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              HEALTH CENTRE (Auck)

              Loula George BSc, ND, Dip Herb.Med
              Sheran Marra ND, Dip.Herb.Med

              Midwives Collective – Integrated Health Centre
              outline Preconception Care Programme

              causes of infertility from a naturopathic perspective

              integrated approach to fertility problems

              demystify natural health methods
             The Fetal Matrix

             “We have learnt how subtle changes in what
             women eat from before they get pregnant and
             through pregnancy have influences on their

             Professor Gluckman (Liggins Institute, Auckland)
              Factors contributing to increasing levels of infertility
               Stress
               Poor diet/nutrition
               Sexually transmitted diseases and genito-urinary infections
               Pollution
               Drugs
               Radiation
               Previous use of contraception programmes
               Greater age of prospective parents
               Toxicity
               Immune system failure
               Hormonal imbalance
             40% female
             40% male
             20% unexplained

             Unexplained infertility may be associated with
              toxins
              immune reactions
              nutritional deficiencies
              inflammation
              stress/HPA activations
             Infertility = major stress
             Undermines effective functioning of the immune
             system, adrenals, digestion and hormone balance all
             of which contribute to the fertile state.

             Cortisol Suppresses Thyroid Hormone Release
             Cortisol stimulates cGMP production in the thyroid
             gland and inhibits thyroid hormone release.
             Cortisol reduces pituitary responsiveness to TRH and
             the thyroid gland sensitivity to TSH.
             J.Investig. Med 2001 July: 49(4) 330-4
              Hypothyroidism Impairs Fertility
              In hypothyroidism, the elevated thyrotropin releasing hormone
              TRH may stimulate prolactin secretion in addition to thyroid
              stimulating hormone (TSH). Prolactin suppresses the release
              of LH and FSH.
              Correction of the hypothyroidism reduces the production of
              prolactin and releases suppression on LH, FSH and ovulation.
              BMJ 327, Sept 2003 546-549

              Stress Reduces Success of IVF
              A prolonged condition of stress, which causes a decreased
              ability to adapt and transitory anxious state, is associated with
              high amounts of activated T cells in the peripheral blood. Such
              a condition in turn is associated with reduced implantation rate
              in women undergoing IVF.
              Fert.Steril.2001 July 76(1) 85-91
        Case Study 1
        Sheryl (30 yrs) – teacher
        Conception attempts for 2 years unsuccessful.
        Generally healthy but suffered with irregular cycles (long) and
        work stress seemed to be a major factor. Given dietary advice
        and nutrient support for fertility. Recommended charting temps
        and mucus. After 6 months of charting, it became very clear
        that during stressful school terms her ovulation was delayed but
        ovulation regulated during holiday times.
        This information was essential in validating her decision to stop
        work for up to 6 months to try for a „successful‟ conception
        .(She had managed to conceive but it was during an ovulation
        that occurred on Day 23 of her cycle and she miscarried.)
        Two months after she stopped work she had had two 28 day
        cycles before she conceived and went on to have a healthy
             Nutritional status preconceptionally, during pregnancy and
             breastfeeding has a profound and direct affect upon fertility
             and embryonic health.

             Multivitamin Use Reduces Birth Defects
             Use of multivitamins from 3 months prior to pregnancy
             through to the end of the first trimester were associated with
             a 7% reduction in the risk of multiple birth defects in a
             Western metropolitan population.
             Paediatrics 2002: 109 904-908
             Use of Multivitamin/Mineral Prenatal Supplements:
             Influence on outcome of pregnancy.
             Preterm delivery (<33 weeks gestation) reduced more than
             fourfold for first trimester users and twofold when use was from
             second trimester.
             Risk of low birth weight was reduced approximately twofold
             with supplement use during the first and second trimester.
             Supplements have potential to diminish infant morbidity and
             Am J Epidemiol 1997; 146: 134-41
      Case Study 2
      Rosanne 35 yrs
      Presented with a history of 3 early miscarriages. Her health
      concerns were abdominal bloating, loose bowels, chronic
      anaemia. Recommended a coeliac screening test but conceived
      once more inadvertently before health issues were addressed
      and had 4th miscarriage.
      Had gliadin antibody test and intestinal biopsy which confirmed
      coeliacs. Also had hair analysis which showed very low mineral
      status( including iron.).
      Treatment plan was to stop all gluten and dairy, went on
      nutritional supplementation for 2 months. Conceived again and
      went on to have a very healthy daughter.
             Folic acid and Zinc Improve Male Subfertility
             A double-blind placebo controlled study showed that zinc
             and folic acid supplementation in subfertile men resulted in a
             74% increase in the number of normal sperm.
             Fert. Steril 2002; 77, 491-8

             Antioxidants Counteract the Effect of Ageing on Oocyte
             Quantity and Quality.
             In mice, both early and late onset administration and oral
             antioxidants C & E counteracted the negative effects of
             female aging on number of oocytes and percentage with
             normal chromosome structure.
             Mal Reprod.Dev 2002; 61: 385-397
             Studies on ROS and Male Fertility
             n 139 couples
             Men with high levels of ROS generation had 7 times less
             chance of conception compared with men with low ROS levels
             Am J Obstet Gynaecol 1991;(164:542-510)

             n 18 infertile patients
             16(88%) had higher ROS production and lower AO levels
             compared to fertile controls.
             -authors stated this ROS/AO imbalance was a major factor in
             idiopathic male infertility.
             -other studies estimate ROS are a feature of 25-40% of infertile
             male population.
             J. Urology 1997; 157140-3)
             74-83% of females of reproductive age did not receive the
             RDA and 67% of men didn‟t.
             1983 Aust. Diet Survey

             Zinc deficiency causes reproductive dysfunction.
             Zinc required for :
              progesterone production
              FSH and LH secretion
              ovarian development
              reduces risk of miscarriage, birth defects, premature
               labour, pre eclampsia, inefficient labour and stretch marks
              spermatogenesis
              testosterone production
              sperm count, motility, morphology and longevity
             CoQ10 Supplementation Increases Fertilisation Rates
             A study of men with idiopathic asthenozoospermia undergoing
             ICSI showed that addition of CoQ10 to sperm prior to injection
             almost doubled their motility rate.
             Oral supplementation (60mg/day) of CoQ10 leads to a marked
             increase fertilisation rates.
             Mol. Aspects Med 1997; 18:521-9

             Magnesium is Necessary for Estrogen Activity
             Trials show that magnesium is a key regulator of the binding of
             estrogen receptors to their ligands. A deficiency of Mg is
             associated with a reduction in estrogenic activity.
             This demonstrates that Mg deficiency may be associated with
             fertility problems.
             J. Biochem(Tokyo) 1984;95(4):1227-30
              GUIs and some other infections such as Toxoplasmosis
             and Cytomegalovirus can cause miscarriage, infertility and
             fetal health problems.
              Comprehensive testing and treatment to be carried out
             before conception.
              Female swabs to be taken HIGH INSIDE the cervix.
             Vaginal swab insufficient.
              Antibiotic therapy may be necessary (repeat tests to
             confirm absence of infection). If so, must be accompanied by
             immuno-supportive herbs and probiotics.
              Many infections obvious, some, e.g.
             Ureaplasma/mycoplasma, subclinical and very common.
              Severe repercussions include – repeated miscarriage,
             reduced fertility, birth defects, neotnatal morbidity and
             FORESIGHT – Screening for UTIs
             Both partners are checked out for the following infections prior
             to conception.
             GUIs gonorrhoea              Anaerobic bacteria
                     B Strep              Staph aureas
                     Chlamydia            Haem influenza
                     Haem Strep           Mycoplasmas
                     Enterococcus         Ureaplasmas
                     Klebsiella           E.Coli
                     Candida              Gardinerella
             Other Toxoplasma, CMV, Rubella immunity
             Serological tests for detecting GUIs could form a routine part
             of infertility investigations as well as screening following
             miscarriage or premature birth.
             A considerably higher incidence of spontaneous abortions,
             prematurity and neonatal morbidity and mortality has been
             reported among mothers with positive mycoplasma cultures
             compared to mothers with negative cultures. Mycoplasmas
             have also been found to be a cause for infertility.
             Cassell & Waites. Venereal Mycoplasma Infection.

             71 infertile men were screened for chlamydia and findings
             were compared to 56 fertile men. Chlamydial IgA antibodies
             were found in semen of 51.9% of infertile men compared to
             23.2% of fertile men.
             Chlamydial infections can affect male fertility.
       Case Study 3
       Paula 39 years
       10 years of infertility. Paula was generally healthy with the
       exception of undiagnosed cystitis-like symptoms.She had had
       many different treatments both allopathic and alternative with no
       success to date.
       Recommended screening for all GUIs including
       mycoplasma/ureaplasma. Found mycoplasma 3+ from high
       cervical swab. Treated with doxycycline, three rounds before
       treatment was successful (included herbal antimicrobial support
       and probiotics).
       After second lot of antibiotics her cystitis-like symptoms were
       gone and one month after infection had cleared completely she
       conceived and had a healthy child. Cystitis-like symptoms never
       returned and 2 years later she conceived her second child.
             From environmental, domestic, industrial, dietary sources.
             Of particular concern being the heavy metals and
             agrochemicals present in water supplies. Will deplete
             antioxidants and contribute to fetal toxicity.
             Sperm density and quality have declined appreciably over
             the past 50 years. Such a remarkable decline in such a
             short time is more likely to be a result of environmental
             rather than genetic.
              heavy metals (hair analysis)
              industrials chemicals (air and water borne)
              agrochemicals (in water supply/spraying)
              domestic (cleaners, renovations, some craft)
              occupational (e.g. hair dressers, motor mechanics,
             farmers, builders, etc.)

              food additives ( buy organic)
              polluted water ( purify)
             HEAVY METALS

              lead (petrol fumes, old paint)
              cadmium (active, passive smoking)
              mercury (dental amalgam, contaminated fish)
              aluminium (cookware, antiperspirants, antacids)
              nickel (body piercing, dental braces)
              copper (water pipes, OCP/IUD, smoking)
             Medicinal and recreational, including caffeine, alcohol, nicotine.
             These again take their toll on nutritional status and thereby can
             affect fertility.

             Alcohol and Caffeine Consumption and Decreased Fertility.
             >50% reduction in probability of conception during a menstrual
             cycle during which participants consumed alcohol. Caffeine
             consumption did not independently affect probability of
             conception but may enhance the negative effects of alcohol.
             Women who abstained from alcohol and consumed less than
             one cup of coffee per day conceived 26.9 pregnancies per 100
             menstrual cycles compared with 10.5 per 100 menstrual cycles
             among those that consumed any alcohol and more than one
             cup of coffee per day.
             Lancet, 1988.

             408 women
             Women who smoke have shorter menstrual cycles
             which may contribute to sub-fertility and early
             Obstetrics and Gynaecology
             X-rays, cosmic radiation, radioactive materials
              damages cells, especially those with high rates of growth
             and division e.g. embryonic, fetal, sperm cells.
              linked to increased miscarriage rates ( esp. lower
             back/abdominal x-rays)
              increased incidence of Downs Syndrome related to
             accumulated exposure rather than age per se.

             Computers, TVs, microwaves, radar, TV/radio/mobile
             phone, UV and infra red light, Wireless technology
             VDU operators shown to have increased incidence of
             miscarriage, still birth, congenital malformations. One study
             given 2 x miscarriage rates of similar workers with no
             Previous Use of Contraception Programmes,
             The Pill can cause severe nutritional deficiencies which affect
             immune status and fertility.

             Greater Age of Prospective Parents
             Increasing evidence links the greater risk of congenital
             defects to the accumulation of radiation and toxins, and
             nutritional deficiencies rather than to age per se.

             Arising from all the above, plus poor eliminative function.

             Immune System Failure
             Including allergic response, autoimmune disease, increased
             susceptibility to infectious diseases such as candiasis, toxo
             or CMV.
             HEALTH CENTRE (Auck)

             Loula George BSc, ND, Dip Herb.Med
             Sheran Marra ND, Dip.Herb.Med

             Midwives Collective – Integrated Health Centre
              Natural Fertility Management – Francesca Naish

                Jocelyn Centre, Sydney

              Foresight – British Assoc. for Preconception Care

              Conceiving HEALTHY babies = HEALTHY adults

              Needs to be undertaken four months prior to conception,
               throughout pregnancy and breastfeeding.

              Takes 116 days for sperm to generate. Eggs are vulnerable
               to damage in the time they need to mature, 100 days.

              Varied types of clients
            Why is Preconception Care Essential?
             1 couple in 6 is infertile
             1 couple in 5 experiences miscarriage
             1 woman in 10 experiences toxemia
             1 woman in 5 has a caesarian
             1 baby in 10 is premature or small for dates
             1 baby in 30 has a congenital defect
             1 woman in 3 has some post natal depression
             1 child in 10 is affected by learning or behaviour problems
             1 child in 5 suffers from asthma

             The number of infertile women (in U.S) aged between 20-25
            years, has tripled in the last 30 years.
             Sperm counts (worldwide) have decreased by 50% in the last 50
             FORESIGHT 1978 – British Association For the Promotion
             of Preconception Care
             Simple non invasive, low technology approach and basic
             preventative medicine.
             Shown conclusively that if in the months preceding conception
             both prospective parents
              eat a nutritious diet
              screen for essential trace elements ( e.g. zinc, mag, iron etc)
              follow a healthy lifestyle
              avoid exposure to environmental pollutants
              have any allergies and infections treated
             they will not only improve their fertility but will also significantly
             reduce their chance of suffering miscarriage, stillbirths,
             congenital defects, premature babies.
             Foresight Study 1992
             Preconceptual Care Research Project
             Conducted by Dr Neil Ward, University of Surrey, UK.
             367 couples over 2 years
             The women ranged in age from 22-45 years, the men from 25-59
             Upon coming to Foresight …
             41% of the couples had no previous adverse reproductive history, but
             among these were the older couples. The remainder had suffered
             infertility (37%), previous miscarriage (38%), therapeutic abortion
             (11%), stillbirth (3%), „small for dates‟ or low birth weight babies
             (15%) and malformation (2%).
             By the end of the Study…
             89% of all the couples had given birth including 81% of those who
             were infertile.
             The average gestational age was 38.5 weeks, and no
             baby was born before 36 weeks.
             Average weight of males was 7lb. 4 oz
             Average weight of females was 7lb. 2oz
             And no baby was lighter than 5lb.3oz

             There were no miscarriages, no perinatal
             deaths and no malformations!
             Normal expectation – 70 miscarriages, 6
             No baby was admitted to Intensive Care!
             Importance of Preconception Care

              ensures presence of essential factors, e.g. nutrients,
               absence of harmful factors, e.g. toxins/infections, for
               conception of truly healthy babies.

              true preventative medicine

              treatment for infertility

              creation of truly healthy babies

              prevention of miscarriage, still birth and congenital defects
             Preconception Health Care Can Help To Achieve

              children that are healthy, intelligent, well formed, well
               balanced, happy and bright.

              increased fertility in male and female and an easy

              normal, healthy, full-term pregnancy

              natural, intervention-free birth

              uninterrupted bonding

              mother free of post-natal depression

              successful and long-term breastfeeding
              What Does Preconception Care Involve?
              1. Lifestyle and environmental toxins
               Improving lifestyle
               cleaning up personal environment
               detoxify
               staying positive and stress free
               getting fit

              2. Nutrition
               nutrients are important in preconception care and fertility

              3. Hair analysis
               showing deficiencies or excesses of any minerals and any toxic
                metal load
             4. Natural Birth Control
              Charting mucus and temperature
              Timing techniques for achieving conception (also a useful
               diagnostic tool)

             5. Natural Remedies for Reproductive Health and
                General Health Issues
             6. e.g. endometriosis, PCOD, fibroids, cysts, miscarriage,
                asthma, autoimmune diseases etc

             6. Screening for any genito-urinary infections
             7. Allergies

              adequate protein

              avoidance of sugars and refined carbohydrates

              avoidance of saturated fats

              a good balance of alkali-promoting foods

              avoidance of all allergens

              avoidance of all toxins

              plenty of fresh, purified water
    Case Study 4
    Lisa 30 yrs
    Presented with amenorrhoea for 1 year, unexplained weight gain,
    severe bloating, nausea, migraines and general chronic pain.
    History of dysmennorhoea probably due to scarring and adhesions
    from earlier PID , discovered by laproscopy a few years prior.
    Treatment included a bowel detox and repair programme and
    recommended a low GI diet, including avoiding wheat.
    Next visit, one month later, she had her first period in a year and was
    not painful. Had not lost any weight yet. No bloating anymore and
    only three days of pain all month. No nausea and no migraines.
    After three months, with only treatment being bowel programme and
    dietary changes, she had had 3 regular cycles. Began treating liver
    herbally. No pain at all anymore.
    Two months later she conceived.
             Healthy Reproductive System = the absence of …
              irregular periods – cycles < 27,>31
              irregular ovulation
              hormonal imbalance – including pre-ovulatory phases >
             17 days and post-ovulatory phases < 12 days long
              amenorrhoea
              severe PMT
              dysmenorrhoea
              menorrhagia
              inadequate mucus at midcycle
              recurrent vaginal thrush
              disease states such as – endo, PCOD, fibroids, cervical
             dysplasia, thyroid or pituitary dysfunction
   Case Study 5
   Jane 31yrs
   Presented with irregular cycles. Diagnosed with PCOS. Treated her
   with herbs and supplements for PCOS. After 3 months there had only
   been minimal improvement. Asked her to chart cycle temps. Chart
   showed very low basal temps. Treated for sub clinical hypothyroidism.
   Cycles became shorter and she began ovulating. Conceived and had a
   healthy girl.
           Healthy Reproductive System = Absence of …
            low sperm count
            low motility
            high levels of abnormalities (morphology )
            GUIs
            varicocele
            prostatitis
            sperm antibodies

            sperm antibodies in female
            hostile mucus
Case Study 6 Dave 41yrs
Dave 2
Dave 3
                        1st test          2nd test     3rd test

Sperm count             75 mill/ml        16 mill/ml   96 mill/ml

Sperm motility          60%               50%          60%

Sperm morphology        39%               21%          79%
              CMV
              Parvovirus
              HIV
              Post-Coital
              Pap Smear
              Herpes
              Hormones – eg. Oestrogen, Progesterone, LH/FSH, etc.
              Fasting Insulin
             Full Pre-Conception Check
                Blood count/ESR
                Toxoplasmosis
                TSH/T3/T4
                Rubella
                Ferritin/B12/iron
                HepB/C
                Chlamydia
                Sperm antibodies
              Glucose/Protein
             Cervical Swab
              Bacterial
              Mycoplasma/Ureaplasma
              Blood Pressure

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