Overcoming Fertility Problems…naturally

M.App.Sc; B.H.Sc.(Nat); P.Grad.Dip.(Acup.); Dip.N.F.M., F.A.N.T.A; M.N.H.A.A; A.M.A.C.N.E.M
Naturopathic Medicine Physician

Infertility problems now affect one in six Australian couples.

Infertility is defined as inability to become pregnant within 12 months of trying to conceive.

While a lot of emphasis is often put on the female, when it comes to infertility, the research clearly shows that the causes are equal in the gender stakes. Forty per cent of the causes of infertility are due to female factors, 40 per cent male factors and 20 per cent is combined male/female factors as well as unknown reasons.

Even in the absence of specific fertility problems, it now takes the average seemingly healthy Australian couple 10 to 12 months to conceive.

In addition, one in five women will suffer a miscarriage, one in ten babies is born prematurely, one in thirty babies is born with a congenital defect and the rates of learning and behavioural problems, asthma and allergies are dramatically increasing. These statistics are concerning.

Couples who have been told that they are suffering from unexplained infertility are encouraged to try ovulation boosting drugs or IVF often without first addressing the foundation of their fertility and looking at what aspects of their general health and lifestyles might be adversely affecting sperm and egg health.

Hormonal problems, stress, nutritional deficiencies and toxicity overload can all affect a couple’s fertility and are often overlooked, but are significant factors.

Successful pregnancy outcomes are all about removing obstacles to fertility. One of the most common problems, even with patients who participate in expensive artificial reproductive technologies such as IVF, is that they simply don’t eat a diet that contains enough nutrients to create healthy eggs and sperm.

Women who suffer from stress, irregular periods and have low energy levels, and men who also suffer from stress and have poor quality sperm, often turn out to be extremely deficient in the many minerals and vitamins which are essential for healthy hormones and reproductive health.

So what are the natural options to improving a couple’s fertility and how successful is natural fertility treatment when compared with IVF?

The official statistics on the success of IVF and other artificial reproductive technologies are just over 30% for people between 25 and 34 and significantly less after that. Natural fertility treatment, involving a specific preconception care program with a qualified natural fertility specialist, can be as high 75-89 per cent . So, there is clearly merit in thinking about a natural approach - either on its own or in combination with medical fertility treatment - which can dramatically improve IVF treatment outcomes.

What Causes Female Infertility?

For women, many factors are at play when looking at the causes of infertility.

Increasing maternal age is a significant issue, with one in three women over the age of 35 experiencing fertility issues and more than ten per cent of Australian women having their first baby at age 35 or older. Australian research has found that with the popularity of IVF and other artificial reproductive technologies (ART), women are often under the misconception that they have a safety-gap of fertility options that allows them to delay starting a family.

This misconception is not helped by a few celebrities who have babies in their forties. While the reasons for choosing to delay motherhood are varied, it is not just because women choose to pursue their careers. For an increasing group of women, societal changes in relationship dynamics and other factors mean that they do not find their ideal partner until their late 30s or 40s.

One of the primary issues with a woman trying to conceive in her later 30s and 40s is not just an issue of ‘older eggs’, as is often the misconception.

Eggs and sperm are single cells, just like any other cell in the body, which form the building blocks of our existence. The health, and therefore the fertility, of sperm and eggs are dramatically influenced by unhealthy lifestyles, nutritional deficiencies, toxin exposures, stress and other health problems - all of which can adversely affect a couple’s chance of conceiving. The older a couple is, the greater the time of exposure and the higher the likelihood of their eggs and sperm being affected by these factors.

The good news is that the health of every cell in your body, including eggs and sperm, can be improved by addressing lifestyle factors, improving nutritional levels, reducing exposure to toxins and reducing stress levels.

This is especially pertinent when it comes to improving fertility and addressing ‘age’ issues in older prospective parents that are trying to conceive.

Another problem with delaying pregnancy is that the likelihood of hormonal problems increases as you age. The effects of endometriosis, Polycystic Ovarian Syndrome (PCOS) and other hormonal issues have a greater impact on fertility the longer you suffer from it. This is compounded by the fact that if a woman has been on the oral contraceptive pill since her teens or early twenties, any underlying hormonal problems will be masked by the artificial cycles induced on the pill.

Rebecca Tanner, a Naturopath and Natural Fertility Specialist at Remède, a wellness medicine practice in Mosman Park WA, has helped countless couples achieving their dream of having a baby. Rebecca says, “Many women who come to me have been on the contraceptive pill for 10-20 years before they are ready to start a family, generally without breaks. Often, the reason for going on the pill in the first place was due to painful or irregular cycles, which can be the early symptoms of hormonal problems, such as endometriosis, but they go untreated because their symptoms are masked while on the pill. It is only when they are ready to start a family and they come off the pill and find that they can’t conceive, that they find that they have hormonal problems.”

Rebecca’s advice to every woman on the contraceptive pill, who may want to have children in the future, is to have a break for a few months every one to two years to see if regular and healthy cycles re-establish, and to seek medical or naturopathic advice if that does not occur.

When it comes to hormonal blocks to fertility, there are a multitude of hormonal problems and imbalances that can affect a woman’s menstrual cycle and her ability to conceive or achieve a healthy full-term pregnancy and baby. These include issues such as irregular cycles, failure to ovulate, bleeding problems, low progesterone levels, high or low oestrogen levels, thyroid problems, endometriosis, PCOS, fibroids, infections, insulin resistance, obesity and much more.

Male Infertility

When looking at a couple’s fertility problem, it is equally important to address a male fertility - especially as sperm counts have dropped by 50% in the last five decades. Indeed, natural fertility specialist in Sydney, Angela Hywood, stated at a fertility seminar in Perth that if she had to make the choice between treating the male or the female in a case of ‘unexplained infertility’, she would choose to treat the male. She explained that because sperm take just three to four months to fully develop and mature, they are particularly susceptible to nutrient deficiencies, toxin exposure and other lifestyle factors - but it also makes them very responsive to treatment when these factors are addressed.

The methods for evaluating male infertility have been typically limited to semen analysis, which measures count (millions per ml of semen - ideally should be over 60 million/ml), motility (if they are alive and moving) and morphology (the number of healthy-looking sperm). However, semen analysis on its own has limitations and new technology that can test the DNA structure of sperm suggests that sperm with certain levels of DNA abnormalities are a strong predictor for fertility problems in men.

There are a number of factors that can increase DNA abnormalities in the sperm resulting in low fertility potential. Research shows that increasing male age, smoking history, drug exposure (recreational and prescription drugs), exposure to radiation (including atmospheric radiation while flying), exposure to toxins/chemicals and exposure to high levels of air pollution are all significant factors. Significant exposure to prolonged heat in the testicles can also contribute to DNA abnormalities from excessive hot tubbing, truck driving and avid cycling. Nutritional deficiencies, especially of zinc and antioxidants, have a significant impact, as do a variety of toxins including heavy metals.

Indeed, much research over the past few years has highlighted the impact of toxins known as ‘xenoestrogens’ on male and female fertility. These oestrogen-like compounds that are commonly found in plastics, but also in pesticides, herbicides and other chemicals, end up in our food supply.

The most common xenoestrogen, Bisphenol A (BPA), is one of the highest-volume chemicals in the world and has found its way into the bodies of most human beings. Used to make hard plastic, BPA can seep from beverage containers, plastic food containers, plastic wrap and other materials.

It is used in all polycarbonate plastic baby bottles as well as other items, including large water cooler containers, sports bottles and microwave oven dishes, along with canned food liners and some dental sealants for children. This compound is known to cause an array of reproductive disorders in males and females and is an increasing factor in ‘unexplained’ fertility. These excess ‘oestrogens’ in the body not only affect fertility, but can cause other hormonal problems, including thyroid issues, and they can potentially increase the risk of some hormonally sensitive cancers.

An Effective Preconception Care Program

Optimal fertility should start with preconception care - for every couple - regardless of if they have known fertility problems or not.

This involves improving the health and nutritional status in both partners and to optimise all factors essential to egg and sperm health and foetal development, as well as treating any health problems, before starting to try to conceive. It also involves ensuring that that a couple’s lifestyle supports their fertility, as well as educating them about their fertility and maximising timing for conception.

The results of preconception care are very encouraging.

Foresight, the Association for the Promotion of Preconception Care, is presently conducting a study in conjunction with Surrey University in the UK involving over 1100 couples, and early results for the preconception care program are already showing a 75% success rate. However, a previous study involving 367 couples over two years was completed in 1992. When the couples came to Foresight, 59% of them had some previous adverse reproductive history, including miscarriage (38%) and infertility (37% - 1-10 year history). By the end of the two-year study, 89% of all the couples had given birth, including 81% of those who were previously ‘infertile’. No baby was born before 36 weeks, none was lighter than 2368g (5.2 pound). There were no miscarriages; no peri-natal deaths, no malformations and no babies were admitted to special care. It is worth noting that in a ‘normal’ population sample of the same size, 70 miscarriages and 12 malformations would have been expected.

Preconception care should start at least four months prior to conception attempts, being the length of time it takes for sperm and ova to fully mature and develop.

Natural Medicine Treatment for Infertility Issues

As part of a preconception care program, natural fertility specialists generally conduct a variety of tests, in addition to conventional medical tests, to identify the reasons behind a couple’s fertility challenges. These tests, which may include cellular health testing, heavy metal testing, salivary hormone testing and others, help to determine the best course of individualised treatment for a couple. Treatment may include specific nutrients, fertility supplements, herbal medicines and specific dietary advice.

It is essential to get the body back to optimum health, so that it is replete with all of the nutrients required for healthy reproduction.

Every aspect of reproductive health, from formation of sperm and maturation of eggs, right through to the production of good quality breast milk, is dependant on an adequate supply of vitamins, trace minerals and essential amino and fatty acids.

However, refined modern diets, common lifestyle factors and environmental pollution can seriously compromise an individual’s nutritional status. Indeed, a CSIRO study showed that the diets of 67% of Australian women were below the RDA (Recommended Daily Allowance) for zinc, yet zinc is the most essential trace mineral in the body. Zinc is involved in over 200 enzyme systems in the body and zinc deficiency is linked to infertility in men and women as it affects almost all aspects of reproduction, especially the longevity of the sperm in the vaginal tract. Zinc is lost during ejaculation and zinc deficiency affects the levels of other minerals, especially magnesium, which influences how sperm clumps together.

Typical male causes of infertility relate to sperm quantity, quality, motility, hormonal balance and of course, DNA structure. In addition to zinc, nutrients such as vitamin E, resveratrol, vitamin C, amino acids L-arginine and L-taurine, as well as the minerals magnesium and selenium are all essential for sperm production and sperm quality.

Common female reproductive problems include endometriosis, polycystic ovarian disease, tubal disease, ovulatory failure and hormonal defects. These conditions interfere with fertility by affecting ovulation, conception and implantation of the foetus. To address these issues, therapeutically effective prescription-strength herbal and nutritional medicines are prescribed by natural fertility specialists to assist hormonal regulation, promote ovulation and improve the health of the uterus for implantation of the embryo. At the same time, specific nutrients such as high strength omega-3 fish oils, antioxidants, B12 and folate, selenium, iron, B-vitamins, iodine and other nutrients are prescribed to improve the health of a woman’s egg. Rebecca Tanner says that when herbal and nutritional medicines are appropriately prescribed, they are incredibly effective at improving fertility outcomes, and that giving concurrent acupuncture treatment often enhances this effect.

In both partners, it is essential to ensure that a high nutrient and low-toxin diet supports treatment. It is often important for both partners to make short-term dietary sacrifices such as limiting caffeine (just two cups of coffee a day has been shown to reduce fertility by 50%), cutting out processed and junk foods and significantly reducing or avoiding alcohol. Tanner says that the latest research indicates that even a glass of wine per night is too much if a couple is trying to conceive as it increases the risk of sperm abnormalities, miscarriage, birth defects and lowers IQ - all compelling reasons to reach for the mineral water instead if a couple is preparing for pregnancy!

Assisting IVF

For those couples who are planning an IVF treatment cycle or any other form of reproductive procedure such as fertility drugs, Tanner advises concurrent naturopathic and acupuncture care to increase the chance of a successful outcome. Natural fertility treatment focuses on general health and nutritional status to support the success of an IVF attempt. Tanner has had considerable experience in treating couples who are undergoing concurrent IVF treatment and has found that overall improvement in the health of both parents will help to make a healthier IVF baby. Patients undergoing concurrent natural fertility treatment with IVF also report reduced medication side-effects, which can be associated with some of the drugs and IVF procedures. It is essential that couples work with an experienced practitioner, who will not prescribe medicines that may interfere with IVF medications, and who is happy to work with your IVF specialist if required.

In addition to herbal and nutritional medicines, research from three separate trials has shown that acupuncture can double the success of IVF, when given before and after embryo transfer, as well as during the cycle. Acupuncture has been shown to increase the blood circulation to the ovaries and uterus and will therefore increase the capacity for conception for all cases of infertility, including IVF. Acupuncture also has an effect on the lining of the uterus, making it more receptive to embryo transfer. In addition, Ms Tanner who often gives concurrent acupuncture treatment to her fertility patients says that research shows that when acupuncture is used together with fertility treatment, the benefit is not affected by age. This means that all age groups show an increase in the IVF success rates from acupuncture therapy.

Get going…

While naturopathic treatment is individually determined depending on a couple’s reasons for seeking preconception treatment or infertility treatment, Tanner confirms that “the results of treatment can be astounding if both parties are willing to make the necessary changes.” She recommends that couples planning for conception or who are experiencing difficulties with fertility visit a degree-qualified naturopathic natural fertility specialist, to ensure they receive the most qualified care and the benefit of practitioner-prescribed medicines.

About the author: Chevonne Clasen and her colleague Rebecca Tanner are naturopathic medicine practitioners, acupuncturists and natural fertility specialists experienced in treating a wide variety of fertility problems, including all female and male fertility issues and IVF support. They can be contacted at Remède – Wellness Medicine, 13 Glyde Street, Mosman Park, 08 9286 1166 or www.remede.com.au