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Female Infertility

There are many possible causes of female infertility. Tubal disease and endometriosis (a condition in which uterine tissue begins to grow where it shouldn't) account for 50% of female infertility; failure of ovulation is the cause of about 30%; and cervical factors cause another 10%.
An immense industry has sprung up around correcting female infertility, using techniques that range from hormone therapy to in vitro (test tube) babies. Although these methods have their occasional stunning successes, there is considerable controversy about the high cost and low rate of effectiveness of fertility treatments in general. The good news is that apparently infertile women often become pregnant eventually with no medical intervention at all.

Proposed Natural Treatments

Women with a condition known as polycystic ovary syndrome (PCOS) may suffer from infertility. A double-blind, placebo controlled study evaluated the effectiveness of N-acetylcysteine (NAC) in 150 women with PCOS who had previously failed to respond to the fertility drug clomiphene . 12 Participants were given clomiphene plus placebo or clomiphene plus 1.2 g daily of NAC. The results indicated that combined treatment with NAC plus clomiphene was markedly more effective than clomiphene taken with placebo. Almost 50% of the women in the combined treatment group ovulated as compared to about 1% in the clomiphene alone group. Pregnancy rate in the combined treatment group was 21%, as compared to 0% in the clomiphene alone group.
Black cohosh ( Cimicifuga racemosa ), an herb with estrogen-like effects, drew the attention of researchers who were interested in whether it might be helpful for women with unexplained infertility who were also being treated with clomiphene, a commonly used medication to induce ovulation, but had yet to conceive. Roughly 120 women were randomly divided into two groups. Both groups continued to receive clomiphene, but the women in one of the groups also received 120 mg of black cohosh. Pregnancy rates were significantly higher in the black cohosh plus clomiphene group compared to the clomiphene only group. 25
In a small double-blind, placebo-controlled trial, use of bee propolis at a dose of 500 mg twice daily resulted in a pregnancy rate of 60%, as compared to 20% in the placebo group. 14 This difference was statistically significant .
Because of its effects on the hormone prolactin, the herb chasteberry has been tried as a fertility treatment. 1 However, the only properly designed study of this potential use was too small to return conclusive results. 2 A larger study evaluated a combination containing chasteberry, green tea , arginine , and multiple vitamins and minerals. 22 In this double-blind study, 93 women experiencing infertility were given either the combination treatment or placebo for three months. After three months, 26% of the women given the real treatment were pregnant as opposed to 10% of those in the placebo group, a difference that was statistically significant.
Weak evidence hints that vitamin D and calcium may also be helpful in this condition. 9
Another small study found some evidence that supplements containing isoflavones may increase the effectiveness of in vitro fertilization. 13
Another study reported that vitamin C supplements slightly improved pregnancy rates in women with a condition called "luteal phase defect," but because researchers failed to give the control group a placebo and instead merely left them untreated, the results are not very meaningful. 15 (For information on why the use of a placebo is essential, see Why Does this Database rely on Double-Blind Studies? ) Yet another study that had severe defects in design found reported that multivitamin supplements may slightly increase fertility. 3
Stress may lead to infertility, and treatments for reducing stress might help increase fertility. 4-8
The herb maca (Lepidium) is widely advocated as a fertility-enhancing herb. However, the only basis for this claim are a few animal studies. 17,18
Caffeine avoidance has also been recommended for improving fertility, but there is no evidence as yet that it really helps. 10
Acupuncture has a long history of traditional use for infertility, but the supporting evidence for its use is weak. 11 A few open trials appeared to show that acupuncture can enhance the success rate of in vitro fertilization (IVF). 19-20 Two better designed studies, however, failed to find acupuncture more effective than placebo. 21,23 A 2008 analysis of 7 randomized trials, involving a total of 1,366 patients, found that, on balance, acupuncture may significantly improve the odds of pregnancy in patients undergoing IVF. However, since not all 7 studies used sham (fake) acupuncture as a control, the reliability of this conclusion is thrown in doubt. 24 Moreover, a second analysis in the same year of 13 randomized controls trials investigating the effectiveness of acupuncture in 2,500 women undergoing a specialized IVF procedure, in which sperm is injected directly into the egg, found no evidence of any benefit. 26 But the story does not end here. In a subsequent review of 13 trials, a different group of researchers concluded that acupuncture may improve the success rate of IVF, but only if it is used on the day of embryo transfer (when the fertilized egg is placed into the womb). 27 According to this study, acupuncture is not effective when used up to three days after embryo transfer or when eggs are being retrieved from the ovaries.
Traditional Chinese herbal medicine also has a long history of use for infertility, but there is little meaningful evidence to indicate that it is effective. In a 2011 review of 14 randomized trials involving 1,316 women, the addition of Chinese herbal medicine to the prescription medication clomiphene (used to induce ovulation) was associated with increased pregnancy rates. 28 The researchers pointed out, though, that the studies were of poor quality with low sample sizes. As with the earlier review, a 2012 analysis of 30 studies, including 8 randomized trials, also found evidence to support the use of Chinese herbal medicine for improving pregnancy rates.29 This review included trials that compared Chinese herbal medicine alone, with acupuncture, or with standard drug therapy to drug therapy alone. While the researchers concluded that Chinese herbal medicine may improve pregnancy rates, as with the previous review, the quality of the studies was questionable.
Note : One case report has linked use of a Chinese herbal product with reversible ovarian failure. 16
Other treatments sometimes recommended for female infertility include ashwagandha , false unicorn , and beta-carotene , but there is as yet no evidence that they work.

References

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2 Gerhard I, Patek A, Monga B, et al. Mastodynon bei weiblicher Sterilitat [English abstract]. Forsch Komplementarmed. 1998;5:272-278.

3 Czeizel AE, Metneki J, Dudas I. The effect of preconceptional multivitamin supplementation on fertility. Int J Vitam Nutr Res . 1996;66:55-58.

4 Newton CR, Sherrard W, Glavac I. The Fertility Problem Inventory: measuring perceived infertility-related stress. Fertil Steril. 1999;72:54-62.

5 O'Moore AM, O'Moore RR, Harrison RF. Psychosomatic aspects in idiopathic infertility: effects of treatment with autogenic training. J Psychosom Res. 1983;27:145-151.

6 Domar AD, Seibel MM, Benson H. The mind/body program for infertility: a new behavioral treatment approach for women with infertility. Fertil Steril. 1990;53:246-249.

7 Gravitz MA. Hypnosis in the treatment of functional infertility. Am J Clin Hypn. 1995;38:22-26.

8 Harrison RF, O'Moore RR, O'Moore AM. Stress and fertility: some modalities of investigation and treatment in couples with unexplained infertility in Dublin. Int J Fertil. 1986;31:153-159.

9 Thys-Jacobs S, Donovan D, Papadopoulos A, et al. Vitamin D and calcium dysregulation in the polycystic ovarian syndrome. Steroids. 1999;64:430-435.

10 Caan B, Quesenberry CP Jr, Coates AO. Differences in fertility associated with caffeinated beverage consumption. Am J Public Health. 1998;88:270-274.

11 Chang R, Chung PH, Rosenwaks Z. Role of acupuncture in the treatment of female infertility. Fertil Steril . 2002;78:1149-1153.

12 Rizk AY, Bedaiwy MA, Al-Inany HG, et al. N-acetyl-cysteine is a novel adjuvant to clomiphene citrate in clomiphene citrate-resistant patients with polycystic ovary syndrome. Fertil Steril . 2005;83:367-370.

13 Unfer V, Casini ML, Gerli S, et al. Phytoestrogens may improve the pregnancy rate in in vitro fertilization-embryo transfer cycles: a prospective, controlled, randomized trial. Fertil Steril . 2004;82:1509-1513.

14 Ali AFM, Awadallah A. Bee propolis versus placebo in the treatment of infertitily associated with minimal or mild endometriosis: a pilot randomized controlled trial. A modern trend. Fertil Steril 2003;80 (Supp 3):S32.

15 Henmi H, Endo T, Kitajima Y, et al. Effects of ascorbic acid supplementation on serum progesterone levels in patients with a luteal phase defect. Fertil Steril . 2003;80:459-461.

16 Edmonds SE, Montgomery JC. Reversible ovarian failure induced by a Chinese herbal medicine: lei gong teng. BJOG . 2003;110:77-78.

17 Ruiz-Luna AC, Salazar S, Aspajo NJ, et al. Lepidium meyenii (Maca) increases litter size in normal adult female mice. Reprod Biol Endocrinol . 2005;3:16.

18 Oshima M, Gu Y, Tsukada S, et al. Effects of Lepidium meyenii Walp and Jatropha macrantha on blood levels of estradiol-17 beta, progesterone, testosterone and the rate of embryo implantation in mice. J Vet Med Sci . 2003;65:1145-1146.

19 Westergaard LG, Mao Q, Krogslund M, et al. Positive effects of acupuncture in ART are not mediated by changes in ovarian and endometrial production of estradiol, progesterone, and placental protein 14. Fertil Steril. 2006 Apr 4 [Epub ahead of print].

20 Westergaard LG, Mao Q, Krogslund M, et al. Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertil Steril. 2006 Apr 4 [Epub ahead of print].

21 Smith C, Coyle M, Norman RJ. Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Fertil Steril. 2006 Apr 4 [Epub ahead of print].

22 Westphal LM, Polan ML, Trant AS. Double-blind, placebo-controlled study of Fertilityblend: a nutritional supplement for improving fertility in women. Clin Exp Obstet Gynecol . 2006;33:205-208.

23 Domar AD, Meshay I, Kelliher J, et al. The impact of acupuncture on in vitro fertilization outcome. Fertil Steril. 2008 Mar 1. [Epub ahead of print]

24 Manheimer E, Zhang G, Udoff L, et al. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ. 2008;336:545-549.

25 Shahin AY, Ismail AM, Zahran KM, et al. Adding phytoestrogens to clomiphene induction in unexplained infertility patients—a randomized trial. Reprod Biomed Online. 2008;16:580-588.

26 El-Toukhy T, Sunkara S, Khairy M, et al. A systematic review and meta-analysis of acupuncture in in vitro fertilization. BJOG. 2008 Jul 23.

27 Cheong YC, Hung Yu Ng E, Ledger WL. Acupuncture and assisted conception. Cochrane Database Syst Rev. 2008;CD006920.

28 See CJ, McCulloch M, Smikle C, Gao J. Chinese herbal medicine and clomiphene citrate for anovulation: a meta-analysis of randomized controlled trials. J Altern Complement Med. 2011;17(5):397-405.

29 Ried K, Stuart K. Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: a systematic review. Complement Ther Med. 2011;19(6):319-331.

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