Fertility problems

On this page

1. Overview
2. Female fertility problems
   • Adenomyosis
   • Amenorrhoea
   • Anovulation
   • Endometriosis
   • Fibroids
   • High FSH level
   • Irregular menstrual cycle
   • Low AMH level
   • Luteal phase defect
   • Miscarriage
   • PCOS
   • Premature ovarian failure
   • Thin endometrial lining
3. Male fertility problems
   • Male infertility
   • Low sperm count
   • Sperm DNA fragmentation
4. Problems affecting both partners
   • Unexplained infertility
   • Repeated IVF failure
5. Related pages
6. My Fertility Guide

1. Overview

Fertility problems are more common than many people realise. Around one in seven couples in the UK experience difficulty conceiving. Female factor issues account for approximately a third of cases, male factor issues another third, and a combination of both — or unexplained infertility — makes up the remainder.

I am Dr (TCM) Attilio D'Alberto, a fertility specialist with over 20 years of clinical experience. I treat both male and female fertility problems using acupuncture, Chinese herbal medicine and tailored dietary and lifestyle guidance, grounded in traditional Chinese medicine (TCM) and informed by the latest western reproductive medicine research. I am the author of My Fertility Guide and My Pregnancy Guide, and have published research on fertility in peer-reviewed journals.

TCM excels at identifying and treating conditions that western medicine finds difficult to address — including unexplained infertility, hormonal imbalances, poor egg quality and poor sperm quality — because it looks at the person as a whole rather than focusing on isolated test results. Many patients come to me after being told by their fertility clinic that there is nothing more that can be done, and go on to conceive with treatment.

I see patients in person at my Wokingham, Berkshire clinic and online via Zoom. Online fertility consultations are available for patients throughout the UK and internationally, with herbal prescriptions posted where needed.

2. Female fertility problems

Adenomyosis

Adenomyosis is a chronic condition in which endometrial tissue grows into the muscular wall of the uterus (the myometrium), causing the uterus to enlarge and become tender. It is associated with some of the most severe period pain experienced by women, heavy and prolonged menstrual bleeding, chronic pelvic pain and, importantly for fertility, impaired uterine receptivity. Adenomyosis can reduce implantation rates and increase the risk of miscarriage, making it a significant but often overlooked factor in unexplained infertility and repeated IVF failure.

In traditional Chinese medicine, adenomyosis is understood as deep-seated blood stasis in the uterus, frequently combined with cold stagnation or Qi stagnation driven by chronic stress. Chinese herbal medicine is the primary treatment — formulas such as Gui Zhi Fu Ling Wan and Wen Jing Tang promote blood circulation, resolve stasis and warm the uterine channels. Moxibustion is particularly effective for the cold stagnation pattern. A 2025 clinical trial of 210 patients found Dan'e Fukang Decoction was markedly effective for adenomyosis pain with significantly fewer adverse reactions than conventional hormonal treatments. Read more: Adenomyosis ›

Amenorrhoea

Amenorrhoea is the absence of menstruation. Secondary amenorrhoea — where periods stop in a woman who has previously menstruated — is most commonly caused by PCOS, hypothalamic suppression (often from overwork, excessive exercise or low body weight), elevated prolactin, thyroid dysfunction or premature ovarian failure. In TCM, amenorrhoea is understood as a deficiency of qi, blood or yin — or a stagnation of qi and blood — affecting the Liver and Kidney.

Research has shown that acupuncture and electroacupuncture can restart menstruation in women with amenorrhoea, including those with PCOS-related amenorrhoea. Chinese herbal medicine is also an effective long-term treatment for restoring the cycle. Read more: Amenorrhoea ›

Anovulation

Anovulation — failure to ovulate — affects approximately 15% of women with infertility, and around 50% of those will have PCOS. Without ovulation there is no egg to fertilise, making anovulation a direct cause of infertility. It is diagnosed by measuring progesterone levels seven days after the expected time of ovulation (the level should be above 3 ng/mL) or by ultrasound monitoring.

Clinical trials have shown that electroacupuncture can induce regular ovulation in a significant proportion of women, including those with PCOS, by acting on the hypothalamic-pituitary-ovarian axis and improving hormonal balance. It also improves live birth rates. Read more: Anovulation ›

Endometriosis

Endometriosis affects around 10% of women of reproductive age and is one of the most common causes of female infertility. It occurs when tissue similar to the uterus lining grows outside the uterus — on the ovaries, fallopian tubes, bowel or bladder — causing inflammation, adhesions, pain and disruption to egg development and implantation.

Acupuncture is well established as an effective treatment for endometriosis-related pain, which it addresses by regulating hormones, reducing inflammation and improving blood flow to the uterus and pelvis. Chinese herbal medicine is particularly effective for more severe endometriosis and for reducing the likelihood of recurrence after surgery. Read more: Endometriosis ›

Fibroids

Uterine fibroids (leiomyomas) are non-cancerous growths that develop within or around the wall of the uterus. They affect up to 70–80% of women by the age of 50 and, depending on their size and location, can significantly impact fertility. Submucosal fibroids that distort the uterine cavity directly impair implantation, whilst larger intramural fibroids reduce blood flow to the endometrium and can cause recurrent miscarriage. Fibroids also cause heavy menstrual bleeding, severe period pain, pelvic pressure and, in some cases, premature labour during pregnancy.

In traditional Chinese medicine, fibroids are classified as Zheng Jia — abdominal masses caused by blood stasis and phlegm-dampness accumulating in the uterus. Chinese herbal medicine is the most evidenced natural treatment for fibroids. The classical formula Gui Zhi Fu Ling Wan is the most widely studied — a meta-analysis of 28 randomised controlled trials involving 2,813 patients found it significantly reduced fibroid volume, improved hormonal profiles and relieved symptoms. A 2024 systematic review confirmed that acupuncture combined with Chinese herbs significantly improved clinical outcomes and reduced fibroid size compared to herbs alone. Read more: Fibroids ›

High FSH level

Follicle-stimulating hormone (FSH) is the hormone produced by the pituitary gland to stimulate the ovaries to grow follicles. When FSH is elevated, it indicates that the ovaries are working harder than they should to produce eggs — a sign of declining ovarian reserve or reduced ovarian response. High FSH is a common reason for IVF cycle cancellation and for poor response to stimulation drugs.

A high FSH does not mean conception is impossible. I have helped patients reduce FSH levels from over 40 pmol/L down to within the normal range using a combination of acupuncture, Chinese herbal medicine, targeted supplementation and dietary changes. Research has demonstrated that acupuncture can reduce elevated FSH levels and improve ovarian blood flow. Read more: High FSH level ›

Irregular menstrual cycle

An irregular menstrual cycle — one that is shorter than 21 days, longer than 35 days, or that varies significantly from month to month — can make it very difficult to predict ovulation and time conception attempts correctly. Common causes include PCOS, elevated prolactin, thyroid dysfunction, stress and hormonal imbalance.

Regulating the menstrual cycle is one of the areas where acupuncture produces the most consistent and well-documented results. By acting on the hypothalamic-pituitary-ovarian axis, acupuncture can synchronise the ovarian and uterine cycles, stabilise hormone levels and reduce the stress that is one of the most common causes of cycle irregularity in modern women. Read more: Irregular menstrual cycle ›

Luteal phase defect

Luteal phase defect (LPD) is a frequently underdiagnosed cause of infertility and recurrent miscarriage, in which the second half of the menstrual cycle is either too short or characterised by inadequate progesterone production. Progesterone transforms the uterine lining into a receptive environment for implantation and maintains the early pregnancy. When it is insufficient, the embryo cannot implant or the early pregnancy cannot be sustained.

The most accessible diagnostic indicators are a luteal phase of fewer than 12 days on cycle tracking, premenstrual spotting, and a mid-luteal progesterone level below 30 nmol/L. In TCM, LPD is most commonly understood as Kidney Yang deficiency — the warming Yang energy that should rise and sustain through the luteal phase is insufficient, preventing adequate endometrial preparation. Acupuncture improves corpus luteum function and progesterone production through its effects on the HPO axis and ovarian blood flow. Chinese herbal medicine, particularly Kidney Yang tonifying herbs such as Tu Si Zi, Ba Ji Tian and Xu Duan, provides daily constitutional support. A cycle-phase prescribing approach — different formulas for the follicular and luteal phases — is the most effective strategy. Read more: Luteal phase defect ›

Low AMH level

Anti-Müllerian hormone (AMH) is produced by the granulosa cells of ovarian follicles and is currently the best marker of ovarian reserve — the number and quality of eggs remaining. A low AMH level indicates diminished ovarian reserve, which reduces the chance of natural conception and of successful IVF. AMH levels decline with age, but can also fall early due to genetics, previous ovarian surgery, repeated IVF cycles, chemotherapy or illness.

Most fertility clinics do not offer treatment to improve AMH, and instead recommend natural IVF cycles or donor eggs. However, in my clinic I have helped some patients improve their AMH level sufficiently to conceive naturally, using acupuncture, Chinese herbal medicine (herbs that nourish yin, blood and astringent jing), moxibustion, DHEA and targeted supplementation. Read more: Low AMH level ›

Miscarriage

Around 20% of confirmed pregnancies end in miscarriage in the first trimester, and this rate increases significantly with maternal age — by approximately 10% per year after 35. In about half of first-trimester miscarriages, chromosomal abnormalities in the embryo are the cause. Recurrent miscarriage — defined in the UK as three or more losses — affects around 1% of couples and is one of the most emotionally devastating fertility experiences.

Acupuncture supports a healthy pregnancy by increasing blood flow to the uterine lining, supporting implantation, regulating immune factors such as natural killer (NK) cells that can attack the embryo, and reducing uterine contractions. Research has shown these mechanisms to be significant in preventing miscarriage. I recommend acupuncture treatment throughout the first trimester for women with a history of miscarriage, and ideally to 20 weeks. Read more: Miscarriage ›

PCOS (polycystic ovary syndrome)

PCOS is the most common hormonal disorder affecting women of reproductive age, estimated to affect 8–13% of women globally. It is characterised by high levels of androgens (male hormones), irregular or absent ovulation, and multiple small follicles on the ovaries visible on ultrasound. PCOS is the single most common cause of anovulatory infertility.

Acupuncture is particularly well-suited to treating PCOS because it acts directly on the hormonal and nervous system pathways that drive androgen excess and anovulation. Research has shown that electroacupuncture significantly reduces testosterone levels, improves menstrual frequency and induces ovulation in women with PCOS. Chinese herbal medicine addresses the underlying patterns of phlegm-damp obstruction and Kidney yang deficiency most commonly associated with PCOS in TCM. Read more: PCOS ›

Premature ovarian failure

Premature ovarian failure (POF), also known as premature ovarian insufficiency (POI), occurs when the ovaries stop functioning normally before the age of 40. It affects around 1% of women under 40 and causes elevated FSH, low AMH, irregular or absent periods and menopausal symptoms. Causes include autoimmune conditions, chromosomal abnormalities, chemotherapy, radiation and, in many cases, are unknown.

Research has shown that both acupuncture and electroacupuncture can reduce premature ovarian failure by protecting granulosa cells through the PI3K/AKT signalling pathway and reducing apoptosis. Specific Chinese herbal formulae including Jin Feng Wan have also been shown in research to treat premature ovarian insufficiency. Read more: Premature ovarian failure ›

Thin endometrial lining

A thin endometrial lining — generally defined as less than 7–8 mm in the periovulatory phase — is a significant cause of implantation failure, IVF cycle cancellation and repeated embryo transfer failure. The endometrium must achieve sufficient thickness and a trilaminar pattern on ultrasound to provide a receptive environment for the embryo. When conventional oestrogen supplementation is insufficient to achieve this, many women find themselves in a cycle of repeated cancelled transfers with no clear solution offered by their clinic.

In TCM, thin endometrium reflects an insufficiency of the Blood and Kidney Yin that build the uterine lining each cycle, often combined with Blood stasis impairing uterine blood flow. Acupuncture has the strongest direct evidence of any complementary therapy for this indication — multiple RCTs have confirmed that it significantly increases endometrial thickness and uterine artery blood flow by improving uterine perfusion, stimulating VEGF and reducing sympathetic vasoconstriction. Chinese herbal medicine provides daily follicular-phase nourishment with Blood and Yin tonics including Shu Di Huang, Dang Gui, E Jiao and Dan Shen, building the endometrium from the root. Many women who have had cycles cancelled for inadequate lining find that a course of combined treatment produces a lining sufficient for transfer. Read more: Thin endometrial lining ›

3. Male fertility problems

Male infertility

Male factor infertility is involved in approximately 40–50% of all infertility cases, yet it is often underinvestigated and undertreated. Male infertility is generally simpler in structure than female infertility — it primarily involves problems with sperm count, motility (movement) and morphology (shape) — but these parameters have been declining significantly in western populations, with sperm counts falling by around 40–50% over the past 70 years.

Acupuncture and Chinese herbal medicine have been shown in multiple research studies to improve all three semen parameters. Research has also shown that acupuncture increases blood flow to the testicular artery, raises testosterone levels and can successfully treat men with very low sperm output. Chinese herbal formulae such as Yi Jing Tang have been shown to improve sperm quality in men with oligozoospermia. Read more: Male infertility ›

Low sperm count

A low sperm count (oligozoospermia) is defined by the World Health Organization as a total sperm count of fewer than 39 million in a single ejaculate. A low sperm count reduces the chances of fertilisation — whether naturally or through IVF — because fewer sperm reach the egg. Low sperm count can occur alongside poor motility (asthenozoospermia) and abnormal morphology (teratozoospermia), which compounds the difficulty further.

Sperm take approximately 74 days to mature, so changes made today will not be reflected in a semen analysis for about three months. This makes early treatment important. Acupuncture, Chinese herbal medicine, dietary changes, targeted supplementation and lifestyle modification can all produce measurable improvements in sperm count and quality within three to six months of treatment. Read more: Low sperm count ›

Sperm DNA fragmentation

Sperm DNA fragmentation (SDF) refers to breaks within the genetic material carried by the sperm. A man can have a completely normal count, motility and morphology on a standard semen analysis and still have a high DNA fragmentation index (DFI) — making it one of the most frequently missed causes of infertility and recurrent miscarriage. A DFI above 25% is associated with significantly reduced natural conception rates, poor IVF and ICSI embryo quality, and a two-fold increase in miscarriage risk. Standard ICSI does not reliably overcome the problem because sperm are selected visually and damaged DNA cannot be seen under the microscope.

In TCM, elevated DFI reflects a depletion of Kidney Jing combined with pathological Heat or Damp-Heat damaging the Essence — an oxidative-equivalent process that is highly amenable to treatment. Acupuncture reduces systemic oxidative stress, improves testicular blood flow and reduces cortisol-mediated reproductive suppression. Chinese herbal medicine — particularly the classical formula Wu Zi Yan Zong Wan and herbs such as Gou Qi Zi, Wu Wei Zi and He Shou Wu — nourishes the Kidney Jing and provides potent antioxidant sperm-protective activity. Because spermatogenesis takes 74 days, a minimum of three months of treatment is recommended before retesting DFI. Many patients reduce their DFI from the high-risk above-25% range to below 15% within one to two treatment cycles. Read more: Sperm DNA fragmentation ›

4. Problems affecting both partners

Unexplained infertility

Unexplained infertility is the diagnosis given when standard western fertility investigations — hormone blood tests, semen analysis, ultrasound and fallopian tube assessment — come back normal, yet pregnancy has not occurred. It accounts for around 20% of infertility diagnoses and is one of the most frustrating and demoralising conclusions a couple can receive.

In my clinical experience, unexplained infertility almost always has a cause that western medicine is not measuring. The most common pattern I see is blood deficiency — where the woman's blood levels, whilst technically within the normal western range, are insufficient to support optimal fertility. This can be easily identified through TCM assessment and is highly responsive to treatment with acupuncture, Chinese herbal medicine, dietary changes and iron supplementation. Research has confirmed the effectiveness of acupuncture and Chinese herbal medicine in treating unexplained infertility. Read more: Unexplained infertility ›

Repeated IVF failure

Repeated IVF failure — two or more failed IVF cycles — is both emotionally and physically draining. Each failed cycle depletes the body's resources, and if cycles are attempted too quickly without allowing adequate recovery and preparation, outcomes tend to worsen rather than improve. Many fertility clinics encourage couples to proceed to the next cycle quickly, which I believe is counterproductive.

Acupuncture has been shown in research to improve IVF success rates through multiple mechanisms: improving blood flow to the uterus, increasing endometrial thickness, regulating immune factors such as natural killer (NK) cells that can prevent implantation, improving ovarian response to stimulation drugs, and producing enough antral follicles for a viable cycle. A meta-analysis of 25 RCTs found that acupuncture significantly raised clinical pregnancy rates (43.6% vs 33.2%) and live birth rates (38.0% vs 28.7%) compared with controls. I recommend at least three months of acupuncture and Chinese herbal medicine preparation between IVF cycles. Read more: Repeated IVF failure ›

5. Related pages

• Fertility treatments — acupuncture, Chinese herbal medicine, IVF support and online consultations
• Fertility acupuncture — how acupuncture supports natural conception and IVF
• Chinese herbal medicine for fertility — individually tailored herbal treatment for fertility conditions
• IVF acupuncture — acupuncture support throughout an IVF cycle
• Fertility advice — how to improve egg quality, sperm count, detect ovulation and more
• Fertility coaching — personalised guidance through your fertility journey
• Online fertility consultations — available via Zoom for patients throughout the UK and internationally
• Adenomyosis — Chinese herbal medicine and acupuncture for adenomyosis pain, heavy bleeding and fertility
• Fibroids — Chinese herbal medicine and acupuncture to shrink fibroids and relieve symptoms
• Luteal phase defect — acupuncture and Chinese herbs to improve progesterone and luteal phase length
• Sperm DNA fragmentation — reduce DFI and improve sperm DNA integrity with acupuncture and Chinese herbs
• Thin endometrial lining — improve endometrial thickness and uterine blood flow for IVF and natural conception
• My Fertility Guide — a comprehensive self-help book covering fertility problems, treatment and natural conception
• Treatment prices

9. My Fertility Guide