When it comes to helping patients get pregnant, practitioners need to uncover the underlying causes of infertility before taking action.
In a study conducted by the Pew Research Center earlier this year, fertility rates were deemed to be at a record low, with 62 births per 1,000 women.1 However, the study concluded that the results could not be interpreted without exploring a number of factors, such as how fertility is defined (the general fertility rate, the completed and the total fertility rate), which yields different numbers. The study referred to another report from the National Center for Health Statistics that indicated that the general fertility rate as of 2016 was at a record low as well.
Not discussed in the research report was why fertility rates are lower than they have been. Perhaps couples are choosing to have fewer, or no, children, or perhaps there are medical issues that affect fertility. Another possible factor is that many women are choosing to have children at a later age.
Fertility is often more of a consideration for women than for men. “In women, infertility can be caused by sex-hormone abnormalities, low thyroid function, endometriosis, scarring of the Fallopian tubes, or any of several other factors. Some of the causes of infertility readily respond to supplementation and natural therapies, while others do not,” said Leah Linder, ND, product education specialist/medical writer with Klaire Labs, a manufacturer in Nevada, adding that the specific cause or causes of infertility should be diagnosed by a physician before considering possible solutions. For men, she continued, “… it essentially comes down to the number, quality or motility of sperm.”
“Many parents believe infertility is primarily a female issue, but in over 35 percent of infertile couples, it is a male condition that leads to infertility,” added Vandana Bhide, MD, ABIHM, a practitioner advisor of the California-based manufacturer, Nordic Naturals.
The Role of Hormone Health in Conception
Many practitioners agree that hormonal health is the foundation of fertility.
“A woman’s reproductive system is delicate and complex. In order for conception to occur, it is important for a woman’s hormones to be balanced and her organs and tissues healthy. Hormones such as estrogen and progesterone play leading roles; however, there are many other hormones that are important players in the intricate process that is the female reproductive system,” said Michelle Violi, PharmD, dispensing pharmacists manager, Women’s International Pharmacy in Wisconsin.
“Follicle stimulating hormone (FSH) works with the ovaries to help produce and release mature eggs. And each follicle produces estrogen, which in turn helps cervical mucus become more hospitable to sperm, thereby increasing the likelihood of conception. In addition, increased estrogen prompts the release of luteinizing hormone or LH, which prompts the egg to emerge from its follicle, where it can be fertilized. The shed follicle then becomes the corpus luteum,” noted Dr. Linder.
“Estrogen, progesterone, luteinizing hormone, follicle stimulating hormone, cortisol, dehydroepiandrosterone and testosterone are all involved in conception of a healthy child. These hormones affect both male and female infertility,” added Dr. Bhide.
A man’s reproductive system is complex as well. “The primary hormones involved in the functioning of the male reproductive system are follicle-stimulating hormone (FSH), luteinizing hormone (LH) and testosterone,” said Dr. Violi.
Diet and lifestyle can play a significant role in hormonal health. External factors that can impact fertility include being significantly overweight or even significantly underweight. Smoking also decreases the likelihood of conception, and even alcohol has been associated with an increased risk of infertility, said Dr. Linder.
Hormonal fluctuation occurs naturally at certain times in a woman’s lifespan, such as during puberty or menopause, but it can also be affected by diet. “Eating a properly balanced diet can not only help to regulate hormones, but can also have an impact on fertility in some cases. For example, in cases of PCOS (polycystic ovarian syndrome), changes in one’s diet to include fewer carbohydrates can have an impact on the symptoms, and dietary modifications are often suggested for women who have this condition,” said Nicole Avena, PhD, assistant professor of neuroscience at Mount Sinai School of Medicine (New York) and visiting professor of psychology at Princeton University (New Jersey) and the author of What to Eat When You’re Pregnant.
On a related note, Jamie Morea, co-founder of Hyperbiotics, a manufacturer based in Nevada, said that those trying to conceive should make sure that their microbiomes are balanced, with beneficial flora, as that can cause a hormonal and bacterial imbalance as well as reduced sperm count. “Given the multitude of roles our friendly flora play in supporting all aspects of our health, nourishing the microbiome can be a very effective method for setting the ideal stage for conception,” said Morea.
Traditional Treatments for Infertility
Treatments often depend on the underlying cause of infertility. Some women turn to assisted reproductive technology (ART), such as in vitro fertilization. “Instead of ART replacing more natural approaches, we are seeing that those seeking ART are using natural treatments along with the fertility interventions. It is now common for fertility specialists to recommend supplementation (most frequently, antioxidant-based supplements),” said Suzanne Munson, MS (Nutrition), vice president of product development and compliance at Fairhaven Health, a manufacturer based in Washington state. Sometimes, hyperthyroidism, or low thyroid function, can affect fertility. This is due to… “menstrual cycles without ovulation, insufficient progesterone levels following ovulation, increased Prolactin levels and sex hormone imbalances. In a study involving 394 infertile women, 23.9 percent had hypothyroidism. After treatment for hypothyroidism, 76.6 percent of infertile women conceived within six weeks to one year,” said Dr. Violi.
Other traditional treatments for women have included the use of such fertility-promoting drugs as Clomid and Letrozole, said Jaclyn Chasse, ND, owner of Perfect Fertility, a telemedicine consultative practice in New Hampshire. “For other hormonal imbalances, patients who look to ‘balance their cycle’ are usually put on oral contraceptive mediations. While these treatments are still used very frequently, there is certainly a greater awareness today of the importance of hormone balance and the importance of overall health in order to not only get pregnant, but have a healthy baby,” she said.
When infertility is a male problem, “Surgically correcting sperm blockage or a common anatomic condition called a varicocele will help improve fertility,” said Dr. Bhide.
Natural Approaches to Fertility
Whether one implements more traditional treatments, such as ART, or natural treatments, the root cause of infertility must first be assessed by a physician before a course of action is selected. Regardless, maximizing optimal health and lifestyle choices, such as losing weight, getting plenty of sleep, reducing stress, and no smoking or drinking, should always be part of a reproductive health regiment. When even one of these factors is out of balance, it can have a marked effect on fertility, said Dr. Chasse. To illustrate, she said, “Alcohol consumption, even at a low to moderate intake (a few drinks per week for women) can lower fertility rates by 30.”
As a healthy diet is the foundation for overall wellness, it is no surprise that a healthy diet is also linked to optimal reproductive health, and it is one that is most within our control. “Good nutrition plays a role in good reproductive health. Whether it is pre-pregnancy, during pregnancy, or postpartum, eating well can improve the overall health of you and your baby,” said Dr. Avena. Eating fewer processed foods and sugar and increasing foods higher in nutrients is crucial, and it will also help those who have to lose weight.
“Limiting exposure to toxins that act as endocrine disruptors by eating clean and avoiding household chemicals is also important. Choosing paraben-free cosmetics, shampoos and personal care products is also important,” added Munson.
Like any other, more invasive treatment, supplements can be useful, again, depending on the underlying reasons for infertility. “Dietary supplements can be beneficial in setting the stage for a healthy pregnancy by promoting detoxification and ensuring optimal nutritional status and providing antioxidant support,” said Munson.
For women who have a uterine condition known as luteal phase defect, both Vitex (chasteberry) and vitamin C can be helpful. Some women take iron, vitamin E or multivitamins to support fertility. “Also, nutritionally, antioxidants like CoQ10, vitamin C, and zinc can help to improve the quality of egg and sperm,” explained Dr. Chasse.
For men with low sperm count, zinc deficiency may be a factor. If so, “zinc supplementation may correct this problem and improve sperm quality. In addition, the amino acid arginine, which is needed to produce sperm, may be a helpful supplement to improve sperm count, quality, and viability. Other nutrients and herbs that might be useful for men to consider include: L-carnitine, maca, selenium, vitamin B12, acetyl-L-carnitine, CoQ10 and vitamin E,” said Dr. Linder.
When a woman is pregnant, or is preparing to conceive, physicians and natural practitioners alike generally recommend prenatal vitamins, particularly those that contain folic acid. “In addition to folic acid (or folate), which is key for brain development, choline is also important for this function. Fats like EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are important for vision and brain development, and they’re associated with improving cognitive skills later in life,” said Dr. Avena.
Dr. Avena added that overall, dietary supplements are an important part of a healthy pregnancy. “The reason is that, even if you are very careful about what you eat, it is pretty much impossible to get the proper balance of nutrients and vitamins that are needed to support a healthy pregnancy from food alone. Plus, with pregnancy comes food aversions, nausea and sometimes gastrointestinal issues (like heartburn), that can make eating some foods (and getting all of the nutrition that one needs) difficult.”
Morea is passionate about probiotics, as they are safe and offer a holistic approach to wellness by supporting a healthy microbiome, which is crucial for a healthy pregnancy, as they help the mother absorb the nutrients important for a baby’s growth and development. “Probiotics can also support healthy fertility by controlling populations of yeast and unfriendly bacteria that can negatively affect fertility,” she said.
During pregnancy, other important supplements include omega-3 fatty acids, specifically, DHA, crucial for brain and eye development in newborns, said Dr. Bhide, as well as folic acid, which also reduces the risk of neural tube defects.
The bottom line, pointed out Dr. Chasse, is that while getting proper nutrients is essential for hormone balance and reproductive health, botanicals can provide benefits to help restore hormones.
Products on the Market
Klaire Labs has had a firm footing in the women’s health market since the company was established in 1969, which include products for various stages of a woman’s reproductive life. One, the Prenatal and Nursing Formula, is a multi vitamin and mineral formula that provides essential nutrients during pregnancy. Others include Ther-Biotic Women’s Formula, a blend of 10 probiotics in a cellulose base to support a women’s genitourinary system. “Our Target b2 (breast and baby) probiotic formulation has shown greater efficacy in improving lactation comfort compared with conventional approaches,” said Dr. Linder.
Fairheaven Health offers a variety of products for reproductive health and for different stages in pregnancy and post-pregnancy. Recently, the company launched a new line of clinical grade fertility supplements called FH Pro for Men and Women. For pregnancy, they offer such products as natural prenatal supplements, Peapod and PregEase for morning sickness relief.
Hyperbiotics manufactures probiotics formulas, such as PRO-15, PRO-Moms, PRO-Women and Prebiotic Powder. “All Hyperbiotics probiotic formulas utilize a patented delivery method called BIO-tract to ensure that the probiotic organisms make it alive deep into the digestive tract,” said Morea.
Nordic Naturals has been a long-time manufacturer of fish oil, and, recognizing the potential benefits of omega-3s for pregnant women, the company has developed formulations to support reproductive health, such as ProDHA 1000, Prenatal DHA and Postnatal DHA, in soft gel form. “Nordic Naturals Prenatal DHA and DHA Infant are the official omega-3 of the American Pregnancy Association,” said Dr. Bhide.
Some natural practitioners choose to carry and sell supplements to their patients for a variety of health concerns. Caution should be taken that a practitioner is educated about the efficacy of the products, the science behind them, the latest research, and should be able to answer detailed questions about any product that they sell.
Many companies, such as Fairhaven, will provide merchandising support for practitioners, such as product brochures and rack cards and will work with practitioners to develop any additional sales materials. And Nordic Naturals maintains a website, www.omega-research.com, to provide practitioners with up-to-date research.
Hyperbiotics has been partnering with the practitioner market for three years. “Our Practitioner Sales Program allows practitioners to receive our significantly discounted pricing in order to carry our products in their practice. We have low minimum quantity purchase requirements and free shipping. Our Patient Sampling Program provides practitioners with 100 sample size bottles of select formulas free of charge to share with their patients,” said Morea. They also provide complimentary informational postcards and coupons for practitioners to distribute in their offices.
Though statistically fewer babies were born in the last several years in this country than ever before, reproductive health is always going to be top priority for the demographic of women who are of childbearing years, as well as for some men. Therefore, practitioners should keep themselves in the know when it comes to issues surrounding fertility and reproductive health, as patients routinely will turn to their doctors should this become an issue.
Munson agreed that staying on top of the research is essential, as is speaking to patients while they’re still in their 20s about how to maintain fertility as a means of preventing fertility issues down the road. “Of course, fertility naturally declines as we age, but if patients plan to wait into their late 30s or 40s before having kids, it is important that they take steps to protect their fertility until they are ready to conceive—otherwise they may not be able to when they want to,” said Munson.
“Of the utmost importance is treating each individual as the unique being that they are. There is no single protocol or supplement that works for everyone. The responsible HCP (health care practitioner) will consider the entirety of the patient’s history, supplement and drug use, health status, etc., before making recommendations. Those recommendations should be evidence-based,” said Kander. “HCPs knowledgeable in the science behind the benefits of supplements to support fertility and conception provide value beyond what a conventional endocrinologist or fertility specialist might have to offer,” she added.
In addition to medical knowledge, practitioners should function as educators—passing along knowledge about nutrition, supplements and the like, to their patients. Nutrition education is one area in which some practitioners don’t often address, observed Dr. Avena, but it is a critical part of reproductive health.
Healthy Take Aways:
• As hormone imbalances can directly affect reproductive health, it is imperative to try to restore them through healthy lifestyle habits.
• Practitioners should try to uncover the underlying causes for infertility before prescribing a course of action.
• Supplements taken before and during pregnancy can help maximize reproductive health and infant health.
For More Information:
Fairhaven Health, www.fairhavenhealth.com
Klaire Labs, https://klaire.com
Nordic Naturals, www.nordicnaturals.com
Perfect Fertility, www.perfectfertility.com
Women’s International Pharmacy, www.womensinternational.com