Case #2: Diminished Ovarian Reserve (high FSH & low AMH)

Female 36 ½ years old.    Office visit date: Sep 2007
            Main complaint: The patient had tried to conceive for three years.
 Nine months before coming to my office, she started consulting a fertility doctor.  At that time her day 2 FSH was 10.  Over the nine months, she received clomiphen citrate and IUI for three cycles without success. 

The patient and her husband decided to go ahead with in vitro fertilization. They went to one of the most renowned hospital IVF centers, but were very disappointed to find her day 2 FSH measured 22.3 .They were told she didn’t qualify for IVF and would have to retest next cycle.  Despite the recommendation to retest the following cycle, from a Western medical point of view one abnormal FSH reading indicates the possibility of Premature Ovarian Aging. The expectation of a successful outcome from the IVF treatment in her case would still be low whether or not the next FSH level were lower. Through a friend’s recommendation, they came to my office for help.

The patient had a very busy and stressful job. She felt tired all the time.  The tongue color was pink and the coating was thin and white.

TCM diagnosis: Kidney Essence deficiency with Spleen Qi and Liver Blood deficiency.
Treatment principle: Tonify Kidney Essence, Spleen Qi and Liver Blood
Treatment plan: Acupuncture twice a week, herbal formula (raw cooked) twice daily
            Herbal formula : gou qi zi, tu si zi, shu di huang, dang gui ,dang shen, fu ling

Acupuncture points: DU 20, DU 24, ST 36 to lift Qi and tonify Spleen, CV 3, 4, ST 29, zi gong, SP 6. Ear: Uteus and Ovary

The patient started her treatment on her cycle day 12.  She followed the protocol thoroughly.  Her seventh visit was cycle day 36. Her menstrual period did not come and pregnancy test showed positive.  The patient continued acupuncture and herbal treatment for preventing miscarriage until 12 weeks of pregnancy. The pregnancy carried smoothly to term. The patient had a healthy baby boy who is now one and half years old.

Summary and discussion:

• After three years of infertility, three cycles of clomiphen and IUI and a new FSH level of 22.3 in this cycle, the patient got pregnant in the same cycle after acupuncture and herbal treatment.
• Her first visit was cycle day 12. The treatment wouldn’t have affected egg quality, but could have had an impact on ovulation, fertilization and implantation.