An Infertility Overview
By Chris Meletis, ND
According to the American Society for Reproductive Medicine, 1 in 7 American couples have difficulty conceiving a child. Nearly 12% of American women between 15 and 44 years of age have impaired fertility, roughly 7.3 million women.
Men are also affected: 30% of all infertility cases are attributable to problems on the male side. The number is about equal for cases exclusively attributable to the woman. The other 40% are due to shared factors or indeterminable causes.
Infertility is a costly problem. Each year, American couples spend between $2-3 billion on fertility drugs, assisted reproduction, and other medical services. In many cases, though, careful attention to nutrition and lifestyle factors can obviate the need for more expensive, drug-based fertility enhancement or assisted reproduction. Primary care doctors can play a vital role in identifying and correcting nutrient deficiencies and lifestyle factors that impair fertility.
Rule Out the Obvious
The first step in helping an infertile couple is to identify and address any obvious anatomic or physiological impediments to conception. In women, these include:
- Ovulatory Dysfunction, which may be caused by aging, anovulatory cycles, amenorrhea, luteal phase defects, premature ovarian failure, and elevated prolactin. Ovulatory problems account for about 25% of all cases.
- Polycystic Ovary Syndrome, affecting 6–10% of reproductive-age women.
- Anatomical abnormalities, such as fallopian tube blockage (sometimes a sequelum of pelvic surgery), uterine fibromas, myomas and leiomyomas.
- Endometriosis, found in 30–45% of infertile women.
- Medications, including hormones, antidepressants, antibiotics, pain-relievers, aspirin and ibuprofen (when taken at mid-cycle).
- Non-gynecological medical conditions, including diabetes, inflammatory bowel disease, celiac disease, epilepsy, and thyroid conditions.
Common causes of male infertility include:
- Impaired spermatogenesis due to cryptorchidism (failure of one or both testes to descend); varicocele; high fevers, infections, kidney diseases, metabolic disorders; hormone dysfunction.
- Ductal obstructions caused by sexually transmitted infections, inflammation, developmental disorders like cystic fibrosis, or retrograde ejaculation.
- Systemic diseases including hemochromatosis (causing iron deposition in the testes); sickle cell anemia, which may cause hypogonadism; testicular cancer, which may cause testicular dysfunction; and testicular trauma.
- Pharmaceuticals used to treat hypertension, arthritis, digestive diseases, and cancer. Recreational drugs can also impair fertility.
Environmental & Lifestyle Factors
Environmental factors such as chemical toxins, radiation, and infections affect fertility in both women and men, modulating the hormonal balance related to conception, implantation and development. Declining sperm counts, observed over the last 50 years in men in developed countries, may be due to exposure to estrogen-like compounds in the environment. One study showed that blood levels of organochlorines are inversely related to sperm count and motility.
Environmental exposures, especially past exposures, are difficult to rectify. But daily lifestyle factors profoundly affect fertility, and they are more easily changed.
In men, avoiding alcohol consumption improves fertility. Excessive alcohol intake may decrease sperm count, reduce sperm motility, and induce sperm morphologic abnormalities. Cigarettes are also bad news. Cadmium, a toxic metal found in cigarette smoke, negatively influences fertility. Smokers have lower sperm counts and reduced motility compared to non-smokers. Marijuana use adversely impacts fertility.
Heavy caffeine intake is also detrimental. Consumption of more than 2 cups of coffee per day may negatively affect fertility, particularly among women with endometriosis and fallopian tube disease.
In women, excessive physical activity and substantial weight loss can cause menstrual irregularities, amenorrhea, and anovulation. In fact, rapid weight loss is known to lower progesterone levels, slow follicular growth, and inhibit the luteinizing hormone surge, suppressing ovulation. Weight loss also mobilizes toxins stored in body fat, increasing systemic exposure. While it is generally healthy for overweight/obese women to shed pounds, it needs to be done carefully and not drastically, especially if a woman is trying to conceive.
Chris Meletis is an internationally renowned naturopathic doctor, author and educator in the field of natural medicine.