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INFERTILITY
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:
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
J
Reprod Med 2001 Mar;46(3):209-12
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
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. A randomized, placebo-controlled clinical double-blind study. Forsch 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
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