Infertility

The term infertility refers to the inability of a couple to become pregnant after one year of unprotected sexual intercourse. It is thought that infertility affects between 10-15% of couples of reproductive age. Although the prevalence of infertility has remained more or less stable over the last 50 years, some researchers speculate that the rate of infertility may be increasing, especially in comparison to rates previously experienced in pre-industrialized society. Much of this concern is attributed to exposure from man-made, industrial chemicals that contaminate the environment, including solvents (e.g. benzene), polyhalogentated aromatic hydrocarbons (PHAHs, e.g. benzo[a]pyrene, PCBs, dioxins), herbicides (e.g. 2,4-D) insecticides (e.g. dibromochloropropane), fungicides (e.g. vinclozolin), metals (e.g. lead, cadmium), and plasticizers (e.g. bisphenol-A). In large part the concern relates to chemicals called xenoestrogens that have an estrogen-like activity, but these chemicals can have other effects as well, such as increasing or decreasing the secretion of estrogen and androgens, inhibiting hormonal activities generally, or causing direct damage to reproductive tissues.

While various studies have demonstrated the negative effects of these compounds in animals, there is little evidence to suggest what impact they have on humans. One recent study suggests however that the risk of infertility and endometriosis is greater for couples living in heavily contaminated regions compared to couples living in less contaminated areas (Carpenter et al 2001). Taking steps to limit exposure to industrial chemicals appears to convey a protective benefit and enhance fertility, as shown by a study published by the Lancet a few years back, in which Danish farmers that ate pesticide-free food had roughly double the average number of sperm than normal (Abell et al 1994). Although there is a significant theoretical risk of infertility associated with exposure to many industrial chemicals, even natural compounds have been implicated. Most notably these include phytoestrogens found in legumes such as soya, as well as in other plants. It has been shown that phytoestrogens can impair fertility in animals (Millan et al 2001; Setchell et al 1987), and when exposed to these compounds continuously from an early age, could promote estrogen dependent diseases in humans later in life such as ER+ breast cancer and endometriosis (Allred et al 2001). Other environmental factors that affect fertility include tobacco and cannabis smoke, stimulants (e.g. coffee, tea, cocaine), and alcohol (in women specifically).

The cause of infertility in couples is often multifactoral, and can be related to defects in the man, woman or both. Most cases of infertility are related to factors within the woman, with a lesser percentage of cases caused by strictly male factors, or combined factors in both the man and woman. Most cases of infertility have a specific cause, such as pelvic inflammatory disease and endometriosis in women, or a chronic genitourinary infection in men. Other causes in women specifically include excessive exercise and weight loss.

When a couple is having difficulty becoming pregnant and all identifiable factors have been ruled out the couple is termed a normal infertile couple (NIC). In this case the problem of infertility may be related to factors that are difficult to detect, such as a dysfunction of the oocyte or sperm, or a problem relating embryonic development or implantation. Medical treatments for infertility typically consist of assisted reproductive technologies including in vitro fertilization and implantation, with hormonal stimulation.

Virilification in holistic medicine

From a herbalist’s perspective, a child is akin to the next generation of plants that arises from the plant during sexual reproduction. It is well known that plants under stress or growing in less than optimal environments tend not to flower, or produce sterile seeds. Thus ensuring an optimal environment is absolutely key in assuring fertility, which enhances the vitality of the organism, and helps to ensure viable reproduction. These factors include:

Diet: the diet should be comprised of whole food, and organically-grown, free of contaminants and pesticides (e.g. herbicides, insecticides, and fungicides). The diet for both partners should also contain an optimal range of nutrients, with an avoidance of calorie-rich, but nutrient dense “junk foods.” Women wishing to become pregnant may take a prenatal vitamin in addition to other key nutrients such as adequate protein, iron, vitamin B-complex, vitamin E, magnesium, zinc and omega-3 fatty acids. In men much the same recommendations are made, with an emphasis on key nutrients such as the B-vitamins, vitamin E, selenium and zinc.

Stimulants, drugs and alcohol: stimulants, drugs and alcohol should be avoided as they tend to deplete the body of vital energy, which is used to nourish and protect the reproductive tissues. This includes tobacco, coffee, tea, cannabis, cocaine, amphetamines, and opiates. Many physicians that specialize in reproductive technologies recognize these factors as well, and routinely refuse to work with the couples that continue to engage in such behaviours, especially drugs such as coffee and tobacco, which many people consider innocuous simply because they can be obtained legally.

Stress reduction: it has been established that mental and emotional stress can negatively affect fertility (Sheiner et al 2003; Sheiner et al 2002). In order to best assist with reproductive success the couple should attempt to reduce work, social and relationship stressors, and develop better techniques to deal with deal with them, including meditation and relaxation exercises, moderate exercise, and counseling.

Cleansing and purification

From a traditional perspective, the accumulation of toxins that impair metabolic process and inhibits the production of the vital essence (e.g. jing, ojas) of the body is a common cause of infertility. Thus before any attempt is undertaken to build up the vital essence, the treatment is directed towards cleansing and purification. In most cases this simply involves the adherence to a quality diet for a period of 2-3 months, and the use of botanicals to upregulate the function of the eliminative organs, e.g. Triphala churnam, 2-3 g tid., or a formula similar to the following, as tinctures:

• Cascara Sagrada aged bark (Rhamnus purshianus) 15
  
• Black Radish seed (Raphanus sativus) 15
  
• Barberry root (Berberis vulgaris) 15
  
• Mullein herb (Verbascum thapsus) 15
  
• Pipsissewa leaf (Chimaphila umbellata) 15
  
• Cleavers leaf (Galium aparine) 15
  
• Ginger root (Zingiber officinalis) 10
  

Rx: 5 mL, tid, aq cal ac.

For women who are attempting to conceive after using oral contraceptives, an additional therapy is to normalize the menstrual cycle. This may include using the above strategy along with botanicals such Chasteberry (Vitex agnus castus), False Unicorn root (Chamaelirium luteum) and Black Cohosh (Actaea racemosa). During this period of cleansing the couple should find alternate methods of contraception, including condoms or natural methods (discussed below).

Virilification

In all traditional cultures children were highly valued, and thus there are a number of natural therapies that can be used to enhance fertility. As the Ashtanga Hrdaya states:

"Stumbling walk and incomplete speech, bodies covered with dust and dirt, the mouth and face dirty and covered with saliva. In spite of all these things the child is gladdening to the heart: what other thing is equal to its sight and touch?"

-Uttarasthana, XL:10-11

In Chinese medicine treatments that enhance virility are those that enhance and support the proper function of jing, qi, blood, yin and yang, collectively identified as Fu Zheng therapy. In women the choice of agents is directed towards supporting yin, whereas in men the treatments tend to focus on yang: nonetheless these emphases do not exclude that either treatment be used in supporting reproductive function in the opposite sex, especially in the individual signs and symptoms indicate this. The following are examples of herbs that restore qi, blood, yang and yin, all of which help to restore the vital essence, or jing, stored in the Kidneys:

• Qi restoratives: Ren Shen (Panax spp.), Shan Yao (Dioscorea opposita), Huang Jing (Polygonatum sibiricum)
  
• Blood restoratives: Shu Di Huang (Rehmannia glutinosa), He Shou Wu (Polygonum multiflorum), Gou Qi Zi (Lycium chinense), Sang Shen (Morus alba)
  
• Yang restoratives: Lu Rong (Deer or Elk velvet), Dong Chong Xia Cao (Cordyceps sinensis), Yin Yang Huo (Epimedium grandiflorum), Bai Ji Tian (Morinda officinalis), Bu Gu Zhi (Psoralea coryfolia), Du Zhong (Eucommia ulmoides)
  
• Yin restoratives: Xi Yang Shen (Panax quinquefolium), Tian Men Dong (Asparagus cochinchinensis), Shi Hu (Dendrobium nobile), Han Lian Cao (Eclipta prostata)
  

In Ayurvedic medicine virilification is an important branch of treatment called vajikarana rasayana, meaning “to do like a horse.” Once a therapeutic regimen of purification has been implemented, specific remedies are given to enhance the production of ojas. Many of these remedies oppose the basic qualities of vata and increase the qualities of kapha: thus the prior regimen of purification is key to the success of the treatment, to eliminate ama and its inhibit its accumulation by enhancing agni. To this end vajikarana treatments are often used along with dipanapachana remedies that strengthen agni. Examples of important vajikarana herbs include Shatavari (Asparagus racemosa), Ashwagandha (Withania somnifera), Gokshura (Tribulus terrestris), Amalaki (Emblica officinalis), Brahmi (Bacopa monniera), Musta (Cyperus rotundus), Guggulu (Commiphora mukul), Arjuna (Terminalia arjuna), Tila (Sesamum indica), Yashtimadhu (Glycyrrhiza glabra), Bala (Sida spp.), Kapikachu (Mucuna pruriens), Punarnava (Boerhavia diffusa), Shuktibhasma (purified oyster shell ash), Shringaputa (deer horn ash), and Shilajitu. These herbs are often used along with dipanapachana herbs that enhance digestion, some of which also have vajikarana-like properties, including Ela (Elettaria cardamomum), Pippali (Piper longum), Jatiphala (Myrsitica fragrans), Tvak (Cinnamomum cassia), and Shunthi (Zingiber officinalis). Overall, these dipanapachana remedies should account for 10-20% of the total formula ingredients, the remainder comprised of vajikarana remedies, such as the one’s listed above. If the formula is administered as a powder, it should be mixed with a proportion of ghee and fresh honey, or be decocted in milk and taken with jaggery.