Herbs and IVF (In-Vitro Fertilization)

Herbs and IVF Using herbs and other supplements to complement conventional treatments by Stacey Roberts PT, MH, Phd-c THE INFORMATION PROVIDED IN THIS EBOOK IS FOR YOUR INFORMATION ONLY. IT IS NOT INTENDED TO DIAGNOSE, TREAT OR SUBSTITUTE FOR ANY MEDICAL TREATMENT. FOR YOUR MEDICAL REQUIREMENTS YOU SHOULD SEEK THE ADVICE OF A LICENSED PHYSICIAN INTRODUCTION When I sat down to write this book, I was aiming to educate patients and practitioners on how to best utilize herbs as a complimentary part of their conventional fertility and IVF programs. But it quickly morphed into something much more significant than a comprehensive explanation on how to use herbs along with IVF to improve the chances of a viable pregnancy. This eBook has become a rallying cry for both the complimentary and conventional sides of treatment to work together to benefit the patient. Bridging the gap here is essential as it would no longer force patients to choose between one or the other, leaving them stranded between a rock and a hard place in the process. Indeed, patients who are already going through intense emotional turmoil don’t need the added pressure of having to make radical and unqualified choices between herbal and conventional therapies which simply adds to the stress and constant wonder whether they are doing the right thing.. Time and time again, patients would be telling me how their doctors advised them to stay away from herbs and other supplements when going through IVF. The reasons the doctors gave, if any, were the potential for herbs to interact with the medications, cause problems with the procedure, make things worse and that herbs were dangerous. While I can relate to those statements because I used to say the same thing myself years ago before I did extensive research on alternative and complimentary therapies, a simple event changed my outlook forever. Some years ago, I was experiencing a minor medical ailment for which the conventional medical system had no cure. So, like may of my patients, I moved from doctor to doctor only to be told that everything looked fine, that they had no idea why I was experiencing such discomfort and pain and there was nothing more they could do for me. I was astounded and bewildered with these comments, particularly because I have so much respect for the medical profession, its advances and the commitment most doctors have to their helping their patients. When my frustration went into overdrive over my lack of improvement, I turned to herbs and supplements, researching every bit of information I could get my hands on. While I remained skeptical, I also allowed myself to have an open mind. And the results were astonishing: not only was I finally able to eliminate my own “non existent” ailment, I also stumbled upon a greater truth: that there was far more credibility in the field of complimentary therapies than I was ever led to believe Another catalyst to writing this eBook stemmed from the frequent one-sided articles written by physicians and/or IVF clinics that use scare mongering to deter patients from using complimentary therapies. Not only do these articles totally disregard proven scientific or clinical research, they also use the same tactics they say are rampant in complimentary therapies i.e. single case studies, no scientific evaluation or clinical studies, opinion and hearsay, to make their argument against herbs. In extreme cases, some IVF clinics would even make their patients sign contracts stating that they will not use any other treatment while in their care. What you might see more of however is a dismissive attitude towards patients who admit to using or considering complementary modalities. Such comments coming from people in such positions of authority often confuse, infuriate and/or frighten patients, hence making them less likely to admit they are using such therapies. While we strongly encourage our patients to be upfront with their physicians about their use of herbs, we also expect physicians to understand how their attitudes and biases truly affect the overall health, safety and expectations of their patients. And I’m not alone in saying this: there have been articles written on the subject published by highly regarded journals such as the Journal of the American Medical Association. Overall, what these practitioners have not yet recognized is the growing body of evidence that shows how beneficial herbs can be in addressing health issues. And as you will see further, IVF clinics are only focusing on one aspect of your fertility. For them, it’s all about directly stimulating the ovaries with medications and preparing the lining of the uterus for implantation. There is little if no consideration given to other possibilities regarding what could be impacting a couples’ fertility such as the role of the thyroid, the adrenals, the pancreas, the gut, the liver and other systems we will discuss in detail. One mustn’t also forget how much these biased notions are supported by the industries whose sole goal is to make a profit for its shareholders. Some conventional physicians are also toeing this line because they might be apprehensive to have their patients starting to take responsibility for their own health by turning to herbal treatments. They might fear this could make their job less important, even obsolete. But that couldn’t be further from the truth: most doctors using an integrative approach are in fact growing in popularity and difficult to get into because of their growing popularity. As for the fertility-challenged couple, there is a growing realization that patient/doctor or patient/therapist relationship is no longer one where the doctor or therapist holds all the power in order to deliver results. It’s the cooperative approach which is now seen as mutually beneficial. This is why I would like this eBook to become the beginning of a conversation that I hope will spark interest from both patients and practitioners. In it, I want to dispel the most common misconceptions and begin a genuine dialogue between patients and their doctors about the potential benefits of utilizing herbs to help prepare and support them through IVF. This discussion is based on clinical evidence my clinic has noted over the past decade which is supported by authoritative peer-reviewed medical journals. In the first part of the book, I will discuss how herbs can be used with IVF. The second is dedicated to dispelling some of the many myths and misinformation about herbs and their use in conjunction with IVF. And in the third section, I will expand further on how to prepare your body for an upcoming IVF cycle. I hope this introduction has not only made clear my desire to support the patient but also the fact that I, along with the other therapists at our clinic, am not against conventional medicine or assisted procedures. What I want is for patients to have the whole spectrum of information available from both sides so that they can make a decision that is right for them, be it to only use IVF, to try naturally or a combination of both. No one should be frightened or bullied into making any kind of decision regarding their fertility. These decisions should be carefully thought out to instill the utmost confidence in the couple that their decision was reached by a team in which they not just a spectator but the most valuable participant. 1 HOW AND WHY HERBS CAN BE USED IN CONJUNCTION WITH IVF While you may have to search a bit to find a doctor willing to work with you on use of herbal medicines with IVF treatments, you will find one as an increasing number are now openly recognizing the benefits of such a collaborative approach. A physician at a local hospital here on the Gold Coast who refers patients to our clinic says he likes working with women who are on our herbs because they tend to be more relaxed and calm while going through the IVF treatments. IN PREPARATION FOR A PROCEDURE Herbal remedies can be used to help a couple prepare their body and optimize their health in the months preceding an IVF cycle. IVF can be very taxing physiologically and emotionally. An experienced naturopath or herbalist can give you guidelines on how to address your lifestyle and optimize your health in order to prepare for IVF. Being overweight or underweight, excessive alcohol consumption, stress, smoking and other lifestyle factors have been shown to effect fertility. A recent study by the Stanford University has a simple explanation supporting this theory. It says that because follicles that are producing the eggs harvested for IVF can take up to 8 menstrual cycles to develop, with the last 3 months being governed by the reproductive system. Therefore it’s a good idea to give your body some time to prepare for any assisted reproductive procedure. Since the follicle contains the fluid filled with nutrients that help support the egg development, it would be important to address your health leading up to the IVF cycle to optmize your results. Herbs and supplementation can be an adjunct to this preparation. So how do complimentary programs using herbs address issues in preparation for IVF? Well for starters, approximately 20 to 25% of infertility cases arise from problems with egg production or release. Because certain herbs have been used for years to support the menstrual cycle, herbal remedies are particularly well suited to support the female reproductive system. Shortly I will provide a list of herbs that may be considered to help support the female reproductive system leading up to an assisted procedure. We do not recommend the use of some of these herbs while on IVF medication. But as you will read later, there are other herbs that can be more supportive through an IVF cycle while on other medications. FEMALE REPRODUCTION There are many herbal remedies used to help support the female reproductive system. These include, but are not limited to: Licorice, red clover, chastetree berry, black cohosh, dong quai, motherwort, false unicorn root wild yam and peony. We are only going to discuss a few of these herbal remedies, what they are used for and when they might be avoided. This is a very brief view of some of the most popular herbs, but be aware that you do need to contact an experienced herbalist or naturopath if you decide to take herbs in conjunction with IVF or fertility treatments. Just as I would not recommend any medications because I am not a trained physician, I think it’s essential that the person you seek should has extensive knowledge of herbs, their uses and effects on physiology gained through appropriate training. Many herbal remedies being supplied to patients consist of multiple herbs in a formula and results can vary from one formula to another. Again, that’s another good reason to work with someone who has the right experience in dealing with a combination of different herbs. NOTE: These herbs can be used in the months preceding and in preparation for IVF cycle. But I suggest they be avoided once the injection phase begins. This is because it doesn’t really make sense to address the ovaries and the uterus while someone is taking medications to stimulate these areas. Taking herbs through this process would be like trying to throw tiny pebbles (herbs) at a raging bull (IVF stimulatory medications). HOWEVER, there are several other systems that impact fertility which the IVF drugs do not address. The effect the drugs have on these systems can contribute to various side effects. The herbs we will discuss in the next section to support these other systems have been found to be complimentary to the IVF process. LICORICE ROOT This herb is very widely used in traditional Chinese medicine. It has been shown to help support the immune system and it is used to support a patient experiencing menopause. Commonly it is also used to support adrenal function. In some studies, licorice root has been shown to support ovulation in otherwise non-ovulating women. It has been associated with effecting blood pressure at certain doses. So women with high blood pressure or taking high blood pressure medication normally should avoid licorice. RED CLOVER Red Clover has been used to optimize hormonal levels and it is thought to nourish the uterine environment too. It contains calcium and magnesium as added benefits. It contains isoflavones, which could be beneficial in perimenopausal and menopausal women. It is thought to help to establish a good environment for conception. There is caution regarding its use with anticoagulants so we avoid it with women who are taking any blood thinning medication. VITEX AGNUS-CASTUS This is sometimes known as CHASTETREE BERRY or Chasteberry. This herb supports reproductive health in women. The German Commission E - a very strict board governing the use of natural medicine in Germany- has approved the use of Vitex Agnus Castus for irregularities of the menstrual cycle, premenstrual disturbances and mastodynia (painful breasts). Generally Vitex has been given to women to address irregular periods, failure to ovulate, or luteal phase insufficiency (short second half of the menstrual cycle). This is a herb that is an excellent adjunct to some programs but we do not recommend its use with IVF medications because most physicians do not want this herb used in conjunction with IVF based on one very unsubstantiated case study. This one case study cited a women taking Agnus Castus - although NO dose, frequency or duration was reported - who experienced mild hyper-stimulation symptoms in the luteal phase of her cycle during an unstimulated IVF attempt in the UK in 1995. Clearly more in depth analysis is needed here to see if this was actually due to the Agnus Castus or anything else the woman may have been taking or doing. No dosage of the Agnus Castus was discussed and no definition of what exactly mild hyper-stimulation symptoms were was ever mentioned. Even if this only one case study which does not give credible evidence that Agnus Castus caused the issue, physicians remain extremely concerned about its use and therefore we avoid this herb in conjunction with IVF. There are other herbs we feel can be more supportive during the IVF process. On the other hand, Agnus Castus however has been beneficial for many women leading up to IVF. BLACK COHOSH There are several studies to support that Black Cohosh has an effect on reducing hot flushes in women. Most recent studies show that Black Cohosh is not a phytoestrogen, or a herb that effects estrogen levels, as previously thought. Instead it appears to act on the vasomotor system which are the neural systems that act on the vascular smooth muscle to control blood vessel diameter which can help to regulate body temperature. Many physicians still consider Black Cohosh a phytoestrogen and therefore approach with caution. Other caution surrounding this herb was created as a result of studies about how Black Cohosh may effect liver function. But when reviewed, all of the studies presented that supposedly linked Black Cohosh with liver damage showed that the blame could not be placed on Black Cohosh. Instead, there were several other variables which were present and more likely factors in the reported liver issues. The roots and rhizomes (horizontal stem of a plant that is usually found underground and often sends out roots and shoots from its nodes) of this herb are used to address menopausal symptoms and problems with the menstrual cycle. Rarely do we utilize Black Cohosh to address fertility issues but it can be utilized in some cases depending on how the individual presents. DONG QUAI This is another herb that is well known in Chinese herbal medicine. It is used to address female issues like PMS, cramping, and symptoms associated with menopause. This herb is also used as a uterine tonic to support the health of the uterus and is considered a very weak phytoestrogen. This herb is usually combined with other herbs to make a formula. FALSE UNICORN ROOT This herb is a native of North America and was once used by the Indians to treat female problems ranging from painful menstruation symptoms (dysmenorrhea) to hormonal imbalances. Traditionally it was also used to prevent miscarriages. It was said to also be beneficial for morning sickness. False Unicorn Root has been observed as an adaptogen or if you prefer a herb that helps normalize the balance between hormones. It has also been shown to have a supporting effect on the uterus. There are some cases where we find small doses of False Unicorn Root to be effective with an IVF procedure. WILD YAM Wild yam is one of the herbs that some conventional doctors think contains progesterone. It actually contains no progesterone or estrogen. It contains plant-like precursors called diosgenin. In some studies it actually shows no effect on hormones. Despite this and because of symptomatic relief some patients report, it has still been used to support a variety of female reproductive problems based on traditional use. It is also used in creams for women experiencing menopausal symptoms. RED RASPBERRY The leaves of the red raspberry are thought to be a good option for various reproductive problems. It is one herb that can be taken in pregnancy, but first check with your physician and herbalist because it can interact with other drugs. It is known to support uterine muscles. It can be indicated during menstruation for painful cycles. It can be used for nausea during pregnancy, and indicated for symptoms associated with menopause. Its use in pregnancy tends to be directed to the third trimester. Along with herbal preparations (that can contain a combination of various herbs), a good naturopath or herbalist would give dietary guidelines and recommendations about vitamin supplements too. What can I do to prepare for my IVF cycle? Herbs used to address the probable causes of endometriosis, polycystic ovaries, recurrent miscarriage, male fertility issues and unexplained fertility can be taken in the months preceding assisted reproductive techniques to hopefully balance the body and encourage optimal development of the follicle. We have found it important to work with the patient a minimum of 3 (but preferably 6 to 7) months prior to an assistive reproductive techniques. The reason is because the development of the follicle which carries the egg and that is responsible for progesterone production in the luteal phase and the first trimester of pregnancy can take up to 8 menstrual cycles (and this according to ‘Initial and Cyclic Recruitment of Ovarian Follicles’ by Elizabeth A. McGee and Aaron J. W. Hsueh from the Division of Reproductive Biology, Department of Gynecology and Obstetrics, Stanford University School of Medicine, Stanford). Based on this information it makes perfect sense to work with the body in the months preceding an assistive reproductive technique to help support the health and development of the follicle which is often discarded or overlooked even though it is an important component of the menstrual cycle and likely health of the eggs. HERBS THAT CAN BE CONSIDERED WHEN HAVING AN IVF PROCEDURE The following organ systems are supportive of fertility and therefore can be a focus of herbal support in conjunction with IVF. Liver: Some physicians have asked me why I think it is important to support the liver. After all, this organ can withstand significant assault and has amazing regeneration capabilities. My answer to this is the same to the question as to why you change the oil in your car. Certainly your car will still function if you don’t change the oil every 5000 miles or so, but its life span may be limited and further damage may be created as a result. In addition, it is the liver that helps to conjugate estrogens in the body. This means that the liver assists to breakdown, get rid of “bad estrogens” and reuse “good estrogens” in the system. With synthetic medications utilized in IVF, estrogen levels spike considerably in the body. By supporting the liver, hepatoprotective (liver supporting) herbs are likely to assist the liver to get rid of what could potentially accumulate and cause health problems in the future. Excess estrogen in the system has been correlated to cancers, tumors, and growths. Thankfully according to some studies, utilizing IVF medication has not been associated with the onset of ovarian cancer or endometrial cancer. But studies are conflicting in this area and longer term research needs to be done to assess whether there is any association with other cancers. More support for liver support: although the liver is able to regenerate itself and can still function under strain, it doesn’t function as effectively when it is burdened by too much substrate or insufficient enzymes. Clear evidence of this is shown when someone takes codeine and alcohol. It’s commonly known that liver detoxification occurs in two stages. In Phase 1 - The extra strain can cause some cytochrome enzymes to become depleted. This can result in the substrates of that pathway either not being detoxified or alternatively being shunted to a different pathway, often resulting in the production of more damaging metabolites. Also after going through phase 1 liver detoxification, the intermediate metabolites are usually quite unstable, until they are either donated an electron by antioxidants (such as Sulphur oxide dismutase or Glutathione peroxidase) or are conjugated by phase II liver detoxification. If Phase I is overworking due to a high liver load, sometimes Phase II conjugation is unable to keep up, often due to exhaustion of conjugates. Supporting the liver with herbal antioxidants such as St. Mary’s thistle, Schisandra and Tumeric etc… have been shown in studies to accelerate regeneration of glutathione and increase levels in the liver. What can also help is ensuring that the patient decreases other lifestyle or dietary factors that are detoxified by the same pathways. In my mind, if there is any way we can help to support the liver to possibly decrease the chance of accumulated estrogens in the system, why not utilize herbs that have been shown to be protective to the liver. St.Mary’s thistle is one of the main herbs we use which is known as a hepatoprotective. This herb has been shown to NOT work on the same pathway as most medications like Cytochrome and therefore it is thought to be protective of the liver and may be useful for supporting the liver when utilizing other medications. Astragalus is a herb supportive of the immune system and as well as the liver. It has no known contraindications with any medications and has been very well tolerated among our patients utilizing IVF. Pancreas: Insulin regulation plays an important part in fertility, especially in women with Polycystic Ovary Syndrome. We commonly support the pancreas, by helping the patient address glucose metabolism and subsequently insulin response by utilizing herbs such as cinnamon. This herb among others when taken in combination with addressing diet and the use of an appropriate exercise program has been a great adjunct for many of our patients with PCOS. Adrenals: The adrenals are situated on top of the kidneys and help mediate the stress response. It is no secret that IVF or simply having to deal with fertility issues - not to mention temperature charts - can cause stress both emotionally and physiologically. By supporting the adrenals with herbs such as Rehmannia, a Chinese herb, our patients have reported feeling calmer while going into IVF. Some physicians have reported they are happy to work with our patients as they go through IVF because they tend to be more calm and less stressed than those who weren’t using our herbs. Rhodiola is another herb supportive of the adrenals but its use is cautioned for patients with a history of depression particularly bipolar disorder. Another herb we tend to use in small amounts based on its possible calming effects is American skullcap. But if a patient is already taking sedative medications then we do not recommend utilizing this herb. Thyroid: The thyroid plays a major role in fertility in both males and females. Though tests such as TSH are done to assess thyroid health, it’s important with fertility cases to go beyond only testing TSH which is a hormone produced by the pituitary and not the thyroid. Pregnancy itself can have a significant impact on the thyroid. So supporting the thyroid leading up to pregnancy has appeared to be beneficial for many of our patients who were told their thyroid was fine but still exhibited symptoms of less than optimal thyroid function based on further blood tests. Along with the minerals selenium and zinc to support the conversion of thyroid hormone from T4 to T3 (as T3 directly impacts progesterone production), we have used the ayurvedic herb Withana to support thyroid function. Bacopa is also a herb that is supportive of thyroid function and has been used to support memory and concentration. These are only a few of the herbs that could be used in conjunction with IVF medications as they do not appear to have any direct impact on the reproductive system. This is because they are supportive of the different systems that indirectly impact on fertility overall. Again, it is important that each individual situation should be considered when choosing which herbs to use to support patients through the IVF process. HERBAL USE WITH INADEQUATE SPERM QUALITY OR FUNCTION I have included this section on working with men because it is often thought that if the man’s sperm fertilizes the egg that there is no problem there. However because most early miscarriages are due to chromosomal abnormalities and the way the sperm and the egg interact with each other, this strongly indicates that the sperm’s responsibility does not end at fertilization. Men are not subjected to the barrage of medications that women have to endure in an IVF cycle. In fact, the use of herbs in males is still looked upon as useless by some medical professionals despite research pointing to the exact opposite. Depending on which study you read, 20 to 50% of infertility cases are due to inadequate sperm quality or function. The motility of the sperm is also a factor. Since so many fertility cases are due to this problem, it stands to reason that the male should be have the basic tests done to rule out problems with sperm production, motility and morphology. If this is the basic problem that is causing the issue, it too can be addressed using herbal remedies. If several implantations fail it is also a good idea to consider asking your physician to look at the sperm more closely by considering the Sperm Chromatin Structure Assay. This test takes a closer look at the sperm’s DNA, helping to determine whether there is any fragmentation which can effect the ability to fertilize an egg or impede the development of an embryo. A growing number of IVF clinics are using Intra Cytoplasmic Sperm Injection, also known as ICSI. This is where the sperm is injected directly into the egg. According to Dr. Tarun Jain Assistant Professor of Reproductive Endocrinology and Infertility at the University of Chicago, it appears that "the percentage of IVF cycles that used ICSI increased dramatically during the 10 year time span from 11 % to 57.5% of procedures while the percentage of diagnosis for male factor infertility remained steady." This was reported in August of 2007. Unfortunately this technique does not address why the sperm may have had difficulty fertilizing the egg in the first place. While ICSI may make the sperm more likely to fertilize the egg and pushing up pregnancy rates in the process, I was unable to find data on whether the actual live birth rate has improved as a result of its popularity. ICSI, though a viable option for some couples, does take away the last bit of natural selection available through IVF. In a non-ICSI IVF cycle, approximately 100,000 sperm are placed with the egg in a Petri dish to potentially fertilize the egg to create an embryo. With ICSI however one sperm, chosen by an IVF medical doctor or scientist (not Mother Nature) is injected into the egg. There is some worry that the future fertility of the child will be effected. A large-scale international study found that 4.2% of the ICSI babies surveyed had a major malformations, which mainly affected boys' urinary and genital systems. The risk of malformation was almost three times higher in ICSI babies than in babies conceived naturally. But improvements are being made as other techniques are being introduced around the world to assess overall sperm health. A clinic in Israel has developed a microscope that amplifies the sperm 6000 times. This allows a closer look at any damage to the nucleus of the sperm and therefore eliminate sperm which are more likely to cause problems. According to the clinic using this new technique, it has increased their pregnancy and birth rates to 48% compared to average rate in the US, Israel and Western Europe which stands at 20 to 30%. Birth rates have also improved from the average 20% to 40% according to the same Israeli professor. But there are also a number of herbal remedies and natural therapies that work with a male’s reproductive system and other systems to help support sperm production and support the development of quality sperm. Even if the woman has had a series of miscarriages, don’t assume that the sperm has nothing to do with the problems being experienced. Studies in 2007 are currently exploring the contribution the sperm has to recurrent miscarriage. So, there is little doubt that in many situations the cause of infertility might be due to a complex interaction of various issues. Maybe the male has a low sperm count and the woman has difficulty producing eggs. Herbal preparations can be administered to both to work toward setting the stage for a viable conception to take place. Programs for men can consist of diet suggestions, vitamin supplementation, and herbs. For specific recommendations regarding male fertility you can log on to www.naturalfertility.com and find an eBook on Male Fertility Solutions in the book section of the website. There are some double blind placebo controlled studies available about a supplement for male fertility called Fertility Blend for Men (www.fertilityblend.com) which showed the positive effects this combination of herbs, amino acids and nutrients had on the overall fertilization rates. REMEMBER: The sperms’ job is not just to fertilize the egg. It must be healthy enough to contribute to the development of an embryo. STRUCTURAL ISSUES AND HERBS Pelvic problems account for about 20 to 25% of infertility cases. Another 5% are due to abnormalities of the cervix. That’s a total of about 30% of cases of infertility that may require conventional medical intervention. Herbs cannot directly address structural issues like blocked fallopian tubes or an abnormal cervix. There are cases where IVF might be the only hope for a couple trying to conceive if they have structural issues such as blockages in the structures that the sperm travels through (vas deferens) or the egg (the fallopian tubes). But even in these cases, herbal medicines can still be used in conjunction with IVF to help support follicular health and the wellbeing of the mother to hopefully produce the healthiest eggs, sperm and uterine lining as possible as well as supporting the health and development of sperm which may be extracted from the testicles through testicular aspiration. If you have a diagnosis of blocked tubes, it is important however to be sure that the tubes in the female are actually blocked. Indeed some procedures used during a laparoscopy or a hysteroscopy can actually cause the tubes to spasm and therefore act like they are blocked which will prevent the dye from making it through. We have so many couples who come to see us saying their tubes were blocked who either become pregnant naturally or have a retest a few months later only to find that one or both tubes are completely clear. Further testing seems to be warranted whenever a diagnosis of blocked tubes is given. The use of the dye through the tubes to check the tubes patency, could potentially help clear the tubes if there was an obstruction present. Another advantage to the use of herbal medicines worth noting here is that they could assist in reducing side effects for some women who are taking medications. Many of our patients report a huge decrease in the side effects from IVF medications when they are on the herbs when they compare it to how they felt in previous IVF cycles without herbs. BETTER TO BE SAFE THAN SORRY Even though you are working with herbs you should always consult an experienced herbalist or naturopath before you decide to compliment your IVF treatments with herbal remedies. Also, self-administering herbs have the potential to lead to dosage problems. Any major side effects such as deaths which are connected to herbs have been attributed to the sale of over the counter supplements that were NOT taken in accordance with the direction on the bottle. Most of these were related to weight loss products. So the best and safest thing to do is to always go to an experienced professional with good credentials. 2 HERBAL MYTHS AND FALLACIES Now that we have discussed what kind of herbs we tend to use or not use with IVF medications, I would like to help dispel some of the myths surrounding herbal remedies in general and their use with IVF in particular. There are a number of misconceptions and objections that you or your physician might harbor about the use of herbal medicines with IVF and other assisted reproductive techniques. Common misconceptions are that herbal remedies are not as widely researched and their benefits questionable. You may wonder about the safety of some of these natural treatments in comparison to standard treatments. Your doctors may dismiss natural therapies as being a waste of time and money or that they are simply ineffective. The medical establishment doesn’t really have any interest in promoting herbal remedies unless they are a part of their practice. Some doctors will even go as far as to suggest that most herbal remedies are scams and the people who administer them are scam artists. Others worry that they may interfere with the IVF treatments that you undergo in their care. And the fact that doctors’ protocols regarding the use of natural remedies vary greatly from clinic to clinic and even from physician to physician, the truth surrounding the benefit of such alternative therapies gets lost in the equation. This confusion and misconceptions about natural therapies was clearly demonstrated in a recent review of Danish IVF patients. In this study, all complimentary therapies were lumped together as one. Reflexology along with herbal and homeopathic use and even acupuncture were all placed together under the same umbrella before the review reached its conclusion that complimentary therapies could hinder IVF. But when taking a closer look at its findings, I discovered that some of the patients were from different clinics with different medical protocols (i.e.different doctors use different combinations of medicines during IVF procedures), some had all of the treatments and some had only one or a few. There was also no indication of how long they had been using complimentary therapies and if the length of time was consistent per patient. This review was very poorly constructed was in my opinion inaccurate because there were too many variables to give a good overall assessment (for more on this review and other fertility information go to www.haveababy.blogspot.com). The real problem with these types of reviews however is that only the headlines are plastered across the news without the public and physicians knowing the whole story. This creates more unnecessary animosity between conventional physicians and natural therapists. The Unspoken fear There can also be an unspoken fear that natural therapists might be trying to steal clients from conventional practitioners leading to a need for less doctors. You may also have natural therapists who make ridiculous statements such as telling their patients they do not need their doctors. Not only are such positions irresponsible, they also fail to look after the patients’ best interests. Unfortunately, when herbs are brought up only one side of the story is discussed and the other just simply dismissed. In fact you might not even get that far once you disclose to your doctor that you are opting to complement conventional treatments with herbal remedies. He might just roll his eyes and sigh or tell you it’s a waste of time and money. The JAMA reported in an article published online in May 2007 that of the 32 million Americans that have reported use of herbals and supplements, only one third have disclosed this to their doctor. A few studies have confirmed that one of the most common reasons patients don’t tell their doctor about the use of complimentary therapies such as herbs is because they are afraid they will get a negative reaction. When comparing what the benefits and risks are of using an herbal treatment versus a conventional one, I find it interesting that some clinics give information about what they feel the risks of herbs are but their patients are not always fully aware of the risks associated with IVF. I want to make it clear here that I am completely supportive of any couple wanting to utilize IVF. As a matter of fact, if I didn’t have my own child or had difficulty conceiving him I have no doubt that I would have strongly considered IVF if natural programs had not worked for me. But if clinicians are going to be reporting on the apparent risks of utilizing herbs when it is not their area of expertise, it is also their responsibility to be upfront with the risks associated with an artificial procedure. I think the patient would be better served by hearing this information from the practitioner and not just finding out about it in the form they are asked to sign just before going into a procedure. Many of our patients have said they did not know there were any risks associated with IVF until right before the procedure. While I cannot say this is the practice of all IVF clinics, it is commonly reported by patients. IVF is not a procedure that comes guaranteed without risks, regardless of whether you use herbal remedies or conventional medicine, or both. If you are committed to this path, make sure you get informed and understand how you can make your journey a safer and more pleasant experience. The choice to use herbal remedies and or assisted procedures such as IVF comes with a degree of personal responsibility in taking charge of one’s own health. That means it is up to you to seek out information and ask questions of your IVF physician and natural therapist. It is also important to understand that more research needs to be done on the combination of IVF and herbs. Thankfully at our clinic, we have been using this combination for over a decade and therefore have the clinical data to support the use of our natural system with IVF programs. You will want to make sure to discuss this with your partner and your physician, but understand that you may end up offering your doctor information at some point or another on the value of herbal remedies in IVF treatment. I hope this eBook helps to bridge the gap for you. Now to a few other major myths. MYTH: PHARMACEUTICALS ARE SAFER THAN HERBS BECAUSE THEY ARE STUDIED EXTENSIVELY In this section we will look at the safety of pharmaceuticals and herbs in general. While pharmaceuticals are subject to a rigorous approval procedure, this doesn’t guarantee that they are necessarily safer than herbs. Conventional drugs can contribute to a significant amount of side effects in some patients and even be fatal if taken in the wrong dosages - as you will see, deaths are in the hundreds of thousands even when taken as prescribed. In comparison, most herbal remedies if dispensed by a reputable practitioner and taken as directed will likely not have as many, if any, negative side effects. And when herbs are taken with pharmaceuticals, one recent study published in Alternative Therapies in Health and Medicine March/April 2007 failed to uncover any serious adverse interactions among any of the 804 patients who took them in tandem. This of course would depend on what herbs are being used and with what medications. THE FATALITY NUMBERS I include the following information to address the common assertion by physicians that somehow pharmaceuticals are safer than herbs because they undergo rigorous testing. In America, the Journal of the American Medical Association, the JAMA, estimates that prescription drugs are responsible for the deaths of over 100,000 people a year. In comparison, according to the Food and Drugs Administration, the FDA, fewer than 37 people die every year by abusing or overusing herbal medicines. Most deaths were associated with over the counter weight loss supplements. What are the mortality rates in other areas of conventional medicine? There are approximately 140,000 people killed via medical mistakes in American hospitals every year. Add to that another 77,000 to 88,000 people killed by hospital-caused nosocomial infections. That’s over 200,000! Compare that with the 37 deaths each year in the US which are associated with herbal medicine abuse or overuse. Perhaps that’s why pharmaceuticals require a prescription while herbal remedies don’t. WHAT ABOUT ADVERSE REACTIONS? In another JAMA article entitled “Incidence of Adverse Drug Reactions in Hospitalized Patients” published in 1998, it was reported that there were 106,000 deaths associated with properly prescribed medications in hospitals due to adverse reactions. When looking at the results overall, the article suggested that the results showed an extremely high ratio of hospital patients experiencing adverse reactions to prescription medications. The sad fact is that you are far more likely to die while you are in a hospital being supervised and treated with prescription medications than if you decide to take herbal medications at home. Even looking at the potential for non-fatal adverse reactions with herbal remedies, there were only 2621 cases reported by the FDA within a five-year period of 1993 to 1998. That’s approximately 524 people a year who had problems with herbal supplements out of a total US population of nearly 350 million. In comparison over 2 million people experienced serious adverse drug reactions in US hospitals making it between the fourth and sixth leading cause of death in the US according to researchers at the University of Toronto. Nearly 10 years later, according to the Sept 10, 2007 issue of the Archives of Internal Medicine, the number of serious adverse drug events more than doubled between 1998 and 2005 in the US, as did the number of related deaths. This is the first study to ask the question: “Are we gaining ground or losing ground in drug safety and improving patient safety in prescription drugs?” In his answer, the study’s lead author Thomas Moore of the Institute for Safe Medication Practices in Huntingdon Valle said, “I think, inescapably, the conclusion is that we're losing ground." If we were to review the information for dietary supplements like vitamins, the contrast couldn’t be greater. There are approximately 0 to 1 deaths per year associated with an overexposure of vitamin supplementation. The American Association of Poison Control Centers Toxic Exposure Surveillance System, the AAPCCTESS, did not have a single incidence of death in 1998 associated with either adult multiple vitamins, pediatric multiple vitamins, nor any single dosage of any vitamin whatsoever, such as Vitamin C, E, or folic acid. You might think that this is because the use of vitamins may not be that high in the average population. Vitamin supplementation is actually a very popular dietary habit. In the last six years, over $6.5 billion dollars were spent in the US alone on vitamins. It is estimated that over 100 million Americans use vitamins and minerals regularly. Yet of the many studies and supervision done on vitamin intake, only 1 death and 8 major adverse reactions were registered among the 40,000 people who had acute and chronic vitamin overdoses. While some conventional doctors may dispute the importance of diet or vitamin supplementation in a fertility program, there is new evidence supporting the fact that an organic diet supplemented with vitamins is beneficial for fertility. Research at the University of Surrey looked at 367 couples, 37% of whom had infertility problems and another 38% who had previous miscarriages. After being put on an organic food diet with vitamin supplementation alone (no herbal medicine) and being told to avoid alcohol or tobacco, 89% of the couples gave birth naturally to healthy babies. Not a single miscarriage was recorded. There is mounting evidence that diet and vitamin supplementation can help people in their quest to have a healthy baby with few complications. In a separate study of the number of adverse reactions reported in 1998 in the AAPCCTESS, the 49,709 toxic exposures of vitamins based on dietary supplementation were broken down by the types of supplementation overexposure. They are as follows: Adult multiple vitamins without iron or fluoride had 1 major outcome (adverse reaction). Adult multiple vitamins with iron but without fluoride had 2 major outcomes. Pediatric multiple vitamins without iron or fluoride had 0 major outcomes. Pediatric multiple vitamins with iron but without fluoride had 0 major outcomes. Vitamin A had 0 major outcomes. Niacin had 2 major outcomes. Pyridoxine had 5 major outcomes. Other B complex vitamins had 0 major outcomes. Vitamin C had 0 major outcomes. Vitamin E had 1 major outcome. In all, there were 14 major outcomes and 0 deaths reported due to dietary supplementation using vitamins. And most of the overexposures occurred in children who were under the age of 6. What these studies suggest is that there may be some risks to taking vitamins unsupervised for the very young, but on average, the risk of overexposing or creating toxic levels of vitamins in your system is very low to nil. This decreases as you age and is not even comparable to the risks taken when ingesting synthetic pharmaceuticals. DRUG INTERFERENCE There is a possibility that in some situations herbal medicines could potentially interfere with an IVF treatment if used in certain dosages. I say potentially because there has only been one reported case of a MILD ovarian hyper-stimulation and it was not clear what dose of the herb was taken or if any other types medications were ingested at the time. With news coming out about the potential risks of common herbal remedies, the media might seem to be suggesting that herbal remedies carry more risks because they are not regulated by the FDA or the Therapeutic Goods Administration (TGA). The reason they are not regulated in the same way as pharmaceuticals is because they carry very low risks in comparison to conventional medicines. Herbal remedies are well respected in Europe, Latin America, and other places around the world because people have used them to address health issues for thousands of years without requiring a doctor’s prescription. Drug companies also hide behind the rigors and high costs of government approval processes and clinical trials to claim the higher ground. Not only do such trials considerably inflate the price of prescription medicines, they by no means guarantee their safety. Clinical trials can often fail to measure side effects. Just to mention one recent example, an antidepressant prescribed to teenagers to reduce depression later turn out to be a potential suicide risk in that population. Another point worth noting is that not all findings from drug companies are made available to the public. This was the case for another popular antidepressant. It had several clinical trials which showed it did not work any better than a placebo. While none of those findings were published, the one study that did show a slight advantage over a placebo was the only one made public. That was until significant life threatening adverse reactions were being noted in the target market for that particular medication. In addition many pharmaceutical drugs are used under the heading of “off label use”. For example, a drug used to address an anti-inflammatory condition may be used on another diagnosis even if it has not been properly tested or approved for the other diagnosis. This process is called “off label use” and is deemed acceptable by the medical profession yet many in the medical profession say that herbs should not be used because they are not tested. It doesn’t make much sense and appears very much like a double standard. Apply this to IVF clinics and their widely varying protocols for IVF treatment and you end up with some drugs which lack a proper evaluation and safety checks when used together. For example, immunosuppressive drugs are used in IVF treatment even though there haven't been any long term studies on their use in combination with other medications such as the reproductive hormones used in IVF. I know of one doctor who uses Valium after the cycle along with all the other hormone and immunosuppressive drugs, none of which have been studied together to see what the potential harm or good it is doing for the patient. Some doctors put their patients on aspirin without any test results to say they may have a clotting issue. And the list goes on. This problem is compounded with medication protocols changing frequently depending on the latest seminar a physician may have attended. In response to the lack of regulation of surrounding IVF protocols around the world, Professor George Annas, a leading US bioethicist at Boston University said: “The whole world of assisted reproduction has been described, I think aptly, as kind of the Wild West mated with American commerce and modern marketing. You have a variety of highly professional individuals pitching their wares - their success rates, their new technology, their cutting edge technology – to this highly susceptible group of infertile couples who are almost willing to try anything, and almost pay any price to get a baby. The industry has consistently resisted regulation.” Again please keep in mind that I am not opposed to IVF or the use of pharmaceuticals. But I become very frustrated when I hear people trying to alienate natural or complimentary therapies on the basis that the rigors surrounding the pharmaceutical industry make their drugs safer. As we just saw, in reality there is a very different story to tell. THE RISKS ASSOCIATED WITH IVF TREATMENTS It is true that there are inherent risks associated with IVF. When you choose to try to create a viable pregnancy artificially there are number of potential treatments involved. There are also varying rules for proper conduct from one country to another. In Britain, the Human Fertilisation and Embryology Authority (HFEA) is responsible for overseeing IVF treatments in the UK. In Ireland, there are no governing agencies to regulate IVF. In the US, the Society for Assisted Reproductive Technologies acts as a watchdog agency for the Food and Drug Administration. The FDA itself only regulates drugs and devices in relation to IVF, but does not regulate medical practices. For that reason, a separate agency is required to oversee some of the practices relating to assisted reproductive technologies, although these are not used to regulate the industry in any way. There is no agency in the US that regulates the medical procedures being carried out by doctors. Australia has many different state and federal laws that regulate IVF, but these can vary widely from state to state. In addition, there is a national regulatory agency responsible for accrediting IVF treatment centers but doctors are able to use many different treatment protocols for IVF with very little or no regulation as to what combinations of medications that they are using. Dr. Amin Abboud, a medical doctor and assistant lecturer in medical ethics and health law at the University of New South Wales in Australia states, “The problem is that the gatekeepers of infertility advice are the reproductive industry themselves.” He goes on to say that “a compounding concern has been the creation of a false infertility crisis through deliberate distortion of infertility data…A study by David Dunson and his colleagues published in the Journal of Obstetrics and Gynaecology in 2004 concluded that sterility did not increase with age. The authors found that even the most difficult demographic, the 35-39 age group could still conceive within a two year period in 9 out of 10 cases.” This brief overview of how IVF is handled from one country to another indicates that IVF is a very complex part of the medical system and not regulated consistently around the world. What might be considered unethical in one country, like choosing the gender of the baby, might be okay in another. Drugs and devices are regulated in the US, but the actual procedures are not. The UK does have a regulatory body that does regulate the practices of IVF in the country. In cases like Australia, one might simply have to go from one state to another to be allowed a different treatment or viewpoint on what is deemed ethical or correct. Adding to the confusion, treatments are constantly changing as new procedures and techniques are discovered. Adding to this lack of consistency, there are some findings that have come to light in the past few years on the risks of IVF treatments. They include: Increased Birth Defect Rate – In March 2002, the New England Journal of Medicine reported that IVF had double the birth defect rate compared to children conceived naturally. In total, no less than 12 different studies supported this claim. The birth defects ranged from heart abnormalities and cancer to genetic disorders. But these were still a very small percentage with some references reporting between 3 and 6% whereas birth defects in the population who did not undergo any form of assisted reproduction techniques was estimated to be between 1.5 and 4%. Ovarian Hyperstimulation Syndrome (OHSS) – It’s estimated only 1% might contract a fatal form of OHSS, but even mild to moderate OHSS comes with risks. Complications like adult respiratory distress syndrome, blood clots, strokes, and brain hemorrhaging can result in lung or liver damage, respiratory failure, heart problems, shock, and even amputation. I must stress that the information above is listed simply to emphasize that many who will make comments about the safety of herbs versus the safety of medications and/or IVF procedures often don’t consider both sides of the story. It is not meant to convince anyone not to do an IVF procedure. This ebook is about a complimentary approach and about dispelling some of the myths that move people away from considering herbs as a compliment to their fertility program due to one-sided and sometimes inaccurate information. Would this information deter couples that are wanting to pursue IVF? Based on communication that I have had with thousands of couples over the years, the fact is that this information might deter a select few but the desperation to have a child most times far outweighs the knowledge of the risks associated with these procedures. I believe the best approach is to support the patient in their decisions while providing them with information from both sides of the equation so they can make an educated decision on how to move forward to address their fertility. So much can be accomplished by a supportive approach from all that are involved. ANOTHER MYTH: HERBAL REMEDIES ARE INEFFECTIVE Some physicians also argue that because herbal remedies are not subjected to the same rigorous approval process as conventional pharmaceuticals they are also ineffective. While it may be true that herbal remedies have relied more on anecdotal and traditional wisdom than what is considered pure science in the past, this is no longer the case. There are a number of different groups who are seeking to investigate and report on natural herbal remedies with the same degree of rigorous scientific scrutiny as most modern day pharmaceuticals. THE JOURNAL OF PHYTOMEDICINE This journal publishes information on phytopharmacology (the study of natural plant components and nutrients for pharmacological uses), phytotherapy (clinical trials of natural plant-based herbal remedies), and phytotoxicology (the study of the toxicity of phytopharmaceuticals). Phytomedicine does many of the same things a regular pharmaceutical company would do when investigating a new drug treatment. They can report on clinical studies, case reports and biochemical information. They can also report on the screening studies that a phytopharmaceutical (herbal remedy) might have undergone. They are interested in the analysis and review of plant drugs. The information published in the Journal of Phytomedicine is even used by drug regulatory agencies to decide on whether to approve or ban a particular remedy from being on the open market. The journal has become a reference for researchers in the field of herbal medicine and is very well respected by both conventional and alternative practitioners. THE MODERN PHYTOTHERAPIST This publication is a journal that blends scientific research with traditional herbal practices to disseminate information for herbalists, medical practitioners and researchers. Although it’s an Australian publication, it also carries articles on studies being done overseas. It follows much of the same philosophy as the Journal of Phytomedicine with information being drawn from clinical trials and case studies for specific herbs. It also discusses practice management to help professionals establish an effective herbal practice. They do talk about potential adverse reactions with some herbal remedies and they disseminate information from the latest international conferences and scientific articles. The journal is available free of charge for healthcare professionals from the Mediherb library at http://www.mediherb.co.uk/?page=literature/resources. JOURNAL OF ECOLOGY The Journal of Ecology is another peer-reviewed publication interested in promoting all aspects of the ecology of plants. It not only studies plants and the environment, but also is interested in how plants interact with other organisms. In it, you can find articles on breaking news or on the understanding of ecological principles. These are just a few of the reputable peer reviewed journals available. I find that many physicians will say there are NO studies that support the use of herbs etc…but the statement should really be “there are no studies that I know of that support the use of herbs….” Indeed, many practitioners don’t read anything else but their own conventional journals that rarely report on the positive effects of complimentary therapies. MYTH 3: HERBAL REMEDIES INTERFERE WITH CONVENTIONAL TREATMENTS AND THEREFORE SHOULD NOT BE USED As with any medicine, whether natural or synthetic, there can be problems with drug interactions. There is some truth that substances that are taken together do have the possibility of interacting with each other. However, this doesn’t really suggest one should or shouldn’t use a specific treatment in conjunction with another. In many cases, an herbal remedy can actually support the conventional treatment and thus react beneficially with the conventional treatment. We choose the herbs we use in conjunction with IVF very carefully based on the patient’s history and what procedure they are going through. Physicians use this myth as an excuse not to use herbal remedies. I find that argument particularly interesting given the frequent lack of long term studies that support or deny the effectiveness or safety of some of the medications that are often used with IVF. What about patients who are prescribed several different medications? These medications are tested to see how they singularly affect the body. But it is rare to find those same drugs trialed together to see how their combination will affect the individual. As you have seen from the previous sections of this eBook, there are many herbs that can be used to compliment an IVF procedure that should not have any negative effects on the procedure. And I can’t stress enough that if you are thinking of using herbal remedies with conventional treatments then you need to find a knowledgeable herbalist and/or naturopath who is also very familiar with IVF and how herbs interact with conventional IVF treatments. Certain herbs have been shown to have a weak effect on reproductive hormones. Therefore, your herbalist needs to be aware of not only how certain herbs affect the reproductive system but also what herbs should and shouldn’t be used with those common medications. In addition, if they are recommending herbal formulas, the practitioner needs to understand the effects of all the herbs in the formula to make sure they are appropriate. You also need to be open with your physician about your use of herbal remedies and keep them apprised of what you are taking. In some countries, herbalists and naturopaths are not required to give their patients a list of herbs but there is nothing wrong with asking them for one. Ideally, your naturopath and physician should be working together as a team to help you create the best result. For example, when a woman is going through IVF there are herbs that we have already discussed that should not be used with medication that is putting the reproductive process in high gear to create multiple follicles and eggs to be fertilized. It is pointless to use herbs that effect the reproductive cycle when the patient is taking medication to that effect. However, there are, as we’ve discussed, several complimentary herbs that can support the other organ systems that indirectly impact fertility which need to be taken into consideration. MYTH 4: COMPLEMENTARY THERAPIES ARE A WASTE OF MONEY Conventional physicians can sometimes roll their eyes, sigh and insist that complementary therapies are a waste of money. They may say the herbs won’t do anything for you and in the same breath add that you can’t use them with IVF because they effect the medications. This contradiction again supports the overall confusion about herbs: if they don’t do anything why is there a concern that they would interfere? Actually, there are a number of herbs that show beneficial results in aiding natural conception. The question here is how they are used in conjunction with IVF and what herbs should be avoided. Herbal remedies have been used for years to address hormonal issues which can affect reproduction. Some herbs are beneficial in supporting the uterus and some can help with cases of amenorrhea and menopause. We have even had women who were diagnosed with early menopause use the herbs and go from FSH of 150 down to 110 and then reach a FSH of 7. This particular case involved a 42 year old women who went on to conceive naturally after she was told she was clearly in menopause and there was no chance of conception. If a women is not close to the average age of menopause which is now 50.5 years old, wouldn’t it be prudent to address why she may be experiencing early menopausal symptoms and address this apparent imbalance in the body, if possible, instead of sending her away with absolutely no options or suggest that she consider a donor as her only option? Typically we find that in these women, if changes can be seen within 6 months of utilizing the herbs then it is likely that they will be able to balance their health, create more optimal hormone balance and possibly conceive naturally or with the help of IVF. If not, at least they will have felt they did everything in their power to improve their situation. Another compelling argument is that if a couple has had difficulty conceiving for over 12 months and were diagnosed as “infertile”, wouldn’t something be amiss? So if herbs have been used over and over for thousands of years to address the menstrual cycle along with female and male reproductive health, doesn’t it make sense that some combination of these herbs could possibly be useful to address various aspects of fertility? Doesn’t it also make sense that if herbs weren’t effective in treating fertility, wouldn’t the use of herbs have been phased out by now. According to the World Health Organization, in Europe, North America and other industrialized regions, over 50% of the population have used complementary or alternative medicine at least once. In China, traditional herbal preparations account for 30-50% of total medicinal consumption. So utilizing appropriate herbs to prepare the body for a pregnancy and a pending IVF cycle makes sense. IVF has been around since the 70’s and carries on average a 30% “success rate” and 20% live baby birth rate. With these stats wouldn’t it be prudent to see if any relatively affordable, proven and compatible herbal support could be used to prepare the body for a cycle of IVF and possibly improve the chances for a viable pregnancy? And when you consider that the cost of your average IVF treatment is anywhere between $6,000 and $35,000 depending on what country you live in, you might start to wonder how any herbal treatment that cost $50 to $60 per bottle could be considered a waste of money. So anything that can be done do to improve your chances to conceive and help you feel better in the process should be considered as a way of saving money or, at the very least, a good investment towards your health and wellbeing. MYTH 5: HERBS ACT LIKE AN ORAL CONTRACEPTIVE There is a great deal of misunderstanding as to how phytoestrogens differ from synthetic estrogens and progestin. This myth arises because some people believe that if a plant is a phytoestrogen, then it will act on the body as a synthetic estrogen and thus could work as a contraceptive. The truth is that although the phytoestrogen is a plant estrogen, it is much weaker than synthetic compounds and it is not human estrogen. The hormones in birth control pills are much more concentrated than any phytoestrogen. Phytoestrogens are also many times weaker than estrogen found in humans. It may mimic estrogen by binding to estrogen receptors but again, it is not estrogen and therefore does not have the same effect on the body as the hamster hormones commonly used in IVF or the horse estrogen used in HRT. I personally would never tell my patients to rely on using herbs as a contraceptive. Phytoestrogens are NOT estrogen and there are only a few herbs that even have weak estrogenic effects. These should be avoided with any type of IVF or assisted reproductive technique. But there are many misconceptions about what is and is not a phytoestrogen. Black Cohosh for example, as discussed, was considered to be a phytoestrogen because it has been shown to help improve and in some cases eliminate hot flushes in perimenopausal and menopausal women. However it has been documented that Black Cohosh has no estrogenic effects and most likely acts on the vasomotor system which is why it contributes to improving hot flushes. MYTH 6: IF YOU GO TO A NATURAL THERAPIST YOU WON’T NEED IVF While it is possible to get some benefit for your fertility through herbal remedies alone, it doesn’t mean you will not need IVF treatments. The two options are not mutually exclusive and can do much to help each other. Using herbal remedies to help address your fertility as well can reap dividends for medical treatment using IVF too. Although natural therapies could help to support better health if appropriate lifestyle and diet choices are followed in conjunction with the therapy, as with IVF treatments, there are no guarantees with herbal remedies either. What can be said, however, is that a good natural therapist isn’t there to treat the eggs and the sperm. Their role is to support the entire individual, which will include stress reduction, health and wellbeing. But most importantly, they will assist in coming up with probable causes that could be contributing to a couple’s infertility. So, in also working with a natural therapist, you may actually increase your chances of getting pregnant naturally or with IVF by addressing and subsequently reducing the emotional and physiological stress that may be contributing to your situation. PREPARATION FOR AN IVF PROCEDURE FOR BOTH MALES AND FEMALES: FERTILITY AND DIET When you go to a conventional doctor, they may never ask you about your diet. They might tell you to avoid alcohol and smoking while you are pregnant, but very few conventional physicians really bother with diet recommendations for fertility issues. This is quite the opposite with natural therapists who know how what you eat or don’t eat may be impacting your fertility. Obesity is linked to having problems conceiving. Being underweight is the same. So your food choices are very important while trying to conceive. Your naturopath will not only give you an idea of what foods to avoid and what to choose, but they will also have some suggestions on antioxidant and multi mineral supplementation as well as different food choices to enhance your chances of conceiving. This is because natural therapists like a herbalist or naturopath isn’t just supporting your uterus; they are supporting the various systems that work to address your fertility. Anything that can enhance your overall health is likely to have positive effects on your fertility as well. Other factors that people may not recognize when it comes to diet are that it is important for both people in the couple to engage in an optimal diet. It’s not just up to the women to give up alcohol or smoking. Many of these habits and food choices can be robbing people of their health by affecting needed nutrients for both the egg and the sperm in order for a viable pregnancy to occur. WHAT TO AVOID Alcohol - As noted earlier, you would want to avoid alcohol, not just when you are pregnant but also prior to conceiving. It has been related to less than optimal sperm counts in men while it may affect sperm quality and motility too. It also has a tendency to reduce the absorption of zinc, a mineral that is very important in male fertility. As for women, some studies suggest that alcohol consumption can reduce your chances of conceiving by half. So if you are having trouble conceiving, it’s important that both men and women make dietary changes and decrease their alcohol consumption to no more than 4 drinks per week spread throughout the week or abstain from alcohol all together. Caffeine – Caffeine can effect your fertility too. Excessive consumption can be related to lower sperm counts and may also affect sperm quality and motility. Caffeine can trigger infertility problems for women. The more caffeine in your diet, the more it may interfere with your fertility quest. When homocysteine is elevated in the follicular fluid or the semen, it can be associated with less than optimal egg and sperm health. And when homocysteine is elevated in the blood is can be linked with cardiovascular issues and other chronic degenerative diseases. Also many drinks and foodstuffs contain caffeine, not just coffee. Many soft drinks and even so-called “healthy” energy drinks contain excessive doses of caffeine. It’s also present in chocolate and black tea. And coffee whether it is decaffeinated or not, contains chlorogenic acid which on its own or combined with caffeine has been correlated with higher homocysteine levels. Smoking - Smoking can be a huge fertility risk as it can affect the fertility of both sexes. It can impact on sperm counts, quality and motility. As for women, it can be associated with early menopause. When pregnant, second-hand smoke can harm the baby. Studies in rats show precancerous lesions on the lungs of baby rats born exposed to second-hand smoke as well as liver growth issues and abnormalities in the kidney and stomach tissues. Many women tell me, I will quit when I am pregnant and I must say, most do. But consider this: the follicle was developing for 8 menstrual cycles prior to having produced an egg for fertilization. And because the cells in the body can be affected by smoking, it could also be damaging the health of the follicle which houses the egg. It produces much needed progesterone for a viable implantation to take place and for a pregnancy to maintained, especially in the first trimester. So, if you have considered quitting, now is the time, especially if you are trying to conceive. Recreational Drugs – Marijuana is one drug that has been studied in depth when it comes to fertility. There is ample evidence that affirms marijuana smoking in both women and men affecting the sperm’s quality and motility. If you want to improve your chances of conceiving a healthy baby, just say no to marijuana and to all other recreational drugs for that matter. Sugars – If you’ve been diagnosed with infertility due to PCOS, then you may have developed some insulin resistance. Lowering or eliminating the sugars in your diet has been shown to be beneficial for PCOS sufferers. Choosing low glycemic eating plans and nutritional whole foods in the diet can significantly improve the chances of a women with PCOS to become pregnant. WHAT TO INCLUDE Soy Products? – There is a debate among practitioners as to whether soy products are beneficial during IVF. But studies are now coming out to show that phytoestrogens, like those found in soy, do not act on the body like synthetic hormones. It does bind to some of the estrogen receptors sites but it does so in a way that seems to be beneficial in some women. However not all soy products are recommended. We tend to recommend only fermented soy products such as miso, natto and tempeh (also fermented soy sauces but be careful of the wheat/gluten in most soy sauces). So, fermented soy products seem to be okay for the fertility cycle. But I do not recommend unfermented soy such as soy milk or tofu because of what I have seen some women’s cycles do when they are on such products are consumed. Organic Fresh Fruits And Vegetables – It goes without saying that a healthy diet can create a healthy baby. To avoid pesticides and other food additives, eat organic fresh fruits and vegetables when possible. If you don’t have access to them or can’t afford them, be sure to wash your produce well to remove pesticide residue. If you have a farmer’s market near you, you can usually find very fresh produce in your area at a competitive price. You may even find some farmers in those markets entirely committed to organic produce. Another added benefit is that organic fruits and vegetables had up to 88% more nutrients available in them according to a recent Rutgers University study in the US. Supplement Your Diet – You may think just eating a well-rounded diet is enough. Actually, if you are pregnant or trying to conceive it helps to supplement your diet with vitamins and minerals. More specifically, you want a multivitamin that includes adequate folic acid and other important antioxidants. In another study on IVF women, the total antioxidant capacity of the follicular fluid was directly related to pregnancies in IVF. Do shop around as you would only want to buy it from a company that uses good manufacturing practices and tests to see whether the supplements actually get absorbed in the body. Over the counter supplements do not do this testing because it is not required by law so check with your herbalist or naturopath for supplement companies that do this testing. Water – Make sure to get 6 to 8 glasses of water a day. Filtered water is generally better. You need to stay hydrated to keep your health at an optimum level. Water can be in the form of herbal decaffeinated teas. A Well-Balanced Diet – A diet balanced in good protein, low glycemic carbohydrates, minimal to no added sugar and good fats will go a long way to helping you optimize your health. But do be wary of diet foods and trans fats which have been shown to work against your fertility so avoid them whenever possible. A CLOSER LOOK AT DIET SUPPLEMENTATION If you decide not to use herbal medications with IVF, you can still opt to supplement your diet with vitamins and minerals to support your cellular health and hopefully improve your chances of conceiving. After all, the eggs, ovaries, follicles, endometrial lining and semen and sperm are made up of cells. Zinc – This supplement is considered beneficial for both men and women who are having fertility problems. It can affect the sperm count and quality while in women it can protect against chromosome changes. It is also helpful in increasing the utilization of reproductive hormones. Folic Acid – A potent multivitamin high in folic acid is usually recommended for women who are pregnant. Some prenatal multi vitamins will have high levels of folate but not much else. It is good to remember that folic acid alone not only helps prevent birth defects associated with the brain and spinal chord, like spina bifida, but that its effects can be optimized by other supplements. For example calcium helps the body absorb folic acid more efficiently in the same way as Vitamin D, magnesium and boron help the body absorb calcium more efficiently. Antioxidants – These include Vitamin C and Vitamin E supplement among others. Men who have been given supplements of vitamin E in some studies have an increased fertility ranging from 19 to 29%. Antioxidant activity in women helps to promote health and wellness. Women taking Clomiphene to stimulate ovulation had an ovulation more often when they added Vitamin C supplementation according to one study. It could promote better egg quality too. Selenium is a mineral that has been reported to help prevent chromosomal damage in some cases. Chromosomal damage is a common finding in low quality embryos or pregnancies that end in early miscarriage. Selenium is also very important for the immune system and thyroid health. Beta Carotene – This is a form of Vitamin A that might be suggested for supplementation. It does not carry the same risk of birth defects as pure Vitamin A. But please be aware that even if dietary supplements are available over the counter they should not be self-prescribed. Always work with a knowledgeable herbalist or naturopath who understands the fertility cycle and treatments you are undergoing with IVF. DON’T FALL FOR THE HYPE Just like you need to be aware of people who may be trying to push you into IVF by using fear based comments such as telling you IVF is the only way, you have to be careful with other practitioners as well and this includes natural therapists. Fertility treatment is big business and it can attract a number of unethical practitioners in either profession. You may be dealing with an unethical therapist or practitioner if they do any of the following: Tell you that they are your only option for getting pregnant. Tell you that herbs are a waste of time and are unsafe. Tell you that if you don’t choose to do their treatment you will waste time that you don’t have trying to get pregnant somewhere else. Pressure you into doing their treatment right away saying you are running out of time. Sell you a bucket of supplements on your first visit with little explanation or understanding of why you might need them and how they could help you. Claim there are no risks with infertility drugs or with any herbs. Put you down or chastise you for trying alternative therapies or assisted reproductive techniques. Refuse to treat you if you are using alternative therapies, or vice versa. CONCLUSION Wouldn’t it be nice if you could go into a fertility clinic and find a large selection of conventional and alternative therapies side by side that all complemented each other? Unfortunately, my patients tell me that the reverse is often more accurate – that there are usually no alternatives offered in conventional practices. Even when they are brought into the discussion they are often ignored. As we’ve seen, this is due to an underlying lack of understanding on how herbs actually work and how they can benefit patients. THE TIME AND MONEY COMMITMENTS Some detractors will tell you say that alternative therapies are simply a “waste of time and money”. But if you look at the statistics of cost versus time, you will find such a statement couldn’t be further from the truth. Alternative therapies are much less expensive than conventional treatments. A single IVF treatment costs between $10,000 to $25,000 and most couples need more than one try. It is estimated that costs to conceive a child with conventional practices typically runs at more than $35,000 per child once all is said and done. Most herbal and dietary supplements cost a tiny fraction of that, somewhere between $50 and $60 per bottle. They can be used in conjunction with IVF treatments when created by an experienced naturopath or herbalist. Consultations can range from $100 to $50. Not only is it possible that they could enhance your chance to conceive the first time around, if you use natural remedies in between procedures and you may well conceive naturally and make huge savings in the process. Add to this the mounting body of evidence to support dietary guidelines for infertility and this makes it an even more attractive proposition, not mention the potential benefits for both the health of the mother and her unborn child whether conceived through IVF or naturally. Waste of money? I really don’t think so. As for time, supplementing your diet with the appropriate herbs and vitamins is a very small commitment. For the most part, unless you are boiling your own herbs bought from a Chinese herbalist, it merely requires some intervention with an experienced herbalist or naturopath who understands the fertility cycle and all the systems that support it. They would be familiar with the IVF treatments you are receiving and what your specific reproductive issues may be. From there, they will be able to make up the best herbs to suit your individual requirements and explain how you should take them based on what has assisted others in the past. As for the conventional fertility treatments themselves combined with the stress of not being able to conceive, is it a waste of time to try and alleviate some of the emotional turmoil fertility challenged couples have to go through? So rather than dismiss complimentary remedies that seek to help patients by increasing their wellbeing and overall health, those practitioners calling them a waste of time could be much better off embracing them alongside their own conventional therapies for the benefit of their patients. WHAT ABOUT IVF, IS IT A WASTE OF TIME AND MONEY? I know I can speak for all of the therapists at our center when I say that we do not believe IVF is a waste of time. But by encouraging their patients to go through cycle after cycle without creating a viable pregnancy and without undergoing further investigations or looking at things such as lifestyle factors, nutrition, emotional wellbeing or physiological stress, it is clear to us that many practitioners are doing their patients a disservice. In many instances, doctors will tell their patients they don’t know what is wrong and in the same breath urge them to hurry up and do another cycle because of their age. But rather than rush through, I believe this time could be better spent preparing their patients bodies for the next cycle. The stress placed on the body through IVF such as mood swings, weight gain and irregular cycles should not be underestimated. It therefore makes perfect sense to assist a person to get their health back on track before undergoing another cycle. Since IVF is a large emotional and financial investment it is certainly worth getting your body ready to handle the journey and the outcome whether it be a viable pregnancy or not. While IVF has its place and function, just like herbal medicines do, I strongly believe patients should have choices and be well informed. The problem may be in finding conventional physicians who are open to working with a natural therapist while undergoing IVF. When our patients express an interest in IVF or they are requiring IVF treatments, then we refer them to specialists in that area. We have great relationships with IVF doctors in Brisbane and on the Gold Coast. We also have IVF physicians and general practitioners referring patients to us too. The key again is finding conventional physicians and natural therapists who are willing to work together. YOUR FIRST STEPS TOWARDS FERTILITY HEALTH You may not have realized it, but you have just taken your first step towards taking responsibility and control of your own fertility health. By becoming more informed on the many compliments to IVF, you have given yourself more options and raised your chances of creating a viable pregnancy. If this is the first time you’ve considered alternative and complimentary therapies, you must know that a good natural therapist will want to hear all about how you are dealing with your treatments. They will want to understand your particular body physiology and the specific obstacles you may be experiencing on your journey to becoming a parent or having more children. Natural therapies attempt to support the entire person, not just the reproductive organs. Your mental and emotional health is just as important to a natural therapist as the health of your ovaries or testicles. Understand that having you take responsibility for your own health with guidance from their program is the goal of any reputable natural therapist. They are there to assist you, not to control you. In return, you will be encouraged to act in self-responsible ways by following diet and supplementation guidelines to the best of your abilities. Natural therapies work only as well as they are followed. You cannot expect to simply take a pill and omit the dietary recommendations because you think they are not important. Reproductive specialist Robert Norman states that while assisted reproductive techniques are the only option for some couples, over 50% of those who seek it are overlooking lifestyle changes that could help lead to a natural pregnancy. Norman says “People assume that if they can’t have a baby then they are going to have IVF, without even considering that if they smoke or are overweight, they are massively limiting their chances of getting pregnant.” Herbalists can and do indicate which herbs can offer support for fertility, but to conceive a healthy child it takes a commitment to health, in all its many facets. If your natural therapist recommends something you are not comfortable with, speak up about your discomfort and keep an open mind. This is also true of the many herbs that are suggested to support your fertility. You may find they have odd names or that your conventional doctor has never heard of them. If your practitioner hasn’t heard about them, that doesn’t mean they aren’t effective. Ask your natural therapist what they are trying to accomplish with the herbs in your formula. As always, keep both your conventional physician and your herbalist in the know about your current state of health. Try to keep the lines of communication open both specialists and seek those who cooperate well with each other rather than those who oppose or belittle your choice of treatments. ABOUT THE AUTHOR Stacey Roberts is a herbalist dedicated to addressing women’s health and couples fertility issues including pre and post natal care, by using her extensive knowledge of conventional and complementary medicine She is internationally recognized both as a speaker and a best selling author with over 7 books/ebooks to her credit. She has also been on prominent TV programs from Oprah to A Current Affair, various radio shows in Australia and the US as well as featured in several articles in magazines and newspapers in the US and Australia. Her clinic Sharkey’s Healing Centre has won the Stevie Award for overall best business in Asia, Australia and New Zealand and Stacey was a finalist in the Telstra Business Women’s Awards in Queensland Australia. She currently spends her time with her family in Australia and the US where she continues to lecture on fertility, optimal hormone health, and other women’s and men’s health issues. Information on her books and clinics can be found at www.naturalfertility.com