For many women trying to conceive, the folder of medical records gets thicker every year: ultrasound reports tracking the follicles, hormone test results, prescriptions from three or four different clinics. Leaf through the whole folder and sometimes not a single test carries the husband’s name. He still drives his wife to her appointments and waits out in the hallway, thinking that a healthy man has nothing to get checked.
Dr. Pham Tran Dan Tam (MD, Specialist Level I in Traditional Medicine) also meets people who come to traditional medicine after several embryo transfers that did not succeed, when both body and mind are already worn out. Traditional medicine can still walk alongside them at that point, but the doctor hopes couples will start preparing earlier, before they begin trying for a baby or before they start assisted reproduction.
When to see a doctor
When a couple has regular intercourse without contraception and there is still no pregnancy after 12 months, this is called infertility (difficulty conceiving), according to the definition of the American Society for Reproductive Medicine (ASRM, 2020). This timeline is shortened depending on age and circumstances:
- Wife under 35: see a doctor after 12 months of trying without a pregnancy;
- Wife 35 or older: see a doctor after 6 months (ASRM, 2020; ACOG, 2014);
- Wife over 40: get checked as soon as you start trying (ACOG, 2014);
- If there is a clear reason, go earlier instead of waiting for the full timeline: very infrequent or absent periods, a past pelvic condition, or a husband already known to have a reproductive health problem.
A woman’s ability to conceive declines gradually with age, clearly from about 32 and faster after 37, according to the American College of Obstetricians and Gynecologists (ACOG) together with ASRM (2014). The older you are, the more common the conditions that lower the chance of pregnancy, and the risk of miscarriage is higher too. For each couple, only an examination can tell.
Infrequent periods over many months are a common sign of polycystic ovary syndrome (Vietnamese), a frequent reason why trying for a baby takes a long time.
The timelines above are for an examination to look for a cause. An examination to prepare, before you start trying, can be done at any time.
Why the husband needs a check-up too
In many families, the question “when is the good news coming?” is usually aimed only at the wife. About 15% of couples have difficulty conceiving, and a male factor is the only cause in 20–30% of cases and contributes to about half of all cases (Agarwal et al., 2015).
Your husband may be healthy, play sports regularly and never have been ill, and still not know whether his sperm count is high or low, or whether the sperm move well or poorly. A semen analysis answers that question. The test is non-invasive and is worth doing right at the start, at the same time as your own tests, so the two of you don’t spend many months heading in the wrong direction. Getting both of you checked also lightens your load, because many women quietly assume everything is their own fault.
Preparing three, six or ten months before trying to conceive
An egg needs a long time to develop to maturity, and sperm take many weeks as well, so changes you start today only show up in your cycles a few months later. How long to prepare depends on the mother’s current health. Some people need 3 months, others 6 months or 10 months. On the husband’s side, a semen analysis is non-invasive, so just do it early, as soon as you start preparing.
Many lifestyle factors in both wife and husband can be changed and yet have a big effect on fertility, including nutrition, weight, physical activity, psychological stress, and exposures at home and at work (Sharma et al., 2013). Smoking, recreational drugs, alcohol and caffeine have harmful effects. During this time, the two of you can:
- Quit smoking together and avoid recreational drugs;
- Cut back on alcohol, coffee, strong tea and energy drinks;
- Eat regular meals with enough vegetables and protein, and less fried food and sweets;
- Bring your weight to a level that suits your build, whether you are overweight or too thin;
- Stay active every week, at a level that is right for you;
- Get enough sleep and set aside time to rest together;
- Tell your doctor if your work exposes you to chemicals, smoke and dust, or high temperatures.
Ask your doctor about taking folic acid from before you become pregnant. Both of you should also have a general health check; any chronic illness and any medicines you take every day should be reviewed by a doctor before you start trying.
How traditional medicine sees trying to conceive
Traditional medicine holds that the Kidney stores the essence and governs reproduction (“the Kidney stores essence”, 肾藏精 / 腎藏精, shèn cáng jīng), in both wife and husband. The classic text Su Wen (素问 / 素問, Basic Questions) also mentions 35 as the age when a woman’s qi and blood begin to decline.
As the gynecology texts often put it, if you want a child, regulate the period first, so the cycle is regular, the flow is moderate and there is not much pain. When the Spleen and Stomach are strong and you eat well, there is enough qi and blood to nourish the period and the pregnancy; long-lasting stress, on the other hand, makes the Liver qi stagnate (Liver qi stagnation, 肝气郁结 / 肝氣鬱結, gān qì yù jié), the period comes early or late without pattern, and an unsettled mind also makes it hard to sleep and hard to eat.
The treatment direction depends on the pattern: it may be to tonify the Kidney and replenish essence, nourish the blood, strengthen the Spleen or soothe the Liver. The herbal decoction is modified for each phase of the cycle, along with acupuncture and moxibustion (warming points with burning mugwort) when appropriate. Your husband is examined and treated according to his own pattern. Modern research on these kinds of support is still limited, so Dr. Tam does not promise results in advance and follows each cycle closely.
If you are going through IUI or IVF
Intrauterine insemination (IUI) and in vitro fertilization (IVF) are the work of a fertility specialist. Traditional medicine walks alongside, supporting the mother’s health; it does not guarantee a pregnancy. In Dr. Tam’s experience, it is best to start a few months before the embryo transfer, so the body has time to adjust sleep, the menstrual cycle and stress levels.
During treatment, you take many hormone medicines on a very strict schedule. Let Dr. Tam know your treatment schedule and the names of your medicines, because herbs can interact with the medicines you are taking (Ulbricht et al., 2008); only with that schedule in hand can the doctor adjust or pause the herbal decoction during phases that call for caution. Your fertility doctor should also be told that you are using traditional medicine. Packs sold online to “boost eggs” or “boost sperm” should not be added on your own in the middle of a treatment cycle.
Once you have good news
Once you are pregnant, the clinic does not use acupuncture needles; Dr. Tam weighs every herb carefully, while your obstetrician monitors the pregnancy.
For people who have had a miscarriage, especially several, traditional medicine has an approach called calming the fetus (“calming the fetus”, 安胎, ān tāi), usually used in the first months. This support is based on traditional medicine experience, and there is not yet enough evidence to say that it lowers the risk of miscarriage. Repeated miscarriage also needs an obstetrics specialist to look for the cause.
Bleeding or abdominal pain during pregnancy means you need to be seen right away at an obstetric facility.
After a miscarriage
Losing a pregnancy, whether early or late, is a loss of both body and mind. Many people quietly wonder whether it was because they lifted something, walked too much or ate the wrong thing. Those questions are worth bringing to a doctor so they can be explained using your own records, rather than carried alone. Dr. Tam once wrote that doctors allow themselves only five minutes of sadness after a case that does not go as hoped; someone who has just lost a pregnancy does not need to set themselves a limit like that.
The uterus needs time to recover, and periods need time to return. The World Health Organization advises waiting at least 6 months after a miscarriage before becoming pregnant again (WHO, 2007); your obstetrician will weigh that timeline for you individually. Once your obstetrician has checked you and said the uterus is stable, traditional medicine combined with Applied Kinesiology helps support the mother’s health and mood after a miscarriage, from replenishing qi and blood to sleep. Your husband is grieving too, even if he says little about it; give each other time.
What Dr. Tam examines
For the first visit, if possible, come together as a couple. Dr. Tam asks about your menstrual cycle, previous pregnancies and miscarriages, any IUI or IVF attempts, past illnesses and current medicines, then reads the results you both already have, such as ultrasound, hormone tests and semen analysis. The doctor carries out a modern clinical examination, followed by the four examinations of traditional medicine (looking, listening, asking, taking the pulse). If any test is still missing, the doctor will suggest doing it before treatment.
Trying to conceive for a long time often comes with stress, and many people don’t realize how tense they are. The clinic also uses Applied Kinesiology (muscle testing) to see whether the stress response involves the frontal lobe, the limbic system or the cingulate gyrus; your husband can be tested too. Muscle testing results add to the semen analysis, hormone tests and ultrasound; they do not replace them. See also the methods we use at the clinic.
When assisted reproduction is needed, Dr. Tam works together with a fertility specialist.
Frequently asked questions
Can I use traditional medicine while doing IVF?
Yes, it is possible, as long as Dr. Tam knows your treatment schedule and the medicines you are taking, and your fertility doctor is informed too.
How long after a miscarriage should we wait before trying again?
The World Health Organization advises waiting at least 6 months (WHO, 2007). The obstetrician following you will also consider your health, the state of your uterus and your emotional readiness before giving specific advice. While you wait, the two of you can start preparing your lifestyle just as you would when trying for the first time.
Worth keeping
- Write down the date you started trying and your period dates for the last three months;
- Work out when to see a doctor: after 12 months, after 6 months if you are 35 or older, right away if you are over 40;
- Book your husband’s semen analysis for the same week as your own tests;
- Put both partners’ ultrasound results, tests and IUI or IVF records into one folder to bring to the appointment;
- Tell both your fertility doctor and your traditional medicine doctor about every medicine and herb you are taking.
If the two of you are trying to conceive or are about to start assisted reproduction, come in together to see Dr. Pham Tran Dan Tam for an examination and early preparation.
References
- Practice Committee of the American Society for Reproductive Medicine (2020). Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril 113(3):533-535. https://doi.org/10.1016/j.fertnstert.2019.11.025;
- American College of Obstetricians and Gynecologists Committee on Gynecologic Practice; Practice Committee of the American Society for Reproductive Medicine (2014). Female age-related fertility decline. Committee Opinion No. 589. Obstet Gynecol 123(3):719-721. https://doi.org/10.1097/01.AOG.0000444440.96486.61;
- Agarwal A, Mulgund A, Hamada A, Chyatte MR (2015). A unique view on male infertility around the globe. Reprod Biol Endocrinol 13:37. https://doi.org/10.1186/s12958-015-0032-1;
- Sharma R, Biedenharn KR, Fedor JM, Agarwal A (2013). Lifestyle factors and reproductive health: taking control of your fertility. Reprod Biol Endocrinol 11:66. https://doi.org/10.1186/1477-7827-11-66;
- Ulbricht C et al. (2008). Clinical evidence of herb-drug interactions: a systematic review by the Natural Standard Research Collaboration. Curr Drug Metab 9(10):1063-120. https://doi.org/10.2174/138920008786927785;
- World Health Organization (2007). Report of a WHO Technical Consultation on Birth Spacing, Geneva, 13–15 June 2005. Geneva: WHO. https://iris.who.int/handle/10665/69855.
