Infertility

infertility

What's happening to our reproductive health? Leading health experts have predicted that infertility rates will rise from a current 1 in 7 couples, to a shocking 1 in 3 couples by next decade. (1)

 

Article Contents:

Falling sperm countsPCOSPillhope for drug-free IVFendocrine disrupting chemicalssoyendometriosisthyroidsmoking, immune system affects fertilityphytoestrogensquestion of ageDHEA,

Putting it all together into a treatment plan

The conventional explanation for the rise of infertility includes three main factors: 1) couples waiting until they are over 35 years, 2) an increasing rate of sexually transmitted disease, and, finally, 3) falling sperm counts.

Falling sperm counts begin to tell the tale. Sperm decline is caused by hormone-disrupting chemicals in our environment, and sperm is not the only thing that suffers.

Only 15 years ago, the phrase "hormone disruption" entered medical discourse for the first time. Now, there are literally 100's of studies proving that common household and industrial chemicals damage our hormonal system [see below]. A very tiny dose of chemical is all that is needed to cause a permanent damage, and now, disturbingly, there is evidence that the damage can be passed to the next generation.

Falling sperm counts

Pesticides, dioxins, and other chemicals have both been shown to decrease sperm counts in experimental animals. In an astounding development, the effect has been shown to be multi-generational. Dr. Anway from the Centre for Reproductive Biology at Washington State found that a single exposure to pesticide is enough to damage sperm for many generations. His team exposed pregnant rats to common pesticides and then measured sperm counts over the next five generations. They found that 10% of male descendants were completely infertile, and 90% had low sperm counts. The effect remained undiminished over five generations. (2) This means that a man today can have a low sperm count because his grandmother was exposed to DDT in the 1940's.

Sperm also declines with age, particularly in terms of quality. Children born to men over 40 are six times more likely to have autism than children born to men under 30, regardless of the mother's age (3). Men over 40 are also more likely to father pregnancies that end in miscarriage (4).

Although sperm is delicate, it can also be regenerated quite quickly. It takes 3 months for a man to grow healthy new sperm and research shows that this can be enhanced with antioxidants, particularly with zinc and selenium. Acupuncture has been shown to improve sperm morphology (5).

Polycystic ovarian syndrome (PCOS)

PCOS is the equivalent of a low sperm count in women. Although women with PCOS have a normal number of eggs in reserve, their eggs do not mature every month the way that they are supposed to. This causes multiple immature follicles to be visible on ultrasound (mistakenly called cysts). PCOS the leading cause of infertility in women, and is currently believed to affect 10% of all women. Sadly, this number is increasing.

The conventional view is that PCOS is caused by obesity. The elevated insulin that occurs with obesity has been shown to interfere with egg development. Type 1 PCOS (insulin resistant) may also be linked to sugar, smoking, Pill use and trans fat. There are also a large number of Type 2 PCOS cases who are not obese and whose insulin is normal. In these women, ovulation is disturbed by other factors such as thyroid, stress , environmental toxins, and the Pill.

After 12 years of specialised work with PCOS patients in our Sydney clinic, I am convinced that hormone-disrupting toxic chemicals (including the Pill) have contributed to the PCOS epidemic. There is some scientific basis for this. Studies have linked bisphenol A from plastics, a common hormone-disrupting chemical, with PCOS (6).

The link between hormone-disrupting chemicals has not been well researched, but if it does exist, there is evidence to suggest that, like falling sperm count, the effect is multi-generational. PCOS today can be correlated with the health of the mother and grandmother during their pregnancies. Women with PCOS are more likely to have had mothers that were overweight or who developed gestational diabetes. They are also more likely to have had mothers who smoked (not necessarily during the pregnancy) and to have had a low birth weight.

Finger length test for PCOS:

Some women with PCOS have a pattern of finger length similar to men. Australian researchers measured finger length in 140 women and found that those with PCOS had a shorter 2nd finger compared to their 4th finger. This is similar to the male pattern and suggests that these women were exposed to excess male hormone in the womb. (12) This may have been the result of a maternal exposure to hormone disrupting chemicals or trans-fat.

PCOS responds well to natural treatment. The herb peony is particularly useful. It coordinates signals coming from the pituitary gland and can re-establish ovulation within 2-3 months of treatment.

The Pill is an endocrine disruptor

Consider the fact that the Pill is many times stronger than human oestrogen and that it is taken by millions of women, including teenagers whose hormones are still developing. Consider the fact that the Pill has been shown to cause permanent hormone changes (even once the pill is stopped) (7). The must be classified as a hormone disruptor. A meta-analysis has linked the Pill with breast cancer in young women (8), and this is just the beginning. Most doctors recognise that it can take 1 to 2 years for normal menstrual cycles to resume after stopping the pill. I am certain that in 2 or 3 decades, or sooner, we will be astounded that we used to blithely give powerful steroid drugs to so many women.

We know that the effect of hormone-disrupting chemicals crosses generations. We know that the birth control pill is a hormone-disrupting chemical. The question that needs to be asked is this. What should we expect when the third and the fourth generation of women take the pill? That generation is now, and we know that one in ten women do not produce eggs properly anymore. It is time to remove the Pill from standard care and increase the fertility of future generations.

IVF drugs are hormone disruptors. (Drug-free options may be coming)

In current practice, IVF carries a steep cost. It is a health risk for women, who develop a greater lifetime risk of cancer, and it is a risk for babies, who are more likely to have health problems. A study from Finland in 2005 showed that 43 out of a thousand IVF babies suffer problems such as brain disorder, genital malformations, and developmental delays. (26)

It is not the IVF procedure itself that is the problem, but rather the powerful drugs that are used. IVF drugs are the only category of drug that is completely unregulated. Prominent health experts are concerned by the lack of restraint used by IVF doctors and the lack of information received by patients. Most women are unaware that 6% of women using IVF drugs develop serious side effects such as abdominal pain, breathing problems, and even death.

Certainly, couples facing infertility are willing to endure risks to the mother and the baby, but they should consider this: The IVF drugs pose a risk to their fertility. IVF has a 25% chance of success. If it is not successful, there is good evidence that the ovaries and the endometrium are damaged, and that natural fertility is thereafter diminished. This is one thing for women who have zero chance of conceiving on their own, but the majority of couples seeking infertility treatment are not absolutely infertile but are merely having difficulty. Studies show that the majority of couples who have not conceived in the first two years will succeed in the next two years even without treatment.

A new technique called in vitro maturation (IVM) may come into practice. With IVM, no drugs are required. Immature eggs are extracted and matured before being fertilised. Because the eggs are not subjected to over-stimulating drugs, the embryos are healthier, and success rate is higher. This new technique is particularly helpful for older women whose ovaries tend to overstimulate with conventional IVF.

Chilling evidence of endocrine disrupting chemicals

In the developed world, girls are reaching puberty an average of a full year earlier than they did earlier in the century. (13) There is growing evidence that this trend is linked to contamination with pesticide and plastic residues. (14,15)

Early puberty is a health risk for girls, both emotionally and physically. They are forced to deal with adult body issues before they have reached emotional maturity. They are also at a greater lifetime risk for hormone-sensitive diseases such as breast cancer and endometriosis.

If anything, boys are even more vulnerable to hormone-disrupting chemicals. For one thing, they are less likely to be born in the first place. Men exposed to chemicals, such as dioxin and PCB's are less likely to father boys. (16) Boys that are born are more likely to have hypospadias, which is a penis malformation caused by too little testosterone. Hypospadias rates have doubled since 1970 (17), and it is believed to be caused by the effect of oestrogen-mimicking chemicals on male foetuses. (18) Other signs of hormonal interference in boys include delayed puberty and abnormally low sperm count.

Quick facts about endocrine-disrupting chemicals:

• The average person tests positive for at least 116 chemicals, many of which were banned over two decades ago.
• 250 toxic substances have been identified in human breast milk, including perfumes, suntan oil, pesticides and heavy metals.
• Infants ingest 42 times above what is regarded as the safe limit for dioxins, a chemical that in may not even have a safe limit, because according to the US Environmental Protection Agency, dioxin is 300,000 times more carcinogenic than DDT.
• Hormone-disrupting chemicals cause damage they are only a few parts per billion (22)

Worse exposure is from:

Household cleaning products
Pesticides on food and, if you spray, in your home and garden
Cosmetics including moisturisers and sunscreen
Styrofoam, especially with hot drinks
Plastic including plastic liners in cans and long-life milk containers
Chewable baby toys
Flame retardants in carpets and furniture
Air and water pollution

Toxins are stored in body fat, so detoxification of the body is a critical part of any fertility treatment.

What about soy?

Soy is a weak oestrogen. This is quite different from hormone-disrupting chemicals which, in most cases, are very strong oestrogens. Soy is so weak that it may almost be regarded as an anti-oestrogen. For example, soy is beneficial for symptoms of oestrogen excess such as heavy flow.

The anti-oestrogen effect appears to interfere with the development of the reproductive system, and there is evidence that concentrated soy is detrimental to fertility. In one experiment, newborn mice injected with genistein, a soy constituent, were later found to be sub fertile or infertile. Their ovaries exhibited an unusual pattern of egg development. (24) Researchers have found that when a woman eats soy, it decreases the ability of the sperm to swim in the female reproductive tract. This effect was not directly attributed to soy's oestrogenic effect. (25)

Why, then, are millions of women able to consume soy as part of their traditional diet, and still fall pregnant? The answer lies in the dose. Traditionally, soy is taken a condiment or side dish. It is only in modern western society that we consume large amounts of concentrated soy as soy milk or soy powder.

Most experts agree that children, whose reproductive system is still developing, should not be fed concentrated soy. Soy sauce and a small amount of tofu are acceptable. Couple attempting pregnancy and pregnant women should also avoid concentrated soy products.

Endometriosis

Endometriosis is caused by a malfunction of the immune system, and the hormonal system, both of which are exquisitely sensitive to chemical damage. Endometriosis has been shown to be induced in laboratory animals by minute exposures to PCB's and dioxins. (19,20) The results have been confirmed by subsequent experiments, and in one recent study, the researchers were able to produce endometriosis with dioxin-contaminated food, exactly at the dose that humans are exposed to every day. (21)

Endometriosis responds very well to natural treatment, particularly to an anti-inflammatory diet. Progesterone cream or pessaries may also be used. Progesterone is anti-inflammatory and reduces the stimulatory effect of oestrogen on the condition.

If endometriosis is severe, surgery may be necessary and can improve fertility outcomes. I strongly recommend against gonadotropin inhibiting drugs, which treat endometriosis by inducing a temporary artificial menopause. These drugs interfere with pituitary function, and the effect can be observed even many years after stopping the drug. Women who have used this drug are more likely to hyper-stimulate during IVF cycles.

Thyroid

When it comes to fertility, the thyroid is just as important as the ovaries. A well functioning thyroid is necessary for ovulation, progesterone production and for implantation. Unfortunately, it is often overlooked by fertility doctors.

In order to fall pregnant, it is not enough to have the thyroid just barely chugging along. The blood test for thyroid (TSH) should fall between 1 and 2 mIU/L. If it does not, there is absolutely no reason to proceed with dangerous fertility drug treatment.

The thyroid gland is particularly susceptible to hormone-disrupting chemicals. The worst are brominated fire retardants found in new furniture and carpet and fluorinated compounds found in Teflon and nail polish (23). The American Environmental Protection Agency plans to implement a ban on this class of chemicals.

Smoking

Cigarette smoke contains numerous toxins that damage fertility, particularly cadmium. Smoking decreased ovarian reserve and damages sperm. It has recently been shown that a woman who has smoked for a period of time in her life has a less receptive uterus lining than a woman who has never smoked.

Healthy immune function

Because implantation is an immune event, a healthy immune system is as important for fertility as a healthy hormone system. Inflammation and autoimmune disease, including thyroid disease can interfere with fertility but can be corrected very well by natural medicine.

Food sensitivities can also be a problem for fertility. Avoiding inflammatory foods such as cow's milk and wheat can dramatically improve fertility.

Phytoestrogens

Phytoestrogens are oestrogen-type molecules found in plants and vegetables. They have always been in our food supply, and our bodies are adapted to a steady supply of them. The good news in our modern chemical age is that these gentle molecules buffer our hormone receptors and protect hormone sensitive tissue from hormone disrupting chemicals.

With the exception of concentrated soy and red clover, which are strongly anti-oestrogenic, phytoestrogens are helpful for fertility. According to a study at the Obstetrics and Gynecology Center in Rome, phytoestrogen supplements improve the outcome of IVF. (27) They work for natural fertility too.

Foods rich in phytoestrogens:

yams lentils carrot
flaxseeds sesame seeds beetroot
apples garlic broccoli
pumpkin rye parsley
millet sunflower seeds

Herbs that Provide phytoestrogens:

dong quai shatavari wild yam
blue cohosh tribulus liquorice root

 

The question of age.

Women suffer a great deal of guilt if they wait until their thirties for pregnancy, and then do not succeed. Yes, fertility declines in our late thirties, but that effect can be moderated with nutrition and a healthy lifestyle.

It may alleviate the guilt to understand that men have a biological clock too. Problems with sperm are the cause of infertility in 60% of couples, and there is new evidence that this worsens after 35, the same as women. Interestingly, men do not seem to suffer anxiety about it.

If you have had to postpone pregnancy for social or financial reasons, then that is just the reality of your life and of modern society. Perhaps you did not meet your husband until later in life? Would you trade all of this to have had a baby at 19?

You are the age that you are. That cannot be changed. Your fertility will be enhanced in the present moment by being as relaxed as possible. Dump the guilt and the panic, and focus on being as healthy as possible now.

If you must blame someone, blame industrial society for the sea of chemicals that have damaged your husband's sperm

DHEA supplements and CoQ10 have been to shown to dramatically improve egg quality and fertility in older women. (28)(29)

Putting it all together.  Making a plan for fertility for both sexes

  • Avoid hormone disrupting chemicals such as bug sprays and plastics (BPA)
  • Avoid the birth control pill and IVF drugs
  • Do not smoke.
  • Sleep
  • Detox
  • Reduce stress
  • Treat sexually transmitted diseases early. Get tested for Chlamydia, an STD that causes no symptoms, but can damage fertility.
  • Maintain a healthy body weight.
  • Avoid concentrated soy products.
  • Avoid food sensitivities
  • Correct underlying autoimmune disease
  • Limit caffeine to none or one cup per day for women. (Caffeine is less of a concern for men.)
  • Include phytoestrogens in your diet (not soy). Talk to a Naturopath about herbs containing phytoestrogens
  • Make sure that your thyroid is functioning optimally. (TSH should be between 1 and 2)
  • Check your vitamin D level. Vitamin D is important for fertility is both men and women. The blood level should be 100 pg/ml.
  • Don't forget about sperm! Consider sperm morphology (shape) as well as count
  • Supplement zinc and selenium for DNA health of sperm and egg.
  • Consider acupuncture to improve sperm morphology and to regulate menstrual cycles.
  • If regular ovulation is not occurring (PCOS), eliminate sugar, and consider natural treatment such as Peony & Licorice
  • If endometriosis is present, implement an anti-inflammatory diet, and consider progesterone cream. Consider surgery.
  • If age is a factor, consider a DHEA supplement

Written by Lara Briden BSc, ND

 

References

1. Infertility threatening Europe's population. www.news-medical.net Published: Tuesday, 21-Jun-2005
2. Anway et al. Epigenetic Transgenerational Actions of Endocrine Disruptors and Male Fertility. Endocrinology 2006.147(6): 43-49
3. Kleinhaus, K et al. Paternal Age and Spontaneous Abortion. Obstetrics & Gynecology; 2006108:369-377
4. Reichenberg, A et al.Advancing Paternal Age and Autism. Arch Gen Psychiatry. 2006;63:1026-1032
5. Magarelli, P. Acupuncture & IVF poor responders: a cure? Fertility and Sterility 2005. 84: 141-7.
6. Takeuchi T et al.. Positive relationship between androgen and the endocrine disruptor, bisphenol A, in normal women and women with ovarian dysfunction. Endocr J 2004.51:165-169
7. Panzer et al. Impact of Oral Contraceptives on Sex Hormone-Binding Globulin and Androgen Levels: A Retrospective Study in Women with Sexual Dysfunction. The Journal of Sexual Medicine. 2006. 3:p.104-113
8. Barclay, L et al. Oral Contraceptive Use Increases Risk for Premenopausal Breast Cancer. Mayo Clinic Proc. 2006;81:1287, 1290-1302.
9. Barclay, L Trans Fatty Acid Intake Increases Risk for Ovulatory Infertility American Journal of Clinical Nutrition. 2007. 85: 231-237.
10. Kavanagh, K. 66th Scientific Sessions of the American Diabetes Association, June 9-13, 2006, Washington; abstract 328-OR. News release, Wake Forest University Baptist Medical Center
11. Franks, F et al. Development of polycystic ovary syndrome: involvement of genetic and environmental factors. International Journal of Andrology 2006. 29(1): 278.
12. Cattrall FR et al. Anatomical evidence for in utero androgen exposure in women with polycystic ovary syndrome. Fertil Steril. 2005; 84(6):1689-9.
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15. Howdeshell, K, et al. Plastic bisphenol A speeds growth and puberty. Nature 1999. 401: 762-764
16. Jongbloet, PH et al. Where the Boys Aren't: Dioxin and the Sex Ratio. Environmental Health Perspectives 2002: 110(1)
17. Paulozzi LJ, et al.. Hypospadias trends in two U.S. surveillance systems. Pediatrics 100:831-834
18. Longnecker, MP et al. Maternal Serum Level of 1,1-Dichloro-2,2-bis(p-chlorophenyl)ethylene and Risk of Cryptorchidism, Hypospadias, and Polythelia among Male Offspring. American Journal of Epidemiology 2002. 155:313-22.
19. Mayani, A et al. Dioxin concentration in women with endometriosis. Human Reprod. 1997, 12: 373-5
20. Rier, Set al. Endometriosis in rhesus monkeys following chronic exposure to 2,3,7,8-Tetrachlorodibenzo-p-Dioxin. Fundamental and Applied Toxicology 1993. 21:433-441
21. Rier, SE, et al.. Serum levels of TCDD and dioxin-like chemicals in rhesus monkeys chronically exposed to dioxin: correlation of increased serum PCB levels with endometriosis. Toxicological Sciences 2001. 59:147-159
22. Frederick S et al. Concerning Low-Dose Effects of Bisphenol A Shows the Need for a New Risk Assessment. Environ Health Perspect. 2005.
23. Compound in Teflon A 'Likely Carcinogen'. Washington Post. June 29, 2005
24. Jefferson, W et al. Neonatal Genistein Treatment Alters Ovarian Differentiation in the Mouse: Inhibition of Oocyte Nest Breakdown and Increased Oocyte Survival. Biol Reprod. 2006. 74: 161-168
25. Fraser, LR. Effects of estrogenic xenobiotics on human and mouse spermatozoa. Human Reproduction 2006 21(5):1184-1193
26. Gissler, M. Monitoring of IVF birth outcomes in Finland: a data quality study. BMC Medical Informatics and Decision Making 2004, 4:3

27. Weekly News review. Dec 20, 2004. www.ObGynWorld.com.

28.Barad DH et al. Increased oocyte production after treatment with dehyroepiandrosterone. Fertility and Sterility. 2005. 84(3):

 

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