Infertility Treatment Protocol

Infertility affects many young couples (estimates are as high as ~ 1 in 6), and the prevalence is increasing. Data from the Centers for Disease Control and Prevention (CDC) National Survey of Family Growth done back in 1995 showed 6.1 million infertile women ages 15 to 44, 9.1 million using infertility services, and 2.1 million infertile married couples in the United States.¹ According to a press release from the National Fertility Association, the data from 2002 indicates an increase in the number of infertile people in the United States to 7.3 million.²

These numbers are continuing to rise as sperm counts drop worldwide and undiagnosed thyroid problems increase—so you are not alone. "It looks as if the amount of infertility in the Western world could double in the next decade," Prof. Bill Ledger, a fertility expert at Sheffield University in England, told a June 2005 meeting of the European Society of Human Reproduction and Embryology.

Various factors may be responsible for the inability to achieve a successful pregnancy. Despite research showing that fertility declines after age 30, women are delaying having children. Infertility may be caused by ovulatory, anatomic, immunologic, infectious, nutritional or hormonal factors on the woman's side. In men, abnormalities of semen parameters are the most common contributors. In 1940, the average sperm count was 113 million/ ml. By 1990 this had dropped to 66 million sperm/ml and semen volume dropped ~ 20 percent from 3.4 to 2.75 cc. These represent an ~ 60 percent decrease in sperm per ejaculate over a 50 year period.³ Treatments that improve cellular energy production may dramatically increase sperm motility.

After a thorough work-up, treatment can sometimes be planned that aims to correct the problems identified. In many cases, however, the cause of the infertility remains unexplained. In this setting, the only option many couples are given is IVF (In Vitro Fertilization). IVF is given attention because it costs ~ $30,000+, while research on inexpensive natural options has been ignored (not because doctors don't care, but simply because no one will pay to publicize the information).

The good news is there are many natural ways to improve all steps of the reproductive process. A large number of studies have successfully explored the use of individual nutritional and hormonal therapies to do this, resulting in women with unexplained/ untreatable infertility often getting pregnant!

For The Woman

Life Style Education
These are important things to avoid from now until after you are three months pregnant, as they can cause infertility. Just do the best you can with these guidelines—OK to not be "perfect" with them.

1. Avoid coffee and sodas⁵ (Tea is OK). Coffee and sodas inhibit fertility-often markedly. Especially avoid caffeine if your Prolactin blood test is LOW as it can lower it further.
2. Avoid melatonin (which is sometimes used to treat insomnia) as it can affect reproductive hormones.⁶
3. Avoid taking over 900 mg of supplemental Vitamin C (causes reversible infertility). Taking 750 mg a day of Vitamin C however helps infertility⁷ so we will supply this amount. Do not take over 7000 units of Supplemental Vitamin A (causes birth defects—beta carotene is OK) daily. The supplement we supply has 3500 IU of Vitamin A (the other 3500 IU it contains is beta carotene).
4. Avoid hot tubbing (it increases birth defect risks). A hot bath, which is not over 100 degrees in temperature, is a safer way to relax. In a bath much of your upper body will remain out of the water, making you less likely to overheat. Additionally, the water in a bath begins to cool off, as opposed to a hot tub, further reducing any risk of overheating.⁸ A hot tub is usually set at 102–104 degrees, which can overheat your body and can harm the baby.
5. Avoid a high protein/Atkins' diet⁹(an Atkins like diet in a rat study decreased fertility over 50 percent).
6. No alcohol if Prolactin levels are higher than 10 (and avoid in general as is convenient).¹⁰
7. Avoid vaginal lubricants such as FemGlide, Replens and Astroglide, which can damage sperm. Pre-seed brand is OK.¹¹
8. If you smoke, stop till after the baby is born. Smoking contributes to infertility in many ways.¹²

Lifestyle Things To Do To Help Get Pregnant

1. It works best to have intercourse on the day you ovulate and up to four days before (otherwise "ad lib" whenever you feel like it). It is OK to have intercourse multiple times during this period. For purposes of getting pregnant, intercourse even one day after ovulation is unlikely to result in pregnancy—but OK to do anyway for its other benefits.
2. Enjoy milk products but use regular ones that have the normal amount of milk fat (e.g.-whole milk) instead of low fat or fat free milk products. In a Harvard study, high intake of low-fat dairy foods was associated with an increased risk of infertility, while an increased intake of high-fat dairy foods was associated with a lower risk of infertility. Women consuming at least two servings of low-fat dairy foods per day showed an 85 percent increased risk of infertility. On the other hand, women consuming at least one serving of highfat dairy foods per day showed a 27 percent reduced risk of infertility.¹³ Whole milk products (instead of low fat ) also taste better!

Treatments

1. Supply overall nutritional support with the "Energy Revitalization Powder" by Enzymatic Therapy and a healthy, wellbalanced diet.^14,15,16,17 As noted above, dieting and high protein/ low carbohydrate diets are to be avoided.^18,19 Stay on these when you get pregnant and through breast feeding.
2. Add prescription Armour thyroid 30 mg adjusted to dose that feels best (to a maximum of 90 mg) or Synthroid 25–75 mcg 19 A&B while keeping Free T4 < 75 percent of the upper limit of normal. Take it in the morning. DO NOT TAKE IRON OR CALCIUM SUPPLEMENTS WITHIN SIX HOURS OF THE THYROID DOSE, OR THE THYROID WILL NOT BE ABSORBED. Take your calcium at dinner and bedtime. If you get shaky or hyper or racing heart, lower the thyroid dose (or stop it) and discuss with your doctor. Stay on the thyroid through your pregnancy (it supports a healthy pregnancy).
3. Optimize iron levels. If the ferritin blood test is under 80 or iron percent saturation under 25 percent, treat with an iron tablet one a day after 2 PM on an empty stomach.^20,21 Continue the iron through your pregnancy.
4. If PCOS (Poly Cystic Ovary Syndrome) is present (often present when testosterone or DHEA-S levels are elevated), research shows that treatment with the medication metformin 1500–2000 mg/day not only increased fertility, but also decreased the risk of serious birth defects considerably.^{22,23,24,25,2}6
5. If the Prolactin level is over 10, alcohol and melatonin, (which can raise Prolactin) are to be strictly avoided. Vitamin B6 100 mg or as needed to bring Prolactin within the normal range (but not greater than 200 mg of B6) should be added. Stop the extra B6 (except for what is in the B complex) around seven months into the pregnancy (otherwise it can suppress breast milk).
6. If folic acid levels are low (lowest 20 percent of normal range) a blood test looking for wheat allergies will be recommended and a gluten free diet instituted if positive. Also Folic Acid 5 mg BID will then be added.²⁷

For The Man

Life Style Education
These are important things to avoid from now until after your wife gets pregnant, as they can cause infertility. Just do the best you can with these guidelines—OK to not be "perfect" with them.

1. When convenient, avoid meat with Estrogen (i.e.—get your meat from a natural foods store).
2. Avoid Soy based foods (e.g.—tofu, tempeh, soy cheese and milk, etc). Even modest intakes drop sperm counts by 40 percent.²⁸
3. Avoid Melatonin, Testosterone, Verapamil and Nifedipine (latter two are heart/blood pressure medications), which can cause reversible infertility.
4. Avoid alcohol when convenient²⁹ and tobacco.³⁰
5. Sperm do poorly at temperatures over 96 (which is why the testes hang below the rest of the body to stay cooler). Avoid elevated scrotal temperatures by wearing boxer shorts. Do NOT wear briefs, tight fitting underwear or jeans. Avoid hottubs. Avoid rowing/ski machines, treadmills or jogging unless the testes can hang free.
6. Avoid aspirin, Motrin or similar medications, which block the hormone prostaglandin (Prostaglandins in the seminal fluid may assist sperm). Tylenol is OK in moderation (if you need high doses regularly, discuss with your doctor).
7. Increase liquid vegetable oils and avoid cottonseed (may contain gossypol which inhibit sperm function)³¹, palm or coconut oils or trans, hydrogenated or saturated fats as comfortably able.

Treatments All of these can be taken together in the morning (or split up or taken any time of day)

1. Supply overall nutritional support with the "Energy Revitalization Powder" (contains > 50 nutrients including 750 mg of Vitamin C and 100 IU of Vitamin E^32,33,34,35) by Enzymatic Therapy). It also supplies folic acid^36,37 and antioxidants.³⁸
2. CoEnzyme Q10 (chewables-contains 400 IU of Vitamin E as well) 200 mg/day.³⁸
3. L-Arginine 4 gm/day.³⁹
4. Acetyl-l-carnitine 1000 mg/day and Carnitine 1000 mg/day markedly improves sperm motility and the sperms defenses against attack.^40,41,42
5. Zinc 15 mg/day⁴³
6. Ribose 5 gm twice a day (can use like sugar and mix in food or drinks or use the chewable tablets). In many studies this increases energy production, which may also help sperm motility. The second dose can be taken any time during the day.
7. Clomiphene (Rx) 25 mg a night (or Monday, Wednesday, Friday nights) can increase sperm counts (more than doubles sperm count and motility).⁴⁴

References:

1. National Center for Health Statistics. Infertility. Accessed April 26,2006.
2. Resolve. National survey results reveal startling lack of awareness of infertility even as numbers climb to 7.3 million. October 27, 2005. Accessed December 8, 2005.
3. Carlson et al. Evidence for decreasing quality of semen over the last 50 years. Br Med J 1992;305:609–13.
4. Weight and pregnancy
5. Wilcox AJ, Weinberg CR. Lancet 337:1159-1160,1991;Williams MA, et al. Coffee and delayed conception. Lancet 335:1603, 1990.
6. Partonen T. Short note: melatonin-dependent infertility. Med Hypotheses. 1999;52(5):487–8.
7. Henmi H, Endo T, Kitajima Y, et al. Effects of ascorbic acid supplementation on serum progesterone levels in patients with a luteal phase defect. Fertil Steril 2003;80:459–61.
8. www.AmericanPregnancy.org for more information.
9. Atkins like diet in a rat study at the Colorado Center for Reproductive medicine decreased fertility over 50%- study presented at [2004] European Society of Human Reproduction and Embryology Conference.
10. Psychiatry Letter 4(7): 35–8,1986.
11. Some Vaginal Lubricants May Damage Sperm WebMD, Oct. 19, 2005
12. Maternal Tobacco Use and Its Preimplantation Effects on Fertility: More Reasons to Stop Smoking.
13. A prospective study of dairy foods intake and anovulatory infertility," Chavarro JE, Willett WC, et al, Human Reproduction, 2007 Feb 28; [Epub ahead of print].
14. Czeizel AE, Metneki J, Dudas I. The effect of preconceptional multivitamin supplementation on fertility. Int J Vitam Nutr Res 1996;66:55–8.
15. Thiessen DD, Ondrusek G, Coleman RV. Vitamin E and sex behavior in mice. Nutr Metab 1975;18:116–9.
16. Bayer R. Treatment of infertility with vitamin E. Int J Fertil 1960;5:70–8.
17. Sieve BF. The clinical effects of a new B-complex factor, para-aminobenzoic acid, on pigmentation and fertility. South Med Surg 1942;104:135–9.
18. Wynn A, Wynn M. The need for nutritional assessment of the infertile patient. J Nutr Med 1:315–324,1990.
19. Green BB et al. Risk of ovulatory infertility in relation to [high or low] body weight. Fertil Steril 50(9); 621-6,1988).
    19a. Thyroid and its indispensability in fertility.
    19b. Improved in vitro fertilization outcomes after treatment of subclinical hypothyroidism in infertile women.
20. Rushton DH et al. Ferritin and Fertility. Letter. Lancet 337:1554, 1991.
21. Iron intake and risk of ovulatory infertility Obstet Gynecol 2006 Nov;108(5):1145-52.
22. Costello MF, Eden JA. A systematic review of the reproductive system effects of metformin in patients with polycystic ovary syndrome. Fertil Steril. 2003;79:1–13 .
23. Glueck CJ, Wang P, Kobayashi S, et al Metformin therapy throughout pregnancy reduces the development of gestational diabetes in women with polycystic ovary syndrome. Fertil Steril. 2002;77:520–5.
24. Glueck CJ, Phillips H, Cameron D, et al. Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce first-trimester abortion: a pilot study. Fertil Steril. 2001;75:46–52.
25. Nestler JE, Stovall D, Akhter N, et al. Strategies for the use of insulin-sensitizing drugs to treat infertility in women with polycystic ovary syndrome. Fertil Steril. 2002;77:209–15.
26. Randomized Placebo-Controlled Trial of Metformin for Adolescents With Polycystic Ovary Syndrome. Bridger T, MacDonald S, Baltzer F, Rodd C. Arch Pediatr Adolesc Med. 2006;160:241–6.
27. Dawson DW, Sawers AH. Infertility and Folate Deficiency. Case Reports. Br j Obstet Gynaecol 89:678–80,1982.
28. Eating soya could slash men's sperm count Roxanne Khamsi, ABC News, Oct. 17, 2007
29. Anderson RA Jr et al. Male reproductive tract sensitivity to ethanol: a critical overview. Pharmacol Biochem Behav 18 Supple 1:305-310, 1983.
30. Infertility: Tobacco, Marijuana, and Other Drugs WebMD
31. Weller DP et al. Gossypol...a male contraceptive Econ Med Plant Res 1985:1;87–112.
32. "Reduction of the incidence of sperm DNA fragmentation by oral antioxidant treatment," Greco E, Iacobelli M, et al, J Androl., 2005; 26(3): 349–53.
33. Dawson EB etal. Effect of Ascorbic acid on male fertility Ann NY Acad Sci 498:312–23,1987.
34. Improvement in human semen quality after oral supplementation of vitamin C," Akmal M, Qadri JQ, et al, J Med Food, 2006; 9(3): 440-2.
35. "Relationship between seminal ascorbic acid and sperm DNA integrity in infertile men," Song GJ, Norkus EP, Lewis V, Int J Androl, 2006; 29(6): 569–75.).
36. "The association of folate, zinc and antioxidant intake with sperm aneuploidy in healthy non-smoking men," Young SS, Eskenazi B, et al, Hum Reprod, 2008 Mar 19.
37. Low Folate Levels May Harm Sperm Steven Reinberg, Washington Post Thursday, March 20, 2008;
38. Mechanisms of male infertility: role of antioxidants," Sheweita SA, Tilmisany AM, et al, Curr Drug Metab, 2005; 6(5): 495–501.
39. Schacter A et al.Treatment of oligospermia with the amino acid arginine. J Urol 110(3):311-313, 1973.
40. Garolla, Fertility and Sterility, February 2005; vol 83: pp 355–61.
41. "Placebo-controlled double-blind randomized trial on the use of L-carnitine, L-acetylcarnitine, or combined L-carnitine and Lacetylcarnitine in men with idiopathic asthenozoospermia," Balercia G, Regoli F, et al, Fertil Steril., 2005; 84(3): 662–71.
42. Sperm Swim Better With Carnitine Miranda Hill, WebMD, March 9, 2005
43. Skandhan KP et al. Semen Electrolytes in Normal and Infertile Subjects ii Zinc. Experientia 34(11):1476–77, 1978.
44. Effect of clomiphene citrate on sperm density in male partners of infertile couples. Indian J Physiol Pharmacol. 2007 Apr-Jun;51(2):195-8.

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