Unexplained Infertility – Herbal Medicine Approaches (originally published in Innerself Magazine)
Infertility can have many causes but as often as 20% of the time no specific cause is determined and the diagnosis of “unexplained” infertility is made. A very frustrating diagnosis in many ways as there is nothing specific to “fix” and often the recommendation is to “keep trying” or “try IVF” and related procedures. But is there another option? Can fertility be improved by natural means? Absolutely!
The first step is to optimise general health and well-being starting with gut and liver health. Estrogen production and elimination is influenced by the gut microflora and maximal gut health and microflora balance is an essential part of hormone management. This has implications for both female and male fertility. Treatment to restore an optimal micro-biota in the gut usually involves herbal antimicrobial medicines, probiotics and prebiotics. Liver health is of extreme importance as there are several liver detoxification pathways for estrogens, some more optimal than others. These can be tested via a “urinary estrogen metabolites” test and if not optimal can be easily influenced with nutritional and herbal medicine. General liver health can also be supported with herbal and nutritional approaches including St Mary’s Thistle, a potent liver antioxidant and Schisandra, a potent liver detoxifier.
Stress hormones can interfere with fertility and lowering hormones such as cortisol has wide ranging health benefits including sex hormone balance and enhanced fertility. Lifestyle approaches such as yoga, meditation and regular exercise balance stress hormones as do many herbs including the Ginsengs, Withania and Rhodiola. Infertility is itself a stressful situation and so stress management is often a priority but rarely dealt with effectively. High cortisol levels are associated with poor sleep patterns which also affect fertility. Correcting these patterns with both adrenal herbs, sleep support herbs and lifestyle measures such as relaxation practices leads to far reaching health benefits including better sex hormone balance.
Maintaining an optimal weight and body fat percentage is a key to normal ovulation and hormone balance – whether underweight over overweight fertility can be negatively affected. Often body weight is not optimal due to a combination of factors such as insufficient or excess exercise and in adequate or over nutrition. However, the interplay between gut, liver, stress and hormone health is also affecting weight issues in many instances. For example high stress hormone levels (cortisol) encourage fat deposition.
In addition to addressing the issues outlined above there are a range of fertility enhancing herbs that have been used successfully for centuries. Which herbal medicines are appropriate obviously depends on the exact circumstance however general approaches for unexplained infertility in the female include normalising and stimulating the follicular phase (estrogen production), ovulation and the luteal phase (progesterone production). If the cycle is much less than 28 days the likely problem is a relative excess of estrogen to progesterone so the approach is to stimulate ovulation and robust progesterone production in the second half of the cycle. Chaste tree or Vitex is a classic herb used to correct relative progesterone deficiency and there are a variety of other herbs available that work synergistically with Chaste Tree. If on the other hand the cycle is much longer than 28 days then the opposite situation is likely and the approach is to stimulate more robust follicular development in the first half of the cycle. Classic herbal approaches include Shatavari, False Unicorn Root and Black Cohosh. If the cycle is pretty much 28 days and regular we will often do gentle stimulation of both the follicular and luteal phase of the cycle switching herbal remedy combinations at day 12 or 13.
In the case of unexplained infertility it is beneficial to treat the male to maximise semen quality at the same time as optimising ovulation in the female even if semen quality is “normal”. There are many subtle aspects to semen quality that may or may not be evident on a semen analysis. Herbs are available which boost specific sperm quality parameters including quantity, mobility and morphology (shape). It is likely they also have more subtle semen support actions. These herbs include Tribulus which stimulates sperm production, motiiity and survival time; Panax ginseng which increases sperm numbers, free and total testosterone levels; Withania which increases sperm count particularly stress related decreases and Astragalaus which increases sperm production and motility. Male life style issues including stress management, gut and liver health and addressing environmental toxins are equally important if not more so in some cases. Because spermatogenesis is ongoing (74 days for a sperm to mature) the environmental influences can be even greater than in the female and even more amenable to intervention. I strongly recommend a Hair Mineral Tissue Analysis for males as part of an infertility assessment.
Both males and females can also benefit for a range of nutritional interventions. Good preconception care formulas are recommended for both partners – particularly one containing activated forms of the B Vitamins and in therapeutic doses.(these are practitioner only ranges). Additional considerations nutritionally include Coenzyme Q10, additional zinc, magnesium, B6 and fish oil. Mineral deficiencies are not uncommon and testing for these via the Hair Tissue Mineral Analysis is recommended.