The Nutritional Supplement

• She describes a weight gain of 15lbs over the past 12 months.
• She points to the conclusion of her infertility workup 15 months ago as the precipitating factor and describes her eating as “stress eating”.
• She states, “We tried for years and years to have a baby. It started with visits to our primary care doctor, then there was 18 months of temperature taking, then courses of fertility drugs followed by two failed attempts at IVF. We gave up a year and a half ago. We just had to admit that we are an infertile couple.”
• Since then, she describes feeling mildly depressed and now has a pervasive sense of general underlying anxiety. She stopped exercising and began to gravitate towards comfort foods. The patient, currently reports the following:

-        She wakes up with mild fatigue. Her energy remains low throughout the day. She does get a second wind in the late afternoon.

-        She sleeps poorly – both having trouble falling asleep and staying asleep for more than 4 hours at a time.

-        She knows that she eats too much, but hasn’t found the motivation to eat less.

-        When speaking about her infertility, she immediately becomes tearful.

-        She has had a recent annual examination with laboratory testing. Of note, this appointment was delayed as she has developed a fear of needles and of doctors since her infertility workup.

• General: Weight gain of 15# over one year. Present weight = 168#; height = 5’5”; BMI = 28.0
• GI: Bowel movement every 2 days; formed, some straining
• Endocrine: Fatigue, periods of feeling weak and irritable that the patient calls “times of low blood sugar”
• Gyn: No history of STD or Pelvic inflammatory disease; History of OCPs x 5 years – stopped 5 years ago. Regular menses; heavy flow with cramps. Last PAP normal.
• Psych: Depression about infertile status; general sense of fear; anxiety about medical care and has developed a needle phobia
• Elevated blood sugar during adolescence
• Epstein Barr virus diagnosed while in college
• Mother – Type 2 diabetes developed in her 50’s
• Father – Asthma
• Married x 6 years; describes marriage as good
• Occupation – Works as an insurance agent
• Diet: No restrictions. Typical day
• B – croissant and jam, coffee
• Sn – fruit yogurt
• L – taco salad or deli sandwich, chips, diet soda
• Sn – cookie
• D – pasta with sauce, rice and chicken, meat and potatoes, desert most nights
• 1 -2 glasses wine nightly
• Activity: Walks on weekends
• Stress: Sad and discouraged about not being able to have children; very (and visibly) anxious about doctors and medical evaluation

Assessment Considerations:

• When working up a couple for infertility, your history-taking is your best ally. Be sure to ask questions to get to the underlying cause of the presenting symptom, whether it’s low sperm count or recurrent miscarriage. The integrative approach digs deeper and provides solutions that go beyond the fertility issue.
• How much stress has the couple been under? Remember that a demand for cortisol can shunt hormone production away from reproductive functions
• To simplify your assessment, ask yourself where the problem lies: is it in the quality of the egg/sperm cells? The health and responsiveness of ovaries/testicles? Hypothalamic-Pituitary-Ovary communication errors? Uterine environment?
• Be sure to consider things that haven’t been looked into conventionally: environmental toxins, stress, food allergy/intolerance, etc.

Insights, Tips and Perspectives:

• Couples are often highly motivated to be compliant with your treatment plan. Be sure to be in communication with them consistently about how much they are willing to do and to take. You may be surprised!
• Most research that has been done on natural medicines for infertility has been conducted in conjunction with In-Vitro Fertilization (IVF) protocols. It’s probable that what you recommend is safe with IVF, but it is important to verify that. Don’t shy away from helping patients who are also pursuing the conventional route- your help may be the bridge to success!

Management Considerations:

• Start with the most important thing: a firm foundation. Focus your first visit on education about diet and lifestyle, and provide a health-promoting behaviour to focus on. This is often the most impactful treatment, both emotionally and physically.
• The main underlying processes resulting in infertility include inflammation, hormone imbalance, and oxidative stress. Be sure to address all that are applicable.
• Every partner should be on a base consisting of a good prenatal (or male equivalent), fish oil 2000 mg EPA + DHA/day, and adequate (to blood levels) vitamin D. Build your treatment protocol from here.

Some of the most well researched nutrients for improved fertility include N-acetyl cysteine, DHEA, inositol, CoQ10, and carnitine. These nutrients are a good place to start.