Introduction
There are many possible causes of female infertility. Tubal disease and
endometriosis (a condition in which uterine tissue begins to
grow where it should not) account for 50 percent of female infertility; failure of
ovulation is the cause of about 30 percent; and cervical factors cause another 10
percent.
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.
Proposed Natural Treatments
Women with a condition known as polycystic ovary syndrome (PCOS) may be
infertile. 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, a
commonly used medication to induce ovulation. Participants were given clomiphene
plus placebo or clomiphene plus 1.2 grams daily of NAC. The results indicated that
combined treatment with NAC plus clomiphene was markedly more effective than
clomiphene taken with placebo. Almost 50 percent of the women in the combined
treatment group ovulated compared to about 1 percent in the clomiphene-alone
group. The pregnancy rate in the combined treatment group was 21 percent, compared
to 0 percent 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 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 milligrams (mg) of black cohosh.
Pregnancy rates were significantly higher in the black cohosh plus clomiphene
group compared to the clomiphene-only group.
In a small, double-blind, placebo-controlled trial, the use of bee propolis
at a dose of 500 mg twice daily resulted in a pregnancy rate of 60 percent,
compared to 20 percent in the placebo group. This difference was statistically
significant.
Because of its effects on the hormone prolactin,
the herb chasteberry has been tried as a fertility treatment.
However, the only properly designed study of this potential use was too small to
return conclusive results. A larger study evaluated a combination containing
chasteberry, green tea, arginine, and multiple vitamins and minerals. In this
double-blind study, ninety-three women experiencing infertility were given either
the combination treatment or the placebo for three months. After three months, 26
percent of the women given the real treatment were pregnant compared to 10 percent
of those in the placebo group, a difference that was statistically
significant.
Weak evidence hints that vitamin D and calcium may also be helpful for
infertility. Another small study found some evidence that supplements containing
isoflavones may increase the effectiveness of in vitro fertilization
(IVF). 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 meaningful. Another study
that had severe defects in design reported that multivitamin supplements may
slightly increase fertility. Stress may lead to infertility, and treatments for
reducing stress might help increase fertility. The herb maca (Lepidium
meyenii)is widely advocated as a fertility-enhancing herb. However,
the only basis for this claim are a few animal studies.
Caffeine avoidance has also been recommended for improving fertility, but there
is no evidence that it helps. Acupuncture has a long history of traditional use
for infertility, but the supporting evidence for its use is weak. A few open
trials appeared to show that acupuncture can enhance the success
rate of IVF. Two better-designed studies, however, failed to find acupuncture more
effective than placebo. A 2008 analysis of seven randomized trials, involving a
total of 1,366 women, found that, on balance, acupuncture may significantly
improve the odds of pregnancy in women undergoing IVF. However, because not all
seven studies used sham (fake) acupuncture as a control, the reliability of this
conclusion is questionable. Moreover, a second analysis in the same year of
thirteen randomized-control 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. In a subsequent review of
thirteen 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). 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 no meaningful evidence to indicate that it is effective.
One case report has linked the use of a Chinese herbal product with reversible
ovarian failure. Other treatments sometimes recommended for female infertility
include ashwagandha, false unicorn, and beta-carotene, but there is no evidence
that these treatments work.
Bibliography
Ali, A. F. M., and A. Awadallah. “Bee Propolis Versus Placebo in the Treatment of Infertitily Associated with Minimal or Mild Endometriosis.” Fertility and Sterility 80, suppl. 3 (2003): S32.
Domar, A. D., et al. “The Impact of Acupuncture on In Vitro Fertilization Outcome.” Fertility and Sterility 91 (2009): 723-726.
El-Toukhy, T., et al. “A Systematic Review and Meta-analysis of Acupuncture in In Vitro Fertilisation.” BJOG: An International Journal of Obstetrics and Gynaecology 115 (2008): 1203-1213.
Manheimer, E., et al. “Effects of Acupuncture on Rates of Pregnancy and Live Birth Among Women Undergoing In Vitro Fertilisation.” British Medical Journal 336 (2008): 545-549.
Shahin, A. Y., et al. “Adding Phytoestrogens to Clomiphene Induction in Unexplained Infertility Patients.” Reproductive Biomedicine Online 16 (2008): 580-588.
Unfer, V., et al. “Phytoestrogens May Improve the Pregnancy Rate in In Vitro Fertilization-Embryo Transfer Cycles.” Fertility and Sterility 82 (2004): 1509-1513.
Westergaard, L. G., et al. “Acupuncture on the Day of Embryo Transfer Significantly Improves the Reproductive Outcome in Infertile Women.” Fertility and Sterility 85 (2006): 1341-1346.
Westphal, L. M., M. L. Polan, and A. S. Trant. “Double-Blind, Placebo-Controlled Study of Fertilityblend: A Nutritional Supplement for Improving Fertility in Women.” Clinical and Experimental Obstetrics and Gynecology 33 (2006): 205-208.
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