by: Jerry Gore, M.D. Esther Kaplan, Ph.D.

Many couples, struggling with a diagnosis of Infertility, have considered the option of Alternative, Integrative, Holistic or Complementary Medicine. These all mean the same and will be used interchangeably in this article. Many of the treatments that are included within Holistic Medicine have been standard medical care in other parts of the world for centuries, if not millennia. Recently they have found their way into standard Western Medicine as practiced in the United States. Scientific research on these therapies is currently underway, supported by the Office of Alternative Medicine which is part of the National Institute of Health. In fact, training in aspects of Integrative Medicine has become a part of the curriculum at prestigious Medical Schools such as Harvard. The most well known spokesman in he field, DR Andrew Wheil, now has a Residency Program in Integrative Medicine at the College of Medicine, University of Arizona in Tucson.

Couples pursuing these treatment options may seek the help of Medical Doctors who indicate a specialization in Alternative, Integrative, Holistic or Complimentary Medicine. There are also individuals who, though not Medical Doctors, and not licensed, have received extensive raining in a specific field included in Alternative Medicine such as homeopathy, Traditional Chinese Medicine or naturopathic Medicine. As with all health practitioners, it is important to ask questions so that you feel comfortable that this trained professional understands you problem and is qualified, i.e., fully trained, experienced and knowledgeable in offering treatment.

In the U.S. it is estimated that as many as 15% of all couples have difficulty conceiving. About 1/3 of the difficulty is due to men, 1/3 is due to both men and women, and 1/3 is due to women. We have tried to organize treatment information from a Holistic perspective. Some of the following information was taken from Murray and Pizzorono’s Encyclopedia of Natural Medicine. Other Sources include Nutritional Influences on Illness by Melvyn Werbach, and The Yoga of Herbs by Frawley and Lad. A list of references including these and other primary sources is found at the end of this article.

Lifestyle Considerations – For Men

Something is affecting sperm count and quality these days. How do we know? Statistics tell us that men now supply approximately 40% of sperm per ejaculate as compared to 1940s levels! Is there anything we can do in a natural way to improve this situation? Yes there is. Keep the scrotal sac cool. The temperature of the scrotal sac is higher in infertile men. As temperatures climb above 96 degrees, sperm production can be inhibited or stopped. Be careful to wear breathable and loose fitting underwear, preferably cotton boxer shorts. Avoid synthetic and tight fitting material. Jogging, and use of exercise equipment such as the treadmill, rowing, and cross-country machines may raise scrotal temperature. Avoid hot tubs and whirlpools.

Dietary considerations – for Men

1. Avoid Estrogen

Estrogen can have a negative effect on the development of the male reproductive tract, semen volume, and sperm count. Therefore, it is important to reduce or eliminate excess estrogen or estrogen-like chemicals in your body. Avoid all dairy products where cows have been fed hormones. The drop in sperm counts since the 1940s parallels a rise in the consumption of dairy products.

Chemicals, such as PCBs, dioxin, etc. are weakly estrogenic and degenerate very slowly, they “hang around” for years in our environment. Avoid the use of toxic substances such as fertilizers, cleaners. Also avoid all fatty animal products where chemicals may be stored up without being degraded. Try to eat foods that are not high on the food chain. Animals high on the food chain would be fish or mammals that have consumed many smaller animals that could be full of the wrong chemicals

A diet high in fiber (whole grain breads and pastas, fruits, vegetables) helps to remove these estrogens by preventing their reabsorbtion during digestion. Beans and peas (legumes) can also help, they are a great source of “isoflavones”, plant chemicals that act to block estrogen receptor sites and prevent the stronger estrogens from having an impact. Sources of isoflavones are also recommended for a cancer prevention diet because, by taking up residence on the estrogen receptor sites, they block the effects of the stronger estrogens that stimulate cell growth.

2. Avoid Heavy Metals

Sperm are affected by lead, cadmium, arsenic, and mercury. There are many sources of exposure to these heavy metals such as deep-sea fish, cigarette smoke, and water from old pipes. There is a simple test that can screen for these metals using a few hair clippings from the nape of the neck. If toxic levels of heavy metals are discovered, natural therapies consisting of supplements and a change of diet can be administered to help remove these minerals

3. Avoid Free Radicals

We have all heard that free radicals (the hungry and unstable oxygen in our bodies) can cause cancer, heart disease, and increase the aging process. Now we have discovered that free radicals can damage sperm via impaired motility and loss of viability. What causes free radicals?

Cigarette smoke

Sunlight

Unsaturated oils (corn oil may be the worst)

Heating oils to too high a temperature when cooking

Foods left out of the refrigerator (oxidation causes butter to turn a slight yellow and cut apples to turn brown)

What can be done? Avoid smoking or passive inhalation of any toxic fumes. Cover exposed skin when outside but allow the normal amount of sun on your face, hands, and in your eyes. Cook with olive oil, sesame oil, or clarified butter. They all are very stable when heated. Avoid use of hydrogenated oils, or unsaturated oils (read the labels on those chips, etc.) and supplement your diet with anti oxidant vitamins: beta carotene, Vitamin C, Vitamin E, and selenium.

Dietary considerations – for Women

1.Weight

Weighing too much or too little is associated with primary infertility in about 6% of women

2. Caffeine and Alcohol

Both can impair female fertility. Excessive alcohol causes prolactin to rise and too much or too little prolactin is associated with infertility. Caffeine causes a decrease in serum prolactin. Caffeinated soft drinks may also reduce the chance of conception.

3. Avoid Heavy Metals.

Just as with men, lead, cadmium, or mercury can impair fertility by affecting sex hormones. Testing and treatment is available (see #2 under Dietary Consideration for men)

Vitamins and Minerals-for Men

As with the anti oxidant vitamins beta-carotene, C, E and selenium, mentioned above, there is an important function for zinc, as it aids in sperm formation and motility. In one study, men who had been infertile for 5 years took a zinc supplement for 50 days. During the study, testosterone levels increased, and many of the wives became pregnant. Zinc is found in whole grains, pumpkin seeds, nuts, and legumes. Zinc supplements can be found in the form of lozenges and capsules taken with food. Other supplements that are recommended include vitamins B12, arginine, and carnitine.

Vitamins and Minerals – For Women

Deficiencies of folic acid, vitamin B12, or iron may contribute to infertility in women. In one study (lacking a placebo controlled group), 14 women, ages 23 to 31, had PMS and had been infertile for 18 months to 7 years. They were given vitamin B6 for 6 months for relief of their PMS symptoms, and 12 of the 14, 86%, were able to conceive.

Botanicals

Plants from all over the world are often used successfully as medicines to help with a wide assortment of health problems. From China, we have Panax ginseng, which has a long history of use as a “male tonic.” Pygeum africanum, a plant commonly used to treat benign prostatic hypertrophy, will help when low prostatic secretion plays a role in infertility. Chayavan Prash, an herbal from India containing pepper, cloves, cinnamon, cardamom and other ingredients is commonly used as a general tonic and for male sexual debility. Shatavari (asparagus racemosus) translated as “who possess a hundred husbands” is considered to be the main ayurvedic rejuvenative for women. It is said to nourish and cleanse the female reproductive organs as well as supply female hormones. Chasteberry (vitex) is a Mediterranean plant that works by stimulating the body’s natural production of progesterone and normalizing the balance between estrogen and progesterone. In one study, 48 women diagnosed with infertility between the ages of 23 and 39 were given 40 drops of Chasteberry once a day for 3 months. During the study, 25 women normalized their progesterone levels and 7 women became pregnant.

Energy Medicine

1. Homeopathy

Homeopathic remedies are natural medicines made from plants, minerals, and animal tissues. The plant, etc., is diluted in its preparation so that there may be little or no plant material left in the remedy. Therefore, the remedy represents the “energy” of the plant and side effects are few to none. Remedies are administered with tiny pellets on the tongue and can be given to the individual based upon their symptoms (infertility, miscarriage) or upon a person’s constitution (size, personality, habits etc.). Some examples for men would include, Thuja (arbor vita) for a history of a sexually transmitted disease and Lycopodium (club moss) for impotence. For women some examples are: Caulophyllum (blue cohosh) for lack of uterine tone i.e., the uterus cannot hold the baby resulting in chronic miscarriages in the early months), Calcaria Carbonica (carbonate of lime) for women who are overworked full of worries, anxious, and suffer from PMS, swelling, cramps, and chills, Natrum Mur (chloride of sodium) for dryness, genital herpes, amenorrhea, and physical problems which are caused by emotional difficulties, and Ovarian Tissue Salt (ovarian animal tissue prepared as a dilute remedy) which acts as a tonic for ovarian function and helps to regularize the menstrual cycle.

2. Flower Essences

The flowers of plants may be prepared in a similar way to homeopathic remedies so that the “essence” of the plant is harnessed in a medicinal way. An example is Pomegranate. Its use is described as a treatment for imbalance, i.e., women who are “ambivalent or confused about the focus of feminine creativity, home or career, creative or procreative, those who attempt to balance both possibilities may feel drained and the psychological tension may be profound resulting in physical illness especially in the female organs.” This flower essence helps to promote an awareness of the feminine self in such a way that a woman can see “her right destiny and choices”. (Kaminski, Flower Essence Repertor

3. Traditional Chinese Medicine

Acupuncture and Chinese herbs have been used for thousands of years to treat the entire range of gynecological problems including infertility. These work by helping energy to flow through their proper channels (meridians) that brings balance and harmony to the organs that use this energy. For example, the kidney energy flowing through its meridian affects the lower part of the body including reproduction. By strengthening the kidney energy and by bringing balance to this organ, a woman is more likely to become pregnant. An example involves a 41-year-old woman who had had three pregnancies. One resulted in a stillborn; one in a baby born deformed that died shortly after birth, and one in a miscarriage. The woman began acupuncture about a month before becoming pregnant for the fourth time; she received acupuncture treatments twice a week during the first trimester and weekly during the rest of her pregnancy. She did not take any medications during her pregnancy and, thankfully, gave birth to a healthy baby boy.

In Traditional Chinese Medicine other factors that are believed to be related to infertility include overwork or exposure to cold and damp while menstruating, as well as diets that include cold food and drink, greasy food, and excess dairy.

Stress Reduction/Relaxation Therapies

1. Emotions and Infertility The relationship between stress and infertility is well documented, and, as Dr V. Jane Kattapong has noted, “each may fuel the other.” She describes a possible mechanism of action in which strong emotions such as anxiety or depression may result in elevated levels of prolactin which “may be associated with low secretory-phase progesterone concentrations and early luteal regression.” Alice Domar, Ph.D. has found that women diagnosed with infertility experience levels of anxiety and depression similar to women diagnosed with life threatening illnesses such as Cancer, heart disease or HIV positive status. Her Mind/Body Program for Infertility at New England Deaconess Hospital has demonstrated success in several areas. She reports that women participating in her program experienced significant decreases in levels of anxiety, depression and fatigue. In addition, her most recent research indicates a 45% pregnancy rate among women who have completed her Mind/Body Program as compared with an 8% pregnancy rate among matched control subjects. While we are waiting for these results to be confirmed by additional research, it does appear that this kind of program may contain the answer for some couples.

2. The Relaxation Response

DR Domar’s program, affiliated with Harvard Medical School, includes 10 weekly meetings during which participants learn different stress reduction techniques as well as receiving information on nutrition and other topics within a supportive group context. However, people can learn and master stress reduction techniques on their own and have been doing so for thousands of years. The basis of all forms of Stress Reduction is the creation of an internal experience. Harvard’s DR Herbert Benson has named this the Relaxation Response and has correlated it with physiological indicators such as reduction in heart rate, blood pressure and muscular tension. Individuals who have had this experience describe the sensations as feeling “calm”, “centered”, and “whole”.

3. Stress Reduction Techniques

The key to all methods of stress reduction is to be wholly and completely present in the experience without having your mind racing about, focused on plans for the future, or misgivings about the past. Some people find that regular prayer or walking in a quiet natural setting creates that sense of peacefulness. Others get involved in artistic or creative activities in order to accomplish feelings of calm and timelessness. DR Domar’s program includes training in meditation, yoga, body awareness and diaphragmatic breathing. Descriptions can be found in her book, Healing Mind, Healthy Woman. Another Psychologist who has worked in the field of infertility, Aline Zolbrod, Ph.D., in her book, Men, Women and Infertility, describes the stress reduction techniques including imagery that she uses in treatment. Other procedures useful in invoking the Relaxation Response include Autogenics, Progressive Muscle Relaxation, and Biofeedback. Books written with the intention of introducing stress reduction and relaxation techniques to a general audience include Jon Kabat-Zinn’s Full Catastrophe Living, Joan Borysenko’s Minding the Body, Mending the Mind, and Herb Benson’s The Relaxation Response.

4. Practicing Stress Reduction

The objective, as you explore these techniques, is to find the one that works for you. For best results you would make a commitment to practice the technique 20-40 minutes each day; but, when life gets hectic, just do the best you can. Even 5 minutes a day is enough to begin the habit of relaxation that you will enjoy for the rest of your life. If, after a week or two, you do not experience a sense of calm or stillness for at least part of the time during your practice, try another technique. Experience has shown that ‘everything works for someone, but nothing works for everyone.’ Your goal is to keep experimenting until you find the technique that works for you and then make that a part of your life.

5. Diaphragmatic Breathing Exercise

One of the simplest and most basic of all relaxation techniques is Diaphragmatic Breathing. It requires no special equipment and can be practiced anywhere, even in a crowded office, without calling undue attention to yourself. The diaphragm is the muscle that separates your lungs from the organs in your abdomen. If you are breathing diaphragmatically, your belly/diaphragm enlarges, inflates, as you breathe in and deflates as you breathe out. If you are having difficulty determining whether you are breathing diaphragmatically, lie on your back, on the floor, with a medium sized hard cover book balanced on your midsection. If you are breathing diaphragmatically, you will see the book rising as you inhale and falling as you exhale. Once you know what it feels like to breathe diaphragmatically, practice this for 15-20 minutes each day. Practice diaphragmatic breathing lying on the floor or sitting in a chair, back straight but not stiff, hands in your lap or resting on the arms of the chair, eyes closed or focused softly at a spot 18″-24″ in front of you. As you breathe, you can focus your attention on the sensation in your belly as it inflates with the inhalation and deflates with the exhalation. You may experiment with thinking of a word or phrase during each out breath, such as “one”, or “peace”, or a religious word/phrase. Do not struggle with intrusive thoughts, notice them, then let them drift away. After you have finished your practice, notice how your body feels. Realize that you have, within your own power, the ability to create this sensation whenever you need it.

Summary

Many couples are struggling with a diagnosis of Infertility. Holistic Medicine can provide options and possibilities for treatment that some have been searching for. We have stressed the importance of carefully choosing an experienced and qualified practitioner in the field. We have attempted, in this article, to review some of the options available to you including; changes in lifestyle and diet, use of vitamins and minerals, and introduced the reader to the fields of herbal medicine, homeopathic medicine, flower essences, Traditional Chinese Medicine, and stress reduction/relaxation techniques. We look forward to answering any questions that you may have or providing you with other assistance in your search for options.

Esther Kaplan, Ph.D. is a Clinical Psychologist. Her specialties include Women’s Wellness and Holistic Health Psychology. She has a private practice in Evanston and in Elmhurst, Illinois, where she provides both Individual and Couple’s Therapy as well as training in Stress Reduction and Relaxation.

Jerry Gore, M.D., is the Director of the Center for Holistic Medicine, 240 Saunders Road in Riverwoods/Deerfield, Illinois (847/236 1701). The center provides Holistic General Medicine that includes treatment by M.D.s, as well as by specialists trained in Nutrition, Acupuncture, Chiropractic, Homeopathy, Massage, Yoga, and Feldenkrais. Counseling, classes, lectures, and training are also available. For additional information, please call (847) 236-1701

References

Benson, H. (1975). The Relaxation Response. New York: William Morrow.

Borysenko, J. (1987). Minding the Body, Mending the Mind. Reading, MA Addison-Wesley Publishing Company, Inc.

Domar, A., Clapp, D., Slawsby, E., Dusex, J., Kessel, B., & Freizinger, M. (2000). Impact of group psychological interventions on pregnancy rates in infertile women. Fertility and Sterility, 73, 805-811.

Domar, A., Seibel, M., & Benson, H. (1990). The Mind/Body Program for Infertility: a new behavioral treatment approach for women with infertility. Fertility and Sterility, 53, 246-249.

Frawley, D., Lad, V. (1986). The Yoga of Herbs. Santa Fe, NM: Lotus Press.

Kabat-Zinn, J. (1994). Full Catastrophe Living: Using the Wisdom of your Body and Mind to Face Stress, Pain, and Illness. New York: Delacorte.

Kaminski, P., & Katz, R. (1994) Flower Essence Repertory. Nevada City, CA: Flower Essence Society

Kattapong, VJ.(2000). Mind-body medicine as treatment for female infertility. Alternative Medicine Alert, 79-82.

Murray, M., & Pizzorono, J. (1998). Encyclopedia of Natural Medicine. Prima House.

Werbach, M. (1993). Nutritional Influences on Illness. Tarzana, CA:Third Line Press.

Zoldbrod, A. (1993) Men, Women, and Infertility: Intervention and Treatment Strategies. New York: Maxwell Macmillan International.