Roughly 1 in 7 American couples have difficulty conceiving, and each year they spend between $2-3 billion on fertility drugs, assisted reproduction, and other medical services. In many cases, drug based interventions can be avoided through greater attention to the couple’s nutritional status and stress level, both of which profoundly affect fertility.

Infertility is a common and costly problem. Each year, American couples spend between $2-3 billion on fertility drugs, assisted reproduction, and other medical services. According to the American Society for Reproductive Medicine, 1 in 7 American couples have difficulty conceiving. Nearly 12% of American women of reproductive age have impaired fertility. That’s roughly 7.3 million women.

Men are also affected: 30% of all infertility cases are attributable to problems on the male side. The number is about equal for cases exclusively attributable to the woman. The other 40% are due to shared factors or undeterminable causes.

In many cases, careful attention to nutrition and lifestyle factors can obviate the need for more expensive, drug-based fertility enhancement or assisted reproduction. Primary care doctors can play a vital role in identifying and correcting nutrient deficiencies and lifestyle factors that impair fertility.

Rule Out the Obvious

The first step in helping an infertile couple is to identify and address any obvious anatomic or physiological impediments to conception. In women, these include:

• Ovulatory Dysfunction, which may be caused by aging, anovulatory cycles, amenorrhea, luteal phase defects, premature ovarian failure, and elevated prolactin. Ovulatory problems account for about 25% of all cases.
• Polycystic Ovary Syndrome, affecting 6–10% of reproductive-age women.
• Anatomical abnormalities, such as fallopian tube blockage (sometimes a sequelum of pelvic surgery), uterine fibromas, myomas and leiomyomas.
• Endometriosis, found in 30–45% of infertile women.
• Medications, including hormones, antidepressants, antibiotics, pain-relievers, aspirin and ibuprofen (when taken at mid-cycle).
• Non-gynecological medical conditions, including diabetes, inflammatory bowel disease, celiac disease, epilepsy, and thyroid conditions.

Common causes of male infertility include:

• Impaired spermatogenesis due to cryptorchidism (failure of one or both testes to descend); varicocele; high fevers, infections, kidney diseases, metabolic disorders; hormone dysfunction.
• Ductal obstructions due to sexually transmitted infections, inflammation, developmental disorders like cystic fibrosis, or retrograde ejaculation.
• Systemic diseases including hemochromatosis (causing iron deposition in the testes); sickle cell anemia, which may cause hypogonadism; testicular cancer, which may cause testicular dysfunction; and testicular trauma.
• Pharmaceuticals used to treat hypertension, arthritis, digestive diseases, and cancer. Recreational drugs can also impair fertility.

Environmental & Lifestyle Factors

Environmental factors such as chemical toxins, radiation, and infections affect fertility in both women and men, modulating the hormonal balance related to conception, implantation and development. Declining sperm counts, observed over the last 50 years in men in developed countries, may be due to estrogen-like compounds in the environment. One study showed that blood levels of organochlorines are inversely related to sperm count and motility.

Environmental exposures, especially past exposures, are difficult to rectify. But daily lifestyle factors profoundly affect fertility, and they are more easily changed.

In men, avoiding alcohol consumption improves fertility. Excessive alcohol intake may decrease sperm count, reduce sperm motility, and induce sperm morphologic abnormalities. Cigarettes are also bad news. Cadmium, a toxic metal found in cigarette smoke, negatively influences fertility. Smokers have lower sperm counts and reduced motility compared to non-smokers. Marijuana use adversely impacts fertility.

Heavy caffeine intake is also detrimental. Consumption of more than 2 cups of coffee per day may negatively affect fertility, particularly among women with endometriosis and fallopian tube disease.

In women, excessive physical activity and rapid weight loss can cause menstrual irregularities, amenorrhea, and anovulation. Rapid weight loss can lower progesterone levels, slow follicular growth, and inhibit the luteinizing hormone surge, suppressing ovulation. Weight loss also mobilizes toxins stored in body fat, increasing systemic exposure. While it is generally healthy for overweight women to shed pounds, it needs to be done carefully and not drastically, especially if a woman is trying to get pregnant.

Vitamins, Minerals, & Amino Acids

Nutritional status strongly influences fertility. There are a number of scientifically validated nutritional supplements that can assist in improving fertility. It is important to assess the nutritional status of both partners, and try to correct deficiencies and imbalances whenever possible.

B Vitamins: B vitamin deficiency may alter hormone balance. Folic acid, in particular, is very important for preventing cellular oxidative damage and maintaining the health of the cervix.

Iron: Iron deficiency may cause amenorrhea, making it difficult to conceive. Supplementation in women with low iron levels improves fertility. An important nutrient for erythropoiesis, pregnant women require substantial amounts of iron. Deficiency during pregnancy is associated with complications and increased perinatal maternal mortality.

Zinc: In men, low zinc concentrations negatively affect serum testosterone levels and seminal volume. Seminal plasma zinc level positively correlates with sperm density, which in turn affects spermatogenesis. Infertile males typically have low seminal plasma zinc, which correlates with reduced blood zinc levels. In one study, men with reduced sperm motility were supplemented with 250mg of zinc daily for 3 months. Within six months, they showed significantly higher sperm counts, better progressive motility, and improved fertilizing capacity, as well as a reduced presence of anti-sperm antibodies.

Vitamins C & E: Vitamin C, and other antioxidant vitamins promote fertility in both men and women. In men, low vitamin C is associated with increased oxidative damage to spermatic DNA. In one study, vitamin C intake in normal healthy men was reduced from 250 mg to 5 mg per day. This dropped seminal vitamin C levels by 50% and caused a 91% increase in spermatic DNA damage.

Vitamin C is also important for female fertility. In animal models, supplementation with vitamins C and E attenuated age-related ovulatory fall-off. A human study found that in women taking clomiphene with no results, the addition of 400 mg of vitamin C daily was often able to induce menses and ovulation.

Vitamin E supplementation significantly decreases malondialdehyde (MDA), an indicator of lipid peroxidation, in seminal plasma and spermatozoa. It also improves sperm motility. Vitamin E and selenium supplementation in men with low sperm counts and decreased motility improved both of these factors after 6 months.

Selenium is important for sperm motility. In one study, infertile men were supplemented with selenium, selenium plus vitamins A, C, and E, or placebo for 3 months. The subjects in both selenium groups had significantly improved sperm motility, and 11% impregnated their partners.

Amino Acids: Arginine is converted to several compounds believed to play a role in sperm motility. In one trial, 74% of men supplemented with 4 grams arginine daily for 3 months showed improved sperm counts and motility. Carnitine also is important for healthy sperm development. Studies of infertile men have shown a direct correlation between seminal carnitine content and sperm motility. Carnitine supplementation appears to improve both parameters.

Botanical Support for Fertility

Several medicinal herbs have proven useful in helping to promote healthy reproductive function in women and men. Here are three of the most effective:

Vitex agnus castus (Chasteberry) has several hormone-normalizing effects. In women with hyperprolactinemia, 3 months of Vitex supplementation at 20 mg per day resulted in suppressed prolactin release, a lengthened luteal phase, and improved progesterone synthesis.  In another study, women with polymenorrhea, oligomenorrhea, and corpus luteum insufficiency were treated with standardized Vitex for 6 months, which increased average progesterone levels, and normalized the menstrual cycle in 64% of the women; 29% became pregnant.

Panax Ginseng (Asian ginseng) is an adaptogenic herb used traditionally to enhance libido. In one study, men supplemented with a Ginseng extract showed an increase in sperm number and motility, as well as total and free testosterone, dihydrotestosterone, LH, and FSH. Prolactin levels dropped.

Lepidium meyenii (Maca), a tuber that is a staple food in the high Andes mountains, has been shown to improve seminal parameters without modulating hormones. In one study, 9 men supplemented with 1,500 or 3,000 mg of Maca per day for 4 months showed increased seminal volume, sperm count, and sperm motility.

Natural Fertility Supplements

Amos Grunebaum, MD, Director of Clinical Maternal-Fetal Medicine at Weill-Cornell Medical Center, reviewed the scientific literature, and developed a line of nutritional supplements specifically for couples struggling to conceive. Recently introduced by FairHaven Health, a Bellingham, WA nutraceuticals company (www.fairhavenhealth.com), the line is formulated to supply the specific vitamins, minerals, and herbs scientifically supported for trying-to-conceive couples. These non-prescription supplements represent a significant savings over purchasing the individual constituents separately.

FertilAid for Women brings together complete prenatal vitamin support (including 500 mg of folic acid) with a select blend of herbal ingredients including Vitex Agnus Castus that have been shown to benefit trying-to-conceive women.

FertilAid for Men has been shown to increase the total number of motile sperm according to a study presented at the 2009 American Society of Andrology annual meeting. FertilAid for Men contains a comprehensive blend of key sperm-enhancing vitamins (including 250 mg Vitamin C and 150 IU Vitamin E), minerals (including 50 mg Zinc and 70 mcg Selenium), and L-Carnitine, which promotes sperm development.

FertileCM, the third product in the line, improves the quantity and quality of cervical mucus. Among other ingredients, FertileCM contains L-Arginine, an amino acid that promotes the synthesis of Nitric Oxide, which supports the production of endocervical secretions before and during ovulation. FertileCM also contains N-acetylcysteine, a natural mucolytic which helps thin mucus secretions.

Stress Reduction & Mind-Body Approaches

Generally speaking, stress impedes fertility. A couple under constant, intense stress may have great difficulty conceiving, assuming they are even able to be intimate with one another. Yoga and acupuncture are both effective in reducing stress and may improve fertility. One study showed that adding acupuncture to conventional treatments for anovulation increased the pregnancy rate to 44% versus just 16% in the women on drug treatment alone. Targeted yoga practices, such as Dr. Anna Davis’ “Bend, Breathe, and Conceive” DVD, have been developed specifically for trying-to-conceive women.

Nutritional protocols, lifestyle change, and stress reduction are relatively inexpensive. While they may not help every infertile couple conceive without drug interventions, they can help many. In cases where they do work, they provide a huge return on investment. Keep in mind that each cycle of in vitro fertilization costs approximately $12,000!

Natural, nutrition-based approaches are also safer, carrying little risk of harm. In contrast, ART increases the risk of multiple births, maternal complications, premature birth, low birth-weight babies, fetal growth restriction, infant death or disability, and health and developmental problems.

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Dr. Chris D. Meletis is an educator, international author and lecturer. He has authored 14 books, and co-authored Enhancing Fertility~ A Couple’s Guide to Natural Approaches (Basic Health Publishing). He served as Chief Medical Officer and Dean of Naturopathic Medicine for the National College of Naturopathic Medicine. During his tenure at NCNM he started 16 clinics to serve the poor. In 2003, the American Association of Naturopathic Physicians recognized him as naturopathic physician of the year. Dr. Meletis has collaborated with Fairhaven Health on the development of a number of natural products to benefit the trying-to-conceive community.