Causes

Reasons for infertility in women include endometriosis, a condition in which the glands and tissues that line the inside of the uterus grow outside the uterine wall (see chapter 54); poor diet; deficiencies in folic acid, vitamin B₆, vitamin B₁₂, and iron; heavy metal toxicity; obesity; immature sex organs; abnormalities of the reproductive system; hormonal imbalances; and genetic damage from electromagnetic radiation.

It may surprise you to learn that the birth control pill and other sources of estrogen can add to the problem. Barbara Seaman, an advocate for women’s health issues and author of The Doctors’ Case Against the Pill, concludes that the chemicals in the pill may increase infertility in three ways: by suppressing the natural productions of hormones; increasing the risk of sexually transmitted diseases (STDs), especially chlamydia; and upsetting the assimilation of nutrients.

ABNORMAL MENSTRUAL CYCLES As Seaman reports, “Fertility experts confirm that many women who have been on the pill for a long time have problems re-establishing their monthly cycles.” Robin Wald, a nutritionist and health-care writer who specializes in infertility, explains further how birth control pills can cause hormonal imbalances that affect fertility.

“The hypothalamus is the gland that produces gonadotropin-releasing hormone, the hormone that triggers the pituitary gland to secrete other hormones that are important for fertility. These hormones, follicle-stimulating hormone, which tells the ovaries to start producing and maturing an egg each month, and luteinizing hormone, which ripens the egg and allows it to be released, signal the ovaries to produce estrogen and progesterone so that you can have a normal menstrual cycle. It’s a very complicated and complex system and must be in a very particular balance to function properly; for the egg to ripen and mature; for the egg to be released and travel through the fallopian tubes; and for progesterone to be there to build up the endometrial lining to nourish an egg, so that if it’s fertilized it can be implanted and nourished and grow so that it doesn’t miscarry. When you have too much estrogen that suppresses pituitary gland function, you disrupt the normal hormone balance.”

CHLAMYDIA “Another reason the pill is bad for female infertility,” notes Barbara Seaman, “is that it promotes the growth of chlamydia. This condition has reached epidemic proportions in the United States, with over half a million new cases yearly. Chlamydia causes pelvic inflammatory disease, which can then cause sterility. Usually, the first time it strikes, chlamydia does not render a woman sterile. Women who get the condition once should give up the pill right away.”

NUTRITIONAL DEFICIENCY Seaman says there are a lot of nutritional issues involved with taking the pill. “If a woman has been on the pill for a long time, she may be very low in folic acid; vitamins B₁, B₂, B₆, B₁₂, C, and E; and trace minerals zinc and magnesium, all essential to normal fertility. Sometimes just getting on a really good diet with really good supplements can get her back into a fertile cycle without needing heavy-duty drugs. It should be noted, however, that any dietary supplements used should be low in vitamin A, niacin, copper, and iron, the levels of which tend to be elevated in pill users.”

Assisted Reproductive Technology

“The laboratory options have just exploded in the past decade for infertile couples,” Carla Harkness reports. “In 1978, the first ‘test-tube’ baby was born in England through a process called in vitro fertilization. Since then, the process has been instituted worldwide. There are now over 260 clinics practicing some form of that kind of laboratory fertilization, which is now called Assisted Reproductive Technology or ART.

“Now the boundaries have even exceeded menopause. Before, you had the practice of donor sperm for artificial insemination. Now there is the ability to fertilize donor eggs from younger women with the husband’s sperm and to implant those eggs in an infertile woman who is over 45 or 50. She is able to carry a child to term that is not genetically related to her. These kinds of options have all become available, and they offer a great deal of hope to many couples.”

ETHICAL ISSUES While modern advances in fertility treatments offer a wealth of new possibilities, they also raise new ethical concerns. “A number of religious groups have raised questions about the intervention of technology in the natural process of reproduction,” Harkness explains. “There is also a theme of pronatalism at any cost here, emphasizing that to be complete as couples or as women, people absolutely must birth a biological child.

Another big issue revolves around extending maternal age past nature’s deadline of menopause. Before, women in their mid-40s probably weren’t able to get pregnant because their bodies would stop that function. Now, it is possible for women in their 50s and 60s to become pregnant. This raises a number of questions: Is that putting too much demand on their bodies? What about the age difference between them and their children? What about obligations to aging parents while having little ones in your midlife? Additionally, there is a legal and moral question revolving around the status of unused, frozen embryos in the event of death and divorce.

“There are further questions surrounding the availability of this expensive technology to those without the means or the medical insurance. Unfortunately, these treatments are quite expensive. From the moment you walk into a specialist’s office asking for an evaluation, you start incurring costs in the hundreds of dollars for examinations and tests, all the way to thousands of dollars for the in vitro techniques. It’s about $10,000 per cycle for a straight in vitro lab procedure, all the way up to $15,000 if egg donor in vitro fertilization is utilized.”

Many women distrust scientific intervention in general. Problems with intrauterine devices (IUDs) have caused pelvic inflammatory disease resulting in infertility. Diethystilbestrol (DES), an estrogen replacement often used as a “morning-after” pill in the United States even after it was linked to cancer and anomalies of the vagina and cervix, has been another big problem, as has thalidomide. Now there is a concern about using female hormones to stimulate ovulation. With most infertility treatments, whether the problem is due to the man or woman, it is mainly the women who undergo the drug treatments, the surgeries, and so forth. What are the long-term effects of exposing women to these drugs?

Natural Options

Dr. Marjorie Ordene, a gynecologist from Brooklyn, New York, believes that while there is a place for technology in fertility, women are too quick to seek out these methods, and she suggests trying various natural options first.

PINPOINTING TIME OF OVULATION Women should learn to recognize their time of ovulation by taking their temperature first thing in the morning, before getting out of bed. Says Dr. Ordene, “Usually, temperature rises in the second half of the cycle, 2 weeks before menstruation. The mucus that is produced around the time of ovulation has a clear and slippery quality. This is the kind of mucus that is needed for the sperm to penetrate the cervix.”

WHAT TO AVOID Robin Wald cautions that women trying to conceive should avoid exposure to toxic substances that not only may interfere with conception but have also been linked to miscarriage and birth defects.

“The first thing I tell people to avoid is tobacco smoke. If you’re a cigarette smoker and you plan on getting pregnant, quit smoking. Tobacco is very high in chemicals, including cadmium, which is a toxic heavy metal that accumulates in the reproductive organs of both men and women. It interferes with sperm production in men and hormone production in women. Secondhand smoke can cause similar problems.

“I also encourage people to stop drinking, even if they only drink moderately. Alcohol interferes with fertility by causing liver toxicity. The liver is the primary organ for building up cholesterol to form the steroid hormones which are important to reproductive health. Marijuana and other drugs can also cause liver toxicity and should be avoided.

“In addition, I suggest that people eliminate caffeine, both in coffee and sodas; switch to decaf coffee or herbal teas, and increase your water intake. Although the subject of caffeine and fertility is controversial, studies have shown that as few as two cups of coffee a day or two cans of caffeinated soda can increase your chance of a miscarriage by four times and your infertility by 50 percent.

Wald further cautions women to avoid taking some over-the-counter medications. “A lot of women who experience menstrual discomfort think nothing of taking an aspirin or ibuprofen. But nonsteroidal anti-inflammatory drugs are also harmful to the reproductive system.

“One thing to avoid that cannot be overemphasized is pesticides—both pesticides that have been sprayed in your garden and pesticide residue from food that you buy. Pesticides are very toxic to the reproductive system. This is because pesticides are in a class of chemicals called xenoestrogens, synthetic chemicals that act like estrogen on the body. Overexposure to xenoestrogens can result in a condition called estrogen dominance. In estrogen dominance there is too much estrogen circulating in the body, which throws off the balance and production of other hormones that are essential for fertility.”

Other sources of xenoestrogens are food additives, preservatives, and meat from animals that have been fed hormones. Dairy products also contain xenoestrogens, both from the cows’ own hormones and from hormones given to them to promote milk production.

DIET AND LIFESTYLE Women should maintain a healthy diet and follow a basic exercise program. Fertility specialists Dr. Talha Sawaf, Dr. Yehudi Gordon, and Marilyn Glenville, writing in Positive Health magazine, recommend eating organic foods as much as possible and avoiding food additives, coffee, and tea. They advise eliminating nonessential medications and avoiding exposure to radiation, hazardous substances in the workplace, pesticides, and pollutants such as toxic metals. They point out that becoming as healthy as possible before conception improves the quality of the egg and sperm, thereby maximizing fertility and reducing the risk of miscarriage. Conversely, fertility is decreased by poor nutrition, vitamin or mineral deficiencies, and too much alcohol, cigarettes, and stimulants.

Robin Wald, who suggests that the very first step in optimizing fertility is to examine your diet, says that the standard American diet does not promote either health or fertility. She recommends an organic, whole, live foods diet. “The advantage of eating live food is that the nutritional value and the quality are that much higher. Good nutrition is vital when you’re trying to get pregnant. Vitamins, minerals, fats, amino acids, and other nutritional components from our foods are essential for keeping the reproductive system healthy. Eat fresh fruit and vegetables, especially leafy green vegetables like collard greens, kale, Swiss chard, red chard, and beet greens, which are very high in folic acids and loaded with calcium. Folic acid is essential for preventing birth defects like spina bifida, and calcium will aid in building your baby’s skeleton as well as keeping your own bones healthy.”

She suggests minimizing your intake of processed flour, bread, baked goods, and pasta, and incorporating more whole grains into your diet. She recommends brown rice, millet, quinoa, oats, and buckwheat. “Whole grains are loaded with fiber and have very high nutritional quality. Raw nuts and seeds are also good, as are chickpeas, lentils, black beans, and pinto beans, which are both high in fiber and a good source of nonanimal protein.

“Fiber is important in promoting the excretion of toxins and bound-up estrogens from the gut. If you have insufficient fiber to move things through your intestines in a timely way, these estrogens sit in the gut and get reabsorbed into the body. So instead of having environmental estrogens or estrogens your body has created circulating through your body once, they’re now going through a second, third, or fourth time, which contributes to estrogen dominance.”Wald advises eating soy products, like tempeh and miso. “Soy is a good source of phytoestrogens, which have a chemical structure similar to estrogen. Phytoestrogen tricks your body into thinking that it’s getting estrogen, but the advantage of phytoestrogens is that they tell your body to lower its own estrogen production, which helps balance your estrogen levels. As well, phytoestrogens block the absorption of xenoestrogens.”

EMOTIONAL AND SPIRITUAL ISSUES Often, a woman has apprehensions about becoming pregnant that need to be addressed. It may be reassuring to talk to the inner child and let her know that even though there will be another child, the little girl in her will still get the attention she needs. This kind of spiritual work is often important in achieving pregnancy.

Feelings of blame, guilt, anger, and frustration that infertile couples often experience will have a negative effect on their fertility. Discussing such issues, perhaps with a counselor, can resolve these negative feelings and improve the chances of conception.

Infertility is a very stressful, major life event, and stress can itself adversely affect fertility. Robin Wald describes how stress affects reproductive function. “Every time there is a stress response in your body, the adrenal glands secrete a group of hormones that have an inhibitory affect on the hypothalamus, which is the master gland that signals the production of the hormones needed for reproduction. When you have excessive stress, the hypothalamus does not function properly.

“Stress can also cause a condition called hypoprolactin anemia. Prolactin is another hormone that prepares the breasts for milk production. If a nonpregnant woman has high levels of prolactin, it will make conception difficult because it can shut down ovulation.

“If you’re under a lot of stress, do whatever you can to reduce it,” Wald suggests. She recommends yoga, meditation, breathing exercises, spiritual work and prayer, visualization and imagery, bodywork, and massage as ways to lower stress levels.

Nutritional supplements can also help. Wald recommends vitamins C and E, beta carotene, alpha carotene, coenzyme Q10, and antioxidants to protect against stress-induced free radical damage.

ASIAN NATUROPATHIC APPROACH The traditional Eastern approach to fertility depends less on modern technology and more on time-tested knowledge. Dr. Roger Hirsch, a naturopathic physician from California, explains Chinese philosophy and infertility treatments based on this point of view: “We look at making the abdomen happy. This is an aphorism for correcting the digestion, menstruation, and hormones, so that women can conceive. Of course, raising the man’s sperm count and sperm motility is important as well, because it is not just the woman who is infertile in an infertility situation. A key to this is the way the blood flows in the pelvic cavity.”

Chinese medicine uses acupuncture, massage, heat, or crystals applied at points along the energy pathways, or meridians, to balance the flow of energy in the body. Changing the diet, decreasing emotional tension, and balancing heat and cold will increase the effectiveness of the basic treatment. Thus acupuncture is more effective when used together with herbs to regulate the menstrual cycle, promote ovulation, and increase general vitality, all of which enhance fertility. Chinese medicine can be combined with assisted reproductive technology to minimize stress and help women tolerate drugs and surgery.

HERBS “In Chinese medicine,” says Dr. Hirsch, “herbs are used to tone renal/adrenal function because reproductive function is related to the kidney and to functions related to the kidney. The actual viability of the eggs for a woman over 40 is related to kidney yang function.”

HERBA EPIMETI. One herb that is very good for kidney yang is an aphrodisiac called herba epimeti, which translates in English to “horny goat weed.” The Chinese noticed that goats become sexually active after eating this particular plant. They put the plant into the herbal formula for women who are kidney yang-deficient, and they noted that it increased sexual desire.

LUTAIGOU. Lutaigou, the gelatin that comes from boiling the antlers of deer, is used by the Chinese to help women over 40 who are trying to extend their egg-producing years. It helps slow down the biological clock.

WORMWOOD. In the European system, we have wormwood, which creates more circulation in the pelvic cavity. The Chinese use this along with daughter seed and fructose litchi, a little red berry.

DONG-QUAI AND CORTEX CINNAMOMI. Both of these help the circulation in the pelvic cavity. Cortex cinnamomi is not the cinnamon you put in your mulled cider, but a cinnamon with a very thick bark.

ACUPUNCTURE In China, acupuncture has been used in the treatment of infertility for centuries. The Chinese look at five principal organs—the liver, spleen, heart, lung, and kidney—and use acupuncture to release blockages from these systems so that energy, or chi, can move freely. This helps the body return to good health. Promoting fertility is one benefit that can be obtained.

Acupuncture to kidney points releases psychological blocks that interfere with reproduction. Dr. Hirsch uses the treatment to help patients overcome deep-rooted fears connected to sexual abuse and low self-esteem. “In treating self-esteem issues, I work on the heart and kidney points. The acupuncture points that seem extremely valuable for this are pericardium 5 and 6. If a practitioner is having a problem with understanding whether or not a psychological issue is involved in the infertility, and the patient does not know what the issue is, pericardium 5 can be needled. If something is holding the person back, that will bring an event or dream to memory, and the patient will understand why she is stuck. In treating self-esteem issues, we may also release stress by needling the heart 7 point, heart 9, and sometimes heart 7 to heart 5.

“We also address conception vessel 17, which is between the breasts. This is a very important place for women because it opens their energy. It also helps relieve liver chi congestion or stuckness. Remember, the liver and the liver hormones, both in Chinese and Western medicine, govern the flow of blood in the pelvic cavity.”

WESTERN NATUROPATHIC APPROACH Dr. Joseph Pizzorno says that as a naturopath and midwife he saw numerous infertile couples and discovered two causes of the condition that were not generally recognized by the orthodox medical profession: “The first was pituitary insufficiency. The pituitary gland was not secreting enough of the hormones needed to stimulate the ovaries to mature, ripen, and produce a viable ovum. Most of these women had been on birth control pills for long periods of time. Even though they had been off the pills for several years, their pituitary never functioned fully again.

“With these women I did two things. I gave them an herbal concoction using herbs that are commonly used for women’s health problems, which are supposed to stimulate proper pituitary functioning. I also gave them raw pituitary gland from an animal. There were surprisingly good results with this treatment. A urine test beforehand measured the level of hormones from the pituitary. If a patient had low hormone levels, I would then use this protocol with them. A surprising number became pregnant once their urinary hormone levels returned to normal.

“The second major cause was pelvic inflammatory disease, where there were infections in the fallopian tubes, the little tubes that go from the uterus to the ovaries. Infections leave scars. Then the ovum cannot penetrate the tube and get into the uterus for fertilization.

“An age-old hydrotherapy procedure, called sitz bath, helps end this problem. A woman gets two big pots of water. (We use washtubs that are about 3 feet in diameter.) One tub gets filled with hot water (as hot as she can stand it). When a woman sits in it with her arms and legs out of the tub, the water level reaches her umbilicus. The other tub gets filled with ice cold water. That tub is filled to the point just below the umbilicus. In other words, there is more hot water than cold water. The woman sits in the hot water for 5 minutes, and then in the cold water for 1 minute. She alternates back and forth three times.

“The first time a woman does this, she will find it startling. But after a while she will actually start to like it. She does this every day. After a few treatments, she starts getting a discharge. As near as we can make out, this discharge is the body throwing off scar tissue and toxic material in the ovaries. This is a particularly dangerous time for a woman to have intercourse. The ovaries are starting to open up, and there is a high probability of an ectopic pregnancy. The egg will only be able to go partway down the tube since the tube is not yet open enough for it to get all the way into the uterus. We therefore tell women no unprotected intercourse for at least 3 months while doing these treatments every day. Again, a surprising number of them become pregnant.”

RESTORING THYROID BALANCE Even as far back as the 1930s, alleviating low thyroid conditions was found effective against infertility. Dr. Ray Peat says to keep thyroid levels up, women should snack frequently and eliminate unsaturated fats. Although unsaturated fats are often touted as beneficial, recent studies show them to inhibit thyroid secretion. More high-quality protein may be needed, especially by women following a weight-loss program or a vegetarian diet. A daily minimum of 40 grams is recommended. Taking a thyroid supplement for a short period of time can greatly help. “People whose thyroid function is suppressed can benefit from a week or two of thyroid supplementation,” Dr. Peat advises. “They don’t need to take this indefinitely.”

NATURAL HYGIENE Dr. Anthony John Penepent, follows the principles of natural hygiene when treating any medical condition: “Over the years, I have seen many wonderful things happen with natural hygiene which would not have been possible with allopathic medicine.” Explaining infertility, Dr. Penepent says there are many causes, but that all of them can be treated similarly: “There are many mechanisms that can come into play. You can have basic amenorrhea or failure to ovulate. You can have any variety of hormonal imbalances or fallopian tube obstruction. In 40 percent of the cases it is not the woman’s fault, although she may take the blame to save her husband’s ego. The man may have a low sperm count, depressed sperm motility, or abnormal sperm morphology. These are all possibilities. Then again, conception may occur but the egg or ovum may not have sufficient nutrients for the embryo to develop. What happens then is you have unrecognized spontaneous abortions that make it appear as if the woman is infertile, when in actuality she just has a nutritional deficiency.

“In many cases, an infertile woman can conceive and go on to have a successful pregnancy with a minor amount of dietary change. In the case of the fallopian tube obstruction, it may be necessary for her to fast for several days. I remember one patient, a rabbi’s wife, who was childless. Because of their religious beliefs, it was absolutely essential for her to bear children. In her particular case, I put her on a fast for several days and followed that up with a nutritional regimen. She was able to conceive within 6 months.”

CONSUMER ADVOCACY GROUPS Carla Harkness recommends becoming a part of a consumer advocacy group that can provide individuals and couples with support and information. One group, called Resolve, has its national office in Somerville, Massachusetts, and a string of chapters across the country: “Resolve is a great ally that provides literature, referrals, and legal advocacy to the infertile. Chances are, wherever you live, there’s a chapter by you.”