A couple of generations ago, women most often faced the problem of having more children than they knew what to do with. For modern women, however—particularly those who delay childbearing until later in their reproductive years—infertility has become a significant concern. Since 1995, at least one in six women of childbearing age has sought professional support for infertility, a number that has grown significantly since the early 1980s and which appears to be steadily rising. If you are a woman or couple experiencing infertility, you can see that you are not alone!
Difficulty conceiving a child can be attributed to a myriad of complex biological, nutritional, social, and emotional factors. The diagnosis of infertility, whether self-defined or medically diagnosed, can lead to further emotional and social stresses, not to mention an odyssey of medical evaluations and interventions.
Although there is no guarantee that natural methods of approaching conception difficulties will be successful, they can improve your overall health and self-concept while laying the foundation for a healthier conception if this is achieved. Further, a number of practitioners using natural fertility-enhancing methods, as well as couples creating their own fertility programs, do find such methods successful. This article provides an overview of the causes of fertility problems and some of the methods of overcoming infertility naturally.
Declining fertility rates in the United States
Some of the explanations for declining childbearing trends in the United States since the 1980s include changing social roles and personal goals of women, delayed age of marriage and postponed childbearing, increased use of birth-control methods, difficult economic conditions, and increased concern for the environment. Basically, fewer women are trying to get pregnant, and more women are waiting until they are older to conceive. In fact, more women are waiting longer now to get pregnant than at any other time in the past thirty years. One in every five women having a first child in the United States is over the age of thirty-five. It is estimated that about one-third of women who wait until the mid- to late-thirties to try to get pregnant will experience some difficulty, and at least half of all women older than forty will experience infertility. While statistics indicate greater difficulty for “older” women, the oldest recorded age of pregnancy in the United States was in a fifty-seven-year-old woman from Oregon, and it is not uncommon to hear stories of women from other cultures having babies well into their late forties. Unfortunately, waiting until they are older to get pregnant often causes women to feel more of an urgency of time when they finally do decide to try, and although women can get pregnant at anytime in their reproductive cycles, it does tend to get harder as we get older.
However, rates of infertility appear to have increased across all age groups, attributed in part to increased rates of gynecologic problems, sexually transmitted diseases, and male reproductive problems. Environmental problems, nutritional deficiencies, and lifestyle may also play important roles.
The increase in fertility difficulties combined with increased access to assisted reproductive technologies such as in vitro fertilization and fertility-enhancing drugs has led to the unprecedented use of medical intervention for conception. In 1995 alone, 15 percent of all women of reproductive age (9.3 million women) used some form of reproductive services to try to achieve a pregnancy.
Underlying causes of conception difficulty
Physical causes of difficulty with conception in women include endocrine changes associated with age; a history of gynecologic disease that caused scarring of the fallopian tubes or other reproductive structures; endometriosis; polycystic ovarian disease; antibody production to sperm; sexually transmitted diseases; insufficient or excessive body weight; overexercise; exposure to excessive amounts of electromagnetic radiation; anxiety; and hormonal imbalances, such as insufficient estrogen levels or luteal phase insufficiencies. In men, increasing age, hormonal problems, and defects in sperm production, formation, and motility can be problems. Natural approaches to many of these problems are discussed below. In 10 to 30 percent of cases, no physical cause of infertility can be found by conventional diagnostic methods. Many causes of infertility can be corrected with natural therapies, medical treatment, or a combination of both.
Seeking medical intervention
Infertility is defined as the inability to conceive a child after a year of trying (while having unprotected sex), yet it is important to remember that only one-third or less of all couples will achieve pregnancy within one month of starting to try and that 93 percent of all couples will eventually become pregnant within two years of trying. Even among those who seek fertility help after one year of trying, about one-half will become pregnant spontaneously within the next year (with no treatment), 45 percent of all couples become pregnant after discontinuing fertility treatments, and 35 percent who never seek treatment become pregnant in this time frame. Sometimes it just takes time! Women younger than thirty should ideally try for three years to become pregnant naturally before seeking fertility treatment. Women in their late thirties and early forties may prefer to set a shorter time limit before seeking advice from a qualified practitioner.
It is also important to recognize that medical testing and medical treatment do not have to go hand-in-hand. It is perfectly reasonable to seek out information from simple diagnostic tests such as hormone level testing, charting basal body temperature, postcoital assessment, sperm analysis, and even examination of the fallopian tubes and ovaries (particularly if there has been a history of pelvic infection). This information can point one in the direction of appropriate natural therapies long before more invasive, costly, and potentially harmful medical interventions are pursued.
Natural fertility therapies
The goal of a natural approach to fertility is to enhance overall wellness in both partners while addressing specific problems. Nutrition, herbs, and even prayer have been shown to improve the success of couples trying to get pregnant. But before touching on natural therapies, a word about love, sex, and babies. Fertility in a relationship is about partnership and communication. Working together to achieve pregnancy needs to be the cornerstone of any fertility program. Frequently, it is one partner or the other who is labeled with a diagnosis of infertility. Regardless of any diagnosis, both partners need to wholeheartedly accept a commitment to the relationship and, without blaming, work toward improving fertility and welcoming a baby into the union. This cooperation can range from seeing a health-care practitioner together to making each other’s herbal teas.
Too often when couples have been trying for a while to become pregnant, especially if they have been timing their cycles religiously with a thermometer and charts, or if they have walked through the gauntlet of fertility tests, sex becomes a mechanical act—a “let’s just do it to get pregnant” act. Sex and conception were not meant to be mechanical, utilitarian acts but healthy, fertile, life-affirming connections between loving partners. Whenever possible, a natural approach to fertility should enhance the overall fertility of a couple on many levels—infusing their lives with passion and creativity, not just improving hormone function or sperm motility. Frequently I instruct couples to toss out the thermometer and focus on the loving relationship and the creativity, as this is what will endure regardless of whether conception is achieved. From this a healthy sexual relationship can develop or be enriched. That said, on to specific treatments.
While the importance of good nutrition is emphasized during pregnancy, its significance for promoting a healthy conception is virtually overlooked. Yet for both men and women, optimal nutrition prior to conception can enhance the likelihood of success as well as optimize the baby’s health. The foundation of optimal fertility is an excellent diet based on minimally processed, natural, organic whole grains, legumes, vegetables and fruits, and small amounts of dairy, poultry, and fish. Healthy oils such as olive oil and canola oil should be a regular part of the diet. Processed and denatured foods, excessive consumption of sweets, and consumption of alcohol and caffeine should be avoided or at least minimized. Smoking must be stopped for your health and that of your future baby, as should the use of unnecessary medications and all recreational drugs. The diet should be supplemented with essential fatty acids (evening primrose oil, borage oil, flaxseed oil, and cold-water fish such as salmon are excellent sources). Both of you should make sure your diet is especially rich in the following nutrients through food and, if necessary, additional supplements: vitamin A, vitamin B-complex, folic acid, zinc, magnesium, potassium, selenium, and vitamin E.
Body weight and exercise
Moderate exercise on a regular basis is healthy for all of us. Further, working out as a couple—whether doing yoga, running, taking a dance class or working out in a gym—can be downright sexy and bonding. Excessive exercise that results in irregular or absent menstrual cycles should be avoided if you are trying to conceive.
It is particularly important for women to be at a healthy body weight for conception to occur. Both overweight and underweight women have increased difficulty with conceiving. Work with a nutritionist or other qualified health-care practitioner to create a nutrition and exercise plan that will optimize your reproductive functioning. You will feel better about yourself, and this will enhance your sensuality, as well as your comfort and health, should pregnancy occur.
Herbal approaches for female reproductive problems
There are a number of gynecologic problems that can interfere with or inhibit fertility. Fortunately, there are also many herbs that can be helpful in treating such problems. Below is a brief review of problems associated with infertility and suggested treatments. For an individualized treatment plan, consult reference books such as Francesca Naish’s Natural Fertility (Sally Milner, 1992), or seek the help of a qualified herbalist, naturopathic physician, or acupuncturist trained in the use of Chinese herbs. Herbal programs to treat infertility can be expected to take from a few months to more than a year. Therefore, don’t be discouraged if you do not conceive within a few weeks of trying.
Decreased estrogen levels, which are associated with low body weight (15 to 20 percent below “ideal” body weight), vitamin A deficiency, excessive fiber intake or overuse of antibiotics (both of which eliminate bowel flora necessary for the circulation of estrogen), overexercising, and smoking may be an underlying factor in infertility. Both diet and herbs can be used to enhance estrogen levels. Legumes, particularly soy foods, are rich in phytoestrogens. Herbs that may enhance estrogen levels and improve fertility include red clover (Trifolium pratense), Asian ginseng (Panax ginseng), black cohosh (Cimicifuga racemosa), wild yam (Dioscorea villosa)\ and licorice root (Glycyrrhiza glabra), taken as teas, tinctures, or capsules.
Luteal phase deficiency, resulting from insufficient progesterone levels, can cause the ovulatory phase to be too short or prevent the ovarian follicle from ripening and the egg being released altogether. Several herbs, including vitex (Vitex agnus-castus), peony (Paeonia spp.), and evening primrose oil can be very effective in promoting a healthy ovulatory phase of the cycle. Typically taken as a tincture, vitex can be used daily. Peony is often found in combination with dong quai (Angelica sinensis) in traditional Chinese herbal formulas, and the two herbs may be used together to promote ovulation.
Endometriosis is frequently associated with difficulty conceiving, and many herbalists have had success helping clients reduce endometriosis with herbal therapies.
Vitex is the most important herb for treating endometriosis; other herbs include cramp bark (Viburnum opulus), Chinese salvia (Salvia miltiorrhiza), also known as dan shen, ginger (Zingiber officinale), licorice, and dong quai. Herbalists may also include herbs to promote the conjugation and elimination of hormones by the liver, including dandelion root (Taraxacum officinale), milk thistle (Silybum marianum) and motherwort (Leonurus cardiaca). Because endometriosis is an inflammatory process, and it is the inflammation and elevated white blood cell levels that may interfere with fertility, herbalists may also include immune-enhancing herbs such as calendula (Calendula officinalis) and echinacea (Echinacea spp.), and anti-inflammatory herbs such as licorice and ginger, into a formula. Evening primrose oil should also be incorporated into the treatment program.
Immunologic response to sperm is an increasingly common explanation for infertility. Immune-regulating herbs such as echinacea, astragalus (Astragalus membranaceus), and calendula should be considered if this is the suspected problem. The traditional Chinese formula Zhi bai du huang, which nourishes the kidney yin, has been shown to be effective in the treatment of infertile couples with antisperm and/or antizona pellucida antibodies.
Polycystic ovarian disease is associated with irregular ovulation and infertility. It is primarily treated with vitex and peony to help regulate ovulation. A healthy diet to regulate blood sugar, reduce excessive weight, and reduce insulin resistance is also especially important in the treatment of this disease. Be sure to include plenty of essential fatty acids in the diet.
General tonic herbs for women should incorporate the traditional Chinese approaches of improving the blood and energy (qi) and nourishing the kidneys, which in Chinese medicine are closely related to fertility. Treatment with traditional Chinese herbal formulas has resulted in improvement in ovulation and progesterone levels, elevated basal body temperature indicative of ovulation, and regulation of the hypothalamus-pituitary-ovarian axis. Chinese tonic herbs for women include dong quai, peony, Asian ginseng, American ginseng (Panax quinquefolius), ligusticum (Ligusticum spp.), rehmannia (Rehmannia glutinosa), and fo-ti (Polygonum multiflorum).
Herbal approaches for male reproductive problems
Studies indicate that male sperm counts are declining. Factors associated with this include environmental contaminants such as pesticides, exogenous estrogens, and heavy metals that affect sperm formation. Avoiding environmental hazards as much as possible is an important step in encouraging healthy sperm production. Nutritional therapies may be helpful in both reducing the harmful effects of environmental exposures and in promoting reproductive health. Carnitine, arginine, zinc, selenium, and vitamin B12 are considered important for enhancing sperm motility and function, as are many antioxidants including vitamin C, vitamin E, glutathione, and Coenzyme Q10. It’s always best to derive nutrients from natural, organic foods through a healthy diet, but using supplements is a boost to a good foundation.
Herbal therapies often focus on enhancing libido or correcting problems with sperm motility or function. Herbs such as Asian and American ginseng and muira puama (Ptychopetalum olacoides) can be used for these purposes. Studies have shown that the traditional Chinese formula Gui zhi fu ling wan, which includes cinnamon (Cinnamomum verum), poria (Wolfiporia cocos), peony, and other herbs, has led to improvement in sperm concentration and motility. In vitro studies have indicated that astragalus may have a significant stimulatory effect on sperm motility. It is a well-known immune-enhancing herb in Traditional Chinese Medicine.
Acupuncture has been shown to be effective for the treatment of both male and female infertility problems due to blockages of qi, to strengthen the liver and kidneys, nourish the uterus, and improve sperm production. Acupuncture treatment for women has been effective in the treatment of luteal phase insufficiency, hormonal imbalances, endometriosis, and other problems related to difficulty with conception. Acupuncture’s overall lack of side effects and positive influence on general wellness make it a reasonable part of a health plan to promote fertility and conception.
Stress reduction, positive thinking, and prayer
While infertility is certainly not “all in your head,” stress reduction and positive thinking have been associated with improvements in fertility. This is because the endocrine and stress hormones are closely linked—our emotions affect our hormones and vice versa. For example, in one study, a reduction in anxiety and emotional stress in women was positively correlated with a reduction in prolactin—a hormone that, when elevated, can inhibit fertility. According to another recent study in the September 2001 issue of the Journal of Reproductive Medicine, prayer seems to almost double the success rate of in vitro fertilization procedures. Any fertility program, whether conventional or alternative, should include some aspect of stress reduction and promotion of emotional and psychological well-being. This can come in the form of counseling, meditation, artistic expression, having more fun in your life, prayer, or anything else that nourishes your sense of peace and joy.
Herbal therapies can also be used for stress reduction. Reliable herbs include chamomile (Matricaria recutita), passionflower (Passiflora incarnata), lemon balm (Melissa officinalis), and hops (Humulus lupulus). These can be used alone or in combination, and as teas or tinctures. Other herbal relaxation methods, such as herbal baths with essential oils and massage with herbally infused oils, can be beneficial.
While fertility problems are never welcome, they do provide couples with an opportunity to ensure their optimum health before they conceive. This actually increases the likelihood of having a healthy baby, should conception occur. Using a natural approach to fertility, whether alone or in combination with other therapies, allows you time to nurture your body, mind, and spirit, along with your relationship, improving your health and enhancing your creative approach to life as you embrace the mysteries of fertility and conception. Were all children conceived with such care and attention, then all children would be wanted children and the world would be a healthier place.
Aviva Romm is president of the American Herbalists Guild and a certified professional midwife. She’s the author of numerous books on herbal family health, including Naturally Healthy Babies and Children (Storey, 2000), The Natural Pregnancy Book (The Crossing, 1997) and Natural Health and Birth (Healing Arts, 2002).