Herbal Therapeutics in Female Infertility - Carol Guyette

Herbal therapeutics in female infertility

Herbal practitioner:Herbal practitioner:

Carole Guyette MNIMHCarole Guyette MNIMH

History Taking for Fertility Problems 1History Taking for Fertility Problems 1

Delay in conceptionDelay in conception DurationDuration Previous Previous

investigations/treatments investigations/treatments Effect on client's lifeEffect on client's life


Menstrual HistoryMenstrual History Menarche - age & how it was experiencedMenarche - age & how it was experienced Menstrual cycle - length/regularity/changesMenstrual cycle - length/regularity/changes Dysmenorrhoea - self help? Dysmenorrhoea - self help? Premenstrual symptoms Premenstrual symptoms Blood: colour/flow/clots/ease LMPBlood: colour/flow/clots/ease LMP Use of pads/tampons - how many? Use of pads/tampons - how many?

Symptoms related to ovulation -Symptoms related to ovulation -


Mittelschmerz Mittelschmerz Mucus changes, bleeding Mucus changes, bleeding Bleeding irregularities - post Bleeding irregularities - post coital, stress...coital, stress...

Feelings/comments re cycle & Feelings/comments re cycle & others' perceptionsothers' perceptions


Reproductive HistoryReproductive History Previous pregnancies Previous pregnancies Same/different partners Same/different partners Time taken to conceive Time taken to conceive Health during pregnancy Health during pregnancy Outcome - incl terminations, Outcome - incl terminations,

miscarriages miscarriages Residual feelings/body/cycle changes Residual feelings/body/cycle changes Labour & delivery, term/pre-termLabour & delivery, term/pre-term


Sexual History Sexual History Intercourse Intercourse Frequency Frequency Enjoyment Enjoyment Lubricants Lubricants Dyspareunia Dyspareunia DifficultiesDifficulties


Past contraceptive history Past contraceptive history Preference, changes, "failures" Preference, changes, "failures" Oral contraception - Duration, time Oral contraception - Duration, time

of cessation, resumption of of cessation, resumption of menses, side effects menses, side effects

IUD - symptoms of infectionIUD - symptoms of infection


History of Mothers History of Mothers and Grandmothers and Grandmothers May reveal interesting May reveal interesting

patterns/attitudespatterns/attitudes

History Taking for Fertility Problems 8History Taking for Fertility Problems 8 Past Medical HistoryPast Medical History

Pelvic inflammationPelvic inflammation STDsSTDs Peritonitis Peritonitis

Pelvic operations Pelvic operations Tubal pregnancy Tubal pregnancy Appendectomy Appendectomy Drug therapy Drug therapy EndocrineEndocrine

Weight changeWeight change GalactorrhoeaGalactorrhoea HirsutismHirsutism Acne Acne

SmearsSmears


Social History Social History Occupation & intentions Occupation & intentions Domestic circumstances Domestic circumstances Relationship with partner Relationship with partner DietDiet Smoking Smoking Alcohol Alcohol Stress Stress ExerciseExercise


Psychological history Psychological history Reasons for wishing Reasons for wishing

conception conception Conflict re. conception Conflict re. conception Depression Depression Previous psychiatric Previous psychiatric

problemsproblems

Female Infertility/ Sub-fertility

What is cause? physical/emotional/mental/spiritual

What block/s prevents successful pregnancy?

Case History Taking

Ideally see both parties Fully assess nutritional status/ alcohol,

cigarette or drug use/ exercise/ stress/ lifestyle/ environmental factors

Further investigations? Treat underlying pathology e.g. Endo,

PID, PCOS, Infections such as Chlamydia, low thyroid function…

Common presentations

failure to conceive (no underlying pathology)

recurrent miscarriage (includes implantation failure)

Diet/supplements/lifestyle

Foresight 99% success – hair mineral analysis

Exercise aerobic 3-4 x weekly Yoga, Tai Chi

Woman slow to conceive/history of miscarriage

Spend 3-6 months preparing woman (improve general health & hormone balance)

Don’t try to conceive in this time Set time limit with patient e.g. 12months

(to review) Inspire hope/ positive thought; identify

blocks Avoid blame – remember that everything

happens for a reason – ?unknown

Herbs contraindicated in pregnancy Toxic herbs: e.g. Phytolacca, Sanguinaria, Aconitum,

Bryonia (Lobelia can be useful for threatened miscarriage & in childbirth) (Gelsemium can be useful in childbirth). Internal use of essential oils due to high risk of overdosage (small quantities fine in flavourings)

Other herbs: Angelica sin. – not in 1st trimester Artemesia spp. - no more than 500mg/day Caulophyllum - only take in last 6 weeks Chelidonium – no more than 1000mg/day Datura – suspected teratogen Mentha puleg. Petroselinum – due to apiol content (negligible in Apium) Peumus boldo Ruta Sarothamnus Tanacetum parthenium – no more than 500mg/day Tanacetum vulgaris Thuja Viscum – only take in last 6 weeks Zingiber – no more than 2000mg/day Panax ginseng – only at delivery Eleutherococcus

Herbs to avoid at high dose > 3g daily (i.e. 6ml 1:2, 15ml 1:5, av. 2 teasp dried)

Achillea Aesculus Angelica arch. Barosma

betulina Berb spp. Hydrastis Juniperus Lycopus Salvia

Herbs to use with caution Essential oils external use –

Cinnamon, nutmeg (these 2 useful for massage in last few weeks), myrrh, clary sage (useful for delivery), jasmine, juniper, pennyroyal, marjoram, oregano, cypress, thyme, sage, savoury, wintergreen, hyssop, basil, aniseed, fennel

Laxatives (avoid though probably safe at normal dosage) Aloe, Rhamnus, Cassia, Rheum

Herbs for infertility FAILURE TO CONCEIVE

Problems with ovulation and/or cervical mucus usually strong hormonal component e.g. amenorrhoea - post-pill, commonly seen

after shock or bereavement, excessive exercise, seriously underweight/overweight… VITEX

Sperm antibodies – what’s going on in relationship?

ensure patient knows fertile times MUCUS CHART Monitor mucus and other

signs of ovulation (e.g. mittelschmertz/temp changes)

Herbal Therapeutics in Female Infertility

Ovulating and no known reason for not conceiving What is condition of tissues? (incl

emotional/mental blocks) What actions required?

Cleanse toxins – individual needs, ensure no GU infection, fertility treatments?

Tonify/nourish/rebalance/relax/stimulate etc…

Fertility tonics Useful herbs:

Chamaelirium (cultivated) – prime fertility herb, magnificent uterine and ovarian tonic, strengthens pelvic tissues and promotes pelvic nutrition. Up to 30ml/week

Rubus – strengthens and tones pelvic muscles, relaxing at same time. Soothes kidneys, tones mucous membranes. Tea or tincture - up to 40ml/week

Relaxes uterus when contracted, contracts uterus when relaxed. Provides excellent support. Emotionally - helps soften the heart and

allow for greater receptivity and intuition. Viburnum prunifolium – uterine sedative, anti-spas, relaxant to

uterine muscle, spec. for uterine irritability & painful conditions of pregnancy improves uterine & ovarian circ > promotes pelvic nutrition Strengthens pelvis after prev. miscarriage One of best remedies for nervous conditions in pregnancy or affecting

fertility

Fertility tonics Vitex increases Progesterone & LH

Hormonal balancer par excellence esp. where low progesterone – e.g. woman prone to early miscarriage e.g.9/40 spotting or miscarriage

Brings inner strength & emotional balance. Alchemilla vulgaris –

Uterine tonic. Hormone balancer. Promotes fertility. Haemostatic. Traditionally for soft, gentle women

Mitchella – Uterine strengthener, inspires self-confidence

Leonurus – Uterine tonic and sedative, reduces nervous tension, anti-spas,

helps pelvic irritability. Helps with fears around motherhood. Dioscorea –

Powerful smooth muscle relaxant relieving spasm and inflammation, regulates hormones, opens up blood vessels

Fertility tonics

Trifolium Alterative, Hormone balancer (phytoestrogens),

lymphatic cleanser, anticoagulant. Trigonella

“there’s a baby in every cup” (Weed) – bitter & warming, stimulates uterus, soothes irritable tissues, reduces blood sugar & cholesterol, benefits weak digestion

Serenoa Adaptagen, sedative, warming, helps sex drive, urinary

antiseptic, endocrine stimulant, helps intimacy & openness, learning to give & receive

Anemone Sedative, anti-spas, reduces pain in repro system,

soothes inflamed mucous membranes

Fertility tonics Too cold

Zing Achillea – improve circ to pelvis Pelvic congestion

above & Calendula – improve circ of blood & lymph, Attention to NS

Scutellaria, Avena, Hypericum, Passiflora, Valerian, Verbena, & Raise vital force

Salvia

Uplift Rosemary, Melissa

Loss of libido Vitex, Serenoa Healthy sex life depends on good ovarian, adrenal and pituitary function (&

psychological) Cause could be hormonal, exhaustion, depression, drug-related,

relationship difficulties, fear of pregnancy… related to family attitudes, childbirth…,psychological(eg prev. abuse)

Turnera aphrodisiac, sexual stimulant, anti-depressive, promotes well-being,

relieves anxiety

Case history 1Case history 1 Woman 40yrs Sec. school teacher – v.busy

lifestyle – worrier/stressed Trying to conceive for 12/12. Stable, happy

relationship. No prev. pregnancies. History of PMT. Regular, ovulatory cycles apart

from times of high stress. Chocaholic. R Vitex 20 Chamaelir 20 Verbena 20 Scut 20

Avena 20 (x2) sig 7 ½ ml. bd Kept her on same or similar mix for 3 months.

Drastically reduced sugar & chocolate. PMT disappeared, reduced Vitex to 10 & put in Chamomilla. Conceived after total 7 months. Healthy pregnancy & normal delivery.

Case history 2Case history 2 Woman 41yrs Trying to conceive 7years. MH 1 healthy FT

pregnancy @ 25. Unplanned. Daughter age 15, raised by patient’s mother for 1st 3 years. GRIEF & ANGER , husband told her she was ‘depressed’ for those years although she did not remember clearly.

Normal ovulation and hormone levels. Partner’s sperm – good numbers & motility

Wanted to avoid IVF. Aim: to dissolve grief and other emotions trapped in tissues. Facilitate letting

go of mistaken beliefs. R Rosa 20 Borage 20 Leon 20 Alth rad 20 Anem 10 Chamaelir 10 (x2)

sig 5ml bd R Alchemilla vulgaris Tea one cup daily + flower essences

Released huge grief. Woke in night saying “I’m not a bad mother”. Healing dreams. Now feels a different person.

Similar herbs over 8 months leading to conception and healthy FT pregnancy.

Use of ‘medicine bundle’ to connect with uterus – release feelings without having to analyse.

IVF etc.

Recurrent Miscarriage

Can’t stop inevitable miscarriage Properly prescribed, herbs will not interfere with nature’s

course - will not delay inevitable miscarriage or in any way endanger the patient

Use at low dose prophylactically at danger time Use higher dose in acute threatened miscarriage Uterus functionally unable to support foetus:

Chamaelirium – esp. helpful where history of miscarriage. Uterine irritability. Poor

tone in cervix. V. safe & nourishing. Ovarian & uterine tonic Vib prun-

tonic, astringent, anti-spasmodic, relaxant, uterine sedative, improves uterine circ, useful for uterine irritability

Combine Chamaelir & Vib prun for threatened miscarriage 10-20gtt every 30-60 mins for spotting, cramping, bleeding. Rept until symptoms clear > 20gtt (or more) mane until 22/40 approx.

Hormonal imbalance Vitex

helpful when history of early miscarriage esp. where low progesterone

eg 9/40 spotting (?corpus luteum insuff?) supports progest/corpus luteum/HCG

up to 10ml daily (usually much lower) if history of early miscarriage, esp. if suspect low progesterone

Case history 3Case history 3 Recurrent miscarriage & low progesterone. Woman – 33 yrs. 5/40 pregnant MH-Age 26- miscarriage at 9/40; age 28 miscarriage at 15/40; age 29 FT pregnancy

given progesterone injections from week 7 (>vomiting,constant fatigue which continued after delivery & cessation of progesterone)

RVitex 20 Chamaelir 30 Galega 10 Vib prun 20 Fucus 20 (x2) sig 5ml tds +resc. Rem Emergency drops: R Chamaelir 30 Vitex40 Vibprun30 (x1) sig 20gtt hourly prn

Started getting period-type cramps at 9/40 – lasting about ½ hr stopping & starting Cramps stopped after 2 days on emergency drops. Bed rest/ relaxation/ visualization/ inner dialogue. Keep bowel moving (avoid reflex

irritation of uterus) Cramps recurred on a few occasions up to 16/40, soon cleared with drops. Continued on original mix until 19/40 when she developed headaches. R changed to:

RChamaelirium 30 Vib prun 30 Mitchella 20 Rubus 20 (x1) sig 40gtt t.d.s. at 24/40 - RRubus 30 Mitchella 30 Achillea 30 Aesculus 10 (x2) sig 5ml bd.(varicose veins)

Went on to have normal FT delivery and healthy baby. Mother made quick recovery and reported that her energy was ‘better than it had

been for years’.

Rubus + Mitchella – Strengthening & relaxing combination for uterus. 20gtt bd/tds up to 5ml bd/tds

Leonurus – tones uterus, reduces nervous tension & spasm. Lovely uterine sedative for false labour pains, nervous debility, pelvic irritability.

Additional nervines/rescue remedy

Case history 4Case history 4

Woman 35yrs.MH Uterine fibroids. Surgery @27. Trying to conceive past 6/12. History alcohol/smoking R Calendula 20 Chamaelir 10 Rubus 20 Tarax rad 30 Achillea

20 (x2) 5ml tds Circ/lymph/ uterine/fertility tonics/ liver/ circ/

Fertility Tea on Full Moon: ALCH. VULG./RUBUS (TRIFOLIUM) Conceived after 5/12. At 32/40 niggling pains like ‘crampy period pains’ back & front on

walking (not Braxton Hicks) could last 30-60mins. No blood loss Stressed. Split with partner.

R Rubus 30 Mitchella 30 Leon 20 Vib prun 20 (x2) 5ml tds (+ rubus tea)

Pains became less frequent, shorter duration and ceased after 10days 36/40 nervine mix R Chamomilla/Val/Pass 10ml nocte

Normal delivery at 41/40 & healthy baby

Herbal Therapeutics in Female Infertility - Carol Guyette

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