Anna is a 35-year-old legal assistant. She presented in our initial visit with complaints of difficulty conceiving. She had been trying for more almost a year, diligently tracking her ovulation cycles with no success. Her family doctor eventually diagnosed her with infertility and referred her on to a fertility clinic. Blood work was performed there and determined a low follicle count, commonly seen with women in her age range and is reflected by the anti-mullerian hormone (AMH, a marker of the size of the remaining egg supply or “ovarian reserve). They proposed a treatment plan of in vitro fertilization (IVF), which included a preparatory phase requiring hormone injections to increase the number of maturing eggs prior to harvesting and fertilizing, as well as continuous hormones throughout the protocol to increase chances of implantation. Having had several of her friends try this path with mixed results and complaints of side effects from the hormones, coupled with the anxiety Anna had about the invasivenes of the procedures, she sought other potential treatments which led her to our initial visit.
Fertility cases are always interesting, as conventional investigations can be minimal. Given there are no other significant abnormalities, such as a blocked fallopian tube, male infertility, history of polycystic ovarian syndrome, fibroids, endometriosis, and reproductive hormone imbalance, the AMH value becomes the target of treatment. With increasing female age, the size of their pool of egg supply decreases and AMH levels also decrease. Once this low level is found, IVF tends to be the
standard treatment protocol.
Although IVF has given a safe and successful opportunity to individuals that have otherwise been unable to conceive, and is more successful than other forms of assisted reproductive technology, IVF success rates are still low (just over 25% of IVF cycles result in live birth), are expensive, and there may be associated side effects such as a higher chance of ectopic pregnancy, prematurity of birth and low birth weight, and takes an emotional/psychological toll.
Many other factors beyond those listed above can play into an infertility diagnosis and as a result, treatment options expand. Infertility is highly complex, also being effected by hormones such as cortisol (a stress hormone) and thyroid hormone (responsible for metabolism), history of hormonal birth control use, nutritional deficiencies (such as iron, folic acid, b vitamins), inflammation, circulation, oxidative stress and egg quality, and uterine lining thickness and implantation ability. With this in mind, treatment options from a naturopathic perspective can expand into helping an individual’s body optimize its roles in fertility through diet and lifestyle, Traditional Chinese Medicine and acupuncture, nutraceutical supplementation, and herbal supplementation.
In Anna’s assessment, several other factors were found. She shared that she had been on the birth control pill (BCP) for thirteen years up until trying to conceive. Once discontinuing the BCP, her period returned regularly but was heavy and extremely painful for the first three days in her upper abdomen, and would have associated loose stools. Premenstrual symptoms (PMS) also developed including bloating, moodiness, and decreased libido. She also began experiencing yeast infections tied to her menstrual cycle.
She also shared that her gastrointestinal health was poor, suffering from heartburn once a week, stabbing pain in the stomach twice a week that could last up to two hours, and increased bowel urgency. Associated symptoms included low energy and weakness. A CT scan and colonoscopy was performed in the past by her family doctor and gastroenterologist and she was diagnosed with colitis. Treatment was done by antibiotics which worsened symptoms.
Both menstrual and gastrointestinal complaints were aggravated by stress. She described herself as an anxious person with a demanding job, coupled with the pressure of conceiving; stress was a major part of her life.
After taking a full history, blood work was performed and found that she had low iron and thyroid stimulating hormone (indicating hypothyroidism). Researchers have found that women that have low iron have a higher risk of ovulatory infertility (an inability to produce healthy eggs), and that abnormal thyroid function is associated with an increased rate of infertility, miscarriage, and adverse pregnancy and neonatal outcomes. Anna returned to her family doctor and was prescribed Synthroid to treat her low thyroid function, and low iron was treated through supplementation.
Anna’s gastrointestinal complaints were concurrently addressed by a gentle detox of initiating a clean diet consisting of low inflammatory ingredients and whole foods, while avoiding any known food sensitivities she had. This was supported with probiotics to help restore healthy bacterial flora of the digestive tract.
She also experienced PMS symptoms which are indicative of suboptimal regulation and production its reproductive hormones, especially progesterone. This is very common with women that have been on BCP long term (longer than 3 years), as it becomes dependant on the pill to regulate its hormones. Other factors such as poor thyroid function and stress can also pull the regulation of hormones out of balance.
Once her body adjusted to a cleaner diet and her digestive complaints resolved, herbal supplementation of Chaste Tree was used to help the body restore its ability to regulate and produce its reproductive hormones. Additional supplementation of the herb Tribulus was used to help boost vitality and support production and maturation of eggs prior to ovulation which was especially important as her AMH levels were low.
L-Arginine was used in conjunction to increase blood circulation to the reproductive organs to optimize egg production and maturation, uterine lining development for implantation, and nutrients to the fetus for healthy development. CoQ10 was also used as it helps to produce energy in our cells and is a strong antioxidant that helps to preserve egg quality.
We monitored this treatment plan for 3 months while taking a break from trying to conceive. PMS and digestive symptoms resolved, energy and mood improved, and she experienced no yeast infections.
She then began trying to conceive again with the addition of acupuncture around ovulation. In two months she was pregnant. She has now the mother of a healthy baby.
Infertility is a reminder that the body is highly complex, intelligent, and unique. As Naturopathic Doctors, each case is individualized and by gaining a thorough understanding of each patient’s overall health, a protocol can be developed to support the body and promote fertility, whether you are seeking an alternative to IVF or for collaborative support during IVF. The benefits of treatment don’t end when you conceive either. Symptoms of discomfort during pregnancy can also be treated such as constipation, morning sickness, emotional changes, yeast infections, and back pain, and care for mom and baby can continue once the baby is born.
Case Study by Cristina Allen, ND of Adelaide Health Clinic