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A Tough Egg To Crack


With infertility a looming threat, getting pregnant requires discipline from patients and emotional, nutritional and lifestyle guidance from practitioners.

An egg and a sperm meet. Nine months later, we have laughter, tears and countless adorable photographs posted on Facebook walls.

Lost in the pageantry and simplicity lies a fact that natural practitioners know all too well: Having a baby is becoming increasingly difficult.

“Infertility, the inability to conceive after 12 months of targeted intercourse, affects about 10 to 15 percent of reproductive age couples,” said Al Peters, DO, a board certified reproductive endocrinologist and medical director at SIRM-NJ (Bedminster).

“Age plays a critical role in a woman’s egg quality,” Dr. Peters said. More women have decided to get pregnant later in life, but “past the age of 35, the chances for pregnancy start to drop significantly,” said Lara Armstrong, ND, of Monarch Wellness Women’s Center in Hamilton, Ontario and the Foot Knee Back Clinic in Anncaster, ON, Canada.

Lifestyle also affects pregnancy and fertility. The culmination of bad habits is arguably diabetes, which affects more than 25 million Americans, according to the National Diabetes Information Clearinghouse (NDIC). Amanda Smith, MediHerb brand manager at Standard Process, a Wisconsinbased whole foods supplement manufacturer, cited the rise in type 2 diabetes as a concern since it’s known to decrease fertility.

That’s only part of the picture, according to the NDIC.

“Poorly controlled diabetes before conception and during the first trimester of Pregnancy among women with type 1 diabetes can cause major birth defects in five to 10 percent of pregnancies and spontaneous abortions in 15 to 20 percent of pregnancies,” the NDIC reported. In addition, improperly managed diabetes during a pregnancy’s second and third trimesters can result in “excessively large babies.”1 

Ethan Lynette, a partner at Fairhaven Health, a Washington-based manufacturer of fertility and pregnancy supplements, sees another cause for concern: a lack of education among aspiring parents regarding fertility and pregnancy wellness.

“Surprisingly, many women we talk to know very little about their own cycles or even that there are only four to five days each cycle they can get pregnant,” he said. “Most couples don’t realize how often male factors contribute to the fertility challenges or what they can do to enhance his reproductive health. A study just came out of Australia that stated only 13 percent of women who had gone in for fertility treatments were able to correctly identify their fertile days each cycle.We’re strong proponents that with a bit of education—and at times, natural supplementation—countless couples could avoid the prescription medication and invasive procedure route.” 

Lynette quipped that Fairhaven is doing its best to share the message, but “Oprah is no longer on the air and the Kardashians won’t return our phone calls.” Looks like the community of natural practitioners has to spread the word one patient at a time. 

Getting Pregnant is Not a One-Woman Job 

Just because the woman carries the baby and gives birth does not mean she also carries the responsibility. “We approach fertility issues as a ‘couples’ problem,” Dr. Peters said, “and we make sure that we do not single out the male or female as the ‘cause.’” 

Echoing Lynette’s earlier concern, Dr. Armstrong said dads-to-be must be evaluated as well. Sperm count, morphology and motility matter are qualities negatively affected by a diet light on fruits and vegetables and heavy on alcohol and nicotine. An ideal sperm count per ejaculation is over 20 million. If those levels are low, Dr. Armstrong usually issues the following nutritional approach to improve quality and quantity: zinc, L-carnitine and CoQ10 (between 300 and 600 mg daily).

Or they could eat walnuts. Researchers at UCLA recently determined that eating 75 g daily “improved the vitality, motility and morphology of sperm in healthy men aged 21 to 35,” according to ScienceDaily.

Cliché alert: Dr. Armstrong observed that some men believe they don’t need testing. That obstacle can be negotiated with a little logic: If a baby is what you want, this is one step to getting there. If you don’t do this, we won’t have all the information we need.

In other words, said Dr. Armstrong: “It’s bigger than your sperm count.” 

The woman’s pregnancy game plan is more complicated, starting with hormone balance. Progesterone levels, which should be tested between Day 18 and 21 of a woman’s cycle, need to be high: at least above 30 nmol/L. Otherwise, Dr. Armstrong said, it will be difficult for a woman to get pregnant—and stay pregnant. Estrogen levels, specifically estradiol, should be tested between Day 3 to 5—an ideal number is 70-500 pmol/L—to gauge fertility potential.

Dr. Armstrong advises patients to take Chinese patent herbs during the cycle to balance progesterone and estrogen levels. A number of companies use formulas geared toward fertility. Among Dr. Armstrong’s recommendations are Golden Flower Chinese Herbs’ Ren and Chong formula and Nourish Essence. She’s also found vitex herbs, or chasteberry, helpful in supporting optimal progesterone levels.

Thyroid activity should also be measured, Dr. Armstrong said, because hypothyroidism can also disrupt fertility. Having patients increase their iodine intake— either through dietary changes (more seaweed) or putting potassium iodine droplets into water—can combat that particular problem.

Getting pregnant can be a time-consuming, emotional ordeal. Perhaps the greatest service a natural practitioner can offer patients is compassion.

“Empathy on behalf of a fertility team is critical,” Dr. Peters said. “We allow time for the patient and spouse to express their concerns and stresses.” If the need arises, he even refers couples to appropriate counseling.

A Supplement Game Plan 

The road to pregnancy is not always this arduous for everyone. Pregnancy has a roster of helpful supplements with long track records. In fact, Dr. Armstrong has what she calls “a pregnancy supplement starter kit:” folic acid (5 mg for older women), iron, vitamin B12 and fish oil.

“There seems to be a big push toward antioxidants,” Dr. Peters said. “Antioxidants tend to clear the body of toxins that accumulate in our systems from environmental toxins or from normal cellular death and metabolism. These supplements provide a better environment for the eggs, sperm and embryo. Some of the current ones being used are açai, resveratrol and Pycnogenol [from Horphag Research]. They can be found in most health food stores and grocery stores, and should be taken as recommended on the bottle.” 

A number of companies provide these in supplements, along with formulas geared toward women. Nordic Naturals offers Prenatal DHA, an omega-3 fish oil featuring docosahexaenoic acid (DHA). The company’s chief medical officer, Keri Marshall, MS, ND, said that DHA has been the subject of nearly 7,500 studies; about 700 have focused exclusively on pregnancy.

“These studies demonstrate that DHA is essential for the development of the brain, eyes, and nervous and immune systems during pregnancy and the first years of life,” Dr. Marshall added.

Nordic Naturals’ Prenatal DHA, she explained, is also the official omega-3 fish oil of the American Pregnancy Association. According to Dr. Marshall, the product’s purity and “extraordinarily low levels of toxins” (e.g., heavy metals and dioxins) make it a worry-free product for pregnant women to take.

Through its MediHerb line, Standard Process offers Tribulus, which contains an extract of the Tribulus terrestris herb (specifically, leaves and stems). According to Standard Process, the product also “contains steroidal saponins, mainly furostanol glycosides (including protodioscin and protogracillin), and small quantities of spirostanol glycosides, sterols and other compounds.” 

According to the company, Tribulus supports normal reproductive function in men and women. Smith, however, warned that not all Tribulus terrestris is created equal. Region and plant part determine the herb’s quality.

“Tribulus sourced from the Central European regions of Bulgaria and Slovakia have been found to contain protodioscin, which is an important indicator of quality and efficacy,” Smith said. “Additionally, only the leaves and stem of the plant contain protodioscin, while the fruit do not contain this phytochemical. MediHerb has undertaken this research to ensure that [our] Tribulus product is of the correct phytochemical profile to ensure phytoequivalence with the Bulgarian clinical trials and therefore optimal therapeutic outcome.” 

As expected of a company that promises to be there “every step of the way” for aspiring parents, Fairhaven Health offers products for pregnancy’s different stages.

“We try to make all products as natural as possible while not sacrificing any efficacy,” Lynette said. “Our prenatal vitamin, for Example, is a natural supplement without any artificial colors, flavors or preservatives, which is surprisingly hard to find when you look on the drugstore shelf.We also have some fairly innovative products such as FertileCM, which helps increase the quantity and quality of cervical mucus for trying-to-conceive women, or our NursingBlend and Nursing Postnatal vitamins for breastfeeding women, which take the unique nutritional needs of nursing women into account.”

Lynette said he sees a lot of “shady entrants” in the pregnancy market released every year that buoy themselves on outlandish claims. In regards to legitimate prenatal vitamins, he is far from impressed.

“While there are a few major brands you’ll see on the drugstore shelf, we’re constantly surprised at how many artificial ingredients they use, important elements they leave out or simply the use of lesseffective (cheaper) formats of some vitamins or minerals,” Lynette said.

“Fortunately, people are able to do their own research and can quickly ascertain which vitamins make the most sense for them.” Fairhaven Health works with “a team of medical professionals that includes Mds, Nds, nutritionists and herbalists whenever formulating a new product or for any changes to an existing product,” Lynette said. The company’s clinical study on its male fertility supplement, FertilAid for Men, was presented at the American Society of Andrology’s annual meeting. And the National College of Natural Medicine is currently conducting a clinical study for its women’s fertility supplement, FertilAid for Women, Lynette said.

A Beneficial Lifestyle from A(cupuncture) to Z(ZZs) 

Medical visits and supplementation only go so far. Pregnancy, at every stage, involves a healthful lifestyle. Patients must go beyond giving up alcohol and cigarettes.

Laurie Binder, Lac, MS, RNCNP, LCCE, an acupuncturist based in Los Angeles, CA, believes that a mother-to-be’s diet may change according to her individual habits. That means adding organic and natural foods—including wild-caught fish and lean meats without added hormones— and avoiding white flour, refined sugar, unpasteurized dairy and deli meats. This diet should be maintained from preconception to birth.

“Herbicides and pesticides are known endocrine disruptors; endocrine systems govern reproduction,” said Deborah Waddell, Dipl Ac, CA, director of Skylands Acupuncture and Wellness Center in New Jersey. “These chemicals are known to wreak havoc on both male and female reproductive systems, hence my dietary recommendations [to eat organic foods]. Additionally, I recommend no heating in plastic, since the bisphenol A (aka BPA) is another major endocrine disruptor.” 

A woman trying to conceive should have the following to-do list, according to Dr. Binder: 30 minutes to an hour of exercise (walking, resistance or a combination) five days a week; seven or eight hours of sleep a night: and 20 minutes of daily meditation to reduce stress. 

Another way for patients to reduce stress is with acupuncture.

“Acupuncture increases blood flow to the reproductive organs for both females and males,” said Waddell. “In addition, both acupuncture and Chinese medicine assist in balancing hormones as well as reducing stress—which is a major factor in infertility. The quality of the egg to be fertilized is highly dependent upon the health of the body and hormonal balance. Acupuncture can help a woman move gently and naturally to a state of overall health, which will ensure that her eggbearing follicles are nourished with a constant supply of balanced hormones and nutrients, so they will flourish and be of the best quality.” 

Acupuncture increases the production of beta-endorphin, Waddell said, which helps reduce anxiety and tension while increasing resistance to stress. “Stress and other negative emotions disrupt hormonal communication between the brain, the pituitary and the ovaries, which causes an imbalance in hormonal function,”Waddell added.

“Stress over stimulates the sympathetic nervous system, which causes constriction of the ovarian arteries and shifts blood away from reproductive organs.” 

As a result, she concluded, egg production in the ovaries is halted.

Citing a 2002 study in Fertility and Sterility, Waddell explained the action behind acupuncture: It influences ovulation and fertility by “normalizing the function of the hypothalamus-pituitaryaxis. This improves ovarian function, creating more follicles—and better egg production.” 

She recommends at least three months of acupuncture and herbal treatments; it takes three cycles for follicular development to mature and for sperm development. Acupuncture treatments should occur weekly.

If three months sound like a lot to your patients, tell them this: The sooner they adhere to this advice, the sooner they can get pregnant—and post those photos on Facebook.


1 http://diabetes.niddk.nih.gov/dm/pubs/statistics/ index.aspx#Pregnancy.

Among the obstacles that can interfere with pregnancy: age, lifestyle, hormonal balance and hypothyroidism. Infertility affects 10 to 15 percent of all reproductive- age couples.

Practitioners should treat conception difficulty as a “couples problem.” Men, regardless of their protests, need to have their sperm tested.

For couples looking to conceive, Chinese herbs may help women regulate their hormones. Men should consider the spermfriendly zinc, L-carnitine and CoQ10.

Some basic supplements for pregnant women include fish oil, folic acid and vitamin B12. Since the market for prenatal supplements is large and prone to bad actors, practitioners must research companies— and their products—thoroughly.

Acupuncture is considered an effective treatment to improve a couple’s pregnancy chances since it lowers stress, a major impediment toward fertility.


Fairhaven Health, (360) 543-7888;

Golden Flower Chinese Herbs,
(800) 729-8509, www.gfcherbs.com

Horphag Research, (201) 459-0300,

Nordic Naturals, (800) 662-2544,

Standard Process, (800) 848-5061,