Infertility, Subfertility, and Fertility Enhancement

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Common Problems seen with ART (Assisted Reproductive Technology)

With women receiving Clomid (Clomiphene citrate) to induce pregnancy, the rate of miscarriage when polycystic ovary syndrome (PCOS) is suspected or diagnosed is very high, nearly 50 percent, according to some experts. Conflicting studies have also reported high rates of miscarriage in the patients without PCOS utilizing Clomiphene or other ovulation inducing drugs, of 13-25 percent, but other studies have found that the patients using Clomid have miscarriage rates similar to the normal population. As of 2014, experts still maintain that the overall statistics are difficult to analyze, and no certain conclusion is yet available.

Miscarriage rates in the normal population, though, are only about 5 percent after the first birth, and 10-20% of women with a first pregnancy are believed to miscarry before 20 weeks of pregnancy, often without fully realizing it if the miscarriage occurs very early. Investigation of this higher incidence of miscarriage with ART has shown that Clomid (clomiphene citrate) and recombinant gonadotropins induce molecular and morphological changes in the endometrium, or lining of the uterine, that could explain the incidence of higher rates of miscarriage in the future. Studies released in 2014, from CHU Nord (Central University Hospital in Saint Etienne, France) found that various drugs used to induce ovulation also carried risk of inducing tissue changes and lesions in the ovaries and fallopian tubes (PMID: 24728105). Higher rates of miscarriage for women with PCOS utilizing ART indicate that both a problem with the ovarian health, and a hormonal imbalance that causes PCOS may be implicated, and certainly, drugs that induce ovulation and act on the hypothalamus-ovarian axis may play a part in PCOS. Insuring greater safety and chance of success with ART is a concern, especially for women with a diagnosis of PCOS. A reported higher risk of breast cancer later in life for women utilizing ART and fertility drugs has also been noted. A long-term multicenter study of breast cancer risk with fertility drugs was completed in 2014 by the U.S. National Cancer Institute and various University Medical Schools across the country, and showed that while a single treatment with Clomiphene was not associated with risk, multiple cycles of this therapy did significantly increase risk (PMID: 24700523). Hormonal balancing in Complementary Medicine before attempting treatment with Clomid or recombinant gonadotropins may increase the chances of a successful pregnancy immensely, and some resolution of PCOS and the underlying causes of subfertility is also highly recommended before starting these fertility treatments. Consideration of the integration of Complementary Medicine into the fertility protocol is thus safe, relatively inexpensive, and offers an array of healthy benefits. Treatment with Traditional Chinese Medicine to prevent miscarriage has also been historically successful, and the herbal medicines used in this protocol are both safe and effective, honed over centuries of clinical practice and study. Complementary Medicine in the form of TCM could be successfully utilized before starting ART, and be utilized for women with a higher risk of miscarriage after successful fertilization.

Treatment with Complementary Medicine prior to utilization of standard fertility treatment may also be the key to success. The Complementary Medicine physician can help the patient to assess holistically individual hormone balance with active metabolite saliva and veinous blood stick tests and analysis, and provide a variety of treatments to optimally restore hormone balance. In some cases, this therapy alone results in a successful pregnancy, saving the patient considerable expense. Many MDs specializing in fertility treatment are now adopting this holistic hormone assessment and balancing into their practice. Resolving underlying health problems that may decrease the chance of success with fertility therapy is sensible before starting such an expensive protocol. Resolution of insulin resistance, or metabolic syndrome, subclinical hypothyroid disorders, polycystic ovarian syndrome, and correction of estrogen to progesterone ratios has become a more important subject in preparation for standard fertility treatment. In the book Perfect Hormone Balancing for Fertility by Dr. Robert Greene, a fertility expert, states that addressing these problems within the standard approach to artificial fertility treatments are being increasingly explored. Dr. Greene states: "First, too many women are rushed into assisted reproductive technologies, often when it is not necessary. There can be an almost assembly line mentality...less than 15 percent of all couples with fertility problems need IVF to successfully have their own biological children, but many more are encouraged to pursue this high-tech avenue. Not only is it unnecessary, but it is often unsuccessful because the underlying hormonal imbalances have not been addressed." Utilizing Complementary Medicine in the form of a knowledgeable Licensed Acupuncturist and herbalist, who utilizes inexpensive testing with saliva and veinous blood samples to obtain a full fertility profile to guide therapy, is sensible and relatively inexpensive.

Many fertility clinics have now themselves adopted Complementary Medicine as a healthier and more successful alternative to drugs and IVF, as well as a successful complement to standard induction of pregnancy. Medical doctors and clinical nursing specialists are increasingly turning to the science of restoration of fertility function, rather than the induction of pregnancy. With scientific study supporting the success of acupuncture, herbal and nutrient medicine, both as a treatment standing alone, and as an aid to increased success with IVF and various drug therapies, a new approach is emerging in the United States. This new scientific study and therapy has given the Licensed Acupuncturist more information to add to an already successful practice of restoring fertility function. While it is unrealistic to expect 100 percent successful outcomes in the acupuncture and herbal/nutrient practice, success rates are high, almost as high as those found with standard ART, and the benefits of improving healthy function in the body are a bonus to both the couple and the child. As ART has increased in practice, studies now show that a risk of cardiovascular defects, asthma and eczema, and childhood obesity and diabetes are increased with the use of fertility drugs and ART. To decrease these risks, initial use of Complementary Medicine in fertility treatment seems sensible.

Recent research at Oxford University Medical College has linked stress-related biomarkers with problems conceiving (see study link below). It is surmised that many young couples may not have a true biological problem with fertility other than the stress related disorders that are common to the population. A short course of acupuncture and herbal medicine may resolve these metabolic stress issues, as well as address irregularities in the menstrual cycle that imply some hormonal imbalance, and increase the health of the ovaries and uterus. TCM may also address potential problems with the health of the male reproductive systems, improving sperm viability, prostatic fluids, and other aspects related to problems conceiving. See the article on stress on this website to gain a better understanding of this problem. While stress reduction is not the only reason to try acupuncture and herbal/nutrient medicine in aiding fertility, it is a significant added benefit.

Preliminary treatment with a knowledgeable Licensed Acupuncturist may take care of problems that are not really addressed in standard fertility treatments, and may help achieve conception without the expense and risks associated with the standard therapies. Standard medicine does not consider infertility a diagnosis until a couple has seriously tried to get pregnant for at least one year, and consultation and treatment with a TCM physician can be utilized during this period. The Licensed Acupuncturist and herbalist should perhaps be the first step in the process of insuring fertility, conception, and a healthy baby. If a couple is resorting to assisted reproductive technology, the Licensed Acupuncturist can provide low cost Complementary and Integrative medical care that is proven to improve the chance of success. TCM physicians with experience may also help when needed with birth and labor, health in pregnancy, and post-partum issues. This treatment does not need to be extensive to be effective, and TCM has historically advised minimal treatment unless needed in pregnancy. The safety of this practice is reflected in the fact that most acupuncturists pay less than one thousand dollars per year in malpractice insurance, and European health authorities have declared it the safest medical practice in world history.

A link between alarming rise in autism rates and chemically-induced pregnancies

In 2012, the U.S. Centers for Disease Control and Prevention (CDC) released data that shows a greater than 20 percent rise in diagnoses of autism spectrum disorders from 2006 to 2008. In 2008, the CDC estimated that 1 in 88 children received one of the autism spectrum disorder diagnoses. This is nearly double the rate from 2002. Health experts have questioned whether the enormous rise in chemically-induced pregnancy at fertility clinics correlates with this concurrent rise in autism rates. This has become widely accepted, and even Time magazine has presented substantial evidence of this link in a May 20, 2010 article entitled Studies Link Infertility Treatments to Autism. In 2010, conservative medicine presented significant evidence. A study by the Harvard School of Public Health found that autism was nearly twice as common among the children of women treated with ovulation-inducing Clomid and similar drugs that women conceiving naturally. The rates of autism rose with longer courses of fertility drug treatment. An Israeli research team found correlation between IVF and increased autism rates. One of the Harvard studies surveyed nurses who conceived with the aid of Clomid or related drugs, a reliable data source, and found that among the 3,985 nurses receiving drug fertility treatment, that 111 reported birthing an autistic child. This risk of autism is played down still in standard medicine, though, and even the Harvard epidemiologist was careful to state that despite doubling of risk, the mother still only faced a 4 percent risk of birthing an autistic child with use of fertility drugs.

In 2012, a study by the Icelandic firm deCODE Genetics also found that de novo mutations linked to sperm of older men increased the risk of autism, and possibly schizophrenia. Such studies had shown links to poor quality sperm and fetal mutations before, but had not been quantified. This study, coauthored by the University of Iceland, Aarhus University in Denmark, and the company Illumina Cambridge Ltd. (a genetic testing company), showed that for the approximately 15 to 30 percent of cases of autism that are genetically linked, that the health of the sperm is important. The overall statistical risk of passing genetic mutations for men over the age of 40 was 2 percent. This finding does not negate the environmental risks for causation of autism, though, and has no bearing on the link to chemically-induced pregnancies. What this finding does show us, though, is that perhaps men, especially over the age of 40, should work to insure that the health of their sperm is as good as possible, not only to increase the chance of fertilization, but to also avoid the considerable risk of autism and other neurological health problems. This study was published in the journal Nature, online in August of 2012.

Increased risk for birth defects is seen with ART, especially ICSI, and increased risk of low birth weight and premature birth has been noted as well

In May, 2012, a large 2002 Australian study was published in the New England Journal of Medicine, and these researchers looked at records of over 300,000 pregnancies, and found a 28 percent greater chance of birth defects associated with assisted reproductive technology, or ART. Considerable variation was seen between methods of fertilization, with IVF, or in vitro fertilization, having considerably less risk. ICSI, or intracytoplasmic sperm injection, where a single sperm is injected into an egg, has become the most popular method of ART, but carries the greatest risk of birth defects, especially if fresh embryos, rather than frozen, are used. Using the drug Clomiphene alone also increased risk of birth defects, and women who failed at ART, but subsequently achieved a natural pregnancy afterwards, were also found to have a higher incidence of delivery with low birth weight or premature birth, as well as a 25 percent greater risk for birth defects. Experts in the field attributed these findings to a possible increased risk of birth defects associated with the infertility, not the treatment, but no current data supports this theory.

The lowest risk was found when using a cycle of a single fresh embryo transfer with IVF alone, followed by a transfer of a frozen embryo if a second treatment is needed. With the addition of acupuncture and herbal medicine preceding the IVF, the chances of success are increased, lowering the risks that come with multiple tries with IVF. Considering that any type of fertility treatment resulted in increased risk of defects or complications, it may be wise to first try to conceive without drugs and ART, utilizing acupuncture and herbal medicine, before resorting to the artificial technologies. The United States Centers for Disease Control and Prevention (CDC) reports that today, 1 in 33 babies is born with a birth defect, and birth defects account for 20 percent of infant deaths. Much has been done to try to reduce this risk of birth defects, with diet, nutritional medicine, and healthy lifestyle recommendations. Increasing the risk by 28 percent, or more with some types of ART, is a consideration for thoughtful parents. Taking a comprehensive approach early in marriage, improving the health of both the mother and the father, avoiding environmental toxins and unhealthy foods, avoiding certain prescription medications linked to birth defects (acne medications, topiramate, antidepressants, asthma medications), and making sure that a healthy hormonal balance exists before trying to get pregnant will certainly insure the lowest risk of this devastating outcome.

Higher dosages of fertility drugs come with higher risks of ovarian hyperstimulation syndrome (OHSS), and other health risks, prompting fertility clinics in Japan and Europe to turn to low-dose IVF

A July 17, 2012 article in the New York Time Science Times, entitled High Dose of Hormones Faulted in Fertility Care, describes the current debate over fertility drug protocols in the United States. While the rest of the world is alarmed at the rate of serious adverse health effects and risks to the fetus, fertility clinics in the United States insist that they need these higher dosage to achieve competitive fertility rates and cost effectiveness. Francine Coeytaux, founder of the Pacific Institute for Women's Health of Los Angeles, California, stated: "Mild stimulation (with ovarian hormones) is clearly much healthier for women." The National Institutes of Health now states that high-dose stimulation leads to OHSS in 10 percent of IVF patients. Ovarian hyperstimulation syndrome (OHSS) may result in large fluid accumulation in the abdomen and chest cavities, blood clots, kidney damage, ovarian torsion, difficulty breathing, sudden weight gain, nausea and vomiting. Duke University Health Center states that OHSS occurs in up to 5 percent of all controlled ovarian hyperstimulation cycles, and is more common with the presence of polycystic ovarian syndrome, other ovulatory disorders, and high-dose ovarian hyperstimulation. A large majority of fertility clinics in the United States use high-dose hormonal ovarian stimulation.

This New York Times article found that such respected clinics as the Yale Fertility Center, with Dr. Pasquale Patrizio, a professor of obstetrics and gynecology at Yale Univerity, as director, have switched to a low-dose IVF protocol in the last few years with good results. Dr. Patrizio states: "It is a shift of minds in the last few years, as we've been realizing that there is no need to stimulate ovaries so aggressively as we've done before." Low-dose IVF is also less expensive, costing about a third of standard high-dose IVF, with lower drug costs and less need for expensive monitoring. More cycles may need to be tried in this protocol to see if there will be success, but the reassurance of less risk for the mother and fetus is worth the extra time spent. Dr. Patrizio stated: "If we can have IVF stimulation at a lower cost and without OHSS, then it would be a great step forward for the United States." Of course, combining this type of low-dose IVF with Complementary Medicine, both proven protocols in acupuncture, and effective herbal and nutrient medicine, would improve the chances of success and may further reduce the need for repeat cycles. Surely, now that the research has proven benefits, this integrated protocol could replace the standard risky high-dose hormonal regimen.

With the more widespread use of drug-induced ovulation and multiple cycles of ART to achieve pregnancy, the incidence of miscarriage has become an issue as well. To help reduce the risk of miscarriage with ART, some clinics are now using synthetic estradiol and progestins during the first trimester of pregnancy. This is not approved by the U.S. FDA, and leading experts continue to state that synthetic estradiol may harm the fetus and advise against using estradiol during pregnancy. FDA warnings concerning the use of estradiol sulfate also include advice that the drug increases risk of blood clots, stroke, heart attack, and increases the risk of developing uterine cancer. Common side effects of synthetic estradiol include nausea, vomiting, bloating, stomach discomfort, and headache, all of which are common to pregnancy and may be linked to increased risk of miscarriage. Common medical guidelines state that there is no indication for use of Estradiol during pregnancy, and the U.S. FDA gives synthetic estradiol a Pregnancy Category X. The U.S. FDA Pregnancy Category X states that this indicates that studies in animals and/or humans have demonstrated that risk of fetal abnormalities and/or positive evidence of human fetal risk is evident and based on adverse reaction data from investigational experience, and that the risks involved in use of the drug in pregnant women clearly outweighs the potential benefits.

Many couples first try to restore fertility rather than to induce pregnancy, and the health benefits to this approach may even help to insure a more healthy pregnancy and eventual health of the baby if ART and reproductive drugs are tried. With success rates in standard fertility treatments still only about 30 percent for even young healthy couples, a consideration of restoration of reproductive health after failing this ART treatment is now being considered as a sensible option as well, and Complementary and Integrative Medicine is producing more and more scientific research each year to increase success in this field.

One reason that more women are seeking treatment for infertility is the choice to have a first baby late in life, and this presents a number of health concerns. An assessment and restoration of healthy physiology with Complementary Medicine may be an important consideration for women over the age of 40 that are seeking fertility assistance. Success rates for standard fertility treatment decrease with the increasing duration of infertility, well below the 30% average. Risks of birth defects rises both with age and with ART treatment. The CDC and the National Birth Defects Prevention Study showed that infants conceived with ART are two to four times more likely to have certain types of birth defects than children conceived naturally. One major concern is the increasing number of triplets or higher multiparity we have seen over time in the United States, which the CDC attributes mainly to the rising use of ART. In 1997, about 43% of triplets were attributed to ART, and about 40% to ovulation-inducing drugs. There were 6,737 cases of triplets in 1997, and each year this number has risen, from 1,798 in 1989 to 6,737 in 1997. Estimates as high as 23,000 triplets in 2009 have been reported, although the official data has not been assembled. It is estimated that at least 5% of births involve multiparity, either twins or triplets, with clomiphene treatment, and some studies have estimated the incidence at 12.5%. These babies are at much greater risk of being preterm and low birthweight, and studies have attributed increased health risks in this subset of children. Studies conducted at Cambridge University found that preterm babies may be at high risk for developing asthma and eczema, and that the incidence of eczema for preterm triplets was 30%, compared to 19% in single birth preterm babies. These same health risks apply to twins as well, to a lesser degree. For these health reasons, and others, many women have chosen to first try to correct the causes of infertility with Complementary Medicine and have a natural childbirth. Many other women have chosen to risk the ART and drug-induced ovulation but to utilize Complementary Medicine to reduce health risks and side effects, as well as to increase the chances of success.

There are many possible reasons for female infertility and subfertility, and various studies have given different statistics concerning the general population. What is most important is not the average or statistically highest reason in the population, but the actual problem of the individual woman. The physicians and the patient must focus the diagnosis and customized treatment to fit the individual woman, and not treat this problem as if the woman was on an assembly line. Careful diagnosis is the first step, and since diagnosis in infertility is often difficult, the physicians must take their time and be sure that the most intelligent diagnosis is reached to properly guide the therapy. Deadlines should be reserved for the office, and when we are talking about a human life, nature and God, we should respect the timetable given to us and do what we can to support this miraculous natural process. If you are seeking safe and natural healthcare from Complementary Medicine, first try to get a thorough diagnosis from a thoughtful medical doctor who is a specialist in fertility, and who is not trying to rush you into an expensive procedure.

The possible causes of female infertility or subfertility may be one or a combination of the following: polycystic ovary syndrome (see a separate article on this website), tubal disease and endometriosis, hypothalamic and hormonal dysfunction, thickened ovarian capsule, essential fatty acid or other nutritional deficiency, reduced liver recycling of estrogens, and certain environmental toxins affecting fertility. You may refer to my articles on this website on hypothyroidism and endometriosis/ovarian cysts to learn more about how these problems may affect fertility and what can be done about them. Certain medications may cause infertility with chronic use, such as SSRI antidepressants, which may increase plasma cortisol and prolactin secretion. Environmental xenoestrogens may also cause excess prolactin release and disruption of follicle stimulating and luteinizing hormone metabolism (FHS and LH), secretion of which depends on a pulsatile release directed by the central nervous system and the hypothalamus. Leptin and insulin balance may also affect this necessary pulsatile release of LH. All of these common causes should be thoroughly examined and appropriate tests administered. Hormonal imbalances that may affect fertility are varied, involving estrogens, GnRH, luteinizing hormone, follicle stimulating hormone, leptin, insulin, testosterone, cortisol and thyroid hormones. Many of these hormonal imbalances present subclinical syndromes, meaning that there are no obvious clinical symptoms or signs. Instead of rushing into an expensive and invasive therapy, a smart patient makes sure that all diagnostic tests and evaluations are performed, so that the safest and surest fertility treatment is used. Because of the complexity of issues in fertility therapy, the patient needs to develop patience and take a step-by-step and day-by-day approach.

Allopathic fertility treatments utilize drugs that increase the gonadotropins FSH and LH, and HCG (human chorionic gonadotropin). Follicle stimulating hormone (FSH) drives the cycle of egg follicle development and maturation, and luteinizing hormone (LH) both drives the creation of the uterine lining (endometrium) as well as the final stage of egg follicle maturation and release. The whole process, though, depends on a complex quantum flow of hormones that change in a feedback mechanism that scientists today still do not fully understand. Just before the final maturation and release of the chosen mature egg follicle, or ovum, the human endocrine system goes through a complex arrray of hormonal changes. LH secretion occurs in stronger pulses of release from the pituitary gland in the brain, which stimulates a pulsatory rise in estradiol, while the FSH release declines significantly. A number of hormones go through significant rises and falls in secretion, including prolactin, testosterone and androstenedione. This results in one egg follicle within a group of viable egg follicles fully maturing and releasing, and another one forming the corpus luteum and growing with a dramatic rise in steroid hormones needed for the healthy growth of the uterine lining. When looking at this complex system of hormonal feedback and balance, we can realize that pregnancy is the result of an optimal and healthy hormonal balance, not just the induction of a single hormone. Restoration and optimization of this hormonal system creates a greater chance of success. A number of therapeutic steps may be taken to promote this optimal homeostatic mechanism. Standard medicine does not achieve this goal. Integrative and Complementary Medicine, on the other hand, has created a variety of protocols to integrate with standard medicine and achieve a healthier and more successful hormonal homeostasis.

Countering side effects of ART with acupuncture and TCM

Clomiphene, or Clomid, is a common drug utilized in assisted reproductive technology which has prevalent side effects. Clomid acts by stimulating the hormonal axis to increase stimulation of the ovaries. Clinical trials performed by the manufacturing pharmaceutical showed that 13.6% of women experienced enlargement of the ovaries, that 10.4% experienced hot flashes, 5.5% experienced abdominal or pelvic pain, with bloat or swelling, 2.2% experienced nausea, vomiting or breast pain, 1.5% experienced headaches or abnormal menstrual bleeding, and less than 1.5% experienced dizziness, nervous tension, insomnia, vertigo, lightheadedness, fatique, depression, constipation or diarrhea. Clomiphene is considered a weak estrogen-like chemical. The exact mechanism of hormonal action is still unknown, but clomiphene strongly stimulates the ovaries. Most of the side effects are attributable to chemical effects rather than ovulatory effects. These side effects can be reduced with Complementary Medicine, acupuncture and herbal medicine, without affecting the stimulation of the ovaries or interfering with the effects of Clomid.

There has been a history of contradictory studies of risk of fetal health problems associated with Clomiphene citrate (Clomid) use, suggesting that the mother may consider measures to reduce these risks after use of ART. While more recent studies assert that there is no more statistical risk of fetal anomalies than what is seen in the normal population, past studies with animals in laboratory testing showed increased risk. A 2006 study at McGill University Medical School, in Montreal, Quebec, Canada, found in a study of nearly a thousand children born after fertility treatments in 5 fertility centers, that the rate of congenital malformations and chromosomal abnormalities with Clomid use was 4.8 percent, with major malformations occurring in 3 percent. A 2010 European Surveillance of Congenital Anomalies (EUROCAT) recorded a prevalence of major congenital anomalies of 2.39 percent, and chromosomal anomalies of 0.36 percent, in the years 2003-2007. This shows a slightly higher risk of fetal defects with use of Clomid (a similar rate for letrozole). The main concern, though, may be the effects of ART and Clomid on the immune system, with a 2013 study at the University of Oxford, United Kingdom, finding that there is a significantly greater likelihood of incidence of asthma in the first 5 years of life in children born to subfertile parents utilizing ART (PMID: 23223378). The incidence of asthma, allergies, ADHD, and eczema have increased during the years that ART has been heavily utilized, and many experts are concerned. ART, C-sections, and multiparity are all studied for explanation of the rising incidences of disease in early childhood. Parents may be aware of these issues and take positive steps in health maintenance to reduce these risks, as well as consider pediatric TCM medicine if these problems occur in their children.