Transcript Integrative Approaches to Infertility

Integrative Approaches to
Infertility
DR. JACLYN CHASSE, ND
Trends in the percentage
of women (aged 15-44
years) with impaired
fecundity by age group,
1982-2002
CDC Report: “Fertility, Family
Planning and Reproductive
Health of US Women: Data from
the 2002 National Survey of
Family Growth” National Center
for Health Statistics, Vital Health
Stat 23(25) (2005).
1982
1988
1995
Fertility in the US
Where are we and why?
2002
2012
Is fertility really declining?
Review of 61 papers (14,947)
1940-1990
450
400
350
300
250
Sperm Conc
(million/mL)
200
Sperm Count
(million)
150
100
50
0
1940
Carlsen et al. BMJ. 1992;305(6854):609.
1990
•Ave. sperm concentration
decreased from 113 million/mL
to 66 million/mL
•Ave seminal volume decreased
3.4 mL to 2.75 mL
•Ave sperm count decreased
384.2 million to 181.5 million
(52.8% decrease!!)
Contributors to Infertility- Lifestyle
 Nutritional changes
 Environmental exposures
 Pesticides
 Exogenous estrogens
 Heavy Metals
 Stress
Potential for Integrative Medicine
 Forsight Study, UK
 367 couples (females age 22-45, males age 25-59)
 Couples had previous hx of
Infertility 37%
 Miscarriage 38%
 Therapeutic abortion 11%
 Still birth 3%
 LBW babies 15%
 Malformations 2%
 SIDS 1%

Potential for Integrative Medicine
 Forsight Study, UK
 After basic preconception care (nutrition counseling, MV),
0 miscarriages, perinatal deaths, malformations
 Expected 70 miscarriages, 6 malformations
 Couples with live births 89%
 Infertile couples with live births 81%
 Ave gestational age 38.5 weeks
 Average baby weight 7 lbs, 3 oz.

Challenges with Lack of Integration of Care
Naturopathic - only Care
Conventional - only Care
 Emphasizes healthy
 Fast timeline
lifestyle
 Treats the underlying
cause
 Many options available
 Poor outcomes
 Long treatment time often
required
 Lack of advanced options,
ie. laparoscopy
statistically
 High cost, high parental
stress
 Possible epigenetic and
genetic outcomes
Current Treatment Paradigms
Integrative
Conventional Treatment
•Clomid-assisted cycles
•IUI
•IVF
•IVF with ICSI
Conventional Fertility
Treatments
Conventional Treatment Options
“Fertility Enhancing” Medications
Artificial Insemination/ IUI
ART (Assisted Reproductive Technology)
IVF: In-Vitro Fertilization
ICSI: Intracytoplasmic sperm injection
GIFT: Gamete Intrafallopian transfer
ZIFT: Zygote Intrafallopian transfer
“Fertility Enhancing” Medications
2 Main Classes:
Clomiphene/Serophine (Clomid)
Gonadotropins
Clomid
Clomiphene Citrate
Interacts with estrogen-receptor containing tissues
(hypothalamic, pituitary, vaginal, ovarian,
endometrial, cervical)
Increases pituitary gonadotropin release which
increases steroidogenesis and folliculogenesis
This causes growth of an ovarian follicle and increase
in estradiol
Clomid (cont.)
Pharmacy: Dose 50-100 mg qd x 5 days starting
on day 5 of menstrual cycle
Drug Interactions: None documented
Contraindications: hypersensitivity, pregnancy
(category X), liver disease, ovarian cysts (not due
to PCOS), abnormal uterine bleeding of unknown
origin, uncontrolled thyroid or adrenal disorders
Toxicity: Unknown toxic dose in humans. S/Sx of
overdose include: nausea, vomiting, vasomotor flushes, visual blurring, spots or
flashes, scotomata, ovarian enlargement with pelvic or abdominal pain.
Gonadotropins
Many choices available on the market
Combination of LH and FSH which directly stimulate
the ovaries to produce a follicle
Brand names include
Pergonal
Repronex
Fertinex
Follistim
Gonal F
Novarel
Ovidrel
Pregnyl
Profasi
Megonon
Puregon
Menopur
Menopur (a menotropin)
Pharmacy: Subcutaneous injection
Dose 225 units qd for up to 20 days
Once follicular development is adequate, dose 5,000-10,000
units of hCG the following day
Drug Interactions: None documented
Menopur
Contraindications
Primary ovarian failure (high FSH)
Uncontrolled thyroid and adrenal dysfunction
Intracranial leision
AUB of unknown origin
Ovarian cysts not caused by PCOS
Sex hormone-dependant tumor
Menopur- toxicity
OHSS (Ovarian Hyperstimulation Syndrome)
S/Sx: Abdominal pain and distention, nausea, diarrhea, dyspnea,
oliguria, rapid weight gain, severe pelvic pain, vomiting
Occurs in about 5 % of patients undergoing gonadotropin therapy.
It is thought that stim. of ovary causes release of VEGF, causing
capillaries to leak out vascular fluids- can lead to hypovolemia and
leave patient more prone to circulatory, renal, and respiratory
problems.
IUI
IntraUterine Insemination (Artificial Insemination)
Placement of ejaculate into the
vagina/cervix/uterus/fallopian tubes (FaST) and
allowing conception to take place naturally within the
fallopian tubes
Helpful in cases of low sperm counts, low motility,
sperm antibodies, hostile cervical mucous
GIFT: A type of IUI where egg and sperm are
deposited in fallopian tube
the ART of IVF
First “test tube” baby conceived in 1978 in
England
Conception outside of the body and embryo(s)
implanted
Procedure used alongside medications (Lupron)
Follicle stimulating meds (Follistim, Gonal-F)
often with Humegon, Pergonal, or Repronex, and
also often used with Clomid and hCG
Eggs retreived by transvaginal ultrasonic needle
aspiration
More ART
ICSI- Intracytoplasmic sperm injection
Sperm is deposited directly into the egg and egg is then placed
in uterus/fallopian tubes
Often used for couples with low sperm count
GIFT: Gametes are transferred into fallopian tube
ZIFT: Zygote is transferred into fallopian tube
Establishing relationships with RE/ObGyn
 Letters summarizing treatment of patients also in
their care
 Refer to them when appropriate!
 Reach out to them to perform testing/procedures
you can not do
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Antral follicle count
Ultrasound
IUI
Advanced lab testing
Address their needs
 Most RE clinics are competing for the best outcomes
in their area. You can offer them help!
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Treating obesity to get patients into healthier BMIs
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BMI limits
Improving egg quality/semen quality
Offering an alternative for patients who are not interested
in/not comfortable with their treatment options
Clinical Courtesies
 Never disparage the clinic’s care to the patient.
 If you disagree, reach out to the doctor directly
through a phone call, letter, etc.
 Understand that they have expertise as well, within a
different paradigm
 Remember that the patient always comes first!

Ie. if they are undergoing IVF and you want them on herbs that
their RE doesn’t want them on…
General Fertility support
•M E D I T E R R A N E A N D I E T
•A D D R E S S I N G O B E S I T Y
•P R E C O N C E P T I O N S U P P O R T A N D F E R T I L I T Y
OUTCOMES
•S T R E S S M A N A G E M E N T
•A C U P U N C T U R E
Mediterranean Diet and Fertility
 Greatest adherence to Mediterranean diet pattern
(vs. western diet) showed lowest difficulty of getting
pregnant in 2154 Spanish women aged 20-45 years.
 Netherlands study of 161 couples undergoing
IVF/ICSI demonstrated that Mediterranean diet
adherence increased the probability of pregnancy
(odds ratio 1.4). It was also associated with high
folate and B6 in red blood cells and follicular fluid
Toledo E et al. Fertil Steril. 2011 Nov;96(5):1149-53.
Vujkovic M et al. Fertil Steril. 2010 Nov;94(6):2096-101.
Mediterranean Diet and Fertility
Addressing Obesity
 In men,
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Lower sperm counts, sperm concentration, sperm morphology,
motile sperm, and testosterone levels are associated with BMI and
central adiposity.
 In women,
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Lower pregnancy rates (20.8% v 28.3% p=0.04) and live birth rates
per cycle (15.2% v 21.5%) with IVF
Increased risk of preterm birth in IVF couples
 For couples,
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Higher rates of miscarraige in assisted reproduction AND
spontaneous conception
Sermondade N et al. Arch Intern Med. 2012;172(5):440-2.
Hakonsen LB et al. Reprod Health. 2011 Aug:8-24.
Pinborg A et al. Reprod Biomed Online. 2011 Oct;23(4):490-9.
Dickey RP et al. Fertil Steril. 2012;97(2):349-54
Boots C, Stephenson MD. Semin Reprod Med. 2011;29(6):507-13.
Addressing Obesity
 Huge factor for fertility clinics!
 Many have BMI limits for patients
 Have a program you can offer a referral for
 Be successful- ensure proper patient follow up
 Even better if you can use a Mediterranean-diet style program
Preconception Support
 Prenatal Vitamin
 Fish Oil
 Cal/Mag
 other
Prenatal Vitamin
 Provides key nutrient support
 Iron
 Calcium
 Folate
 Zinc
 Studies have demonstrated significantly improved
pregnancy rates in women on multiple micronutrient
supplements compared to folic acid alone. (66.7% vs
39.3% after 3 clomid supported cycles, 60% vs 25%
ongoing pg rate)
Agrawal R et al. Reprod Biomed Online. 2012 Jan;24(1):54-60.
Prenatal Vitamin
 Also associated with better birth outcomes than folic
acid and iron alone
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Birth weight
Pregnancy outcome
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Decreased rate of stillborn, miscarraige, and neonatal death
(nonsignificant trend)
Maternal micronutrient status
Sunawang et al. Food Nutr Bull. 2009;30(4 Suppl):S488-95.
Fish Oil and Men
 Fertile men have higher blood and spermatozoa
levels of omega-3 FA as well as lower serum omega6/omega-3 ratios compared to infertile patients.
 In men with oligoasthenoteratospermia (OAT),
supplementation with omega-3s
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Increased sperm count (from 38.7 to 61.7 million) and
concentration (from 15.6 to 28.7 million/mL)
Increased SOD-like and catalase-like activity.
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Positive correlation with increased sperm count, motility, and
morphology.
Safarinejad MR et al. Clin Nutr. 2010 Feb;29(1):100-5.
Sarafinejad MR. Andrologia. 2011 Feb;43(1):38-47.
Fish Oil and Women
 Increased dietary intake of omega-3 (esp. alpha-
linolenic and DHA) improve embryo morphology
with IVF/ICSI
Hammiche F et al. Fertil Steril. 2011 Apr;95(5):1820-3.
Stress Management
 Stress mediators can be both protective and
damaging. High levels of stress can lead to
“allostatic overload”, meaning a chance in stability of
physiological systems affecting fertility.
 The link between stress and female fertility exists
even independent of stress hormone levels
 Selye observed ovarian atrophy in response to stress
in rats. Additional studies have confirmed that
stress inhibits HPG axis.
McEwen BS. J Psychiatry Neurosci;30:315-8.
Sanders KA, Bruce NW. Hum Reprod 1999;14:1656-1662.
Berga SL. Reprod Endocrinol Surg Tech 1996. Lippencott-Raven, Philadelphia:1061-76.
Stress Management
 Stress hormones and HPA axis directly interact with
 GnRH
 Prolactin
 LH
 FSH
 Cortisol
 Endogenous opoids
 Melatonin
Stress Management
 In women, higher rates of infertility correlated with
follicular cortisol/cortisone ratios
 In men, increased stress has negative impact on
sperm quality and motility
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Loss of glutathione and free sulphydral content of semen
And/or inhibition of androstenedione into testosterone in
Leydig cells due to high ACTH and cortisol levels
Arcuri F et al. Endocrinology 1996;137:595-600.
Boivin SL. Reprod Endo Surg Tech. Lippencott-Raven, Philadelphia. Vol 1:1061-1076.
Eskiocak S et al. Hum Reprod 2005;20:2595-2600.
Klimek M et al. Neur Endocrinol Lett 2005;26:347-50.
Stress Management
 Group mind/body intervention increased IVF
pregnancy rates from 43% to 52% in women <40
about to start their first IVF cycle.
 “Letting go” counseling associated with improved
pregnancy rates with IVF (by 1.9 times)
 Many other psychological interventions showed
benefit
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Psychotherapy accompanying IVF
Benefit varied male/female
Domar A et al. Fertil Steril. 2011 Jun;95(7):2269-73.
Rapoport-Hubschman N et al. Fertil Steril. 2009 Oct;92(4):1384-8.
Acupuncture
 2012 Meta-Analysis of 24 trials (5,807 patients)
included
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Clinical pregnancy rate significantly higher in acupuncture
treatment groups
 Studies of RCTs have mixed results on outcomes, but
consistently report positive patient experience and
outlook
 Typically treatment surrounds embryo transfer
Zheng Ch et al. Fertil Steril. 2012;97(3):599-611.
Patient Education
 Eliminate/avoid teratogens and toxins which can
impair fertility
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Alcohol
Caffeine
Cigarettes
Pesticides
Pollutants
Endocrine-disrupting compounds
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Environmental estrogens
Improving Male Factor
Infertility
Semen Evaluation
 Best to evaluate 2 samples
 Samples obtained by masturbation after 2-5 days of abstinence
 Usually requires advance scheduling with the lab
 Kept body temp until analyzed
 Analyzed in under 2 hours, preferably under 1 hour
“Normal” semen parameters
According to WHO
Ejaculate Volume
Sperm concentration
Motility
Morphology
(WHO)
(Kruger)
Forward progression
Other
1.5-5.5 mL
>20 x 106 sperm
>50%
>60%,
>30%
>14%
2 (scale 1-4)
No agglutination
No WBC
Normal viscosity
Abnormal semen
 Low ejaculate volume
 Low sperm count (oligospermia, azoospermia)
 Poor motility (asthenospermia)
 Poor morphology
 Leukocytospermia
 Immunologic factors
Improving Semen Quality- conventional
HCG 2x/wk can stim cells within the testicles that
produce testosterone
Parlodel: Prolactin antagonist, can increase
testosterone prod.
Aromatase inhibitors: block conversion of test to
estrogen
Kallekrein: anti-inflamm protein can increase sperm
motility
 Usually, nothing is done- only one sperm is needed!
Sperm Health
 Growing evidence indicates that oxidative stress can
be a primary cause of male (and female?) infertility
 Oxidative stress
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Alters membrane fluidity
Alters membrane permeability
Impairs sperm’s functional competence
 Correlations of semen/sperm quality with
 Superoxide dismutase (SOD)
 Catalase
 Glutathione (GSH)
Atig F. BMC Urol. 2012 Mar;12:6.
Shamsi MB et al. Indian J Biochem Biophys. 2010;47(1):38-43.
CoQ10 and sperm parameters
 212 infertile men
 300 mg Kaneka CoQ10 vs placebo for 26 weeks
 Significant improvement in motility, concentration,
and morphology
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Greatest effect on motility
 CoQ10 has effect as antioxidant, and mitochondrial
energy production
Safarinejad MR. J Urol. 2009;182(1):237-46.
Balercia G. J Endocrinol Invest. 2009;32(7):626-32.
Carnitine and Acetyl-L-Carnitine
 Demonstrated efficacy in improving sperm motility
(total and forward)
 Improved seminal free-radical scavenging ability
 Carnitine and acetyl-L-carnitine both studied and
have positive effect (usually at dose of 3g/day)
Carnitine and Acetyl-L-Carnitine
 PCDBR trial
 60 infertile men, age 20-40 with low sperm motility (normal
count and morphology)
 LC 3g/d, ALC 3g/d, LC 2g/d + ALC 1g/d, or placebo x 6
months
 Motility significantly improved in ALC and LC+ALC groups
 Review of 9 RCTs
 Improvement in pg rate (p<0.0001)
 Total sperm motility (p=0.04)
 Forward sperm motility (p=0.04)
 Sperm morphology (p<0.00001)
Balercia, G et al. Fertil Steril. 2005;84(3):662-71.
Zhou X et al. Asia Pac J Clin Nutr. 2007;16(1):383-90.
Function of Carnitines
 Mitochondrial metabolism
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Controls transport of acetyl and acyl groups across mitochondrial
inner membrane
 Found in high concentrations in the epididymis, where
they exert antioxidant functions
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Protect spermatazoa from reactive oxygen species
 Seminal carnitine concentration associated with
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Sperm concentration
Total sperm count
Total motility
Rapid forward progression and linearity of movement
Membrane function
Nuclear DNA integrity
Capacity for cervical mucous penetration (after 6 months of tx)
DeRosa M et al. Drugs R D. 2005;6(1):1-9.
Antioxidants
 Selenium
 Zinc
 Vitamin A, C, E
 Pycnogenol
Stanislavov R. et al. Phytotherapy Res. 2009;23(3):297-302
Low sperm count
 Multivitamin
 Zinc
 Selenium
 Reduced glutathione
 Fish Oil
 CoQ10 (50-300 mg/day)
Atig F. BMC Urol. 2012 Mar;12:6.
Singh AK et al. Indian J Physiol Pharmacol. 2010;54(2):157-63.
Shamsi MB et al. Indian J Biochem Biophys. 2010;47(1):38-43.
Low sperm motility
 Zinc
 Reduced glutathione
 CoQ10 (50-300 mg/d)
 Carnitine and Acetyl-L-Carnitine, 3g/day total
Atig F. BMC Urol. 2012 Mar;12:6.
Shamsi MB et al. Indian J Biochem Biophys. 2010;47(1):38-43.
Low sperm morphology
 Glutathione
 CoQ10 (50-300 mg/d)
 Theoretically, antioxidants
Atig F. BMC Urol. 2012 Mar;12:6.
Shamsi MB et al. Indian J Biochem Biophys. 2010;47(1):38-43.
Other semen parameters
 Leukocytospermia
 Autoimmune reaction to sperm
Case Studies
 Joe O., Steven P.
Improving Female Factor
Infertility
POOR EGG QUALITY
PCOS
THIN UTERINE LINING
IRREGULAR CYCLES
RECURRENT MISCARRAIGE
Egg Quality
 As you would predict, oxidative stress also plays a
significant role in egg quality.
Poor Egg Quality
 Melatonin and IVF
 Italian study, 65 women undergoing IVF randomized to
receive myo-inositol and folate or the same combination plus
melatonin.
 Significant increased number of mature oocytes and decreased
number of immature oocytes (no difference in total number)
after GnRH stimulation in the melatonin group
 Positive trends in clinical pregnancy rate and implantation
rate (non-significant)
 Many studies have mirrored these results
Rizzo P et al. Eur Rev Med Pharmacol Sci. 2010;14(6):555-61.
Batioqlu AS et al. Gynecol Endocrinol. 2012;28(2):91-3
Poor Egg Quality
 Melatonin (cont.)
 115 women with history of failed IVF and low fertilization rate
(<50%) in previous IVF cycle
Melatonin 3mg/day or
 No intervention
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Fertilization rate significantly improved in melatonin group
only
Tamura H. et al. J Pineal Res. 2008;44(3):280-7.
Unfer V et al. Gynecol Endocrinol. 2011;27(11):857-61.
Poor Egg Quality
 DHEA
 Used by 1/3 of all IVF centers worldwide
 Improves ovarian function and ovarian reserve
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Promote preantral follicle growth and reduction in follicle atresia
Increases pregnancy rates with IVF
Lowers miscarriage rates by reducing aneuploidy, especially in
women over age 35
Gleicher N. Reprod Biol Endocrinol. 2011;9:67.
Gleicher N et al. Reprod Biol Endocrinol. 2009;7:108.
Poor Egg Quality
 DHEA
 Supplementation with 25 mg three times daily significantly
improved AMH (Anti-mulerian hormone) (p=0.002),
especially for women under age 38.
 Improvement of AMH was about 60% (p<0.0002)
 Longer use showed greater improvement up to 120 days.
 Significant increases in fertilized oocytes (P<0.001), normal
day 3 embryos (P=0.001), transferred embryos (P=0.005), and
improved embryo scores (P<0.001).
Gleicher N. Reprod biomed Online. 2010;21(3):360-5.
Barad D et al. Hum Reprod. 2006;21(11):2845-9.
PCOS
 Affects 10% of women of reproductive age
 Anovulation or irregular menses
 Elevated LH/FSH, elevated testosterone, elevated prolactin
 Current standard of care is insulin sensitizing agents
such as metformin, but metformin doesn’t enhance
ovulation in many patients.
 Studies have demonstrated superior effect of inositol
in:
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Sensitizing cells to insulin in PCOS patients
Restoring ovulation
Nestler JE. NEJM. 1998;338(26):1876-80.
Sturrock ND. Br J Clin Pharmacol. 2002;53(5):469-73.
Inositol and PCOS
 Phosphoglycan that mediates insulin action contains
d-chiro-inositol
 This phosphoglycan is deficient in PCOS patients
 Administration of inositol
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Improves insulin sensitivity
Improves ovulatory function
Decreases serum androgens
Decreases elevated blood pressure
Decreases elevated plasma triglycerides
Improves oocyte quality in women with PCOS
Galletta M. et al. Eur Rev Med Pharmacol Sci. 2011;15(10):1212-4.
Nestler JE et al. NEJM. 1999;340(17):1314-20.
Ciotta L. Eur Rev Med Pharmacol Sci. 2011;15(5):509-14.
PCOS
 Myo-inositol seems to perform better then d-chiro
inositol
 Standard dosage 4g/day
Galletta M. et al. Eur Rev Med Pharmacol Sci. 2011;15(10):1212-4.
PCOS
 Other useful therapeutics: vitex, licorice/peony
combination (shakuyaki-kanzo-to)
 In women undergoing clomid-supported cycles,
coadministration of N-acetyl-cysteine 1200mg/day
cd 3-8 showed improvement in ovulation rate (52.1%
vs. 17.9%), mature follicles, endometrial thickness,
follicular E2 levels, and luteal P levels.
Badawy A et al. Acta Obstet Gynecol Scand. 2007;86(2):218-22.
Thin Uterine Lining
 Common side effect of clomid, letrozole, and other
ovulation induction meds is a thinner endometrial
lining
 This can prevent proper implantation
 No research to support, but Shatavari can be helpful
to mitigate this effect.
Thin Uterine Lining
 Black Cohosh
 Studied in CC induction cycles
 134 women randomized to receive black cohosh (120 mg/day
of extract cd 1-12 or ethinyl estradiol (EE)
 Black cohosh group needed fewer days for follicular
maturation, had a thicker endometrium, and had higher
estrogen levels (P<0.001). Also, higher luteal phase
progesterone levels compared to EE group.
 Clinical pregnancy rates 36.7% compared to 13.6% in EE group
Shahin AY et al. Reprod Biomed Online. 2009;19(4):501-7.
Shahin AY et al. Reprod Biomed Online. 2008;16(4):580-8.
Cycle Abnormalaties: Luteal Phase Defect
 Defined by shortened luteal phase or inadequate
production of progesterone
 Timing is vital for proper implantation!
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Egg/embryo takes 7 days to get from ovary to implantation in
the uterus
Cytokine/prostaglandin cascade triggering menstruation
begins 3-4 days before menstruation onset
Need long enough luteal phase to allow for implantation and
continuation of progesterone synthesis by corpus luteum.
Cycle Abnormalaties: Luteal Phase Defect
 Animal models have suggested that oxidative stress
can impair ovarian development of corpus luteum,
leading to low progesterone.
 In humans, melatonin treatment (3 mg/day at
10pm) through the luteal phase increased serum
progesterone concentrations compared to
unmedicated group.
Noda Y. et al. Biol Reprod. 2012;86(1):1-8.
Taketani T. J Pineal Res. 2011;51(2):207-13.
Pregnancy Loss
Undisputed causes:
Parental chromosomal
structural abnormalaties
Antiphospholipid antibody
syndrome
Frequently cited causes:
Advanced maternal age
Luteal phase insufficiency
Untreated hypothyroidism
Hyperprolactinemia
PCOS
Diabetes mellitus
Uterine anatomic abnormalities
Unknown (likely immunologic)
Managing Miscarriage
 Many patients want workup sooner than medical
standard
After 1 miscarriage, likelihood of next pregnancy healthy is
76%
After 2, 70%
After 3, 65%
After 4, 60%
Work-up after 2 consecutive losses if no prior term
pregnancies, after 3 if prior term-pregnancy
Miscarriage
Fetal Stage
Timing
Key milestones
Contributing factors
Preembryonic
LMP to
week 4
Implantation
Genetic, implantation-related
(thrombotic, thin uterine
lining, low P)
Embryonic
Week 5-9
Organogenesis
O2 and nutrients
through placenta
Genetic, hormonal (low P)
Fetal
Week 10delivery
Autoimmune, thrombotic,
anatomic
Miscarriage
 No research supporting specific clinical interventions
for pregnancy loss, but consider your naturopathic
therapeutics
Suspected
Cause
Considerations
Genetic
Oxidative stress, toxic burden, etc
Thrombotic
Aspirin, blood-thinning herbs, omega 3s, etc
Immune
Evaluate possibility of food intolerance, manage with favorite
auto-immune protocol
Unexplained Infertility
TAKING A NATUROPATHIC LOOK
INTEGRATIVE TREATMENT OPTIONS
Unexplained Infertility
 Consider other compounding factors
 Food intolerance/celiac disease
 Chronic inflammation
 Toxicity (heavy metal or otherwise)
 Exposure to endocrine-disrupting compounds
 Stress
 Low nutrient status
 Emotional/spiritual state
 Institute the classic naturopathic tools!
Heavy Metals and Fertility/IVF
 UK study of 30 women with failed IVF history
 Hair mineral/metal analysis completed.
 Hair mercury concentration negatively correlated
with oocyte yield (p<0.05) and follicle number
(p<0.03)
 Hair zinc and selenium positively correlated with
oocyte yield (p<0.05) and follicle number (p=0.03).
Dickerson EH et al. J Assist Reprod Genet. 2011;28(12):1223-8.
It’s not just about getting
pregnant…
KNOWN AND SUSPECTED RISKS OF
ADVANCED FERTILITY TREATMENT
LOWERING THE RISK
Are there risks of fertility technologies?
 Most risk associated with greatest level of
intervention

IVF with ICSI
Bypassing mother nature’s limitations around who can conceive
 Manual selection of sperm based on gross morphology
 Either egg or sperm (or both) may not have been good enough
quality to conceive on own

Are there risks of fertility technologies?
 Obesity
 Female teens born through ICSI have significantly higher rates
of obesity (compared to spontaneous conception group).
Measured higher peripheral adiposity (skin fold measurement,
upper arm circumference) and central adiposity (skin fold
measurement, waist circumference), and total adiposity (BMI)
(p<0.05)
 Neither parental or early life factors could explain the differences
 Same trend not observed in males

Belva F et al. Hum Reprod. 2012 Jan;27(1):257-64.
Risk of ART
ART, especially ICSI, alters natural selection.
Increased rates of chromosomal abnormalaties
Increased rates of hypospadias, Angelman syndrome, Beckwith-Wiedemann
syndrome
Developmental delays and defects (subtle) have been reported. Increased rates
of ADHD, Autism. Could there be more?
The Bottom Line
Integration is KEY for Fertility!
 Naturopathic medicine provides effective fertility
support for most couples on its own; however,



Most couples are pursuing advanced fertility support
Success rates are low
Many safe and effective adjunct therapies exist that can allow
NDs to safely work with these couples.