Over 15% of couples in the U.S. have difficulty conceiving a child. Infertility is defined as the failure to become pregnant after a year of regular, unprotected intercourse. The first step in dealing with infertility should always be a thorough health exam of both partners to diagnose any obvious physical problems. Women over 35 should consider evaluation after 6 months, since age itself will start to become a factor. If there is no obvious cause for infertility, some patients (especially those under 35) may want to consider less aggressive forms of treatment.
Good nutrition and a healthy lifestyle can have a positive affect on fertility and childbearing. For example, an adequate intake of essential nutrients, such as folic acid in the peri-conceptual period, can lower the incidence of neural tube birth defects (CDC, 2004), and good B vitamin status may improve pregnancy outcome (Ronnenberg, et al., 2002). Vitamins, minerals, and specific co-factors play a major role in fertility function, although this is still an area that needs further investigation. William Keye, Jr., M.D., past President of the American Society for Reproductive Medicine (2002), has commented that, "...The more we discover about the effects of nutrition on fertility, the better advice we can give our patients."
An increasing number of couples feel strongly about trying natural remedies first. If infertility is "unexplained", it may be due to subtle hormonal imbalances, aging reproductive systems or nutritional deficiencies. In many of these cases, natural remedies may be the most important first step. In cases of hormone imbalance like polycycstic ovarian syndrome (PCOS), this step may help regulate menstrual cycles and improve natural pregnancy rates. In "unexplained" cases that don't respond to natural interventions, success of later procedures may still be improved by optimization of nutrition, female hormone balance and male sperm parameters prior to those treatments.
Improving Female Fertility Lifestyle changes often are helpful in increasing chances for conception. Smoking, alcohol consumption, and excessive or insufficient weight have all been related to infertility in women (McLeod, 1996). Stress reduction is important for overall health and may be beneficial for women trying to conceive. Excessive exercise can stop normal menstrual cycles, so some women may need to cut back on their activity levels.
Antioxidants have proven to be helpful in reducing free radical damage to ova, sperm and reproductive organs, particularly the oxidative damage that occurs with age. Vitamins C, E and selenium are usually used for this purpose, but green tea further enhances antioxidant capacity, without requiring a mega-dose of any single antioxidant (Haas, 1992). Green tea also may be a stronger antioxidant than vitamin C or E (Khalsa, 1999). In studying the effects of caffeine on conception (usually considered a negative effect), Caan et al. (1998) actually found that drinking tea (as opposed to other caffeinated beverages) approximately doubled the odds of conception per cycle.
Folic acid, vitamins E, B6 and B12, iron, magnesium, zinc and selenium deficiencies have been known to cause infertility that is easily reversible with supplementation (McLeod, 1996). Many separate studies have shown the effect of supplementation on improvement of female fertility: vitamin E (Bayer, 1960), vitamin B6 (Abraham & Hargrove, 1979), vitamin B12 (Bennett, 2001), folic acid (Dawson & Sawers, 1982), multivitamins (Czeizel, et al.1996), magnesium and selenium (Howard, et al.1994), iron (Rushton, et al.1991) and zinc (Bedwal & Bahuguna, 1994).
Chasteberry (Vitex agnus castus) has been used for centuries for gynecologic disorders. Chasteberry has weak dopamine agonist activity and can decrease prolactin levels. Luteinizing hormone (LH) levels are increased and better development of the corpus luteum results, with increase in progesterone levels (Brown, 1995; Yarnell, 1997). Several clinical studies in Europe used chasteberry tincture successfully to improve progesterone balance and fertility (Propping, et al. 1988; Milewicz, et al. 1993; Gerhard, et al. 1998). A more recent study on a nutritional blend including chasteberry demonstrated similar results (Westphal, et al. 2004).
L-arginine, an amino acid, can help improve circulation to the reproductive organs (Burnett, 1995). Improvement of uterine lining may enhance receptivity to egg implantation. Battaglia, et al. (1999) monitored uterine and follicular response to L-arginine treatment during in-vitro fertilization treatment of poor responder patients. The L-arginine treated group demonstrated improved circulation and an increased number of oocytes collected and embryos transferred. Of the 17 in the L-arginine supplemented group, 3 became pregnant, compared to none of the 17 in the non-supplemented group. The researchers concluded that L-arginine supplementation improved ovarian response, endometrial receptivity and pregnancy rate.
Diet and Nutrition for Male Fertility Most cases of low male fertility display an abnormal sperm count or low sperm motility. Out of the many million sperm in an average ejaculate, as few as 40 reach the vicinity of the eggs. Low sperm count or motility dramatically reduces the chances of the sperm reaching and penetrating the egg.
In about 10% of the cases of low sperm count (oligospermia) the cause can be identified and treated by standard medical procedures. In the other 90%, the cause of low sperm count cannot be identified. Many of these cases, however, can be treated by changes in lifestyle and nutrition. Often a reduction in intake of alcohol, tobacco, prescription or nonprescription drugs, or avoidance of environmental contaminants can enhance sperm production. Reduction of excessive heat in the testicular area is also effective in some cases. An improvement in nutrition or supplementation may help reverse damage to the reproductive system incurred by stress or past abuses.
Sperm are highly susceptible to free radical or oxidative damage from environmental toxicants and natural aging. Vitamins E and selenium are potent antioxidants that help improve sperm counts and quality (Bayer, 1960; Geva, et al. 1996; Kessopoulou et al, 1995; Scott et al, 1998). Vitamin C supplementation has been shown to improve the sperm quality of smokers (Dawson et al, 1992). Ferulic acid, an antioxidant found in Dong quai, has also been shown to enhance sperm quality (Zheng and Zhang, 1997). Antioxidants, including vitamin C, E, ferulic acid, green tea and selenium, are believed to work better in combinations than alone because they protect each other from oxidation (Haas, 1992). Antioxidant combinations also preclude the need for mega-dose levels of a single nutrient, which can be harmful. Certain green tea compounds have been reported to be 100 times more potent than vitamin C, and 25 times more potent than vitamin E as an antioxidant (Khalsa, 1999).
Zinc and B vitamins (especially B6 and B12) are critical nutrients in male reproductive systems for several reasons, including hormone metabolism, sperm formation and motility (Moriyama et al, 1987; Netter et al, 1981;Takihara, 1987). Folic acid and/or zinc sulfate treatment has been shown to increase sperm counts in subfertile men by 74% (Wong, et al., 2002). The amino acid, L-carnitine, has also been shown to be critical to the formation of healthy, active sperm (Costa et al. 1994; Vitali, et al. 1995).
The fatty acid composition of sperm cell membranes may be influenced by diet. Supplementation with essential omega-3 fatty acids (high in fish, evening primrose and flaxseed oils) by both men and women will contribute to healthier cell membranes. Higher intakes of fruits, vegetables, whole grains and nuts are important, but supplements may also be needed to get sufficient amounts of these nutrients for noticeable effects on reproductive health and sperm quality. Peri-natal supplementation with omega-3 fatty acids is also recommended for the child's central nervous system development and long-term health concerns (Das, 2004; Helland, et al. 2003; Makrides, et al. 1995).
Some studies have shown that men with an abnormal sperm test, the DNA Fragmentation Index (DFI), have poor reproductive potential. In a recent report by Barnes, et al. (2004), men with an abnormal (high) DFI were advised to use the nutritional supplement, FertilityBlend™ for Men, several months prior to IVF treatment. Men with high DFI who took FertilityBlend™ for Men were able to produce healthy children.
Conclusion Good nutrition an healthy lifestyle are pre-requisites for fertility and childbearing , particularly for those deciding to become pregnant at a more advanced age. Nutritional supplementation may play an important role in optimizing fertility health, leading to improved conception rates, and providing an alternative or complement to conventional fertility therapies. Conception rates may be improved nutritionally by optimizing overall reproductive system health, normalizing menstrual cycles and hormone balance in women, or supporting healthy sperm development in men.
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