Do's and Don'ts for couples trying to conceive

Few would argue that any event is as miraculous as the birth of a child. But some potential parents delay the blessed event until they are solidly planted in a profession that ensures fiscal stability. The downside to this strategy is that as they age, women increase their risk of reproductive failure, which is often influenced by physical, emotional and lifestyle factors. Fewer than 10 percent of women in their early 20s have difficulty becoming pregnant, compared with nearly 30 percent of those in their early 40s.¹

But age isn't the only factor that contributes to infertility. According to the National Center for Health Statistics of the Centers for Disease Control and Prevention, 6.1 million women ages 15 to 44 have an impaired ability to have children, and 1.2 million married couples are infertile.2 Ovulation disorders, polycystic ovary syndrome and pelvic factors are all types of infertility. These affect women exclusively; however, in an estimated one-third of cases, the male is the sole cause of infertility,3 with abnormalities that include low sperm count, low sperm motility or abnormal sperm morphology. There are also unexplained infertility cases, where the cause of the couple's infertility is unknown despite a thorough—and usually quite expensive—medical evaluation; in these cases, a variety of treatments may be tried.

Most of these categories of infertility lend themselves to conventional and more "natural" approaches, and the ideal treatment protocol may integrate both. Pelvic factors, which include mechanical restrictions such as fibroid tumors, blocked fallopian tubes and endometriosis, do have a few natural treatments,4 but are not discussed here.

Ovulation disorders
Ovulation disorders involve disturbances in the production and release of the eggs from the ovaries; these disorders are usually caused by complex hormonal imbalances involving the pituitary and thyroid glands. Ovulation disorders require extensive diagnostic testing to isolate which gland(s) are causing the imbalance. This testing includes measuring levels of the thyroid-stimulating hormone, prolactin, and follicle-stimulating hormones, progesterone and estradiol.

Conventional treatments
The standard medical treatment for ovulation disorders is hormonal supplementation, either through oral administration or injection. Pregnancy may also be pursued through intrauterine insemination, a form of artificial insemination in which specifically prepared and concentrated sperm are inserted into the uterine cavity through a small catheter at the time of the woman's ovulation. This increases the odds of sperm finding what eggs might be present.

Natural treatments
Trans fat avoidance. Women with ovulation disorders benefit by reducing their consumption of specific nutrients. In an eight-year study involving 18,555 premenopausal women without a history of infertility who attempted a pregnancy or became pregnant, results indicate that the consumption of trans fats may increase the risk of ovulatory dysfunction. For each 2 percent increase of calories obtained from trans fats, instead of other fats and oils, women were calculated to have a 79 percent increased risk of infertility.5

Carbohydrates, fats and protein.
Another study earned the cover of the Dec. 10, 2007, issue of Newsweek under the title "Fertility & diet – how what you eat affects your odds of getting pregnant." The inside article was adapted from the book The Fertility Diet (McGraw Hill, 2007). The authors reviewed the ongoing Nurses' Health Study, a long-term research project observing factors that affect chronic illnesses such as heart disease and cancer. Of the estimated 18,000 participants in the study who attempted conception and childbirth, one in six encountered difficulties. Data analysis revealed that carbohydrates, fats and protein all affect chances of ovulation.

It was not the amount of carbohydrates but the quality that mattered: Women in the highest glycemic category were 92 percent more likely to have ovulation disorders than women in the lowest category.

Cholesterol, saturated fat and monounsaturated fat had little effect on fertility. The amount of trans fats in the diet, however, was directly correlated to a decline in fertility.¹

Protein consumption also affects fertility. Women in the highest-protein grouping were 41 percent more likely to report infertility due to ovulation disorders than those in the lowest-protein group. Again, the type of protein makes a difference. Study results linked high animal-protein consumption with ovulatory infertility, whereas high plant-protein consumption was associated with increased fertility.¹

Polycystic ovary syndrome
Although 4 percent to 10 percent of women are diagnosed with PCOS, they represent a fraction of the total incidence.⁶ Most women affected are not infertile, but the cysts can provoke hormonal imbalances, resulting in obesity, hypertension, insulin resistance, acne, hirsutism (excessive body or facial hair) and irregular or absent menstrual cycles that can make women unable to ovulate. The majority of women with PCOS have insulin resistance, and many of the symptoms of PCOS are caused by that resistance.7^,8 Genetic predisposition, obesity, environmental toxins, chronic inflammatory diseases and abnormalities in the hypothalamic-pituitary-gonadal axis (an endocrine system consisting of the hypothalamus, pituitary gland, gonads and their interactions) may cause PCOS.

Conventional treatments
The various hormonal imbalances, androgen-induced hair and skin changes, obesity, insulin resistance and infertility are treated with hormonal supplementation with estrogens and progesterones, anti-androgens, anti-obesity agents, insulin-altering drugs and fertility agents. Surgical interventions such as removing a section of ovarian tissue, removal of one or both ovaries and removal of the uterus are options of last resort.

Natural treatments

D-chiro-inositol. D-Pinitol (Inzitol), an enzyme commonly found in legumes, fruits, vegetables, whole grains and nuts, is converted by gut bacteria into D-chiro-inositol, which affects glucose metabolism in the human body. Because of its role in glucose metabolism, D-chiro-inositol may treat infertility caused by PCOS.9 In one study, 1,200 mg of D-chiro-inositol or a placebo were given once daily for six to eight weeks to 44 obese women with PCOS. Serum progesterone concentration was measured weekly to monitor ovulation. The 22 women treated with D-chiro-inositol demonstrated decreases in plasma insulin, serum-free testosterone, systolic and diastolic blood pressures, and plasma triglyceride concentrations. Nineteen of the 22 women in the treatment group ovulated, compared to only six of the 22 women in the placebo group. The researchers concluded that D-chiro-inositol increases the action of insulin in patients with PCOS and thus improves ovulatory function.10

Vitex agnus castus.
PCOS sufferers may also find hope for normal ovulation by taking vitex agnus castus, a preparation made from the chasteberry plant. In one study, 20 women with secondary amenorrhea (cessation of the menstrual cycle in women who previously menstruated) took a chasteberry extract for six months. Laboratory determination of progesterone, follicle-stimulating hormone (secreted by the pituitary gland to stimulate egg development) and luteinizing hormone (released by the pituitary gland to cause ovulation) serum levels, as well as standard pap smears, were carried out at the beginning of the study, at three months and at six months. Ten of the 15 women who completed the study experienced a return of regular menstrual cycles, with increased progesterone and LH levels. FSH values did not change for some or decreased slightly for others.¹¹

Diet and exercise.
Exercise and its attendant weight loss are also relevant treatments for PCOS because of its link to obesity and insulin resistance. A four-month study from Otago University in New Zealand involving 79 insulin-resistant female and male participants, ages 25 to 70, analyzed the effects of diet and exercise on insulin resistance. Participants were randomly assigned to one of three groups: modest level, intense level or control. The modest-level group was given a diet recommended by health authorities. This diet restricted cholesterol intake to less than 200 mg a day, increased fiber to over 25 g a day and included a preponderance of low-glycemic carbohydrates, fish, nuts, seeds, grains, pasta, rice, fruit, vegetables, legumes and low-fat dairy products. The participants were also required to exercise for 30 minutes five times a week, with no instruction as to the level of physical activity. The intense-level group was given a diet similar to the modest-level group, although their fiber intake was somewhat higher (at least 35 g a day) and the total fat intake was somewhat lower. In addition, the intense-level group was asked to exercise for at least 20 minutes five times a week at 80 percent to 90 percent of the maximum heart rate for their age. After four months, only the intense-level group had a significant reduction in insulin resistance (a 23 percent drop versus a 9 percent drop for the modest-level group) and an increase in aerobic fitness (11 percent versus 1 percent).¹²

A study conducted at the University of Adelaide in Australia showed that a six-month program of diet and exercise helped 18 overweight to obese, infertile women ages 22 to 39 with PCOS normalize their hormones. Participants achieved an 11 percent reduction in central fat, a 71 percent improvement in insulin sensitivity, a 33 percent decrease in serum insulin and a 39 percent reduction in LH levels.¹³

Male infertility
Low sperm counts and hypoactive sperm can result from many environmental factors, including viral upper-respiratory infections, increased stress, overuse of social drugs such as tobacco, alcohol and marijuana; overuse of pharmaceutical agents such as anti-hypertensives and anti-inflammatories; and free-radical damage to the sperm themselves.14^,15,16

Low sperm counts and altered sperm motility account for up to one-third of cases of infertility.³ Review of semen analyses demonstrates that the total sperm count in the general male population is deteriorating from an average count of 113 million per ml in 1940 to 66 million per ml in 1990.17

Conventional treatments
Intrauterine insemination with concentrated volumes of sperm and other forms of artificial insemination are conventional treatments for male infertility.

Natural treatments

Hormone avoidance. Therapeutic approaches include ensuring that the testes' environmental temperature remains below 96 degrees Fahrenheit, and avoiding dietary estrogens³ such as livestock and poultry hormones, especially those from dairy cows; and recycled estrogens excreted into the water supply by women using birth control pills.¹⁶ People can decrease their exposure to dietary estrogens and recycled estrogens by eating organic food and drinking bottled spring water.¹⁸

Antioxidants. Because the integrity and fluidity of the sperm cell membrane is significantly harmed by free radicals, antioxidants improve sperm performance. In one study, 30 infertile men were randomized to receive either 200 mg of vitamin C, 1,000 mg of vitamin C or a placebo daily. After one week, the high-dose subjects demonstrated a 140 percent increase in sperm count, while the 200 mg group had a 112 percent increase; the placebo subjects had no change.19 Dietary supplementation with vitamin E (100 mg, three times a day, for up to six months) is shown to decrease the level of lipid peroxide concentration in sperm pellet suspension, an experimental sperm form. This improved sperm motility and allowed 11 of 52 infertile men ages 27 to 52 to impregnate their spouses within two to six months into the treatment. None of the men in the placebo group impregnated their wives during the study period.20

In another study, 27 percent of men with sperm counts less than 20 million per ml were administered 1,000 mcg of vitamin B12 per day, increasing the total count to over 100 million per ml.²¹

The trace element zinc may be the most critical mineral for male sexual function; it plays a role in every aspect of male reproductive function.22 Infertile men with secondary to low sperm counts were given 60 mg of elemental zinc daily. In the 22 men with low testosterone levels, testosterone levels rose, and the mean sperm count increased from 8 million per ml to 20 million per ml. Nine of the 22 men in the low-testosterone group were able to impregnate their spouses after the zinc treatment, six of them within three months after beginning treatment. The men with normal testosterone levels showed no increase in testosterone after the treatment and no resultant pregnancies.23

Botanicals. Panax ginseng has long been employed as a male tonic. Although quality human studies are lacking, ginseng is shown to increase testicular growth, sperm formation, testosterone levels and mating behavior in bulls.²⁴

The bark of Pygeum africanum increases prostate gland secretions and levels of the essential enzyme alkaline phosphatase in infertile males;²⁵ it also improves erectile capacity in patients with benign prostatic hyperplasia (noncancerous enlargement of the prostate gland).26

Conclusion

The causes of infertility are as complex as the process of pregnancy itself. Appropriate nutrition, physical activity, D-Pinitol, vitex agnus castus and maintenance of a healthy weight are effective treatments for ovulatory dysfunction. Men should avoid elevated scrotal temperatures and consider supplementation with zinc and vitamins C, E and B12, as well as Panax ginseng and Pygeum africanum. In both genders, the best therapeutic approach appears to be multifaceted, including avoidance of environmental toxins, dietary enhancement and appropriate botanical assistance.

Bill Benda, M.D., is associate editor of The Journal of Alternative and Complementary Medicine and Integrative Medicine–A Clinician's Journal.

Natural Foods Merchandiser volume XXIX/number 12/p. 28,30