It is known that fertility can be influenced by age due to biological changes that occur over time. For women, fertility typically begins to decline in their late 20s to early 30s, with a more significant decrease after the age of 35. This decline is primarily due to a decrease in the quantity and quality of eggs, as well as changes in hormone levels. Advanced maternal age also increases the risk of pregnancy complications and chromosomal abnormalities in offspring.
Similarly, men experience a decline in reproductive health starting mid-30s, often seen in poor sperm quality, decreased sperm count and motility, as well as increased risk of genetic abnormalities. These can affect fertility, pregnancy as well as the eventual health of the child.
Drawing upon millennia of wisdom, Traditional Chinese Medicine (TCM) recognizes age as a crucial factor in the delicate dance of reproductive health. The interplay between them is based on the intricate balance of energies within the body. These energies are also the foundation to growth and the inevitable process of ageing. Today, we explore the TCM perspective between age and one’s reproductive health.
Female’s age and reproductive health
From the Han Dynasty, 《黄帝内经》(Yellow Emperor's Inner Canon) states: “女子七岁肾气盛，齿更发长。二七而天癸至，任脉通，太冲脉盛，月事以时下，故有子。三七肾气平均，故真牙生而长极。四七筋骨坚，发长极，身体盛壮。五七阳明脉衰，面始焦，发始堕。六七三阳脉衰于上，面皆焦，发始白。七七任脉虚，太冲脉衰少，天癸竭，地道不通，故形坏而无子也。”
TCM records a female's growth and development stage in multiples of seven.
Upon reaching seven years of age, the Kidney Qi flourishes, she changes a set of teeth and her hair grows.
In the second multiple of seven (which is 14 years of age), Tian Gui (a refined substance) travels from Kidneys to Ren and Chong Meridians, promoting its reproductive development. The action of both Chong and Ren Meridians causes menstruation to start. And thus, the female is able to start bearing children.
Third multiple of seven (equivalent to 21 years old), the Kidney Qi reaches its peak, displayed through the emergence of wisdom teeth and its growth complete.
When her age is the fourth multiple of seven (which is 28 years old), her tendons and bones are strong, hair is luscious, and body is strong.
Upon reaching the fifth multiple of seven (equivalent to 35 years of age), the Yang Ming Meridian starts to deteriorate, her face begins to become dull and her hair starts to thin.
After the sixth multiple of seven (which is 42 years of age), all three Yang Meridians decline, her face loses its radiance and her hair begins to turn white.
At the seventh seven, equivalent to 49 years of age, both Chong and Ren Meridians are empty, Tian Gui is exhausted, the female experiences menopause and making conception difficult afterwards.
Male’s age and reproductive health
Conversely, male’s developmental stages are recorded in multiples of eight. In the same passage, it states: “丈夫八岁肾气实，发长齿更。二八肾气盛，天癸至，精气溢泻，阴阳和，故能有子。三八肾气平均，筋骨劲强，故真牙生而长极。四八筋骨隆盛，肌肉满壮。五八肾气衰，发堕齿槁。六八阳气衰竭于上，面焦，发鬓斑白。七八肝气衰，筋不能动。八八天癸竭，精少，肾脏衰，形体皆极，则齿发去。”
For males at the age of eight, Kidney Qi is robust, hair grows and teeth are replaced.
At the second multiple of eight (16 years of age), the Kidney Qi and Tian Gui peaks, essence overflows, Yin and Yang are in harmony, thus enabling fertility.
Upon reaching the third multiple of eight (24 years of age), Kidney Qi reaches equilibrium, bones are strong, wisdom teeth grow, and physical growth is complete.
At the fourth multiple of eight (32 years old), the bones and tendons remain strong, and muscles are robust.
At the quintuple of eight (40 years of age) see a decline in Kidney Qi, hair starts to drop, and teeth become weak.
At the sixth multiple of eight (48 years old), Yang energy declines from the top, face becomes dull and hair starts to turn grey-white.
Upon reaching the seventh multiple eight (56 years of age), Liver Qi deteriorates, tendons weaken and affect mobility.
At the eighth eight (64 years old), Tian Gui is depleted, essence diminishes, Kidney function declines, physical appearance deteriorates resulting in loss of hair and teeth.
Kidney, the Cornerstone
After stating the developmental stages of females and males, the text goes on about why the Kidney organ is so important in the growth and decline of humans.
《黄帝内经》records “肾者主水，受五藏六府之精而藏之，故五脏盛，乃能演。今五藏皆衰，筋骨解堕，天癸尽矣，故发鬓白，身体重，行步不正，而无子耳。” Translated to: The Kidney is responsible for the metabolism and storage of water and the essence of the Five Organs and Six Viscera, which allows for these organs’ function to be optimal. When the organs have deteriorated and Tian Gui is depleted, it results in white hair, heavy body, abnormal gait and infertility.
We see that Kidney Qi plays a pivotal role in nurturing and supporting the body’s maturation process. It provides the foundation for strong bones, healthy teeth and robust reproductive organs. Apart from that, the Kidney is an organ that stores essence, which is an important substance in the area of fertility. When Kidney Qi is abundant and balanced, it supports optimal reproductive function, including menstruation in women and sperm production in men. As we grow older, our Kidney Qi will eventually deplete.
Understanding the pattern of growth and ageing, we know what to expect at each developmental stage. For example, if the Kidney Qi is not as robust as it should be or if Kidney Qi declines earlier, this will give rise to problems such as infertility and early ageing. Similarly, if a growing child’s Kidney Qi is not robust enough, he/she may see problems in menstruation or sperm production, or have weaker bones and tendons. Supposedly if one consumes enough tonics to keep his/her Kidney Qi as strong as possible, this can slow down the ageing process too!
In conclusion, the association of fertility and age in TCM is found largely in the robustness of the Kidney Qi. In this aspect, the Kidney functions as a cornerstone in the area of fertility. As TCM views the human body as one whole, we cannot neglect the roles that other organs and viscera play. With that being said, even though the Kidney plays a pivotal role in fertility, the body also relies on the harmonious and proper function of the other organs to establish optimal fertility.
Furthermore, Kidney Qi is believed to be inherited from one’s parents, which predetermines the level of Kidney Qi one begins with. While Kidney Qi will eventually deplete as one ages, the speed of growth and decline is greatly dependent on the individual’s lifestyle and dietary habits.
By recognising the importance of Kidney Qi in growth, development and fertility, TCM supports fertility through various methods aimed at nourishing and tonifying Kidney Qi. Moreover, taking into account the individual’s overall health and other organ functions, TCM offers personalised strategies to enhance fertility and promote wellness.
Author: Physician Aw Ching Yi Eunice
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