For the longest time I lived like the Eight of Swords. I never made my own decisions and was always persuaded by someone else to follow their (usually terrible) advice. Despite a decision not sitting right with me, I still went ahead with it because I didn't know any better and didn't want to either. Usually this ended with me playing victim in the blame game. And I became a Handless Maiden, unable to decide anything by myself and living life passively like a doormat while being stabbed by other people's "good intentions." It took a lot of work to find my way out of the forest. But it was also really easy to sink back into old patterns as soon as I started fertility care. There are many options and everyone has an opinion. There's also the white-blouse syndrome: we treat doctors like omniscient gods and will agree without questioning (and we don't really understand their jargon, do we?). And yet, as one of my teachers always says, "Ask ten different doctors and you will hear ten different opinions." Who is right? Whose advice do I follow? How do I make informed, empowered decisions? Something I learnt that was really helpful is the BRAIN acronym.
Recently I chose to pause Western fertility treatment and instead to focus my time, energy, and money on Traditional Chinese Medicine (TCM) which consists of acupuncture, Chinese herbs, and lifestyle/diet. In full transparency I still go to my clinic for monitoring (bloodwork + ultrasound, you know the drill). Needless to say it’s a very different choice that can surprise many. Indeed, why forego the scientific precision of Western fertility for needles & herbs? That sounds a bit woo, doesn’t it? Of course this decision didn’t just suddenly come to me. I read quite a bit on TCM and I’ve also experienced it on other occasions so I know what I’m getting into. Plus, in Vietnam there is usually a blend of different medicines and TCM is one of them, meaning it’s not new to me culturally speaking. And finally, I hope this is obvious already but we’re very woo over here.
But regardless of the cosmic talk, I still try to ground a lot of what I say in more practical ways. Today I’m sharing how this transition from Western treatment to TCM came about. The purpose of this post is not to convince anyone that TCM is the solution, but rather to demonstrate how we can use the BRAIN acronym to make informed decisions. This is something I’ve learnt during childbirth education training and it works really well for fertility-related decisions. The acronym stands for:
B: Benefits
R: Risks
A: Alternatives
I: Information or Intuition
N: No or Not Now
Benefits: What are the benefits of this treatment, intervention, procedure, etc.?
What are the benefits of TCM in the context of fertility care? There are several ways to answer this question: TCM literature, evidence-based research, doctors’ recommendations (note the plural), testimonials from people we know (or not), and personal experience. According to TCM, the female body is fully capable of becoming pregnant and giving birth to a healthy baby naturally. But sometimes there are imbalances that may prevent this from happening. TCM comes in to address those imbalances: it focuses on treating the root cause rather than patching up the problem. Similarly to other traditional medicines, TCM is able to do this because it looks at the whole body, rather than the one hormone or malfunctioning organ. Basically, it helps the body return to its healthiest.
Does my Western fertility doctor recommend it? Not specifically, but he’s not against it either. Is there research on this topic? Yes, quite a bit but not all convincingly equal. For example, one study suggests that TCM could potentially increase the success of IVF treatment while another study concluded that TCM could help with PCOS. And yet, other studies tell us that TCM may have no benefits whatsoever. In the end, it seems there’s still a lack of concrete evidence in terms of scientific research because not all studies are created equal. It’s up to us to determine what that means. (If we cannot determine the benefits just yet, we can move on to the next letter of the acronym.)
Let me give my two cents on scientific research since I have some knowledge (as a PhD dropout, make of that what you will). Research can be complicated when it comes to human subjects, and especially so with regards to fertility and pregnancy. Nobody would willingly screw up their treatment or pregnancy for the sake of research, and performing research that can be harmful to the subject is not only unethical but pretty much illegal. As a result, it can be a little challenging to find research that straight out tests the negative effects of a treatment on human subjects. Thus, a careful evaluation is necessary when reading about a research protocol. And this can be complicated. In essence, we need to be able to evaluate if a study is any good (e.g. assess the validity of the methods used, understand the findings, be aware of the general literature on the topic, etc.). One way to work around this is to find resources that will do this for us. For example, Lamaze International’s blog Connecting the Dots is really good at breaking down the research on childbirth-related questions. For fertility and TCM, there are books but these can be biased since they’re usually written by TCM doctors. They can also quickly become outdated vs. an online source that is updated frequently. (When I find a resource similar to Lamaze’s, I will be sure to add it here.)
Risks: What are the risks?
What are the risks of TCM on fertility? Again, we can consult the same sources we used previously for this new question (TCM literature, scientific papers, doctors’ recommendations, etc.). From what I’ve seen, even when a research paper determines that TCM has no benefits, there usually are no indications of great risks either. From personal experience, there can be mild bruising from the needles or potential negative or no reactions with certain herbs. However, since TCM treats each body individually, there is no one-size-fits-all herbal concoction. The body is re-evaluated at each appointment and other herbs may be given. My experience with Chinese herbs is completely different from the routine of Letrozole > Ovidrel > Progesterone suppositories.
Since I briefly touched upon research and my own doctor’s recommendation just above, I’ll say a few words on testimonials and personal experience. The truth of the matter is that TCM has existed for thousands of years, while Western fertility treatment is fairly recent. We can find testimonials in books (TCM/Fertility books) or on practitioners’ websites, or perhaps on FB groups and forums, but chances are you might already know someone in your own circle that has tried TCM for one reason or another. My first experience with TCM went like this: a few years ago I was an avid circus aerialist (silks was my favourite, but I also did aerial hoop and static trapeze). You can’t tell from the way I share yoga on this blog, but I love monkeying around and circus was the perfect training to complement my vinyasa practice that focused mainly on inversions and arm balances (btw, I don’t do this anymore). But circus is also very hard on the body and has a cumulative effect. One day I woke up no longer able to do the front split on my right side, just like that. I consulted a physiotherapist, a sports medicine doctor, a chiropractor, and a TCM practitioner. The only method that solved my issue was acupuncture. Was it woo? Super woo. The practitioner inserted needles into certain parts of my right leg and low back. He then linked the needles into a circuit with a wire and turned on a device that sent very mild electric shocks into those areas while burning mugwort. Sounds wild, doesn’t it? But in reality, there are studies (surprisingly!) on the effects of moxibustion & acupuncture on sports injuries, and I even found one on dysmenorrhea. I only needed 3 sessions and could do the split again. It was really amazing! (Just a quick note: There is a difference between TCM acupuncture and sports acupuncture. I’ve never tried the latter.)
Alternatives: Are there alternatives?
Now that I’ve determined that the risks of TCM on fertility are rather minimal and that there may even be some benefits, let’s talk about the next letter of the BRAIN acronym. Are there any Alternatives to TCM? Probably. Western herbalism and Ayurveda are two that I can think of, but I’m sure there are more. Usually when we alternatives are introduced, we could go back to the beginning of BRAIN and reassess the benefits and risks of those new options. In my case, I had tried Western herbalism and didn’t like it. Specifically, I didn’t like the approach of that particular herbalist and didn’t feel like trying again (my insurance doesn’t cover it). And since I had success with TCM for a different concern, it felt right to try it again for fertility as opposed to starting something entirely new with Ayurveda.
I’ll give a second example for Alternatives: Someone is pregnant for the first time and they’re terrified of giving birth so they’re considering scheduling an epidural. They’ve read about the benefits & risks and now are wondering if there are alternatives. They eventually learn about comfort measures and opioids, and they also know that their hospital provides nitrous oxide.
Information or Intuition: Do I need more information? What does my gut say?
Sometimes we just don’t have enough information to make an informed decision. That said, typically in fertility care, clinics do a really good job at informing their patients regarding the benefits and risks of each treatment. And we can always look for more information elsewhere, even with a second opinion from a different health care provider. Once we have gathered all the information we need, we can ask ourselves: Is this right for me? How do I feel about this? What is my gut feeling? If we take a look again at our three-card spread (featured image above), we can see that the Justice card is half-brain half-heart. This is what it’s illustrating: we need to make decisions from more than just brain alone.
No or Not Now: What happens if I say no?
The gut feeling might just be a thanks but no thanks. Yes, you read that right. Refusing a medical treatment is allowed *gasp* We are paying for it, after all. But let’s take a step back for a moment. The question for the letter N of BRAIN is: What happens if I do nothing? (Or, what happens if I don’t do this right now?) What happens if I don’t seek any alternatives and keep pursuing Western treatment? It might eventually work, but in the present moment my body is completely imbalanced: I am very tired but cannot get any proper sleep, I sweat excessively at night, I have cravings, etc. Ultimately, my reasoning is this: I’ve been doing Western treatment on its own for almost a year and it hasn’t worked. Why continue? And yet, I’m not ready to commit to IVF so what else can I do? My answer for myself is TCM. (I’m not X-ing IVF altogether. Just not now, you know?)
And voilà! You can use this anything you need to make an informed decision 😀
🌓 ♋
Decks featured:
Outgrow Yourself Oracle Tarot (Äkta Spåman)
Antique Anatomy Tarot, Italian edition (Claire Goodchild)
References:
Connecting the Dots (https://www.lamaze.org/Connecting-the-Dots)
Hullender Rubin, L. E., et al. (2015). Impact of Whole Systems Traditional Chinese Medicine on In Vitro Fertilization Outcomes. Reproductive Biomedicine Online, 30(6): 602–612.
Liu, W., et al. (2022). Efficacy and Safety of Acupuncture and or Moxibustion for Managing Primary Dysmenorrhea: A Systematic Review and Meta-Analysis. Clinical Nursing Research, 31(7), 1362–1375.
Wu, J., Chen, D., Liu, N. (2020). Effectiveness of acupuncture in polycystic ovary syndrome: A systematic review and meta-analysis of randomized controlled trials. Medicine, 99(22), e20441.