Dr. Angela Nation on Women’s Health: Supporting Fertility, Pregnancy, and Postpartum with Herbal Medicine
Sherri: Hi, Angela, thank you for taking the time to meet with me today, I appreciate your expertise in women’s health, fertility, and pregnancy and want to give our practitioners some insight into what it is like treating fertility and pregnancy in eastern medicine. 
Angela: Thank you so much for having me. I appreciate the opportunity to share some of my clinical experience in this area.
- I want to begin Angela, with learning a little more about your background and how you ended up specializing in women’s health, fertility, and prenatal and post-partum care?
Angela: I’d be happy to. I am a graduate of Bastyr University in Seattle, Washington. I have approximately 19 years of clinical experience. Throughout my years of general clinical practice, I realized there were many women coming in for irregular cycles, having trouble conceiving, and with issues that arose with pregnancy and/or post-partum. So, I began educating myself more, learning more about how to treat some of these complex conditions that women experience. I also connected emotionally with these situations after having my own daughter. My studies led me into getting the American Board of Oriental Reproductive Medicine (ABORM) certification, which led to receiving referrals from other healthcare providers to help women and couples going through fertility and other conditions associated with women’s health. I ended up expanding my practice and hiring another acupuncturist to treat general health conditions so that I could focus on my fertility and pregnancy patients.
- Can you walk me through your focus during an initial intake for a woman that comes to see you for fertility verses doing a general medicine intake?
Angela: Yes, for a female fertility intake, I focus on the regularity of the menstrual cycle, the quality of blood, the basal body temperatures (BBT), the ovulation predictor kits (OPK) to determine which day in their cycle they are ovulating. I also review bloodwork that includes follicular stimulating hormone (FSH), luteinizing hormone (LH), and anti-mullerian (AMH). The AMH levels are used to assess the ovarian reserve in women. The AMH number gives me a good foundation of where the female is in her fertility process. If the patient is older, I am very conscious about getting all these tests and evaluations done earlier because of the time sensitivity due to their advanced maternal age. Other things to consider when doing a fertility consult for a woman are if they have had any abdominal surgery such as gastric bypass or laparoscopic surgery, as well as any sexual transmitted infections (STI’s) and any loop electrosurgical excision procedures (LEEP).
Another area I focus on is their use of vitamins and supplements. Usually these women will be taking many vitamins and supplements, so I have them bring all of them in with their first visit to review what is good or necessary to take. I also encourage the female to bring her partner in on the first visit as well to get an idea of what the spouse is taking for supplements, so I can better guide them as a couple with what is necessary to improve their health and fertility.
- Do you have many males that come to see you for fertility? And if so, what do you focus on for their initial intake?
Angela: I don’t see many males but when I do, I ask about any trauma history, any history of a varicocele, STI’s, and any medical testing such as labs and a sperm analysis. Typically, I will treat a male once per week for 6-8 weeks for general constitution and improving overall health and fertility. Once we have more information from some of these tests, I will prescribe herbs/supplements in addition to their acupuncture treatments. We also review lifestyle habits such as tobacco, alcohol, exercise, and their vitamin and supplement regimen as well.
- Can you explain how you approach regulating a woman’s cycle in terms of the phases of the cycle?
Angela: To regulate a woman’s cycle, I recommend weekly acupuncture for a minimum of 3 months, and I adjust the acupuncture points according to their eastern medicine diagnosis and the phase of the cycle that they are currently in. I also support their cycle with herbal medicine for the different phases of the cycle. In the follicular phase you want to support and nourish yin and prescribe yin tonics during this time. With ovulation, you will want to prescribe more yang tonics and also treat the male partner twice during the week of ovulation. The focus for the luteal phase is adding yang tonics and acupuncture points to support that. During the menstrual phase blood stagnation is more of an issue and you want to prescribe herbs and acupuncture points for blood stagnation. If you are just treating with acupuncture, then the frequency of visits should be increased.
- What are some of the herbs and formulas you prescribe to support these different phases in a woman’s cycle?
Angela: For the menstrual phase and blood stagnation I prescribe Tao Hong Si Wu Tang. During the follicular phase, I prescribe Gui Shao Di Huang Tang to nourish yin and blood and for the luteal phase I often prescribe You Gui Wan to support the yang phase of the cycle. Other herbs I like to add to formulas during the ovulatory phase are Tu Si Zi and Du Zhong.
- What type of herbal medicine do you prescribe to patients?
Angela: I prescribe mostly TCM granules for patient compliance. I do some raw herbs but primarily do granule base formulas and have a dispensary of single herb granule packets so I can modify the base formula.
- What are some common herbs that you use to help improve sperm parameters in males?
Angela: Gui Zhi Fu Ling wan is a formula I like to use for males that have a varicocele due to the dampness and qi and blood stagnation. For liquefaction issues with the sperm, I use yin tonics such as Liu Wei Di Huang Wan, and single herbs such as Mai Men Dong and Tian Men Dong. I recommend Shan Zhu Yu for motility issues and Tu Si Zi and Xu Duan for low sperm count. And for impotence issues, I use yang tonics such as Du Zhong and Yin Yang Huo.
- Are there specific herbs that boost estrogen or progesterone in the body?
Angela: As practitioners we know that when we treat the right eastern medicine diagnosis with herbs they have a positive effect of balancing the body. I would say that the yin and blood tonics can help support the body to improve estrogen and yang tonics to help the effectiveness of progesterone but there isn’t a specific herb that has an estrogen or progesterone quality.
- What are some common supplements that you prescribe for female and male infertility?
Angela: Some of the core supplements I prescribe for female infertility are COQ10- 400-600mg to assist with ovarian quality, and Vitamin D3 and Vitamin C are important for overall health of the immune system as well as for fertility, and a prenatal vitamin. For males, I recommend antioxidants such as vitamin C and vitamin D, selenium and zinc. And L-Carnitine, L-Arginine, and COQ-10 assist with motility issues.
- What advice do you have for practitioners treating pregnant women who don’t see pregnant women on a regular basis?
Angela: Be more cautious, but do not be scared! Stick to your basics when treating and know the contraindicated points to pregnancy. Take some classes or webinars and get educated. Knowledge is power.
I want to mention that there are some patients that experience a subchorionic hematoma where patients will have some vagina bleeding with this. A less experienced acupuncturist may think that the acupuncture could cause this bleeding but it is not a cause, it is the hematoma that is the cause of bleeding and can be found more with women that go through in vitro fertilization (IVF).
- Do you have a treatment protocol for pregnant patients that you implement in your clinic?
Angela: Yes, generally for the first trimester we provide weekly treatments. During the second trimester, patients are seen every 3-4 weeks and the third trimester is weekly at 36 weeks for labor preparation and delivery. Depending on a patient’s presentation, you may increase the frequency of acupuncture treatments with higher risk conditions such as hypertension with swelling and gestational diabetes.
Patients that get treated regularly throughout their pregnancy spend less time in labor and are likely to recover faster from delivery.
- What is your advice to women for care post-partum?
Angela: I instruct patients to get treatment 7 days post-delivery warming the womb with moxibustion and supplementing with acupuncture points as well as needle scar therapy. The goal is to build qi and blood post-partum. The frequency of treatment will depend on the birth of the baby. I often prescribe Sheng Hua Tang in the post-partum period to move blood, and Da Zao, Gou Qi Zi, and kidney tonics to tonify qi and blood and liver regulating herbs for conditions like mastitis.
- Do you have any other advice to practitioners that may want to consider specializing in women’s health and fertility?
Angela: Yes, I want to mention a couple of resources that are helpful for practitioners to learn more and helpful for patients to find a practitioner. There is the ABORM organization https://aborm.org/ and the Obstetric Acupuncture Association https://www.ob-acupuncture.com/
Sherri: Thank you so much for speaking with me today and sharing some of your clinical pearls in reproductive medicine.
Angela: Thank you, I appreciate it.