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From the Townsend Letter
April 2013

Sperm Meets Egg: An Initial Fertility Checklist
by Amy Terlisner, NMD
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There is some evidence which concludes that higher intensities of exercise may lower fertility. In one study including 3887 women less than 45 years old, researchers found that after adjusting for age, parity, smoking, and marital status, women who were active on most days were 3.2 times more likely to have fertility problems than inactive women. Exercising to exhaustion was associated with 2.3 times the odds of fertility problems versus low intensity.15 IVF should remove most adverse effects on fertility parameters; however, one study of 2232 women undergoing their first round of IVF found that those who reported exercising 4 hours or more per week for 1 to 9 years were 40% less likely to have a live birth, 3 times more likely to experience cycle cancellation, and twice as likely to have implantation failure. These findings suggest that, beyond simple alterations of endogenous hormone responses that affect menstrual function, exercise may also contribute to subtle detriment of the developing follicle.16

In summary, a couple needs to have done these initial steps to insure fertility. If pregnancy has not been achieved in 6 months, I would recommend seeking out a naturopathic physician as well as beginning to investigate more advanced diagnostic testing through a urologist (for men) or reproductive endocrinologist (for women).

  • Timing: have sex every day or every other day from cycle day 5 past ovulation.
  • Avoid saliva, oral sex, and lubricants besides Pre-Seed.
  • Elevate hips (for women) after sex for at least 20 minutes.
  • Begin blood work and imaging/procedures for both men and women.
  • Diet: alkaline diet for both male and female partner, avoiding gluten, dairy, sugar, alcohol, and caffeine.
  • Do not smoke.
  • Increase pelvic circulation through acupuncture, massage, and/or yoga.
  • Increase fluids to a minimum of 64 oz of water daily to ensure proper internal lubrication.
         o  Consider use of guaifenesin and/or NAC to improve cervical and male fluid quality.
  • Supplements for men should include a multivitamin (I recommend Thorne brand), additional zinc/copper formula, L-carnitine, L-arginine, CoQ10, vitamin D3, essential fatty acids.
  • Supplements for women should include a prenatal vitamin (I recommend Thorne brand, L-arginine, vitamin D3, essential fatty acids.
  • For women, diagnosis and treatment of PCOS should be considered along with additional supplements and/or metformin 1000 to 1500 mg per day.
  • For women, exercise intensity and duration should be considered and adjusted.
  • For men and women, avoid hot tubs/saunas or medications (prescriptions and over the counter) that could affect fertility.

I've seen correcting small imbalances in fertility help time and time again. There is much within the control of patients, and I truly believe that a healthy body is a fertile body. Making these changes to lifestyle will go a long way in creating that healthy body, so that if other more advanced techniques are needed such as intrauterine insemination or IVF, both sperm and egg will be of highest quality.

1.   Arnoult C, Pierre V, Ray PF. Chemotaxis of spermatozoa is regulated by progesterone binding on calcium channel CATSPER. [In French.] Med Sci (Paris). 2011 Aug–Sep;27(8–9):702–704.
2.   Al-Azemi MK, Omu AE, Fatinikun T, Mannazhath N, Abraham S. Factors contributing to gender differences in serum retinol and alpha-tocopherol in infertile couples. Reprod Biomed Online. 2009 Oct;19(4):583–590.
3    Colagar AH, Marzony ET, Chaichi MJ. Zinc levels in seminal plasma are associated with sperm quality in fer­tile and infertile men. Nutr Res. 2009 Feb;29(2):82–88.
4.   Battaglia C, Salvatori M, Maxia N, Petraglia F, Facchinetti F, Volpe A. Adjuvant L-arginine treatment for in-vitro fertilization in poor responder patients. Hum Reprod. 1999 Jul;14(7):1690–1697.
5.   Morgante G, Scolaro V, Tosti C, Di Sabatino A, Piomboni P, De Leo V. Treatment with carnitine, acetyl carnitine, L-arginine and ginseng improves sperm motility and sexual health in men with asthenopermia. [Article in Italian.] Minerva Urol Nefrol. 2010 Sep;62(3):213–238.
6.   Lenzi A, Lombardo F, Sgrò P, et al. Use of carnitine therapy in selected cases of male factor infertility: a double-blind crossover trial. Fertil Steril. 2003 Feb;79(2):292–300.
7.   Mancini A, Balercia G. Coenzyme Q(10) in male infertility: physiopathology and therapy. Biofactors. 2011 Sep–Oct;37(5):374–380.
8.   Lerchbaum E, Obermayer-Pietsch B. Vitamin D and fertility: a systematic review. Eur J Endocrinol. 2012 May;166(5):765–778.
9.   Blomberg Jensen M, Bjerrum PJ, Jessen TE, et al. Vitamin D is positively associated with sperm motility and increases intracellular calcium in human spermatozoa. Hum Reprod. 2011 Jun;26(6):1307–1317.
10. Zagré NM, Desplats G, Adou P, Mamadoultaibou A, Aguayo VM. Prenatal multiple micronutrient supplementation has greater impact on birthweight than supplementation with iron and folic acid: a cluster-randomized, double-blind, controlled programmatic study in rural Niger. Food Nutr Bull. 2007 Sep;28(3):317–327.
11. Singh AK, Tiwari AK, Singh PB, et al. Multivitamin and micronutrient treatment improves semen parameters of azoospermic patients with maturation arrest. Indian J Physiol Pharmacol. 2010 Apr–Jun;54(2):157–163.
12. Nasr A. Effect of N-acetyl-cysteine after ovarian drilling in clomiphene citrate-resistant PCOS women: a pilot study. Reprod Biomed Online. 2010 Mar;20(3): 403–409.
13. Dijck-Brouwer DA, Hadders-Algra M, Bouwstra H, et al. Lower fetal status of docosahexaenoic acid, arachidonic acid and essential fatty acids is associated with less favorable neonatal neurological condition. Prostaglandins Leukot Essent Fatty Acids. 2005 Jan;72(1):21–28.
14. High protein diet for fertility: approach with caution [online article].
15. Gudmundsdottir SL, Flanders WD, Augestad LB. Physical activity and fertility in women: the North-Trøndelag Health Study. Hum Reprod. 2009 Dec;24(12):3196–3204.
16. Morris SN, Missmer SA, Cramer DW, Powers RD, McShane PM, Hornstein MD. Effects of lifetime exercise on the outcome of in vitro fertilization. Obstet Gynecol. 2006 Oct;108(4):938–945.

Amy TerlisnerDr. Amy Terlisner attended the University of Georgia in Athens, Georgia, where she obtained a BS in holistic medicine, a degree that she customized for her later studies in naturopathic medicine. She graduated summa cum laude (with highest honor) and published an undergraduate thesis in health psychology. Dr. Terlisner then attended Bastyr University in Seattle, Washington. She has an extensive teaching background and has taught physiology, anatomy, clinical laboratory diagnosis, pharmacognosy, physical exam diagnosis, and manipulation at the doctorate level. Her specialties include women's health, cardiovascular disease, gastroenterology, anti-aging medicine, and natural hormone replacement therapy. Dr. Terlisner is the current president of the Arizona Association of Naturopathic Physicians and owns ALETRIS Center of Integrative Medicine, located in Scottsdale, Arizona.

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