Alternative Treatments for Female Infertility
Alternative Treatments for Female Infertility
August 2000; Volume 2; 60-62
By Adriane Fugh-Berman, MD, and Anthony Scialli, MD
Infertility can be a source of great distress to both men and women. There are an ever-growing number of technological options for treating infertility, but relatively few studies on alternative therapies, and those that exist are not methodologically robust. The following is a brief review of studies published in English on alternative therapies for female infertility. None of the studies with pregnancy as an endpoint were double-blind or placebo-controlled.
Mind-Body Interventions
Some think stress can contribute to infertility in those without obvious mechanical barriers to conception, and several studies indicate that depression may inhibit fertility (depressed women also have less successful in vitro fertilization [IVF] than non-depressed women).1 The effects of a mind-body program incorporating the relaxation response (RR) on stress in infertile women was examined in an uncontrolled study of 54 women infertile > 1 year (mean 3.3 years); those with "definitive sterility" (not otherwise defined) were excluded from the study.2 The Mind-Body Basic program, a 10-week program taught at New England Deaconess and Beth Israel Hospital, was designed to teach the RR as a way of treating symptoms associated with stress. A modification of this basic program was used in this study, which consisted of 10 sessions, each providing an optional 30-minute time for sharing and support, a group RR exercise, paired discussion of home practice, a lecture, group or paired exercise, and another short RR exercise. Lecture topics included physiology of stress and introduction to RR, diaphragmatic breathing, cognitive restructuring/affirmations, self-empathy and compassion, mindfulness, emotions, anger, and forgiveness; the last session was a review and follow-up. Two sessions were longer, including a half-day session emphasizing nutrition and exercise, and an all-day session devoted to yoga, exercise, and couples cognitive behavioral exercises. Spouses were invited to the all-day session and the session on self-empathy and compassion.
Participants were enrolled in the program over a year. All participants were tested at baseline and after the trial was completed with Profile of Mood States, Spielberger State-Trait Anxiety Inventory (STAI), and the Spielberger Anger Expression Scale. At the end of the study participants experienced significant decreases in depression, tension/anxiety, fatigue/inertia; increased vigor/activity; and decreased State and Trait subscales of STAI. There were no changes in anger expression. Eighteen women (34%) conceived within six months of completing the program. This result is uninterpretable, however, as an unknown number of women were receiving treatment, and it is not stated what percentage of those who conceived were receiving treatment.
A recent, year-long, randomized, single-blind controlled trial in 184 women who were infertile for 1-2 years tested a combination of mind-body techniques against a support group intervention as adjuncts to conventional treatment; the control group received routine care.1 All women in this study were receiving fertility drugs. When recruitment was too slow to fill both intervention groups, women were randomized to control and one intervention. The intervention groups met once weekly for two hours. Cognitive-behavioral treatment included relaxation techniques, cognitive restructuring, methods for emotional expression, and nutrition and exercise information. The support group met weekly for two hours; the first hour was spent "checking in" and the second discussing specific topics, including relationships and the impact of infertility on self-esteem. Dropout rates were high: 9/56 (16%) in the cognitive behavioral group, 16/65 (25%) in the support group, and 38/63 (60%) controls left the study. Among study completers, 55% in the cognitive-behavioral group, 54% in the support group, and 20% of controls experienced viable pregnancies. Time to viable pregnancy using survival analysis indicated a significantly different viable pregnancy rate among both treatment groups compared to control; there was no significant difference between the two groups. The large and inequitable dropout rate renders these data uninterpretable.
Auricular Acupuncture
Auricular acupuncture is a form of acupuncture in which only the ear is needled (points on the ear are said to represent different parts of the body). In a matched-pair study, 45 infertile women with oligomenorrhea or luteal insufficiency were treated with auricular acupuncture weekly for three months.3 If conception was not attained during this time, therapy was suspended for six months, after which hormone therapy was offered. These women were compared with 45 women receiving hormone treatment (matched for age, duration of infertility, BMI, primary vs. secondary infertility, amenorrhea vs. oligomenorrhea, and tubal patency). Women treated with hormones had 20 pregnancies (5 spontaneously, 15 in response to medical treatment). Women in the acupuncture group had 22 pregnancies, 11 of which occurred during treatment (four occurred more than three months later and seven after hormonal therapy). There was no difference in pregnancy rates between the two groups. However, the use of medical treatment in the acupuncture group hopelessly confounds this study, which is reported in an extremely confusing manner. It would have made more sense to randomize women to medical treatment or auricular acupuncture for some time period and do a direct comparison.
Vitex agnus-castus (Chaste Tree Berry)
Although vitex has not been directly tested as an infertility treatment, this herb could prove a fertile area to research. Chaste tree berry, which contains flavonoids and an alkaloid called viticin, is believed by herbalists to "balance" hormone levels. Used for various gynecological conditions, chaste tree berry may have profound hormonal effects in reproductive-age women. In a double-blind, placebo-controlled trial of 52 women with luteal phase defect and high prolactin levels, one 20 mg capsule of vitex daily reduced prolactin levels, normalized the length of luteal phases, and normalized luteal phase progesterone levels.4 Vitex has been reputed to lower libido in both women and men; hence its common names chaste tree berry and monk’s pepper. Additionally, a case of ovarian hyperstimulation was apparently caused by vitex ingestion.5 A 32-year-old woman with tubal infertility who had developed single follicles with gonadotropin stimulation in three cycles took vitex prior to and during the early follicular phase of the fourth (untreated) cycle. Vaginal ultrasonography on day 6 revealed three developing follicles on the right ovary and one on the left.
Conclusion
It should be clear that there is no reliable evidence supporting the use of acupuncture or mind-body therapies for the treatment of infertility. There is some intriguing information on Vitex that warrants further research. v
References
1. Domar AD, et al. Impact of group psychological interventions on pregnancy rates in infertile women. Fertil Steril 2000;73:805-812.
2. Domar AD, et al. The mind/body program for infertility: A new behavioral treatment approach for women with infertility. Fertil Steril 1990;53:246-249.
3. Gerhard I, Postneek F. Auricular acupuncture in the treatment of female infertility. Gynecol Endocrinol 1992;6:171-181.
4. Milewicz A, et al. Vitex agnus-castus-extrakt zur Behandlung von Regeltempoanomalien infolge latenter Hyperrolaktinamie. Arzneimittelforschung 1993;43:752-756.
5. Cahill DJ, et al. Multiple follicular development associated with herbal medicine. Hum Reprod 1994;9:1469-1470.
August 2000; Volume 2; 60-62
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