Luetial Phase Defficency/Infertility

[Guest guest]

Anyone have ideas? I have a 34 patient who has a low BBT in luetal phase after a

nice rise in ovulation. Slight jig-zag up & down but mainly low temp. She has

one child, has had mild endometriosis. Cycle is 28-30 days flow 3-5 no digestive

problems, has some PMS, acne & HA before period.Doesn't state she feels cold but

always wants heater on. She was taking chlomid (6 cycles)since stopping(2 cycles

ago) has had

slightly lower BBT esp luetial. She was esp irritable with Clomid but still has

some issues. Tongue pink,pale slightly fat slightly wet, thin

white coat, pulse sl slippery rt inch & bar left sl wiry inch & bar weak cubit.

I have been giving her Gui Zhi Fu Ling Wan with menses &

a golden flower formula Yuan Support (build Sp,Kd yang & sl harmonize Lv) my

kneejerk reaction is Wen Jing Tang (dx Yang Xu with some Lv Qi)

possibly modified, during luetial phase. Am I missing something, possibly dose

is too low with pills? Steve

[Guest guest]

A few questions:

 

One child - spontaneous conception or with ART?

How old is the child?

Any Male Factor?

The Clomiphene cycles - were these with LH-Timed intercourse, or with

IUI?

How many follicles were generated with each cycle of Clomiphene?

What dose of Clomiphene - 50, 100?

How was her uterine lining on the Clomiphene?

How was the endometriosis diagnosed - with Laparoscopy?

Do you have her lab values, i.e. day-3 FSH/E2, Prolactin, TSH, and

post-ovulatory Progesterone?

Any tubal disease/has she had an HSG?

 

The answers to these questions can help sort this out.

 

Thanks,

 

Ray Rubio, D.A.O.M. (FABORM)

President/CEO ABORM

Chair: Reproductive Medicine Department/Yo San University DAOM Program

 

Westlake Complementary Medicine

910 Hampshire Road, Suite A

Westlake Village, CA 91361

Phone: (805) 497-1335

Fax: (805) 497-1336

email: rtoo

 

 

 

 

On Jan 5, 2010, at 12:46 PM, snydez99 wrote:

 

> Anyone have ideas? I have a 34 patient who has a low BBT in luetal

> phase after a nice rise in ovulation. Slight jig-zag up & down but

> mainly low temp. She has one child, has had mild endometriosis.

> Cycle is 28-30 days flow 3-5 no digestive problems, has some PMS,

> acne & HA before period.Doesn't state she feels cold but always wants

> heater on. She was taking chlomid (6 cycles)since stopping(2 cycles

> ago) has had

> slightly lower BBT esp luetial. She was esp irritable with Clomid

> but still has some issues. Tongue pink,pale slightly fat slightly

> wet, thin

> white coat, pulse sl slippery rt inch & bar left sl wiry inch & bar

> weak cubit. I have been giving her Gui Zhi Fu Ling Wan with menses &

> a golden flower formula Yuan Support (build Sp,Kd yang & sl

> harmonize Lv) my kneejerk reaction is Wen Jing Tang (dx Yang Xu with

> some Lv Qi)

> possibly modified, during luetial phase. Am I missing something,

> possibly dose is too low with pills? Steve

>

>

>

 

 

 

 

 

 

 

[Guest guest]

She had her child now 3 after she stopped clomid (about 4 cycles) took 18 cycles

total to get PG Patient said no Male factor? Clomid

cycles were LH-Timed.

Cholmid dose 25

Don't know about uterine lining but patient says mucous was good ie

ferning

Had removal of uterine polyps & endo dx by laproscopy two subsquent

ultrasounds no polyps

I don't have lab values, wish I did, would these be approiate?

No mention of tubal disease, what is HSG?

 

Thanks Steve

 

, Ray Rubio <RTOO wrote:

>

> A few questions:

>

> One child - spontaneous conception or with ART?

> How old is the child?

> Any Male Factor?

> The Clomiphene cycles - were these with LH-Timed intercourse, or with

> IUI?

> How many follicles were generated with each cycle of Clomiphene?

> What dose of Clomiphene - 50, 100?

> How was her uterine lining on the Clomiphene?

> How was the endometriosis diagnosed - with Laparoscopy?

> Do you have her lab values, i.e. day-3 FSH/E2, Prolactin, TSH, and

> post-ovulatory Progesterone?

> Any tubal disease/has she had an HSG?

>

> The answers to these questions can help sort this out.

>

> Thanks,

>

> Ray Rubio, D.A.O.M. (FABORM)

> President/CEO ABORM

> Chair: Reproductive Medicine Department/Yo San University DAOM Program

>

> Westlake Complementary Medicine

> 910 Hampshire Road, Suite A

> Westlake Village, CA 91361

> Phone: (805) 497-1335

> Fax: (805) 497-1336

> email: rtoo

>

>

>

>

> On Jan 5, 2010, at 12:46 PM, snydez99 wrote:

>

> > Anyone have ideas? I have a 34 patient who has a low BBT in luetal

> > phase after a nice rise in ovulation. Slight jig-zag up & down but

> > mainly low temp. She has one child, has had mild endometriosis.

> > Cycle is 28-30 days flow 3-5 no digestive problems, has some PMS,

> > acne & HA before period.Doesn't state she feels cold but always wants

> > heater on. She was taking chlomid (6 cycles)since stopping(2 cycles

> > ago) has had

> > slightly lower BBT esp luetial. She was esp irritable with Clomid

> > but still has some issues. Tongue pink,pale slightly fat slightly

> > wet, thin

> > white coat, pulse sl slippery rt inch & bar left sl wiry inch & bar

> > weak cubit. I have been giving her Gui Zhi Fu Ling Wan with menses &

> > a golden flower formula Yuan Support (build Sp,Kd yang & sl

> > harmonize Lv) my kneejerk reaction is Wen Jing Tang (dx Yang Xu with

> > some Lv Qi)

> > possibly modified, during luetial phase. Am I missing something,

> > possibly dose is too low with pills? Steve

> >

> >

> >

 

[Guest guest]

Are you saying her chart is bi phasic?

 

If not bi-phasic then low P during the luteal phase?

 

with the acme and pms may want to look at urine 2ohE/16ohE ratio as high 16oh

will down regulate the P.

 

Also would consider 3 formulas keyed to the differerent phases, like maybe a

xiao yao prior to the menses, nourishing during the pre luteal and warming

during the luteal phase.

 

Thanks,

 

Warren L. Cargal www.acuatlanta.net

www.fertilitynow.net

www.canceroptions.net

404-233-5080

 

--- On Tue, 1/5/10, snydez99 <snydez99 wrote:

 

snydez99 <snydez99

Luetial Phase Defficency/Infertility

 

Tuesday, January 5, 2010, 3:46 PM

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Anyone have ideas? I have a 34 patient who has a low BBT in luetal phase

after a nice rise in ovulation. Slight jig-zag up & down but mainly low temp.

She has one child, has had mild endometriosis. Cycle is 28-30 days flow 3-5 no

digestive problems, has some PMS, acne & HA before period.Doesn' t state she

feels cold but always wants heater on. She was taking chlomid (6 cycles)since

stopping(2 cycles ago) has had

 

slightly lower BBT esp luetial. She was esp irritable with Clomid but still has

some issues. Tongue pink,pale slightly fat slightly wet, thin

 

white coat, pulse sl slippery rt inch & bar left sl wiry inch & bar weak cubit.

I have been giving her Gui Zhi Fu Ling Wan with menses &

 

a golden flower formula Yuan Support (build Sp,Kd yang & sl harmonize Lv) my

kneejerk reaction is Wen Jing Tang (dx Yang Xu with some Lv Qi)

 

possibly modified, during luetial phase. Am I missing something, possibly dose

is too low with pills? Steve

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[Guest guest]

Steve -

 

Thanks for this information. An HSG is a hysterosalpinogram. The

doctor will inject radio-opaque dye up through the the uterus and take

an x-ray of the dye spilling out of the fallopian tubes to check for

blockages in the tubes. It's usually indicated for patients who might

have had a previous history of PID, Chlamydia, or use of an IUD. In

the case of this patient, if she conceived after the clomiphene

cycles, naturally, then we can safely assume that she has at least one

functional tube - and most likely two.

 

When was the laparoscopic removal of the polyps and the discovery of

the endometriosis - before or after she had her child?

 

The lab values might be informative for a couple of reasons: sometimes

patients with low luteal phase temps due to subclinical

hypothyroidism. Also, normal values for TSH can vary widely as a

reference range: i..e. 0.5-5.0, when it's really best to have it below

2.0 for conception and a healthy pregnancy. And many women will

develop subclinical hypothyroidism after delivering their first child

due to the demands of an infant: lack of sleep, having to return to

work too soon, etc.

 

It is also always helpful to start with a good baseline of lab values

for infertility. You might want to refer her and her husband to a good

REI in your area for an initial consult. They will do day-3 values for

her, and probably check her partner, and they will do a transvaginal

ultrasound to do a basal antral follicle count. These will all help to

evaluate her ovarian reserve. (I am assuming that if they were doing

such a low dose of Clomiphene with only LH-Timed intercourse that they

got the Clomid from her OBGYN, not an REI - is that correct?)

 

Also, if they conceived naturally, that usually portends favorable

semen densities for the male partner, but not always. Taking 18 months

for a a 29 year-old patient to conceive is not typical if they were

monitoring ovulation, etc. (I figured if she is now 34, and her child

is 3 = 31-18 months to conception = around 29). You might suggest that

he get checked, just to be safe. 30% of all infertility is male factor

alone, and 60% of all infertility results from problems stemming from

both partners. Again, considering he has a 3 year-old, he is probably

fertile, but males can develop secondary infertility for reasons that

are more in depth than I can go over here.

 

From a TCM point of view, remember that the whole phasic treatment

idea doesn't mean that you have to treat each phase (i.e. move blood

during the period, tonify yin/xue during the pre-ovulatory phase,

boost SP Qi and Kidney Yang during ovulation and the luteal phase, and

move Qi and support the kidney during the premenstrual phase) - these

are just guidelines to help you arrive at treatment principles,

acupuncture, and herbs - if there are identifiable problems with one

or more of the phases.

 

So, in this patient, you might simply focus on treating the phase that

looks weak, i..e the luteal phase. Maybe just have her come in to see

you in the several days leading up to the ovulatory window, and really

move Qi and Blood in order to help produce a good corpus luteum. Then

you can prescribe a combination of Yu Lin Zhu/Bu Zhong Yi Qi Tang for

the luteal phase w/some Huang Qin to control the heat (acne+headaches

that she gets with her periods). Also Huang Qin is one of the " secure-

the-fetus " fetus herbs.

 

Anyway, these are just some thoughts, and if you want to discuss this

more in depth, feel free to call me any time: (323) 793-5131.

 

Good luck,

 

Ray Rubio

 

 

On Jan 5, 2010, at 4:41 PM, snydez99 wrote:

 

> She had her child now 3 after she stopped clomid (about 4 cycles)

> took 18 cycles total to get PG Patient said no Male factor? Clomid

> cycles were LH-Timed.

> Cholmid dose 25

> Don't know about uterine lining but patient says mucous was good ie

> ferning

> Had removal of uterine polyps & endo dx by laproscopy two subsquent

> ultrasounds no polyps

> I don't have lab values, wish I did, would these be approiate?

> No mention of tubal disease, what is HSG?

>

> Thanks Steve

>

> , Ray Rubio <RTOO wrote:

> >

> > A few questions:

> >

> > One child - spontaneous conception or with ART?

> > How old is the child?

> > Any Male Factor?

> > The Clomiphene cycles - were these with LH-Timed intercourse, or

> with

> > IUI?

> > How many follicles were generated with each cycle of Clomiphene?

> > What dose of Clomiphene - 50, 100?

> > How was her uterine lining on the Clomiphene?

> > How was the endometriosis diagnosed - with Laparoscopy?

> > Do you have her lab values, i.e. day-3 FSH/E2, Prolactin, TSH, and

> > post-ovulatory Progesterone?

> > Any tubal disease/has she had an HSG?

> >

> > The answers to these questions can help sort this out.

> >

> > Thanks,

> >

> > Ray Rubio, D.A.O.M. (FABORM)

> > President/CEO ABORM

> > Chair: Reproductive Medicine Department/Yo San University DAOM

> Program

> >

> > Westlake Complementary Medicine

> > 910 Hampshire Road, Suite A

> > Westlake Village, CA 91361

> > Phone: (805) 497-1335

> > Fax: (805) 497-1336

> > email: rtoo

> >

> >

> >

> >

> > On Jan 5, 2010, at 12:46 PM, snydez99 wrote:

> >

> > > Anyone have ideas? I have a 34 patient who has a low BBT in luetal

> > > phase after a nice rise in ovulation. Slight jig-zag up & down but

> > > mainly low temp. She has one child, has had mild endometriosis.

> > > Cycle is 28-30 days flow 3-5 no digestive problems, has some PMS,

> > > acne & HA before period.Doesn't state she feels cold but always

> wants

> > > heater on. She was taking chlomid (6 cycles)since stopping(2

> cycles

> > > ago) has had

> > > slightly lower BBT esp luetial. She was esp irritable with Clomid

> > > but still has some issues. Tongue pink,pale slightly fat slightly

> > > wet, thin

> > > white coat, pulse sl slippery rt inch & bar left sl wiry inch &

> bar

> > > weak cubit. I have been giving her Gui Zhi Fu Ling Wan with

> menses &

> > > a golden flower formula Yuan Support (build Sp,Kd yang & sl

> > > harmonize Lv) my kneejerk reaction is Wen Jing Tang (dx Yang Xu

> with

> > > some Lv Qi)

> > > possibly modified, during luetial phase. Am I missing something,

> > > possibly dose is too low with pills? Steve

> > >

> > >

> > >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

yes her chart is biphasic, however it doesn't stay up in the luetal

phase. Interestingly with chomid it did, but she had short cycles.

 

 

, Warren Cargal <wcargal9 wrote:

>

> Are you saying her chart is bi phasic?

>

> If not bi-phasic then low P during the luteal phase?

>

> with the acme and pms may want to look at urine 2ohE/16ohE ratio as high 16oh

will down regulate the P.

>

> Also would consider 3 formulas keyed to the differerent phases, like maybe a

xiao yao prior to the menses, nourishing during the pre luteal and warming

during the luteal phase.

>

> Thanks,

>

> Warren L. Cargal www.acuatlanta.net

> www.fertilitynow.net

> www.canceroptions.net

> 404-233-5080

>

> --- On Tue, 1/5/10, snydez99 <snydez99 wrote:

>

> snydez99 <snydez99

> Luetial Phase Defficency/Infertility

>

> Tuesday, January 5, 2010, 3:46 PM

>

 

>

>

>

Anyone have ideas? I have a 34 patient who has a low BBT in luetal phase

after a nice rise in ovulation. Slight jig-zag up & down but mainly low temp.

She has one child, has had mild endometriosis. Cycle is 28-30 days flow 3-5 no

digestive problems, has some PMS, acne & HA before period.Doesn' t state she

feels cold but always wants heater on. She was taking chlomid (6 cycles)since

stopping(2 cycles ago) has had

>

> slightly lower BBT esp luetial. She was esp irritable with Clomid but still

has some issues. Tongue pink,pale slightly fat slightly wet, thin

>

> white coat, pulse sl slippery rt inch & bar left sl wiry inch & bar weak

cubit. I have been giving her Gui Zhi Fu Ling Wan with menses &

>

> a golden flower formula Yuan Support (build Sp,Kd yang & sl harmonize Lv) my

kneejerk reaction is Wen Jing Tang (dx Yang Xu with some Lv Qi)

>

> possibly modified, during luetial phase. Am I missing something, possibly dose

is too low with pills? Steve

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

>

 

[Guest guest]

Hi Ray,

 

have you ever used saliva teating? Have you ever used Diagnosis-Techs Inc? Just

wondering because many of my female patients have trouble

with MD's doing lab tests. If you have used salvia, is it as good as blood

tests?

 

Thanks again Steve

 

, Ray Rubio <RTOO wrote:

>

> Steve -

[Guest guest]

Steve -

 

It is pretty normal for patients with weak luteal phase BBT charts to

see an improvement when they do ovulation induction - either with

Clomiphene Citrate, or with Gonadatropins (i.e. Follistim, Gonal F,

Menopure, etc.). This is because these medications result in " rescue "

of more follicles from the follicular atresia that occurs in a normal

menstrual cycle. Because these medications result in supra-physiologic

levels of FSH to be available for the follicles, there are more

follicles that survive through to ovulation, and therefore more Corpus

Lutea, and Voila! More Progesterone being secreted by the increased

number of Corpus Lutea. This increased Progesterone Production from

the higher number of Corpus Lutea is what results in the stronger

luteal phase.

 

Ray

On Jan 6, 2010, at 10:15 AM, snydez99 wrote:

 

> yes her chart is biphasic, however it doesn't stay up in the luetal

> phase. Interestingly with chomid it did, but she had short cycles.

>

> , Warren Cargal

> <wcargal9 wrote:

> >

> > Are you saying her chart is bi phasic?

> >

> > If not bi-phasic then low P during the luteal phase?

> >

> > with the acme and pms may want to look at urine 2ohE/16ohE ratio

> as high 16oh will down regulate the P.

> >

> > Also would consider 3 formulas keyed to the differerent phases,

> like maybe a xiao yao prior to the menses, nourishing during the pre

> luteal and warming during the luteal phase.

> >

> > Thanks,

> >

> > Warren L. Cargal www.acuatlanta.net

> > www.fertilitynow.net

> > www.canceroptions.net

> > 404-233-5080

> >

> > --- On Tue, 1/5/10, snydez99 <snydez99 wrote:

> >

> > snydez99 <snydez99

> > Luetial Phase Defficency/Infertility

> >

> > Tuesday, January 5, 2010, 3:46 PM

> >

> >

> >

> >

> >

> >

> >

> > Â

> >

> >

> >

> >

> >

> >

> >

> >

> >

> > Anyone have ideas? I have a 34 patient who has a low BBT in luetal

> phase after a nice rise in ovulation. Slight jig-zag up & down but

> mainly low temp. She has one child, has had mild endometriosis.

> Cycle is 28-30 days flow 3-5 no digestive problems, has some PMS,

> acne & HA before period.Doesn' t state she feels cold but always

> wants heater on. She was taking chlomid (6 cycles)since stopping(2

> cycles ago) has had

> >

> > slightly lower BBT esp luetial. She was esp irritable with Clomid

> but still has some issues. Tongue pink,pale slightly fat slightly

> wet, thin

> >

> > white coat, pulse sl slippery rt inch & bar left sl wiry inch &

> bar weak cubit. I have been giving her Gui Zhi Fu Ling Wan with

> menses &

> >

> > a golden flower formula Yuan Support (build Sp,Kd yang & sl

> harmonize Lv) my kneejerk reaction is Wen Jing Tang (dx Yang Xu with

> some Lv Qi)

> >

> > possibly modified, during luetial phase. Am I missing something,

> possibly dose is too low with pills? Steve

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

I don't use Saliva Testing myself - I am kind of " old-school " in that

way. But I know of many competent TCM Clinicians who do it regularly,

and who swear by it - as opposed to regular serum testing - so maybe

some of them could chime in here and share their experience.

 

Ray Rubio

On Jan 6, 2010, at 10:26 AM, snydez99 wrote:

 

> Hi Ray,

>

> have you ever used saliva teating? Have you ever used Diagnosis-

> Techs Inc? Just wondering because many of my female patients have

> trouble

> with MD's doing lab tests. If you have used salvia, is it as good as

> blood tests?

>

> Thanks again Steve

>

> , Ray Rubio <RTOO wrote:

> >

> > Steve -

>

>

 

 

 

 

 

 

[Guest guest]

Steve, Ray, et al,

 

Was she doing a BBT prior to taking Clomid? The reason I ask is because I

frequently see Clomid creating as many problems as it solves, particularly in

(blood and yin) deficient patients.

 

I know her issue is with the luteal phase, which would point to yang being

deficient more than yin, but if her spleen qi is also weak it may not be

generating yang (or blood, which could contribute to some of the signs of

binding depression of liver qi that you mention).

 

Ray, I'm assuming that from a TCM perspective that clomid depletes blood and

yin, as I've been taught--does it also damage the SP qi? And I'm with you about

the thyroid. She should request a full panel from her MD, if she hasn't already.

 

The other thing to keep in mind with mothers of young children is that not only

do you have the taxations of pregnancy, lactation, and irregular/insufficient

sleep to contend with, but usually irregular eating, eating standing up while

feeding your kids, relying what one patient of mine calls " astronaut food " (ie,

energy bars and other packaged food) or eating " kid food " (pasta, chicken

nuggets, fish sticks, cheese sandwiches, etc.). So, I find it's the rare mom

who's not SP xu! Urging her to carve out some time to eat better and focus on

her food (and herbs) will greatly increase the efficacy of her treatment.

 

--Sarah Rivkin

 

 

, Ray Rubio <RTOO wrote:

>

> Steve -

>

> It is pretty normal for patients with weak luteal phase BBT charts to

> see an improvement when they do ovulation induction - either with

> Clomiphene Citrate, or with Gonadatropins (i.e. Follistim, Gonal F,

> Menopure, etc.). This is because these medications result in " rescue "

> of more follicles from the follicular atresia that occurs in a normal

> menstrual cycle. Because these medications result in supra-physiologic

> levels of FSH to be available for the follicles, there are more

> follicles that survive through to ovulation, and therefore more Corpus

> Lutea, and Voila! More Progesterone being secreted by the increased

> number of Corpus Lutea. This increased Progesterone Production from

> the higher number of Corpus Lutea is what results in the stronger

> luteal phase.

>

> Ray

> On Jan 6, 2010, at 10:15 AM, snydez99 wrote:

>

> > yes her chart is biphasic, however it doesn't stay up in the luetal

> > phase. Interestingly with chomid it did, but she had short cycles.

> >

> > , Warren Cargal

> > <wcargal9@> wrote:

> > >

> > > Are you saying her chart is bi phasic?

> > >

> > > If not bi-phasic then low P during the luteal phase?

> > >

> > > with the acme and pms may want to look at urine 2ohE/16ohE ratio

> > as high 16oh will down regulate the P.

> > >

> > > Also would consider 3 formulas keyed to the differerent phases,

> > like maybe a xiao yao prior to the menses, nourishing during the pre

> > luteal and warming during the luteal phase.

> > >

> > > Thanks,

> > >

> > > Warren L. Cargal www.acuatlanta.net

> > > www.fertilitynow.net

> > > www.canceroptions.net

> > > 404-233-5080

> > >

> > > --- On Tue, 1/5/10, snydez99 <snydez99@> wrote:

> > >

> > > snydez99 <snydez99@>

> > > Luetial Phase Defficency/Infertility

> > >

> > > Tuesday, January 5, 2010, 3:46 PM

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > > Â

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > > Anyone have ideas? I have a 34 patient who has a low BBT in luetal

> > phase after a nice rise in ovulation. Slight jig-zag up & down but

> > mainly low temp. She has one child, has had mild endometriosis.

> > Cycle is 28-30 days flow 3-5 no digestive problems, has some PMS,

> > acne & HA before period.Doesn' t state she feels cold but always

> > wants heater on. She was taking chlomid (6 cycles)since stopping(2

> > cycles ago) has had

> > >

> > > slightly lower BBT esp luetial. She was esp irritable with Clomid

> > but still has some issues. Tongue pink,pale slightly fat slightly

> > wet, thin

> > >

> > > white coat, pulse sl slippery rt inch & bar left sl wiry inch &

> > bar weak cubit. I have been giving her Gui Zhi Fu Ling Wan with

> > menses &

> > >

> > > a golden flower formula Yuan Support (build Sp,Kd yang & sl

> > harmonize Lv) my kneejerk reaction is Wen Jing Tang (dx Yang Xu with

> > some Lv Qi)

> > >

> > > possibly modified, during luetial phase. Am I missing something,

> > possibly dose is too low with pills? Steve

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

> > >

[Guest guest]

Sarah -

 

I love your your patient's description of " astronaut food " . Couldn't

agree more. I remember what my wife went through with a 2 year-old and

and infant to contend with. It was like some advanced form of Tai Qi

and The Matrix with her feeding the kids, answering the phone, feeding

herself while standing up, and catching the sippy cup before it

crashed to the ground...If that isn't a prescription for Sp Qi Xu and

exhausted adrenals and thyroid, I'm not sure what is.

 

Also, you are correct that Clomid often causes more problems than it

solves - sometimes even more than Ganadatropins - because it is a SERM

(i.e. it acts systemically on the Hypothalamus, Ovaries and Uterus).

In patients that have pre-existing yin or blood deficiency, Clomid

will only worsen their pattern of disharmony, and they will often

experience hot flashes, night sweats, irritability, and thinning of

the uterine lining - even at conservative dosages. Additionally,

Clomid doesn't work too well with patients who have prominent Liver Qi

Depression signs and symptoms because it causes congestion in the free

coursing of Liver Qi as a result of the increased demands on

metabolization of the Estradiol created by the increased number of

follicles. This type of patient will exhibit dysphoria (i.e.

disorientation), irritability/anger/depression, significant lower

abdominal bloating, and often very poor recruitment of follicles -

i.e. high dose of Clomid yields 1-2 follicles only.

 

And you bring up a good point about Clomid potentially depleting Sp

Qi. I think the pathomechanism that might account for this is the way

that Clomid results in such significant hormone-related water

retention, bloating and edema. This probably puts excessive demands on

the Spleen's function of T & T, and when you combine that with the

Liver Qi Depression noted above, this further exacerbates the issue.

 

Just a hunch,

 

Ray Rubio

On Jan 6, 2010, at 12:00 PM, saydit wrote:

 

> Steve, Ray, et al,

>

> Was she doing a BBT prior to taking Clomid? The reason I ask is

> because I frequently see Clomid creating as many problems as it

> solves, particularly in (blood and yin) deficient patients.

>

> I know her issue is with the luteal phase, which would point to yang

> being deficient more than yin, but if her spleen qi is also weak it

> may not be generating yang (or blood, which could contribute to some

> of the signs of binding depression of liver qi that you mention).

>

> Ray, I'm assuming that from a TCM perspective that clomid depletes

> blood and yin, as I've been taught--does it also damage the SP qi?

> And I'm with you about the thyroid. She should request a full panel

> from her MD, if she hasn't already.

>

> The other thing to keep in mind with mothers of young children is

> that not only do you have the taxations of pregnancy, lactation, and

> irregular/insufficient sleep to contend with, but usually irregular

> eating, eating standing up while feeding your kids, relying what one

> patient of mine calls " astronaut food " (ie, energy bars and other

> packaged food) or eating " kid food " (pasta, chicken nuggets, fish

> sticks, cheese sandwiches, etc.). So, I find it's the rare mom who's

> not SP xu! Urging her to carve out some time to eat better and focus

> on her food (and herbs) will greatly increase the efficacy of her

> treatment.

>

> --Sarah Rivkin

>

> , Ray Rubio <RTOO wrote:

> >

> > Steve -

> >

> > It is pretty normal for patients with weak luteal phase BBT charts

> to

> > see an improvement when they do ovulation induction - either with

> > Clomiphene Citrate, or with Gonadatropins (i.e. Follistim, Gonal F,

> > Menopure, etc.). This is because these medications result in

> " rescue "

> > of more follicles from the follicular atresia that occurs in a

> normal

> > menstrual cycle. Because these medications result in supra-

> physiologic

> > levels of FSH to be available for the follicles, there are more

> > follicles that survive through to ovulation, and therefore more

> Corpus

> > Lutea, and Voila! More Progesterone being secreted by the increased

> > number of Corpus Lutea. This increased Progesterone Production from

> > the higher number of Corpus Lutea is what results in the stronger

> > luteal phase.

> >

> > Ray

> > On Jan 6, 2010, at 10:15 AM, snydez99 wrote:

> >

> > > yes her chart is biphasic, however it doesn't stay up in the

> luetal

> > > phase. Interestingly with chomid it did, but she had short cycles.

> > >

> > > , Warren Cargal

> > > <wcargal9@> wrote:

> > > >

> > > > Are you saying her chart is bi phasic?

> > > >

> > > > If not bi-phasic then low P during the luteal phase?

> > > >

> > > > with the acme and pms may want to look at urine 2ohE/16ohE ratio

> > > as high 16oh will down regulate the P.

> > > >

> > > > Also would consider 3 formulas keyed to the differerent phases,

> > > like maybe a xiao yao prior to the menses, nourishing during the

> pre

> > > luteal and warming during the luteal phase.

> > > >

> > > > Thanks,

> > > >

> > > > Warren L. Cargal www.acuatlanta.net

> > > > www.fertilitynow.net

> > > > www.canceroptions.net

> > > > 404-233-5080

> > > >

> > > > --- On Tue, 1/5/10, snydez99 <snydez99@> wrote:

> > > >

> > > > snydez99 <snydez99@>

> > > > Luetial Phase Defficency/Infertility

> > > >

> > > > Tuesday, January 5, 2010, 3:46 PM

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > Â

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > Anyone have ideas? I have a 34 patient who has a low BBT in

> luetal

> > > phase after a nice rise in ovulation. Slight jig-zag up & down but

> > > mainly low temp. She has one child, has had mild endometriosis.

> > > Cycle is 28-30 days flow 3-5 no digestive problems, has some PMS,

> > > acne & HA before period.Doesn' t state she feels cold but always

> > > wants heater on. She was taking chlomid (6 cycles)since stopping(2

> > > cycles ago) has had

> > > >

> > > > slightly lower BBT esp luetial. She was esp irritable with

> Clomid

> > > but still has some issues. Tongue pink,pale slightly fat slightly

> > > wet, thin

> > > >

> > > > white coat, pulse sl slippery rt inch & bar left sl wiry inch &

> > > bar weak cubit. I have been giving her Gui Zhi Fu Ling Wan with

> > > menses &

> > > >

> > > > a golden flower formula Yuan Support (build Sp,Kd yang & sl

> > > harmonize Lv) my kneejerk reaction is Wen Jing Tang (dx Yang Xu

> with

> > > some Lv Qi)

> > > >

> > > > possibly modified, during luetial phase. Am I missing something,

> > > possibly dose is too low with pills? Steve

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

[Guest guest]

Good discussion -- thanks to all posters.

 

I am treating a patient currently with this same BBT pattern, but different

disease -- both eastern and western -- she is able to conceive, but has had 3

early miscarriages. Western Dx Hashimoto's. While your patient may not have this

autoimmune disease, the BBT and symptomology are very suggestive of need to

check and regulate thyroid. So I'll add my echo to the previous posters.

 

I wanted to respond to the idea about tablets -- I think tablets all depend on

manufacture and dosage, and I do have a strong bias towards decoctions. For my

patient, diagnosed with SP/KI yang xu and liver depressive heat, I have been

prescribing shu di huang, xiang, fu, ji xue teng, ai ye, huang qin, e jiao, lu

jiao jiao, bai shao, sang ji sheng, ba ji tian, yin yang, huo, rou gui -- This

is a modification of Fu Ke zhong Zi Wan. I think the lu jiao jiao, yin yang huo

and huang qin have all been essential. My patient took this formula beginning in

June 09 and is now 15 weeks pregnant.

 

Every time she would stop the formula, she would get a dip in her post luteal

BBT. Weaning her off the Rx has been tricky as well, as our first move to

granulars (along with some strenuous activity) brought on some bleeding (no

cramping) a couple weeks ago. Back on the decoction, and everything seems fine.

 

She is concurrently seeing an western doc and maintaining tx for Hashimoto's

with synthroid, which is also new in this pregnancy.

 

If I am counting right, you patient has had 10 cycles with clomid -- seems like

alot of stimulated cycles. If she isn't being seen by a Reproductive

Endocrinologist, she should be. There are some alternatives to clomid.

 

Hope this helps.

 

Valerie Hobbs

[Guest guest]

Hi Ray,

I have always been interested the pathomechanisms and TCM physiology of

Clomid, FSH, Estradiol, etc. I actually got a good laugh out of the old

fertility doc and his whole team I was following in Nanjing when I asked: " What

is the TCM effect of Clomid? " Silly American- " Clomid is a western drug- it has

no TCM effects!!! " was his answer.

Since I and many others are treating patients while on these meds I think it is

important that we understand how these meds are effecting our patients. I can't

think of a better place to discuss this than in this forum.

I agree with the idea of Liver qi as an important part in the effects of

Clomid but I feel there is a more direct effect on the Kidneys. If Kidney yang

is being used to create more follicles wouldn't that then be the cause of

decreased fluid metabolism? You could say that there then is less yang

available to the Spleen to complete its normal functions. This may be blasphemy

but I feel there is a strong component of Kidney yang and not only yin being

important in follicle growth. I also don't feel that estrogen or estradiol are

purely " yin substances " as many sources state. As you can see in patients when

on estradiol supplementation there are many yang excess side effects. What is

your feeling on this topic?

I also wonder what is the pathomechanism of Liver qi with this drug and

hormone supplementation. Is it direct or is Liver blood being depleted in some

way? This would go along with your idea of increased yin deficiency- ie liver

blood/kidney yin.

Hope to get a discussion started.

Rich Blitstein

 

 

, Ray Rubio <RTOO wrote:

>

> Sarah -

>

> I love your your patient's description of " astronaut food " . Couldn't

> agree more. I remember what my wife went through with a 2 year-old and

> and infant to contend with. It was like some advanced form of Tai Qi

> and The Matrix with her feeding the kids, answering the phone, feeding

> herself while standing up, and catching the sippy cup before it

> crashed to the ground...If that isn't a prescription for Sp Qi Xu and

> exhausted adrenals and thyroid, I'm not sure what is.

>

> Also, you are correct that Clomid often causes more problems than it

> solves - sometimes even more than Ganadatropins - because it is a SERM

> (i.e. it acts systemically on the Hypothalamus, Ovaries and Uterus).

> In patients that have pre-existing yin or blood deficiency, Clomid

> will only worsen their pattern of disharmony, and they will often

> experience hot flashes, night sweats, irritability, and thinning of

> the uterine lining - even at conservative dosages. Additionally,

> Clomid doesn't work too well with patients who have prominent Liver Qi

> Depression signs and symptoms because it causes congestion in the free

> coursing of Liver Qi as a result of the increased demands on

> metabolization of the Estradiol created by the increased number of

> follicles. This type of patient will exhibit dysphoria (i.e.

> disorientation), irritability/anger/depression, significant lower

> abdominal bloating, and often very poor recruitment of follicles -

> i.e. high dose of Clomid yields 1-2 follicles only.

>

> And you bring up a good point about Clomid potentially depleting Sp

> Qi. I think the pathomechanism that might account for this is the way

> that Clomid results in such significant hormone-related water

> retention, bloating and edema. This probably puts excessive demands on

> the Spleen's function of T & T, and when you combine that with the

> Liver Qi Depression noted above, this further exacerbates the issue.

>

> Just a hunch,

>

> Ray Rubio

> On Jan 6, 2010, at 12:00 PM, saydit wrote:

>

> > Steve, Ray, et al,

> >

> > Was she doing a BBT prior to taking Clomid? The reason I ask is

> > because I frequently see Clomid creating as many problems as it

> > solves, particularly in (blood and yin) deficient patients.

> >

> > I know her issue is with the luteal phase, which would point to yang

> > being deficient more than yin, but if her spleen qi is also weak it

> > may not be generating yang (or blood, which could contribute to some

> > of the signs of binding depression of liver qi that you mention).

> >

> > Ray, I'm assuming that from a TCM perspective that clomid depletes

> > blood and yin, as I've been taught--does it also damage the SP qi?

> > And I'm with you about the thyroid. She should request a full panel

> > from her MD, if she hasn't already.

> >

> > The other thing to keep in mind with mothers of young children is

> > that not only do you have the taxations of pregnancy, lactation, and

> > irregular/insufficient sleep to contend with, but usually irregular

> > eating, eating standing up while feeding your kids, relying what one

> > patient of mine calls " astronaut food " (ie, energy bars and other

> > packaged food) or eating " kid food " (pasta, chicken nuggets, fish

> > sticks, cheese sandwiches, etc.). So, I find it's the rare mom who's

> > not SP xu! Urging her to carve out some time to eat better and focus

> > on her food (and herbs) will greatly increase the efficacy of her

> > treatment.

> >

> > --Sarah Rivkin

> >

> > , Ray Rubio <RTOO@> wrote:

> > >

> > > Steve -

> > >

> > > It is pretty normal for patients with weak luteal phase BBT charts

> > to

> > > see an improvement when they do ovulation induction - either with

> > > Clomiphene Citrate, or with Gonadatropins (i.e. Follistim, Gonal F,

> > > Menopure, etc.). This is because these medications result in

> > " rescue "

> > > of more follicles from the follicular atresia that occurs in a

> > normal

> > > menstrual cycle. Because these medications result in supra-

> > physiologic

> > > levels of FSH to be available for the follicles, there are more

> > > follicles that survive through to ovulation, and therefore more

> > Corpus

> > > Lutea, and Voila! More Progesterone being secreted by the increased

> > > number of Corpus Lutea. This increased Progesterone Production from

> > > the higher number of Corpus Lutea is what results in the stronger

> > > luteal phase.

> > >

> > > Ray

> > > On Jan 6, 2010, at 10:15 AM, snydez99 wrote:

> > >

> > > > yes her chart is biphasic, however it doesn't stay up in the

> > luetal

> > > > phase. Interestingly with chomid it did, but she had short cycles.

> > > >

> > > > , Warren Cargal

> > > > <wcargal9@> wrote:

> > > > >

> > > > > Are you saying her chart is bi phasic?

> > > > >

> > > > > If not bi-phasic then low P during the luteal phase?

> > > > >

> > > > > with the acme and pms may want to look at urine 2ohE/16ohE ratio

> > > > as high 16oh will down regulate the P.

> > > > >

> > > > > Also would consider 3 formulas keyed to the differerent phases,

> > > > like maybe a xiao yao prior to the menses, nourishing during the

> > pre

> > > > luteal and warming during the luteal phase.

> > > > >

> > > > > Thanks,

> > > > >

> > > > > Warren L. Cargal www.acuatlanta.net

> > > > > www.fertilitynow.net

> > > > > www.canceroptions.net

> > > > > 404-233-5080

> > > > >

> > > > > --- On Tue, 1/5/10, snydez99 <snydez99@> wrote:

> > > > >

> > > > > snydez99 <snydez99@>

> > > > > Luetial Phase Defficency/Infertility

> > > > >

> > > > > Tuesday, January 5, 2010, 3:46 PM

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > > Â

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > > Anyone have ideas? I have a 34 patient who has a low BBT in

> > luetal

> > > > phase after a nice rise in ovulation. Slight jig-zag up & down but

> > > > mainly low temp. She has one child, has had mild endometriosis.

> > > > Cycle is 28-30 days flow 3-5 no digestive problems, has some PMS,

> > > > acne & HA before period.Doesn' t state she feels cold but always

> > > > wants heater on. She was taking chlomid (6 cycles)since stopping(2

> > > > cycles ago) has had

> > > > >

> > > > > slightly lower BBT esp luetial. She was esp irritable with

> > Clomid

> > > > but still has some issues. Tongue pink,pale slightly fat slightly

> > > > wet, thin

> > > > >

> > > > > white coat, pulse sl slippery rt inch & bar left sl wiry inch &

> > > > bar weak cubit. I have been giving her Gui Zhi Fu Ling Wan with

> > > > menses &

> > > > >

> > > > > a golden flower formula Yuan Support (build Sp,Kd yang & sl

> > > > harmonize Lv) my kneejerk reaction is Wen Jing Tang (dx Yang Xu

> > with

> > > > some Lv Qi)

> > > > >

> > > > > possibly modified, during luetial phase. Am I missing something,

> > > > possibly dose is too low with pills? Steve

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

[Guest guest]

Valerie,

 

I wish I could get patients to take dedocotions What is your

dosage?(75-100/day?). Do you give only during luetal phase? I've only seen her

for 3 months and only 2 cycles off of clomid. While on clomid her cycle was

short (once only18 days) now it's back to normal Here is pills(Golden Flower)

I'm giving her, believe it or not years ago I had a patient with severe endo get

PG with Golden Flower but it did take over 2 years and the endo was the main

focus not getting PG.

GF Yuan Support dosage now 9/day 75

 

Polygoni Multiflori Caulis (Fo-ti Stem, Polygonum Vine / Ye Jiao Teng) 10%

Dioscoreae Rhizoma (Chinese Yam / Shan Yao) 10%

Cuscutae Semen (Chinese Dodder Seed, Chinese Cuscuta / Tu Si Zi) 10%

Angelicae Sinensis Radix (Dong Quai, Tang Kuei / Dang Gui) 9%

Dipsaci Radix (Japanese Teasel Root, Dipsacus / Xu Duan) 9%

Paeoniae Radix, alba (Chinese White Peony / Bai Shao) 9%

Codonopsis Pilosae Radix (Codonopsis / Dang Shen) 8%

Atractylodis Macrocephalae Rhizoma (White Atractylodes Rhizome / Bai Zhu) 8%

Poria (Poria, Hoelen, Tuckahoe / Fu Ling) 8%

Eucommiae Cor tex (Eucommia Bark / Du Zhong) 7%

Lycii Fructus (Lycium Fruit, Chinese Wolfberr y / Gou Qi Zi) 6%

Bupleuri Radix (Bupleurum Root / Chai Hu) 6%

 

Chinese Medical Actions

Supplements spleen qi and kidney yang, nourishes blood, moves liver qi

stagnation, nourishes and calms spirit.

 

Any suggestions?

 

 

, " ValerieH " <hobbs.valeriehobbs

wrote:

>

>

> Good discussion -- thanks to all posters.

>

> I am treating a patient currently with this same BBT pattern, but different

disease -- both eastern and western -- she is able to conceive, but has had 3

early miscarriages. Western Dx Hashimoto's. While your patient may not have this

autoimmune disease, the BBT and symptomology are very suggestive of need to

check and regulate thyroid. So I'll add my echo to the previous posters.

>

> I wanted to respond to the idea about tablets -- I think tablets all depend on

manufacture and dosage, and I do have a strong bias towards decoctions. For my

patient, diagnosed with SP/KI yang xu and liver depressive heat, I have been

prescribing shu di huang, xiang, fu, ji xue teng, ai ye, huang qin, e jiao, lu

jiao jiao, bai shao, sang ji sheng, ba ji tian, yin yang, huo, rou gui -- This

is a modification of Fu Ke zhong Zi Wan. I think the lu jiao jiao, yin yang huo

and huang qin have all been essential. My patient took this formula beginning in

June 09 and is now 15 weeks pregnant.

>

> Every time she would stop the formula, she would get a dip in her post luteal

BBT. Weaning her off the Rx has been tricky as well, as our first move to

granulars (along with some strenuous activity) brought on some bleeding (no

cramping) a couple weeks ago. Back on the decoction, and everything seems fine.

>

> She is concurrently seeing an western doc and maintaining tx for Hashimoto's

with synthroid, which is also new in this pregnancy.

>

> If I am counting right, you patient has had 10 cycles with clomid -- seems

like alot of stimulated cycles. If she isn't being seen by a Reproductive

Endocrinologist, she should be. There are some alternatives to clomid.

>

> Hope this helps.

>

> Valerie Hobbs

>

[Guest guest]

I think I missed something (no digests have been sent since 12/12!!) - but do

you have her FSH / E2? Can you post a link to a picture of her chart (or last

several)? I wouldn't be surprised if her E2 is low and maybe even her

follicular phase temps aren't stable (and low). I find that's a common

presentation with my patients... and silly to use clomid for those patients, but

in Western medicine, you treat the average, not allowing for individuality...

blah blah... :-) but it does seem to work pretty well for heavier than ideal

BMI. If so, you can use more aggresive blood / yin nourishing (I really like Wu

Chi Bai Feng Wan) until/if she gets some PMS symptoms - I find that works better

than just following nourishing until ovulation and moving after. If you have

that FSH/E2 - let us know.

Geoff