Infertility is defined as the failure to conceive after a year of unprotected intercourse. It is further differentiated into First Degree in a childless couple, Second-Degree if the couple already has at least one child, or Sub-fertile if the couple conceives naturally after 18 months. Since education, career, and a sense of financial security often precede the efforts of childbearing many couples opt to begin their family in their late thirties or forties. Approximately 33% of couples in their 30’s are infertile. [1] Difficulty conceiving in women increases along with age. Although this has been commonly observed, new evidence is increasing our understanding of the mechanism of action of this phenomena. For instance there is a substantial decrease in the level of normal mitochondria in granulose cells in women over 38 years old, indicating a decrease in energy and the ability of the cell to undergo mitosis. 2

The exact cause of infertility may be difficult to pin down. Even if a couple is considering natural intervention to deal with infertility, diagnosis by a physician is the first step in determining the cause. The first possibility that needs to be ruled out is any kind of blockage of the woman’s fallopian tubes, which is the leading cause of female infertility.3 Fallopian tube blockage may be due to an occurrence at birth, the after effect of an STD (sexually transmitted disease), endometriosis or fallopian tube scarring. Other female organs must also be checked for normal structure and function. The male partner needs to be assessed for any physical problems including blockages, as well as deformed or low number of viable sperm.

Hormones should be measured to determine the balance of FHS(follicle stimulating hormone), LH(lutenizing hormone), progesterone, estrogens, prolactin, anti ovarian antibodies, testosterone, thyroid and adrenal hormones. Other important factors to consider include stress levels and systemic illness. In addition to the above mentioned assessments, natural health care practitioners will often investigate environmental factors, such as levels of heavy metals 4 and PCB’s 5 which have been shown to interfere with both male and female fertility. Of all couples who go through in depth testing, approximately 10% cannot be diagnosed with a specific problem.

For the purposes of this paper, we will forgo a discussion of conventional tests and treatments and focus on natural testing techniques and interventions that have shown promise in fertility enhancement.

Pinpointing Ovulation:

Mapping out the timing of ovulation is the first step to take in the otherwise healthy female that is having a difficult time conceiving. Here is an excellent opportunity for the pharmacist to act as “health educator” in guiding the customer through self testing techniques. Ovulation generally occurs 14 days after day 1 of the last menstrual cycle. Conception efforts should center around those dates.

Basal body temperature mapping (BBT)

A basal thermometer is a tool available at all pharmacies that can help to determine the exact time of ovulation. The BBT should be recorded daily for 2-3 months. During the first phase of the menstrual cycle, the BBT generally has only slight fluctuations. Upon ovulation, there may be a dip in temperature, followed by a 1.0 to 1.5 degree (F) rise in temperature in the luteal phase. This elevation will continue until one to two days before the next period. If the temperature rise does not last 10-12 days, the patient may suffer from a short luteal phase. 6 This rise in temperature occurs in response to the thermogenic effect of progesterone secreted by the corpus luteum. Intercourse should be planned 2 days prior to anticipated ovulation, at an interval of every 48 hours, and should continue until at least three days after ovulation. Patients that are taking progesterone supplementation are not good candidates for BBT, as the supplemented progesterone will falsely raise the temperatures. 7 A flat temperature chart is indicative of an anovulatory cycle. Temperatures that remain elevated may indicate pregnancy.

Cervical Mucous Monitoring

Changes that occur to the cervical mucous during the menstrual cycle can often help determine ovulation. Women can perform self monitoring of the cervical mucous. After the period has ended, the vagina is dry, with little to no mucous. Just before ovulation the mucous production increases in response to increasing levels of estrogen. It usually becomes creamy, wet, and white. Upon ovulation, the “ovulation mucous” becomes clear, thin, and stretchy like an egg white, and has some special characteristics. It forms a ‘corridor’ pattern within the vagina, stretching from the opening to the os, or mouth of the uterus. This corridor guides sperm to the egg. In addition this mucous is high in glucose and other nutrients that nourish sperm cells and keeps them alive for up to 5 days, to increase chances of fertilization. Intercourse should be initiated when these mucous changes are noted, and repeated every forty eight hours. After ovulation occurs, the mucous becomes sticky, like rubber cement.8 The cervical mucous can be effected by intercourse, infection, showering, bathing, douching, recent birth control pill use, and lower levels of estrogen that can occur in the third and fourth decades of life.

Home Ovulation Detection Kits

These kits are widely available in pharmacies. They measure the elevation of LH that occurs just prior to ovulation. Ovulation should occur within 12 to 16 hours after the test is positive.

Fern Test

Body fluids, including saliva, dry in different crystalline patterns according to hormone levels which relate to fertility status. Early in the menstrual cycle, before the maturation of the egg, while the woman is not fertile, the saliva will dry into dots. The pattern will change to straight lines, and then into a fern-like pattern right before ovulation. Observing this pattern change can act as a monitor to determine ovulation status. The test is accomplished with the use of a tiny, inexpensive microscope. The woman touches her tongue to a slide, allows it to dry, and then views it through the lens. This can empower an individual with self-care information that can be useful to enhance the chances of conception. Pharmacies can offer this specialized testing equipment.

Dietary Focus for Enhanced Fertility

Dietary emphasis on whole organic foods, high in dark green leafy vegetables and devoid of fried, processed, high sugar and ‘junk’ foods is an important step for increasing the chances for conception for both men and women. Organic foods are free of pesticides, xenoestrogenic substances that interfere with fertility. 9 Food allergy testing(IGG) should be considered. Many women are sensitive to dairy products, and dairy consumption may decrease fertility, possibly due to incomplete breakdown of galactose, a lactose breakdown product. 10

Excessive intake of caffeine and alcohol have been linked to decreased fertility. 11 12 While the amount of what is considered excessive varies, a good rule of thumb is to limit consumption of caffeine containing beverages (coffee, tea, colas) and alcohol to no more than 2 cups per day.

Dietary Supplements for Infertility

Multivitamins are now recommended for every adult according to a study in JAMA, which links sub-optimal levels of nutrients to chronic illness. 13 Natural health care practitioners have long associated sub-optimal nutrient status to infertility, especially when no physical deterrents can be found. Both men and women may experience an increase in fertility after using multivitamins. 14

In my own clinical practice, infertile couples are analyzed individually, and a specific fertility enhancing protocol is designed. The following is a typical supplement schedule, which, along with dietary and life style changes, addresses colon cleansing, liver detoxification, increased antioxidant status and hormonal balance. A combination approach such as this, has resulted in conception in a majority of the couples who have implemented this protocol.

The supplement schedule:

SUPPLEMENT	RATIONALE
Multivitamin/mineral with adequate zinc, chromium, and B complex (capsule with minimum fillers)	Supply micronutrients; The B Vitamin group, including folic acid and B-12, has been proven to positively influence fertility in both men and women  15 16
Acidophilus	to regain proper intestinal flora; enhance nutrient absorption
Vitamin E ( as mixed tocopherols with tocotrienols) 400-800 IU/day	Antioxidant, anti-inflammatory, enhances fertility in human studies 17 18
Magnesium with B6 (avoid magnesium oxide)  500mg/day	to improve low magnesium; mobilize fluids;  support progesterone production
Flax powder with apple pectin1 tsp-1 TBS in water or juice/day	Cleanse the bowels, aids       detoxification
Milk Thistle (standardized to 80% silymarin) 80-200mg/day	Aids liver with detoxification and hormonal conversion  19
MACA (Lepidium Meyenii) 500-1000 mg/day	Traditional fertility tonic/adaptogen
GLA(Gamma linolenic acid) 500-1000 mg/day	to support cervical mucous; aid in blood pressure regulation; anti-inflammatory   20
False Unicorn (for women) 500mg/day 1-2 ml extract	may act as a uterine tonic in ammenorrhea; traditionally used for fertility enhancement
Agnus Castus ( Vitex,) 40 mg/day, (for women)	to balance progesterone (discontinue in pregnancy) 21 22
Arginine 1000mg/day(for men)	Improves sperm motility   23

 

Lifestyle Factors

Cigarette smoking has been linked to decreased fertility. Furthermore, the more a woman smokes, the less her chances are of conceiving. 24 Maintaining normal weight is important. Both underweight and overweight conditions decrease fertility. 25 Moderate exercise is essential for maintenance of overall health and wellness, but OVER exercising may lead to exercise-related female reproductive dysfunction (ERFRD), with associated symptoms of amenorrhea and infertility. 26

Creating ‘Time’

Many couples experiencing infertility are professionals with demanding schedules. If a couple’s schedule is already stressed to the breaking point, it is wise to consider creating more ‘downtime’ by cutting back work hours, giving up some civic duties, and scaling down social commitments.

Visualization Aids

Here is a simple visualization aid that pharmacists can suggest to clients:

Get a large piece of oaktag. Cut out pictures from magazines to create a collage . Design it to represent what you hope to create in your life. Fill the blank sheet with pictures of pregnant women, babies, families walking down the street with a stroller, and whatever else conjures a picture of the scene you would like to see in your own life. Place the completed collage near your bed. Allow yourself to look at it through half-closed eyes as you drift off to sleep, and as soon as you awaken. After looking at the images, create a movie in your mind before you go to sleep. Remember, you are the star, the producer and the director. Allow your vision to be the apex of the best, happiest , healthiest scene you can imagine. After a week or two of doing this exercise, women and men may start to have actual dreams about the happy family they hope to create. In many cases conception follows close behind!

Footnotes

Lemcke D,Pattison J, Marshall L, Cowley D:Primary Care of Women,: Norwalk:Appleton and Lange,1995, pp. 440-504.

Seifer DB, DeJesus V, Hubbard K. Mitochondrial deletions in luteinized granulosa cells as a function of age in women undergoing in vitro fertilization. Fertil Steril 2002 Nov;78(5):1046-8

Speroff L, et al. (1999). Female infertility, In Clinical Gynecologic Endocrinology and Infertility, 6th ed., pp.1013–1042. Philadelphia: Lippincott Williams and Wilkins.

Choy CM, Yeung QS, Briton-Jones CM, et al. , Relationship between semen parameters and mercury concentrations in blood and in seminal fluid from subfertile males in Hong Kong. Fertil Steril 2002 Aug;78(2):426-8

Buck GM, Mendola P, Vena JE, et al. Paternal Lake Ontario fish consumption and risk of conception delay, New York State Angler Cohort. Environ Res 1999;80(2 Pt 2):S13–S18.

Strott C, Cargille G, Ross and M. Lipsett: The Short Luteal Phase. J. Clin.Endocrin 30:2446ff, 1970.

Check J, Adelson H: The Efficacy of Progesterone in Achieving Successful Pregnancy: II. In Women with Pure Luteal Phase Defects. International Journal of Infertility: 32(21): 139-141, 1987.

Flynn A, Collins W, Royston, Barbato M, Mena-Gonzales P, Alliende ME: Volumetric Sampling of Cervicovaginal fluid to Determine Potential Fertility: A Multicentre Pre-effectiveness Study. Human Reproduction: 32: 1826-31, 1997

Golden RJ, Noller KL, Titus-Ernstoff L, et al. Environmental endocrine modulators and human health: an assessment of the biological evidence. Crit Rev Toxicol 1998 Mar;28(2):109-227

Cramer, D., H. Xu and T. Sahi, 1994. Adult hyplactasia, milk consumption, and age-specific fertility. Am. J. Epidemiol. 139(3):282-289

Hatch EE, Bracken MB. Association of delayed conception with caffeine consumption. Am J Epidemiol 1993;138:1082–92

Hakim RB, Gray RH, Zacur H. Alcohol and caffeine consumption and decreased fertility. Fertil Steril 1998;70:632–7

Fletcher R.H., Fairfield K.M , Vitamins for Chronic Disease Prevention in Adults , JAMA, Vol. 287 No. 23, June 19, 2002

Czeizel AE, Metneki J, Dudas I. The effect of preconceptional multivitamin supplementation on fertility. Int J Vitam Nutr Res 1996;66:55–8

Wong WY, Merkus HM, Thomas CM, et al. Effects of folic acid and zinc sulfate on male factor subfertility: a double-blind, randomized, placebo-controlled trial. Fertil Steril 2002 Mar;77(3):491-8

Bennett M. Vitamin B12 deficiency, infertility and recurrent fetal loss.

J Reprod Med 2001 Mar;46(3):209-12

Bayer R. Treatment of infertility with vitamin E. Int J Fertil 1960;5:70–8.

18. Nugent D, Newton H, Gallivan L, Gosden RG., Protective effect of

vitamin E on ischaemia-reperfusion injury in ovarian grafts. J Reprod

Fertil 1998 Nov;114(2):341-6

19. Saller R, Meier R, Brignoli R., The use of silymarin in the treatment of

liver diseases. Drugs 2001;61(14):2035-63

Horrobin DF. The role of essential fatty acids and prostaglandins in the

premenstrual syndrome. J Reprod Med. Jul1983;28(7):465-8.

21. Propping D, Katzorke T. Treatment of corpus luteum insufficiency.

Zeitschr Allgemeinmedizin 1987;63:932–3.

22. Bergmann J, Luft B, Boehmann S, et. al., The efficacy of the complex

medication Phyto-Hypophyson L in female, hormone-related sterility.

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Komplementarmed Klass Naturheilkd 2000 Aug;7(4):190-9

23. I Scibona M, et al. L-arginine and Male Infertility. Minerva Urol Nefrol.

Dec1994;46(4):251-53.

24. Howe G, Westhoff C, Vessey M, Yeates D. Effects of age, cigarette

smoking, and other factors on fertility: findings in a large prospective

study. BMJ 1985;290:1697–9.

25. Green BB, Weiss NS, Daling JR. Risk of ovulatory infertility in relation to body weight. Fertil Steril 1988;50:621–6.

26. Cannavo S, Curto L, Trimarchi F., Exercise-related female reproductive dysfunction. J Endocrinol Invest 2001 Nov;24(10):823-32