Taking Charge of Your Fertility: Book Review and Tips

A lot of patients ask for information on fertility and I recommend a number of books. One that is very interesting is Taking Charge of Your Fertility, by Toni Weschler, MPH. It is subtitled "The definitive Guide to Natural Birth Control, Pregnancy Achievement, and Reproductive Health." It is an easy-to-read overview of natural approaches to enhancing fertility, as well as a discussion of the medical options for fertility and for birth control.

The center piece of her discussion is what she calls the Fertility Awareness Method. Basically, this a method to become aware of the signs of fertility, primarily temperature changes and changes in cervical mucous. I find this method of particular interest because it allows a woman to determine her specific fertility cycle and best days for getting pregnant, as opposed to taking the standard 28-day cycle, ovulation on day 14 as a guide. Ovulation can occur as early as day 8 for some, and very late for others, day 22 or beyond. For couples who are timing their sexual intercourse to coincide with fertile days, using the statistical generalization of 'day 14' may mean missing the actual days when fertility can occur, and missing their goal of pregnancy. Acupuncture and herbs are very good at regulating the menstrual cycle -- and helping a patient get to the ideal of a 28-day cycle, but it is always better to know the exact period of fertility for a particular patient, especially for those who have a long history of birth control use (the Pill) and irregular cycles.

Here are a few of my tips for fertility, some of which are also discussed in Ms. Wechsler's book.

1. Avoid the use of lubricants. Most are harmful to sperm, including saliva and glycerin (which is found in most lubricants). Changes in pH and osmolality both affect sperm motility and life span. Wechsler notes that canola oil and baby oil have shown minimal negative impact of sperm activity, and that egg white is considered by some to be the best option for those needing natural help, with some concern for the fact that egg white is not determined to be bacteria free. Pre-Seed Lubricant is a commercial option that has been created to avoid negative effects on fertility.

2. Related to the first item, douches, vaginal sprays and tampons are not recommended. Anything which alters the pH of the vagina or affects cervical mucous can negatively impact sperm motility and one's chances of getting pregnant.

3. Excessive exercise and low body fat can reduce fertility. This is something I discuss with patients regularly. For achieving pregnancy, and regulating the menstrual cycle, adequate intake of healthy fats and oils is very important. Reducing stress on the body is also important, and that includes avoiding over-exercising. Moderation is very important, as well as getting adequate rest and sleep.

4. Caffeine, nicotine, marijuana, alcohol and other recreational drugs should be eliminated or reduced. This seems obvious to most people, but it is worth mentioning. With my patients, I evaluate the stress-impact of these changes. Recreational drugs have to be eliminated, but for those who can't function without coffee or tea, it is sometimes better to reduce than to eliminate. The stress of going completely without may have a more negative short-term impact than the caffeine. For those with fertility challenges that persist for 4 months or more, it becomes more important to eliminate any factor which impacts fertility.

5. Anti-histamines -- this is an interesting one for those with allergies, and it is worth considering alternatives to their use if you are experiencing challenges in getting pregnant. Antihistamines can alter the cervical mucous -- which is usually not a good thing. Expectorants can be used to thin cervical mucous. This is an effect which is rarely discussed. For men, steroids, antimalarial drugs and ulcer medications can suppress sperm production.

6. Hot tubs, saunas, jacuzzis -- anything that increases the temperature of the testicles can reduce male fertility, or cause sterility in some. Avoid overheating -- it takes at least 6-weeks to recover, and may take up to 3 months. For men whose sperm is very sensitive to heat, wearing boxers and loose pants becomes important, as well as to avoid sitting with legs crossed for long periods. Bike riding can also have a negative impact for some, even long hot baths.

Byron Russell

Daily Sex Improves Male Fertility

In my fertility practice it is very common that only the wife of the couple comes in for treatment. Often I never see the husband. This reflects the fact that there remains in our culture a sense that fertility issues are a woman's problem. However, current estimates suggest that 30% of fertility problems result from male factor infertility issues, including problems with repeated miscarriage. An additional 30% of couples show problems for both partners. So, there is good reason for evaluation and treatment to include the male partner for any couple experiencing problems. This is becoming a bigger issue as human male sperm counts continue to decline, an issue that has been well-documented and well-publicized over the past few years and is a factor of increasing concern.

A study presented at the European Society of Human Reproduction and Embryology looked at the effect of regular ejaculation on sperm quality, specifically DNA damage.

The study was conducted with 118 male test subjects; all of whom had a history of infertility. Infertility includes such conditions as damaged sperm, repeated miscarriages and recurrent failure of in vitro fertilization. Samples from all 118 test subjects showed over 15% of their sperm showed DNA damage.

The test was very simple: for a week each man was required to ejaculate daily. At the end of the week, a sperm test sample was provided for clinical review. The results showed that DNA damage was reduced in a whopping 81% of the men; by any standard that is a very significant change.

Nineteen percent of the test subjects actually showed increased damage to the DNA in the sperm. The study concludes that the 19% that showed increased DNA damage most likely had underlying problems that were not “treatable” with the ejaculation method.

The results here are a little mixed, showing improvements in DNA quality for most (81%) of the men. One item to note is that the testing period was only one week long. The effects of daily ejaculation over a longer period of time are not addressed in this study, and Chinese Medicine would expect a decline in fertility over the long-term for most men due to over-taxing the Kidney Jing (or vital essence).

The traditional Western medical advice has been for men to refrain from ejaculation from 3-7 days before their partner's ovulation time. A number of research studies are showing that this is not true and that more frequent sex during the fertile window can improve the chances of pregnancy.

Chinese Medicine makes a prescription for ejaculation based on a person's age and state of health - particularly the state of the Kidney Jing. For a healthy man in his mid-30's, the number tends to be 3-4 times a week. I see great variation in my patients, from those who ejaculate 5-6 times a day, to those who ejaculate 1-2 times a month. This reflects differences in basic constitution as well as current health and it is not helpful to state a single number that is right for all men or all situations. For instance, one of my patients who ejaculated multiple times a day had problems with insomnia and migraine headaches if he cut back on that number. I've had other patients who experienced sore throats and frequent colds with increased sexual activity beyond a couple times a month. So, it is important to evaluate your state of health and how sexual activity plays into that. Remember also that there is a very long tradition in Chinese Medicine for maximizing virility and fertility into old age. This was a very important issue in Chinese culture and many treatments were developed to address this issue.

When fertility is the goal, we want to maximize the health of the Kidney Jing and the quality of the sperm. Acupuncture has been shown to do that when low sperm quality is an issue. Herbs like Huang Qi have been shown to improve specific factors like sperm motility. Another possible approach that is recommended in Taoist texts is frequent sexual activity without ejaculation. This has a strong effect on increasing testosterone levels, and higher testosterone levels have been linked with higher quality sperm. In a general sense, balancing the body and improving general health reduces demands on the vital (or constitutional) essence, leaving more body resources for creating healthy sperm.

Lastly, here is a look at current research from the World Health Organization (WHO), via the Oxford Journals on sperm quality parameters for fertility.

semen volume, 1.5 ml (1.4–1.7);
total sperm number, 39 million per ejaculate (33–46);
sperm concentration,
15 million per ml (12–16);
vitality, 58% live (55–63);
progressive motility, 32% (31–34);
total (progressive + non-progressive) motility, 40% (38–42);
morphologically normal forms, 4.0% (3.0–4.0)

These numbers came from a study of men whose partners became pregnant in 12 months or less.

Byron Russell

Timing Your Fertility

Here are some tips from FertilityFriend on the timing and frequency of sexual intercourse in promoting pregnancy. This is an update on what was generally recommended in the past, particularly regarding the frequency of intercourse.

The Fertile Window

Sperm may last up to 5 days in cervical fluid and the egg may last up to 1 day after ovulation -- but these are the extremes. Intercourse during the two days prior to ovulation and on the ovulation day is more likely to produce a pregnancy.

Your fertile window is made up of the days in your menstrual cycle when pregnancy is possible. The length of this fertile phase is determined by the maximum life span of your partner's sperm and your egg. Sperm can survive a maximum of five days in fertile cervical fluid and your ovum can survive for up to one day. Your theoretical fertile window is thus six days long, comprised of the five days before ovulation and the day of ovulation. You only have a chance to conceive when you have intercourse on these days. This means that pregnancy is technically possible from intercourse on any of these six days. The likelihood of actually becoming pregnant, however, is dramatically increased when you have intercourse in the three days immediately leading up to and including ovulation. This makes a practical fertile window of just three days.

Frequency of Intercourse --

In the past it was suggested that the male refrain from ejaculation for 3 days prior to intercourse, giving the sperm cells a chance to mature in the epididymis, and giving the semen volume and sperm count time to build. But, this is no longer thought to be true. Frequent intercourse during the fertile window produces a higher chance of pregnancy.

There has been some speculation that couples who are trying to conceive should reduce the frequency of sexual intercourse during the fertile window to increase sperm supply. This is not true for most couples. While couples with known male factor issues should consult their doctor for the best intercourse strategy, couples with normal fertility and no known sperm issues should not reduce the frequency of intercourse in the fertile window. Your probability of conception is increased when you have intercourse multiple times in your fertile window. While it is true that sperm concentrations decrease slightly with increasing intercourse frequency, frequent intercourse is still more likely to result in conception than infrequent intercourse for couples with no male factor fertility issues. Each additional act of intercourse within your fertile window increases your probability of conception for that cycle.

Byron Russell

Acupuncture for Fertility

Here is a small summary of the use of acupuncture for fertility issues from Acupuncture.com, October 2009. I was particularly struck by the comment on a study from the British Medical Journal showing nearly twice as many live births for IVF when acupuncture is added.

Acupuncture and Chinese medicine can be used in combination with conventional reproductive medical care or as a primary treatment approach. Acupuncture can be effective for women taking fertility drugs or reproductive technology techniques (such as IVF or IUI). Acupuncture and traditional Chinese medicine can also be effective as a stand-alone approach to treat infertility for those not undergoing conventional medical treatment. Acupuncture helps to regulate hormonal activity, thus regulating menstruation, ovulation, and pregnancy. A recent study from the British Medical Journal found that among women who received acupuncture and IVF, the pregnancy rates were 65% higher and the rates of live births were nearly twice as high than among women who received IVF with sham acupuncture or no acupuncture.

Acupuncture helps to reduce stress and decrease the hypersympathetic nervous system response. Studies have shown that high stress levels decrease the likelihood of conceiving. Acupuncture has been shown to stimulate chemical changes within the uterine lining, thickening the endometrium, and preparing the uterus for implantation.

In men, acupuncture can improve sperm motility, volume and concentration as well as increase libido. From the perspective of Chinese medicine, optimum fertility enhancement would involve a course of treatments with the aim of nourishing the Kidney Essence and regulating the menstrual cycle as well as clearing any pathogens that may be interfering with the natural process of conception.

Byron Russell

Fertility Talk: Propecia May Reduce Male Fertility

One of the goals of this blog is to collect news stories about fertility issues. There certainly is more information out there than anyone can keep track of. But, it is nice to have some of the more unusual or interesting stories collected in one place.

This one surprised me, and is something I could easily see causing problems for some of the couple who come in to see me for fertility issues. Propecia (used to prevent hair loss, and a very commonly prescribed drug)can reduce semen volume and affect fertilty in men.

A back ground quote from NetDoctor:

Primary infertility is an extremely common problem, affecting more than one in seven (15 per cent) couples attempting their first pregnancy. Among those experiencing difficulty with conception, a male fertility problem is considered important in around 40 per cent of couples. In 15 per cent of couples it will be solely a male fertility problem and in around 25 per cent, there will be a problem in both partners.

And a comment from Dr. Turek, one of the leaders in the study and treatment of male infertility:

“The FDA does not require fertility studies of these drugs, and it has been the suspicion of most of us in the field that if you take this drug for more than five years then you might consider stopping it because it does look like a player in decreasing spermatogenesis.”

click below for the full article:
Renal&Urology News

Byron Russell