Autoimmunity and Infertility: An Eastern Approach to Healing

by Andrew Pacholyk MS L.Ac. 
ProAcuMed.com

Our immune system is a complex network of cells, tissues and organs, which work together to defend the body against attacks from “foreign” invaders. The body does this in two different ways. First, the body must recognize that it is being invaded, either by pathogenic disease, toxins or some other outside threat. Second, the immune response should then be activated quickly so the pathogen does not destroy many cells.

In autoimmune conditions, the body is unable to distinguish between what is beneficial and what is non-beneficial, losing the ability to differentiate. When an autoimmune condition is diagnosed, unusual antibodies can be found circulating in the blood, targeting its own body tissue.

In cases of immune system over activity, the body attacks and damages its own tissues (autoimmune diseases). Immune deficiency diseases decrease the body’s ability to fight invaders, causing vulnerability to infections.

Autoimmune disorders include:

Systemic lupus erythematosus (lupus): Lupus develops autoimmune antibodies that can attach to tissues throughout the body. The joints, lungs, blood cells, nerves, and kidneys are commonly affected in lupus.

Multiple sclerosis (MS): The immune system attacks nerve cells, causing symptoms that can include pain, blindness, weakness, poor coordination, and muscle spasms.

Type 1 diabetes mellitus: Immune system antibodies attack and destroy insulin-producing cells in the pancreas.

Guillain-Barre syndrome: The immune system attacks the nerves controlling muscles in the legs and sometimes the arms and upper body resulting in weakness, which can sometimes be severe.

Chronic inflammatory demyelinating polyneuropathy: Similar to Guillian-Barre, the immune system also attacks the nerves in CIDP, but symptoms last much longer. About 30% of patients can become confined to a wheelchair if not diagnosed and treated early.

Thyroid disfunction: hyperthyroidism, hypothyroidism, Hashimoto’s thyroiditis. Antibodies produced by the immune system attack the thyroid gland, slowly destroying the cells that produce thyroid hormone. Low levels of thyroid hormone develop (hypothyroidism), usually over months to years. Symptoms include fatigue, constipation, weight gain, depression, dry skin, and sensitivity to cold. Taking a daily oral synthetic thyroid hormone pill restores normal body functions. Graves’ disease produces antibodies that stimulate the thyroid gland to release excess amounts of thyroid hormone into the blood (hyperthyroidism). Symptoms of Graves’ disease can include bulging eyes as well as weight loss, nervousness, irritability, rapid heart rate, weakness, and brittle hair. Destruction or removal of the thyroid gland, using medicines or surgery, is usually required to treat Graves’ disease.

Myasthenia gravis: Antibodies bind to nerves and make them unable to stimulate muscles properly. Weakness that gets worse with activity is the main symptom of myasthenia gravis.

Endometriosis: is an often painful disorder in which tissue that normally lines the inside of your uterus or endometrium, grows outside the uterus. Endometriosis most commonly involves the ovaries, fallopian tubes and the tissue lining the pelvis. With endometriosis, displaced endometrial tissue continues to act as it normally would, thickening, breaking down and bleeding with each menstrual cycle. Because this displaced tissue has no way to leave the body, it becomes trapped. When endometriosis involves the ovaries, cysts (called endometriomas) may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions causing pelvic tissues and organs to stick to each other. Endometriosis can cause pain, especially during someone's period. Fertility problems also may develop.

Polycystic ovarian syndrome (PCOS): is a hormonal disorder common among women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid (follicles) and fail to regularly release eggs. The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may reduce the risk of long-term complications such as type 2 diabetes and heart disease.

Premature ovarian failure (POF): is a common cause of infertility in women and is characterized by amenorrhea before the age of 40. Menopause before the age of 40 is considered to be premature and is a non-physiological disorder. POF, also known as premature menopause or premature ovarian insufficiency, is defined by the presence of menopausal-level serum follicle-stimulating hormone (FSH) in women younger than 40 years, the mean age of natural menopause depends often on the patients family history. This syndrome is associated with the symptoms and metabolic effects of sex steroid deficiency, as well as the emotional stress experienced by couples who have difficulty in conceiving a pregnancy.

It is known that autoimmune diseases such as diabetes, autoimmune thyroiditis and systemic lupus erythematosis are linked to decreased fertility. Other causes of infertility such as premature ovarian insufficiency, endometriosis and polycystic ovarian syndrome include autoimmune components.

Another element that comes into to play is the regulator of these hormones. The hypothalamic–pituitary–adrenal axis (HPA axis or HTPA axis) is a complex set of direct influences and feedback interactions among three endocrine glands: the hypothalamus, the pituitary gland (a pea-shaped structure located below the thalamus), and the adrenal (also called “suprarenal”) glands (small, conical organs on top of the kidneys).

These organs and their interactions constitute the HPA axis, a major neuroendocrine system that controls reactions to stress and regulates many body processes, including digestion, the immune system, mood and emotions, sexuality, and energy storage and expenditure.

The HPA axis has a central role in regulating many homeostatic systems in the body, including the metabolic system, cardiovascular system, immune system, reproductive system and central nervous system. The HPA axis integrates physical and psychosocial influences in order to allow an organism to adapt effectively to its environment, use resources, and optimize survival.

The hypothalamic-pituitary-adrenal axis (HPA) has been shown to be an important mediator of infertility, involved in the excretion of CRH, ACTH and cortisol, respectively. Data gathered in the literature suggests the involvement of the HPA axis on the hypothalamic-pituitary-gonadotropic axis (HPG). Specifically, changes in diurnal excretion patterns of cortisol have been shown to accompany mental stress and to mediate the down-regulation of the HPG axis.

This impact could possibly involve inhibitory mechanisms at the pituitary level, by reducing the release of FSH and LH by GnRH. Furthermore, research has shown that the effect of cortisol on the HPG axis is dependent on the endocrine status of the ovary in its different stages within the menstrual cycle. From the studies presented in this review it can be hypothesized that stress can induce altered cortisol-excretion patterns along the menstrual cycle, which ultimately affect the hormonal profile in critical stages of the fertilization process.

Traditional Chinese Medicine looks at a Western diagnosis and approach differently than its Western Medicine counterpart. In TCM, every disease is differentiated into a group of patterns or stages. This is done by using the pulse, tongue and symptoms presented to determine the degree of excess of deficiency, interior or exterior invasion, hot or cold in contrast, and location.

Once these parameters have been determined, a long-term treatment plan to regulate the immune response is used to alter the path of the disease.

What TCM is more interested in, is not whether FSH is high, auto-antibodies are determined or T-cell counts are low, but the need to determine the “root cause” of the disorder.  What is it, that caused the body to stop determining between its own cells and disease. Patients have been successfully treating with a combination of acupuncture, herbal therapy, diet and supplementation.

Pattern diagnosis is crucial to determine the root cause of an immune disorder, followed by proper treatment of acupuncture points and a differential herbal formula. Depending on the autoimmune response, nutrition and dietary restrictions can help to coax the body back into a state of equilibrium.

Clinical Research Studies 

POF

Premature ovarian failure (POF) is a common cause of infertility in women and is characterized by amenorrhea before the age of 40. Women with POF have been reported to have diminished general and sexual well-being, are less satisfied with their sexual lives, have increased risk for low bone density, and early onset of osteoporosis.

The TCM etiology of amenorrhea includes insufficient transformation of blood of the spleen and stomach, severe consumption of blood and exhaustion of blood source and blockage or blood stasis in the vessels due to retention of pathogenic factors in the uterus. In this study, local and distal acupoints with functions of reinforcing liver and kidney, regulating Qi and blood, and adjusting mental activity were selected according to the amenorrhea etiology.

The present results indicate that the acupuncture treatment can adjust patients’ serums FSH, and LH level, improving patients’ SAS score and Kupperman score. The serum FSH level dropped to IU/L from baseline to the end of treatment, the serum level rose, and the serum LH level dropped to (17.01). The changes of hormones produced by acupuncture in the present study were similar to the previous investigation using Electro-stim Acupuncture.  Modulation of serums FSH and LH level may partially explain the effects of acupuncture in treating POF, which is also observed in acupuncture improving other gynecological disorders. Four patients regained menstrual cycle after treatment and two during a one-month follow-up period of this study. Such result of present study is similar to the gaining of menstruation in a top athlete reported in a Japanese acupuncture study.

Endo

Approximately 10% of reproductive age women suffer from endometriosis. Additionally, approximately 50 percent of infertile women have endometriosis. Biomedical approaches to controlling endometriosis include surgery, oral contraceptives and anti-inflammatory drugs. GnRH agonists are also used as a treatment modality. However, GnRH agonists lower estrogen levels and maylead to endometrial atrophy and amenorrhea.

Researchers find that acupuncture and Chinese herbal medicine are effective for the relief of endometriosis pain. The total effective rate for auricular acupuncture was over 90%. The total effective rate for Chinese herbal medicine was 60%. A closer look revealed that the effective rate for mild to moderate dysmenorrhea due to endometriosis for both auricular acupuncture and Chinese herbal medicine was similar. However, auricular acupuncture showed greater efficacy for the relief of severe dysmenorrhea due to endometriosis.

A total of 24 studies were reviewed for this investigation. One of the studies met all of the inclusion criteria and was the basis for the research conclusions. The study reviewed by the researchers meeting all inclusion criteria consisted of 67 patients. Based on the positive clinical outcomes reviewed, the researchers suggest that additional studies are appropriate to investigate the efficaciousness of acupuncture for the treatment of endometriosis related pain.

In related findings, Dr. L.C. Giudice, MD, PhD cited acupuncture as effective for the treatment of endometriosis related pain in the New England Journal of Medicine (NEJM). Dr. Giudice cited another randomized, sham-controlled trial of women suffering from endometriosis pain. The study concluded that acupuncture definitively and significantly reduces endometriosis related pain.

PCOS

Polycystic ovarian syndrome is the number one reproductive disease in women. This disease disrupts normal ovulatory cycles which can result in heartbreaking infertility for millions of women. Known hormonal changes in PCOS include excess androgens (ie: testosterone) and insulin resistance.

Electroacupuncture has been found to profoundly affect the reproductive organs, through mechanisms in the sympathetic nervous system, endocrine system, and neuroendocrine system.  When needles are inserted into certain points and stimulated in a specific manner, this produces a neurological reflex transmitted to the organ correlated with that nerve pathway.

Several studies exist on low frequency electroacupuncture and ovulation induction. In one trial, the effect of a series of 14 electroacupuncture treatments on 24 anovulatory women with PCOS was investigated.  In 38% of these women, regular ovulation was induced.

Three months after the last treatment, LH/FSH ratios and testosterone levels were significantly decreased, a sign of improvement in PCOS pathology. In another study done on a group of women given human menopausal gonadotrophin (a commonly used drug in the treatment of infertility), acupuncture was compared to hCG injections in order to assess its effect on ovulation.  Traditionally hCG is given to stimulate ovulation during medicated cycles at fertility clinics.  It was found that a single acupuncture treatment induced ovulation as effectively as the as the hCG injection and reduced the incidence of ovarian hyperstimulation syndrome, a painful side effect of medicated cycles.  Other studies have also indicated enhanced ovarian response when acupuncture is added to medicated cycles.

Determining and Differentiating

In conclusion, with autoimmune conditions, the body is unable to distinguish between what is beneficial and what is non-beneficial, losing the ability to differentiate. When an autoimmune condition is diagnosed, unusual antibodies can be found circulating in the blood, targeting its own body tissue.

Traditional Chinese Medicine looks at a Western diagnosis and approach differently than its Western Medicine counterpart. In TCM, every disease is differentiated into a group of patterns or stages. This is done by using the pulse, tongue and symptoms presented to determine the degree of excess of deficiency, interior or exterior invasion, hot or cold in contrast, and location.

Once these parameters have been determined, a long-term treatment plan to regulate the immune response is used to alter the path of the disease.

What TCM is more interested in, is not whether FSH is high, auto-antibodies are determined or T-cell counts are low, but the need to determine the “root cause” of the disorder.  What is it, that caused the body to stop diffentiating between its own cells and disease? Patients have been successfully treating their conditions with a combination of acupuncture, herbal therapy, diet and supplementation. 

References

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