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The rate of infertility is increasing in the United States. It is
currently estimated that one in six American couples have
difficulty conceiving a child. Furthermore, the Centers for
Disease Control and Prevention (CDC) estimated that
approximately 7.3 million women, or 12 percent of women
between the ages of 15 and 44, have impaired fertility.
Data indicates that in infertility cases, 30 percent of cases are due to male causes, 30 percent are attributed to the female, and the remaining 40 percent of cases are due to both partners or undetermined causes.
Primary care physicians can play an active role in determining obvious causes of infertility. In women, these may include:
1. Problems attributed to ovulation, which account for 25 percent of all cases. This includes anovulatory cycles, amenorrhea, luteal phase defects, premature ovarian failure, elevated prolactin levels and aging.
2. Anatomical defects. This includes fallopian tube blockage and uterine masses such as fibromas, myomas and leiomyomas.
3. Polycystic ovary syndrome. This endocrine disorder affects approximately 6 to 10 percent of reproductive-age women.
4. Endometriosis. This condition is characterized by ectopic uterine tissue and adhesions, and is present in 30 to 45 percent of infertile women.
5. Numerous medications can impact fertility, such as hormones, antidepressants, antibiotics, pain relievers and nonsteroidal anti-inflammatory drugs (aspirin and ibuprofen taken at mid-cycle).
6. Non-gynecological systemic or inflammatory conditions such as diabetes, inflammatory bowel disease, celiac disease, epilepsy and thyroid conditions.
In males, common causes of infertility may include:
1. Impaired sperm production. Specific causes may include hormone dysfunction, infections or high fevers, metabolic abnormalities, varicocele or cryptorchidism (undescended testes).
2. Obstruction in the ducts, which can be due to inflammation, sexually transmitted infections, developmental disorders or retrograde ejaculation.
3. Systemic diseases or trauma, such as testicular cancer, testicular trauma, hemochromatosis and sickle-cell anemia.
4. Numerous medications, including those used to treat arthritis, cancer, hypertension and digestive disorders.
5. Recreational drugs.
Environmental and lifestyle factors can also adversely affect fertility. Environmental chemical exposures, although poorly studied in humans, have been linked to infertility in animals. Additionally, the increasing presence of estrogen-like compounds in the environment may play a role in the decrease in sperm count that has been occurring over the past 50 years. Furthermore, organochlorines have been associated with decreased sperm count and motility. Lifestyle factors such as excessive alcohol intake, smoking, marijuana and caffeine intake have also been shown to negatively impact fertility. In women, additional factors include excessive physical activity and substantial weight loss, which can lead to menstrual irregularities, amenorrhea or anovulation.
Adequate nutrition is also imperative for fertility. Nutrient deficiencies are increasingly common and have been associated with impaired fertility. Some of these include:
B vitamins: deficiency is associated with altered hormone levels; folic acid is required for optimal cervix health
Iron: deficiency may cause amenorrhea
Zinc: deficiency is linked to decreased testosterone levels, seminal volume, sperm counts and sperm motility in men
Vitamin C: deficiency is linked to increased spermatic DNA damage in men and combined with vitamin E, may prevent age-related reduction in ovulation rates in women
Vitamin E: deficiency is associated with lipid peroxidation in seminal plasma and spermatozoa, and reduced sperm motility
Selenium: deficiency is associated with decreased sperm motility
Arginine: supplementation of this amino acid has been shown to increase sperm counts and motility
Carnitine: supplementation with this amino acid has been shown to improve sperm count and motility
Several natural therapies have been shown to improve various aspects of fertility. Studies have shown that the botanicals Vitex agnus castus (Chasteberry), Panax ginseng (Asian ginseng) and Lepidium meyenii (Maca) may be efficacious in the treatment of suboptimal fertility. Vitex has been used in women with oligomenorrhea, polymenorrhea and corpus luteum insufficiency; study results found increased progesterone levels, normalized menstrual cycles in 64 percent of the women, and 29 percent of the women in the study became pregnant. Ginseng has been shown to increase sperm number and motility, and increase total and free testosterone, dihydrotestosterone, luteinizing hormone and follicle-stimulating hormone. Another study found that Maca increases seminal volume, sperm motility, sperm count and motile sperm numbers.
Several natural combination products provide the specific vitamins, minerals and herbal ingredients recommended for couples trying to conceive, such as FertilAid and FertileCM from Fairhaven Health. Additionally, stress reduction techniques may be beneficial for some couples. Yoga programs, such as Dr. Anna Davis’ Bend, Breathe, and Conceive DVD, have been developed specifically for women attempting to conceive. Furthermore, research has shown that adding acupuncture to conventional treatments for anovulation improved pregnancy rates.
Natural products and lifestyle modifications are inexpensive interventions that may help couples conceive. Additionally, these therapies have low risk compared with conventional medical interventions. Thus, natural interventions provide low-cost and low-risk therapies that may help some couples conceive.
Dr. Chris Meletis is a celebrated author and recent recipient of the Naturopathic Physician of the Year award by the American Association of Naturopathic Physicians. He is internationally recognized and has written more than 200 nationally published wellness articles.
He has previously served as the dean of naturopathic medicine and chief medical officer for the National College of Naturopathic Medicine, opening 16 clinics serving lower-income couples. Dr. Meletis has also consulted for and helped formulate products for Fairhaven Health, a specialty supplier of natural products for trying-to-conceive couples.
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