Infertility Factors

Table of Contents 

1.About

Infertility both primary and secondary, male and female are a fact of life in the 21st Century. Causal factors may be due to stress, taking on too much or a medical condition.

Other factors include poor lifestyle, diet, lack of exercise, excess alcohol, caffeine, smoking, advanced age, fibroids, many invisible atmospheric pollutants, pesticides, or patients with a history of sexually transmitted diseases

At The Cork Natural Fertility Clinic, we have helped many couples achieve their bundle of joy or joys! (see patient testimonials).

We have had excellent success with assisting conception in patients suffering from the following conditions:


2.Ovulatory Dysfunction 

Detecting and predicting your own body's ovulation cycle is key to enhancing your fertility. The "window of opportunity" for conception is much shorter than many people realize; therefore, advance preparation is needed to make the most of that brief time. Some cases of female infertility are caused by ovulation disorders. Disruption in the part of the brain which regulates ovulation can cause a disruption in the synthesis of for example luteinizing hormone (LH) and follicle stimulating hormone (FSH). Even slight irregularities in the hormone system can affect ovulation.

This is the single most frequent cause of female infertility and denotes a problem with the monthly release of an egg (ovulation). There are varying causes for ovulatory dysfunction; the most frequent one is Polycystic Ovarian Syndrome (PCOS). Others include:

Women are born with two ovaries that contain all of their eggs for a lifetime. Ovulation occurs each month when the ovaries are stimulated by the hormone FSH and eggs are recruited within the ovarian follicles. Once the egg matures it is ovulated and travels through the fallopian tubes to the uterus.

In a normally ovulating female, an egg matures and is released during each monthly menstrual cycle. Anovulation is "lack of ovulation" and oligoovulation is "irregular ovulation" both of which cause infertility. Ovulation is a complex event under the influence of many hormones.

The hypothalamus is a small gland at the base of the brain that, among many other functions, produces gonadotropin releasing hormone (GnRH). GnRH travels through the bloodstream to the pituitary gland where it stimulates the production of follicle stimulating hormone (FSH) and leutinizing hormone (LH).

FSH stimulates the recruitment and development of eggs within the ovarian follicles. As the follicles develop, estrogen production increases which stimulates the development of the endometrium and signals a reduction in FSH production. Approximately twelve hours after the peak estrogen level, the pituitary signals a surge of LH which causes ovulation

Measuring morning body temperature daily can help determine whether and when ovu.lation is occurring. However, this method is often inaccurate and has an error margin of 2 days. More accurate methods include home testing kits, which detect an increase in urinary luteinizing hormone (LH) excretion 24 to 36 h before ovulation, and pelvic ultrasonography, which is used to monitor ovarian follicle diameter and rupture. Also, serum progesterone levels of ≥ 3 ng/mL (≥ 9.75 nmol/L) or elevated levels of one of its urinary metabolites, pregnanediol glucuronide (measured, if possible, 1 wk before onset of the next menstrual period), indicate that ovulation has just occurred.

Irregular ovulation should prompt evaluation for disorders of the pituitary, hypothalamus, or ovaries (eg, PCOS).

Biomedical treatment of ovulatory dysfunction depends on the underlying reason. In luteal insufficiency, the luteal phase is supported with a progesterone suppository. Women with complete ovulation failure can, with the correct treatment, expect a virtually normal chance of conceiving. Women with oligomenorrhea have a less good chance of conceiving because of the underlying pathologies of PCO.

Chinese medicine can be equally effective in treating ovulatory dysfunction as biomedicine. Chinese herbal medicine restores ovarian function effectively and promptly. It offers a valuable option for treating infertility in patients with premature ovarian failure and/ or raised FSH and LH levels, as well as treating patients with polycystic ovarian syndrome. Many studies demonstrate that the correct application of herbs can restore a regular cycle with a good basal body temperature and an efficient luteal phase.

Acupuncture can be equally effective in the treatment of ovulatory dysfunction. Studies suggest that acupuncture adjusts FSH and LH and normalize oestrogen and progesterone levels, thus regulating ovulation.


3.PCOS (Polycystic Ovarian Syndrome)

Polycystic ovary syndrome (PCOS) is a condition most often characterized by irregular menstrual periods, excess hair growth and obesity, but it can affect women in different ways. Irregular or heavy periods may signal the condition in adolescence, or PCOS may become apparent later when a woman has difficulty becoming pregnant.

An increase in androgen hormone production causes PCOS. In women with increased body mass, elevated androgen production may come from stimulation by higher levels of insulin. In lean women, the elevated levels of androgen may be stimulated by a higher ratio of luteinizing hormone (LH). Lack of menstruation (amenorrhea) or irregular periods are common symptoms in women with PCOS.

In PCOS, increased androgen production prevents the follicles of the ovaries from producing a mature egg. Small follicles that start to grow but can't mature to ovulation remain within the ovary. A persistent lack of ovulation may lead to mild enlargement of the ovaries.

Without ovulation, the hormone progesterone is not produced and estrogen levels remain constant. Elevated levels of androgen may cause increased dark or thick hair on the chin, upper lip or lower abdomen as well as acne and oily skin.

Acupuncture has shown promising results in women with polycystic ovarian syndrome in regulating their periods. Almost all women suffering from polycystic ovarian syndrome who subscribed to acupuncture had their periods regulated in a study conducted. It has also helped women lose weight and relieve headaches in the long run leading to a calmer and stable mind.

Homeopathic treatments

It is because of this variation of presentation from one individual to another that there are no specific homeopathic remedies for the treatment of this condition. Every patient is treated holistically & as individuals. One size does not fit all in our approach. However, that does not mean to say PCOS does not respond to homeopathy, in fact quite the contrary. The single factor that does remain constant though is that all cases of PCOS require constitutional & individualized homeopathic treatment.

Constitutional treatment requires a remedy that has been selected to treat the individual based on the entire case. This does not just include the period symptoms but all of the general facts about you; your personality, food likes and dislikes, weather/season likes and dislikes, sleep patterns and body temperature amongst others. Once selected the appropriate remedy is often prescribed in a very short dosage programme - this acts like a short sharp accelerator to the body's energy system in order to get it vibrating at the right frequency which equates to health.


4.Male Fertility

Common causes of male infertility include abnormal sperm production or function, impaired delivery of sperm, conditions related to a man's general health and lifestyle, and overexposure to certain environmental elements:

Abnormal sperm production or function. Most cases of male infertility are due to sperm abnormalities, such as:


Erectile Dysfunction (E.D.)


 Also known as impotence, erectile dysfunction refers to a man's inability to achieve and maintain an erection. While a man experiencing erectile dysfunction may think he is the only one having this type of problem, the reality is that an estimated 25 to 30 million men will encounter impotence during their lifetime. Despite the fact that impotence can make it nearly impossible to conceive a child, erectile dysfunction is generally not credited as a cause of infertility. This is because impotence causes are normally the result of underlying factors that need to be addressed.

 With age, the quality of a man's erection and orgasm will change. It is not uncommon for older men to find it harder to achieve an erection and therefore rely on impotence medications. In younger men, though, sustaining an erection should generally not be difficult. While stress or illness may cause a man to experience temporary impotence, this type of erectile dysfunction should not last for too long. However, if impotence seems to be becoming a permanent problem, then it is necessary for the problem to be medically assessed.

 In the past, as much as 80% of impotence causes were credited to psychological problems, such as fears and inhibitions. Nowadays, though, psychological causes, including stress, depression and anxiety, are seen to account for only 10% to 20% of erectile dysfunction cases. A further 70% of chronic impotence cases can be traced back to diseases, like kidney disease, alcoholism and diabetes, which can restrict blood flow to the penis. Other erectile dysfunction causes include the use of illicit and prescription drugs, including certain antidepressants and high blood pressure medications.

 Men with spinal cord or brain injuries or some other type of nerve disorder may also find that maintaining or even achieving an erection is difficult. This is because their nerve impulses may be impaired thereby preventing the brain and penis from communicating properly. Radiation therapy, pelvic injury and surgery can also cause a man to be confronted with chronic impotence.

 Traditional Chinese Medicine and acupuncture can provide a safe natural alternative to helping men with this disorder. The practitioner makes a diagnosis based on Chinese medical theory, and then determines whether acupuncture or herbal medicine or a combination of both would be the best means of treatment.

 According to Chinese Medical theory there are two main causes to this disorder. The disorders are determined by the other signs and symptoms that are presented in addition to erectile dysfunction.

 Traditional Chinese medical treatments can be very effective if treatment is pursued early. Both acupuncture and herbal therapy take a holistic approach accounting for mental, physical and environmental aspects.

 When you think of erectile dysfunction, acupuncture is usually not the first thing that comes to mind. Many assume it would be a painful alternative to traditional treatments. Quite the contrary, acupuncture is not used locally to treat this particular disorder. Because the energy pathways run all along your entire body, acupuncture points on the extremities, abdomen and back are used to successfully relieve this condition.
 

5.Endometriosis

Endometriosis is a condition where tissue similar to the lining of the uterus (the endometrial stroma and glands, which should only be located inside the uterus) is found elsewhere in the body.

Endometriosis lesions can be found anywhere in the pelvic cavity - on the ovaries, the fallopian tubes, and on the pelvic wall. Other common sites include the uterosacral ligaments, the cul-de-sac, the Pouch of Douglas, and in the rectal-vaginal septum.

In addition, it can be found in caesarian-section scars, laparoscopy or laparotomy scars, and on the bladder, bowel, intestines, colon, appendix, and rectum.

In rare cases, endometriosis has been found inside the vagina, inside the bladder, on the skin, even in the lung, spine, and brain.

The most common symptom of endometriosis is pelvic pain. The pain is often correlated to the menstrual cycle, but a woman with endometriosis may also experience pain that doesn't correlate to her cycle. For many women, the pain of endometriosis is so severe and debilitating that it impacts their lives in significant ways.

Endometriosis can also cause scar tissue and adhesions to develop that can distort a woman's internal anatomy. In advanced stages, internal organs may fuse together, causing a condition known as a "frozen pelvis."

Chinese medicine treats the western disease diagnosis of 'endometriosis' by reframing the signs and symptoms displayed by the client into traditional Chinese medical disease categories. The most common symptom associated with endometriosis is pain surrounding menstruation. The traditional Chinese medical disease category for pain during menstruation would be 'Painful Periods'. Another common symptom of endometriosis is the inability to conceive. This becomes reframed into the traditional Chinese medical disease category of 'Infertility'. There can also be erratic bleeding cycles, i.e. bleeding outside of the cycles, early spotting, spotting mid cycle, or spotting after the end of the cycle for several days. The traditional Chinese Medical disease category in these instances would be 'Erratic Menses'. There may also be profuse bleeding during the period (the bleeding is very heavy), this would fall under the category of 'Profuse Menstruation'. Therefore, the western medical diagnosis of 'endometriosis' can be reframed into at least 1-5 different traditional Chinese medical disease categories depending on the signs and symptoms displayed by the woman, mainly painful periods, infertility, and profuse menstruation. This is representative of how traditional Chinese medicine treats the individual person, not the disease.

The success of TCM treatment for those with Endometriosis is really dependant on the degree of compliance and commitment the client displays toward the requirements necessary for success. One must be willing to invest in themselves, make room for some lifestyle changes, modify their diet (sometimes drastically), undergo regular acupuncture treatment, religiously take the prescribed herbal formulas, and practice the intention required by the body mind and spirit to overcome a severe health condition. With time and diligence, 70-80% of women being treated with traditional Chinese medicine can expect to see significant reductions in their symptoms. 20% of women will get minimal to no results (as in every type of disease, there is always a small group of people who will not respond to the treatments, there is no explanation for this). Some women see results within just a few treatments, although, it should be noted that it is not unrealistic to expect six months to one-and-a-half years of treatment with traditional Chinese medicine to see results with lasting effect.

During treatment with traditional Chinese medicine, the woman's menstrual cycle can change, sometimes drastically. Some months it may look like things are heading in the right direction, and some months it may seem as though things are going backwards. The more severe the condition, the longer the body must take to heal. Many women that find no relief with traditional Chinese medicine have set unrealistic expectations, and quit before changes can occur. Treatment with traditional Chinese medicine is, in most cases, a more permanent fix, but, it must be remembered that it takes time for traditional Chinese medicine to make the adjustments and changes that must occur within the reproductive body tissue.

Diet Recomendations for Endometriosis

Women with Endometriosis should be particularly vigilant about increasing their consumption of kelp and wheat germ.

Endometriosis has been linked to thyroid dysfunction and kelp is particularly good for thyroid problems. The vitamin E in wheat germ improves the healing of scar tissue caused by internal endometrial bleeding. Women who suspect endometriosis should cut down on their yeast consumption, as yeast overgrowth has been recently implicated in endometriosis. Also, since yeast thrives on sugar, strictly avoid sugar, as well as any artificial sweeteners and dairy, though yogurt can be helpful for this problem.

In general, women with endometriosis should stick to a high-fibre, vegetarian based diet. Particularly, the elimination of fats from animal sources such as meat and dairy products is beneficial. Women with endometriosis should also particularly avoid caffeine and salt and should indulge in antioxidants such as sweet potatoes, yams, apricots, cantaloupes, carrots, spinach and broccoli, whole grains and beans for necessary B vitamins, and citrus fruits for bioflavonoids and natural vitamin C.


6.Tubular Issues

Fallopian Tube Damage or Blockage

This condition usually results from the inflammation of the fallopian tube. Chlamydia is the most common cause of this inflammation. Tubal damage with scarring is the most serious risk factor in pregnancy rendering the egg unable to travel through the fallopian tube to implant in the uterus (ectopic pregnancy).

7.Unexplained Infertility

Unexplained infertility is the most frustrating diagnosis a woman can receive. Luckily, according to traditional Chinese medicine there is always an underlying cause and it will be found if you look deeply enough, and pay attention to what the body's messages are. It is as if the body-mind-spirit hides the expression of fertility when your life is out of balance.

There are many steps in the journey of fertility, and even a small misstep can make the difference between a happy mother and a woman faced with unexplained infertility. One hormone produced at the wrong time in the menstrual cycle, a tiny change in the pH of cervical mucus, or a millimeter less depth in the endometrial lining can be the deciding factor between a pregnancy and yet another period. Treatment

The first step is always to address the manifestation of the problem and determine the underlying pattern. In most cases of unexplained infertility, there is some sort of indication of where the problem lies-whether it be in symptoms involving the menstrual cycle, or feelings of hot or cold, lethargy or nervousness amongst others and when these imbalances are addressed, the reproductive system can begin to function normally again.

One of the best ways to discover subclinical fertility problems is to examine the different stages of a woman's menstrual cycle. Possible indications of fertility problems include menstrual irregularities such as:

These are all physical manifestations and important reflections of which aspects of the reproductive system are out of harmony. When we discover what energy imbalances cause the menstrual irregularities to appear, the infertility is no longer unexplained. And when we have an explanation, we have a diagnosis, a treatment, and a remedy.


8.Early Menopause (Premature Ovarian Failure)

Premature Ovarian Failure (POF) is essentially very early menopause, before a woman reaches the age of forty. Most women have hundreds of thousands of eggs at the time of their first period. By the time we hit menopause that supply of eggs has dwindled down to a handful.

This gradual loss of eggs during our fertile years is normal. However, in premature ovarian failure for some reason either the loss of eggs is accelerated or the follicles themselves become less responsive to hormonal stimulation (of course, these conditions contribute to each other). Unfortunately, POF is one of the more common conditions affecting a woman's fertility, occurring in one in every thousand women (0.10%) between the ages of fifteen and twenty-nine, and in one in every hundred women (1.0%) between the ages of thirty and thirty-nine.

Symptoms and Signs

Women with POF will have stopped menstruating altogether, or will have short cycles characterized by early (or no) ovulation. Sometimes periods do not occur at all, and menopausal symptoms-hot flashes, amenorrhea, and vaginal dryness-may appear suddenly over one to two months, or gradually over several years.

What is Happening?

As ovulation occurs increasingly early in women with POF, the cycle is often accompanied by elevations in FSH, a signal indicating that the ovaries are not responding to clues from the brain. This lack of communication causes hormonal "confusion." The hypothalamus gives the pituitary gland messages to try harder to stimulate the ovaries to respond. More FSH is produced to stimulate the ovaries, but the ovaries, whose receptors are down, have become less responsive to this message.

Western Medicine Diagnosis of POF

POF is an extremely frustrating diagnosis, as Western medicine cannot pinpoint its cause with any degree of accuracy. Some theories include chromosomal defects, damage from pelvic surgery, chemotherapy, radiation therapy, or pelvic inflammatory disease (PID). One promising avenue of investigation has to do with autoimmune disorders, where a person's immune system attacks the body's own tissues, including (in theory) the ovaries. Often a woman diagnosed with POF will have a concurrent diagnosis of conditions like autoimmune thyroiditis or Graves' disease, or Addison's disease (involving the adrenal glands).

Unfortunately, no matter what the cause of POF, Western medicine can do little to help it. Sometimes treating the associated autoimmune disorder (hypothyroidism, for example) will restore function to the ovaries, but this doesn't always work. If there is evidence of ovarian antibodies indicating an autoimmune disorder, high doses of steroids may be given in an attempt to restore ovarian function. However, the side effects of this treatment are severe. The treatment of choice for POF is usually estrogen replacement therapy (a version of HRT), which is not an option for women who are attempting to conceive because administration of estrogen feeds back to the hypothalamus that it doesn't need to prompt the pituitary to stimulate the ovaries to produce estrogen. The whole hormonal system then goes to sleep.

Women with POF who consult reproductive endocrinologists are usually given one option: IVF with donor eggs. While this might give a woman a baby, it does nothing to address the underlying failure of the ovaries and all of the menopausal symptoms that occur as a result. And since the average age of POF onset is 27-28, most women with POF would prefer a treatment that will restore their ovaries and hormonal system to full, functional health.

Treatment

According to the traditional Chinese female fertility model, the average age most women go into premature ovarian failure is precisely when they should achieve their reproductive prime. Something has halted this process. Sometimes it's physical. Often there is a deep seated emotional component. Yet, the remedy is, always, to gently restore all aspects of her body, mind, and soul. We must open up the communication between the hypothalamus, pituitary gland, and ovaries. This is not only a physical process, but one that evaluates all aspects of a woman's life that may be preventing this open communication.

Although treatment of POF may be challenging for the TCM practitioner, the results are extremely rewarding, because Chinese medicine is one of the most effective ways to address POF. TCM views most cases of POF as a combination of excess and deficiency patterns that cause the Penetrating and Conception meridians to become "empty." The lack of menstrual bleeding tells us that there is also a deficiency in Blood. Blood deficiency may be due to an obstruction, but in most POF cases it is due to deficient Blood production, usually from faltering Spleen energies or insufficient Kidney Yin. If a woman is experiencing short cycles, early ovulation, and heat signs like night sweats and hot flashes, there is also concurrent heat.

We view the condition of POF as a failure of communication: messages from the brain just aren't getting to the ovaries, and they cease their performance. As a result, the whole system increases its (Yang) energy to try to evoke a response from the ovaries, producing a frenetic cycle of stimulation with no effect. The result is depletion of Yin and deficiency Heat. Most POF cases we have treated have presented with a severe Kidney Yin deficiency, usually accompanied by (Liver or Heart) Blood deficiency, and Spleen Qi deficiency accompanied by deficient heat. It also is not unusual to see concurrent Kidney Yang deficiency.

A typical treatment will consist of the following recommendations.


9.Secondary Infertility

Secondary infertility is defined as the ability to conceive one or more children, followed by the inability to conceive subsequent children. This particularly frustrating diagnosis is compounded by the emotional frustration of not knowing why a sibling isn't forthcoming and why your family isn't expanding according to your dreams..

Unlike those experiencing primary infertility (when a childless couple is unable to conceive), couples that are affected by secondary infertility are much less likely to get infertility treatment. This is usually due to the misconception that once you're fertile, you'll always be fertile. It is not uncommon for a couple to be told to just keep trying and that eventually it will happen. While this may be true in some cases, in many others, advice like this only adds to the frustration and heartache experienced by a couple having fertility problems.

Secondary infertility may happen at any time and the causes, where they have been pinpointed, are almost identical to those of primary infertility. The problem can lie with the woman's reproductive system; the man's reproductive system; or with both partners, as follows (RCOG, 2004):

This still leaves one third of cases in which the cause of infertility is not identified. This can be frustrating if you are desperate to find out why you cannot conceive. However, in cases of unexplained infertility there is still hope -- one to two thirds of couples with unexplained infertility will conceive within three years if they keep on trying.

Reasons for secondary infertility tend to be the same as reasons for primary infertility. Since you were last pregnant, you or your partner may have had an infection, gained some weight, or started eating fewer healthy foods. These seemingly small variances in your life can have large repercussions on your reproductive health. Additionally, if it has been a few years since you last had a child, your egg quality may have begun decreasing or your partner's sperm may not be what it once was. Abnormalities with sperm and ejaculate are frequently cited as causes of secondary infertility.