Optimizing Female Fertility

By Jason Barker, ND, Chris Meletis, ND
Phone: (303) 382-9200
Visit: drjasonbarker.com

Once a subject that was paid relatively little regard, fertilityhas become increasingly popular, as the wear andtear of modern living has altered fertility levels. Varioussources cite differing statistics surrounding this phenomenon:1

Some sources report that 1 in every 6 couples may be infertile.

Other sources note that 14 percent of couples have infertilityproblems.

In the United States, approximately 10.2 percent of womenbetween 15 to 44 (roughly 6.2 million women) have some kindof impaired fertility and this incidence is increasing.

25 percent of women have infertility problems during theirreproductive years, and the incidence of this problem increased37 percent in 35Ð44 year-old women between 1982 and 1988.

The number of women with infertility problems is projected toreach 7.7 million by 2025.

Infertility is generally defined as the inability to achieve pregnancyafter 1 year of unprotected intercourse. Women in their 20s are usuallyadvised to be persistent and but have greater leeway before seekingmedical consultation while couples in their mid-to-late 30s areadvised to be much more persistent. Female age is considered moreof a factor than in males2 and, if a woman is near or older than 35,she is advised to seek assistance sooner rather than later. Yet, becausemale factors actually account for an estimated 40 percent of conceptiondifficulties, the first step in evaluating a couple who is havingproblems with conceiving is to determine which partner is infertile.

Causes of Female Infertility

There are many reasons for female infertility, ranging fromanatomical to hormonal to nutritional. Complementary and alternativemedicines can be helpful for addressing nearly all conditionsand causes; a select few of these are covered in this article.There are also many confounding factors. Some of the betterknowncauses of infertility are:

Ovulation problems - Ovulatory dysfunction may result fromthe aging process, anovulatory cycles, amenorrhea, lutealphasedefects, premature ovarian failure, polycystic ovariansyndrome, and hyperprolactinemia.

Tubal defects - Anatomical problems in the structure or functionof the fallopian tubes from past abdominal or pelvic surgerycausing adhesions or past infections (pelvic inflammatory disease)may prevent eggs from traveling through the tubes.

¥ Uterine growths - Growths, such as fibromas, myomas, andleiomyomas, may exist inside the uterus and negatively affectimplantation of the fertilized egg.

¥ Endometriosis - Fragments of endometrial tissue may be carriedupward through the fallopian tubes and become implantedthere and elsewhere in the pelvic area. Endometrial cysts mayblock passage of eggs through the tubes or become implantedon the ovaries, preventing release of eggs. Endometriosis canaffect fertility in a number of other ways.

¥ Medication use - Several different types of medications havebeen reported to affect female fertility; among these are hormones,antibiotics, antidepressants, pain-relieving agents, andaspirin and ibuprofen when taken at midcycle.3

Other medical problems, such as inflammatory bowel disease,celiac sprue, epilepsy, thyroid conditions, and diabetesmay all adversely affect a woman's state of fertility.4 In sum,fertility problems are attributable to either mechanical factors,such as endometriosis and adhesions, or ovulatory dysfunctionor failure.

Although there are many documented causes for infertility,unexplained infertility affects many women. Many women, afterhaving adequate medical workups for themselves and their partners,are still unable to conceive although both members of thecouple appear to be in normal health. Women, in particular, aresusceptible to more influences that affect fertility than men;women typically produce one egg per month and the entire menstrualcycle is governed by strict hormonal events.

In addition, female reproductive organs are more complexthan those of males; thus women are more vulnerable to anatomicand physiologic factors that could reduce fertility. Therefore,when attempting to discern the cause of female infertility, multiplefactors should be taken into account.

Fertility Treatments

The treatments discussed below are supports that assist awoman's body to attain a state of highest fertility. It is not surprisingnor new that, when provided with adequate nutritionaland environmental support, the body can achieve a state of excel lent health; enhancing fertility. Until then, patients who have difficultyin conceiving are advised to take as many steps towardhealth as necessary to prepare their bodies for reproduction.

Nutritional and Lifestyle Factors

A number of strategies can be used to address certain femalehealth conditions. Incorporation of all factors is important forachieving overall reproductive health, regardless of the diagnostic "label" a patient has been given. In particular, females willneed to work on a variety of factors to optimize their fertility. It isalso important that woman who wish to use nutraceutical andbotanical regimens be strongly advised to work closely with aphysician because some supplements taken to improve fertilitymay alter the fetal environment.

Dietary Deficiences

Regardless of research studies on the benefits of specific supplementsfor enhancing fertility, there is no substitute for ahealthy diet. The foundation of good health has always been theproper care and feeding of the human body. Diet, in both womenand men, has a profound effect on fertility; what is (and what isnot) put into the body can affect the multiple things that must goright for conception to occur (or not occur).

Interestingly, the human body almost seems to have a built-inmechanism to prevent conception to the degree a person isundernourished or overstressed. Certainly, pregnancy occursoften in undernourished individuals, yet, this tendency isthought-provoking at the very least.

Indeed, food is the best medicine and avoiding contaminatedfood is equally important as proper diet and nutrition. Consumptionof therapeutic foods and correctly prescribed supplementscan help offset less-controllable environmental factors.

Fertility-Promoting Lifestyle Factors - What to Tell Your Patients

Help your patients improve their fertility by advising them to:

Maintain an optimal diet, including varied sources of nutrition
Avoid environmental chemicals at work, home, and in food sources Eliminate or avoid caffeine prior to conception
Avoid drastic weight loss and dieting at least 6 months prior to conception.

Environmental Contaminants

Increasing evidence relates the effects of environmental exposureto chemicals, radiation, and infections on germ cells, fertilizedeggs, and on hormonal balance to implantation and development.5 Passive environmental exposures to pollutants arecommon, from workplace chemicals, to products in the air frommanufacturing facilities, to urban water supplies with supposedly "acceptable" levels of contaminants.

Environmental chemicals that affect fertility are also in manypeople's food if they do not consume foods from organic farms orderived from similar production means. Second-hand cigarettesmoke presents a problem because cadmium, a toxic metal insmoke, is absorbed in the body and is known to have negativeeffects on fertility, as well as other components of cigarette smoke.6

It is easy to become overwhelmed by the numerous ways inwhich the world has become increasingly inconducive to optimalfertility levels; patients must be trained to be diligent in protectingthemselves without becoming overwhelmed.

Alcohol

Research has proven that alcohol affects the fertility of womenand men adversely and that fertility can be improved when alcoholis eliminated from the diet.7 The strong link between alcoholconsumption by a pregnant mother and the incidence of fetal-alcoholsyndrome provides strong evidence for alcohol avoidance duringpregnancy; however research now points to the importance ofavoiding alcohol prenatally as well, in order to boost fertility.8

Caffeine

Caffeine, while not the most detrimental of dietary incursions,does apparently have a rather negative effect on fertility. In fact,there is strong evidence that avoidance of caffeine is importantfor women who are trying to conceive. One study indicated thatconsumption of more than 2 cups of coffee per day may lead toadverse effects on fertility, especially among women with fallopian-tube disease and endometriosis.9

Other studies have shown interesting evidence associating caffeineconsumption with delayed conception. Hatch and associatesdiscerned that women who consumed >300 mg of caffeineper day had a 27-percent lower chance of achieving conceptionwhile woman who consumed <300 mg per day of caffeine had a10-percent lower chance of conception compared to women whoconsumed no caffeine.10 Studies have also shown a decreasedincidence of miscarriage in women who avoid caffeine duringpregnancy.

Sources of caffeine other than coffee include green andblack tea, soft drinks, cocoa, chocolate, and some over-thecountermedicines. Elimination of caffeine, even though the supplementationwith these vitamins may ensure fertility andhealthy pregnancy in a number of ways.

Folic acid, is well-known as a necessary nutrient for preventingneural-tube defects in fetuses. The vitamin can also be used tomaintain proper cervix health by preventing cellular oxidativedamage. Folic acid acts as a chemopreventive agent that interfereswith the activity of human papilloma virus infection (aleading cause of abnormalities that are revealed by Papanicolaousmears) and of cervical cancer.15

B-vitamin deficits may be relatively common today as a resultof certain medications (oral contraceptives) or lifestyle factors(inadequate intake of vegetables and fruits). Inadequate B-vitaminlevels may predispose a person to depression, carpal tunnelsyndrome, and most importantly, altered hormone levels.16What is more, it is interesting to note the therapeutic ability of vitaminB6 and folic acid to prevent and treat morning sickness; itappears that women who ingest inadequate amounts of these vitaminstend to experience more illness during the course of pregnancy.

Vitamin C

Known for its multiple health effects, vitamin C has beenshown to assist certain populations of women to achieve pregnancy.An older study showed that women taking a fertilityagent (clomiphene) with no results were then able to have a menstrualperiod and ovulate following 400 mg of vitamin C supplementation.17

Another study, using laboratory animals as models, showedthat animals who were given vitamins C and E experienced adecrease in age-related reduction in their ovulation rates; that is,the animals were able to ovulate more frequently when given thesupplements compared to other animals of similar age who werenot given the supplements.18 Although direct implications forhuman fertility cannot be assumed on the basis of this study, itdoes have suggest implications for age-associated infertility inhumans.

Iron

Iron, which is important for erythropoiesis, may prove to be animportant preconception nutrient for women who are trying toconceive. One report noted that women with lower levels of iron

could improve their fertility by taking iron supplements.19 Physiologically,this makes sense, because women with insufficientamounts of iron will not be able to respond to the high demandfor this nutrient once conception has been achieved. It is importantto note that, prior to taking iron, women should be tested todetermine the actual (ferritin) and apparent (complete bloodcount) levels of iron in their bodies. It is also important to beaware if a woman is taking a multvitamin/mineral supplementbecause many of these contain required amounts of iron andadditional supplementation may becontraindicated.

Multivitamins - Minerals

Prenatal vitamins, as their namesuggests, should be taken duringpregnancy and prior to it. Multivitamin/mineral supplements promotegeneral health and supply the bodywith the nutrients it needs as well asthose needed for a new, developinglife.

A study that evaluated multivitamin supplementation duringa 28-day preconception period demonstrated a significantlyincreased rate of conceptions among women that took a test supplementpreconceptually compared to women who took placeboduring the same time period; this difference was a 5-percentdecreased time to achieve conception for the women who tookthe test supplement.20

In addition, the same research team noted a significantly higheroccurrence of multiple births among the women in the supplementtreatedgroup compared to women in the placebo group as well asthe entire population from which the study groups were taken.21Multivitamin supplementation seems to increase chances for successfulconception when taken during preconception; supplementationshould begin 3Ð6 months prior to conception, if possible.

Botanical Medicines and Fertility

When utilizing herbal medicine to treat medical conditions,including infertility, it is important to note that herbal medicine,when used in traditional practice, embodies the concept of naturalmedicines. Herbal medicines are not necessarily meant totreat specific health problems directly but rather to support thebody or organ systems to regain physiologic, functional controlover a body system that needs fine-tuning. Many herbalmedicines can be used to help women to become pregnant, basedupon patients' individual symptoms and designed to nourisheach patient's body allowing it to be at its healthiest.

Puncture Vine

Puncture vine (Tribulus terrestris) is useful for helping the bodyproduce productive ovulatory cycles. A concentrated form oftribulus, standardized to 45 percent steroidal saponin contentused in a clinical study, assisted women in achieving ovulatorycycles when the test preparation was administered at 250Ð500mg, 3 times per day, for 3 months.22

Chasteberry

Chasteberry (Vitex agnus-castus) appears to have prolactininhibitingeffects, among others, and has been used for womenwho are sterile as a result of secondary amenorrhea and lutealinsufficiency.23 The herb seems to normalize luteal-phase defectsand may increase the chances of becoming pregnant for womenwith relative progesterone deficiency.

For women with hyperprolactinemia, vitex was shown to suppressprolactin release, lengthen luteal phases, and improve progesteronesynthesis after 3 monthsof treatment.24

In another study, 120 women withpolymenorrhea, oligomenorrhea, andcorpus luteum insufficiency weretreated with a standardized extract ofvitex for 6 months. Sixty (60) percentof these women had sought conceptionassistance previously. Duringthe study, the women's progesteronelevels were increased from an averageof 6.4 ng/mL to 9.3 ng/mL while 64 percent of the women's cycles became normalized and 29 percentof the women became pregnant.25

Two Chinese Herbal Preparations

Shakuyaku-Kanzo-To, a Chinese botanical combination of extractsfrom Paeonae radix and Glycyrrhizae radix has been used to lower elevatedtestosterone levels in a number of settings.26 When this preparationwas given to subjects at a dose of 5Ð10 mg per day for 2Ð8weeks, women with elevated circulating levels of androgens had significantlowering of testosterone. Six (6) of the 7 subjects in this studybegan ovulating regularly and 2 of them were able to conceive.27

Zhibai Dihuang, another Chinese formula (comprised of theherbs Anemarrhena, Phellondendron, and Rhemannia) andgiven in pill form, has shown promise for helping couples withantisperm and/or antiÐzona pellucida antibodies. Infertile coupleswere treated with this formula; following treatment antibodyconversion to negative was at 81.3 percent of the infertilecouple subjects in the study.28 Moreover, in the 1Ð9 months followingthe study, all 8 previously immunolgically infertile coupleswere able to conceive, and the women's antibody statusremained negative throughout their pregnancies.

Conclusions

This paper provided information on a short list of female-specific,reproductive-focused botanical and nutritional medicinesthat may be used to help woman become pregnant via regulationof reproductive organ function.

Botanical medicines offer an opportunity to treat each womanas an individual to address her specific cause of infertility. Thisapproach serves patients best, especially when dealing with multipleconfounders, such as those that occur in infertility.

Lifestyle factors are "fertile ground" for addressing numerouscauses of infertility. One can examine each woman's diet, place ofwork, home environment, and other lifestyle choices to give her options for achieving adequate nutrition. A balanced and varieddiet is essential and optimal amounts of the key supplements arealso important for helping women achieve conception. This isvital in addition to examining other avenues for addressing infertilityfully to help woman prepare their bodies for the miracle ofconception. ¡½

References

1. Online document at: www.ucdmc.ucdavis.edu/

2. Meletis CD, Barker J. Natural ways to enhance male fertility. AlternComplement Ther 2004;10:22Ð27.

3. Online document at: www.ucdmc.ucdavis.edu/

4. Bauer J, Isojarvi JI, Herzog AG, Reuber M, Polson D, Tauboll E, GentonP, van der Ven H, Roesing B, Luef GJ, Galimberti CA, van Parys J, FlugelD, Bergmann A, Elger CE. Reproductive dysfunction in women withepilepsy: Recommendations for evaluation and management. J NeurolNeurosurg Psychiatry 2002;73:121Ð125.

5. Premalatha GD, Ravindran J. Reproductive problems of the work force.Med J Malaysia 2000;55:146Ð151.

6. Younglai EV, Foster WG, Hughes EG, Trim K, Jarrell JF. Levels of environmentalcontaminants in human follicular fluid, serum, and seminalplasma of couples undergoing in vitro fertilization. Arch Environ ContamToxicol 2002;43:121Ð126.

7. Eggert J, Theobald H, Engfeldt P. Effects of alcohol consumption onfemale fertility during an 18-year period. Fertil Steril 2004;81:379Ð383.

8. Grodstein F, Goldman MB, et al. Infertility in women and moderatealcohol use. Am J Public Health 1994;84:1429Ð1432.

9. Grodstein F, Goldman MB, Ryan L, Cramer DW. Relation of femaleinfertility to consumption of caffeinated beverages. Am J Epidemiol1993;137:1353Ð1560.

10. Hatch EE, Bracken MB, Association of delayed conception with caffeineconsumption. Am J Epidemiol 1993;138:1082Ð1092.

11. Van Der Spuy ZM, Jacobs HS. Weight reduction, fertility and contraception.IPPF Med Bull 1983;17:2Ð4.

12. Wynn M, Wynn A. Slimming and fertility. Mod Midwife 1994;4:17Ð20.

13. Petreas M, She J, Brown FR, Winkler J, Windham G, Rogers E, ZhaoG, Bhatia R, Charles MJ. High body burdens of 2,2¡¬,4,4¡¬-tetrabromodiphenylether (BDE-47) in California women. Environ Health Perspect2003;111:1175Ð1179.

14. Damstra T. Potential effects of certain persistent organic pollutantsand endocrine disrupting chemicals on the health of children. J ToxicolClin Toxicol. 2002;40(4):457Ð465.

15. Kelloff GJ, Boone CW, Crowell JA, Nayfield SG, Hawk E, Steele VE,Lubet RA, Sigman CC. Strategies for phase II cancer chemoprevention trials: Cervix, endometrium, and ovary. J Cell Biochem Suppl 1995;23:1Ð9.

16. Werbach MR. Female infertility [review]. Townsend Letter for Doctors & Patients, August 1995:34

17. Igarashi M. Augmentative effect of ascorbic acid upon induction ofhuman ovulation in clomiphene-ineffective anovulatory women. Int JFertil 1977;22:168Ð173.

18. Tarin J, Ten J, Vendrell FJ, de Oliveira MN, Cano A. Effects of maternalageing and dietary antioxidant supplementation on ovulation, fertilisationand embryo development in vitro in the mouse. Reprod Nutr Dev1998;38:499Ð508.

19. Rushton DH, Ramsay ID, Gilkes JJH. Ferritin and fertility. Lancet1991;337:1554.

20. Czeizel AE, Metneki J, Dudas I. The effect of preconceptional multivitaminsupplementation on fertility. Int J Vitam Nutr Res 1996;66:55Ð58.

21. Czeizel AE, Metneki J, Dudas I. The higher rate of multiple birthsafter periconceptional multivitamin supplementation: An analysis ofcauses. Acta Genet Med Gemellol (Roma) 1994;43(3Ð4):175Ð184.

22. Tabakova P et al. Clinical study of Tribestan¨ in females withendocrine sterility. Cited in: Werbach, MR, Murray MT. Botanical Influenceson Illness, 2nd edition. Tarzana, CA, Third Line Press Inc.,2000:399.

23. Gerhard II, Patek A, Monga B, Blank A, Gorkow C. Mastodynon¨ infeminine sterility. Forsch Komplementarmed 1998;5:272Ð278.

24. Milewicz A, Gejdel E, Sworen H, et al. Vitex agnus castus extract in thetreatment of luteal phase defects due to latent hyperprolactinemia:Results of a randomized placebo-controlled double-blind study.Arzneimittelforschung 1993;43:752Ð756.

25. Bubenzer RH. Therapy with Agnus castus extract (Strotan¨) Therapiewoche1993;43:32Ð33,1705Ð1706.

26 . Online document at: www.honsousa.com/Research/Abstract_Shakuyaku-kanzo-to_SYGCT.pdf

27. Yaginuma T, Izumi R, Yasui H et al., Effect of traditional herbalmedicine on serum testosterone levels and its induction of regular ovulationin hyperandrogenic and oligomenorrheic women. Nippon SankaFujinka Gakki Zasshi 1982;34:939Ð944.

28. Li DJ, Li CJ, Zhu Y. Treatments of immunological infertility with Chinesemedicinal herbs of ziyin jianghuo. Chung Kuo Chung His I Chieh HoTsa Chih 1995;15:3Ð5.

Female Infertility