Infertility: Exploring the “Why?”

Written by Carol Petersen, RPh, CNP – Women’s International Pharmacy


Infertility is a complex and emotional topic. However, the vital premise is that if you want to have healthy children, you have to be a healthy mom, and the father has to provide healthy sperm. We know that the rate of infertility is climbing, and that more people are seeking professional help to try to have a family. The fundamental question most of us ask is “Why?”

In her book, 8 Weeks to Women’s Wellness, Dr. Marianne Marchese cites some environmental exposures as potential contributors to rising infertility rates:

    • Topping the list is cigarette smoking, with passive exposure affecting both women and men, particularly sperm quality
    • Lindane, which is used to treat lice, disrupts the lipid layer of the sperm cell
    • Pentachlorophenol, a pesticide and wood preservative, interferes with both ovarian and adrenal function
    • Polychlorinated biphenols (PCBs) interfere with fertility by lowering progesterone, the primary hormone involved in the success of implanting a fertilized egg and maintaining pregnancy
    • Pesticides and solvents can affect the pituitary and hypothalamic signaling to the ovaries
    • Mercury, particularly that found in fish, has been linked to infertility and to preterm labor

Whether or not the underlying causes are environmental, autoimmunity plays an important role in infertility. Diseases such as diabetes, autoimmune thyroiditis, systemic lupus erythmatosis, polycystic ovarian syndrome (PCOS), endometriosis, and premature ovarian failure are all associated with an active inflammatory process, antibodies impairing organs, hormones, and clotting factors. Both progesterone and DHEA have shown effectiveness in quelling some of the overactive immune components.

In Generative Energy, Dr. Ray Peat questioned the societal view that women over 50 can no longer bear children. Regardless of age, both the implantation of a fertilized egg and the successful maintenance of pregnancy depend on the ratio of estrogens and progesterone. When estrogens are relatively high, the supply of oxygen to the fetus is compromised; progesterone supplies the oxygen. The hormones progesterone and thyroid are critical to a woman’s fertility, while for men, it is pregnenolone and thyroid. Both sexes need adequate vitamin E.

Progesterone has far-reaching effects for the baby after birth as well. Dr. Peat also described a study by Dr. Katrina Dalton in which she prescribed generous amounts of progesterone to her patients during the whole of their pregnancy. The results showed that these children were superior in many ways when they were tested years later.

In 2003, a study sponsored by the National Institutes of Health (NIH) demonstrated the usefulness of hydroxyprogesterone caproate for maintaining preterm labor. Hydroxyprogesterone is an active metabolite of progesterone.  Adding the caproate ester made it possible to use weekly injections instead of daily injections of progesterone itself for preterm labor. It has been in the news recently because, upon approval by the FDA, Makena announced that the market price will increase to $1500 per injection. Alternatives to this injection include injectable progesterone or oral and vaginal progesterone.

Luteal phase defect describes the inability to produce enough progesterone after ovulation for the fertilized egg to implant. Dr. Gary Frishman reported in The Journal of Reproductive Medicine that oral progesterone in doses of 200 mg three times daily produced effective blood levels. Earlier studies had successfully used progesterone vaginally in suppositories.

Vitamin D has become a headliner (again) and it is no surprise that it would affect fertility, as well. One study reported a higher rate of successful full-term pregnancies after in vitro fertilization when the woman’s serum and the follicle exhibited adequate vitamin D levels. An Australian study described fragmented sperm (damaged DNA) and infertility in men with low levels of vitamin D and folate, and high homocysteine levels.

Gluten-sensitivity can also be a silent, underlying contributor to infertility. Even without a diagnosis of full-blown celiac disease, a less severe gluten-sensitivity can impair circulation to the uterus, such that it is not possible to implant and nourish a fertilized egg. The remedy is to avoid all foods containing gluten (such as wheat) while trying to get pregnant.

With so many hormones, lifestyle choices, and environmental factors all contributing to (or denying) the opportunity to have a family, exploring the “why” of infertility can be daunting, particularly when emotions are running high. Working closely with professional healthcare practitioners for advice and support will help you unravel the mystery of infertility and empower you on the path to optimum prenatal health.