Integrative fertility care
April 2013
In healthcare today, reproductive health is generally focused on ways in which pregnancy can be delayed or avoided.
Standard healthcare has a wealth of advice on contraceptive planning for women and men and obviously this is a vital consideration in any individual’s total health program and wellbeing. However, with so much focus on pregnancy planning being about ‘not falling pregnant’, there is a need for much more involved education around ‘falling pregnant’.
Preconception health, conception and pregnancy care are critical and demanding times in a prospective parent’s lifecycle. Often the search for answers, or for healthier ways of enhancing fertility, is sparked by an inability to conceive. For many couples this opens a doorway to the world of IVF treatments, but there are many lifestyle factors that can be addressed to enhance the couple’s efforts and improve chances for a healthy baby.
Infertility is defined as the failure to conceive after one year of trying without any form of contraception, or the inability to achieve a live birth. It is a situation that affects one in six Australian couples. In 35 percent of cases, the factor(s) contributing to infertility can be identified as part of the woman’s reproductive situation, and in 30 percent of cases, the man’s – so in 35 percent of cases, issues remain unknown. For many people experiencing infertility, the pathway leads directly to Assisted Reproductive Technology (ART). In vitro fertilisation (IVF) is a well-known term associated with ART and is just one of the procedures that can be used depending on the particular circumstances of the infertility identified. In 2008, around 62,000 cycles of IVF were undertaken in Australia, and this figure grew by 50 percent in a four year period. The success rates for IVF are around 20 percent, the definition of success being a live birth. For any typical ‘fertile’ couple not involved in an IVF program, the chance of falling pregnant is around 25 percent in any one month. Apart from the significant financial cost of IVF cycles (around $6,000 per cycle), there are also enormous emotional and physical challenges that can accompany such procedures.
Integrative Medicine has long been recognised for its validity in disease prevention and treatment. A fundamental principle of Integrative Medicine advocates a healthy lifestyle, which is essential to every age in a person’s life. By adopting an integrative approach to fertility in the lead-up to, and during, pregnancy we can optimise the chances of pregnancy as well as the health of a child before they are even born. For those who are faced with infertility or challenges becoming or remaining pregnant, the integrative approach offers many ways to enhance or support ART strategies, and includes many evidenced-based complementary therapies, in particular from the disciplines of Chinese Medicine (TCM) and acupuncture. Both men and women can benefit from an integrative approach to reproduction.
Approximately 70 percent of all people use at least one complementary therapy for a spectrum of health concerns each year in Australia. In a UK fertility clinic, around 40 percent of women had used some form of complementary therapy in addition to conventional care. In Australia, a study showed 66 percent of women in a fertility clinic were using complementary therapies. There is significant opportunity for new ways of approaching fertility care through lifestyle change.
Lifestyle risk factors for infertility
• Age. Women over age 35 may experience infertility, and take longer to fall pregnant. Men also experience a decline in fertility after age 30.
• Poor lifestyle factors. Such as shift work, sleep disorders and amount of sexual activity all play a part in infertility.
• Psychological factors/emotional stress. Reproductive hormones can be severely disrupted during times of stress.
• Excessive exposure to toxins. Chemicals, heavy metals and toxins burden the reproductive system, compromising sperm and ova quality and causing reproductive disorders.
• Smoking. Creates oxidative stress and DNA damage in sperm and ova and has detrimental effects on the uterus and the embryo.
• Lack of physical exercise. In females, a sedentary lifestyle has a direct effect on the menstrual cycle and fertility. Excessive exercise generally increases the chance of infertility. In males, a sedentary lifestyle may impair sperm production. Excessive physical activity (more than 90 minutes per day) may actually lower sperm production in men compared with more moderate exercise activity. The compounding effect of obesity as a result of lack of exercise is another negative factor for both women and men.
• Underweight or overweight. A body mass index (BMI) between 20-25 is optimal for fertility.
• Poor dietary habits. High consumption of trans fatty acids is linked to infertility. Low-fat dairy foods may be problematic. The ethanol in alcohol is detrimental to fertility in both men and women and high level caffeine consumption can be associated with a temporary reduction in conception.
• Nutrient deficiencies. Selenium, B group vitamins including folate, vitamins C, E and D, iron and zinc deficiencies affect fertility. Amino acids such as L-Arginine, L-Carnitine, co-enzyme Q10, glutathione and lipoic acid are all associated with infertility as they influence sperm quality in men and fertility in women.
Some of the most effective, evidence-based integrative treatments for fertility care are:
THE FERTILITY DIET
The ‘fertility diet’ has been proven in research to lower the risk of infertility. It includes a lower intake of trans fat (found in commercially baked and fried products such as fries, burgers, chicken nuggets, corn chips, doughnuts, cakes and pastries), higher intake of monounsaturated fat (such as olive oil), lower intake of animal protein, and higher vegetable protein intake, as well as high-fibre, low-glycaemic carbohydrates, and optimal iron intake.
Omega 3 intake is vital (through low mercury-containing fish consumption or supplements) and supports healthy brain development in utero, which translates to higher IQs in children.
VITAMINS AND MINERALS
Vitamin D levels play an important role in human reproduction, according to the European Journal of Endocrinology. For men, vitamin D supports healthy sperm development and increases testosterone levels. For women, it influences the hormones, regulates menstrual cycles and has a positive influence on endocrine disorders such as endometriosis and polycystic ovary syndrome. It can improve IVF outcomes. The ‘sunshine vitamin’ virtually influences every cell in the human body, the deficiency of which is linked to many health conditions, making it an essential vitamin for every stage of the life cycle.
Multivitamins can provide essential B group vitamins and some can provide adequate folate. Testing for iodine deficiency is recommended.
Zinc is an important mineral for both men and women. It is involved in more than 80 enzymes to do with DNA and protein synthesis. It can enhance immunological function and hormone metabolism and is important not only for pre-conception and conception, but also for pregnancy as well. Zinc is also connected to collagen production and healthy zinc levels can influence the extent of ‘stretch marks’ experienced. A zinc deficiency can reduce the body’s capacity to counter the toxicity of heavy metals such as cadmium, lead and mercury, which have well established associations with infertility, so it is important to optimise zinc levels in both partners as an essential part of integrative preconception healthcare.
The antioxidants, vitamin C, vitamin E, lycopene and selenium, are also important and can be sourced through food or as a supplement.
Supplementation of the above micronutrients leads to lower infertility rates, fewer miscarriages, fewer birth defects, and less incidence of learning difficulties, so they are essential for the mother-to-be, and important to consider for the whole family as part of an ongoing health strategy.
TOXICITY
There are over 80,000 chemicals now in regular use in our world and many of them are hormone disruptors. Research by the Environmental Working Group has suggested that babies are born today with 287 chemicals detectable in the umbilical cord (which means bloodstream).
Pesticides, paint solvents and even household cleaning products can be reviewed and replaced for low-toxic options in households where pregnancy is desired.
An astonishing percentage of chemicals are not tested for how they impact the human reproductive system. Be vigilant also for PFCs (perfluorinated compounds), which, for example, are in non-stick cookware, carpet treatments, food wrappers, stain-proof treatments and fabric protectors. Bisphenol A (BPA), an estrogen-like compound that has drawn increased scrutiny in recent years, has been linked to changes in thyroid hormone levels in pregnant women and newborn boys, according to a recent study at the University of California. Removing the prevalence of chemicals in the home is necessary to reduce the risk of infertility disorders.
TCM AND ACUPUNCTURE
Couples with fertility problems were twice as likely to get pregnant after using traditional Chinese Medicine (after four months of treatment) when compared to Western medicine, research conducted at Adelaide University found recently. The study found TCM treatment was far less expensive and less stressful than conventional treatments and could be readily incorporated into an integrated care plan for those undergoing ART. Acupuncture is an important component of TCM healthcare, which also includes herbal preparations and dietary therapies. (Herbs such as Vitex and Maca [although not TCM] can also influence fertility through improving hormonal balance. Advice should be sought from a health professional as many herbs are contraindicated during pregnancy.)
Integrative fertility care starts well before the conception of a healthy baby and is recommended as a foundational health approach for both parents. It provides essential starting blocks for happy healthy children, and in those couples with infertility it provides support for conventional treatments such as IVF. Integrative Medicine also offers a best practice approach for family health well beyond the birth.’
Professor Avni Sali is Founding Director of the National Institute of Integrative Medicine (NIIM). He oversees the facilitation of the practice of Integrative Medicine at the NIIM Clinic in Hawthorn, as well as the promotion of education and research.
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