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TCM Causes of Female Infertility
According to the TCM physiology, normal conception happens as follows:

On a monthly basis, a woman's essence (acquired and congenital) will gradually be enriched to a particular level by the kidneys, the kidneys will then produce a substance called tian-gui. Under the action of this substance, the Conception Vessel and Thoroughfare Vessel become exuberant and flushed with abundant qi and blood. When the excessive qi and blood in the vessels become overflowing, they drift into the uterus and turn into menses. This signals the woman is ready to conceive. When an egg from her ovary is fertilized with a sperm, pregnancy results. From a TCM understanding, this fertilization process involves the combination of congenital essences from both sexes, which are transmitted into the embryo in the uterus. Thereafter, the uterus supplies the nutrients for the growth and development of the fetus until childbirth.
In TCM, the kidneys rule reproduction, which provides the material basis for genital development and maturation of sexual instinct.
The Yizong Jinjian (Golden Mirror of Medicine), a classic TCM text completed 1742AD, documented this process clearly by stating: "When a woman reaches puberty, she produces tian-gui for promotion of the Conception Vessel and Thoroughfare Vessel to be exuberant and flushed with qi (vital energy) and blood, which leads to regular menstruation. Therefore, she has the ability to become pregnant and give birth."In cases of infertility it goes on to say, "If the three kinds of pathogenic factors damage her extra meridians, she will suffer from complaints like menstrual problems or vaginal discharge. In some cases, her uterus may have difficulty in menses forming because the old blood cannot be expelled completely, or, the uterus has been invaded by cold evils / heat evils and cannot facilitate sperm collection and allow conception, or, there is too much phlegm inside her body leading to turbid fat obstructing the uterus cavity. All these situations should be carefully identified with the underlying causes so as to employ a proper treatment based on syndrome differentiation. As a result, infertility is no longer a problem."

Based on the classic texts understanding of infertility, modern TCM believes conception needs three criteria:
1. Abundant kidney-qi
2. Non-obstructed meridians around the uterus and
3. A favorable environment inside the uterus.

As previously discussed, there are various causes of infertility in women. TCM identifies the cause of infertility in terms of energy imbalances in the body. The imbalances may be due to a wide variety of factors, such as an unhealthy lifestyle, poor diet or improper eating habits, lack of exercise, stress, environmental factors, emotional or psychological issues, toxins or hereditary influences.

Basically, TCM understands that the location of infertility begins in the uterus, and its development is related to the liver, spleen and especially kidney function. The kidneys control our congenital essence, which is our inherited self; the spleen provides an acquired foundation based on our nutrition, and, the liver stores blood and regulates qi (vital energy) movements. Normal functioning in these organs ensures a proper material basis for conception.

The final pathological development is summarized as follows:

1. Exhaustion of kidney-qi
Congenital deficiency or indulging in excessive sex usually damages kidney-qi. When this happens, there will be inadequate essence to produce tian-gui regularly, which leads to a deficiency in the Conception and Thoroughfare Vessels. The uterus becomes malnourished and cannot collect sperm and promote conception.

2. Insufficiency in blood
Blood is the material basis for conception. When an individual has a constitutional weakness or dysfunction in the spleen and stomach, blood production is affected. As a result, the extra meridians become vacuous (deficient and/or dysfunctional) and the uterus is not nourished making it impossible for a woman to conceive.

3. Stagnation of liver-qi
TCM believes normal emotional health depends on a smooth flow of qi (vital energy) and blood, which are mainly regulated by the liver. In cases of emotional disturbances, especially frustration and anger, the liver's regulating functions are impaired and a condition termed "stagnation of liver-qi" results. When internal qi and blood flow become disharmonious, the extra meridians are affected and the menses will not come regularly resulting in difficulty conceiving.


4. Obstruction by phlegm and dampness
Improper dietary habits or yang deficiency in the kidney and spleen lead to dysfunction in water metabolism and cause excessive phlegm and dampness evils to accumulate. When the body has too many phlegm and dampness evils, qi movement is disturbed and meridians around the uterus are obstructed resulting in irregular menses and conception problems.


5. Retention of stagnated blood in the interior
Damage during a previous delivery, exogenous evils invasion, long term illness and qi deficiency are factors that affect the blood flow and lead to stasis. If stagnated blood remains in the uterus and impairs the Conception and Thoroughfare Vessels, a woman's menstruation can become irregular and conception may be difficult.

6. Accumulation of damp-heat
Improper sanitary habits in the perineum region may allow dampness and heat evils to invade the uterus. When the extra meridians become obstructed, blood and qi supplies are interrupted. There will be difficulty in combining the congenital essences from both sexes to transmit into the embryo in the uterus.
Development of female infertility from a TCM perspective.

a. Exhaustion of kidney-qi
b. Insufficiency in blood
c. Stagnation of liver-qi
d. Obstruction by phlegm and dampness
e. Retention of stagnated blood in the interior
f. Accumulation of damp-heat