Fertility and Dong Quai

I thought about writing a little bit more about the herbs I took to get pregnant.
I developed for myself, a special regime I followed diligently over about two years (after that I got pregnant), including exercise and taking special vitamins, herbs, supplements and maca .

I will start today with some information on dong quai.
I was lucky to be pretty healthy, not taking any medication, therefore it was a safe choice for me.
Before start taking it, please read carefully about drug interactions and evaluate if it’s a suitable alternative for you.

Dong quai ( Angelica sinensis ) root has been used for over a thousand years as a spice, tonic, and medicine in China, Korea and Japan. Although there are few definitive studies on dong quai, it is reputed to relieve constipation, increase red blood cell count (which helps treat anemia), and provide relief from menstrual disorders such as cramps, irregular menstrual cycles, infrequent periods, premenstrual syndrome (PMS), and menopausal symptoms. In Traditional Chinese Medicine (TCM), it is used for various purposes, including reproductive, circulatory, and respiratory conditions.

Though dong quai does not actually contain steroids or hormone molecules, one of its constituents is coumarin. Coumarin is most widely known for its use in preventing blood clotting, but constituents related to it may have numerous actions. Coumarin compounds have an anti-inflammatory and antispasmodic effect, especially on the uterus.

Dong quai also contains ferulic acid, a pain reliever and muscle relaxer. Indeed, the herb is often used to treat painful menstrual cramps or other cases of uterine spasms. Oddly enough, several studies have shown that dong quai acts as a muscle relaxant overall, but before it relaxes the uterus, it stimulates the uterus briefly. The uterus is a muscle, and when dong quai stimulates it, its tone improves and it becomes tight and contracts more readily.

All muscles function better when they are well toned, and the uterus is no exception. A well-toned, strong, healthy uterus is less prone to cramps and muscle spasms. In addition to relaxing the uterus, ferulic acid also may relax the heart muscles, lower blood pressure, and calm cardiac arrhythmias (a variation in the normal rhythm of the heartbeat).

Reports and studies of possible uses of dong quai include the following:
• Menopausal symptoms – some women report relief of symptoms such as hot flashes from this medicinal herb. However, some clinical studies to date do not support the effectiveness of dong quai for menopausal symptoms.
• PMS – studies suggest that dong quai offers some value when used in conjunction with other Chinese herbs, particularly black cohosh ( Actaea racemosa ), to treat PMS.
• Anemia -there are individual reports of successful treatment of anemia using dong quai, but to date no studies verify this.
• Heart disease – when used in combination with Asian ginseng ( Panax ginseng ) and astragalus ( Astragalus membranaceus ), dong quai decreased symptoms of chest pain and improved exercise tolerance in a small group of people with heart disease.
• Stroke – a series of reports published in China indicate that the use of dong quai just after a stroke demonstrated a decrease in the amount of brain damage.
• High blood pressure – reports indicate that dong quai may lower blood pressure in some people.
• Ulcers – animal studies suggest dong quai may soothe ulcers, but studies in people are needed.

Other conditions for which dong quai has been used in people, although studies are still lacking, include:
• Constipation
• Migraine headache
• Pain
• Liver disorders
• Correct hormone imbalance
• General tonic for female reproductive system

Precautions:

Because dong quai dilates the blood vessels and improves circulation in the uterus, regular use can sometimes make menstrual flow heavier – in China, dong quai is called a “blood mover.” Many herbalists recommend stopping the use of dong quai during the actual menstrual period in women prone to heavy flow or if heavy bleeding is a concern.

Do not use dong quai if you take blood-thinning or high blood pressure medication.

Dong quai should not be used during pregnancy because it may affect the muscular functioning of the uterus. It should also be avoided by nursing mothers, because there is little information about its effect on the infant through breast milk.

Warning

Dong quai may interact with the following medications and herbs:

Warfarin
Dong quai may increase the potency and, therefore, potential risks of blood-thinning medications, such as warfarin. It should not be taken with these medicines unless you are under the supervision of a doctor.
Hormone medications
Although there is little research on the use of dong quai with hormone medications — such as estrogens, progesterones, oral contraceptives, tamoxifen or raloxifene — health care providers advise against using them together, due to the possibility of adverse effects, unless you are under the supervision of a doctor.
Blood-thinning herbs
Although reported extremely rarely and not published in the scientific literature, the practice of combining dong quai with other herbs that thin the blood could possibly increase the risk of bleeding in some people. The following herbs with this potential when combined with dong quai — and which should be used only with caution and under the supervision of a doctor include:
• Feverfew ( Tanacetum parthenium )
• Garlic ( Allium sativum )
• Ginger ( Zingiber officinale )
• Ginkgo ( Ginkgo biloba )
• Ginseng ( Panax ginseng )
• Licorice ( Glycyrrhiza glabra )
• Chinese skullcap ( Scutellaria baicalensis )
• Turmeric ( Curcuma longa )

Herbs or medications that cause sun sensitivity
Given that dong quai may increase your sensitivity to sunlight, you should not take it with other medications or herbs, such as St. John’s wort ( Hypericum perforatum ), that may cause the same reactions.

How to make a good Fertility Action Plan

According to the current school of thoughts, if you have actively tried for a year to get pregnant and failed, you may have a fertility problem.
You should not be desperate; maybe you just kept missing the time when you were the most fertile.

Before rushing to the doctor to run expensive testing, the first thing to do is to draw an action plan.
Nothing works better than an action plan, where you can put down the steps you are to follow to get some answers.
Because you know, every person is different. People think in cliché and very often is better to learn to understand your body first, and then take the decisions.

I was talking previously about taking the basal temperature and what you can learn from it.
So, let’s try to make an action plan, shall we?

1.Start by taking good quality vitamins that include 1 mg Folic Acid, very, very important for the good neural development of the baby. It’s best to have be taking it for a year prior to conceiving, especially in our baby boomer’s case, more prone to pass genetical defects to the baby.
2. Purchase a basal thermometer and get a piece of paper ready for taking notes.
3. Establish how do you feel comfortable taking your temperature: vaginal or oral. I was asked if it’s embarrassing taking it vaginally. Yes, it is. That’s the reason I took my vaginal temperature in the bathroom, not in the bed. I was asked another question: how do you take the temperature vaginally? Although taken aback by the question, I tried to give a straight answer: the same way you have intercourse, only that instead of a penis you insert a thermometer in the vagina. Naturally you have to be careful not to push it too much inside, because then you have to dig in and recover it. Again, it’s a thermometer, not a dildo.
4. Take your temperature at the same time if possible, every day. Start monitoring even if you are having your period.
5. Along with the temperature, record the cervical mucus. It’s an important tool to evaluate the changes that occur within your body. A normal mucus should be translucid, increasing in quantity around ovulation time. You are going to see that right after the end of the period, there are going to be some ‘dry’ days, with hardly any mucus. Approaching ovulation, it should be an increase in the quantity and the aspect. The mucus will ensure a nutritious medium for the sperm as well.
6. Between two periods you are going to get a graph. From the graph you will see how long is the time between ovulation and the onset of the next period. This is called the lutheal phase (LP) and a normal one should be about 13 days. If the ovulation is not a fix date or time of the month, the LP should be almost the same, plus or minus a day. If the LP is too short, you have to work something on prolonging it. But let’s not get ahead of ourself. We’ll talk about it more later on.
7. Pay attention to your libido; it tends to increase around ovulation time. I guess the Mother Nature is sending signals that it’s time to procreate.

You have to go through this monitoring for a few months in order to establish a tendency and draw conclusions.
When you know more about your cycle, you will be able to choose options. It’s not point of starting taking supplements (other than multi vitamins) until you figure out what’s happening with your body.

Along with my taking vitamins, I put my husband through the same regim. Why? Because he was over 40 as well, and because I wanted to improve the quality of his sperm. Very often men mistakenly think that just because they ejaculate, they can procreate as well. Not true.
They can have lazy sperm or not motile at all ones. At that point there is no chance to be able to fecundate anything. The sperm is dead.
But that’s the worst scenario. We’ll talk about men vitamins and supplements later on as well.

Debunking fertility myths

The miracle of conceiving a child it’s mind blowing to me, not only because it took me so long to have one, but to think of how many different aspects are involved.
And how many must happen sequentially following pretty rigorous criteria.
Cycle, ovulation, hormones, fecundation, implantation… it’s like a complex machinery that must be perfectly tuned to function properly.
How many women take the pregnancy for granted? Probably most of them don’t even realize how traumatic could it be not to be able to conceive.

I was thinking about how many things I did not know and it cost me so many years of not having a baby in my arms.
If we are to put together the fertility myths, I guess it’s not an easy task.
Let’s try to browse the most popular ones:

1. A normal menstrual cycle is 28 days.
Not quite right; it can be normal and still be anywhere between 24 and 36 days. Probably the myth generated from the birth control pills, that are designed to modify the hormones as to make the cycle a ‘perfect’ 28 days.

2. Women can get pregnant only one day per cycle
Actually the reality is that the egg lives for 12-24 hours, that may be the misconception. But a women may get pregnant from intercourse occurring five days prior to ovulation or even 2 days past the ovulation.

3. Orgasms may cause the spontaneous release of the egg
It’s a progressive increase of estrogen over a few days period of time the cause for egg release.

4. Sperm can only live up to three days
Sperm can survive five days (some studies even suggest seven days) inside women’s reproductive tract.

5. Infertility is a female problem
The truth? Is equal to male problem, standing at 40 per cent each. The rest of 20 per cent is a common problem. That would be the worst case.

6. Fertility is related to sexuality
It’s not. There are two different characteristics, not related to each other.

7. Ovulation occurs on day 14 of the cycle
That is in relation to the normal menstrual cycle being 28 days probably. This is a dangerous myth because it can cause unwanted pregnancies or induce extra stress while trying to conceive. Not only that, but there is another tool used by doctors to estimate the due date: the pregnancy wheel. Based on the pregnancy wheel, some other tests are scheduled, tests like amniocentesis, where it’s rather important to have an accurate estimate of how far the pregnancy is.

Temperature as an ovulation prediction

Before getting serious about dealing with my infertility problem, I had no idea about the correlation between the temperature and ovulation.
Only when I started digging into the infertility issue I found out that there were many things I should have known, among them, the importance of temperature and the fragile balance between estrogen and progesterone.

Let’s start with: Cycle overview
The first day of the dreadful period is the beginning of a new cycle. From this moment until ovulation occurs, the temperature starts dropping.
During the first part of the cycle the temperature is anywhere between 96.5 and 97.5°F. The temperature is low due to the presence of estrogen in higher amount.
In majority of the cases, the transition from estrogen dominated phase to the progesterone dominated one is marked by a thermal shift. How big is the temperature rise? It depends on the body, but as a rule of thumb, a minimum of 0.4 to 0.6°F should occur.
Between 24 and 48 hours after the temperature shift, the ovulation is said to occur.
We enter into the progesterone dominated phase, when the temperature rises to ensure a warm and fertile environment for the fecundated egg to implant and develop.

Let’s move on to the next step: Taking the temperature
You have to get a basal thermometer, and from my experience, a digital one works fine.
Over the years I had 2 glass basal thermometers. Pros: not very expensive and they were accurate. Cons: glass. I broke one while washing it after one use.
Then I switched to a digital thermometer. It’s got a temperature probe capable of pretty accurate reading.
You don’t need a super scientific precision, all you need is to identify the thermal shift, meaning that any accuracy will do it.
Pros: flexible tip, easy to insert the thermometer in the vagina (I highly recommend taking the temperature vaginally, because it’s by far the most reliable one).
Cons: more expensive than glass ones.

Notes:
- It’s very important NOT to switch from one thermometer to another within any given cycle!!!
If possible use only one thermometer for the whole time you monitor your cycles. That’s why the glass thermometer may become a liability down the road.
- Make up your mind if you want to take your temperature vaginally or orally before starting monitoring your cycles. They differ a lot!! Vaginal temperature is higher than the oral one.

When to take the temperature?
There are many school of thoughts, the most popular one recommends taking the temperature first thing in the morning, after at least 4 hour sleep, while still in bed.
This method did not work for me, because I did not want to wake my husband and you know what? men DO get bothered after a few months of hearing the beeping of the thermometer. And it’s a private moment you may want to spend with yourself only.
So, I used to take my temp in the bathroom and it was not different than the one taken while in bed.
Also it’s said that it’s pretty important to take the temperature at the same time each day.
I did not take it at the same time for the simple reason that I did not want to wake up in weekend at the same time I woke up during the week. But to be true, during the week I used to wake up at 6:30 and in weekends I slept until 7:30. One hour would not make a big difference, if any at all.
Of course that if you usually sleep until noon in weekends, you will have to wake up earlier, please don’t follow my ‘it-does-not-matter-it’s-weekend’ rule.

Next step: What to do with the temps?
That is simple : you have to make a chart.
You can use a simple excel spreadsheet, handy to everybody. Enter the data and get the graph.
Or you can go on line and download a more fancy version.

Now that you mastered temperature taking, you have to learn to ‘read’ you body and trust me, you will become aware of so many things you would be amazed.
It’s the same old body you have known for the past 40 years, and still… it’s so new.

In my next installment I will talk about other gizmos available on the market to complete the ovulation picture.

Walking down the infertility memory lane

Dealing with infertility is one heart breaking issue women are more and more confronted with.
Been there, done that.
I had my son when I was 43. The chances to get pregnant at that age were below 1 per cent, actually some literature mentioned a more accurate prognosis: 0.3 per cent.
Not very encouraging, eah?
What I can tell, remembering the years of trying and trying, is that it put a huge strain on my marriage. Your whole life revolves around ovulation and temperature taking.
Simon Cowell- the famous/infamous American Idol judge- said that you can’t really be happy for somebody else’s success.
Jay Leno was surprised and could not believe that somebody could think in such a way. But I understood the dude perfectly well.
No, when you deal with infertility you are NOT happy seeing pregnant women, and you are even less happy when you hear stories about ‘oops’.
That drives you bonkers.

Infertility is a huge psychological burden. You don’t understand why in this word you can’t have kids, why it is so easy for everybody else, what’s so wrong with you?
At the time when developed countries struggle with low birth rate, the not so developed ones seem to thrive.
Why is that? is it something in their water or in their food?. Or maybe it’s in what is missing, like maybe pollution generating only God knows what chemicals affecting our capability to procreate?

We were told that Caucasians don’t want to have more than maximum two kids because of the financial burden of raising children these days. People from other cultures have no such a thought and as a consequence they have many children.
OK, bear with me here: maybe in other cultures it’s a written or unwritten rule that the role of the wife(s) is to procreate and she (they) are not allowed or expected to work. It may be true, but it does not answer the question: why they don’t have infertility problems?

I have been struggling with infertility since I realized I could not have children, meaning shortly after I got married, twenty something years ago.
I was young at that time, freshly out from University, and we were not in a big rush.
Then we started working, we were still young, more interested in having fun. We thought that if it’s going to be an ‘oops’ – like the one my cousin had- it would be fine.
But it did not happen.
Years passed, and we immigrated to Canada. Another life, another struggles, definitely not a good time to start investigating the infertility issue.
Finally when we had our ducks in the row I was almost 40.
It became clear that an ‘oops’ it won’t happen and that we had to do more if we wanted to have a baby.
That was the beginning of the long journey that finally brought us our son.
I am going to be forever grateful to the Universe for the amazing gift offered. To be parent it’s not easy but everytime I feel tired or short on patience I have to take a step back and remember everything I have been through in order to have my beatiful son.

I hope I am going to be diligent enough to put together all my memories and tell everybody how I got pregnant.
Note: I did not have any artificial insemination or any kind for the simple reason that we could not afford it.