn’t stick. However, week after week, I continued to stay pregnant, and 18 months after my first baby was born by C-section, baby Claire was born by vaginal birth after cesarean section (VBAC). What a healing and wonderful experience that was! My nurse midwife was 100% confident that I would be able to have a VBAC, and she was right. Once again, I didn’t have the natural, drug-free birth that I thought was expected of a woman in natural health care, but honestly, the epidural was a little slice of heaven. And once again, my baby was perfect and it didn’t matter how she came out, as long as she was healthy.
My fertility struggles were a difficult time for me personally, but the experience allowed me to really understand my patients’ struggles. We all have our own story. The happy ending to mine is being able to have this rewarding career helping couples with infertility.
