– written by Managing Director of Pillar Healthcare, Mark Whitney, as a Continuous Professional Development article for pharmacists in the UK
Infertility is a disease, usually of the reproductive system, defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.
Infertility can be categorised as primary infertility or secondary infertility. Primary infertility is defined as a couple who have never had a pregnancy. Secondary infertility describes a couple who are having trouble conceiving again, even though they have previously achieved pregnancy.
There are many fertility conditions, both common and uncommon, that can make it difficult for a couple to conceive. Presenting cases of infertility are broken down into thirds. One third of all cases will be female related, one third is male related and one third is defined as ‘unexplained infertility’. Unexplained infertility is so named as its causes remain unknown even after an infertility work-up.
Healthcare providers evaluate men and women differently to diagnose infertility. Fertility testing and investigation can be a lengthy process. It is best to advise a couple to make an appointment early on, especially if the female partner is aged 36 and over. This can be done through a GP or by a fertility clinic. It is always best for both partners to visit their GP or clinic, because fertility problems can affect a man or a woman and sometimes both partners.
What are the causes?
There are many factors contributing to infertility problems. In many cases infertility is the result of multi-factorial conditions, in both the female and the male. Even when a definite physical cause can be found, the situation can be extremely complex and several issues have to be resolved simultaneously for pregnancy to ensue.
Infertility in men can be caused by different factors and is typically evaluated by a semen analysis. A specialist will evaluate the number of sperm (concentration), motility of the cells (movement), and morphology (shape) of the sperm.
Infertility in women is a multi-factorial problem. Factors can include age, hormonal health, lifestyle and genetics. An evaluation of a woman for infertility is appropriate for women who have not become pregnant after having 12 months of regular, unprotected intercourse. An initial diagnosis for women will normally involve blood tests, a possible urinary examination, ultrasound, a basal body test and possibly, more invasive investigative tests.
Causes of male infertility include:
- Varioceles (a condition in which the veins on a man’s testicles are large and cause them to overheat, damaging the cells)
- Medical conditions (diabetes, cystic fibrosis, trauma, infection, including STIs (Sexually Transmitted Infections), testicular failure, chemotherapy or radiation)
- Unhealthy habits such as heavy alcohol use, testosterone supplementation, smoking, anabolic steroid use and illicit drug use
- Nutritional deficiencies that impair sperm and hormone creation
- Environmental toxins including exposure to pesticides and lead
Causes of female infertility include:
- Damage to the fallopian tubes, not allowing the sperm cell and egg to meet
- Ovulatory problems (insufficient ovulation will impair fertility)
- Endometriosis & PCOS (Polycystic Ovary Syndrome)
- Conditions affecting the uterus (Polyps & Fibroids)
- Gynaecological problems such as previous ectopic pregnancy or having had more than one miscarriage
- Medical conditions such as diabetes, epilepsy, and thyroid and bowel diseases
- Lifestyle factors such as stress, being overweight or underweight, and smoking
- Nutritional Deficiencies that can impair egg development and reproductive function
Why the increase?
11.9% of women have received infertility services in their lifetime. In the UK, one in six couples are diagnosed as infertile (and consistently getting worse) and one in every four couples in developing countries have been found to be affected by infertility. However, these figures are based from the ages of 15 to 49, which leads to a great deal of inaccuracy. Anecdotally, most people under the age of 26 are trying to avoid pregnancy.
Infertility has increased across the globe. This includes both the western world, the Middle and Far East and even developing countries.
- Age & Timing: 52.7% of first time Irish and UK mothers were aged 30-39 in 2013, making Irish & British women some of the oldest mothers in Europe. About 20% of women in the United States now have their first child after age 35 and this leads to age becoming a growing cause of fertility problems, in men and women.
- Nutrient deficiencies impair sperm creation, egg development, ovulation and hormonal profiles. It has been shown in so many instances, by the British Government Food testing laboratories (McCance & Widdowson), that the nutrient values of many of our current foods have declined considerably, sometimes up to 50% in the case of magnesium and in excess of 20% in many vitamins and minerals in foods generally, in the last 50-60 years.
- High Stress levels impair fertility in both men and women. High stress (increased cortisol) impairs the hormonal system, the immune system, requires more nutrients and can impair ovulation and even sperm creation.
- Being overweight or obese impacts our hormonal process, our endocrine system and sperm and egg creation. Poor dietary habits will increase the problem and make the problem worse.
- Hormonal Insufficiencies that impair egg maturation and sperm creation. Your lifestyle, including smoking, lack of exercise, alcohol consumption, constant low grade radiation from mobile devices will impair both male and female fertility.
Infertility can be treated with medicine or assisted reproductive technology. Many times these treatments are combined.
Clomiphene citrate is a medicine that causes ovulation by acting on the pituitary gland. It is often used in women who have polycystic ovarian syndrome (PCOS) or other problems with ovulation. Many of the medicines used to treat both male and female fertility are hormonal based, like Follicle Stimulating Hormone (FSH), Gonadotropin-releasing hormone (Gn-RH) and Human menopausal gonadotropin (hmg). Metformin or Glucophage can be used for PCOS and pre-diabetic conditions and infertility.
Assisted Reproduction: In vitro fertilization (IVF) is the most common ART technique. IVF involves stimulating and retrieving multiple mature eggs from a woman, fertilizing them with a man’s sperm in a dish in a lab, and implanting the embryos in the uterus three to five days after fertilization. Intrauterine insemination (IUI) is another form of assisted reproduction. In this procedure, healthy sperm that have been collected and concentrated are placed directly in the uterus. Intracytoplasmic sperm injection (ICSI) is similar to an IVF procedure but more precise. In ICSI, a single healthy sperm is injected directly into a mature egg. Then the viable embryo is implanted into the womb.
The Harvard Fertility Diet showed us, on a large scale that nutrition and nutrient intake, coupled with lifestyle advice, can improve fertility significantly. Over 80% of the 17,000+ women improved their fertility in a number of months. This should be the first port of call for any and all treatments.
Individual nutrients have been shown to improve fertility over several decades. These nutrients have been shown to be incredibly safe and extremely well tolerated by the general public. In fact, some nutrients are known to be directly involved in sperm and egg creation. Selenium is directly involved in sperm creation. Folic acid helps prevent neural tube defects. Magnesium, Vitamin D and B vitamins support hormonal health. Vitamins E and C have been shown to reduce oxidative stress. Zinc contributes to normal fertility and reproduction. All of these statements are approved by the European Food Safety Authority. Glutamine, Glycine and NAC (N-Acetylcysteine) have been shown to improve Glutathione (which is directly associated with sperm health).
Arginine, with over 10,000 medical citations, has been clinically shown to improve both male and female fertility. Coenzyme Q 10 or Co-Q-10, has been shown to improve AMH (anti-mullerian hormone – a key indicator of ovarian reserve) in women and sperm quantity and quality in men. Carnitine, Omega 3, Zinc, Selenium, B Complex and Vitamin E have all been shown to improve key fertility parameters in both men and women.
Dr. David Smallbone, M.B., Ch.B., L.R.C.P., M.R.C.S., M.F. Hom., F.C.O.H., the most recent past President of the Food & Health Section of the Royal Society of Medicine (UK), says:
“I believe that providing adequate nutritional materials can and does influence the body systems. It becomes apparent that important systems, such as the endocrine system, can be affected by correct nutrition but it needs time and six months is not an unreasonable amount of time. Unless the nutritional requirements of the body are specifically catered for, it is highly unlikely that full health can be expected. pre-Conceive consciously provides those specific nutritional needs for full fertility health to be achieved. It may be that, in most cases, very little else is required – except time.”
Treatment in the Pharmacy
In the pharmacy setting, the pharmacy team can supply many supports and offerings to those trying to conceive. Ovulation testing kits, home testing kits for AMH, other hormones and even semen analysis kits, lubricants designed to support conception, names and contact details for trusted healthcare providers in the community and nutritional supplements, like those mentioned above.