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12.12.2014

Most women do not get excited about the monthly visit from “Aunt Flo.” In fact, most wish they did not have it and many actually take medication to stop it!
Understanding hormonal fluctuations can help in identifying and making sense of how you can feel so good one day and so awful the next! Every phase of the menstrual cycle serves a very specific purpose in the building and integrity of the endometrial wall, creating the perfect space for the fertilization of an egg and implantation.
Gonadotrophin Releasing hormone (GnRH) released from the hypothalamus to stimulate the pituitary. Follicle stimulating hormone (FSH) and Luteinizing hormone (LH) –released by the pituitary under influence by the hypothalamus. Homeostasis is the ability to maintain a constant internal environment in response to environmental changes.
Around day 10 FSH begins to decline in response to another key reproductive hormone, estrogen. Estrogen becomes very built up during the follicular phase and gets quite high at ovulation in response to follicular development. The endometrium will grow from just a few millimeters thick following your period to around 10 millimeters thick during the ovulatory phase. On day 14-16 there is a sudden surge in LH, stimulating ovulation; the rupture of the follicle and the release of the egg into the fallopian tubes.
Under the influence of LH “luteinizing hormone” the remnants of the follicle develop into the corpus luteum. After ovulation the egg is brushed by waves of hairlike cilia through the fallopian tubes and towards the womb.
Estrogen declines and LH drops off the map following the development of the corpus luteum or the “luteal body”.  Its function it to secrete progesterone to warm the body for pregnancy.
Progesterone helps the endometrium thicken and become more vascular and also inhibits contraction of the uterus and the development of a new follicle.
If no implantation occurs following ovulation, the corpus luteum will begin to degenerate half way through the luteal phase and progesterone levels will begin to decline. If an egg is fertilized and conception takes place a hormone called human chorionic gonadatrophin (HCG) then takes over the role of LH for the purpose of maintaining the corpus luteum. There are many nutritional and lifestyle factors which can exacerbate hormonal imbalance leading to Amenorrhea, Dysmenorrhea, Ovarian cyst, PCOS, Endometriosis, infertility and all associated symptoms. Stay tuned for Part 2 where we will be exploring some of these causes and to learn what you can do to begin balancing your hormones. If you have questions about how to regulate your own hormones using food, CLICK HERE to schedule some time to talk with Josh or Jeanne. Acupuncture, All Blog Posts, Fertility Medicine In Part I and Part II in this series of articles on fertility and traditional Chinese medicine, we discussed the how’s and why’s of basal body temperature (BBT) charting, and how to analyze the follicular phase of your BBT chart.
This article focuses on BBT chart analysis of the luteal phase (post-ovulation phase), addressing some of the patterns that you are likely to see, and ways in which acupuncture and herbal medicine can be used to optimize fertility.
In review from the previous post, BBT should drop to its “base level” a day or two before the start of period.
Temperature readings in this phase of the menstrual cycle tend to be more stable than readings in the follicular phase – ideally they do not vary more than ~.2°F. Basal body temperature typically drops about one to two days before the onset of the period – this temperature shift signifies that the corpus luteum is disintegrating and progesterone is no longer being produced. The length of the luteal phase is a measure between ovulation and the first day of your period.
If temperature rises adequately at ovulation time, but then drops dramatically about one week after ovulation (and rises again to a stable temperature), this is typically due to a surge of estrogen in the luteal phase (See Figure 2.5). Ideally, the initial BBT surge that signifies ovulation is a significant one – around ~1°F – and happens over the course of one to two days.
If your luteal phase temperature does not drop, this usually indicates pregnancy (See Figure 2.8). It must be noted that while it is uncommon for the luteal phase to last longer than 14 days, it can occasionally last up to 16 days. I hope you have found this series of articles on basal body temperature and chart analysis helpful. In addition to the organ systems, there are four vital substances – Yin, Yang, Qi and Blood that can become deficient, excessive or stagnant and create a state of unbalance that may manifest as infertility. All TCM treatments for fertility are founded upon restoring balance and health to these organ systems and vital substances.
TCM diagnoses are made by Naturopathic Doctors after a thorough physical examination and comprehensive intake.  Naturopaths who use TCM in the treatment of fertility will also look at your tongue and take your TCM pulses to both diagnose your TCM pattern and to monitor treatment. The movement of Qi through the Liver is necessary for both ovulation and menstruation to occur. Women with Liver Qi stagnation often experience symptoms of imbalance both at ovulation (bloating, irritability, breast tenderness) and at menstruation (premenstrual breast tenderness, irritability, anger, painful periods). This pattern is often seen in women with polycystic ovarian syndrome (PCOS) and in women with long menstrual cycles. In TCM Spleen Qi manages the second half of the menstrual cycle (the luteal phase).  Together with the Kidney Yang, the Spleen Qi allows for buildup of the endometrial lining and supports progesterone production. Women with Spleen Qi deficiency typically have low energy, cravings for sugar or breads, poor circulation and may experience spotting before their periods, menstrual cramps and fatigue during their periods. Kidney Yang works together with the Spleen Qi to control the luteal phase of the menstrual cycle.  Kidney Yang supports the production of progesterone and maintains an elevated body temperature after ovulation. Women with Kidney Yang deficiency experience symptoms of coldness – cold feet or hands or an intolerance to cold.  They may have menstrual cramps that feel better with use of a heating pad. Kidney Yang deficiency often occurs with a Spleen Qi deficiency and is common in women with a luteal phase defect and in women with a prolonged follicular phase or long menstrual cycle (greater than 30 days). While Kidney Yang and Spleen Qi control the luteal phase, Kidney Yin controls the follicular phase (the first half of the menstrual cycle, while the egg is developing prior to ovulation).  Kidney Yin also controls production of cervical mucus and opening of the cervix during ovulation. Women with Kidney Yin deficiency may experience night sweats, hot flashes and have little or no midcycle cervical mucus.  They may not experience any significant symptoms around their period.
Kidney Yin deficiency often occurs with shortened follicular phases, prolonged follicular phases and in elevated FSH and low estrogen states.  Amenorrhea (absence of menses) is also often indicative of a Kidney Yin deficiency.
Once you have received a TCM diagnosis from your Naturopathic Doctor you embark on a journey of rebalancing your body to support your fertility.  Whether you are using natural therapies exclusively, or working with a reproductive endocrinologist or assisted reproductive therapies (IVF or IUI) you can begin making changes to balance your systems and improve your chances of pregnancy.


If you have been struggling with infertility and are interested in another approach, a Traditional Chinese Medicine diagnosis may be a good place for you to start.  Bring balance back to your body and book an appointment with a Naturopathic Doctor who is knowledgeable about TCM in fertility today.
Acupuncture, All Blog Posts, Fertility Medicine Basal body temperature (BBT) charting serves many purposes, the most basic of which is to distinguish fertile times in a woman’s cycle and confirm if ovulation has occurred. Using BBT charting in conjunction with traditional Chinese medicine (TCM), as your acupuncturist, I will be able to evaluate your overall reproductive health, and identify weaknesses in your menstrual cycle. I will say that BBT charting is not for everyone, and if it is not for you, please don’t feel discouraged – ovulation predictor kits can be used to confirm ovulation, and monitoring reproductive signs throughout your menstrual cycle is still helpful.
Basal body temperature readings are graphed for analysis – this graph corresponds to your TCM diagnosis and reflects weaknesses and improvements in your reproductive health over time. BBT charting for at least two to three full cycles is most informative, but you can begin your first chart at any time.
There are many factors that affect our reproductive hormones – most notably stress …and who of us does not experience significant bouts of stress? During Phase I, the ovaries produce estrogen, which results in lower basal body temperature readings. The total menstrual cycle lasts between 27 to 30 days, with the first day of full menstrual bleeding signifying a new cycle.
Some women may have a 27 to 30 day menstrual cycle and think everything is fine until they start BBT charting. BBT charting can be a helpful tool in both conceiving and preparing your body for a healthy pregnancy. In Part II of this article, I will discuss BBT chart analysis of the follicular phase in more depth, and in PART III, the luteal phase. If you would like to make an appointment to begin fertility acupuncture treatments, or simply discuss your options, please feel free to contact me.
There is an explanation for how you feel and understanding your body gives you the opportunity to learn how to support yourself and minimize the effects your monthly cycle can have on you! The hormones of the reproductive system communicate through a negative feed back loop reducing the output or activity of any organ or system back to its normal range of function. By puberty, when a girl starts menstruating, the number of eggs remaining drops down to 300,000- 400,000.
Cervical mucus in central to fertility and assists in helping protect, nourish and transport sperm.
The color can change as well from white or yellow to clear and translucent or “egg white” look and feel. The sharp decline in estrogen and progesterone, leading to menstruation, functions as a hormonal trigger to begin the production of GnRH and FSH, the beginning of a new cycle.
Progesterone is essential for the maintenance of the corpus luteum and in the preservation of the endometrial wall which would otherwise degenerate (menses).
BBT charting is an incredibly useful tool in identifying potential fertility challenges, and optimizing your reproductive health in preparation for pregnancy. Base temperature, or starting temperature of the follicular phase, varies from woman to woman, and can also vary slightly from cycle to cycle. This is important to identify, as this information will more effectively guide your treatments.
If temperatures rise adequately at ovulation time, but then drop and rise dramatically over the course of the luteal phase, the diagnosis is usually Heart and Liver qi stagnation, coupled with Kidney yang deficiency (See Figure 2.4). Similar to the previous pattern where there are dramatic fluctuations throughout the luteal phase, the diagnosis is usually Heart and Liver instability, coupled with Kidney yang deficiency.
If your luteal phase temperature rises too slowly, taking three or more days, your body may be slow to respond to the circulation of progesterone making the actual day of ovulation more challenging to pinpoint (See Figure 2.6). In this case, the length of the luteal phase is adequate, but declining temperatures reveal another weakness. About ten days after ovulation, it is possible for a sensitive pregnancy test to detect sufficient levels of human chorionic gonadotrophin (hCG) for a positive result. If your temperature remains elevated 16 or more days post-ovulation, and then drops, this may be indicative of an early stage miscarriage.
If you would like to schedule an appointment to discuss your fertility and ways in which acupuncture and herbal medicine may help – here are the ways you can contact me.
If you are planning to conceive, BBT charting is also an incredibly useful tool in identifying potential fertility challenges, and optimizing your reproductive health in preparation for pregnancy.
Your BBT chart corresponds directly to reproductive challenges identified through TCM pattern diagnosis, and through acupuncture and herbal medicine, we can work together to improve your fertility. Basal body temperature should be taken with a minimum of four hours of relatively uninterrupted sleep, and immediately upon waking. Even without BBT charting, it is possible to identify times during your cycle that could use improvement. A BBT thermometer is calibrated to register lower temperatures associated with women’s hormone levels, and will record temperatures within two decimal places (for example, 97.45°).
Day-1 of the graph represents a new menstrual cycle indicated by the first day of a full menstrual flow (not spotting). If you start charting on any day other than day-1, be sure that you record your starting temperature on the appropriate day of your graph.
Interrupted sleep affects the pituitary gland, which regulates reproductive hormones and influences their release – do you get eight solid hours of good quality sleep every single night? Estrogen production also generates cervical mucus, which commences up to five days before ovulation.
This transition starts with a surge of luteinizing hormone (LH), as evidenced by a slight dip in temperature, up to 0.3°. It is dominated by progesterone, a thermogenic hormone produced by the corpus luteum (a temporary endocrine structure formed from the ovarian follicle that released an egg), hence the higher temperature readings post-ovulation. Some women discover they are ovulating on day-18 or 20, with a short Phase II; less commonly, women find they are ovulating on day-11 or 12, with a long Phase II – neither pattern is optimal. Tracking your basal body temperature and other reproductive signs is instrumental in identifying the strengths and weaknesses in your cycle, and through traditional Chinese medicine pattern differentiation, we can use acupuncture and herbal medicine to support fertility. We will look at the patterns that are commonly seen in BBT charts, and what these patterns signify from a traditional Chinese medicine perspective. Temperature readings in the luteal phase, however, are under the influence of the corpus luteum, a temporary endocrine gland that forms from the ovarian follicle that ovulated (released an egg).


In the event of conception and successful embryonic implantation, the corpus luteum will be maintained and continue to produce progesterone until the embryo is capable of producing it on its own (at about 8 weeks of pregnancy).
If your luteal phase is short, about 8-10 days, there may be question as to whether there are sufficient Kidney energies (e.g. Post-ovulation, BBT readings ideally rise and are maintained at about ~1°F higher than average temperature in the follicular phase (See Figure 2.3). Similar to temperature instabilities in the follicular phase, stress is often a key factor.
Your BBT chart may also reflect a second slight spike in temperature due to embryo implantation in the days after ovulation; slight spotting may also be seen as a result of the embryo burrowing into the endometrium.
Another potential reason that BBT may not drop at this time is the presence of a corpus luteum cyst: pregnancy tests will be negative, but BBT will be sustained and the period delayed due to continued progesterone production. If you are BBT charting, please bring your charts to your appointments so we can review them together. This means you should not have gotten out of bed within the last four hours before taking your temperature. You should be able to find a BBT thermometer (ideally, digital) in the family planning section of most drugstores. Please note that if your full flow begins in the late hours of an evening, day-1 should be recorded as the next day. For example, if you begin on day-7, be sure that your recording for that day reflects that this reading is for the seventh day since the first full day of menstrual flow for this cycle. In terms of menstrual cycles, what is normal for many women falls outside the textbook definition of “normal,” which is a 28-day cycle with ovulation occurring on day-14. Cervical mucus has several phases indicated by changes in consistency with the most fertile type being the stretchy, egg white-like mucus at ovulation. This dip is then followed by a spike in temperature, about 0.5° or higher, confirming ovulation has occurred. After ovulation, your temperature should rise quickly, ideally over one to two days, and remain steadily elevated until just before your period. The corpus luteum produces progesterone, a thermogenic hormone, which is thought to account for the rise in basal body temperature during this phase.
Other potential insufficiencies include: your BBT in the luteal phase fluctuates too much, is slow to climb to an adequate temperature, never reaches an adequate temperature, or temperature drops too soon resulting in a short luteal phase. Again, this sustained rise in temperature is due to progesterone production, and ideally, does not vary by more than .2°F throughout the luteal phase.
To get the most accurate reading, I recommend setting an alarm to take your temperature at the same time every morning, and keep your thermometer next to your bed. There are many excellent app’s these days designed for BBT charting that will also allow you to chart cervical fluids, and other reproductive signs.
Your BBT charts will change in correspondence to lifestyle changes, and clarify whether current choices enhance, or weaken, your reproductive health. What is your “normal?” – we all have individual needs, and Chinese medicine treatments for fertility are tailored to meet your specific fertility needs. Phase I ideally lasts until around day-14 of a cycle and ends with a slight dip in temperature, signifying transition to Phase II. A dip in temperature begins as the corpus luteum dissolves and progesterone production ceases.
The cervical fluid that is generated before ovulation provides a hospitable environment for sperm to live in for a few days.
Once ovulation has occurred, BBT readings should rise about ~1°F higher than temperatures during the follicular phase, and should be maintained at this level for about 12-14 days. Acting as a kind of “adhesive,” it is responsible for maintaining the lining of the endometrium for the duration of the luteal phase….
From a traditional Chinese medicine perspective, in all of these cases, the yang of the Kidneys is most likely deficient, and sometimes, in combination with other diagnostic patterns.
A low luteal phase is due to a weakness of Kidney yin, leading to a weakness in Kidney yang. To treat this pattern, blood tonics to soothe the Heart and Liver are prescribed, as well as herbs to support Kidney yang. This may sound like a hassle, but most women find the benefits outweigh this minor inconvenience. You can also chart your temperature readings and reproductive signs on a paper graph (there are many blank BBT charts available for download online) – choose the method that is easiest for you.
This allows time for sperm to make it through the uterus and fallopian tubes, and wait for the timely release of an egg. Below is an explanation of the trends you may see in your BBT chart, and the ways in which acupuncture and herbal medicine may be of help in optimizing fertility. In some cases, qi and blood will also need to be supplemented to support the yang – all of this may be done through the application of acupuncture and herbal medicine.
If your sleep is regularly disturbed, or you wake up at erratically different times everyday, accurate readings will be difficult to obtain. By charting consecutive menstrual cycles, patterns in your reproductive health can be discerned. Your BBT chart will also monitor the effects of acupuncture fertility treatments clarifying the most beneficial types of treatment for you. It will be especially important to support healthy egg maturation in the follicular phase – this builds the necessary foundation for the progression of a healthy cycle.
For optimal results, fertility acupuncture is often used in conjunction with Chinese herbal medicine prescriptions.
To explain, it may be said that the yin (follicular phase) is the basis of yang (luteal phase) – so if the yin is weak, yang cannot adequately grow. Acupuncture and herbal supplementation to support Kidney yin and yang are typically prescribed; if deficiencies are especially severe, the jing (basis of all Kidney energies) will also need to be nourished.



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