NATURAL FERTILITY

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• NATURAL FERTILITY WOMENS HEALTH CENTRE (Auck)
• Loula George BSc, ND, Dip Herb.Med
• Sheran Marra ND, Dip.Herb.Med
• Midwives Collective Integrated Health Centre

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• AIMS
• outline Preconception Care Programme
• causes of infertility from a naturopathic
  perspective
• integrated approach to fertility problems
• demystify natural health methods

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The Fetal Matrix We have learnt how subtle
changes in what women eat from before they get
pregnant and through pregnancy have influences on
their offspring. Professor Gluckman (Liggins
Institute, Auckland)
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• Factors contributing to increasing levels of
  infertility
• Stress
• Poor diet/nutrition
• Sexually transmitted diseases and
  genito-urinary infections
• Pollution
• Drugs
• Radiation
• Previous use of contraception programmes
• Greater age of prospective parents
• Toxicity
• Immune system failure
• Hormonal imbalance

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• CAUSES OF INFERTILITY
• 40 female
  
• 40 male
• 20 unexplained
• Unexplained infertility may be associated with
• toxins
• immune reactions
• nutritional deficiencies
• inflammation
• stress/HPA activations

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STRESS Infertility major stress Undermines
effective functioning of the immune system,
adrenals, digestion and hormone balance all of
which contribute to the fertile state. Cortisol
Suppresses Thyroid Hormone Release Cortisol
stimulates cGMP production in the thyroid gland
and inhibits thyroid hormone release. Cortisol
reduces pituitary responsiveness to TRH and the
thyroid gland sensitivity to TSH. J.Investig. Med
2001 July 49(4) 330-4
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Hypothyroidism Impairs Fertility In
hypothyroidism, the elevated thyrotropin
releasing hormone TRH may stimulate prolactin
secretion in addition to thyroid stimulating
hormone (TSH). Prolactin suppresses the release
of LH and FSH. Correction of the hypothyroidism
reduces the production of prolactin and releases
suppression on LH, FSH and ovulation. BMJ 327,
Sept 2003 546-549 Stress Reduces Success of
IVF A prolonged condition of stress, which causes
a decreased ability to adapt and transitory
anxious state, is associated with high amounts of
activated T cells in the peripheral blood. Such a
condition in turn is associated with reduced
implantation rate in women undergoing
IVF. Fert.Steril.2001 July 76(1) 85-91
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Case Study 1 Sheryl (30 yrs) teacher Conception
attempts for 2 years unsuccessful. Generally
healthy but suffered with irregular cycles (long)
and work stress seemed to be a major factor.
Given dietary advice and nutrient support for
fertility. Recommended charting temps and mucus.
After 6 months of charting, it became very clear
that during stressful school terms her ovulation
was delayed but ovulation regulated during
holiday times. This information was essential in
validating her decision to stop work for up to 6
months to try for a successful conception .(She
had managed to conceive but it was during an
ovulation that occurred on Day 23 of her cycle
and she miscarried.) Two months after she stopped
work she had had two 28 day cycles before she
conceived and went on to have a healthy baby.
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POOR DIET/ NUTRITION Nutritional status
preconceptionally, during pregnancy and
breastfeeding has a profound and direct affect
upon fertility and embryonic health. Multivitamin
Use Reduces Birth Defects Use of multivitamins
from 3 months prior to pregnancy through to the
end of the first trimester were associated with a
7 reduction in the risk of multiple birth
defects in a Western metropolitan
population. Paediatrics 2002 109 904-908
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Use of Multivitamin/Mineral Prenatal Supplements
Influence on outcome of pregnancy. Preterm
delivery (lt33 weeks gestation) reduced more than
fourfold for first trimester users and twofold
when use was from second trimester. Risk of low
birth weight was reduced approximately twofold
with supplement use during the first and second
trimester. Supplements have potential to diminish
infant morbidity and mortality. Am J Epidemiol
1997 146 134-41
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Case Study 2 Rosanne 35 yrs Presented with a
history of 3 early miscarriages. Her health
concerns were abdominal bloating, loose bowels,
chronic anaemia. Recommended a coeliac screening
test but conceived once more inadvertently before
health issues were addressed and had 4th
miscarriage. Had gliadin antibody test and
intestinal biopsy which confirmed coeliacs. Also
had hair analysis which showed very low mineral
status( including iron.). Treatment plan was to
stop all gluten and dairy, went on nutritional
supplementation for 2 months. Conceived again and
went on to have a very healthy daughter.
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Folic acid and Zinc Improve Male Subfertility A
double-blind placebo controlled study showed that
zinc and folic acid supplementation in subfertile
men resulted in a 74 increase in the number of
normal sperm. Fert. Steril 2002 77,
491-8 Antioxidants Counteract the Effect of
Ageing on Oocyte Quantity and Quality. In mice,
both early and late onset administration and oral
antioxidants C E counteracted the negative
effects of female aging on number of oocytes and
percentage with normal chromosome structure. Mal
Reprod.Dev 2002 61 385-397
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Studies on ROS and Male Fertility n 139
couples Men with high levels of ROS generation
had 7 times less chance of conception compared
with men with low ROS levels Am J Obstet Gynaecol
1991(164542-510) n 18 infertile
patients 16(88) had higher ROS production and
lower AO levels compared to fertile
controls. -authors stated this ROS/AO imbalance
was a major factor in idiopathic male
infertility. -other studies estimate ROS are a
feature of 25-40 of infertile male
population. J. Urology 1997 157?140-3)
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• ZINC
• 74-83 of females of reproductive age did not
  receive the RDA and 67 of men didnt.
• 1983 Aust. Diet Survey
• Zinc deficiency causes reproductive dysfunction.
• Zinc required for
• progesterone production
• FSH and LH secretion
• ovarian development
• reduces risk of miscarriage, birth defects,
  premature labour, pre eclampsia, inefficient
  labour and stretch marks
• spermatogenesis
• testosterone production
• sperm count, motility, morphology and longevity

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CoQ10 Supplementation Increases Fertilisation
Rates A study of men with idiopathic
asthenozoospermia undergoing ICSI showed that
addition of CoQ10 to sperm prior to injection
almost doubled their motility rate. Oral
supplementation (60mg/day) of CoQ10 leads to a
marked increase fertilisation rates. Mol. Aspects
Med 1997 18521-9 Magnesium is Necessary for
Estrogen Activity Trials show that magnesium is a
key regulator of the binding of estrogen
receptors to their ligands. A deficiency of Mg is
associated with a reduction in estrogenic
activity. This demonstrates that Mg deficiency
may be associated with fertility problems. J.
Biochem(Tokyo) 198495(4)1227-30
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• INFECTIONS
• GUIs and some other infections such as
  Toxoplasmosis and Cytomegalovirus can cause
  miscarriage, infertility and fetal health
  problems.
• Comprehensive testing and treatment to be
  carried out before conception.
• Female swabs to be taken HIGH INSIDE the
  cervix. Vaginal swab insufficient.
• Antibiotic therapy may be necessary (repeat
  tests to confirm absence of infection). If so,
  must be accompanied by immuno-supportive herbs
  and probiotics.
• Many infections obvious, some, e.g.
  Ureaplasma/mycoplasma, subclinical and very
  common.
• Severe repercussions include repeated
  miscarriage, reduced fertility, birth defects,
  neotnatal morbidity and mortality.

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FORESIGHT Screening for UTIs Both partners are
checked out for the following infections prior to
conception. GUIs gonorrhoea Anaerobic
bacteria B Strep
Staph aureas Chlamydia
Haem influenza Haem Strep
Mycoplasmas Enterococcus
Ureaplasmas Klebsiella
E.Coli Candida
Gardinerella Herpes Other
Toxoplasma, CMV, Rubella immunity Serological
tests for detecting GUIs could form a routine
part of infertility investigations as well as
screening following miscarriage or premature
birth.
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MYCOPLASMAS A considerably higher incidence of
spontaneous abortions, prematurity and neonatal
morbidity and mortality has been reported among
mothers with positive mycoplasma cultures
compared to mothers with negative cultures.
Mycoplasmas have also been found to be a cause
for infertility. Cassell Waites. Venereal
Mycoplasma Infection. CHLAMYDIA INFECTIONS IN
MALES 71 infertile men were screened for
chlamydia and findings were compared to 56
fertile men. Chlamydial IgA antibodies were found
in semen of 51.9 of infertile men compared to
23.2 of fertile men. Chlamydial infections can
affect male fertility.
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Case Study 3 Paula 39 years 10 years of
infertility. Paula was generally healthy with the
exception of undiagnosed cystitis-like
symptoms.She had had many different treatments
both allopathic and alternative with no success
to date. Recommended screening for all GUIs
including mycoplasma/ureaplasma. Found mycoplasma
3 from high cervical swab. Treated with
doxycycline, three rounds before treatment was
successful (included herbal antimicrobial support
and probiotics). After second lot of antibiotics
her cystitis-like symptoms were gone and one
month after infection had cleared completely she
conceived and had a healthy child. Cystitis-like
symptoms never returned and 2 years later she
conceived her second child.
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POLLUTION From environmental, domestic,
industrial, dietary sources. Of particular
concern being the heavy metals and agrochemicals
present in water supplies. Will deplete
antioxidants and contribute to fetal
toxicity. Sperm density and quality have declined
appreciably over the past 50 years. Such a
remarkable decline in such a short time is more
likely to be a result of environmental rather
than genetic.
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• TOXINS TO AVOID/ DETECT/ ELIMINATE BEFORE
  CONCEPTION
• Environmental
• heavy metals (hair analysis)
• industrials chemicals (air and water borne)
• agrochemicals (in water supply/spraying)
• domestic (cleaners, renovations, some craft)
• occupational (e.g. hair dressers, motor
  mechanics, farmers, builders, etc.)
• Dietary
• food additives ( buy organic)
• polluted water ( purify)

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• HEAVY METALS
• lead (petrol fumes, old paint)
• cadmium (active, passive smoking)
• mercury (dental amalgam, contaminated fish)
• aluminium (cookware, antiperspirants, antacids)
• nickel (body piercing, dental braces)
• copper (water pipes, OCP/IUD, smoking)

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DRUGS Medicinal and recreational, including
caffeine, alcohol, nicotine. These again take
their toll on nutritional status and thereby can
affect fertility. Alcohol and Caffeine
Consumption and Decreased Fertility. gt50
reduction in probability of conception during a
menstrual cycle during which participants
consumed alcohol. Caffeine consumption did not
independently affect probability of conception
but may enhance the negative effects of
alcohol. Women who abstained from alcohol and
consumed less than one cup of coffee per day
conceived 26.9 pregnancies per 100 menstrual
cycles compared with 10.5 per 100 menstrual
cycles among those that consumed any alcohol and
more than one cup of coffee per day. Lancet,
1988.
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SMOKING 408 women Women who smoke have shorter
menstrual cycles which may contribute to
sub-fertility and early menopause. Obstetrics and
Gynaecology
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• IONISING RADIATION
• X-rays, cosmic radiation, radioactive materials
• damages cells, especially those with high rates
  of growth and division e.g. embryonic, fetal,
  sperm cells.
• linked to increased miscarriage rates ( esp.
  lower back/abdominal x-rays)
• increased incidence of Downs Syndrome related
  to accumulated exposure rather than age per se.
• NON IONISING RADIATION
• Computers, TVs, microwaves, radar,
  TV/radio/mobile phone, UV and infra red light,
  Wireless technology
• VDU operators shown to have increased incidence
  of miscarriage, still birth, congenital
  malformations. One study given 2 x miscarriage
  rates of similar workers with no exposure.

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Previous Use of Contraception Programmes,
Terminations The Pill can cause severe
nutritional deficiencies which affect immune
status and fertility. Greater Age of Prospective
Parents Increasing evidence links the greater
risk of congenital defects to the accumulation of
radiation and toxins, and nutritional
deficiencies rather than to age per
se. Toxicity Arising from all the above, plus
poor eliminative function. Immune System
Failure Including allergic response, autoimmune
disease, increased susceptibility to infectious
diseases such as candiasis, toxo or CMV.
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• NATURAL FERTILITY WOMENS
• HEALTH CENTRE (Auck)
• Loula George BSc, ND, Dip Herb.Med
• Sheran Marra ND, Dip.Herb.Med
• Midwives Collective Integrated Health Centre

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• PRECONCEPTION CARE PROGRAMME
• Natural Fertility Management Francesca Naish
• Jocelyn Centre, Sydney
• Foresight British Assoc. for Preconception
  Care
• Conceiving HEALTHY babies HEALTHY adults
• Needs to be undertaken four months prior to
  conception, throughout pregnancy and
  breastfeeding.
• Takes 116 days for sperm to generate. Eggs are
  vulnerable to damage in the time they need
  to mature, 100 days.
• Varied types of clients

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• Why is Preconception Care Essential?
• 1 couple in 6 is infertile
• 1 couple in 5 experiences miscarriage
• 1 woman in 10 experiences toxemia
• 1 woman in 5 has a caesarian
• 1 baby in 10 is premature or small for dates
• 1 baby in 30 has a congenital defect
• 1 woman in 3 has some post natal depression
• 1 child in 10 is affected by learning or
  behaviour problems
• 1 child in 5 suffers from asthma
• The number of infertile women (in U.S) aged
  between 20-25 years, has tripled in the last 30
  years.
• Sperm counts (worldwide) have decreased by 50
  in the last 50 years.

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• FORESIGHT 1978 British Association For the
  Promotion of Preconception Care
• Simple non invasive, low technology approach and
  basic preventative medicine.
• Shown conclusively that if in the months
  preceding conception both prospective parents
• eat a nutritious diet
• screen for essential trace elements ( e.g.
  zinc, mag, iron etc)
• follow a healthy lifestyle
• avoid exposure to environmental pollutants
• have any allergies and infections treated
• they will not only improve their fertility but
  will also significantly reduce their chance of
  suffering miscarriage, stillbirths, congenital
  defects, premature babies.

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Foresight Study 1992 Preconceptual Care Research
Project Conducted by Dr Neil Ward, University of
Surrey, UK. 367 couples over 2 years The women
ranged in age from 22-45 years, the men from
25-59 years. Upon coming to Foresight 41 of
the couples had no previous adverse reproductive
history, but among these were the older couples.
The remainder had suffered infertility (37),
previous miscarriage (38), therapeutic abortion
(11), stillbirth (3), small for dates or low
birth weight babies (15) and malformation
(2). By the end of the Study 89 of all the
couples had given birth including 81 of those
who were infertile.
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The average gestational age was 38.5 weeks, and
no baby was born before 36 weeks. Average weight
of males was 7lb. 4 oz Average weight of females
was 7lb. 2oz And no baby was lighter than
5lb.3oz There were no miscarriages, no perinatal
deaths and no malformations! Normal expectation
70 miscarriages, 6 malformations. No baby was
admitted to Intensive Care!
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• Importance of Preconception Care
• ensures presence of essential factors, e.g.
  nutrients, absence of harmful factors, e.g.
  toxins/infections, for conception of truly
  healthy babies.
• true preventative medicine
• treatment for infertility
• creation of truly healthy babies
• prevention of miscarriage, still birth and
  congenital defects

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• Preconception Health Care Can Help To Achieve
• children that are healthy, intelligent, well
  formed, well balanced, happy and bright.
• increased fertility in male and female and an
  easy conception
• normal, healthy, full-term pregnancy
• natural, intervention-free birth
• uninterrupted bonding
• mother free of post-natal depression
• successful and long-term breastfeeding

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• What Does Preconception Care Involve?
• 1. Lifestyle and environmental toxins
• Improving lifestyle
• cleaning up personal environment
• detoxify
• staying positive and stress free
• getting fit
• 2. Nutrition
• nutrients are important in preconception care and
  fertility
• 3. Hair analysis
• showing deficiencies or excesses of any minerals
  and any toxic metal load

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• 4. Natural Birth Control
• Charting mucus and temperature
• Timing techniques for achieving conception (also
  a useful diagnostic tool)
• Natural Remedies for Reproductive Health
  andGeneral Health Issues
• e.g. endometriosis, PCOD, fibroids, cysts,
  miscarriage, asthma, autoimmune diseases etc
• 6. Screening for any genito-urinary infections
• 7. Allergies

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• AREAS OF CONCERN FOR PRECONCEPTION DIET
• adequate protein
• avoidance of sugars and refined carbohydrates
• avoidance of saturated fats
• a good balance of alkali-promoting foods
• avoidance of all allergens
• avoidance of all toxins
• plenty of fresh, purified water

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Case Study 4 Lisa 30 yrs Presented with
amenorrhoea for 1 year, unexplained weight gain,
severe bloating, nausea, migraines and general
chronic pain. History of dysmennorhoea probably
due to scarring and adhesions from earlier PID ,
discovered by laproscopy a few years
prior. Treatment included a bowel detox and
repair programme and recommended a low GI diet,
including avoiding wheat. Next visit, one month
later, she had her first period in a year and was
not painful. Had not lost any weight yet. No
bloating anymore and only three days of pain all
month. No nausea and no migraines. After three
months, with only treatment being bowel
programme and dietary changes, she had had 3
regular cycles. Began treating liver herbally. No
pain at all anymore. Two months later she
conceived.
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• Healthy Reproductive System the absence of
• WOMEN
• irregular periods cycles lt 27,gt31
• irregular ovulation
• hormonal imbalance including pre-ovulatory
  phases gt 17 days and post-ovulatory phases lt 12
  days long
• amenorrhoea
• severe PMT
• dysmenorrhoea
• menorrhagia
• inadequate mucus at midcycle
• recurrent vaginal thrush
• disease states such as endo, PCOD, fibroids,
  cervical dysplasia, thyroid or pituitary
  dysfunction

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Case Study 5 Jane 31yrs Presented with irregular
cycles. Diagnosed with PCOS. Treated her with
herbs and supplements for PCOS. After 3 months
there had only been minimal improvement. Asked
her to chart cycle temps. Chart showed very low
basal temps. Treated for sub clinical
hypothyroidism. Cycles became shorter and she
began ovulating. Conceived and had a healthy girl.
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• Healthy Reproductive System Absence of
• MEN
• low sperm count
• low motility
• high levels of abnormalities (morphology )
• GUIs
• varicocele
• prostatitis
• sperm antibodies
• MUTUAL
• sperm antibodies in female
• hostile mucus

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Case Study 6 Dave 41yrs
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Dave 2
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• Dave 3
• 1st test 2nd test 3rd test
• Sperm count 75 mill/ml 16 mill/ml 96 mill/ml
• Sperm motility 60 50 60
• Sperm morphology 39 21 79

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• CMV
• Parvovirus
• HIV
• Post-Coital
• Pap Smear
• Herpes
• Hormones eg. Oestrogen, Progesterone, LH/FSH,
  etc.
• Fasting Insulin

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• Full Pre-Conception Check
• Blood
• Blood count/ESR
• Toxoplasmosis
• TSH/T3/T4
• Rubella
• Ferritin/B12/iron
• HepB/C
• Chlamydia
• Sperm antibodies
• Urine
• Glucose/Protein
• Cervical Swab
• Bacterial
• Mycoplasma/Ureaplasma
• Other
• Blood Pressure