Infertility is becoming an increasingly frequent problem. Many people go to fertility experts and, by discovering an anatomic problem (e.g. blocked fallopian tubes), or problems with ovulation, are able to get help. Unfortunately, many people find their tests are negative or, despite therapy, find they are unable to get pregnant.
Comprehensive Medicine, which includes both prescription/surgical and natural therapies, can often help when regular day-to-day medical approaches cannot. Infertility is one such case. It is important to recognize that 40% to 50% of problems with infertility are secondary to the man having a low sperm count or underactive sperm activity. Because of this, I recommend the man and woman both do the things noted below to increase their fertility. Before one begins with these things, it is important to look at the optimum timing for intercourse.
When Is the Best Time to Get Started?
Research shows that intercourse that occurs even one day after ovulation is unlikely to result in pregnancy. Intercourse the day of ovulation is most effective and often effective during the three to four day period before ovulation. Intercourse more than six days before ovulation is also unlikely to result in pregnancy. One can use an ovulation thermometer to time their ovulation. Also, the more frequently one has intercourse in the three or four days before ovulation, the more likely one is to get pregnant. New research has overturned the old misconception that frequent intercourse within this three to four day period decreases the chance of pregnancy.
What Can the Woman Do?
There are many day to day things which worsen and improve fertility. Having more than four cups of coffee a day (and possibly any coffee) can result in infertility. Some researchers joke that coffee actually acts as a reasonable form of birth control (I would not rely on it though!). Alcohol also increases infertility caused by ovulatory problems. This results because of increases in a hormone called prolactin. In people who have ovulatory infertility, alcohol can increase the problem by 30% if you have even one drink a day and by 60% if you have more than two drinks a day. Alcohol can also aggravate infertility caused by endometriosis. Of much greater concern, however, is the problem of birth defects caused by drinking alcohol during the pregnancy. This is called fetal alcohol syndrome and it is important that alcohol be avoided during the pregnancy. I would also note that taking very hot baths during pregnancy, including hot tubbing, can increase birth defects quite a bit as can taking more than 8,000 IU of vitamin A daily (beta carotene is okay). In addition, it is important that any woman of childbearing age take at least 800 mcg (0.8 mg) of folic acid a day to prevent birth defects. If the woman has had a child with neural tube birth defects in the past, I would increase this up to 4,000 mcg a day. For most women, taking a good multivitamin powder is very helpful.
Other things that can cause infertility include taking more than 1,000 mg of vitamin C a day. If a woman is doing this and trying to get pregnant, she should decrease it to 500 mg a day. Infertility caused by a higher dose should resolve within a few weeks. Drinking caffeinated sodas (even one a day) can decrease conception by 50%. It is also important to avoid toxic metals (lead, mercury, cadmium), and I would not take melatonin (or much of anything else besides a good multivitamin as noted above and magnesium) when pregnant. High doses of melatonin can raise prolactin levels and may result in temporary infertility. A recent study has also found douching temporarily decreases the probability of getting pregnant by 30%. If your doctor has not checked your prolactin level, be sure this is not elevated.
Now that we have looked at some of the avoidable things which can keep you from getting pregnant, lets take a look at things you can do to help you get pregnant. These include:
- Taking a good multivitamin with folate as noted above. This can increase fertility.
- Taking extra vitamin B6 (approximately 50 mg a day—also present in a good multivitamin powder) can also help you get pregnant. This is especially true if one has irregular periods or absent periods or inappropriate production of breast milk outside of one's period.
- Be sure your iron levels are adequate. A blood test (a ferritin level combined with an iron level and iron binding capacity) will tell you this. Unfortunately, doctors are trained to say the iron is normal if your ferritin level is at least 9 ng/ml. Although a ferritin level of 9 shows you have enough iron to prevent anemia, one can have infertility from ferritin levels less than 40. Because of this, I would look at your ferritin test results yourself and make sure the level is at least 40 ng per ml. In a study of women with hair loss with ferritin levels less than 40, seven women who also had infertility became pregnant within 7 months when put on iron. If for some reason you are unable to get your ferritin level checked, it is not unreasonable to take iron (e.g. Chromagen FA 1 tablet a day) for 7 months. Take it on an empty stomach and with at least 200 mg of Vitamin C. Do not take it with in 6 hours of thyroid hormone therapy, or you will not absorb the thyroid. I also would take iron if the percent saturation of iron (calculated from the iron & percent saturation tests noted above) is under 22%.
- If one's thyroid is low, and this is frequently the case even with normal blood tests, a very low dose of thyroid hormone will often result in people getting pregnant. If you have a tendency to constipation, cold intolerance, dry skin and thin hair, and/or temperatures which run under 98.2 during the day, there is a good chance your thyroid may be slightly underactive despite normal blood tests. In the absence of underlying heart disease, a trial of a low dose of thyroid hormone (e.g. Armour Thyroid 1/2 grain a day) may help you get pregnant and has a low risk of causing problems. You might have to fight with your doctor a bit to get them to try this for you, but it is worth it. If you have the symptoms I mentioned, remind your doctor that the best endocrinologists stress that it is important to address an issue based on the patient and not the blood test. Something he or she might want to remember is that each time we come up with a new thyroid blood test we find a large number of people with an underactive thyroid that the old test missed. There is a very high probability that our current tests are still missing many people with this disease. Do not take iron within six hours of thyroid supplements or the iron will prevent absorption of the thyroid hormone.
- Research by William Jeffries, M.D., an emeritus professor of endocrinology at Case Western Reserve University, has shown that some women's difficulty getting pregnant can be overcome by taking a low dose of cortisol (Cortef). Although cortisol in high doses for prolonged periods can be very toxic, taking Cortef 5 mg twice a day for 2 to 3 months is unlikely to cause major problems in the absence of high blood pressure or a family history of diabetes. His experience is this can often result in people with infertility getting pregnant as well (although he uses 5 mg 4 times a day). This is especially true with polycystic ovaries (Stein-Leventhal syndrome).
- Avoid a high protein diet. An animal study conducted at the Colorado Center for Reproductive Medicine has linked high protein diets to impaired pregnancy and less viable offspring. The researchers fed half of their study mice a diet of 25 percent protein (typical daily Atkins' protein consumption) and the other half 14 percent protein (normal protein consumption) for four weeks before mating them. Only one third of the mouse mothers on the high-protein diet were able to become pregnant, compared to 70% in the normal diet group. The researchers then transferred 174 mice embryos from both groups of mice to surrogate mice fed a normal diet. Only 36 percent of the high protein moms' embryos developed into fetuses, compared to 70 percent in the control group. The study results were presented in the European Society of Human Reproduction and Embryology.
What About the Guys?
Research suggests that sperm counts are dropping throughout the industrialized world. There is a good possibility this is coming from chemicals, especially pesticides, which mimic estrogen effects in the body. In many countries this is becoming an area of major concern. Avoiding chemicals or other toxins is helpful.
I would note there has been over a 50% decrease in sperm counts in the last over 50 years. Interestingly studies show that organic farmers have had increasing sperm counts, as opposed to farmers who use chemicals (who have had a large drop in sperm counts). Using meat from cows that have not been raised and fattened using estrogen (such as meat which is available at Whole Foods Market) is important in any man whose wife is having trouble getting pregnant. Melatonin, verapamil and nifedipine (common heart and blood pressure medicines), or excess alcohol can also cause reversible infertility in males.
There are several things a man can do to markedly improve his sperm count and motility:
- Although in females high dose vitamin C can cause infertility, increasing vitamin C to at least 500 to 1,000 mg a day in males has a marked effect on increasing sperm count and motility. The vitamin C also protects the sperm from genetic damage which can cause inherited diseases or cancer in the child. Taking 500 mg twice a day, for example, can successfully address infertility in 20% of infertile males.
- Astragalus—an herbal remedy, can increase sperm motility by about 50%.
- Research has shown that high doses of intramuscular vitamin B12 (which are very safe) can increase sperm count in 50% of males with low counts. The dose used in the study was quite high at 1,500 to 6,000 mcg intramuscularly daily. Although the tablets might be helpful, one would only absorb a tiny fraction of the B12 taken by mouth and the therapy needs to be given by injection.
- Coenzyme Q10 200 mg/day (use only the Vitaline form—many others are poor quality) can be very helpful.
- L-arginine Aspartate 9 gm a day for low sperm motility or 4 gram a day for low sperm counts can be helpful.
- Ginkgo Biloba—another herbal remedy taken 120 mg twice a day can help with erectile dysfunction. This takes about 6 to 12 weeks to start working.
- Acetyl-L-Carnitine 1.5-3 gram (1500-3000 mg) a day for 4 months can also increase sperm motility.
- Selenium 200 mcg a day (not more than this as higher doses can be toxic). Taking a good multivitamin powder is a good idea for the man as well as the woman and will supply the 200 mcg of selenium (and 49 other key nutrients).
- Vitamin E 400 IU a day (not more) can also increase male infertility.
- 50 mg of zinc a day for four months is also helpful.
- Soy and Soya products (e.g. tofu, miso, tempeh, soy milk) increase estrogen production and may decrease sperm counts significantly.
What Are the Risks of These Therapies?
Although even natural remedies sometimes have side effects, they are usually safe. Too much iron can be toxic and I prefer to check the iron levels (as noted above) before supplementing with iron. The risk of taking iron for only three to four months (in the absence of a genetic iron excess disease), however, is low. The main side effect of taking high-dose zinc intake for short periods is nausea.
So Do You Think I Should Go For It?
If you want to get pregnant I certainly would go for it! When you get pregnant, here are some helpful hints:
10 Tips for a Healthy Pregnancy
As mothers tend to sacrifice during their lives to meet their children's needs, a mother's body will give up its own essential nutrients to provide health and growth for her developing baby. Unfortunately, the Standard American Diet (S.A.D.) is often so nutritionally deficient that even this sacrifice does not guarantee adequate nutrition for the unborn baby.
Fortunately, there are a number of tips that if followed during pregnancy, can help both baby and mother stay healthy and vital!
Here is my top 10 list for ensuring a healthy pregnancy. It includes recommendations on nutrition, vitamins, minerals and other common sense tips that can lead to a happier, healthier and more vital pregnancy. Powdered vitamin formulas are available that can markedly decrease the number of supplement tablets needed (e.g. a good multivitamin powder is excellent for pregnancy—and for everyone who wants to be healthy and feel great!—and contains #1-4 below and much, much more):
- Zinc - Inadequate zinc is the most common and problematic deficiency during pregnancy. Zinc is critical for two reasons: proper growth and for developing a healthy immune system for the baby. Studies suggest that inadequate zinc may even cause immune deficiency in the next generation (i.e. your grandchild) as well. Be sure to get at least 15 milligrams per day of zinc in your diet, which can be found in high protein foods such as meat and beans.
- Folic Acid - Getting enough folic acid is critical both before and during pregnancy to help assure proper growth and to prevent birth defects. It is present in deep green, leafy vegetables. Women should get at least 400 to 800 micrograms per day.
- Magnesium - Magnesium deficiency is routine in the American diet and can increase the possibility of high blood pressure and seizures during pregnancy, a condition known as eclampsia. To prevent this deficiency, take 200 milligrams of magnesium in the glycinate form daily. Whole grains, green leafy and other vegetables and nuts are good sources of magnesium. Taking the proper amount of magnesium a day also helps to decrease the leg cramps and constipation often experienced during pregnancy. In addition, magnesium is critical for more than 300 other body functions and will generally help you to feel a lot healthier.
- B Vitamins - These are critical for energy, mental clarity and to prevent depression. B vitamins have also been found to improve pregnancy-related complications such as gestational diabetes. Taking 200 milligrams a day of vitamin B6 can improve the health of those women suffering from this form of diabetes. But please note that only women who develop gestational diabetes during pregnancy should take this high level of B vitamins, and should drop the level of consumption to 100 milligrams per day during the last month. For all other soon-to-be moms, take approximately 25 to 50 milligrams a day of B vitamins and plenty of vitamin B12 for normal nerve function.
- Fish Oils - The human brain is made predominantly of DHA, an essential fatty acid found in fish oils. Perhaps this is why there is an old wives' tale about fish being brain food. Regardless, DHA deficiency is very common and it is critical that pregnant women get adequate fish oils so that their baby can develop healthy and optimal brain tissue. DHA may also decrease the risk of postpartum depression. Unfortunately, though, the FDA has raised concerns about high mercury levels in the same deep sea fish (salmon and tuna) that have the highest levels of these oils. So if you take fish oil, choose a brand that has been tested to make sure that it does not have mercury or other problematic compounds.
- Calcium - Ideally, pregnant women should ingest 1,500 milligrams of calcium per day plus 400-600 units of Vitamin D. It is best to take Calcium at night (it helps with sleep) in the liquid, powdered or chewable form. Many calcium tablets are simply chalk and do not dissolve in the stomach, and therefore are not absorbed properly. Each cup of milk or yogurt contains 400 milligrams of calcium.
- Iron - Approximately 18 to 36 milligrams of iron per day can be helpful. Interestingly, iron deficiency can sometimes cause infertility. And pregnant women who don't get enough iron are at risk for anemia, fatigue, poor memory and decreased immune function.
- Water - Be sure to drink plenty of water. When pregnant, blood volume can increase about 30 percent and it is easy to become dehydrated. If your mouth or lips are dry, drink more! Adequate salt is also helpful in preventing dehydration (less so if you have problems with fluid retention).
- CHECK YOUR THYROID! Millions of women have undiagnosed hypothyroidism, which accounts for over 6% of miscarriages, and is associated with learning disabilities when the child is born. Addressing a low thyroid is both safe and easy during pregnancy. The earlier it is addressed the better. As soon as you know you're pregnant (or trying to get pregnant), check a TSH blood test to check your thyroid. Most doctors do not yet know that the TSH HAS TO BE LESS THAN 3 OR YOU NEED TO ADDRESS IT, SO SEE THE RESULT FOR YOURSELF (many still use the dangerous and outdated criteria of a TSH over 5 being abnormal). If you were on thyroid before getting pregnant, it is normal to need to increase the dose during pregnancy (the TSH should be kept between .5 and 2.0). If your doctor is not familiar with the new guidelines, let them know they can e-mail me at my web site and we'll send a copy to them.
- Things to Avoid: A few cautions for pregnant women: avoid taking more than 8,000 units of vitamin A per day. And don't partake in anything that can raise your body temperature too high (hot tubs, saunas or steam rooms). These have been implicated as possibly increasing the risk for birth defects. Most pregnant women are also, of course, aware that smoking, drugs and alcohol should all be avoided during pregnancy. Exercise, on the other hand, has been shown to be very beneficial and results in babies and moms that are quite healthy.
What Else Can I Do?
There are certainly emotional things which can be done which can also be very helpful. In my experience, when women play with newborn babies a lot (e.g. right after they adopt one) they do seem to get pregnant fairly frequently. Starting to let yourself relax and to let the process of getting pregnant be fun as opposed to a chore or a task (where you are paying attention to every detail) is also very helpful. Let go! Once you have done the things noted above you have done your work and now it is time to let your body do its part. There are reasons why one might not want to get pregnant (fear of being trapped is a common one) and simply being conscious of these concerns is very helpful. When one is conscious of these conflicts, one often does not even need to do anything further about them.
Good luck on getting pregnant!
Jacob Teitelbaum, M.D. is one of the world's leading integrative medical authorities on fibromyalgia and chronic fatigue. He is the lead author of eight research studies on their effective treatments, and has published numerous health & wellness books, including the bestseller on fibromyalgia From Fatigued to Fantastic! and The Fatigue and Fibromyalgia Solution. Dr. Teitelbaum is one of the most frequently quoted fibromyalgia experts in the world and appears often as a guest on news and talk shows nationwide including Good Morning America, The Dr. Oz Show, Oprah & Friends, CNN, and Fox News Health.