When, in the mid-1990s, Dr Xiao-Ping Zhai began using traditional Chinese medicine to treat infertility, her Harley Street practice was confined to a couple of rooms, each no bigger than a stationery cupboard. Patients would climb the four flights of stairs to sit on a hard chair in the tiny hallway outside her room, like lost and frightened children waiting to see the headmistress.
Along with the usual complex and paradoxical emotions felt by those desperately trying for a baby, the swings from optimism ("Yes – this could be the month it happens!") to panic ("I'll never have a child. Why me? Why me?"), there was also for many of them the feeling that Zhai was another guilty secret, in addition to their infertility. If these women revealed to friends and family, but especially to their mainstream gynaecology and fertility consultants, that they had resorted to acupuncture and brewing up bits of twig and moss to help them get pregnant, it would be the final proof that, in their quest to achieve what most women take for granted, they had lost the plot completely.
I first met Zhai more than six years ago, when Michael Dooley, a gynaecologist and fertility consultant, formerly at the Lister hospital in London and now running his own clinic in Dorset, told me about her success rate in getting women pregnant. Between 1995 and 2000 she had treated 224 patients (average age 37) with traditional Chinese medicine (TCM). After treatment for at least six months 76% of the women had become pregnant. Of these pregnancies, 77% resulted in a baby, and of the 23% who miscarried, 69% went on to have a baby later. In 2000 the fertility clinic at the very top of the Human Fertilisation and Embryology Authority league table was claiming a success rate of up to 38.8%. Zhai's success was in the 70s.
"I don't know what she does," Dooley told me. "I don't understand it at all, but her results are amazing and I'm keeping an open mind." He'd begun sending his most difficult patients to her, many of them poor candidates for IVF due to age or egg supply or FSH levels (a measure of the perimenopause); women who, by normal diagnosis, did not stand a hope in hell's chance of conceiving naturally or through assisted treatment (many of them wouldn't even qualify for treatment in some clinics). Zhai, with her herbs and her acupuncture and all the bizarre practices that go with a TCM consultation – more of which later – was Dooley's last-chance saloon.
As it turns out, it was just the beginning. Today, as I sit across from Zhai, she is still the tiny, polished woman I first met, except that her once stiff, bowl-like bouffant has now grown into soft shoulder-length curls. If a hairdo can ever be a metaphor for the relaxing consequences of success and acceptance, hers would do perfectly.
"I've seen so many women," she says smiling, "I know what I do works."
That is putting it mildly. Her practice has more than doubled in size in the past five years. She sees between 50 and 80 women a week, some of whom fly in from other countries. She now has two clinical assistants and a PA; the rooms are five times bigger and there are more of them. Her patients still come to her by word of mouth, but an increasing number are referred by mainstream consultants such as Michael Dooley and Stuart Lavery, director of the IVF unit at Hammersmith hospital, who work in conjunction with Zhai to maximise women's chances of success of conception.
It helps that Zhai trained in western medicine in China, working as a paediatrician in Guangzhou before coming to the UK, and consultants seem happy that she speaks their language in clinical terms. Lavery says: "We have had pregnancies occur in which her input has been critical. It is quite rare to come across somebody practising such therapies with a degree of credibility, but the thing about Zhai is that she doesn't only embrace her own philosophy. She works with us, not against us, and that overlap with western medicine is what makes her unique. I don't know if her success is to do with her acupuncture, her herbs or just her being a very, very good physician – which is an important part – but the feedback is remarkable. At our clinic, we think she brings something new to the table."
Zhai's success rate remains phenomenal. In 2005 alone, for example, she helped 61 women get pregnant – 80.3% of her patients that year; 45 of them carried the baby full term. News of her extraordinary talents is spreading. She regularly flies off to international conferences – proof that she has gained respect and acceptance beyond the UK. "I've seen her hold a room in front of fertility consultants from all over the world," says Dooley. "I've seen her at medical conferences and presenting national meetings, and she is fantastic."
It is for this reason that she has been nominated by Clare Lewis-Jones, CEO of Infertility Network UK, as a key speaker at the Fertility Show in London next month. This follows on the heels of another breakthrough: Zhai has secured an agreement with the London Fertility Centre that allows her to use its facilities to carry out natural-cycle IUI (intra-uterine insemination) without losing control of the patient's care. With natural-cycle IUI there are no drugs, no invasive procedures – sperm is simply placed near the Fallopian tube at the start of ovulation. Zhai says she will use this on the patients for whom she feels IVF is not necessary, but for whom time might be running out.
"The downside of Chinese medicine is that it is a slow process," Zhai says. "I often get a woman's body very, very ready for pregnancy and then we are waiting for it to happen. These women do not need IVF, they don't need the invasive procedure or the expense or the drugs, but in the past I'd send them to a consultant for something quite natural like IUI, and before I'd know it the women would be back to me in tears saying the clinic had refused something so low-tech and that they were being steered towards IVF or ICSI [intra-cytoplasmic sperm injection]. It was very frustrating for me. This new agreement is very exciting. It is not necessary for every woman, and I won't be using it when I can avoid it, but it gives me another way of shortening the treatment cycle and staying in control."
The first – and as yet only – woman Zhai sent over to the London Fertility Centre successfully conceived on her second try – at the age of 43. Amanda (not her real name) married when she was 40 and started trying immediately with no success. Her baby is due on 1 January next year and she is over the moon.
"I'm now 44," she says. "I'd had three IUIs and IVF before going to Zhai, and my consultant told me to give up because I was just too old and my eggs were too weak. I saw Zhai throughout 2008 and then we did one IUI in the LFC and I got pregnant but miscarried. The second time, in April, it worked. I was 43. I still can't believe it. It can only be because of her – not only did she improve my egg quality, but the IUI at the LFC, with her in charge, was completely different to any other clinic, where you are aware that, really, you have people around you thinking you're past it and should have a donor egg."
Dr Magdy Asaad, clinical director of the LFC, stops short of endorsing TCM for fertility: "For it to be really accepted there have to be big trials, double-blinded and evidence-based research, and our physicians at the clinic here only follow evidence-based medicine." But he stresses that he is entirely comfortable with his new arrangement with Zhai. "The patients who come to us from her clinic are very happy with what she does. They are convinced that that is the way they want their treatment handled, and we understand that it is not harmful to them and that it is actually very good to offer them what they want."
Despite the conferences and meetings, for Zhai the most important part of what she does remains getting her patients pregnant. She passes me a handwritten note across the table. It is from a woman called Susan Namkung-Torch, an American corporate lawyer approaching 40 and now living in London, who saw Zhai for secondary infertility (she now has a nine-and-a-half-month-old son as well as her first child, who is seven and a half): "Thank you so much for bringing about the delivery of our long-awaited son after five long years, failed IVF attempts, two miscarriages and countless IUI attempts," Namkung-Torch writes. "I will be forever grateful for not only your medical expertise and wisdom but for maintaining my hopes during the darkest days when even I could not imagine a positive outcome and had all but given up… you always stated that I could – and would – get pregnant."
When I talk to Namkung-Torch she tells me that at first she and Zhai didn't get along. "I fired questions at her," she says. "I wanted answers, I wanted strategies. And some she could give, some she couldn't – but she remained very, very calm and, crucially, absolutely confident of my body getting fit enough to conceive.
"You see, I'm a corporate lawyer, very proactive. I am a very positive person, and for five years of trying to get pregnant, I remained positive. I did everything, from skipping, because I read it increased the circulation, through to colonoscopies and three cycles of IVF. My husband and I enlisted the most prestigious IVF doctors in the world, in London, in LA, in New York. I'd either not get pregnant or when I did, I didn't hold the pregnancies.
"By the end, I went to Dr Zhai. I saw her for 18 months, and still nothing happened. But never once did she give up hope. She just kept telling me that every month my body was getting stronger and stronger. Finally, I told her I was considering surrogacy. She just said: 'Susan, that's the right decision for your personality. You need to feel in control.'
"Having got her blessing, I think I relaxed. That month I conceived, and I now have a little boy. People say I would have got pregnant anyway, but that's not true, otherwise why didn't I get pregnant at the start? My hormones were all over the place, and she prepared my body, and because she is who she is, I finally relaxed. She was critical, and I'm going back to her again for our third child."
''When I tell a couple they do not need to waste their time and money on IVF, I know what I'm talking about," Zhai says. "Often it is a matter of clearing the system, increasing the blood supply to the ovaries, and restoring a level of general health in order to make pregnancy possible. Men are very easy to treat – sperm counts can improve very quickly – but I always treat the man and the woman to make sure there is optimum health."
Zhai often hears what Namkung-Torch reported, that sceptics say to her patients: "You would have got pregnant anyway."
This, understandably, angers her: "When a woman comes under my care, I am looking at the overall picture. I tell them that we will see the difference in their bodies. It is different from anything else. It is not about blood tests or scans – although I do use scans occasionally – but a scan is a scan; it is not going to tell you how your body is functioning. I see their temperature charts every month, and often women who think they have normal cycles actually show in temperature charts to have hormones all over the place. I regulate the body and I watch those charts change. It is not a matter of chance or luck, the evidence is there for me. You can measure it."
With some women, she tries to steer them away from IVF, or at least delay it. Some take her advice, some don't. Anne Spencer, an economics lecturer at London University, who conceived with Zhai when she was nearly 44, said: "We came to her in the middle of other treatments. Six months in, Zhai said: 'Don't do this scheduled IVF! Your body is not ready yet.' I went ahead anyway, and it failed. She said: 'Let's carry on anyway.' Four months later, she got me pregnant naturally. I have complete faith in her, complete faith. You are so pressured by clinics that time is running out, but she kept saying: 'You have eggs; this can happen.'"
As we talk, Spencer begins to cry. I can hear her three-month-old daughter snuffling on her lap: "This is very emotional for me," she says. "I had always wanted a family and spent my career competing with men and putting it off. She gave us the hope we needed."
Zoë Evans, 39, spent two years on an NHS list for a free cycle of IVF/ICSI while she was seeing Zhai, who was also treating her husband for problems with his sperm. Then the call came that Evans had finally reached the top of the list. She began taking the contraceptive pill to shut down her system ready for the crash menopause that comes with IVF – and then she changed her mind: "My husband and I concluded that we were not prepared to pursue a baby at any cost. I had real ethical issues with ICSI, and so pulled out of the NHS treatment. Zhai had done wonders with my husband's sperm count to such an extent that the fertility nurse at the clinic was gobsmacked at the improvements. We agreed to give TCM until Christmas. Last September I got pregnant, and in June I gave birth to our son."
Stuart Lavery is right when he says Zhai is a first-class physician. Though far from touchy-feely, there is something extremely assured and calming about her bedside manner. She is very confident in the prognosis she gives. How can you possibly know for sure, I ask her. Does it not keep you up at night, telling older women to delay or cancel their IVF cycles?
"I do know," she says, "because I'm treating the whole body, man and woman, and I can see the improvements. The only thing I don't know is which bit of the treatment helps a pregnancy to happen." She stresses, too, that she will also be the first to refer on if she believes surgery or western treatment – say for blocked tubes – is needed. Lavery tells me of an experimental treatment they worked on together in which a patient was given a drug used for diabetes mixed with TCM. The patient conceived: "That's what makes her so unique," Michael Dooley says. "It is a proper integrated approach."
It is estimated that between 10% and 15% of all British couples have trouble conceiving and will, at some point, look for specialist fertility treatment. The latest statistics from the Human Fertilisation and Embryology Authority show that in 2007 alone, 36,861 women received some kind of IVF treatment in UK clinics, an increase of 5.8% on 2006. Women aged 35 and below were successful in 32.3% of cases. Only 3.1% of 44-year-old women ended up with a baby.
Given that only 18% of all IVF is NHS-funded, Zhai's treatment presents an attractive alternative – not cheap, but cheaper than IVF. An initial consultation with her costs £190, and then there are the twice-a-month appointments, including acupuncture at £85. The herbs cost roughly £180-£200 each month. And as she is the first to point out, even if a couple is prepared to pay £5,000 for a cycle of IVF, clinics do not pay attention to the state of the woman's body. In other words, you wouldn't dream of running a marathon with a broken leg.
Watching a Zhai consultation is bizarre. She will check the tongue, the pulse, sleep patterns, whether a patient is thirsty, peeing a lot and their bowel movements. Often changes are made to the diet – no sugar, coffee, alcohol, dairy, wheat, spicy foods – and every month a woman is asked to keep a temperature chart.
Slowly, through the use of herbs and acupuncture, Zhai begins to regulate the vital energy, or Qi, that flows through the body. According to this ancient practice, good health and metabolism depend on Qi. As it flows, it provides warmth and distributes body fluids.
Each organ has its own pattern of Qi and each organ is represented on the tongue, which presents Zhai with a kind of map of the body's health. If one organ is not functioning properly, it affects the rest of the body: "It only takes one thing to be wrong to throw the whole system out," she explains.
Common diagnoses seem to be too much liver heat and blood stagnation, damp-heat obstruction in the abdomen, slow blood circulation to the ovaries – you get the picture.
Zhai says she can start seeing changes within three months but will not put a time frame on treatment: "Every woman is different."
The herbs she uses are mostly shipped in from China and made up to her prescriptions, although she is currently looking at manufacturing them in the UK. They include carthamus flower (huang hua) for regulating the flow of Qi to alleviate pain, glossy privet fruit (nu zhen zi) for nourishing the kidney and liver, as well as peach kernel, angelica root and codonopsis root.
It is easy to see why many western clinicians distrust TCM. To them it seems so random, so weird, although acupuncture is slowly gaining more credibility for fertility. (Last year a Dutch and US research project published in the British Medical Journal revealed that for every 10 cycles of IVF with acupuncture there would be one extra pregnancy compared with cycles performed without acupuncture.)
Zhai is aware of the scepticism: "I wish TCM could be regulated," she says, "I really do."
She tells me about a recent collaboration with Darren Griffin, professor of genetics at the University of Kent. Zhai entered into a trial in which the university's biosciences department tested some of her male patients to measure the effectiveness of her herbs on their sperm count. All six men had severe genetic abnormalities in their sperm, and by the end of the trial on Zhai's treatment, all had "levels not distinguishable from normally fertile males".
"What you don't know is how much of that was determined by her lifestyle advice," says Griffin, "but we were very, very surprised by the findings." A man's sperm quality is closely linked to his lifestyle and varies greatly from month to month. In other words, a period of no booze, no cigarettes and healthy eating could have just as good an effect: "I suspect it was a combination of both," says Griffin. "Also, six is a tiny study."
But then this study was followed up by a second last year, which tested the properties in the herbs Zhai had used to treat the men. The herbs contained every ingredient the scientists were looking for in order to explain such a positive causal effect. Could TCM be working on correcting genetic abnormalities?
Griffin says it would be necessary to take the study further. "I'd like to do double-blinded trials with placebos in which even the doctors don't know if they are giving the medicine. I want three groups of 20 to 50 men in each group, with men getting changing herbs every time, men getting the same herbs and men getting a placebo. But a trial like that will cost up to £1m."
He has already approached the Medical Research Council, the NHS and the Wellcome Trust charity, but so far there have been no takers. "It is very hard to establish the veracity of non-standard medicine," Griffin says, "precisely because it is not controlled. Every treatment is different."
Whether or not you buy into Zhai's clinic, there can be no doubt about one thing: her patients get pregnant when previously they did not. I'd bet £1m that if you asked any woman who had faced infertility whether, in the event of finally becoming a mother, she cared how or why it had happened, she would not give a hoot. Just having a baby is enough. And if what Zhai offers is choice and hope – another way of making a pregnancy happen – then what could be better?
The Zhai Clinic, 020 7486 8438; zhaiclinic.com
The Fertility Show is at London's Olympia, 6 and 7 November
