Physician and patient use of and attitudes toward complementary and alternative medicine in the treatment of infertility

Herbal supplement use among reproductive-aged women in an academic infertility practice

Objective

To address the knowledge gap surrounding herbal medicine and supplement usage patterns and supplement-prescription medication interactions among patients seeking treatment for infertility.

Design

Cross-sectional survey study.

Setting

Academic infertility practice.

Patients

Ninety-five reproductive-aged patients.

Interventions

Not applicable.

Main Outcome Measures

Use of herbal medications and supplements, baseline demographics, history of infertility treatments, and potential supplement-medication interactions.

Results

We surveyed 95 participants with a median age of 35 years. Overall, 68.4% of patients reported ever having used supplements or herbal medicines in the past. Current use of herbal supplements and vitamins was reported by 53.7% and 93.7% of participants, respectively, with a median of 2 (range 19) supplements used per person. There were no significant associations between patient demographics, comorbidities, or infertility treatments with increased rates of supplement use. The most commonly used herbal supplements were: green tea (n = 14), chamomile (n = 12), peppermint (n = 9), turmeric (n = 8), elderberry (n = 7), ginger (n = 7), maca (6) with the most common modalities being pills/capsules (23.8%) and tea (42.3%). The most common reasons for use were: general health and wellness (24.5%), immune support (16.2%), stress (14.0%), and fertility (15.0%). Patients used maca (n = 5), chasteberry (n = 3), goji berry (n = 2), ginger (n = 2), yam-based progesterone (n = 2), and combination product (n = 2) for fertility purposes. A total of 7.9% of patients learned about these products from their general health care provider, and 33.3% of supplements were disclosed by patients to their provider. We identified 41 moderate-risk supplement-drug interactions, with 12 of these interactions attributed to infertility therapies. Based on the interaction checker, the most commonly proposed mechanisms of interaction were CYP3A4 and CYP2C19 inhibition. In terms of safety in pregnancy, cannabidiol and chasteberry were suggested to be "possibly unsafe in pregnancy," and red raspberry leaf "likely unsafe in pregnancy" without direct medical supervision.

Conclusions

We found over two thirds of women seeking treatment for infertility reported past and over half reported current herbal medicine and supplement use. Notably, the Natural Medicines Interaction Checker suggested high rates of moderate-risk supplement-drug interactions and possible harmful effects in early pregnancy. Our results call for further investigation of clinically relevant supplement interactions with infertility therapies.

Complementary and alternative medicine use in infertility: A review of infertile women's needs

The use of complementary and alternative medicine (CAM) is common in infertile women in different countries. The purpose of the current study was to review the infertile women's needs in relation to CAM use. This narrative review was conducted through searching English databases including Scopus, PubMed, Embase, Web of Science, Cochrane library as well as Persian databases consisted of SID, and Magiran. The used keywords included "CAM/therapy, needs, and Infertility." All studies published in English peer-reviewed journals from conception to October 2020, which examined the infertile women's needs in the field of CAM use were included in the review. In the process of data extraction, two researchers screened the title, abstract, and full text of the articles. Out of the 2166 articles reviewed, 29 articles including six qualitative and mixed methods studies, four review, and 19 quantitative studies met the inclusion criteria. The results showed that infertile women have different needs in six domains consisted of educational and informational needs, the need for psychological counseling, supportive needs, the need for CAM use counseling, the need to treatment consistent with women's culture and demands, and the need to the integration of CAM with conventional medicine. Awareness of infertile women's needs toward CAM use can help health policymakers and planners in designing and implementing counseling services in accordance with the demands and culture of infertile couples. It also helps to develop a coherent program to integrate the use of CAM in the classical infertility treatment.

Epimedium promotes steroidogenesis by CREB activation-mediated mitochondrial fusion in endosulfan treated leydig cells

Epimedium, is used traditionally in Chinese medicine to treat infertility problems. In this study, we establish the cell model to elucidate the protective effect of epimedium against ES by analyzing the molecular relationship between mitochondrial dynamics and steroidogenesis and to explore the molecular mechanism focusing on mitochondria function relating to fertility. ES induced ROS accumulation in mitochondria and the epimedium treatment significantly reduced the ROS accumulation. Furthermore, mitochondria morphology was restored to elongated shape following epimedium treatment. Epimedium treatment promoted dynamin-associated protein 1 (Drp1)-mediated steroidogenesis pathway by upregulating PKA, CREB, Drp1, and StAR protein expression in response to ES exposure in Leydig cells. Moreover, it was also identified that, CREB plays an important role in epimedium activation in Drp1-mediated steroidogenesis signaling pathway by increasing, phospho-CREB expression in nucleus. Testosterone level is decreased in ES-exposed cells; however, the testosterone level was increased after epimedium treatment. In conclusion, epimedium treatment improved mitochondria function in ES-exposed Leydig cells and activated downstream Drp1-dependent steroidogenesis by CREB mediated signaling pathway.

Engagement in Nonbiomedical Practices for Fertility Enhancement: A Scoping Review

Objectives: This scoping review aims to (1) describe the scope and coverage of the body of literature on nonbiomedical practices used for enhancing fertility, (2) summarize and map the existing evidence on the extent and types of nonbiomedical practices used, and (3) examine how the research on this topic has been conducted with particular attention paid to how participants are asked about their use of nonbiomedical practices for fertility enhancement. Design: We conducted a scoping review by which four databases were searched (PubMed, Psychinfo, Socindex, and CINHAL). Articles were screened for inclusion by two researchers through a title and abstract screening followed by a full-text screening. Data were extracted from included articles and results summarized and compared across studies and regions. Results: A total of 32 studies were identified from 16 countries in five regions of the world. The majority of studies were clinic-based, primarily recruiting participants from fertility clinics in urban and suburban areas. More than half of the studies included only women, a few studies included only men, and the remainder of studies included both men and women. Most quantitative studies reported the prevalence of nonbiomedical practice use, which ranged from 8% to 83%; however, there was variation across studies regarding the time frame for which these percentages were derived. Few studies reported on other measures of the extent of use such as duration or frequency. A variety of nonbiomedical practices were identified with biologically based treatments, particularly herbal medicine use, being the most common followed by religious and spiritual interventions. Regional differences were identified. Variation in the wording and format of the question(s) used in survey instruments asking participants about their use of nonbiomedical practices exists and may impact participants' reporting of use. Conclusions: Infertility affects millions of individuals worldwide often with severe social, emotional, and financial consequences. To enhance fertility and, in some cases, overcome infertility, many individuals and couples are engaging in a variety of nonbiomedical practices. This scoping review describes the scope and nature of the existing literature on the use of nonbiomedical practices for fertility enhancement and highlights important gaps and limitations in the conduct of this research. A more comprehensive and inclusive investigation of nonbiomedical practices for enhancing fertility is needed to improve our understanding of how individuals and couples are managing infertility, identify educational and counseling needs, and to improve research related to effectiveness and safety of nonbiomedical practices.

Women's perspectives towards traditional and complementary medicine used to conceive, during pregnancy and the postpartum period

OBJECTIVES

This study aims to explore pregnant and postpartum women's understanding of the meaning of traditional and complementary medicine (T&CM) and how that may affect their T&CM use.

METHODS

A cross-sectional study was conducted using self-administered questionnaires. Data collected from 374 women were analysed and represented via descriptive statistics.

RESULTS

Out of the 374 participants, 285 (76.2%) reported using at least one type of T&CM to conceive, during pregnancy or in the postpartum period. The majority of the participants identified that T&CM is all about plants or natural products without chemicals or drugs (n = 267, 71.4%, p < .001). The category of T&CM with the highest usage was biological based therapies (n = 272, 95.4%), while the lowest was energy therapies (n = 8, 2.8%). The most commonly used T&CM was the traditional Malay massage (n = 170, 59.6%). The main sources of information and recommendations for using T&CM came from their family members or friends (n = 199, 69.8%). Almost half of the participants incurred minimum expenditures of MYR100 and below on the T&CM used (n = 137, 48.1%) and there was no significant difference between pregnant and postpartum women (p = .056).

CONCLUSION

This study reveals that many women are practising T&CM when trying to conceive and during pregnancy and the postpartum period even though they are aware that there is insufficient evidence on its safety and efficacy. Therefore, further studies are needed in order to gain sufficient clinical evidence that could be used to structure better guidelines for T&CM practices and services in Malaysia.

Restoration of Spermatogenesis Using a New Combined Herbal Formula of Epimedium koreanum Nakai and Angelica gigas Nakai in an Luteinizing Hormone-Releasing Hormone Agonist-Induced Rat Model of Male Infertility

Purpose

We investigated the protective effect of a mixture of 2 herbal extracts, KH-465, which consisted of Epimedium koreanum Nakai and Angelica gigas Nakai, on spermatogenesis in a luteinizing hormone-releasing hormone (LHRH) agonist-induced rat model of male infertility.

Materials and Methods

Seventy-five 12-week-old male Sprague-Dawley rats were randomly divided into 5 groups, containing 15 rats each: a normal control group that received no treatment and 4 experimental groups (I, II, III, and IV) in which an LHRH agonist was administered for 4 weeks to induce spermatogenic failure. Group I received distilled water, and groups II, III, and IV received 200 mg/kg/day of KH-465, 400 mg/kg/day KH-465, and depo-testosterone for 4 weeks, respectively. Weight changes of the testis and epididymis, sperm count motility, and levels of testosterone (T), free T, follicle-stimulating hormone (FSH), luteinizing hormone (LH), superoxide dismutase (SOD), and 8-hydroxy-2′-deoxyguanosine (8-OHdG) were estimated.

Results

Body, testis, and epididymis weight showed no significant differences among the control and experimental groups. Treatment with KH-465 increased the sperm count and motility. Serum hormone levels of T, free T, and FSH were not significantly different in the experimental groups, while the LH level was higher than in the LHRH agonist-induced control group, but not to a significant extent. Levels of SOD were higher and 8-OHdG were lower in the groups that received KH-465 than in the LHRH agonist-induced control group.

Conclusions

Our results suggest that KH-465 increased sperm production via reducing oxidative stress and had a positive effect in a male infertility model.

Perspectives of complementary and alternative medicine (CAM) practitioners in the support and treatment of infertility

BACKGROUND

Infertility patients are increasingly using complementary and alternative medicine (CAM) to supplement or replace conventional fertility treatments. The objective of this study was to determine the roles of CAM practitioners in the support and treatment of infertility.

METHODS

Ten semi-structured interviews were conducted in Ottawa, Canada in 2011 with CAM practitioners who specialized in naturopathy, acupuncture, traditional Chinese medicine, hypnotherapy and integrated medicine.

RESULTS

CAM practitioners played an active role in both treatment and support of infertility, using a holistic, interdisciplinary and individualized approach. CAM practitioners recognized biological but also environmental and psychosomatic determinants of infertility. Participants were receptive to working with physicians, however little collaboration was described.

CONCLUSIONS

Integrated infertility patient care through both collaboration with CAM practitioners and incorporation of CAM's holistic, individualized and interdisciplinary approaches would greatly benefit infertility patients.

Effects of KH-204 on the expression of heat shock protein 70 and germ cell apoptosis in infertility rat models

Background

Idiopathic infertility is a significant number of causes of male infertility. Empirical treatments are used for idiopathic male infertility, and antioxidant supplementation is a kind of management of oxidative stress related infertility. We investigated the antioxidant effects of the modified Ojayeonjonghwan (KH-204) in a rat model of cryptorchidism.

Method

Male rats were divided into four groups (n = 8 in each): a normal control group, a cryptorchidism-induced control group and two cryptorchidism-induced groups treated p.o. with either 200 or 400 mg/kg, KH-204 for 4 weeks. The testes and epididymides from rats in all groups were removed, weighed and subjected to histological examination and semen analysis after surgery. Oxidative stress was assessed by measuring 8-hydroxy-20-deoxyguanosine (8-OHdG), superoxide dismutase (SOD) and heat shock protein (HSP) levels. Apoptosis was determined using a terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick end-labeling assay.

Results

Treatment with the multi-herbal medicine KH-204 (1) increased the mean weight of the cryptorchid testes; (2) restored sperm counts, motility and germinal cell layer thickness; (3) decreased levels of 8-OHdG and increased levels of SOD; and (4) decreased HSP70 levels and apoptosis.

Conclusions

KH-204 reduces the oxidative stress in an experimental rat model of cryptorchidism, and it may alleviate HSP expression and germ cell apoptosis.