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Holistic Approach to Infertility

by Talha Sawaf, Yehudi Gordon & Marilyn Glenville(more info)

listed in women's health, originally published in issue 23 - November 1997

The inability to conceive challenges the couple’s emotional and physical health. To overcome their problem they will need to take into consideration the many facets of their fertility problem and address their relationship and their needs. For the best possible chance of successful conception, they will need an holistic approach which removes the boundaries between conventional and complementary care. This approach utilises complementary therapies to improve the results of high-tech care – or uses minimally invasive diagnostic techniques to improve the results of complementary care. The combination of complementary and conventional care works well but more importantly, it can give the couple the highest potential for success.

It is very important to acknowledge and understand the emotions and anxieties which arise when fertility is not as straightforward as it should be. An understanding of the physiology of conception will enable greater awareness of fertility problems and how best to improve them.

Understanding Fertility

Girls are born with around two million eggs in their ovaries. The development of the eggs and ovulation is stimulated by the release of hormones FSH and LH (Follicle Stimulating Hormone and Luteinising Hormone) from the pituitary gland in the brain. The cells surrounding the egg release oestrogen and progesterone which alter the internal lining of the uterus and the cervix before conception. The cervical mucus appears as a discharge in the vagina, which is a signal that ovulation is approaching. After ovulation the egg enters the fallopian tube, ready for fertilisation.

After puberty, men produce millions of sperms in their testicles which travel along the vas deferens and are stored in the seminal vesicles. Semen, ejaculated during intercourse, consists of sperm and secretions from the prostate and seminal vesicles. The sperm reach the fallopian tubes by travelling up the cervix and through the uterus. Sperm and egg meet in the tube and conception occurs. The embryo travels down the fallopian tube for five days until it implants into the soft lining of the uterus.

Nutrition & Lifestyle

As a nation, we take more care of our cars than our bodies! We use the right petrol, listen out for suspicious noises and regularly check oil and water levels, particularly before a long journey. If we maintain the same levels of responsibility for our physical and emotional health we could greatly improve our ability to conceive.

Maximising health before conception improves the quality of egg and sperm, increases fertility and reduces the miscarriage rate – whereas sub-optimal nutrition, vitamin or mineral deficiencies, or an excess of alcohol, cigarettes, stimulants, pollutants, pesticides, food additives and toxic metals reduce fertility.

The Foresight Association was formed in 1978 to optimise nutrition before conception. Levels of vitamins, minerals and toxic metals in the body are measured using an hair analysis and by completing a lifestyle questionnaire. Once a diagnosis has been carried out, a simple treatment programme is based on introducing supplements, sensible eating and reducing toxins and pollutants. It may be necessary to delay conception for a few months until treatment is effective.

Emotional Needs

The "infertile" couple may be experiencing a wide range of feelings, emotions and pressures but learning to deal with their anxiety and tension may benefit their relationship and improve their chances of conception. Many couples discover feelings of blame, guilt and anger which may impinge dramatically on their self esteem and effect their lives, their sexuality and their fertility. Their self image may feel threatened as their masculine or feminine roles come under investigation.

Often, one partner will exhibit more of the anger, guilt and frustration which surrounds the fertility issue. The two partners may feel differently about the importance of having a baby – and this can threaten the relationship but with good support from family and friends, or from a professional counsellor, the couple can explore their feelings safely, without the fear of upsetting or distressing their partners.

Making love at the time of ovulation obviously improves the chances of conception. However, the concept of "sex on demand" may reduce spontaneity and enjoyment and the pressure of wanting to conceive may have a negative effect on orgasm and ejaculation. Having to discuss such "private", intimate details of their relationship may be difficult and trying. A sympathetic doctor or counsellor can discuss the effect the fertility problem is having on their lives and their relationship and emotional support can be of enormous help in reestablishing closeness, libido and virility. This process may provide a wonderful opportunity for the couple to share responsibility and grow stronger.

Complementary Treatment

Every culture has had its own tradition of healing and complementary therapy to alter and balance the flow of body energy. People feel better physically and emotionally, and anxiety, anger and fear are reduced. This may be sufficient to tip the scales for conception to occur. During the last few decades treatments which originated on one continent are now commonly used throughout the world, for example homoeopathy originated in Germany and now the main centre is India. Perhaps, with the wide choice available, the greatest difficulty is deciding which therapy to use.

Acupuncture and Chinese Herbal Medicine

In Chinese philosophy everyone has a balance of 'yin' (female, moon, water) and 'yang' (male, sun, fire) energy which flows along pathways called meridians. Diagnosis consists of assessing the person's pulse and observing their posture and energy. Treatment utilises either massage, acupuncture, crystals or heat applied at points along the meridians to alter and balance the flow of energy. The potency of the treatment is increased by altering food intake, reducing emotional tension and balancing heat and cold.

Acupuncture is often used alone but the effect is enhanced when combined with Chinese herbs. Treatment regulates the cycle, boosts ovulation and improves fertility, vitality and well-being. It may also be used in conjunction with assisted conception to reduce stress and help recovery from the effects of drugs or surgery.

Reflexology

Hand and foot massage has been used for thousands of years in India and China. The body energy meridians are all represented on the hands and the soles of the feet. Every organ in the body can be accessed and treated by massaging the feet and the balance of the entire energy of the body can be aligned using reflexology. Reflexology is an excellent form of stress-management and may also have a direct effect on fertility.

Homoeopathy

Every homoeopathic remedy has an energy or "personality" which embraces a set of symptoms and hundreds of remedies exist. Homoeopathic diagnosis assesses emotional, physical and environmental details and then matches the remedy to the symptoms. Homoeopathy can be used alone or in conjunction with conventional medicine to treat a variety of conditions including recurrent miscarriage, endometriosis, anovulation, low sperm count and recurrent infection. Remedies are also used to diminish the effect of medical or surgical treatment, reduce anxiety and improve well-being.

Creative Healing, Visualisation and Meditation

Healing, visualisation and meditation have been used for millennia to maintain health and treat disease. The physical, psychic, hormonal and emotional energy of an individual and of a relationship may be sensitive to healing and meditation. The effect depends on the power of the healer and the receptivity of the person being healed.

Aromatherapy and Massage

Aromatherapy utilises essential oils distilled from plants and flowers. Each oil has a distinctive energy and personality. Combined with massage, aromatherapy can help to release mental, emotional and physical stress and promote overall health. The essential oils have been used to support the immune and hormonal systems, promote ovulation and sperm production and treat disorders like fibroids and endometriosis.

Shiatsu

Shiatsu was developed at the turn of the twentieth century in Japan – and is a comparatively modern therapy. Meaning "finger massage", Shiatsu stimulates the body's vital energy by balancing the flow along the meridians. It is a wonderful way to relieve stress, support and nurture. It is effective in infertility treatment, although very few practitioners specialise in this area.

Indian Ayurvedic Herbs and Yoga

Traditional Indian medicine utilises herbs in conjunction with attention to nutrition, meditation and yoga. The herbs are used to enhance vitality, balance the body energy and the hormones, and improve the sense of well-being. Ayurveda is also used to treat specific conditions like fibroids, endometriosis or ovulation disorders.

Jeyarani

The Jeyarani Fertility Programme was created in the 1980s by Dr Gowri Motha. It includes the use of reflexology, creative healing, massage, guided visualisation and Ayurvedic herbs. This gentle and powerful holistic approach enhances the flow of energy, balances the body, releases mental and physical stress and improves reproductive capacity. Jeyarani can be used as the primary approach or in conjunction with medical treatment.

Conventional Medicine

Diagnosis and Investigations

The greater the advances in technology, the lower the requirement for physically invasive testing. A diagnosis which required surgery in the past, can now be carried out by ultrasound scan. In order to monitor each element of conception, the couple will undergo a series of tests timed with the menstrual cycle to diagnose the cause of the fertility problem.

Ultrasound Scans

State-of-the-art ultrasound scan images can be used safely and comfortably to assess the quality and timing of ovulation, receptivity of the uterus to implantation and the need for hormonal support. They are also used to time investigation and monitor treatment.

Pelvic Anatomy

Ultrasound scans can be used to diagnose pelvic fibroids, endometriosis, cysts or adhesions which may cause fertility problems in women and to assess the testes, prostate and seminal vesicles in men.

Hormone Output

Fertility is hormone dependent so the hormonal balance of the woman must be assessed. The essential hormones are thyroid, pituitary (LH, FSH and prolactin) and ovarian (oestrogen and progesterone) which are assessed using blood tests.

Infection Screen

Both partners need to be screened (and treated if necessary) for the main genital infections, such as Chlamydia, which may alter fertility. A combination of blood, cervix, urine and semen tests are used.

Post Coital Test

Within a few hours of intercourse, at mid-cycle, the mucous from the cervix is examined under a microscope (similar to a smear test) to count the number and viability of the sperm. This test will also confirm whether the cervix is "sperm friendly". It is simple and painless and does not interfere with conception.

Sperm Analysis

A sperm sample, produced by masturbation, is examined in the laboratory. Analysis usually indicates normal male fertility.

Timing Ovulation

(release of the egg from the ovary)

Ultrasound scanning is the gold-standard way of detecting ovulation. Urine test kits which detect a rise of luteinising hormone (and therefore, ovulation) are available for home use. Observing the vaginal secretion is another useful marker of ovulation because the mucous from the cervix appears like 'egg white' at ovulation. Scans combined with urine kits and mucous awareness accurately time ovulation.

Pelvic Anatomy and Fallopian Tube Patency

An ultrasound test which assesses the patency of the fallopian tubes, involves neither anaesthesia nor x-radiation and is performed in the ultrasound department prior to ovulation and is called a sonohystersalpingogram (SHG). Fluid is instilled via the cervix and the scan follows the flow of fluid, outlining the cavity of the uterus, the fallopian tubes and the ovaries.

Laparoscopy or hysteroscopy will provide the most accurate assessment of the pelvic organs. Hysteroscopy involves the insertion of a camera via the cervix to visualise the internal cavity of the uterus. Laparoscopy involves the insertion of a camera via the umbilicus to visualise the pelvic organs, but it requires general anaesthesia.

Conventional Treatment

Conventional medical treatment is geared around the results of the diagnostic tests. For example, disorder of ovulation may be corrected using pills or injections. Obstructed fallopian tubes may be treated surgically or by assisted reproduction techniques (ART). There are various stages of conventional medical treatment and assistance.

Stage One

The most simple treatment techniques include medication to boost ovulation and enhance progesterone levels; advice about the timing of love-making; and emotional support to reduce stress and anxiety.

Stage Two

The next level of assistance may require injections to induce ovulation and boost hormone production. Treatment may also include intrauterine insemination (IUI) where ovulation is stimulated, the sperms are prepared in the laboratory and placed in the uterine cavity at mid-cycle.

Stage Three

Moderate assistance may also be provided using minimal access surgical techniques at laparoscopy or hysteroscopy.

Stage Four

Sometimes, there is no alternative to maximum assisted reproduction.

In IVF (in vitro fertilisation) the eggs are collected vaginally under ultrasound control, then incubated with sperms to be fertilised. Embryos are transferred into the uterus two days later.

In GIFT (gamete intra fallopian transfer) the eggs are collected under laparoscopic control. Eggs and sperms are mixed and immediately placed in the fallopian tubes where fertilisation normally occurs. Sometimes both GIFT and IVF are combined.

ICSI (intracytoplasmic sperm injection) is used when sperm function is impaired. The sperm is injected, under microscopic control, directly into the egg which has previously been collected from the ovary. Each egg receives one sperm and the resultant embryos are transferred to the uterus two days later.

In the UK a maximum of 3 embryos (or eggs) may be used during any one treatment cycle. The remaining embryos may be frozen and replaced in subsequent cycles.

The role of nutrition, with vitamin and mineral support, in assisting with IVF (test-tube baby) programmes is now well documented and there is an increasing body of evidence to suggest that the results of conventional, "high-tech" medical treatment are improved and enhanced when supported by complementary treatment.

Merging Conventional & Complementary Care

Some people believe in and prefer to use conventional medical "high-tech" diagnostic tests and treatment, whereas others prefer a minimalist approach using complementary therapies. Each of the methods have their strength, weaknesses and limitations. There are still couples who do not conceive in spite of the wealth of technological aids and complementary therapies. Whatever the approach, one should retain a realistic and honest picture of the likelihood of success.

Modern "high tech" medicine continues to improve the results of fertility treatment and these results can be greatly supported by the addition of complementary therapy. The results of conventional medical treatment are well documented and success rates are published yet there is still a high percentage of "unexplained infertility" which often leaves no conventional option other than maximum assisted reproduction.

Complementary therapies, which alter and balance the flow of body energy, have been healing infertility difficulties for millennia. Many couples have used this approach alone to improve their overall health, reduce their emotional and physical stress, treat specific disorders and overcome their fertility problems. Yet there are few statistical resources and the success rate is not well documented. It is however true to say that complementary therapies can be of enormous support to couples choosing high-tech, conventional medicine. The complementary approach may be more effective when conventional, minimally-invasive diagnostic and treatment techniques have been carried out.

Fertility diagnosis and treatment may be physically demanding, emotionally and psychologically draining. The needs of the couple are paramount and the onus is on the fertility practitioners to acknowledge and support these needs.

The most holistic, and most successful, approach would therefore be a multi-disciplinary "fertility team" which combines safety and education, with minimally invasive, high quality technologies; encourages optimal nutrition and health; provides a range of healing and complementary approaches and above all, allows nurturing, emotional support and understanding.

Nutritional Dos and Don'ts

* Don't smoke.
* Don't drink.
* Don't take drugs.
* Don't expose yourself to radiation or other workplace hazards.
* Do eliminate non-essential medication.
* Do avoid food additives, pesticides and pollutants.

Shopping List

* Plenty of fresh vegetables and fruit (organic if possible).
* Whole cereals: brown rice, oats, millet, etc.
* Whole wheat: wholemeal flour, pasta, bread and crackers.
* Beans (lentils, aduki, chickpeas etc).
* Sea salt.
* Nuts and seeds.
* Fish and organically reared poultry and meat.
* Organic dairy produce where possible or goat's milk.
* Live, plain yoghurt.
* Free range eggs.
* Butter (organic).
* Cold-pressed unrefined vegetable oils (sesame, sunflower, extra virgin olive oil).
* Coffee substitutes (Caro, Bambu).
* Tea alternatives (herbal teas, fruit teas, Rooibosch).
* Aqua Libra, Appletize or half fruit juice with sparkling mineral water.
* Honey, concentrated apple juice or maple syrup (for sweetening in cooking).

Further Information

Fertility Diagnostix is an holistic, multi-disciplinary fertility team located in St John's Wood, London, England. For more information please call +44 (0)171–483 3611.

Acknowledgements

Ann Herreboudt (Emotional Needs), Bill Smith (Ultrasound), Lynn Osborne (Chinese Medicine) Felicity Fine (Homoeopathy), Gowri Motha (Jeyarani), Nick Pole (Shiatsu); Joanna Sigalov (Coordinator)

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About Talha Sawaf, Yehudi Gordon & Marilyn Glenville

Talha Shawaf is Consultant Gynaecologist, Obstetrician and Reproductive Medicine and Fertility Specialist. His interest in infertility began over 10 years ago, during which time he has built up a profound experience in all aspects of infertility management and has written over 50 papers on the subject. Yehudi Gordon is a Consultant Gynaecologist and Obstetrician. For many years he has augmented his vast expertise in conventional hi-tech medicine with a range of complementary therapies to aid treatment. He is highly experienced in infertility diagnosis and treatment. Marilyn Glenville is a nutritional therapist and psychologist. She specialises in the optimal nutritional approach to pre-conceptual care, infertility and female hormone disorders. She is the Chairperson for Foresight, the Association for Pre-conceptual Care and Infertility.

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