3 Reasons Acupuncture Supports Couples Facing Infertility

 Acupuncture
Nov 042019
 
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When you consider all the changes in our agricultural practices, the increased number of medications we take, as well as our dependence on plastic and technology that is constantly emitting low-grade radiation, it’s no surprise more couples are having trouble conceiving. Current statistics show one in six couples who are trying to conceive are facing fertility issues. And while many times infertility is thought of as a female issue, it is really a factor for both the man and woman and should therefore be addressed as such.

In Traditional Chinese Medicine (TCM) we talk about qi a lot, the energy or life force in everyone. Qi regulates the mental and physical body. When qi is disrupted or blocked due to poor health or other circumstances, then disease may occur. Regular acupuncture treatments help to keep the normal flow of qi moving and unblocked. A healthy flow of qi increases a couple’s chances of conceiving.

One of the most important ways acupuncture treatments can support a couple facing fertility issues is through reducing stress. Stress is frequently a key component that contributes to infertility in both men and women. When people are stressed, the brain releases a hormone known as cortisol. Too much cortisol alters the brain and changes the hormone levels which are key to the reproductive cycle. Due to the delicate balance between the brain, pituitary gland and the reproductive glands, excess stress is capable of preventing ovulation completely. Stress can also cause spasms in the uterus and fallopian tubes, which may interfere with implantation of a fertilized egg. In men, stress can alter sperm count, sperm motility and cause impotence. Acupuncture has the ability to counter the effects of stress.

Regular acupuncture treatments are also very effective at decreasing and removing excess phlegm in the lower body. This buildup of excess phlegm can be caused by numerous factors. In the United States, there are two causes that are most common. The first is the standard American diet that is saturated with fast, greasy, sugary and fried foods and lacking in fresh, whole plant-based foods. The second cause is the sedentary lifestyle that many people now live. Studies confirm that these two situations lead to increased infertility issues. But specific acupoints, herbs and exercise can all be beneficial in creating a healthy environment for a baby to be conceived.

Acupuncture can also be a great option for those facing fertility issues, because it doesn’t cost nearly as much as other options. The average cost of in vitro fertilization (IVF) is $15,000 per session and the success rates are only about 33 percent. However, the use of TCM over a 6 month period can increase success rates by nearly 65 percent for a fraction of the cost of IVF. With acupuncture, people also get the added benefits of more restful sleep, less stress and anxiety, improved digestion and better health overall.

Studies show acupuncture can increase fertility and allow couples to conceive more frequently. If you are experiencing fertility problems, acupuncture may hold the answer. Ask me today if you would like more information.

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Homeopathy for Infertility

 Homeopathic
Oct 062017
 

In today’s stressful times, infertility (an inability to conceive successfully) is becoming more and more prevalent. On top of it, because of the stigma associated with it, despite of the paramount importance in parents trying to conceive, it usually is a taboo topic where people find it difficult to seek help. The cause is often extremely difficult to determine and western medication tends to throw the kitchen sink at this problem through hormonal treatments, fertility drugs and a lot of assisted reproduction techniques designed to fertilize the egg in some way. The results are often mixed bag from these methods and the side effects of these treatments are sometimes very severe for the parents and the potential fetus.

How does homeopathy view this topic? To be fertile and having a healthy ability to reproduce is an important function of every living organism. The problem can be on father’s side or the mother’s side but an inability to reproduce according to homeopathy is indicative of a subtle energetic disturbance in the person’s vital energy which results in the reproductive functions getting disturbed thereby resulting in improper results in the efforts to conceive. Often, I see patients in my practice where the patient comes and sees me for some other chronic complaint, and it gets revealed that the patient along with his/her partner has also been unsuccessfully trying to conceive for an year or two. I have seen very often that under the right homeopathic remedy, not only does the chief complaint resolve, but a successful conception/pregnancy is also achieved. Again, due to the taboo nature of infertility in our society, most of these cases are where I accidentally come up against the infertility problem while I am seeing patients for other complaints. Many of these cases also have some other deep seated problem on the mental or physical planes, thereby confirming the homeopathic view of infertility being a systemic problem requiring a holistic view rather than through a tunnel vision of reproductive health alone.

Let us hope that more and more people are able to seek help for this tough problem, and as a society we rise above our social prejudices, removing the stigma associated with this problem, and are able to view it just like any other chronic systemic complaint. Homeopathic remedies can be a very powerful tool for parents who are not able to conceive successfully as these remedies correct the subtle energetic disturbances which are at the root cause of the problem, and at the same time also correcting any mental stress/anxiety around this problem, leading to healthier relationships between couples, paving the way for healthy functioning of hormonal and reproductive systems.

There are a lot of remedies which can be indicated for this condition, and the choice depends on a lot of factors. It need a careful analysis by a competent homeopath.

The best illustration of this in an 1881 case by HC Allen (the case below taken from reference [1])

A case of infertility cured by homeopathy in 1881 in the words of HC Allen. My annotations are in green below.
============================================================================================================
G. R., aged forty-five, light brunette, married ten years, general appearance healthy.
For six years has had no discharge of semen during coitus (Coitus means sexual intercourse). Occasionally nocturnal emissions.
Erections usually weak, give out during coitus.
Burning in perineum, worse after going to bed, and when thinking of it. Drawing pains in testicles, with sensation of weakness of genitals. Occasionally itching, dry eruptions in crotch and inner upper surface of thighs and anus.
With the sensation of weakness of genitals his eyes feel weak. Very sensitive to cold and changes of atmosphere.
Takes cold easily, usually affecting nose and throat first with dryness, then with watery catarrh and sneezing, or he has aching pains in different parts of the body and limbs, changing location frequently.
Twenty years ago had African fever.
Never had gonorrhea, syphilis, or other eruptions than those mentioned above.
All other functions normal.
While on a visit to Philadelphia he applied to Dr. Lippe, (Read more about Adolph Lippe) at my advice Dr. Lippe wrote me the following letter :
“I find that your patient had diphtheria about ten years ago, and was treated with inappropriate mercurials and gargles by Dr. -.
The character of the attack was that it went from one side to the other and finally back again to the original side. Great weakness, almost paralytic, followed the attack, and he thinks he has never regained his full vigor and usual strength since this illness. His acute cold has always the character of shifting pains and change of location. I have given him a dose of Lac can. Cm.., (This means a remedy named Lac Caninum in 100M potency; Lac Caninum is potentized milk of dog) which may be required to be followed by a dose of Pulsatilla.”
Suffice it to say that my patient never needed the suggested dose of Pulsatilla. (The patient got better on the single dose of Lac Caninum, and never needed the second medicine)
In three months after his visit to Philadelphia his wife was pregnant. She has since borne two remarkably healthy children.
As far as we know Lac can. has no sexual weakness. That fact disturbed Dr. Lippe very little in his selection. He looked deeper and found the cause and the remedy. This is true homeopathic pathology. All the knowledge in the world of the special pathology of this case could not have revealed the remedy to any one. To the homeopathic artist, however, it was revealed, and a man regained his manhood and became the father of two children, after ten years of impotence.

[1] http://www.homeoint.org/seror/nosodes/laccaninum.htm

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The Ayurvedic Approach To Female Infertility

 Ayurvedic
Feb 092017
 

Infertility is usually defined as the inability to conceive despite regular sexual intercourse for more than 12 months. This article will address primarily female infertility or “female-factor” infertility.

In the conventional Western medical paradigm, a woman’s advanced age, hormonal abnormalities, tubal-, uterine-, or endometrial-related conditions are common causes of female infertility. In men, infertility is seen to occur due to poor sperm quantity and/or quality and spermatogenesis as well as erectile dysfunction.

In both sexes, psychosomatic aspects and stress levels are important but rarely addressed. Ayurveda would add another unique aspect as well which impacts fertility–karmic effects. Frequently we see infertile couples in whom standard investigations including hormonal levels, semen analysis, ovulation testing, and tubal patency are normal. This accounts for 25-30% of all couples seeking help.

The complete evaluation for female infertility includes patient history, gynecological examination, record of basal temperature, vaginal and cervical cultures, ultrasound studies, hormonal analysis [i.e. follicle stimulating hormone (FSH), luteinizing hormone (LH), prolactin, testosterone, dehydroepiandrosterone sulfate (DHEAS), and thyroid-stimulating hormone (TSH)], hysterosalpingogram with dye to visualize the fallopian tubes, and semen analysis of the partner.

Depending on the presumed cause(s) of female infertility conventional drug treatment can include any of the following:

  • Gonadotropins in the case of hypogonadotropic ovarian failure
  • Selective Estrogen Receptor Modifiers (SERMs) like clomiphene
  • Prolactin inhibitors in the case of hyperprolactinemia
  • Metformin in the case Polycystic Ovarian Syndrome (PCOS)
  • Progestogens, surgical measures to lyse adhesions in case of endometriosis
  • Gonadotropin Releasing Hormone (GnRH) in case of hypothalamic ovarian failure

However, the most common treatment offered for most women is in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI).

In Vitro Fertilization is a very recent and still evolving treatment. The first pregnancy using it was in 1973, however it ended after a short time in a miscarriage. Back then it was making a great deal of news and controversy and the phrase “test-tube baby” was in the headlines. A second pregnancy was recorded in 1976, however, the embryo was embedded in the fallopian tubes and had to be surgically removed. In 1977, a study with 68 women was conducted, resulting in only two pregnancies: one woman having a deformed, still-born child, and another woman requiring an abortion. Altogether, up to the birth of the first successful IVF child, only about 200 embryos transfers were attempted.

In 1978, the first child was born using IVF in England (Louise Brown, age 38 today). In the U.S. it happened in 1981. I recall at that time the news was met with both amazement by some and revulsion by others.

Today the procedure has changed greatly from those early days, but it’s certainly not a simple or natural process. First, a medication is given to suppress the woman’s LH surge and her ovulation until the developing eggs are ready. This drug is commonly a GnRH-agonist (gonadotropin releasing hormone agonist) such as Lupron. Next an FSH analog (follicle stimulating hormone) is given to stimulate (hyperstimulate, in my opinion) development of multiple eggs (Gonal-F and Follistim are the most common).

Finally HCG (human chorionic gonadotropin) in a usual dose of 10,000 mIU/mL is given to cause final maturation and ovulation of the eggs. The eggs (oocytes) are collected and assessed for their health and degree of maturity. Following preparation of the ejaculate, insemination takes place by mixing the eggs and sperms. A maximum of 3 embryos are transferred to the uterus. The embryo, at this point, is in the four- to eight-cell stage.

In addition to IVF, ICSI has also been introduced in cases of more complex male subfertility (insufficient sperm count or motility). In this procedure a single spermatozoon is injected directly into the cytoplasm of the oocyte using a micropipette.
After 48-72 hours the embryo is transferred into the uterus. After transferring the embryo, implantation is no longer controllable, and everyone waits and hopes. The ensuing 2-week luteal phase is supported with medication (commonly progesterone injections every day!). Using IVF with intra-cytoplasmatic sperm injection and subsequent embryo transfer, most Reproductive Medicine centers around the world claim their rate of successful pregnancy is around 60%; the “baby take home” rate depends on the age of the mother ranging from about 40% for women under 35 to about 10% if over 40.

The physiology of the reproductive system as a whole is governed by sadhaka pitta, prana vata, and apana vata, yet the reproductive organs themselves are endowed with the qualities of kapha. Kapha is the growth-promoting (anabolic), structure-forming dosha that generates and sustains creation. Together with ojas (life force) and rasa dhatu (plasma tissue), kapha dosha organizes the nourishment required to build and re-build the endometrial lining during a lifetime of artava (menstruation) and has an unctuous quality that lubricates the uterus and its ‘sister’ organs (e.g. ovaries, fallopian tubes, cervix, vaginal canal). Kapha also confers stability and strength to the reproductive tissues helping maintain ovarian structure and uterine shape, tone and ability to contract.

A woman whose artava is exhausted, is called vandhyatva (vandhya-barren, childless). This disease entity—vandhyatva—is the condition closest to infertility in the Ᾱyurvedic classification of diseases. Detailed diagnostic and therapeutic strategies were already described as early as 200 AD in the authoritative Ᾱyurvedic text Caraka Samhita (chapter Cikitsa-sthana, Yonivyapat).

In the centuries that followed, specialized texts on gynecology evolved, including the Kashyapa-Samhita which contains detailed descriptions of various diseases and dedicates a complete chapter to female infertility. As we shall see below, both samshamana (gentle) and samshodhana (strong) therapies are advised for the treatment of infertility in Ᾱyurveda.

The main Ᾱyurvedic treatment goals are (1) the purification and (2) the functional optimization of reproductive tissues (artava- and shukra-dhatu) of both sexes. According to Ᾱyurveda, reproductive health is primarily determined by the health of tissue metabolism and tissue nutrition, both being ultimate requirements for conception. The presence of any accumulated tissue toxins will hamper treatment.

Therefore, general panchakarma purification measures must almost always be the initial step in the treatment sequence. Depending on the Prakriti (unique constitution) of the individual these purification measures may include emesis, purgation, medicated enema, blood purification, and several other specific procedures pertinent to reproductive health. One such example is uttara-basti, intrauterine douche with medicated oils or decoctions. A description of the complete range of these specialized treatment options is beyond the scope of this article.

As Ᾱyurveda is a holistic science, it is important to always consider the patient’s overall health condition, including her mental health and living environment. Importantly, the unique feature of the Ᾱyurvedic approach to fertility is that it emphasizes improving the overall health of both the prospective parents. Fertility therefore may ensue partly due to improved overall health. This approach contrasts with the biomedical approach, which does not directly consider overall health and narrowly focuses on the reproductive tissues.

After thorough patient history taking (prashna) including modern and Ᾱyurvedic parameters, the eightfold and tenfold diagnostic processes (ashtasthana– and dasha vidha-pariksha) are performed according to traditional diagnostic principles of Ᾱyurveda (see below). Patients are understood by Ᾱyurvedic diagnosis as having a particular sub-type of vandhyatva based on their doshic constitution (prakriti).

The most obvious and relevant pathological findings in all cases of infertility from the Ᾱyurvedic perspective are: (1) an overall imbalance of all of the 3 doshas (sannipata-prakopa of vata-, pitta- and kapha-dosha), but usually with dominating kinetic and metabolic principles (vata and pitta) and (2) an irregular functioning of the digestive principle (agni) at both the organ and cellular levels, (3) srotodushti, obstruction or blockage of the channels for both gross and subtle nutrients and energies.

According to the Ᾱyurvedic explanatory model for etiopathogenesis/disease staging (samprapti), most woman, by the time they are aware of any problem, are in the fifth stage of the disease sequence (manifestation or vyakti) or the sixth and latest stage (chronic disease or bheda).

Ashtasthana Pareeksha (Eightfold Examination)
Nadi – Pulse diagnosis
Mutram – Urine examination
Malam – Fecal matter examination
Jihwa – Tongue and taste assesment
Sabdam – Voice and speech of the patient; heart, lung and abdominal sounds
Sparsham – Touch, skin and tactile sense
Driksha – Eyes and vision
Akriti – General physique (i.e. lean, muscular, etc.); general complexion

Dasavidha Pareeksha (Tenfold Examination)
Dushyam- Regarding the structural and functional abnormalities of the body
Desham -Geographical situation of the place where patient lives (eg: marshy)
Balam -Physical strength
Kalam- The season and climatic conditions
Analam -The digestive system of the patient
Prakriti- The natural Tridosha constitution of the body
Vayas -Age of the patient.
Satvam- Psychological strength of the patient
Satmyam- General and personal habits of the patient e.g. tobacco use, regular exercise, yoga asana practice, napping, etc.
Aharam- Nature of food (e.g. vegetarian or non-vegetarian)

Although there are usually strategies to neutralize the negative effects of most conditions, one should be aware of the influence of all aspects of health on female fertility. Here I will mention a few of the more common ones. Chronic menstrual irregularities and associated symptoms like excessive bleeding and severe cramping represent signs of imbalanced gynecological functions (apana vata prakopa and artava dhatu-dushti); anatomical abnormalities (ovarian cysts, retroverted or T-shaped uterus, etc.) also have significance (vata-kapha prakopa). Previous Caesarian section, curettages, miscarriages, intramural pregnancy with iatrogenic abortion, and IVF procedures represent traumas to the reproductive tissues (vata, particularly apana-vata, rakta dhatu-dushti, etc.), leaving scars and leading to a ‘channel obstruction’ (sroto-rodha) of apana-vata, the subdosha regulating gynecological functions; ovarian cysts (artava-dhatu-vrddhi and vata-kapha-prakopa) interfere with implantation. The ovarian hyperstimulation with FSH drugs which is casually recommended by doctors certainly causes significant Vata aggravation (vata-prakopa).

Lyme disease, multiple sclerosis, Hashimoto thyroiditis, allergies, obesity, anorexia, irritable bowel syndrome as well as any other low-grade chronic inflammatory condition are indicators of a generally disturbed immune system (rasa-kshaya, rakta- and majja-visha and ojovyapat (loss of vitality) with vata as dominant active factor) – creating a suboptimal environment for implantation and conception in general. Any history of drug intake or environmental exposures is another inhibiting factor for natural fertilization according to Ᾱyurveda, which is why Panchakarma is so vitally important. Sleeping disorders engender mental stress weakening both physical and emotional stability. Furthermore, there can be any number of other factors which create imbalances (e.g., excessive traveling, job stress, relationships, moving to a new home, illnesses in the immediate family, etc.).

Except for acute causes such as the various traumas listed above, female infertility is almost always a result of a gradually-incremental, slowly developing disease process. The holistic Ᾱyurvedic treatment to any disease or condition, including infertility, utilizes a multimodal approach. Both samshodhana (strong; purifying) and samshamana (gentle; balancing) treatments are always used.

Ᾱyurvedic treatments are not merely a series of single and autonomous treatments, but on the contrary, are a carefully formulated highly-individualized and complex arrangement of treatments whose functioning can only be understood if viewed as an integrated whole. A defining feature of the holistic-oriented Ᾱyurvedic strategy is the therapeutic integration of the physical (e.g. purification through Panchakarma, dietary recommendations, herbal medicines, etc), psychological, and spiritual realms (e.g. mantra recitation, use of gemstones, placement of sacred objects in the home, prayer, etc). In Ayurveda, female infertility is understood as a somato-psycho-spiritual disintegration with a tendency to somatize unresolved emotional and mental conflicts; these conflicts are either wholly or partially causative or they further aggravate co-existing epigenetic, traumatic, and biochemical causes.

The selected purification methods (most commonly purgation, enemas, intrauterine enemas and nasal irrigation) are delivered to restore balance to the kinetic vata principle, according to Ᾱyurvedic theory. The far-reaching therapeutic benefits for this are difficult to explain through conventional modern pathophysiological principles. A detailed explanation of Ayurvedic theory and energetics though fascinating and compelling is beyond the scope of this article.

However, what can pragmatically be said here is that these methods optimize mucosal transport and general function, regulate and stabilize the intestinal microbiome, restore hormonal homeostasis to the interior milieu, enhance intestinal digestion, metabolism and excretion, and counteract side effects of both endogenously-produced and environmental toxins. These effects are augmented if the individual is concurrently observing an appropriate individual dietary approach, receives the appropriate herbal medicines, and also follows the other prescribed Ᾱyurvedic principles.

Here is a brief description of some of the Ᾱyurvedic approaches used and the reasoning behind them. Not every therapy is used for every woman and they are always modified according to the individual constitution.

Virechana (purgation): This procedure involves several days of internal oleation by taking either pure ghee or a specially prepared medicated ghee followed by a gentle herbal purgative. Purgation acts on aggravated and accumulated pitta and kapha doshas. It decreases the heat (ushna guna) of pitta and increases coolness (sheeta guna) required for formation of shukra dhatu (ovum and sperm). Impaired agni due to disturbed pitta is also rectified by the virechana procedure. A strong and balanced dhatvagni (tissue agni) is required for dhatnirmiti of shukradhatu (creation of reproductive tissue). Obstructing kapha dosha is removed through virechana and the blocked apana vata obstructed by kapha dosha is also relieved by virechana. Common virechana dravyas: mahatiktaghrit, trivrit (leha or churna).

Anuvasana and Niruha Bastis (medicated enemata): These are two different types of medicated enemas. The reproductive system present in katisthana (hip and loin region) which is a region chiefly regulated by of apana vata. Action of basti is predominantly on vata dosha and pakvashaya (large intestines). The uterus (garbhashaya) is made up of vayu and akasha mahabhuta. In basti, mainly tiktarasadravya (vayu + akasha mahabhutas) despite being potentially vatavardhak (vata-increasing), are useful because they act as a vehicle and catalyst to deliver medicines to vatasthana (vata regions). Sneha in basti promotes trans-membrane absorption of herbal medicinal components. Since Basti is targeted at regulating the apana vata, it facilitates the well-timed release of ovum and also normal motion of sperms.

Uttar Basti (medicated intrauterine enema): Uttar basti plays a very prominent role in treating female infertility because it has a direct local action upon the reproductive tissues. The ovaries contain receptors which receive hormones secreted by the hypothalamus and pituitary gland. The herbal medicines used in uttar basti stimulate and sensitize these receptors, so that proper ovulation occurs in each cycle. It also helps to increase the receptivity of the genital tract to the entry of sperms.

In addition, uttar basti relieves artava srotosanga (congested channels of menstrual flow) and corrects artava dhatvagni (reproductive metabolism). Because selected medicines are administered directly to affected areas, it can help clear tubal blockage by direct lysis of adhesions. Finally, altered cervical pH can be corrected by uttar basti. Depending on the specific issue identified, different uttar basti dravyas are used. For example: in ovulatory disorders: shatavarighrita, balaguduchyadi taila, phalaghrita; in tubal obstruction: kshar taila, bhallataka taila, til taila; in uterine fibroids or PCOD: dashmoola taila, panchatiktaguggulghrita, varunadi kwath, hapushadi ghrita.

Nasya (administration of nasal medications): All Ᾱyurvedic students learn the sloka: “nasya hi shiraso dwaram,” which means “the nostrils are the gateway to the brain.” Therefore any substance introduced intranasally (even smoke) acts directly on the brain and specifically in this context, the hypothalamus and pituitary glands.

Today we know that the olfactory nerve fibers literally enter the back of the nasal passage through the cribiform plate and conveys stimuli directly to the brain. The mucosal epithelium is sensitive to a variety of stimuli including various herbalized ghritas and tailas which are easily absorbed through mucosal epithelium. Nasya medications may help to stimulate the hypothalmal- pituitary axis to secrete FSH & LH hormones. We often use chandanbala taila, shatpushpa taila, and phalaghrita.

Adjuvant Panchakarma Treatments: The specialized physical therapy techniques, including Shirodhara (forehead-dripping therapy), Shirobasti (oil-crown), and Lepa (herbalized mud) with precisely selected medicated oils and other substances, further facilitate the stabilization of the overall constitution by balancing the impaired vata and pitta doshas.

Oral Herbal Medicines: While it is beyond the scope of this article to describe the many individualized formulas which can be used as part of the treatment for vandhyatva, it can be stated that Ᾱyurvedic herbal formulas used in these patients primarily target adaptogenic, rejuvenative, aphrodisiac, and general strengthening (ojo vardhana) as well as strengthening of the reproductive tissues; they also are designed to enhance digestion and cognition as needed and have mild anxiolytic and antidepressant properties.

That being said, some of the more common plants used include Ashwagandha (W. somnifera), Shatavari, (A. racemosus), Guduchi (T.cordifolia), Brahmi (B. monnieri), Yogaraj guggulu, Krishna Jeeraka (N. sativa), Shatapushpa (A. graveolens), Atibala (A. indicum), dashmoolarishta, maharasnadi kwath.

Lifestyle Factors: In a similar way to everything mentioned above, yoga, meditation, and mantra recitation address the physical and mental stress caused by the often numerous futile fertility attempts with conventional therapy. One other interesting practice is to have a woman simply place a stone shiva linga of any size under the foot of her bed. The connection between detoxification, stress and infertility is not yet well understood. However, in my more than three decades of Ᾱyurvedic practice, it is not uncommon to see patients finally give up IVF, undergo Panchakarma and Ᾱyurvedic protocols–and then become pregnant shortly thereafter. Once the stress, expectations, and adverse physiological effects of IVF treatment subside, the body is sometimes able to function normally again. That is why from the Ᾱyurvedic perspective, these seemingly gentle mind-body recommendations are effective; they also target the regulation of vata, in this case on the level of manas (i.e. the mind).

Despite the many successful case reports in India and other Ayurvedic clinics around the world, it remains an open scientific question whether the Ᾱyurvedic approach exerts any specific fertility-promoting effects. Besides my own U.S.-based medical practice, the effectiveness of Ᾱyurvedic interventions is based primarily on numerous case studies and rather small and mostly preliminary clinical trials conducted in India. From the perspective of modern scientific research, given the many successes documented and despite the lack of well-designed randomized controlled studies, further research is warranted. In particular, the integration of Ᾱyurvedic treatments into modern medical strategies for fertility has the potential to improve patient outcomes with little to no downside.

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Naturopathy, Paternalism and Infertility Treatments

 Naturopathy
Oct 092014
 

Pregnancy Test
This is another post in the naturopathy versus science series, where a naturopath’s advice is assessed against the scientific literature.

It’s Naturopathic Medicine Week in the United States, so it’s time for another look at the alternative medicine practice that blogger Orac likes to call the One Quackery to Rule them All. Naturopathy is an oddity among alternative medicine, because it’s a hodgepodge of other practices linked by an underlying belief in vitalism: the pre-scientific notion that living things have a “life force”. Vitalism disappeared from medicine when Wöhler synthesized urea in 1828, yet the belief in vitalism is a central tenet of naturopathic philosophy. Naturopaths liken themselves to be primary care providers akin to family physicians (general practitioners) but their practices are quite different: rather than make decisions based on scientific evidence, naturopaths pick and choose based on what they feel is congruent with their vitalistic philosophy, sometimes despite good scientific evidence that shows they are wrong. For example, homeopathy is an alternative medicine practice that is very popular with naturopaths. It is an elaborate placebo system where “remedies” contain no medicinal ingredients: they are literally sugar pills. There is no demonstrable medical effect from homeopathy, and so it isn’t part of science-based medicine. Yet homeopathy is a “core clinical science” for naturopaths, and the practice of homeopathy is part of their licensing exam.

Naturopathy: Alt-Med Paternalism

According to naturopaths, what they offer is a return to the practice of medicine that’s now been lost:

While the training and approach of ND’s is progressive, they practice in ways reminiscent of old-fashioned family doctors. They take the time and effort to learn about each patient and his/her family. This means seeing fewer patients a day. Naturopathic physicians commonly spend 60 to 90 minutes per patient visit, listening to patient concerns, diagnosing and treating each patient as an individual. This is a practice that benefits both patient and doctor.

Likening naturopathy to “old fashioned” medicine is apt. On the positive side, naturopath consultations are much longer than medical doctors. But that’s where the positives end. Like old-fashioned medicine, naturopaths don’t practice according to what the scientific evidence says. Without a scientific basis for decision-making, “treating each patient as an individual” is justification for making treatment decisions on the fly, without any standard of care, or even an expectation that naturopaths must defend or explain their decisions from an evidence perspective. And despite all the claims that naturopaths do “individualize” their treatments, what naturopaths offer for virtually every condition tends to be based around the same pseudoscientific beliefs: You’re toxic. You’re acidic. You’re filled with yeast. Your adrenals are tired. And lately, gluten is poison. And the solutions offered are strikingly similar: homeopathy, acupuncture, and lots and lots of supplements.

The era of paternalism in modern, science-based medicine largely disappeared with the “old time family doctor” too. Today’s medical model is based on principles of patient autonomy and informed consent. Health professionals are responsible for providing objective information on treatments to support informed decision-making by patients. This advice must be defensible and is judged by what is considered that profession’s standards of practice — which are scientific standards. Patients, as partners, take information provided by health professionals and make care decisions based on a consideration of their own values and preferences. In an informed consent model, lying to patients about a treatment’s efficacy, or withholding information about the evidence, is not only unethical, it could put a health professional’s license at risk.

Naturopathy, like other alternative medicine practices, appears to be highly paternalistic, and consequently may be compromising patient autonomy and choice. It does this by first promoting the idea that science and evidence is relative, poisoning the well for what comes next — the erosion of an objective standard of care. Second, providers fail to offer full disclosure on the efficacy of their treatments. Naturopaths do not offer treatments based on good evidence (as I’ve described in my series of posts and as documented in the literature). While naturopaths can offer science-based advice, they can also promote practices that are are either not proven to work, or are proven not to work. Third, vitalistic beliefs push naturopaths to shift responsibility for illness on to the patient, a tactic which has been described as “Your disease, your fault”, implying that many illnesses are preventable — confusing patients about the scientific facts of their own health conditions. Finally, naturopathy creates fake diseases like adrenal fatigue out of whole cloth, and conveniently offers the treatments for them as well. True patient-focused, autonomous care requires discussions that are grounded in honest disclosures between provider and patient, which seem incompatible with the philosophy and practices of naturopathy. An illustrative example of naturopathic paternalism can be found in today’s case study: naturopathic treatments for infertility.

The Facts of Infertility

Infertility is formally defined a failure to conceive after 12 months of regular intercourse without use of contraception (in women under 35 years of age) or after 6 months of regular intercourse without contraception (women 35 or older). The number of couples that are infertile isn’t clear. Current estimates from the CDC [PDF], suggest around 6.0% of America women are affected, which is over 1.5 million women between the ages of 15-44. Infertility isn’t rare, and many women (and couples) seek medical advice for what’s perceived as impaired fertility.

It’s important to note that failure to conceive isn’t an issue for an individual — it’s an issue for a couple, and should not be assumed to be due to the female. Infertility is a disease of physiology, not psychology. Causes include a lack of sperm, tubal obstruction, or a failure to have regular periods. Often it may not clearly be an identifiable cause, and it can be difficult to sort out probable from possible causes. But medical science has made significant progress in identifying the (true) root causes of infertility, and addressing them. Treatments either target reversible causes, or the attempt to circumvent causes that can’t be reversed. Lifestyle factors that are usually suggested include smoking cessation, minimizing caffeine and alcohol, and ensuring coitus is attempted regularly around the appropriate time in the ovulatory cycle.

Medical therapies for infertility include drug treatments with fertility drugs. Other treatments can include surgery and procedures like intrauterine insemination or in-vitro fertilization. Medical advances have brought significant advances in treating infertility, and up to 50% of infertility cases can be addressed with medical interventions.

Naturopathy and Fertility: Where Anything Goes

Fertility is big business for naturopaths. An Alberta survey of naturopath websites found that 45% advertised that they could treat fertility issues. And it’s not surprising that there would be a search for alternative options. “Medicalizing” what usually occurs naturally can be quite distressing. If only there were a “natural” approach to infertility that could eliminate the poking, the prodding, and all the drugs. So is there? Here are the themes from among the 251,000 sites featuring naturopathy+infertility. Perhaps not surprisingly, most naturopaths offer similar lists of causes (and treatments):

Toxins, toxins, toxins: According to naturopath Iva Keen, you’re not pregnant because you’re toxic:

Most chemicals used in everyday life do not go through the same checks medicines do. Consequently; poisonous chemicals end up circulating in our environment, food supply, air and water. … Unfortunately, our waterways are constantly being polluted by industrial waste and by products, pharmaceutical drugs, pesticides and herbicides and commercial cleaning products. Heavy metals are the most common of the reprotoxins reaching our water supply through industrial waste, jet fuel exhaust residue and a variety of other sources.

Keen suggests drinking filtered water — an unnecessary recommendation, as there’s no evidence that municipal water supplies are causing infertility.

You need to detox: According to naturopath Shawna Darou:

In many cases, treatment may start with a 10-14 day detoxification program with the aim to reset hormone levels, remove toxins as much as possible and remove inflammatory foods. Toxins may be an impediment to fertility and before the body can conceive it needs to detox various toxins that have built up in fat cells over many years of living in polluted environment and consuming unhealthy foods that contain fertility inhibitors.

As has been pointed out many times, “detox” as advertised by naturopaths is a delusion. Genuine detoxification treatments are medical procedures that are not casually selected from a naturopath’s menu of services. Yet the term has been co-opted to give a veneer of medical legitimacy to what is effectively a catharsis, with no objective medical benefits — and zero impact on infertility.

You need homeopathy: Darou continues:

Homeopathy is a powerful aid in stimulating fertility. In 50% of our clinical case we observed a dramatic positive change in fertility directly related to homeopathic treatment. Each case will undergo a thorough homeopathic assessment and constitutional remedy recommendation.

How magic beans stimulate fertility isn’t clear — you’d think with a 50% effect, that a clinical trial would be easy to perform. The one trial I could find showed no effect.

You need herbs: Naturopath Nicola McFadzean Ducharme is a strong proponent of herbal medicine for infertility, listing dozens of herbal remedies she recommends for infertility:

For many natural therapists, herbal remedies form the foundation of naturopathic treatment of infertility.

and

Given that hormonal balance is dependent on the hypothalamic-pituitary-reproductive axis, as well as the pineal gland, remedies to support this should be given, such as Avena, Passiflora and Pulsatilla. These herbs also act as nervines, strengthening and supporting the nervous system. Rehmania, Peony and Licorice may also strengthen pituitary function.There are particular herbs that have estrogenic, progesterogenic or adaptogenic effects. Estrogenic herbs include Alfalfa, Licorice, Fennel, Hops and Clover. Progesterogenic herbs include Wild Yam, Birth Root, Sarsaparilla and Stargrass; while Chaste Tree, Saw Palmetto and Blue Cohosh are adaptogenic, meaning they regulate either way depending on the need.

Prolactin excess can be treated with Chaste Tree or Rehmania; Bugleweed and Hops will help high levels of LH; FSH levels can be raised through use of Black Cohosh, which also lowers raised LH and increases estrogen. Chaste Tree lowers elevated FSH, testosterone, prolactin and raises low levels of LH and progesterone.

Emmenagogues are herbs used to promote circulation and menstruation, and therefore are indicated if amenorrhea is present. Such herbs include Mugwort, Pennyroyal, Tansy, Rue and Southernwood. These should be used with the herbs that promote normal ovarian function. If excessive bleeding is the problem, hemostatic and astringent herbs such as Shepherd’s Purse, Beth Root, Lady’s Mantle, Cranesbill, Raspberry and Black Haw may help.

This advice goes on for several more paragraphs. Perhaps not surprisingly, there is no established role for herbal remedies to treat infertility. No products have been demonstrated to have meaningful effects. Then there’s the teratogen (birth defect) risk of herbal medicines. Combined with the unclear quality control of herbal products in North America, herbal products bring risk, with no established benefit.

You need vitamins: Prenatal vitamins are a science-based treatment during the pre-conception period, but there’s no good evidence that prenatal vitamins provide a fertility benefit. Naturopath Pamela Frank who claims that “We only recommend science based treatments” makes the following recommendations:

As a naturopathic doctor, my 4 years of post-graduate nutrition training and 14 years of experience makes me one of the most highly qualified diet and nutrition experts in health care. Naturopathic doctor training in nutrition is unbiased by political interests such as the Canada Food Guide, the dairy marketing board or the wheat marketing board, based instead on what is scientifically proven to help balance hormones and improve fertility. Diet can either cause or contribute to infertility. Likewise correcting your diet can help your body to reverse infertility. Special individually customized diets will be recommended, and treatment may include nutritional supplements such as vitamins, minerals, enzymes, and other natural supplements.

i.e., Your body, your fault. She continues:

Certain vitamins and minerals can help balance hormones, nourish the endocrine glands like the adrenals, thyroid, ovaries and pituitary and support liver detoxification. Most are safe to use along with fertility treatments and to continue throughout pregnancy. Multivitamins in our experience do not work to fix a deficiency. Why? Because they contain too many different vitamins and minerals, often at too low a dose, that are all competing to be absorbed. We find it far more effective and efficient to target the specific vitamins and minerals that our individual patients need. Vitamins and minerals can also have a significant impact on the health of your future child. Conditions like ADHD and autism have been linked to deficiencies of B vitamins and minerals like magnesium, environmental toxins and hormone imbalances in the mom.

Again, no references, and no basis in reality.

You need acupuncture: Acupuncture is widely touted as an effective treatment for infertility, particularly in combination with in-vitro fertilization. According to naturopath Fiona McCulloch,

We also provide acupuncture, using research driven protocols that have been proven to increase fertility by a substantial margin (40-60% increase in success rates for IVF cycles). Acupuncture provides you with the time and space to feel completely relaxed while physically enhancing blood flow to your pelvic organs and developing follicles as you go through natural cycles, or prepare for your IVF or IUI cycles. Overall, the program will substantially improve follicle health, enhance implantation, and restore hormonal and emotional balance.

Naturopath Shawna Darou claims the following:

Acupuncture is a non-invasive, all-natural way to improve your chances of becoming pregnant with assisted reproductive procedures by up to 65%1.

To her credit, Darou at least lists references. Unfortunately the facts (when you don’t cherry pick) are less impressive than the claims. The evidence for the effectiveness of acupuncture on infertility is less than established. In fact, there’s no good evidence that acupuncture has medical effects for any condition, including infertility. And why would it? Infertility has a physiologic cause. Acupuncture is a theatrical placebo which lacks any objective effects. It is a belief system that’s also based on vitalistic thinking except with acupuncture, ‘Qi’ is the life force.

Stop eating gluten: Naturopaths are proponent of clinically useless IgG food intolerance tests. They recommend these tests as part of fertility evaluations, and also recommend avoiding gluten, linking it to infertility.

Naturopathy reduces stress, which improves fertility: Naturopath Jen Newell claims:

Research into Naturopathic Medicine has found that seeing a Naturopath reduces stress for patients by 15-20%. Patients feel listened to and are able to discuss aspects of their care and lives to reduce perceived stress. Managing stress increases chances of successful conception. Naturopathic care is also helpful at reducing anxiety associated with fertility treatments.

No evidence or citations are provided. I could find no data in medical literature to substantiate this point, though I can see how a 90 minute consultation where unrealistic promises are made to patients could in fact reduce stress. However the link between stress and infertility is not clear, and while stress reduction is probably beneficial for its own reasons, there’s no established evidence that stress reduction will increase fertility rates.

Conclusion

Naturopaths claim to be primary care providers, like medical doctors, but practicing with an older model of medicine. Given the paternalism and disregard for scientific evidence displayed in this evaluation of naturopathic infertility treatments, one wonders if naturopaths realize just how accurate this statement is. Naturopaths were identified to routinely and consistently offer treatments that are either not proven effective, or are proven to be ineffective. They uniformly failed to disclose on their websites that their treatments lack good scientific support, which may leave consumers with a misleading impression about the effectiveness of naturopathic treatments. Given there is no evidence that these treatments have any meaningful effects, there is no demonstrated role for naturopathy in the treatment of infertility.

Photo from flickr user TipsTimesAdmin used under a CC licence.

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