Sex & fertility

Infertility: an alternative perspective

by Marcelle Pick, OB/GYN NP

When patients come to see me concerned about infertility, each woman has her own story, her own set of circumstances. The cause of infertility is different for everyone. We treat each woman individually, but they all get the same prognosis. The same one I’m going to give you right now. No matter where you are in the fertility process, if you continue to want to move forward, you will arrive at your destination: a child.

I don’t know right now how you’ll get there. Your path may have many twists and turns and maybe some setbacks.  You may find success in the natural methods described in this article. You may require assistance from a specialist, infertility drugs, or in vitro fertilization (IVF). Maybe you’ll decide donors, surrogates or adoption is the best course. But the important thing is that barring any extraordinary event, I firmly believe that every dedicated parent will hold a child in her arms at the end.

Modern technology has been the answer to many prayers and, despite being an alternative health practitioner for over 25 years, I am a big supporter of doing whatever you can to facilitate a pregnancy, even if it means temporary drug treatment and/or surgical procedures. There is no right or wrong way to make or adopt a baby, as long as you and your partner fully understand your treatment options in the context of your whole health picture — and that includes financial health. Natural approaches, including optimal nutrition, detox (both physical and emotional) and alternative techniques like acupuncture can be very successful as an enhancement to high-tech fertility measures or as a course of action in and of themselves.

So let’s talk frankly about this loaded topic. I want you to know as much as possible so you and your partner can make informed decisions and take control of your fertility.

Infertility treatments: first things first

It’s always good to ask yourself a few basic questions as you consider your options:

Will this be your first pregnancy? Different factors may come into play if you are experiencing primary infertility (no previous children) or secondary infertility (you have other biological children).

How old are you? Thirty-five is the magic number in conventional medicine (though, for a broader perspective, see below). If you’re under 35 and have been trying to get pregnant for over a year, or you’re over 35 and have been trying for over six months-it’s time to find out why.

What is your heart’s desire? Do you absolutely have to have a biological child that carries both you and your partner’s genes? Would donor eggs/sperm or surrogates be acceptable? Do you just want a child, even if it is not biologically related to you? This is not an all-or-nothing question and your answer may change during the process. However, if you are willing to adopt a child, this is a good thing to know at the outset.

What are your resources? The cost of infertility treatment is notoriously expensive, and it may take several tries before you are successful. Do you have enough savings at your disposal to solve this problem or are your finances limited? Be honest in this assessment! You won’t have an easy time raising your child if you ruin yourself financially.

What is your medical history? The first thing your doctor should do is rule out any existing medical conditions that may be contributing to infertility issues, including polycystic ovarian syndrome (PCOS), hypertension, diabetes, and thyroid problems. Clearing up or controlling these issues will go a long way toward helping you get pregnant. It’s also important to keep in mind your nutrition levels and detoxifying capabilities. If you are evidencing symptoms of hormonal imbalance, inflammation or GI distress, don’t overlook them.

What are your limits? Do you have a clear idea of your boundaries? For some it is drug therapy, for others it is surgery, for others it’s donor gifting. Fertility doctors want you to be happy and they will use whatever methods available to try and do so. It is up to you to work with them and sketch out your plan ahead. You can always change your mind, but you need a plan.

And a useful place to begin is at the crossroads of pursuing a biological or adoptive strategy. Both cost money, and for couples with limited funds or time, the choice may need to be made sooner rather than later.

Adoption

For many couples, adoption is their first choice. For others, adoption becomes the right choice when other options are unsuccessful. And for others, both paths may be followed simultaneously. If adoption is interesting to you, there are legions of counselors and adoptive parents out there to guide you. I want to remind you that there are many children in the world who desperately need a loving parent. Rising to this need creates a powerful bond that rivals a biological bond. Families are created with attention, time and emotional availability — not blood. Your biography becomes your biology, which means parents are as important as genes. And I don’t know of any parent who has ever regretted adopting a child.

It’s wise to think about this option early, even if you intend to pursue having a biological child, because adoption can take months or years. You have two choices with adoption, state departments or private agencies. Adopting through your state is much less expensive, but the process can take a decade. You have the option of putting your name on the list while you try other measures — you can always take it off later. Different states may have different rules, so check first.

Most approaches to becoming a mother take time, and that is precisely what many women have very little of. Still, a woman in her 40’s should not put herself out of the game by any stretch. After all, there is a difference between chronological and biological age — something many healthcare practitioners don’t take into account when they talk about “old eggs.”

“Advanced Maternal Age”: Do eggs really get old?

For the past 50 years or so, science has told us that all mammals are born with a certain number of eggs and that they decline as we age-both in number and viability. This, and declining fertility rates, is where the idea of a biological clock comes from. Women say to themselves “I’d better get pregnant now, or my eggs will be too old and worn out to conceive.” New research may prove that theory wrong. Preliminary studies have shown that our ovaries have specialized stem cells which may be capable of creating more eggs throughout our lives. So far, the studies have been restricted to female mice, and more research is necessary. But the news brings hope.

Also, keep in mind that statistics on abortion show that the bulk of women seeking abortion are either in their 20’s or 40’s! Of course their reasons are individual, but these numbers prove that being 40 and up does not put you out of the game. It just may take a little more effort. Menopause is the true end of reproductive potential, not any particular birthday.

Unfortunately, older women do have more of an uphill battle. It’s beyond doubt that as an egg ages, it is more and more likely to develop chromosomal defects and abnormalities. The older an egg is, the less likely it is to divide properly. And it’s not only the first days of conception that we need to consider, but a woman’s ability to carry the baby to term. Women in their 20’s only have about a 15% chance of miscarriage, while women over 40 have a 50% chance. So, if you are over 40 and have been trying to get pregnant for a year with no success — or if you are miscarrying repeatedly — you may want to give serious consideration to donor eggs or sperm to increase your odds. If you are currently undergoing IVF, ask your doctor about the viability of your eggs.

Nurturing your eggs means thinking about them months before they are released — as they do in Eastern medicine. Western fertility specialists deal with eggs in the narrow window between development and ovulation. Other modalities like Traditional Chinese Medicine approach the follicles 120 days before ovulation, while the egg is still developing in the ovary.

Secondary infertility: is it adhesions?

Forty percent of infertile women suffer from a blockage in one or both of their fallopian tubes. This is the leading cause of secondary infertility, when you can’t conceive after already experiencing an intervention–free pregnancy and birth. The blockages can happen for any number of reasons. Adhesions and scarring can occur following infections, endometriosis, trauma, abdominal or gynecological surgeries, including C-sections — but the good news is that they are physical. They show up on diagnostic tests, specifically one called a hysterosalpingogram (HSG). Once identified, we can treat them successfully 60–70% of the time.

If your doctor confirms you have a blockage, he or she will probably schedule you for laparoscopic surgery. The procedure is quick, minimally invasive, and enjoys high success rates depending on the extent of tubal damage. Some patients opt to forego the surgery and pursue IVF which bypasses the damaged tubes entirely.

The Wurn Technique is an alternative to surgery that uses manual massage to find where soft tissue has become stiff or painful and break up the adhesions. The treatments are private and last about one hour. How many sessions you may need depends entirely on your own body and how many obstructions need to be cleared. Clinical tests show that 71% of women who received treatments conceived naturally within one year. Women who received treatments prior to IVF experienced a 67% pregnancy rate — much higher than normal. You can find out more about this procedure at www.clearpassage.com.

Both surgery and the Wurn Technique have about the same success rate, but surgery can be performed faster and closer to home. There are only a handful of Clear Passage clinics in the United States, but if you have the time and can get there it may be useful to investigate a nonsurgical approach. After all, pelvic surgery can also cause adhesions.

And remember that the egg is only half the story. Sperm counts, too!

Men and infertility

Female infertility isn’t the only concern. Twenty percent of diagnosed infertility stems from the male partner alone. In another 30–40%, the difficulty is a combination of both male and female physiologies. Preexisting medical problems, poor nutrition, and emotional issues can all affect your partner, too. Make sure he is included in any fertility discussions and lifestyle adjustments — whether he is your partner or a donor.

Sperm issues
Probably the most common male fertility problem is low sperm count or mobility. Sperm count studies around the world confirm that the average count in 1950 was 100 million per mL. In 1990 that number declined to 50 million. The most startling declines were in Western industrialized nations. Many environmental factors, like increased exposure to pesticides, radiation, and other endocrine disruptors have been blamed for reduced male fertility. But whatever the cause, these days a man is in the normal range if he has as few as 20 million sperm per mL.

Now, just because your partner or donor has a low sperm count doesn’t mean he can’t father a child. A man with a sperm count of five can still impregnate a woman, it’s just much less likely. So, the goal is to do everything possible to make sure the sperm he does have are healthy and mobile. Lifestyle choices can go a long way toward healthy sperm. The father should refrain from illicit drugs, especially marijuana, cocaine, and steroids. He should stop smoking cigarettes and heavy drinking. Excessive heat in the testicles, such as from a high fever, tight underwear, obesity or soaking in a hot tub, can affect sperm quality, as can some medications such as calcium channel blockers (prescribed for high blood pressure). Your partner should ask his doctor if any of his medications could be an issue. If you are choosing a donor, investigate his lifestyle and health history as thoroughly as you can.

Remember, a man is constantly making new sperm. And an unhealthy choice or illness he experiences today will affect the sperm being made ten days from now. So, these changes need to be integrated into his daily life, not just followed now and then.

Your partner’s emotional concerns
It’s easy for women to feel like the only victim during fertility procedures. After all, you are the one who has to go through all the pelvic exams, needles, scans, and surgeries. But be mindful, if you can, of the affect the process has on the father. Donating sperm may seem like a walk in the park compared to what a woman goes through, but it is more strenuous than you might expect. 

First of all, men don’t donate a “little” sperm. A man who is undergoing fertility treatments with his partner must ejaculate over and over “on demand,” whether or not he feels like it. He may feel embarrassed, violated, or just plain incapable when asked for the tenth time if he wants a movie or a magazine. He may doubt his own masculinity and potency. He may feel like he is to blame for all the pain and heartache you are going through. He may think he doesn’t deserve a child, and so feels guilt over denying you what you want most.

And this goes for lesbian couples, as well. You don’t have to donate sperm to feel the emotional wages of infertility. Female partners can feel estranged from the process, undeserving, or conflicted. If her egg is not used, she may have some trepidation about her role as a parent.  However, keeping communication lines open allows couples to focus on taking care of each other.

Talk to your partner often. You’re both in this together, and the more you communicate with each other, the easier it will be.

Infertility and stress: the emotional toll

I hesitate to even bring this issue up. Women are so tired of hearing “just relax and let it happen.” Sometimes it works. Sometimes it doesn’t. Stress is a fact of life. How you cope with it affects your health, and yes, your ability to reproduce. I think there is a lot we don’t know about the miracle of life; we’ve all heard stories of previously infertile couples who conceive naturally within days of bringing home their adopted child. This is rare, but certainly possible.

The whole process of becoming a parent is an emotional rollercoaster in the best of circumstances. When you are having trouble, your emotional history becomes even more important. The mind wields incredible power over the body and women coping with infertility can become overcome by negative thoughts. Most women feel they are the only ones who’ve ever felt this way, but in fact, these worries are incredibly common. Do you recognize any of this negative self-talk?

• I’m being punished by God
• I was abused as a child. What if the same things happen to my own children?
• The world today is so dangerous. Should I really subject an innocent child to this place?
• I’m afraid my husband won’t find me sexy any more/won’t love me once I’m pregnant.
• What if there’s something wrong with the baby? Will I be able to handle it?
• I’m gay. Gay people shouldn’t have children.
• If I were a better person, I would be able to have a baby.
• My husband has a bad temper, what if he hurts the baby?
• Will sex ever be fun again?

Another very common thought among infertile couples is If I can’t have a child, what am I here for anyway? Women who struggle to conceive often feel inadequate, and our culture reinforces that feeling. The fact is that anyone who is actively seeking to raise a child is fertile, even if her reproductive organs are not. As I mentioned before, we have a saying at Women to Women that “your biography becomes your biology.” This means that your emotional and personal history directly influence your physiology. So delving into your buried emotions may be just what your body needs. For more on this powerful connection, please see our article on how the mind/body connection affects fertility.

You can explore your feelings through talk therapy, meditation, prayer, journaling, talking to a trusted friend or clergyperson.  I’ve seen great success with the Emotional Freedom Technique (EFT). Another option is called the Quadrinity Process or the Hoffman Process. It’s an eight–day retreat where you use guided visualization, journaling, and other cathartic exercises to explore childhood experiences and conditioning which may be affecting your current behavior.

How to enhance your fertility naturally

If you have determined that you want to try and have a biological child, there are many considerations to keep in mind as you go through the maze of fertility treatments. And while no one can absolutely guarantee your success, doing all that you can to enhance your fertility with proper diet, lifestyle and complementary therapies can really boost your chances. Whatever age you are, a healthy body is more likely to receive and nurture a fertilized egg. Getting healthy doesn’t happen overnight, so the sooner you start, the better.

• Get on a pre-natal multivitamin. This is standard procedure for any couple wanting to get pregnant. And don’t forget the father! If he (or a donor) is contributing sperm, maximize his nutrition as well, especially his zinc status.



• Quit using stimulants like caffeine, alcohol, and nicotine Cigarette smoke (including secondhand smoke) has been linked to spontaneous miscarriage, accelerated egg loss and menopause, and the inability for ovaries to produce estrogen. Smokers require twice as many tries at IVF before they are successful. Women who smoke are more likely to have ectopic pregnancies, low birth weight babies, and episodes of SIDS. Men who smoke have lower sperm counts. Many studies have shown that caffeine consumption is related to infertility. Caffeine is also linked to insulin resistance, which can halt ovulation. Studies performed on rats and humans suggest a link between heavy alcohol consumption and lower fertility rates. Other studies show that women who drink alcohol while pregnant pass abnormalities on to their babies, known as fetal alcohol syndrome.



• Cleanse your system.  Before you get pregnant, do a gentle detox like the one we describe in our quick-cleanse plan. Start eating organic food whenever possible and steer clear of toxic cleaners and solvents.  Just by being alive today, you are inundated with manmade chemicals that can wreak havoc with your hormones and other vital systems. Endocrine disruptors, certain types of chemicals which mimic hormones in the body, are especially troublesome when you are trying to conceive. Do what you can to reduce your body burden by avoiding obvious sources of contamination. Read the labels on everything, from cosmetics and soaps to garden fertilizers and air fresheners. Replace plastics with natural substances like glass or wood. Never microwave in plastic containers or wraps — in fact, you may want to forego the microwave altogether. In addition to obvious sources of contamination, you might also look into disruptive organisms. Systemic Candida, parasites or bacteria can alter your hormonal balance and decrease fertility. So work with a qualified practitioner to see if this is a piece of the puzzle.



• Get more exercise — or less. BMI plays a significant role in fertility. A woman with 10–15% excess body fat may have an estrogen imbalance which can cause ovulation problems. On the other hand, body fat levels at 10–15% below normal may completely disrupt a woman’s cycle. If you have irregular or nonexistent periods due to excessive or strenuous exercise, consider reducing your activity or adopting a gentler form of exercise like yoga or qi gong.



• Reduce stress wherever you can. This is good advice for anyone, whether or not they are trying to have a baby. Everyday stress is at the root of many conditions and diseases, including fatigue, weight gain, depression, headaches, and you might as well add infertility in there, too. Studies have shown direct links between the adrenal gland, which is responsible for your stress response, and ovulation. Elevated cortisol levels in your blood can cause you to stop ovulating, a condition called anovulation. Environmental, emotional, and physical stress are also known to cause low sperm counts. The fact that many couples have to schedule sex doesn’t help matters. You and your partner may feel like slaves to your ovulation calendar and temperature charts — hardly a low-stress approach. So, I recommend postponing the charts and schedules as long as possible.



• Restore your hormonal balance. The older you are, the more crucial it is to have good hormonal health if you want to conceive. As you creep toward menopause, your body is preparing itself to not have any more children. If you are imbalanced, it may manifest as missed or irregular periods and ovulation cycles. Using bioidentical progesterone support for a few months may help your system kick back into regular cycles by restoring the right ratio of progesterone to estrogen. Talk to your healthcare practitioner if you think this may apply to you. Also, cutting down on simple carbs, refined sugars and processed foods will help balance your insulin levels and boost your metabolism, which will help when you try to balance your sex hormones. Remember, you can’t balance the minor hormones (estrogen, progesterone and testosterone, for example) without first balancing your major hormones (insulin and glucagon).



• Try an alternative therapy. Homeopathy, naturopathy, Ayurvedic and Traditional Chinese Medicine use ancient techniques, such as herbal remedies, cleanses, and acupuncture, to increase fertility. These approaches usually work best if both partners (producers of egg and sperm) are involved. These methods treat each individual holistically, trying to balance specific deficiencies and increase your life force. (In TCM, this is called qi; in Ayurvedic medicine it is referred to as prana.) In TCM, practitioners will also assess the nature of the energy flow between a couple and adapt their treatments accordingly. These techniques have helped people become parents for millennia and can be undertaken in addition to any other measures.

You’re more in control than you think

Just as infertility is usually a combination of causes, the path to conception usually takes a combination of changes, treatments and options. Don’t be afraid to combine the ancient with the modern, or the natural with the high-tech. As I said before, your way will be individual. Finding the right professionals to guide you may be critical. I’ll give you a simple shortcut right here: stop worrying about what–ifs and start acting. Know down deep that you will be a mother if you truly want to be. Your fertility is not tied to your reproductive organs. To truly accept this you may have to rewrite the script in your head, but you are strong and you will get there — and we are here to help.

Taking control of your needs and your whole health picture can do wonders in terms of fertility and in every aspect of your life.  Feel free to explore the health-related topics women ask us about most.

Related to this article:

References & further reading on infertility

 

Original Publication Date: 10/26/2006
Last Modified: 02/16/2010
Principal Author: Marcelle Pick, OB/GYN NP