SECONDARY INFERTILITY (SUB-FERTILITY) – WHAT CAN I DO? The equation, egg + sperm= foetus is not always a straightforward one. It can be confusing, isolating and a source of grief for many couples struggling to have a baby. Infertility and secondary fertility or sub-fertility as it is also known, are no respecters of our five-year plans. One in six couples are infertile. It is impossible for them to conceive or sustain a pregnancy. What is less well known is that one in four couples have difficulty conceiving at some time during their reproductive life. This becomes more apparent in our late thirties and early forties, but can happen much earlier. Secondary or sub-fertility can occur even after several children, it is reduced or unexplained infertility caused by physiological and/or environmental factors. A great deal of information is available about treating infertility using IVF and high technology treatments. Fewer people are aware of the relatively high incidence of sub-fertility or the low technological strategies available to address this problem. The best way to deal with the complexity of issues and information on this topic is to find out as much as you can. That way you will be in a much better position to ask questions and to choose a form of treatment. Learn about reproduction, chart your cycle, investigate different therapies and start sooner rather than later. There are two approaches to address the issue of infertility or sub-fertility. One is the medical model of high technology drugs, microsurgery and IVF at considerable cost to the couple and the community. The other is low technology natural therapies e.g. Naturopathy, Chiropractic, Herbal medicine etc to try to restore the body’s fertility levels. In fact, IVF conception would also be greatly assisted by natural therapies with a pre-conception diet and lifestyle changes. The goal of either model of course is to have a healthy egg, sperm and uterus to produce a healthy baby. Medical Model Reproductive endocrinology is a high technology field that covers a range of investigations to diagnose the nature of a couple’s infertility. For example, tests to establish ovulation, egg quality and sperm quality i.e. formation, motility and quantity, fallopian tube capacity, mucus receptivity and other mechanical causes e.g. adhesions. The costs of IVF are considerable for a number of reasons. Most obviously is the financial outlay, which can run into tens of thousands of dollars. You cannot put a price on the life of a child, but not everyone has access to these treatments. The treatment can be invasive, repetitive and distressing when treatment cycles fail, or miscarriage occurs. Couples should endeavour to familiarize themselves with the processes and the outcomes of treatment before proceeding. Recent long-term research conducted in Western Australia indicates that IVF babies have a 2-3 times higher chance of having a congenital defect. Many of these difficulties do not become apparent until several years after birth. According to the Australian Reproductive Technology Accreditation Committee (2000) live birth rates for couples that proceed with IVF and related treatments are on average about 25%. Results vary in different facilities and are higher for younger women and drop dramatically for women 40 and over. It is important to comprehend the nature of treatments and the likelihood of outcomes in considering a course of action. Alternative Model Alternative therapies look at strengthening each partners whole system with reference to their past and current health. Instead of primarily looking at what may have caused the deficits of the reproductive system. In The Natural Way to Better Babies, Naish and Roberts argue that preventative healthcare such as dietary and lifestyle changes and a reduction in environmental toxicity factors for the couple will result in better overall health. These approaches are less stressful, much cheaper, result in better overall health of parents and child and are free of ethical dilemmas. Research conducted by Foresight in the UK (results published in The Journal of Nutritional and Environmental Medicine, 1995) indicates nutritional therapies have a much greater likelihood of improving fertility. They have a much higher rate of conceptions and births than high technology approaches. Not only do they result in healthy late term pregnancies, and healthy babies with sound birth weights but also there are fewer complications after birth. Infertility Infertility is a condition of one or both partners who have physiological abnormalities that prevent them from conceiving and maintaining a pregnancy. Male factors include: lack of sperm, congenital defects, blocked epidermis or vas deferens, testicular damage, impaired ejaculation and impotence. Female factors include: absence of ovulation, egg formation, viability of fallopian tubes and uterus, endometriosis and frequent miscarriage. Both partners can also be affected by hormonal imbalance, anti immune disorders and damage from sexually transmitted diseases. Some of these physiological deficits can be overcome by surgery to clear blockages, stimulate hormones or artificially inseminate using IVF or GIFT. A couple is classified as infertile when they have had regular (2-3x per week) unprotected sexual intercourse for 12 months. Recurrent miscarriages and inability to sustain a pregnancy also indicate the need for thorough evaluation. Male and female factors contribute about 40% each and the remaining 20% are a result of a combined problem or unknown causes. Secondary or Sub fertility is a decreased capacity to conceive, including miscarriage. It also covers the 20% of unknown causes. The important distinction between infertility and sub fertility is that it may take considerably longer for sub fertile couples to conceive but there is still a possibility that they can. Why the increase in Sub fertility? Numerous factors contribute to sub fertility. The environment is heavily laden with pollution. Our reproductive systems are very sensitive to many pollutants, which undermine their ability to reproduce. What is sufficient capacity to sustain an adult is often insufficient to facilitate a conception. The peak period for women’s reproductive health is in their late teens and early twenties. As women get older, their chances of conceiving can be diminished by disease, allergies, toxicity of environment and early menopause. However, with specific nutritional care many women do go on to conceive healthy babies into their early forties. Our soil is nutrient poor, mostly farmed with unsustainable practices using high doses of fertilizer and pesticides. The nutritional content of food deteriorates with preservation, heating and additives. A nutrient depleted food uses up the bodies store of vitamins and minerals. Illness and allergies also require nutrients in the body to fight infection. Lifestyle factors such as: alcohol, tobacco, oral contraceptives, prescribed and social drugs further stress the body and leach essential nutrients from the body. Alternatives However, Naish and Roberts in “Better Babies”, and Reed in Sub-fertility – A natural approach to getting pregnant, argue that there is an alternative to having your general health and fertility undermined in these ways. It is impossible to eliminate all stressors but you can counteract some of the damage your body has sustained and will continue to sustain. You can utilize the knowledge and benefits of nutritional therapies. These are low technology, achievable, non-invasive approaches to preventative healthcare. Like all dietary and lifestyle changes, they can seem insurmountable initially but with a clear goal to maximize fertility they can be accomplished. Significant improvement will occur if only one partner modifies their diet and lifestyle but obviously, the outcome will be much better if both commit to the changes. In fact, men who might be reluctant to radically change their lifestyle could get away with only doing four months preconception care. Diet and Lifestyle The above mentioned books recommend that both partners need to drink pure water, avoid caffeine e.g. coffee, cola, chocolate etc., and eat whole, mostly raw food grown on healthy soil e.g. organic foods. It is necessary to reduce stress, do moderate exercise and maintain optimum weight. It is important to have infections and allergies treated and reduce exposure to environmental pollutants in our homes, gardens and workplaces. We need to be aware that many of the convenience products to which we have become accustomed have ‘green’ alternatives, which are better for our environment and us. Healthcare Support Natural therapies cover a wide range of approaches. For e.g. Naturopathic, Homeopathic, Chiropractic and Chinese Herbal Medicine to name a few. For those who prefer to see a medical practitioner there are doctors who specialize in Nutritional and Environmental Medicine. Given the complexity of nutritional deficits and an individual’s specific needs it is essential to be clinically assessed. Professional diagnosis and treatment is a prerequisite to determine your treatment requirements and any supplements needed. You undertake the diet and lifestyle changes yourself but have the advice and support of the practitioner. Where to start? Read first and establish the issues and what is relevant to you. Contact the professional association of each discipline and get names of practitioners who specialize in infertility treatment in your area. Look for a practitioner who will support your endeavours to improve your health and chances of conception. If you’re not sure which approach might be most beneficial for you ring a range of practitioners and ask them how they would approach treating your condition. Of course, there are no guarantees whether you opt for a medical or an alternative mode of treatment. However, if there are comparatively inexpensive, relatively simple (if not easy) things that you could do to promote your family’s health wouldn’t they be worth your consideration? If you think that you might be one of the 25% of couples who are sub-fertile then maybe you haven’t run out of options just yet. RESOURCES: The Natural Way to Better Babies – Preconception Healthcare for Prospective Parents Francesca Naish, Janette Roberts Random House Australia 1998 Natural Fertility Management The Jocelyn Centre Woollahra NSW Ph:02 9369 2047 Options for Postal Clients Sub-fertility – A natural approach to getting pregnant. Julie Reed Tandem Press, New Zealand 2000 Billings Family Life Centre, 27 Alexandra Pde, Fitzroy North, Vic. Freecall 1800 335 860 Birth over 35 Sheila Kitzinger Allen and Unwin 1994 Foresight Association for the Promotion of Preconception Care 124 Louisa Rd, Birchgrove, NSW 2041Ph/Fax 02 9818 3734 Access Australia’s National Infertility Network P.O.Box 164, Montville 4560 PH: 07 54429145 Handmade Naturals By Corinne (Non-Toxic Cosmetics, Cleaning Products) 7 Gladstone Rd, Highgate Hill PH: 07 3846 4685 Simple things to reduce stresses on your body in the preconception phase (According to The Natural Way to Better Babies by Naish and Roberts – see book for complete list) Drink and cook with pure water Eat organically grown and/or fed foods. Eliminate food and drinks with caffeine Eliminate alcohol and nicotine Avoid drugs, oral contraceptives, medicinal drugs (if possible) and recreational drugs Meditate or develop relaxation strategies Moderate exercise Maintain Optimum weight Treat allergies Use non-toxic alternatives to products e.g. kitchen, bathroom, laundry, garden and cosmetics. Avoid exposure to radiation E.g. x-rays, microwaves, computers, photocopiers and mobile phones. Avoid pesticides, herbicide, insecticides, solvents, glues etc Avoid traffic pollution-close car windows, don’t exercise near traffic Avoid renovations with lead based paints (pre-1960’s) Use safety gear handling chemicals Avoid use of aluminium; e.g. cooking equipment, toiletries and food additives Have mercury dental amalgams replaced with ceramic ones Simple things to increase fertility for him- Limit hot baths/ saunas Wear boxer shorts/no tight jeans Limit time wearing synthetic sports pants