There are many ways herbs can help a couple deal with fertility. A simple red clover infusion can kick off a pregnancy for many women. Herbalists can make specific formulas for the five parts of the menstrual cycle identified by Chinese medicine or more simply incorporate menstrual charting with formulas, using herbs to tonify the yin or yang phases of the menstrual cycle as needed. One may even managed to open a blocked fallopian tube with a phlegm stasis formula. Or reduce insulin resistance in PCOS. Or improve sperm quality and motility in the male partner. Or use flower essences with a frightened first time mother. We can even use plants to deal with the residues of sexual abuse so that a prospective mother can embrace her fertility.
Here are the results of our August Herbal Blog Party where different people wrote articles on various aspects of fertility:
The indomitable Henriette Kress’s article Trying to Get Pregnant? looks at stress, tight jeans, model-thin proportions and discusses going off of carrot seed or taking lily and peony.
Kristena Haslam at Dreamseeds Organics has written a tribute to Exotic, Erotic Damiana and even has a picture of the (in)famous Mexican Liqueur bottle shaped like a sitting pregnant woman.
Karen Vaughan has written Staging Herbal Formulas to Enhance Fertility, taking the stance that the yin and yang parts of the cycle deserve different formulas, since women have cyclical tides of hormones and discusses how menstrual charting can be used for more than finding fertile days.
Angela Ferri’s piece on Herbal Fertility Support Within A Mayan Abdominal Practice discusses herbs for vata imbalance and boggy uterine tissue. She brings the experience of a body worker who looks at physical connections with the internal chemistry.
Darcey Blue of Gaia’s Gifts wrote Nutrition for Pregnancy which looks at nutrient dense foods and micronutrient requirements from a combined Paleo-diet and modern nutrition perspective.
Many women respond to single herbs or single formulas in their quest to get pregnant. A strong overnight infusion of red clover, or red clover mixed with nettles and oatstraw has pushed many women over the brink from infertility to fertility. This seems to work best when a little extra nourishment is needed in an otherwise healthy woman. But hormones are complex, and the reasons why they may be out of balance are varied.
But before giving targeted formulas , the first thing I suggest to women is that they check their nutrition. While I believe that women with a variety of fruits, vegetables and meat in their diets probably do not need to supplement most vitamins, minerals are another thing entirely. Between the mid 1970s and mid 1990’s the USDA tested the nutritional content of food and found most minerals declined by a third due to soil depletion. Magnesium is one of the most important, but zinc, boron and a number of trace minerals are also significant. I suggest at least 500mg of magnesium plus a multi-mineral or trace concentrate supplement. Fish oil sufficient to provide 1000mg of DHA (several capsules) will help keep the cell membranes of your egg responsive to the sperm. Vitamin D is not really a vitamin, but a pro-hormone and you probably need 5000-10,000 iu (a quarter to half of a physiological sun dose.) If you live north of Atlanta, are fat, have diabetes or have dark skin, you probably need more. Folic acid is very important to prevent birth defects and is found in a good quality prenatal formula which you should take in anticipation of getting pregnant.
It is important to know how to use herbs for fertility since there are so many causes. Missing minerals, insulin resistance, lack of essential fats, lack of protein, strong fears of motherhood or pregnancy, low quality menstrual cycles, silent infections like chlamydia or gonorrhea, blocked fallopian tubes, PCOS, aging eggs and sperm, and many other factors affect fertility and the remedies are all different.
The menstrual cycle has clearly defined parts as you can see on the bottom of this article (click to enlarge). The first part of the cycle, from bleeding to ovulation is ruled by Yin and is characterized by climbing estradiol (one of the estrogens) which rises to spike just before ovulation. That is followed by short spikes in FSH and LH during ovulation, which trigger progesterone for the Yang luteal phase. The pattern must be balanced to have enough Yin for a high estrogen spike, to have a good temperature differentiation between the Yin and Yang phases of the cycle and to have a high enough transition to allow the egg to be released.
Basal Body Thermometer and Chart
How would you tell if your menstrual cycle is not well balanced? In Chinese medicine we always normalize the menstrual cycle of the woman to get her pregnant. I find that it is easier to get pregnant if you actually follow your cycle by charting your basal body temperature and check your cervical mucous. To do this you keep a basal body thermometer (a digital thermometer that has an extra decimal place) by your bed and take your temperature before you start moving around. You plot the temperature on some graph paper or a chart You can find instructions for taking your temperature and making a chart here. Typically you see a low fairly steady temperature until about 12 days after you start menstruating. The temperature dips slightly, spikes high at ovulation and finishes higher. You can see an example on the chart at the bottom of the page, in the second band.
The chart is often used by women to decide when to have intercourse (just before and after ovulation) but a skilled practitioner can use it to choose herbs and to rebalance the cycle. For instance if the temperature is sawtooothed there may be Liver Qi Stagnation and herbs to move the liver and release emotions may stabilize it. The follicular (Yin, estrogen) phase may be too short or the luteal (Yang, progesterone) phase too long, so you may tonify Yin with herbs like rhemannia. The ovulation spike may occur but not be high enough to actually release the egg and vitex may be helpful. The progesterone phase may not produce a high enough temperature to prevent miscarriage so Yang tonics like walnuts and red meat are needed. The entire cycle may be too short or too long. Different herbs would be selected for different conditions and for different constitutional types.
Shatavari tonifies Yin
There are many reasons to consider giving different formulas during different phases of the menstrual cycle in order to enhance fertility. A simple way is to give Yin-tonifying herbs (with a touch of Yang) from menstruation to ovulation (the follicular phase) and Yang tonifying herbs during the luteal phase. Typically the Yin tonifying formula Rhemannia 6 (Liu wei di huang wan) is given up until ovulation and a pregnancy-safe version of the Yang tonifying formula Rhemannia 8 (Jin gui shen qi wan) post ovulation. The formulas are identical except that the yang tonifying formula has two extra warming herbs and they can be mixed and matched for partial conditions. Sometimes a third formula will be given during the few days of ovulation, especially if there is a FSH or LH defect in the cycle.
However a woman goes through more than two different hormonal processes during her menstrual cycle. In the first phase she ripens the egg and builds the endometrium in her womb, which depends upon Kidney Yin and Blood. In the second , Liver Q and Blood movement govern ovulation. In the third phase Kidney Yang and Spleen Qi regulate the luteal stage or hold the pregnancy if it occurs. In Phase 4, when PMS is most prevalent, Liver Qi helps the premenstrual transformation. And Phase 5 is menstruation, covered by Blood and a little Qi to keep it moving.
It is not necessary to come up with five formulas unless the cycle is seriously disturbed. If only one part of the cycle is not functioning well, you can target it. This is not only done by, say giving vitex which increases progesterone during the luteal phase. Instead I might use magnesium and zinc throughout the cycle as these help the body form progesterone itself. Or I might add a little warming cinnamon and maca to the Yin phase of the formula in order to give the yin enough oomph to transform to yang at ovulation.
Now normally I wouldn’t go for simple herbs given as examples in the chart above. I give herbs in formulas that are individualized for the client. The client may have a pattern of phlegm or dampness or yin deficiency which would need addressing in all stages. In formulas for all stages I would probably include an appropriate adaptogen to balance the HPA-Ovarian axis like ginseng or shatavari or eleuthero. The body will do better overall if its own balancing is engaged rather than being just pushed, but since women tend to come to me towards the end of their reproductive cycle, I don’t rely upon adaptogens alone.
I may use Yang-supporting herbs during the Yin phase since Yin engenders Yang. And I never tonify Yang without also tonifying Yin. If you look at the chart on the right you see that there is some level of progesterone during the follicular, estrogen-dominant phase and quite a bit of estrogen during the progesterone-dominant luteal phase. (This fits Yin/Yang theory quite well.)
The other reason for staging formulas is that certain formulas useful for fertility may be contraindicated in pregnancy. For instance if a woman has blocked fallopian tubes or phlegm stasis PCOS, I would want to use herbs that would be too strongly moving to be used in pregnancy. The best way to do this is to have the woman use a barrier method of birth control for two to three cycles. However in women who fear that they have few cycles left, we may only give the formula up until ovulation then stop during the time that she might get pregnant, starting up again as menstruation begins.
Women are cyclic creatures, with hormonal tides. It makes sense that we follow those tides when treating herbally, ensuring that there is enough Yin, Yang, Jing and Blood to support a healthy pregnancy. And staging herbal formulas to support those tides can give a woman what she needs to nourish a healthy baby.
It is well known that insulin resistance is the basis of polycystic ovarian syndrome (PCOS) which is a major cause of infertility, but insulin resistance affects other infertility conditions as well.
Many infertility doctors are aware of this. I had one, non PCOS, client whose fertility doctor prescribed Metformin, a diabetes drug that improves insulin sensitivity, but failed to suggest to her that she had blood sugar problems (at a stage in her life where she might be able to make changes to avoid diabetes.) Doctors routinely suggest weight loss for infertility which is also known to correct insulin resistance.
But drugs are not the first resource for insulin resistance. Diet is. In this piece we will discuss insulin resistance, inflammation and how it affects fertility.
First of all, when you eat sugar- and by sugar I mean not only refined sugar, but starches like bread (even whole grain), pasta, and potatoes and even sweet fruit. All of these cause blood sugar to significantly rise, which causes an insulin spike. In a person with normal metabolism, the elevated blood glucose level causes beta (β) cells in the Islets of Langerhans located in the pancreas to release insulin into the blood. Insulin ferries sugar into the cells under normal conditions and when the sugar is delivered, is broken down. The beta cells then sense the lower blood glucose and stop producing insulin.
Normal CellInsulin Resistant Cell
The cells in our bodies are surrounded by a membrane made up by fats and watersolube compounds called the phospholipid bilayer. The overdose of Omega 6 fats compared to Omega 3 fats makes that layer stiff. In the bilayer are receptors and gates which require minerals in the form of enzymes to ferry in nutrients like sugar, neurotransmitters and even sperm into an egg. Our diets are bereft of most minerals, chiefly magnesium and trace minerals. As a result, the sugar/insulin compound cannot easily get into the cell.
With sugar in the modern diet, we have a second problem. There is just too much for the cells to absorb. So the cell starts shutting down GLUT4 receptors, creating insulin resistance. And the sugar and insulin builds up in the blood vessels. The pancreas, which senses high blood sugar, sends out more insulin.
Fibroids stimulated by insulin growth factor can interfere with fertility
The problem is, that insulin and other carriers can be very caustic and inflame the blood vessels, further shutting down receptors. As a result the level of inflammation grows in endothelial tissue in a vicious cycle. This causes the body to “bandage” the inflammation with cholesterol. And that reduces circulation which is necessary for proper development of sex cells, and fetal development.
Insulin also promotes Insulin Growth Factor, which causes things to grow- like cysts, fibroids and even cancer cells. This can further promote problems with fertility.
Elevated insulin levels contribute to or cause the abnormalities seen in the hypothalamic-pituitary-ovarian axis as well. This affects hormone levels. Adaptogens can be used to rebalance the HPA axis after insulin sensitivity is regained.
PCOS and Insulin Resistance
Insulin resistance leads to abdominal fat. Visceral fat tissue possesses aromatase, an enzyme that converts androstenedione to estrone and testosterone to estradiol. The excess of adipose tissue in obese patients creates the paradox of having both excess androgens (which are responsible for unwanted hair growth and virilization) and estrogens (which inhibits FSH via negative feedback.)
So if you suspect the begining of any sort of blood sugar problem, there are things you can do. Weight loss will lower aromatase levels and reduce insulin resistance. Exercise reverses the loss of GLUT4 receptors. At least alter your diet so that most of your calories come from leafy vegetables, protein and fat, as lower carbohydrate diets lower insulin resistance. Exercise after eating to bring your blood insulin levels down and don’t eat between meals. And have a very low carbohydrate breakfast- say a vegetable omelet- so that you have the long stretch between dinner and lunch when blood insulin is low. When blood insulin is low, you can lose weight, build muscle and balance hormones. Take anti-inflammatory fish oil (with enough DHA to make 1000mg/day), Vitamin D to get your levels up above 50ng/ml of 25 Hydroxy D, magnesium, chromium and vanadium. And get enough sleep since lack of sleep is known to increase insulin resistance.
Image via Wikipedia
Acupuncture and herbs can be quite useful in dealing with insulin resistance and infertility issues. From cinnamon and fenugreek for insulin sensitivity, to bitter herbs to stimulate proper digestion, to adaptogens and hormonally balancing herbs like shatavari and red clover, your herbalist can find an individualized treatment that addresses your underlying issues.
While I used to think otherwise, I firmly believe that nursing mothers should supplement both themselves and their babies with Vitamin D. The exceptions to this are mothers who live south of Atlanta, who together with their babies are out of doors without sunscreen between 11:00 am and 1:00pm and who don’t use soap when they wash (because it washes away the D2 oil involved in the process of making D3.) We used to have government programs to encourage parents to take children out into the sun. See this informative and entertaining video from UCSD.
In Finland, babies were routinely given cod liver oil providing 4500 iu of D (and modern cod liver oil is NOT recommended for it due to lower D/A ratios). Then, since research showed that rickets could be prevented at 400 iu, the recommended daily amount was lowered. As a result, Type 1 Diabetes skyrocketed. We have very good data showing that 90% of Type 1 Childhood Diabetes can be eliminated by Vitamin D supplementation.
The link between Vitamin D and Type 2 diabetes in children is less supported but there is good evidence that it may also play a role.
Vitamin D deficiency may also play a role in some autism. The blood levels of Vitamin D in autistics is generally low.
Vitamin D Council’s John Cannell, MD, (http://www.vitamindcouncil.org/health/autism/ is convinced that vitamin D deficiency is linked to autism and that the autism “epidemic” started at the exact same time that the vitamin D deficiency epidemic started. As soon as we started limiting sun exposure and using sunscreens, the number of autism cases shot up. Science Magazine published a similar article. There are groups of Somali children in Sweden and Minnesota who are hugely overrepresented among autistics, with the only real difference between their lighter skinned peers is that their skin color prevents Vitamin D absorption. It is correlation, but is compelling.
I have here a number of articles on Vitamin D and its health benefits. While theoretical toxicity is a potential problem, it is hard to get high enough to be toxic. And since 13,000 Finnish babies managed on 4500 iu, then we have good evidence that isn’t so high.
While it is very important that a pregnant or nursing mother have high D levels, it isn’t easy to do that from diet alone. Most of us drink less milk, eat less liver or organ meat, don’t go out into the sun around noon without sunscreen and we wash the oils off of our skin that might be turned into the vitamin. We are also heavier, which reduces Vitamin D. Our foods used to have a lot more D: cattle grazed in the sunlight foraging for wild plants, wild fish ate plankton instead of Purina fish meal, and pigs and chickens weren’t penned indoors. The supplementation of Vitamin D from irradiated milk is insufficient to make up for the loss. And your prenatal vitamins won’t have enough because the RDA is too low.
If your skin is dark, chances are that your D levels are low. The National Health and Nutrition Examination Survey) found African Americans were low: just 3 percent of blacks sampled in 2004 were found to have the recommended levels compared with 12 percent two decades ago. If you don’t have it, you can’t pass it through your milk. Breastfed infants have been taken away from nursing African American mothers on suspicion of abuse because they had hidden fractures from rickets and were not tested for them. Since we are out of our ecological niche, we no longer have the natural sources of Vitamin D at our disposal and we probably need to supplement.
I would personally take 10,000 iu during pregnancy and lactation, more if I had conditions that reduce Vitamin D like dark skin, autoimmune disease, diabetes or obesity. I would personally give my baby 2000 iu, and would massage in a D-supplemented skin oil (even if I had to add it in myself.) We would both spend time in the noonday sun without sunscreen. And just to be safe, I would ask for 25-hydroxy-D blood tests to make sure I was getting it high enough.
Watching this You-Tube video from the University of California at San Diego might be one of the best things you can do for your health. It explains clearly and in detail which levels of vitamin D3 are necessary to prevent a great variety of diseases. Rickets, the disease our woefully inadequate RDA was designed to prevent, needs very little Vitamin D. Cancers, diabetes, heart attack, falls, fractures, hypertension, neurological impairment, even pain will be prevented by raising your blood Vitamin D levels to the recommended range.
I have been taking 10,000 iu of Vitamin D3 daily for the last year and am only in the low end of the recommended range.
A blood level of Vitamin D (have your doctor test it) should be 40-60 ng/ml, which is likely higher than the reference range of the test. You would need to reach 200 ng/ml to suffer from toxicity. The amount you need to supplement will vary, but is way way higher than you find in any multi. Unless you seek out a special high concentration vitamin D supplement, you are not getting enough, at least above the Mason-Dixon line (and usually below as well.)
This video puts together the Vitamin D research and offers a public health program designed to raise Vitamin D3 and calcium to levels that would prevent 58,000 new cases of breast cancer and 49,000 new cases of colorectal cancer annually in the US and Canada within the next five years. The researchers model also predicted that 75% of deaths from these cancers could be prevented with adequate intake of vitamin D3 and calcium.
In Finland, in the 1960s, mothers gave babies 4500 iu of Vitamin D daily. When the dosage was lowered to 2000 iu, type 1 diabetes rates began to rise and when the dosage was lowered to 400 iu, the level we usually find in a US multi-vitamin, type 1 diabetes skyrocketed. With sufficient supplementation during pregnancy and early childhood you can prevent 8/10 cases of type 1 diabetes. You will rarely find the higher level of Vitamin D recommended for children in the US because we have only focused on the association of Vitamin D and rickets.
Vitamin D helps maintain tight junctions between cells so that signaling is better and viruses or other infectious agents cannot get in between the cells. Some of those agents will trigger autoimmune reactions.
The chart linked below shows why higher doses are needed for cancer, type 1 diabetes, MS, and a variety of other diseases than rickets- the MDR was based on preventing rickets which responds well enough to low doses of vitamin D. Note that 35% of all cancers were prevented with at a level of 1000 iu daily, giving a blood level of 38 that is below the recommended range -perhaps much higher prevention would be found if they had tested higher ranges. Most disease tested were prevented in the 40-60 range, with toxicity not found below 200. It is all based upon good research:
