Fertility Trends & Support

Have you ever watched on ultrasound a baby move around in the mother’s womb? It is amazing. However, not every couple gets to experience that joy without hurdles. Experts have sat together at the Fertility Symposium organised by the Australian Traditional Medicine Society. They discussed latest statistics, trends and evidence-based supportive treatments for couples struggling with falling pregnant (Ref: 1). 

Pregnancy Trends in Australia

• Couples seeking fertility support are more complicated (Ref: 2). 
• Fewer mothers have a spontaneous vaginal delivery. 
• Infertility is now a global health issue. 
• Demand for assisted reproductive procedures has increased. 
• With the advancement of fertility technology, treatment outcomes have also improved. 
• Genetic fertility technology has become more comprehensive.  

Challenges of Fertility Specialists

• Patients are older
• Some patients respond poorly to intervention
• Recurrent implantation failure
• Recurrent miscarriage
• Rising infertility rates  (Ref:2)

Evidence-based Chinese Medicine

• Extensive fertility research has been done on Chinese herbal medicine (Ref: 7).
• The Blood tonic formula, Si Wu Tang, is shown to decrease ovarian oxidative stress, reduce inflammation, improve ovarian function and egg quality. It activated the development of follicles and increased blood flow to the ovaries (Ref: 8).
• The Kidney Yin tonic formula, Liu Wei Di Huang Wan, improved the quality of ovarian cells, embryos and pregnancy rate in certain infertile women. These women went through IVF (in vitro fertilisation) in a randomised control trial (Ref: 9).
• Research on acupuncture intervention showed that women who used Chinese medicine before and during the IVF cycle had a higher live birth rate than those doing IVF alone. These women had an average of 12 acupuncture treatments as a course (Ref: 10). 

Naturopathic Findings

• Reproductive microbiome, or good bacteria in reproductive organs, have significant effects on fertility (Ref: 3). Improving bacteria colonisation in the body is beneficial in fertility. 
• Oxidative stress plays a negative role in testosterone production. It has negative effect on the health of the mitochondria, which is the powerhouse of sperm cells. It impairs embryonic health and the fertilisation process (Ref: 3, Fig 2). It is thus important to maintain a healthy diet and to reduce stress, smoking, alcohol, radiation and environmental toxins. 
• CoEnzyme Q10 in the form of ubiquinol strengthened the female power house function of the cell, or mitochondria. It protected eggs from oxidative damage and delayed ovarian reserve depletion. It also improved sperm count, motility, morphology and density (Ref: 4, 5). Liver, kidney, fatty fish, meats, pistachio, sesame seeds and vegetables and legumes are good sources of CoEnzyme Q10.
• Lifestyle changes such as exercise, appropriate fasting, healthy caloric intake, quality sleep, the circadian rhythm, heat/cold shocks, dietary adjustment help to alleviate reproductive decline in ageing. (Ref: 6)

Stress and Fertility

• Studies suggest that our mental space has an impact on fertility through the interplay between neurotransmitters and sex hormones. (Ref: 11)
• Stress lowers immunity, libido, sleep and resilience and increases oxidative stress. (PMID:30501641)
• To support mental health and fertility, these supplements were suggested: magnesium, zinc, iron, B6, C, D Omega 3, NAC (N-acetyl-cysteine). However, it is highly recommended that an assessment is made by a professional therapist as overdose can occur with unwanted side effects. 

Male Factor Fertility 

• Infertility is not just a female issue. Sperm issues contribute to around 50% of all infertile cases, according to Andrology Australia, 2019.
• Male factor fertility continues to decline at an alarming rate. A most definitive study on human fertility (Ref: 12, 13) showed that from 1973 to 2011 there was approximately 50% reduction in sperm count. 185 studies of 43,000 men from Europe, North America, Australia and New Zealand were involved. 
• The researcher claimed that reduced sperm count is associated with increased all-cause mortality and morbidity. Semen quality is the ‘canary in the coal mine’ for human health (Ref:17). Thus where there is abnormal sperm analysis, it is necessary to address male overall health.    
• Low semen volume, sperm concentration, sperm motility, total sperm count and total motile sperm count were all associated with higher risk of death. 
• Reduced sperm count is associated with testicular issues such as testicular cancer. 
• Environmental influences are thought to play a part in rising male infertility. Hormonal disrupting chemicals such as bisphenol, pesticides, phthalates, heavy metals, mobile phone radiation and tobacco smoke exposure are thought to be some of the examples.  
• Healthy diet is associated with better semen quality (Ref: 14).
• Vitamin D at a range of 50-124 nmol/L was found to be beneficial to sperm count, sperm motility and testosterone count. Too little or too much vitamin D is harmful. It is therefore important to test before taking supplements (Ref: 15).  
• Covid-19 infection has been shown to negatively affect male fertility outcomes probably due to the thrombosis and inflammation it caused (Ref: 16). 

References

1. Fertility symposium held by Australian Traditional Medicine Society (ATMS) 22 May, 2022. Speakers: William Ledger, head of Discipline of Obstetrics and Gynaecology of the Faculty of Medicine UNSW and Directory of Reproductive Medicine; Leah Hechtman, naturopath; Amy Forth, Chinese medicine practitioner, Katey Weekes, naturopath 
2. Professor William Ledger presentation at Fertility Symposium on 22 May, 2022.
3. Trends in Ecology in Evolution, Rowe ….
4. Hernández-Camacho, Bernier, López-Lluch, & Navas, 2018; Xu et al., 2018; Ben Meir et al, 2015; Ben-Meir A et al 2015b; Özcan, P., et al, 2016
5. Cecchino, G., et al 2018.
6. Poljsak et al., 2020; L. Liu et al., 2018; Palmer et al., 2021; Covarrubias et al., 2021.
7. Amy Forth, Chinese medicine practitioner at Fertility Symposium on 22 May, 2022.
8. Li et al, 2017; Zdunska et al., 2018; Park et al., 2020.
9. Fang et al., 2014
10. Hollender 2015 
11. Katey Weekes, Complementary practitioner at Fertility Symposium on 22 May, 2022.
12. Rhiannon Hardingham, Naturopath at Fertility Symposium on 22 May, 2022.
13. Levine, et al., Human Reproduction, 2017
14. 14. Fertility and Sterility, 2018
15. Hammound et al., 2012, Asian Journal of Andrology
16. Collins et al., 2022, Impact of COVID-19 on male fertility, Urology. 
17. Eisenberg et al., 2014 , Semen quality, infertility and mortality in the USA Human Reproduction.