Fertility, Restoring or Inducing?

Paul Reller, L.Ac.

Infertility is an increasingly common problem in modern industrial societies, but most couples seeking infertility treatment are subfertile, with a decreased monthly possibility of pregnancy, not a true infertility. Overtreatment with harsh drug regimens and expensive fertilization techniques are becoming an increasing concern as fertility clinics are heavily promoted. In 2000, 1/6 of all marriages suffered infertility or subfertility, with approximately 60% due to female health dysfunction, and 40% due to male health dysfunction. About 1/3 of these couples had problems related to infertility or subfertility in both the man and the woman. The numbers continue to rise, prompting a great increase in fertility therapy in the United States. In 2002, the Centers for Disease Control (CDC) reported that at least 8% of women of reproductive age had sought treatment from a medical doctor for infertility or subfertility in their life. By 2007, a study in the Oxford Journals found that in more developed nations, this rate had risen to 16%. This statistic does not represent couples that sought medical care from Complementary Medicine, which is a rapidly expanding and popular form of therapy in fertility issues, nor does it represent couples who sought care from a medical doctor or clinical nursing specialist and wished to preserve confidentiality.

Problems with fertility function do not imply poor health or inadequacy, but are common health problems that need to be addressed with the most sensible health restoration of both the woman and the man. The basic choice when the possibility of fertility issues arises is whether to restore health and healthy reproductive function, or to use artificial methods to induce pregnancy. Hopefully, attention to your health will not be ignored even if you resort to the latter. Today, the most successful fertility clinics advise that the most sensible route to take is to patiently resolve health problems in the reproductive system first, even when ART, AI or IVF is chosen (assisted reproductive technology, artificial insemination or in vitro fertilization). Reproductive health may have an impact on the health of your baby as well as related health problems that may arise in the future for both the mother and the child. Restoring health to the reproductive system may also result in pregnancy without IVF, or may decrease the necessary cycles of attempted fertilization, saving a large amount of money and preventing the adverse health problems that come with the array of drugs, and the stress of the fertility process.

When a couple is trying to get pregnant, Complementary Medicine, especially acupuncture and herbal/nutrient medicine, can help with general improvement of physiological and hormonal health, stress reduction, and pertinent advice on fertility related issues such as clearing environmental chemicals from the body that may affect fertility, as well as low grade microbial infection that may impair ovarian health or cause problems with the fallopian tubes or uterus. Acupuncture and herbal medicine may also help address related health problems that are sometimes not apparent, or subclinical, such as polycystic ovarian syndrome, subclinical hypothyroid and hyperparathyroid disorder, metabolic syndrome, and endometriosis. These treatments, unlike the pharmaceutical protocols, come with no side effects and adverse health effects. This healthy and beneficial medical approach is relatively inexpensive and helps to insure the most healthy pregnancy and birth.

Despite the research and science devoted to this health problem, success rates with the various standard therapies to treat infertility are still poor. The IVF (In vitro fertilization) Registry in 1997 gave a 27.9% delivery rate per retrieval for IVF, with each subsequent implantation of ova having approximately 10% less chance than the previous implantation. They gave a 30% delivery rate for gamete intrafallopian transfer (GIFT), and a 28% rate for zygote intrafallopian transfer (ZIFT). The CDC was required to report success rates for all Assisted Reproductive Technology (ART) by law in 1992, because of the impression that women were being given that the technology had a high success rate. In 2007, data from 430 fertility clinics showed a 30.47% success rate for all ART, only slightly improved from 1997 (approximately one in five of these pregnancies resulted in multiple births, often triplets, which poses significant health risks for the children later in life). This data is available at http://www.cdc.gov/ART/. The CDC reports that women under the age of 35 have only a 30-35% succes rate with the first cycle, and women between the age of 35-40 have only a 20-25% success rate. The rates of success with each subsequent attempted cycle decrease. The average cost of the IVF is $12,000 now, as the clinics utilize more intensive and frequent testing and monitoring.

Most highly rated fertility clinics no longer perform IVF on women over 40 years of age due to the very low success rates. The CDC reports that women over the age of 40 have only a 6-10% chance of success with the first cycle of IVF. Drug induced pregnancy has a slightly higher success rate for targeted patients, but the harsh side effects cause a great number of women to stop the therapy. The number of women that do complete therapies with drugs such as clomid have nearly a 50% success rate largely because of the high number of women that have become alarmed by negative health effects and stopped the therapy. This drop-out rate tilts the rate of success. Complementary and Integrative Medicine, especially in the form of acupuncture combined with professional herbal and nutrient medicine, is proven to increase the rates of success if performed properly, and may reduce the need for allopathic overtreatment and help resolve some of the harmful effects of drug therapies. Even if these therapies have been tried and have failed, restoration of healthy reproductive function with Complementary Medicine may still produce a healthy pregnancy. Because assisted reproductive technology has failed, this does not mean that underlying health problems cannot by resolved and a normal healthy pregnancy finally achieved, and Complementary Medicine may help with this task.

A relatively short course of therapy with a knowledgeable Licensed Acupuncturist and herbalist is inexpensive and may save a lot of money and prevent a lot of stress when choosing to utilize assisted reproductive technology (ART) when trying to get pregnant. Acupuncture and herbal/nutrient medicine also offers an array of health benefits that may insure a healthier outcome, and decrease the side effects of the harsh drugs utilized in standard fertility protocols.

Acupuncture combined with herbal/nutrient medicine is now highly studied and shows a variety of ways that contribute to a healthy pregnancy, even when ART, such as IVF, is utilized. To take full advantage of the Complementary protocol, first go through a thorough testing process, then bring these test results to the Licensed Acupuncturist. Patiently resolving the standard problems, such as poor ovarian health or viability, hormonal imbalances in the menstrual cycle, and low grade microbial infections, may be very important. Acupuncture and herbal/nutrient medicine may also integrate to help clear polycystic ovary syndrome or thyroid problems. Pregnancy may occur as these problems resolve. Preparing the health of the ovaries, fallopian tubes and uterus before IVF or AI may be the key to success as well. Most of the failures with ART are not due to the technology itself, but to the problems with optimal health of the woman, which is very important in ART. Clearing of mild enodometriosis, restoring a health uterine lining, clearing inflammatory tissue problems in the fallopian tubes, and restoring ovaries to the best state of health may insure that the ART works and that less time and money is spent. Complementary Medicine provides a thorough restoration of reproductive homeostasis, not a targeted allopathic induction of pregnancy. Also, the side effects of ART are common, and may be addressed with Complementary Medicine as well.

Common Problems seen with ART (Assisted Reproductive Technology)

With women receiving Clomid to induce pregnancy, the rate of miscarriage when polycystic ovary syndrome (PCOS) is suspected or diagnosed is very high, nearly 50%, according to some experts. Conflicting studies have also reported high rates of miscarriage in the patients without PCOS, of 13-25%, but other studies have found that the patients using Clomid have miscarriage rates similar to the normal population. Miscarriage rates in the normal population, though, are about 5% after the first birth, and 10-20% of women with a first pregnancy are believed to miscarry before 20 weeks of pregnancy. Higher rates for women with PCOS indicate that both a problem with the ovarian health, and a hormonal imbalance that causes PCOS may be implicated. Hormonal balancing before attempting treatment with Clomid may increase the chances of a successful pregnancy immensely, and some resolution of PCOS and the underlying causes is also highly recommended before starting these fertility treatments.

The Complementary Medicine physician can help the patient to assess holistically individual hormone balance with active metabolite saliva and veinous blood stick tests and analysis, and provide a variety of treatments to optimally restore hormone balance. In some cases, this therapy alone results in a successful pregnancy. Many MDs specializing in fertility treatment are now adopting holistic hormone assessment and balancing into their practice. Resolution of insulin resistance, or metabolic syndrome, subclinical hypothyroid disorders, and correction of estrogen to progesterone ratios has become a more important subject in preparation for standard fertility treatment. In the book Perfect Hormone Balancing for Fertility by Dr. Robert Greene, a fertility expert, these problems with standard approach to artificial fertility treatments are explored. Dr. Greene states: “First, too many women are rushed into assisted reproductive technologies, often when it is not necessary. There can be an almost assembly line mentality...less than 15 percent of all couples with fertility problems need IVF to successfully have their own biological children, but many more are encouraged to pursue this high-tech avenue. Not only is it unnecessary, but it is often unsuccessful because the underlying hormonal imbalances have not been addressed.”

Many fertility clinics have now adopted Complementary Medicine as a healthier and more successful alternative to drugs and IVF, as well as a successful complement to standard induction of pregnancy. Medical doctors and clinical nursing specialists are increasingly turning to the science of restoration of fertility function, rather than the induction of pregnancy. With scientific study supporting the success of acupuncture, herbal and nutrient medicine, both as a treatment standing alone, and as an aid to increased success with IVF and various drug therapies, a new approach is emerging in the United States. This new scientific study and therapy has given the Licensed Acupuncturist more information to add to an already successful practice of restoring fertility function. While it is unrealistic to expect 100% successful outcomes in the acupuncture practice, success rates are high, and the benefits of improving healthy function in the body are a bonus to both the couple and the child.

Recent research at Oxford University Medical College has linked stress related biomarkers with problems conceiving (see study link below). It is surmised that many young couples may not have a true biological problem with fertility other than the stress related disorders that are common to the population. A short course of acupuncture and herbal medicine may resolve these metabolic stress issues, as well as address irregularities in the menstrual cycle that imply some hormonal imbalance, and increase the health of the ovaries and uterus. TCM may also address potential problems with the health of the male reproductive systems, improving sperm viability, prostatic fluids, and other aspects related to problems conceiving. See the article on stress on this website to gain a better understanding of this problem.

Preliminary treatment with a knowledgeable Licensed Acupuncturist may take care of problems that are not really addressed in standard fertility treatments, and may help achieve conception without the expense and risks associated with the standard therapies. Standard medicine does not consider infertility a diagnosis until a couple has seriously tried to get pregnant for at least one year, and consultation and treatment with a TCM physician can be utilized during this period. The Licensed Acupuncturist and herbalist should perhaps be the first step in the process of insuring fertility, conception, and a healthy baby. If a couple is resorting to assisted reproductive technology, the Licensed Acupuncturist can provide low cost Complementary and Integrative medical care that is proven to improve the chance of success. TCM physicians with experience may also help when needed with birth and labor, health in pregnancy, and post-partum issues. This treatment does not need to be extensive to be effective, and TCM has historically advised minimal treatment unless needed in pregnancy. The safety of this practice is reflected in the fact that most acupuncturists pay less than on thousand dollars per year in malpractice insurance, and European health authorities have declared it the safest medical practice in world history.

Many couples first try to restore fertility rather than to induce pregnancy, and the health benefits to this approach may even help to insure a more healthy pregnancy if ART or drugs are tried

One reason that more women are seeking treatment for infertility is the choice to have a first baby late in life, and this presents a number of health concerns. An assessment and restoration of healthy physiology with Complementary Medicine may be an important consideration for women over the age of 40 that are seeking fertility assistance. Success rates for standard fertility treatment decrease with the increasing duration of infertility, well below the 30% average. Risks of birth defects rises both with age and with ART treatment. The CDC and the National Birth Defects Prevention Study showed that infants conceived with ART are two to four times more likely to have certain types of birth defects than children conceived naturally. One major concern is the increasing number of triplets or higher multiparity we have seen over time in the United States, which the CDC attributes mainly to the rising use of ART. In 1997, about 43% of triplets were attributed to ART, and about 40% to ovulation-inducing drugs. There were 6,737 cases of triplets in 1997, and each year this number has risen, from 1,798 in 1989 to 6,737 in 1997. Estimates as high as 23,000 triplets in 2009 have been reported, although the official data has not been assembled. It is estimated that at least 5% of births involve multiparity, either twins or triplets, with clomiphene treatment, and some studies have estimated the incidence at 12.5%. These babies are at much greater risk of being preterm and low birthweight, and studies have attributed increased health risks in this subset of children. Studies conducted at Cambridge University found that preterm babies may be at high risk for developing asthma and eczema, and that the incidence of eczema for preterm triplets was 30%, compared to 19% in single birth preterm babies. These same health risks apply to twins as well, to a lesser degree. For these health reasons, and others, many women have chosen to first try to correct the causes of infertility with Complementary Medicine and have a natural childbirth. Many other women have chosen to risk the ART and drug-induced ovulation but to utilize Complementary Medicine to reduce health risks and side effects, as well as to increase the chances of success.

There are many possible reasons for female infertility and subfertility, and various studies have given different statistics concerning the general population. What is most important is not the average or statistically highest reason in the population, but the actual problem of the individual woman. The physicians and the patient must focus the diagnosis and customized treatment to fit the individual woman, and not treat this problem as if the woman was on an assembly line. Careful diagnosis is the first step, and since diagnosis in infertility is often difficult, the physicians must take their time and be sure that the most intelligent diagnosis is reached to properly guide the therapy. Deadlines should be reserved for the office, and when we are talking about a human life, nature and God, we should respect the timetable given to us and do what we can to support this miraculous natural process. If you are seeking safe and natural healthcare from Complementary Medicine, first try to get a thorough diagnosis from a thoughtful medical doctor who is a specialist in fertility, and who is not trying to rush you into an expensive procedure.

The possible causes of female infertility or subfertility may be one or a combination of the following: polycystic ovary syndrome (see a separate article on this website), tubal disease and endometriosis, hypothalamic and hormonal dysfunction, thickened ovarian capsule, essential fatty acid or other nutritional deficiency, reduced liver recycling of estrogens, and certain environmental toxins affecting fertility. You may refer to my articles on this website on hypothyroidism and endometriosis/ovarian cysts to learn more about how these problems may affect fertility and what can be done about them. Certain medications may cause infertility with chronic use, such as SSRI antidepressants, which may increase plasma cortisol and prolactin secretion. Environmental xenoestrogens may also cause excess prolactin release and disruption of follicle stimulating and luteinizing hormone metabolism (FHS and LH), secretion of which depends on a pulsatile release directed by the central nervous system and the hypothalamus. Leptin and insulin balance may also affect this necessary pulsatile release of LH. All of these common causes should be thoroughly examined and appropriate tests administered. Hormonal imbalances that may affect fertility are varied, involving estrogens, GnRH, luteinizing hormone, follicle stimulating hormone, leptin, insulin, testosterone, cortisol and thyroid hormones. Many of these hormonal imbalances present subclinical syndromes, meaning that there are no obvious clinical symptoms or signs. Instead of rushing into an expensive and invasive therapy, a smart patient makes sure that all diagnostic tests and evaluations are performed, so that the safest and surest fertility treatment is used. Because of the complexity of issues in fertility therapy, the patient needs to develop patience and take a step-by-step and day-by-day approach.

Allopathic fertility treatments utilize drugs that increase the gonadotropins FSH and LH, and HCG (human chorionic gonadotropin). Follicle stimulating hormone (FSH) drives the cycle of egg follicle development and maturation, and luteinizing hormone (LH) both drives the creation of the uterine lining (endometrium) as well as the final stage of egg follicle maturation and release. The whole process, though, depends on a complex quantum flow of hormones that change in a feedback mechanism that scientists today still do not fully understand. Just before the final maturation and release of the chosen mature egg follicle, or ovum, the human endocrine system goes through a complex arrray of hormonal changes. LH secretion occurs in stronger pulses of release from the pituitary gland in the brain, which stimulates a pulsatory rise in estradiol, while the FSH release declines significantly. A number of hormones go through significant rises and falls in secretion, including prolactin, testosterone and androstenedione. This results in one egg follicle within a group of viable egg follicles fully maturing and releasing, and another one forming the corpus luteum and growing with a dramatic rise in steroid hormones needed for the healthy growth of the uterine lining. When looking at this complex system of hormonal feedback and balance, we can realize that pregnancy is the result of an optimal and healthy hormonal balance, not just the induction of a single hormone. Restoration and optimization of this hormonal system creates a greater chance of success. A number of therapeutic steps may be taken to promote this optimal homeostatic mechanism. Standard medicine does not achieve this goal. Integrative and Complementary Medicine, on the other hand, has created a variety of protocols to integrate with standard medicine and achieve a healthier and more successful hormonal homeostasis.

Problems with male infertility should be considered as well as female, and the combination of factors that create the male and female combined infertility syndrome

The possiblities in male infertility or subfertility are also varied and complicated. Male sexual inadequacy is not the clinical reason for problems with fertility, and this notion must be put aside so that the man may feel comfortable discussing potential physiological problems related to the production of healthy sperm. If erectile dysfunction is a problem inhibiting timely fertilization, this is a separate health matter, but one that Complementary Medicine may also address, but when addressing the problems of male infertility and concurrent health problems with both the male and female, these are rarely the issues. Subfertility in various populations now exceeds 10%, and in some studies 40% of the males tested were diagnosed with some form of subfertility problem. Various problems create lowered sperm counts, decreased sperm motility, and problems with the quality of prostatic fluid. A number of common medications and drugs are proven to potentially impact male fertility. These include Tagamet (cimetadine), sulfasalazine (Azulfidine), nitrofurantoin (many brand names), steroid medications (e.g. prednisone or cortisone), and chemotherapy agents, as well as radiation. Tagament treats gastric problems such as acid regurgitation and heartburn, but also is prescribed for herpes zoster, warts, and tendinitis. Azulfidine is a sulfa drug prescribed to treat inflammatory bowel disease, arthritis, and other inflammatory diseases. Nitrofuorantoin is an antibiotic used to treat urinary tract infections. Steroids are common components of many drugs that treat chronic inflammation, pain, asthma, skin problems, and many other diseases and symptoms. Synthetic steroids may also be used as a sports or body building supplement. If a man is taking these drugs, or has taken them recently, this may be a cause of male subfertility or infertility, and discontinuing use may a an easy and inexpensive way to solve infertility problems.

More recent research at the Weill Cornell Medical Center found that antidepressant SSRI medications may affect sperm quality. This 2009 study, headed by Dr. Cigdem Tanrikut, found that SSRI medications appeared to contribute to fragmented DNA in sperm, which is correlated with poorer fertility outcomes, even when in vitro fertilization or other assisted fertility techniques are used. This appeared to occur because the movement of the sperm in the male reproductive tract was slowed, allowing for greater genetic fragmentation over time. The affects of SSRI medications have been well studied due to the high incidence of reports of impaired ability to ejaculate, and electrophysiologic studies have shown that the medications affect the pudendal nerve (Uchio et al; J Urol 1999:1983-86). The sperm volume, concentration, motility and morphology were not significantly changed by the SSRI therapy in this study, and the standard fertility tests would not detect a problem with sperm quality in this case. In another clinical trial, at the Montefiore Institute for Reproductive Medicine and Health in Hartsdale, New York, researchers found that SSRI medication appeared to also significantly effect the sperm motility. The rise in prescription of these medications, and others, may account for the increased incidence of male subfertility and overall fertility problems.

There are a variety of real issues that the man may address to improve chances of natural fertility. Male infertility may be caused by one or a combination of the following problems: deficient androgen production or regulation, alteration of GnRH release from the hypothalamus/hypophysis, problems with FSH receptors, and LH/hCG dysfunction. As we see, men and women may have similar problems hormonally, but the resolution of these problems may be quite different. Also, decreased potassium circulation, acidity of the prostatic fluid, environmental toxin accumulations, imbalances in zinc, which is an important component of prostate fluid, and various lifestyle concerns, such as long soaking in hot tubs, constricting underwear, cigarette smoking, and general issues of health, may also play a part. A thorough testing and analysis of sperm, prostate fluid, hormonal health, and body chemistry should be performed. Both prostate, or seminal fluid, and the sperm itself, may present problems inhibiting male fertility, and clearing of chronic prostate inflammation, neutralizing acidity, and correcting problems with seminal fluid citrates and calcium may be necessary to increase the chances of success. A comprehensive holistic approach will insure a greater chance of success with male fertility issues. No one wants to hear that the issue is so complex, but this is the reality.

With so many potential causes of male infertility or subfertility, it is difficult to assess and treat. Most likely, a combination of underlying causes acts in concert to promote subfertility in the male. While standard medicine still look for a single and clinical cause, this may not be effective in a majority of cases of male subfertility. A thorough holistic approach is necessary, and sometimes patience, sorely lacking in couples today that decide to have children. Immediate gratification and entitlement is the hallmark of our modern society, especially if the couple has money. Unfortunately, this may not be Nature's way. To assess male subfertility we need to start with the subjects that scientific research has found to be most prevalent. A program of avoidance of environmental chemicals that could contribute to subfertility, changes in diet when necessary, changes in lifestyle and habits, and also improvements in health and use of Complementary and Integrative Medicine to guide the use of herbs and nutrient medicines, perhaps enhanced with acupuncture, may all be combined in a very workable protocol. A knowledgeable Licensed Acupuncturist and herbalist can best individualize and guide this protocol.

Some health issues that affect male fertility are very prevalent in modern industrialized society. Subclinical hormone dysfunction is clearly linked, and many of the pertinent hormone dysfunctions mentioned above are linked to pituitary and hypothalamic disorders, as well as subclinical adrenal syndromes. In 2001, researchers (Arafah and Nasrallah) at Case Western University and Univerity Hospitals of Cleveland, Ohio, released a study of pituitary tumors that showed an incidence in the population of the United States estimated at 10% of the population (some studies showed up to 20% incidence). This was based on autopsy series, but a more recent review of MRI studies in otherwise healthy individuals confirmed this rate of incidence. The researchers found no clear record of the frequency of clinically diagnosed pituitary tumors, but found that the estimations of this diagnosis is much lower than the incidence in autopsy and MRI studies. Most of these tumors were found undiagnosed in otherwise healthy individuals, and a variety of 6 tumor types was found, each secreting different pituitary hormones, except for the Null-cell adenoma, which secreted no hormones, but accounted for only 5-10% of the tumors. Most of the tumors were either small or very small (microadenomas) and difficult to detect and diagnose. Pituitary tumors can mildly increase the amount of various hormones in the body that could adversely affect male fertility, as well as female. Signs of these hormonal excesses may be subtle. As stated, research acknowledges the role of Gonadatropin-releasing hormone (GnRH), luteinizing hormone (LH), and follicle-stimulating hormone (FSH) in the male as directly associated or causative of male subfertility or infertility, and many researchers also point to excesses of prolactin and thyroid stimulating hormone (TSH) as potentially involved. Small pituitary tumors may also affect the hypothalamus, which sits directly atop the pituitary, and is closely linked in tissue and function, in male subfertility, as well as adrenal function. The pituitary gland secretes the main hormones that stimulate hormonal release from the adrenals.

Another very prevalent problem seen in male subfertility is the viability of the sperm. Standard tests may only look at the sperm count and motility, and sometimes just the sperm count is tested, but the actual functional capacity of the sperm is a more important consideration. Only recently have scientists uncovered the complex way that sperm function in a drastically changed acidic environment. In 2010, researchers at the University of California in San Francisco discovered the perplexing manner in which sperm stay viable in the acidic male reproductive system, and then adapt to a much more alkaline female reproductive tract, and in fact trigger a drastic change in intercellulary acidity to become viable both in motility and the ability to enter and fertilize the egg. In fact, changes of acidity up to a hundred-fold may be necessary for the male sperm to become active and viable. The sperm cell has a proton pump to keep the acidity inside the cell high as sperm remain idle, and a protein triggered ion channel on the sperm cell membrane that rapidly pumps protons out of the sperm to activate and initiated viability in coordination with the female reproductive tract and eggs. It has long been noted that changes in zinc concentration and levels of cannabinoids (marijuana and endogenous) affect male fertility. This research clearly shows how zinc and cannabinoids may either decrease or increase the male fertility viability. To see a review of this research, click here: http://www.ucsf.edu/news/2010/. Testing for zinc deficiency, avoiding sources of inadvertent zinc excess, and changing the habits of marijuana use, as well as correcting problems with mood disorder that could stimulate excess endogenous cannibinoids or create deficiencies, may be simple and important aspects of a comprehensive male subfertility treatment protocol.

The increasing role of environmental and food chemicals in the rising incidence of male subfertility

In 1996, researchers at the University of Edinburgh, Great Britain, Reproductive Medicine Laboratories, and the Medical Research Council, Centre for Reproductive Biology, reported on a long term study of 500 men and changes in semen quality for men born between 1951 and 1973. The conclusion was that evidence clearly finds that male semen quality is deteriorating over time, and that the probable origin of the problem was exposure to xenoestrogens and other hormonally modulating synthetic chemicals in the food and environment in modern industrial society (British Medical Journal 1996 Feb 24: 312-467-71). This study confirmed meta-analysis of studies of about 15,000 men by Carlsen et al, examining research from 1973 to 1991. The response to this fact by the reproductive medical community in the United States was skepticism, and testing that still looks for more extreme problems with sperm viability, and continues to ignore the real problem of deteriorating sperm quality and the impact this may have on couples trying to conceive and having difficulty despite no significant medical conditions that should be interfering with the ability to conceive. There has been no significant call to regulate these xenoestrogens, xenoandrogens, and other hormonally modulating chemicals in food and industrial products, pesticides, insecticides or other pollutants. The individual males trying to have a child, though, may try to improve sperm quality with Complementary Medicine, and also voice an opinion to our government that this problem should be addressed for future generations of men.

Environmental chemicals may play an extensive role in both female and male infertility. Many chemicals have been created by modern industry that have proven hormonal effects, as xenoestrogens, xenoandrogens, estrogen mimics, and androgen mimics. The role of these many chemicals in hormonal health has been downplayed, as most do not exert strong direct estrogen and androgen effects, but research has uncovered many ways that indirect effects of these chemicals may affect fertility, and with the addition of more and more of these chemicals in the environment, the potential for an accumulative effect is now considered a real threat. Xenoestrogens, xenoandrogens and synthetic hormonal mimics may antagonize normal hormonal effects, disrupt synthesis and metabolism of normal hormones, and disrupt synthesis and metabolism of hormone receptors. Estrogen mimics may affect prolactin release (a hypothalamic/pituitary hormone). Hyperprolactinemia causes both female and male infertility, amenorrhea, erectile dysfunction, chronic fatique, and is linked to polycystic ovarian syndrome. Mild prolactin excess may inhibit pulsatile release of luteinizing and follicle stimulating hormones (LH and FSH), which not only control the ovarian cycle, but also the release of testosterone (via GnRH), affecting follicle stimulating hormone in a feedback mechanism, as well as sperm quality and count, viscosity of prostate ejaculate, and seminal vesicle secretion. These xenoestrogens and xenoandrogens may also affect calcium channels and indirectly create excess prolactin secretion this way as well.

While a single xenoestrogen or xenoandrogen, or other hormonal mimics in the environment may not exert a substantial effect, the accumulation of these chemicals is increasing each year, and cumulative effects are now recognized as a serious threat to fertility. The most well know of these chemicals are Bisphenol A in soft plastics and can linings, Organochlorines as byproducts of plastic and insecticide breakdown, dry cleaning chemicals, bleaching agents, etc., commercial phenolic antioxidants used in the electronics industry, plastic manufacture, petroleum product protectants (on car seats, mattresses etc.), and food preservatives (BHA and BHT), surfactants, insecticides (e.g. kepone), and pesticides (e.g. DDT). Soaps and cosmetics may contain these chemicals as alylphenol polyethoxylates, which may not directly affect you, but when degraded in waste water treatment and sewage may release estrogenic alkylphenols. Some organochlorines used as bleaching agents in feminine hygiene products, and sealants and composites used in dentistry, create more immediate effects. The actual list of these products is now so large that we hardly know where to turn to regulate this health threat. The individual couple may try to avoid these chemicals as much as possible, and also consider help with detoxification, utilizing Complementary Medicine to help stimulate appropriate metabolic channels of detox, and perhaps some soft tissue mobilization. An assessment can help you understand the various ways that Complementary Medicine may assist in rebalancing hormonal health as well. While no one likes to overcomplicate health problems, a serious examination and education of these complex issues allows a couple to take a more natural and holistic approach to fertility and health in general.

Standard medicine still takes a stubborn attitude towards the problems of sperm quality affected by xenoestrogens, xenoandrogens, and other hormonal modulating environmental chemicals, citing the fact that extreme individual variation is seen in sperm counts and ejaculate quality in standard testing, making this issue unclear. Testing for problems that are more nuanced are usually not conducted. The standard fertility experts concentrate on a number of problems that they see from research that are also confirmed variables in sperm count and quality. These include the role of overheating of the testicles with tight clothing and prolonged sitting at work, as well as habitual hot bath soaking, aging and natural deterioration of sperm quality, ejaculatory frequency affecting sperm quality, seasonal effects, a history of reproductive tract disorders, and Sertoli cell numbers. Some simple recommendations are given to try to resolve these factors when trying to have a baby, such as wearing loose cotton underwear and avoiding prolonged sitting, avoiding soaks at spas in hot water, and resolving issues of reproductive tract ill health. There is much more that the man can do to improve semen viability, though, in a healthy manner, utilizing Complementary Medicine. Sertoli cells are testicular cells responsible for maintaining semen health. Research has shown that the widespread problems seen with deficient numbers, and abnormal Sertoli cells, are associated with a number of biological markers, such as aromatase, anti-Mulleian hormone, abnormal genetic expression related to androgen receptors, and various antigens, that affect Sertoli cell maturation at various life stages. Standard medicine hypothesizes that this occurs in fetal development, but many researchers link environmental chemicals that affect hormones and hormone receptors to this problem. The pathophysiology of this is complex, but well documented. While simple recommendations to prospective fathers to avoid scrotal heating are perhaps helpful, one can do much more than this to promote viability of the male role in fertility.

Other potential environmental issues have also been uncovered in recent years. Studies in 2007 found that fluoride levels commonly seen in drinking water were found to be associated with reduction in sperm counts in laboratory animals, as well as sperm capacitation, and correlations have been found between water fluoride levels exceeding 3 parts per million and decreased birth rates in areas of the U.S. A review of this problem by the U.S. National Research Council found that “the relationship between fertility and fluoride requires additional study.” Fluroride accumulation has been found to be able to affect tissues in the brain and reduce melatonin production, and other hormonal relationships exist as fluoride, as well as bromides, are hologens that compete with iodine absorption, potentially causing thyroid problems, as well as poor antioxidant potential in various tissues, including the prostate. In January of 2011, the U.S. Department of Health and Human Services finally lowered the recommendations for ideal fluoride levels to 0.7 mg per liter in drinking water supplies, and the EPA is considering drastically reducing the maximum concentration allowed. This is in response to the health issues mentioned here, and are long overdue when looking at the research and concerns in the scientific community for decades. The last time regulated fluoride levels were lowered was in 1962, in response to similar research warnings. Today, most toothpaste is fluoridated, and fluoride is increasingly found in many commercial food products manufactured with heavily fluoridated water. Fluoride acid, or hydrofluorisilic acid, is a hazardous waste of the phosphate fertilizer industry that has been allowed to be barreled and sold for both water fluoridation and commercial manufacture. Fluoride byproducts in various forms are useful in various industries, and this is the reason why water fluoridation has been allowed despite the health hazards for decades. We've been told that people that are afraid of water fluoridation are just ‘health nuts’, and the public is unaware of the health hazards of fluoride that should have been reduced long ago. The Obama administration may be the first presidential administration that takes these issues seriously, and sides with public health over industrial lobbying. The couple that want to increase chances of fertility may want to avoid these sources of fluorides, and perhaps try to clear fluoride accumulations with detoxification regimens, antioxidants, and chelation.

Finally, the subject of flame retardant chemicals may also be an important consideration in the assessment of environmental chemicals that affect male fertility and may be avoided. A number of flame retardant chemicals have been proven to be carcinogenic, impairing of fertility in both male and female study subjects, and potentially damaging the functions of the central nervous system, and the only defense against these chemicals by the industry is that low dosage does not appear to present significant risk. This defense holds no weight over time, though, as these chemicals do not break down easily, and accumulation in both the environment and in human tissues has been demonstrated. Since these flame retardant bromines are lipophilic, they accumulate in fatty tissues, the source for many hormones in the body, affect the brain more extensively, and accumulate in breast tissues and affect nursing infants. PBDE flame retardants not only affect individuals exposed and nursing infants, but also the developing fetuses, where recent research has proven that they can diminish the future fertility of males. There is no coincidence between the rising use of these chemicals, their environmental accumulation, the lowering of male fertility in the population, and the large rise in assisted reproductive technology in standard medicine since 1997.

The chemical group PBDE (polybrominated diphenyl ethers), is a class of chemicals called organobromine compounds, consisting of 290 possible substances, that is similar to PCBs (polychlorinated biphenyls). PCBs have long been noted for their toxicity, accumulation in the environment, as well as human tissues, and their ablility to act as xenoestrogens enhancing breast cancer risks, as well as affecting fetal development and the health of the nursing infant. PCBs have been proven to alter fetal sexual development, stimulating hermaphroditism, and impairing future fertility in the male. PCB production was banned by the United States Congress in 1979 and by the Stockholm Convention on Persistent Organic Pollutants in 2001, and the industry that produced these chemicals was proven to be aware of their toxicity even before introducing the widespread industrial applications before 1930. Numerous studies proved toxicity, and a Harvard School of Public Health conference in 1937 outlined these toxicities, yet massive industry lobbying prevented the government from regulating these chemicals. In the same way, PCBEs have been allowed to be used as flame retardants, often for no logical reason, in a wide array of products, most of which do not need the addition of a chemical flame retardant. PBDEs are used in building materials, electronics, household furnishings, motor vehicles, airplanes, plastics, polyurethane foams, and textiles. Studies have proven that PCBEs reduce fertility in humans at levels found in households, and one study in Sweden (Meironyte et al 1999) found a 60-fold increase in PBDE levels in the breast milk of Swedish women from 1972 to 1997. A 2002 study in San Francisco also found alarming accumulation in breast tissue (She et al 2002), and numerous studies across the U.S. have found mounting accumulations in soil sediment, sewage sludge, plants and human tissues. The public can no longer ignore the threat of flame retardant PCBEs as an accumulative threat that exceeds the toxicity levels and impairs male fertility (see the link below to a 2005 study from the Charite University Medical School in Berlin, Germany, outlining the scientific proof of low-dose PCBE effects on male fertility and neurohormonal health).

A number of flame retardants have been found to be toxic at normal levels, accumulative in the environment, carcinogenic, and destructive of fertility, and have been voluntarily withdrawn from manufacture in the United States, while being banned outright in most other developed countries. An example of this action is found with Penta-BDE, a PBDE. This PBDE was voluntarily phased out of production in the U.S. in 2004, yet a study of infant products containing foam padding in 2010 found that 4 of 14 common products on the store shelves still contained Penta-BDE (see the New York Times article In Nursery, A Chemical Feared Toxic from the May 18, 2011, Busines Times). In one product randomly tested, the flame retardants represented 12 percent of the weight of the foam in an infant changing pad! The persistence of the industry to include these chemicals that potentially damage male fertility, as well as causing adverse health effects in fetuses, infants, nursing mothers, and the general population, is inexplicable, especially considering the lack of need for the flame-retardants in many products, and the ready availability of harmless flame retardant foams and other products. Today, the couple with fertility issues cannot ignore the possibility that these industrial toxins may be heavily contributing to the problems with subfertility and infertility, and that standard tests of fertility in clinics are not looking at this source of the problem.

Protocols to improve male fertility and viability of sperm

Avoiding environmental xenoestrogens, xenoandrogens, and other hormonally altering chemicals as much as possible is helpful, as well as trying to detoxify and clear these chemicals from the body (you may want to read my article on this website on detox). Studies (cited below) also show that utilizing antioxidants has been proven to improve problems with male subfertility. Since it takes about 30 days for your body to generate new sperm, there may be some time between avoiding environmental and food chemicals that impair sperm quality and count, and the time that your body may produce more viable sperm. Utilizing antioxidants, acupuncture, herbal medicine, and detoxifying or chelating therapies may help during this time. Improving the health and circulation of the reproductive tract is also a simple strategy. Changing sexual habits is important. Since it takes some time for sperm to mature and accumulate, avoiding ejaculation in the days before the optimal window of opportunity for conception is important. Working with the spouse to accurately chart this most opportune time is valuable. Since sperm counts are highest in the morning, timing the opportune sex and having sex upon waking, or during a leisurely morning, may help. Avoiding some lifestyle habits that may decrease sperm count may be helpful, such as decreasing cigarette use, alcohol consumption, and drug use, and avoiding processed and fast foods. Eating healthy will certainly help, and a high protein diet rich in fresh vegetables, whole grains, and healthy fats is advisable. Improving health and circulation with a little increase in daily exercise is helpful, although spending a lot of time bicycling, or on an exercise bike, should be avoided.

Other dietary considerations have not been sufficiently studied, but present enough concern to warrant caution. High fructose corn syrup is the sweetener additive of choice in the food industry, and may negatively impact male reproductive health. A key component of seminal fluid is fructose, and altered fructose may have a negative impact, or carry other potentially harmful chemicals to the seminal fluid. Studies have shown that high fructose corn syrup contains traces of mercury used in the processing, and such heavy metals may be found in toxic forms that are known to negatively impact male fertility. Studies have found an association between male obesity and sperm motility, and increased levels of fructose in seminal fluid associated with obesity. Levels of true corrected seminal fructose are highly associated with male infertility and are suggested as a potentially accurate marker for this health problem. The type of fructose in seminal fluid is called D-fructose, and the fructose in high fructose corn syrup is an altered fructose believed by many experts to be difficult for the body to break down and utilize. Essential fatty acid imbalances are thought to be able to negatively impact male fertility also, and if one is a red meat eater and consumes the standard array of simple carbohydrates in a typical diet, supplementation with omega-3 fatty acid supplements may benefit tremendously.

Stress reduction may also be very important, as both physiological and emotional stress may have a negative impact on reproductive health. An array of herbs and nutrient medicines have been found to promote improved sperm quality and count, ejaculate quality, and hormonal health. The Complementary Medicine phsician can guide this care individually, provide professional products, and increase the effects by providing acupuncture stimulation concurrently. Common herbal and nutrient aids include zinc supplement with isoflavones, L-carnitine, selenium, and a variety of antioxidants, as well as Maca, Vitex, and more specific Chinese herbs. Each individual is different in their needs, though, and a professional assessment and prescription is a better ticket for success.

The importance of thorough diagnostic testing to uncover the array of potential problems contributing to both female and male infertility

In both male and female infertility there is a tendency to perform fewer tests than is practicle. The cost of testing is not great, but insurance companies and medical clinics often want to cut costs unnecessarily. Since fertility issues are often complicated, thorough testing is warranted. The couple could start with standard minimal testing, but if the results do not give a clear diagnosis, insist on further testing. Bring these test results to the Licensed Acupuncturist to help guide the therapy. While the acupuncturist relies on pulse analysis and other signs and symptoms patterns more than the standard medical doctor, test results and analysis are a concrete and reliable aid to the often tricky diagnosis. Even though this is standard medicine, and TCM uses different protocol, modern diagnostic evidence is important and applicable to the practice of the Complementary Medicine physician, and helps integrate the care with other health professionals.

Making sure you really have a problem with infertility before pursuing expensive synthetic fertilization techniques that have potential health risks

It is important to remember that a diagnosis of infertility is not made until the couple has unsuccessfully tried to get pregnant for one year. The couple must be aware that there is a short window of opportunity each month for an ovum to be fertilized. This window of opportunity, after ovulation, is one to three days, and so careful calculation and testing each month to take advantage of this short time period for the viable egg is important. Also, sperm counts may decrease by as much as a third with repeated ejaculations, and most fertility clinics will recommend that the male abstain from ejaculation for at least 2 days prior to collecting samples for measurement of sperm counts. Abstaining from ejaculation, and timing the first attempt each month correctly, may be important for couples that suspect the possibility of problems with getting pregnant, especially with aging. If the sperm and egg are as healthy as possible, the sperm may survive 3 days to fertilize a viable ovum, but if there is some problem with either the health of sperm, or the egg and surrounding support tissues, this window of opportunity for fertilization may be only one day. There are kits and other aids to help you determine this time of fertility each month, and this calculation and planning may be vitally important to conception. If your menstruation is irregular, or a premenstrual syndrome is a problem, these may be problems that inhibit conception, and it is advisable to first correct these problem with acupuncture, herbs and nutritional supplements. Optimum hormonal health within the menstrual cycle may be very important. Sometimes, nature does not give us a baby immediately, and patience and persistence are needed. A couple has to realize that natural conception sometimes takes time, and you can't just buy a pregnancy if you want a natural birth. Receiving healthy treatment with Complementary and Integrative Medicine while trying to conceive naturally is inexpensive and helps increase the chances of success. These treatments with acupuncture, herbs and nutrient medicines may also alleviate other health problems, prevent health problems, and contribute to overall health and quality of life. The side effects of treatment from a Licensed Acupuncturist or Naturopathic Doctor are better overall health, not negatives like we see with standard pharmaceutical care.

Statistics show that a high percentage of couples that assume that they are infertile do have a child if they persist in trying for 3 years. When adding this to the statistics for fertility treatments, we see that perhaps many of the couples that have paid a large amount of money for treatment and took powerful drugs conceived a child because of persistence, and not because something was medically wrong. This would bring down the statistics of real success for ART further, which are about 30%, when couples who conceived merely because of persistence are factored in. Of course, there are no studies comparing these treatments to no treatment, which would emphasize the possible lower rate of success of ART and drug induced pregnancy. This is another reason to first try an inexpensive and healthier method to try to conceive a child. In addition, synthetic hormonal drugs utilized even in IVF create sometimes drastic hormonal changes and have side effects that could potentially inhibit the chance for a natural conception following the IVF or other artificial fertility therapies. Trying to conceive naturally before utilizing these artificial fertility treatments is the sensible choice if there is any desire to try for a natural conception. Drugs used in fertility treatment do also have some potential risk for the fetus, as well as potential contribution down the line for the woman receiving these drugs. To avoid all risk of contribution to future hormone related pathologies, a natural conception is desirable.

If a healthier diet and lifestyle, coupled with persistence, is the formula for success in natural conception for many couples, the Licensed Acupuncturist is ideal to help advise on these issues and provide medical care to improve overally health and healthy reproductive function. Added counseling, improvements in overall health, focus on potential problems and solutions, and decrease in stress, are all added benefits to the care of a Licensed Acupuncturist. Integrating this care with standard fertility assessment, and even fertility advice from clinics promoting natural conception and problem solving, provides for even more chance of success. The cost of this integrated care is usually a small fraction of the cost from standard fertility clinics.

Both modern research and a long history of TCM treatment guides the treatment strategies for a Licensed Acupuncturist and Certified Herbalist

As modern research uncovers new methods for fertility treatment, this same research may be utilized in Complementary Medicine to achieve success. Herbal chemistry is well studied and use of specific herbal chemicals may accomplish the same physiological actions as chemical pharmaceuticals. These are combined with formulas used successfully for centuries, as well as specific nutrient therapies. Each year the research data with herbal medicine and nutriceuticals grows exponentially. Strategies with acupuncture stimulation are well documented and success in acupuncture often depends upon the skill and experience of the acupuncturist. A number of studies have documented improved success with IVF when utilizing acupuncture. Use of herbs that act as phosphodiesterase inhibitors have also been studied with IVF and found to increase success. The successful Complementary Medicine physician is able to review these studies and separate unsubstantiated claims from scientific fact, applying this research to the specific case.

Treatment outcomes with Complementary Medicine may be relatively quick, or may take quite some time. If there are problems with the physiological production of ova or sperm, the successful outcome will occur many months after the correction of the bodily function. There is a 13 month cycle of ovary production, and restoration of healthy ovarian function and ova viability may occur with therapy but still this natural cycle must occur for pregnancy to be successful. The man also may need to wait for a natural period of time of sperm production after the therapy is successful. This is one reason that healthy treatment with Complementary Medicine should be considered early in the process of attempting to get pregnant. Of course, these scenarios depend on the diagnosis, and the acupuncturist will discuss these possibilities with each patient and schedule the therapy accordingly. Other fertility issues, such as hormonal irregularities and metabolic concerns, may resolve quickly and allow for immediate results.

Hormonal imbalances in Infertility, Pre-Menstrual Syndromes, Anovulation, and related health problems

A high percentage of women have hormonal imbalance, many despite leading a healthy lifestyle with few serious health problems. The most common symptoms are premenstrual symptoms, or PMS, which are typically caused by a relative deficiency of progesterone during the second half, or luteinizing phase of the menstrual cycle. This, of course, has direct consequences on the viability of ovulation. A more indirect hormone imbalance results when a woman experiences subclinical adrenal fatique syndrome or a subclinical hypothyroid syndrome. These conditions affect the adrenal pituitary axis in the endocrine system and may produce a deficient hypothalamic hormonal response, affecting the timely release of pituitary hormones that control the fertility cycle, such as LH and FSH (luteinizing and follicle stimulating hormones) and prolactin. All hormonal excesses and deficiencies are seen as relative excesses and deficiencies, with physiological effects relative to the levels of other hormones. Polycystic ovary syndrome is a common fertility problem that actually means that a syndrome of hormonal factors, including a relative excess of androgens, prolactin excess, insulin resistance, leptin resistance, improper conversion of hormones in local tissues, and a relative progesterone deficiency may be present. The ovarian cysts are not causing the problem, but are merely the manifestation of unseen hormonal imbalances. If one is looking for an easy and simple answer to explain hormonal problems affecting fertility, there is none.

The human hormonal system is a complex quantum feedback system that relies on maintenance of endocrine, or hormonal, homeostasis. Hormonal problems in cases of subfertility and infertility are often complicated and not easily addressed by targeting one hormonal aspect with allopathic drugs. Use of these hormonal drugs may further imbalance the endocrine system. Attempting to first restore hormonal balance, or endocrine homeostasis, with Complementary and Integrative Medicine, acupuncture, herbal and nutrient medicine, is the healthy and sensible approach with problems of subfertility and infertility.

The endocrine system, or release of hormones, is a complex system of feedback signals, and one problem with hormones may affect other horomonal functions. We now know that hormones act in a complex quantum manner, both systemically and locally, with one hormone stimulating other hormones that act to control and modulate its effects. Hormones also convert to other hormones in local tissues, and enzymes such as aromatase control the rates of conversion. Hormones stimulate hormone-like growth factors and inflammatory mediators that then act as hormone controls and stimulate other hormones in local tissues. Many hormones are thus implicated in fertility issues. Insulin resistance is another common hormonal imbalance that afflicts a high percentage of our population, and produces indirect effects on the hormone leptin, which is integral to regulation of fertility, as well as creating an indirect progesterone deficiency and affecting PPARG receptors (intercellular receptors that regulate cell inflammatory mechanisms, fatty acid storage and glucose metabolism). Leptin, a hormone associated with appetite and metabolism, also regulates the important pulsatile release patterns of luteinizing hormone that are integral to a healthy reproductive cycle. Insulin resistance is also integral to polycystic ovary syndrome in the majority of cases, which is one of the most prevalent causes of female subfertility and infertility.

These examples of hormone imbalance are highly studied, yet still difficult to understand. In fact, modern science still does not completely understand how the fluctuating mix of hormones in the reproductive cycle actually works. A healthy menstrual cycle is a good indication, though, that the hormonal balance may be optimal, and correction of problems within the menstrual cycle may be very important to the achievement of a natural pregnancy. What is important for the woman seeking fertility therapies is not a full understanding of complex hormonal physiology, but rather the implications presented by these conditions, and the trust that the various physicians helping her have a good working knowledge of these problems.

The book Leptin and Reproduction by Michael Henson and V. Daniel Castracane, outlines how this remarkable hormone has a key role in reproductive health. The hypothalamus is the neural command center for our hormones, and is linked intimately with parts of the brain that regulate mood and emotion, such as the limbic system. This is one explanation of how stress may inhibit fertility. The hypothalamus has long been noted as an important site in the regulation of body weight, and the hormone leptin was not seriously investigated until 1994, with a link in study to obesity and insulin resistance. Since this time, much research has revealed the relationship of leptin to much hormonal regulation in the body, affecting bone health, health of the breast tissues, insulin effects, and reproductive health. Changes in leptin biosynthesis during the menstrual cycle spurred research that showed in recent years how this hormone, and hypothalamic function is integral to the complex flux of hormones that need to be balanced in the menstrual homeostatic mechanisms for fertility and reproduction to be achieved. Leptin resistance, like insulin resistance, may develop unseen over time, and negatively impact follicular development and oocyte (egg) maturation.

While numerous studies now link obesity and infertility, the woman does not have to have overt signs of obesity for leptin resistance, and leptin dysregulation to affect fertility. Problems with leptin physiology are also found to affect male fertility. The researchers in this book found that leptin has equal potency in the male metabolism to affect hypothalamic control of LH releasing hormone to affect the balanced release of FHS and LH, which have an important role in sperm count and viability, as well as the quality of prostatic fluid and semen. These processes are controlled by the regulation of nitric oxide, a key molecule in vasodilation and blood pressure control, and chronic inflammatory regulation as well. These mechanisms exert much control of gonadotropin releasing hormone, and the subsequent regulation of gonadotropins which regulate the gonads, which of course produce male sperm and most of the testosterone in circulation. So a restoration of normal healthy hormonal homeostasis, optimization of hypothalamic and adrenal function, and a healthy leptin metabolism are important in fertility issues to both the man and the woman.

Leptin is closely associated with obesity and total amount of body fat in women more than men. A number of factors contribute to excess leptin production from fat cells. These include the adrenal hormones and catecholamines, the sexual steroid hormones, and certain inflammatory cytokines. Imbalance of diurnal cortisol, both excesses and deficiencies, have been shown to have a direct affect on leptin production. Relative deficiency of testosterone or other androgens, and relative excess of estrogen, specifically estradiol over progesterone, both are proven to be able to stimulate excess leptin production from the fat cells. Conversion of excess androgens to estrogen in fat cells, which occurs in polycystic ovary syndrome, stimulates excess leptin, and shows how complex the analysis of hormonal problems can be. Excess androgens can mean excess estrogens in specific tissues. Catecholamines, namely adrenaline, norepinephrine, and dopamine, have been shown to affect leptin production, and the diurnal mechanisms are intricately tied to levels of melatonin. Hormonal imbalances and diurnal cortisol levels should be assessed with saliva and veinous blood stick metabolites and necessary corrections of homeostasis achieved if these problems are a suspected contributor to infertility. Inflammatory cytokines have also been found in research to stimulate excess leptin production at the fat cells, and resolution of chronic inflammatory problems and inhibition of TNF-alpha and interleukin 1a may resolve contributing factors to leptin excess affecting fertility. The authors of Leptin and Reproduction state that the research reveals that leption plays a central role in the physiology of reproduction, mainly because the major funtion of leptin is to inform the central nervous system of the size of energy stores in the body, and the brain than modulates energy intake and expenditure appropriately for successful reproduction.

Restoration of hypothalamic function and metabolic mechanisms, decrease in inflammatory stress, and addressing aspects of suspected insulin resistance may play important roles in reproductive hormonal health for the female and the male. These problems may be addressed with Complementary Medicine. Standard medicine does not have the goals of restoration of health homeostatic mechanisms, but instead concentrates on more severe dysfunctions and their correction. This is where Integrative and Complementary Medicine come into play in modern medicine. Much research is now documenting how acupuncture, herbal chemicals, and nutrient medicines can achieve these goals with very specific guidelines of therapy.

Research into the role of leptin in the fertility cycle has revealed other important aspects of neurohormonal health that may also inhibit fertility. Leptin is a hormone that fluctuates during the day and night, with circadian rhythms that have normal peak values in the middle of the night. All aspects of circadian rhythm pertaining to hormones and the central nervous system (CNS) are partially controlled by the hormone neurotransmitter melatonin. Restoration of a healthy sleep cycle and quality, and normal melatonin metabolism may be integral to restoration of circadian cycles of leptin production and have an important effect on pulsatile release of the key fertility hormone LH (luteinizing hormone). The integral relationship between leptin and the CNS, especially the hypothalamus, also shows the intimate relationship of this hormone with prolactin production. Now prolactin is another key hormone that in the past was thought to only exert an appreciable effect on milk production in breast feeding (hence the name pro-lactin), but is now recognized as an important hormone in a number of physiological systems. Hyperprolactinemia, or excess prolactin release, is now a well known cause of a high percentage of infertility problems, as well as linked intimately with polycystic ovarian syndrome, a predominant cause of infertility in young otherwise healthy women. One does not need to have a severe hyperprolactinenia and drastic growth of ovarian cysts to have these problems. A large percentage of young healthy women are surprised when they receive the diagnosis at a fertility clinic that polycystic ovarian syndrome is probably the cause of their infertility. The growth of multiple cysts on the ovaries may come and go in this syndrome, and are driven by excess androgens and hormonal imbalance. Underlying problems of hormonal health may be both complex and elusive, but restoration of hormonal balance often will restore health in these circumstances. Complementary Medicine has much to offer with such restoration.

Chronic adrenal stress syndromes have also been implicated in lowered leptin levels within a circadian cycle of production. Beta-adrenergic stimulation has been shown in studies to lower circulating leptin levels. Chronic inflammatory states are also implicated in this neurohormonal dysfunction. Leptin acts as an inflammatory cytokine excreted from fat cells, and chronic inflammation has a direct role on both leptin and insulin dysfunction and receptor resistance. All of these factors may contribute to leptin deficiency, receptor resistance and excess leptin, or other problems with the metabolism. Since leptin is found to increase the luteinizing hormone releasing hormone (LHRH) via the hypothalamus and pituitary, leptin fluctuations may have a direct effect on luteinizing hormone and viability of the ovum, or egg, to be fertilized. The solution to these problems is neurohormonal restoration, resolution of chronic inflammation, improved hypothalamic function, resolution of adrenal stress, and correction of metabolic syndromes. A comprehensive treatment protocol will individually assess each patient and concentrate on the areas of greatest need and impact.

The most difficult problem for the couple unable to conceive, or the woman utilizing insemination or assisted reproductive technologies, is the determination of what is wrong, and how it can be fixed. Of course, everyone would like to have a simple, direct answer and treatment, but for many couples and individuals, there is no obvious reason for apparent infertility or subfertility. Even after tests are performed, the diagnosis may be one of exclusion, meaning that no test results clearly point to a problem, and so we can assume that the diagnosis is one that has not been excluded by test data. A majority of women with subfertility issues are faced with this type of unclear diagnosis. This is another reason to choose Complementary Medicine and a holistic approach, which seeks to restore the healthy function to the couple and is comprehensive in its approach. Holistic medicine, while focusing on an apparent fertility or subfertility problem, also works to correct any possible problem with hormonal homeostasis, or contributing health problems. The various reasons for infertility are all tied together, one problem caused by or causing another, and with holistic medicine, healthy function, or homeostasis, may be restored, thus restoring the ability to conceive.

Dietary and Lifestyle Recommendations in Fertility Therapy

A 2007 study by the Harvard School of Public Health found that a sixfold decrease in infertility risk occurred if at least 5 of 7 dietary factors were observed. These dietary regimens are: 1) avoid transfats and simple carbohydrates, such as refined sugars and flours; 2) eat a greater percentage of fresh vegetables as opposed to meat; 3) eat more whole grains to obtain fiber and usable iron; 4) eat more whole dairy products and avoid low-fat items in your diet; 5) consume more vitamins, preferrably from fresh vegetables and fruits; 6) achieve a better BMI index by reducing excess fatty weight if necessary; and 7) exercise more. These recommendations are proven and should be the basis for all fertility treatment.

Essential fatty acid imbalance or deficiency is a major factor in female infertility. Essential fatty acids (EFAs) are integral building blocks for antioxidant and inflammatory regulating chemicals in the body. Essential is a term meaning that they must be obtained from the diet. Our modern diet of dominance of red meat and refined foods has lead to an overabundance of arachidonic acid and subsequent problems. Following the above dietary recommendations from Harvard Medical School as well as consumption of healthy EFAs may be the most important basic ingredient to natural restoration of fertility physiology. It has been found that during the periovulatory phase of the menstrual cycle, enhanced activity of various antioxidant pathways are present in the normally fertile woman. An imbalance of essential fatty acids may inhibit this needed increase in antioxidant activity, and increased oxidative stress may negatively affect ovulation. Imbalances of hormonal stimulation combined with EFA deficiency or imbalance of the Omega-3 and Omega-6 fatty acids may be an explanation for many cases of infertility. Krill oil, a type of fish oil, is extremely high in the healthy EFAs, EPA and DHA, and contains a natural preservative to protect the fish oil from oxidative degeneration. This product is highly recommended in the fertility protocol. A diet high in antioxidants, and avoidance of excess omega-6 arachidonic acid, which comes with a diet high in meat and simple carbohydrates, explains why the Harvard public health study cited above reduces risk of infertility.

The book entitled The Fertility Diet, written by researchers at the Harvard School of Public Health, Drs. Chavarro and Willet, decribes how their research follow-up on findings of the long range Nurses Health Study found that ovulatory infertility may be due to excess poor quality meat fats and trans fats, refined carbohydrates, essential fatty acid imbalances, and chemicals in red meat, and that a dietary protocol with healthy vegetable fats, whole grain and plant proteins are proven to significantly guard against ovulatory infertility. These researchers conclude that full-fat dairy products appear to be good for fertility, while low-fat dairy products and sugared sodas contribute to the root problems of ovulatory infertility and hormonal imbalance. The Nurses Health Study revealed that adoption of 5 of 10 simple dietary strategies appeared to reduce the risk of ovulatory infertility by 80-90%. Considering the enormous cost and health risks associated with in vitro fertilization and other chemically induced pregnancies, recommendation of such a diet as a standard treatment protocol would seem a no-brainer, yet we still do not see a significant set of such guidelines suggested to the patient population.

How does acupuncture and TCM work in restoration of fertility?

This is the question that is most frequently heard from couples that are seeking consultation when deciding what treatments to utilize to help conceive. There is no simple answer to the question, and the question itself perhaps reflects skepticism about the science, which is only natural, considering the fact that standard medicine and medical doctors have told patients for many years that acupucture didn't work, despite overwhelming evidence to the contrary. The term acupuncture refers both to the treatment with trigger point stimulation and to the overall medical specialty, and the term “acupuncture” actually refers to the full array of herbal and nutrient medicine, with needle stimulation, dietary and lifestyle advice, and patient instruction and education. All of these modalities of treatment have been heavely researched and the effects verified objectively with scientific study, testing, and human clinical trials. Finally, acceptance of the science of acupuncture, and the knowledge that the Licensed Acupuncturist also is well trained in herbal science and nutritional medicine, is becoming generally accepted in the medical community and general population.

Much scientific study has been performed showing how acupuncture stimulation affects both the central nervous system and local tissue responses, including organ function. Specific research supporting acupuncture in fertility treatments has demonstrated how acupuncture stimulation increases production of endogenous opioid peptide neurotransmitters, such as endorphin, and that these chemicals are a key to healthy neuroendocrine function controlling the pulsatile release of leutinizing hormone. Acupuncture has both these specific types of effects, as well as overall balancing effects that greatly benefit systems like the hormonal, or neuroendocrine system. The acupuncturist also utilizes herbal and nutrient chemicals that are well studied and have been proven to affect pulsatile release of GnRH and LH when prescribed properly. Hormonal balance can be achieved with both herbal formulas and topical creams. The list of studied effects of herbs and nutrient chemicals useful in fertility treatment is a long list at this point in time. The knowledge of the physician himself in the practice of acupuncture is perhaps the most important fact.

Since the release of a number of studies showing that acupuncture increases the success rates of IVF by decreasing stress, many physicians and patients are focused on this aspect of treatment. The patient needs to understand what the term “stress” refers to scientifically, though, in relation to the positive effects on fertilization. The public generally thinks that the term stress refers only to an emotionally anxious state generated by worry or overwork. In actuality, the term stress applied physiologically in a scientific report refers to the decrease in biochemical and physiological stress parameters that may negatively affect optimum ability of the body, especially the organs, to function. In regards to fertility, decreasing stress may refer to resolution of oxidant stress, or a physical or chemical cause of disease or dysfunction. The positive effects of acupuncture are to improve physiological functions and reduce physical stress, or to improve homeostasis. Medical definitions of stress define it as the body’s response to environmental demands and pressures, which include excess immune stressors such as toxins, pathogens, and diseases, as well as social circumstances and overwork. Webster’s dictionary defines stress as “a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation.” The reference to acupuncture decreasing stress refers to more than just calming the patient. Hormones related to fertility that are affected by stress, mental and physical, include cortisol and prolactin. A 2009 study cited below shows how acupuncture performed concurrently with IVF treatments significantly modulated circulating cortisol and prolactin levels in a beneficial manner, which may explain some of the success with this strategy.

How do you utilize Complementary Medicine in the treatment of infertility? Acupuncture with herbal and nutrient therapy is not an alternative to standard care, or at odds with standard care. It is a safe and conservative method of treatment that you should try first, before resorting to expensive and possibly dangerous treatments. It is a medical science that is proven to increase the chances with IVF, and may prevent or reduce potential side effects. It will not interfere with your standard medical treatment, and has produced no harm in many years, in fact, thousands of years of practice. It is not a simple form of treatment, and in fact is more varied and complex than standard medicine in dealing with the wide variety of factors that could affect fertility. You need to spend the time for a thorough history and consult. Careful monitoring and adjustment of the therapy may be needed over time.

The couples seeking help with infertility and subfertility should not avoid allopathic fertility clinics. Standard medicine offers as its chief benefit the ability to test and diagnose. Thorough testing and diagnosis will help the Complementary and Integrative Medicine physician, or Licensed Acupuncturist, to apply more specific treatment protocols and enhance effectiveness. By utilizing a standard fertility clinic, the patient does not need to commit to harsh drug therapies or assisted reproductive technologies immediately. A responsible medical doctor will advise that you may try more conservative means first and see what happens. If this fails, acupuncture and herbal/nutrient medicine may also be utilized to increase the effectiveness of assisted reproductive technologies. Most fertility clinics today even offer some form of acupuncture and Compelmentary Medicine, although a specific practititioner in private practice may offer better overall knowledge and skills than those employed in the fertility clinic, as well as lower costs. Finally, if ART and drug therapies are utilized, acupuncture and TCM may be utilized to restore damage to the health created by these therapies.

When you and your health provider are on the same page you can expect to get great results. In complementary medicine you need to take a proactive approach to the therapeutic course and the adjustments in therapy that are needed. You need to gain an understanding and work with the Complementary Medicine physician to insure that lasting success is obtained. Some causes of infertility may be resolved quickly, while others, such as ovarian dysfunction, may need patience. If your ovaries are not producing viable eggs, and there are a number of reasons this may occur, not limited to the presence of polycystic ovarian syndrome, there may be a 13 month wait for the healthy egg production cycle once the ovarian function and health is restored with acupuncture and herbal medicine. In other cases, the results of treatment may be quick. In all cases a comprehensive assessment and individualized treatment protocol should address any possibility that could interfere with pregnancy. The end result of this comprehensive holistic care will be the assurance that you did everything possible to insure that your pregnancy is natural and that your baby is healthy, and that you avoided potential health problems with chemical fertility treatments as much as possible. You’ll be glad you did.

Countering side effects of ART with acupuncture and TCM

Clomiphene, or Clomid, is a common drug utilized in assisted reproductive technology which has prevalent side effects. Clomid acts by stimulating the hormonal axis to increase stimulation of the ovaries. Clinical trials performed by the manufacturing pharmaceutical showed that 13.6% of women experienced enlargement of the ovaries, that 10.4% experienced hot flashes, 5.5% experienced abdominal or pelvic pain, with bloat or swelling, 2.2% experienced nausea, vomiting or breast pain, 1.5% experienced headaches or abnormal menstrual bleeding, and less than 1.5% experienced dizziness, nervous tension, insomnia, vertigo, lightheadedness, fatique, depression, constipation or diarrhea. Clomiphene is considered a weak estrogen-like chemical. The exact mechanism of hormonal action is still unknown, but clomiphene strongly stimulates the ovaries. Most of the side effects are attributable to chemical effects rather than ovulatory effects. These side effects can be reduced with Complementary Medicine, acupuncture and herbal medicine, without affecting the stimulation of the ovaries or interfering with the effects of Clomid.

Information Resources

1. A 1998 article in the Oxford Journals reveals the success rates for standard fertility treatment, which has changed very little over the last decade. On overall success rate for intrauterine insemination with clomiphene and HMG ovarian stimulation was about 13%, with a miscarriage rate of 23.5%, and a multiple pregnancy rate of about 14%. The rates of success declined in women over age 40, and with those experiencing fertility problems for over 6 years: http://humrep.oxfordjournals.org/content/14/3/698.full
2. Stress has been linked positively to problems with fertility and conception, as this New York Times Health article shows in August 17, 2010. Simple stretegies such as acupuncture and herbal medicine can help resolve stress and increase your chances: http://www.nytimes.com/2010/08/17/health/research/17stress.html
3. The study that linked stress biomarkers with problems conceiving were conducted at Oxford University Medical College: http:/www.nih.gov/news/health/aug2010/nichd-11.htm
4. Many sound scientific studies now exist confirming the efficacy of acupuncture therapy in fertility protocol. The discouraging advice is now mostly anecdotal and obvious in its prejudice. Fertility clinics utilizing acupuncture, such as this one in Toronto, Ontario, provide links to an array of scientific studies: http://totalwellnesscentre.net/infertility_studies.html
5. A 2009 study at the Reproductive and Fertility Centers in Colorado Springs, Colorado, and published in Fertility and Sterility 2009 Dec;92(6):1870-9, found that there exists a beneficial regulation of cortisol and prolactin from acupuncture performed when receiving IVF, and that these benefits may explain the higher rates of success with concurrent IVF and acupuncture stimulation: http://www.ncbi.nlm.nih.gov/pubmed?term=acupuncture cortisol prolactin fertility
6. A 2010 study at the University of Pittsburgh found that women who received acupuncture achieved pregnancy with IVF at a rate fo 64.7%, compared to the group not receiving acupuncture, who achieve pregnancy at a rate of 42.5%. Examining the stress scores, the researchers stated: "The acupuncture regimen was associated with less stress before and after embryo transfer, and it possibly improved pregnancy rates": http://www.ncbi.nlm.nih.gov/pubmed/20621276
7. A 2010 study of published randomized controlled human trials utilizing Chinese herbal medicine (CHM) in the treatment of infertility in women with polycystic ovary syndrome found that evidence supported the addition of CHM to clomiphene treatment to improve outcomes of a successful pregnancy. No evidence of ill effects or contraindication were noted: http://www.ncbi.nlm.nih.gov/pubmed/20824862
8. This website from the University of Maryland gives a succinct description of the workup for male infertility that is standard: http://www.umm.edu/patiented/articles/what_causes_of_male_infertility_000067_4.htm
9. A 2003 study of environmental chemicals that possess androgenic or antiandrogenic activities via effects at androgen receptors found that 202 chemicals have been identified in industrial use and environmental pollution. http://www.ncbi.nlm.nih.gov/pubmed/14565775
10. A 2011 meta-analysis of studies of couples undergoing assisted reproduction techniques (ART) found that evidence suggests that antioxidant supplementation for subfertile males may significantly improve the rates of success for pregnancy: http://www.ncbi.nlm.nih.gov/pubmed/21249690
11. A 2010 study at the University of Kelaniya, Sri Lanka, found that sperm count, motility, and viability, and pH and viscosity of seminal fluid, was affected greatly by variations in seminal zinc: http://www.ncbi.nlm.nih.gov/pubmed/21234172
12. A 2008 study at King George's Medical University in Lucknow, India, found that treatment with the herb Mucuna pruriens increases sperm concentration and motility in various infertile and subfertile groups of men, and subsequent study found that the herb acted on the hypothalamic pituitary gonadal axis to improve steroid hormone profile as well to correct male infertility. This herb is dopaminergic, which accounts for its reputation as a aid to poor libido: http:/www.ncbi.nlm.nih.gov/pubmed/18001713
13. A 2002 study by the American Society for Reproductive Medicine published in Fertility and Sterility Vol 78(6);1187-1194, Dec 2002, found with randomized controlled studies that environmental xenoestrogens, such as biphenyls (e.g. PCBs) and phthalates, were highly associated with sperm and ejaculate quality. An unfortunate conclusion suggests that this problem in the environment is limited to fish eaters and vegetarians, showing the continued obstinate attitude toward this ubiquitous problem and misdirecting patients and doctors who may have concerns. http://www.fertstert.org/article/S0015-0282(02)04389-3/abstract
14. Studies citing the potential of fluoride to reduce sperm count and viability, as well as cause other hormonal problems, especially as a halogen competor with iodine, are seen here: http://www.fluoridealert.org/2007research/06.html /// or go to the main website to navigate: http://www.fluoridealert.org/
15. A 2005 study from Charite Medical University in Berlin, Germany, outlines the ways that normal accumulative amounts of PCBEs affect male fertility. This is another group of halogens, namely bromines, that like flouride, both reduces sperm counts and affects the health and development of the male reproductive system while also competing with iodine and contributing to iodine deficiency, subclinical hypothyroidism, poor neurohormonal health, and decreased antioxidant protections: http:/www.ncbi.nlm.nih.gov/pmc/articles/PMC1277857/
16. A number of studies on animals and humans has found that a variety of hormones are involved in the reproductive cycle. A 2000 study by the University of Michigan Reproductive Sciences Program found that the hormone leptin, previously thought to exert effects only on appetite and metabolism in conjunction with insulin hormone, is actually a key regulator of the pulsatile release of luteinizing and growth hormones that are integral to the success of the reproductive mechanism: http://endo.endojournals.org/cgi/content/abstract/141/11/3965
17. The syndrome called polycystic ovary syndrome (PCOS) now affects more than 10% of women of reproductive age, and some recent studies have noted this problem in ver 20% of some populations in industrialized countries. PCOS seems simple, an abnormal growth of cysts in the ovaries, but is a very complex hormonal imbalance with much variation, as this article explains. The cysts are actually egg follicles that have not matured due to hormonal imbalance: http://www.infertilityphysician.com/androgen/pcos.html
18. A meta-analysis of standard therapies for clearing of ovarian cyst tissue in uterine endometria, or endometriomas, in 2010, at the University of Amsterdam, Netherlands, found that no standard treatment protocol is proven effective to clear this common problem and improve reproductive outcomes. Acupuncture and TCM are effective in this regard, though, and underutilized: http://www.ncbi.nlm.nih.gov/pubmed/21069706
19. Scientific study in China in 1997 has proven that acupuncture exerts significant beneficial effects on the hypothalamus: http://www.wellspringintegrative.com/acup_pit.htm
20. Scientific study in 2007 at the Martinos Center for Biomedical Imaging at Massachusetts General Hospital proved with functional MRI imaging that acupuncture stimulation significantly affects the hypothalamus using human subjects: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1997288/
21. Studies in 2010 at the Chongqing Medical University in China found that electroacupuncture could significantly lower total cholesterol and triglyceride levels, acting in a similar fashion to the hypothalamic leptin stimulating effects noted with electroacupuncture. These effects were measure using just 2 points, ST40 and ST36: http://www.ncbi.nlm.nih.gov/pubmed/21090330
22. Studies in 2008 at the University of Gothenberg, Sweden, found that low frequency electroacupuncture on laboratory animals could resolve polycystic ovarian syndrome by its effects on insulin metabolism and adipose cells. Both electroacupuncture and mild exercise was shown to benefit leptin metabolism and reduce insulin resistance: http://www.ncbi.nlm.nih.gov/pubmed/18388196
23. Followup studies at the University of Gothenberg, Sweden, confirmed that 2Hz intense electroacupuncture could resolve polycystic ovarian syndrome by decreasing insulin resistance and improving adipose cell metabolism, creating improved balance between insulin and leptin, which drives a hypothalamic generated hyperprolactinemia responsible for polycystic ovarian syndrome: http://www.ncbi.nlm.nih.gov/pubmed/20663984

The information on this website is not intended to be used as a specific medical advice or cure. Please consult with the practitioner or an appropriate physician, such as a licensed acupuncturist, naturopath, or medical doctor, to discuss the proper application of the information contained on this website.