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Female Infertility

Infertility is defined by doctors as the failure to become pregnant after a year of unprotected intercourse. It can be caused by sex-hormone abnormalities, low thyroid function, endometriosis, scarring of the tubes connecting the ovaries with the uterus, or a host of other factors. Some of the causes of infertility readily respond to natural medicine, while others do not. The specific cause of infertility should always be diagnosed by a physician before considering possible solutions.

Checklist for Female Infertility

Rating Nutritional Supplements Herbs
2Stars   Vitex
1Star Arginine (for in vitro fertilization)
Iron (for deficiency)
Multivitamin-mineral
PABA
Vitamin E		  
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of infertility? For most infertile women, no symptoms accompany the infertility. Some women with symptoms of obesity, acne, and excessive facial hair; heavy, irregular, or absent menstrual periods; or fluid leaking from the breasts could have hormone imbalances that might interfere with fertility.

How is it treated? Fertility drugs such as clomiphene (Clomid®, Serophene®), gonadorelin (Factrel®, Lutrepulse®), human chorionic gonadotropin or “hCG” (A.P.L.®, Fullutein®, Humegon®, Pregnyl®, Profasi®), and human menopausal gonadotropins or “hMG” (Metrodin®, Pergonal®, Repronal®) are commonly prescribed. Artificial insemination can also be used to place sperm directly in the cervix or uterus. Another more advanced procedure is called “in vitro fertilization,” wherein the egg (collected from the ovary in a surgical procedure) and the sperm are combined under controlled conditions in a laboratory. The fertilized embryo is then implanted into the woman’s uterus.

Dietary changes that may be helpful: Consumption of one to one and a half cups of coffee per day in one study1 and about three2 or four3 cups per day in other studies has been associated with delayed conception in women trying to get pregnant. Caffeine consumption equivalent to more than two cups of coffee per day has been associated with an increased incidence of infertility due to tubal disease or endometriosis.4 In another study, women who consumed more than one cup of coffee per day had a 50% reduction in fertility, compared with women who drank less coffee.5

Caffeine is found in regular coffee, black tea, green tea, some soft drinks, chocolate, cocoa, and many over-the-counter pharmaceuticals. While not every study finds that caffeine reduces female fertility,6 many doctors recommend that women trying to get pregnant avoid caffeine.

In one study, consumption of three cups of decaffeinated coffee per day was associated with an increased risk of spontaneous abortion.7 In another study, caffeine consumption compounded the negative effects of alcohol consumption on female fertility.8 Some researchers suspect that the tannic acid found in any kind of coffee and black tea may contribute to infertility.9

Consumption of fish contaminated with polychlorinated biphenyls (PCBs) may reduce the ability of women to conceive. In one study, women who ate more than one fish meal per month of fish caught in Lake Ontario (known to be contaminated with PCBs) had reduced fecundity (meaning that it took longer for them to become pregnant) compared to women who ate less contaminated fish.10

Lifestyle changes that may be helpful: The more women smoke, the less likely they are to conceive.11 In fact, women whose mothers smoked during their pregnancy are less likely to conceive compared with those whose mothers were nonsmokers.12 Quitting smoking may enhance fertility.

Even moderate drinking of alcoholic beverages by women is linked to an increased risk of infertility in some,13 although not all, research.14 In a preliminary study, there was a greater than 50% reduction in the probability of conception in a menstrual cycle during which participants consumed alcohol. Caffeine appeared to enhance alcohol’s negative effect in this study. Women who abstained from alcohol and consumed less than one cup of coffee per day were more than twice as likely to conceive (26.9 pregnancies per 100 menstrual cycles) compared with those who consumed any amount of alcohol and more than one cup of coffee per day (10.5 pregnancies per 100 menstrual cycles).15 Based on this preliminary evidence, women who wish to improve their chances of conception should avoid alcohol and caffeine.

Being excessively overweight or underweight may also contribute to infertility in females.16 Infertile women who are overweight or underweight should consult a physician.

Some conventional medications can interfere with fertility. When in doubt, women taking prescription drugs should consult their physician or pharmacist.

Nutritional supplements that may be helpful: A double-blind trial found that taking a multivitamin-mineral supplement increased female fertility.17

Vitamin E deficiency in animals leads to infertility.18 In a preliminary human trial, infertile couples given vitamin E (200 IU per day for the female and 100 IU per day for the male) showed a significant increase in fertility.19

In preliminary research, even a subtle deficiency of iron has been tentatively linked to infertility.20 Women who are infertile should consult a doctor to rule out the possibility of iron deficiency.

Some previously infertile women have become pregnant after supplementing with PABA (para-aminobenzoic acid), 100 mg four times per day.21 PABA is believed to increase the ability of estrogen to facilitate fertility.

Supplementation with the amino acid, L-arginine (16 grams per day), has been shown to improve fertilization rates in women with a previous history of failed attempts at in vitro (test tube) fertilization.22

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may he helpful: Vitex is occasionally used as an herbal treatment for infertility—particularly in cases with established luteal phase defect (shortened second half of the menstrual cycle) and high levels of the hormone, prolactin. In one trial, 48 women (ages 23 to 39) who were diagnosed with infertility took vitex once daily for three months.23 Seven women became pregnant during the trial, and 25 women experienced normalized progesterone levels—which may increase the chances for pregnancy. In another double-blind trial, significantly more infertile women became pregnant after taking a product whose main ingredient is vitex (the other ingredients were homeopathic preparations) than did those who took a placebo.24 The amount used in this trial was 30 drops of fluid extract twice a day, for a total of 1.8 ml per day. This specific preparation is not available in the United States. Some doctors recommend taking 40 drops of a liquid extract of vitex each morning with water. Approximately 35–40 mg of encapsulated powdered vitex (one capsule taken in the morning) provides a similar amount. Vitex should be discontinued once a woman becomes pregnant.

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

Other integrative approaches that may be helpful: Acupuncture may be helpful in the treatment of some cases of female infertility due to problems with ovarian function. In a preliminary trial, women who did not ovulate were treated with acupuncture 30 times over three months. Effectiveness was determined by a combination of measures indicating ovulation was returning to normal. Acupuncture treatment resulted in a marked improvement in 35% and slight improvement in 48% of trial participants.25 The beneficial results achieved with acupuncture may be due to alterations in the hormonal messages from the brain to the ovary.26

Auricular (ear) acupuncture has been studied in a preliminary trial and compared with standard hormone therapy for treatment of infertility. In both the acupuncture and hormone therapy groups, 15 out of 45 patients became pregnant. Although the pregnancy rates were similar with either treatment, side effects occurred only in women taking hormones.27 Still, double-blind trials are needed to conclusively determine whether acupuncture is a useful treatment for female infertility.

References:

1. Hatch EE, Bracken MB. Association of delayed conception with caffeine consumption. Am J Epidemiol 1993;138:1082–92.

2. Stanton CK, Gray RH. Effects of caffeine consumption on delayed conception. Am J Epidemiol 1995;142:1322–9.

3. Williams MA, Monson RR, Goldman MG, et al. Coffee and delayed conception. Lancet 1990;335:1603 [letter].

4. Grodstein F, Goldman MB, Ryan L, Cramer DW. Relation of female infertility to consumption of caffeinated beverages. Am J Epidemiol 1993;137:1353–60.

5. Wilcox A, Weinberg C, Baird D. Caffeinated beverages and decreased fertility. Lancet 1988;2:1453–6.

6. Joesoef MR, Beral V, Rolfs RT, et al. Are caffeinated beverages risk factors for delayed conception? Lancet 1990;335:136–7.

7. Fenster L, Bubbard A, Windhan G, et al. A prospective study of caffeine consumption and spontaneous abortion. Am J Epidemiol 1996;143(11 suppl);525 [abstract #99].

8. Hakim RB, Gray RH, Zacur H. Alcohol and caffeine consumption and decreased fertility. Fertil Steril 1998;70:632–7.

9. Cramer DW. Letter. Lancet 1990;335:792.

10. Buck GM, Mendola P, Vena JE, et al. Paternal Lake Ontario fish consumption and risk of conception delay, New York State Angler Cohort. Environ Res 1999;80(2 Pt 2):S13–S18.

11. Howe G, Westhoff C, Vessey M, Yeates D. Effects of age, cigarette smoking, and other factors on fertility: findings in a large prospective study. BMJ 1985;290:1697–9.

12. Weinberg CR, Wilcox AJ, Baird DD. Reduced fecundability in women with prenatal exposure to cigarette smoking. Am J Epidemiol 1989;129:1072–8.

13. Grodstein F, Goldman MB, Cramer DW. Infertility in women and moderate alcohol use. Am J Public Health 1994;84:1429–32.

14. Florack EIM, Zielhuis GA, Rolland R. Cigarette smoking, alcohol consumption, and caffeine intake and fecundability. Prev Med 1994;23:175–80.

15. Hakim RB, Gray RH, Zacur H. Alcohol and caffeine consumption and decreased fertility. Fertil Steril 1998;70:632–7.

16. Green BB, Weiss NS, Daling JR. Risk of ovulatory infertility in relation to body weight. Fertil Steril 1988;50:621–6.

17. Czeizel AE, Metneki J, Dudas I. The effect of preconceptional multivitamin supplementation on fertility. Int J Vitam Nutr Res 1996;66:55–8.

18. Thiessen DD, Ondrusek G, Coleman RV. Vitamin E and sex behavior in mice. Nutr Metab 1975;18:116–9.

19. Bayer R. Treatment of infertility with vitamin E. Int J Fertil 1960;5:70–8.

20. Rushton DH, Ramsay ID, Gilkes JJH, Norris MJ. Ferritin and fertility. Lancet 1991;337:1554 [letter].

21. Sieve BF. The clinical effects of a new B-complex factor, para-aminobenzoic acid, on pigmentation and fertility. South Med Surg 1942;104:135–9.

22. Battaglia C, Salvatori M, Maxia N, et al. Adjuvant L-arginine treatment for in-vitro fertilization in poor responder patients. Hum Reprod 1999;14:1690–7.

23. Propping D, Katzorke T. Treatment of corpus luteum insufficiency. Zeitschr Allgemeinmedizin 1987;63:932–3.

24. Gerhard I, Patek A, Monga B, et al. Mastodynon® for female infertility. Randomized, placebo-controlled, clinical double-blind study. Forsch Komplementärmed 1998;5:272–8.

25. Mo X, Li D, Pu Y, et al. Clinical studies on the mechanism for acupuncture stimulation of ovulation. J Tradit Chin Med 1993;13:115–9.

26. Chen BY. Acupuncture normalizes dysfunction of hypothalamic-pituitary-ovarian axis. Acupunct Electrother Res 1997;22:97–108.

27. Gerhard I, Postneek F. Auricular acupuncture in the treatment of female infertility. Gynecol Endocrinol 1992;6:171–81.