Natural Fertility

The World Health Organization (WHO) estimates that 15% of couples worldwide have difficulty conceiving a child (Behboodi-Moghadam, Salsali, Eftekhar-Ardabily, & Ramezanzadeh, 2012).  Couples who have trouble conceiving are labeled as “infertile,” defined as failure to conceive while regularly engaging in unprotected intercourse for one year (Polotsky & Houston, 2009).  Many couples suffering from infertility automatically seek conventional medical treatment, such as assisted reproductive technology (ART), to facilitate conception.  This approach aligns with the traditional western medicine viewpoint that addresses health concerns in a highly technical manner with medication and/or medical interventions and procedures.  While there are women of child bearing age who may indeed require conventional medical treatment to promote conception, there are alternatives that may be incorporated prior to or in conjunction with conventional medical treatment to improve conception outcomes.  The public, however, is largely unfamiliar with alternative and complementary therapies in the United States, especially in relationship to fertility.  Additionally, healthcare professionals, including nurses, may or may not be familiar with these alternative and complementary methods.

 There are many factors that impact ovulation and fertility such as lifestyle choices like smoking and exercise, stress, body mass index (BMI), diet, and proper ovulation tracking.  The purpose of this literature review is to evaluate if natural and complementary interventions increase the likelihood of pregnancy and improved psychosocial well-being.  To facilitate this review of literature, evidence regarding specific complementary/alternative methods were assessed and evaluated.  Specific complementary interventions include successful stress management, proper nutrition, weight loss if indicated, smoking and alcohol cessation, avoiding exposure to environmental toxins, fertility awareness, moderate consistent exercise, homeopathic medicines, healthy sexual behaviors, and management of chronic illness, like diabetes.  Most of these methods have been shown to regulate hormones and promote ovulation.  Quite importantly, the review of literature indicated that these interventions provided varying degrees of psychosocial and physiological improvements which ultimately lead to increased incidences of conception.  For example, it was shown that a low-fat, low glycemic diet reduces anovulation, thus leading towards a higher chance of conception.  Another example is BMI regulation.  Since it is shown that obesity leads to numerous reproductive problems including anovulation, irregular menses, subfertility, and miscarriage, losing weight and therefore lowering BMI increases overall reproductive health.  However, losing too much weight could also be a problem since energy is critical for reproduction and restricting key nutrients can be counterproductive for the growth of new cells.  Extensive weight loss and rigorous exercise can actually lead to amenorrhea and infertility.  Additionally, managing chronic diseases can help increase fertility since a wide variety of chronic illnesses, from heart disease to diabetes, can suppress both ovulation and sperm production, which can make conception difficult.  Controlling the symptoms of certain chronic illnesses can increase the chances of conception.  High risk behaviors, such as smoking, also decrease fertility for both men and women since chemicals in cigarette smoke speed up the loss rate of genetic material.  Managing stress can furthermore increase the chances of conception.  Although the direct link is unknown, high levels of cortisol and epinephrine have an effect on fertility and it is shown women with a decreased level of stress are more likely to achieve conception.  Lastly, fertility awareness education is warranted.  It is important for women to be educated on how to recognize their own fertility window and when ovulation occurs.  The review of literature indicated that over 50% of women had poor fertility-awareness knowledge.  This means that most women are not aware of when they are the most fertile.  Advanced technology in the United States has become available to help women estimate when they ovulate, but it is also important to teach women about signs of ovulation including changes in cervical fluid and basal body temperature. 

 The review of literature also indicated that many women of childbearing age have insufficient knowledge of reproductive health and complementary and alternative methods signaling a need for healthcare professionals to use patient centered care to better educate their patients on these methods as possible treatment for infertility.  Due to the multifaceted nature of the role of nursing practice and in adherence to patient centered care facilitation, patient education emerges as paramount to employ.  Thus it is important for the nurse to be knowledgeable about natural and complementary methods to improve fertility and the best ways in which that information can be communicated to couples.  Using the framework of Nola Pender’s Health Promotion Model, which defines health as a positive dynamic state influenced by patient behavior which is modifiable through nursing actions, nurses should familiarize themselves with natural remedies that are known to increase a woman’s likelihood for conception and provide education to their patients in order to influence and modify patients’ behavior.  The nurse also should be aware of different methods the patient is currently partaking in to advise her correctly to avoid possible drug interactions and other negative effects.  Beliefs about fertility vary greatly from culture to culture and it is of great importance that the nurse and the healthcare team be informed of what methods the patient is currently using in order to best prescribe other treatments. 

 In conclusion, most of the research examined in this literature review was found to be limited and dated.  Recent articles discussing infertility focus primarily on ART and those that do discuss natural and complementary methods are mostly literature reviews of past research and are not high levels of evidence that suggest the actual cause and effect.  This indicates a knowledge gap and a need for further studies to be completed.  This is especially true in the United States, which mainly focuses on conventional methods.  However, more and more Americans are currently seeking out complementary and alternative methods in healthcare to improve their chances of conception.  This is due in part to conventional methods, like ART, being expensive, complex, and having a high risk of failure.  With this renewed upswing in popularity, it is now more important than ever for new research to be completed examining some of these natural ways to improve female fertility.