The Use of Herbal Medicine while undergoing ART By Anca Sira, Dipl. Ac, L.Ac.
There are many herbs that are used for treating fertility and herbal medicine can dramatically improve the success rate of ART. However, due to the complexity of herbs and ART, anyone interested in taking them while undergoing ART should do so only under the supervision of a licensed herbalist that specializes in fertility. When one is undergoing a timely and expensive procedure such as IVF and the desired outcome is to produce many follicles with mature eggs and have good uterine lining, these outcomes can actually be hindered by the use of certain herbs during the wrong phase of the cycle. Therefore, while undergoing ART one should only be under the treatment of a licensed herbal specialist who can customize a formula based on your individual constitution and needs. It is also extremely important that the specialist understand every phase of fertility, the biochemistry involved, the ART process and the various herbs and formulas that can be prescribed.
There are hundreds of herbs in Chinese medicine, each with its own distinct character and function. Individually, each herb has a different degree of potency and when combined with other herbs, an even stronger potency and more successful outcome can be achieved. In a formula, there can be as few as three herbs or as many as 15. All of the herbs together create a synergistic formula that is well balanced and targets the root of the problem in the body and not just the symptom.
Generally, there are no negative side effects from taking herbal formulas when prescribed by a licensed herbalist. The licensed herbalist understands the complexity of the herbs, appropriate dosages of each of them and their relationships to each other when combining them in a formula. Occasionally, some individuals experience some gastric discomfort as a side effect but this is easily corrected by altering dosages.
It is very common for people to take herbs or supplements for a stated beneficial effect without fully understanding their mechanism of action or possible interaction with other medications. Taking only one herb or self-prescribing can actually have negative outcomes because of the complexity of herbs and their interrelationships with each other. Inappropriate dosages and combining of herbs can be detrimental and even life threatening in some cases. It’s important to remember that herbs are not just benign plants without any potential side effects or contraindications. Herbs, like synthetic medicines can have very potent effects on the body and may even alter the biochemistry of other medications thus increasing or inhibiting their effects.
An example of herbal misuse that had a potentially life-threatening outcome was when “a newborn infant whose mother ingested an herbal medication, blue cohosh, to promote uterine contractions presented with acute myocardial infarction associated with profound congestive heart failure and shock. The infant remained critically ill for several weeks, although he eventually recovered. Other causes of myocardial infarction were carefully excluded. Blue cohosh, Caulophyllum thalictroides, contains vasoactive glycosides and an alkaloid known to produce toxic effects on the myocardium of laboratory animals. We believe this represents the first described case of deleterious human fetal effects from maternal consumption of blue cohosh.” 1
Many pregnant women have taken blue cohosh to help with labor with no deleterious effect on the baby. Some unanswered questions remain in the above case: What dosage did the woman take? Did she take it alone or was it prescribed to her?
Seeking an appropriate herbal specialist is an important part of the decision in deciding to use herbal treatment in conjunction with ART. In California, acupuncturists are primary healthcare providers who are trained and licensed in both acupuncture and herbs. Outside California, almost all states accept the NCCAOM (National Certification Commission for Acupuncture and Oriental Medicine) exam for licensure. The certification for herbology is a separate exam and not all states require both licenses, therefore it is important to seek an acupuncturist that has their licensure in both acupuncture and herbs.
There are several herbs that have been touted as being beneficial to the reproductive system because they are estrogenic. This is true for some herbs but not all. Some herbs have been described as containing phyto-estrogens. Most of these herbs actually have an extremely weak estrogen activity, especially in the dosage amount usually provided. Some do show competitive binding to certain estrogen receptor sites.
While these herbs show marked improvement in hormonal deficiencies with pregnancy outcomes, it is important to realize that though these herbs can be very beneficial for natural conception they should be used cautiously when undergoing ART.
With this in mind, listed below are some common herbs with their contraindications in regards to ART that people commonly take for reproductive benefits. As you will learn, some herbs are beneficial while others do not affect the reproductive system in the manner expected.
Wild Yam, Dioscorea sp.
Extracts of wild yam were claimed to either contain natural estrogens or to provide precursors that the body could transform to estrogens. Today, research has shown that this is a fallacy: wild yam neither contains estrogens nor does it contain precursors that can be modified by the body; however, it does contain precursors that can be modified in pharmaceutical laboratories to yield estrogens. In a study of 23 women with menopausal symptoms taking wild yam cream, after three months of treatment, no significant side-effects were reported with either active treatment or placebo, and there were no changes in weight, systolic or diastolic blood pressure, or levels of total serum cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol, FSH, glucose, estradiol, or serum or salivary progesterone. It was therefore concluded that wild yam had no effect on hormones.
In a study published in Fertility and Sterility about whether dang gui has estrogenic effects in postmenopausal women, the results showed no statistically significant differences between control and placebo groups leaving the authors to conclude that dang gui alone did not produce estrogen like responses in endometrial thickness or in vaginal maturation and did not relieve menopausal symptoms when used alone. For relief of PMS symptoms, dang gui was believed to be efficacious when used in a traditional Chinese multiple herb formula.
Contraindications: Phytochemical analyses found dang gui to consist of natural coumarin derivatives, as well as constituents possessing antithrombotic, antiarrhythmic, phototoxic, and carcinogenic effects. Dang gui potentates warfarin and should be discontinued if taking warfarin or any other blood thinner. If a woman has clotting issues and is given heparin as treatment, dang gui should be omitted from the herbal formula.
Yi Mu Cao, Motherwort, Leonurus Artemisia,
Normal fertile women given an oral dose of Yi Mu Cao decoction (30 g. dry weight equivalent) showed an increase in intra-uterine pressure in 41.3% of 121 cases. The increase ranged from 150% to over 300% of spontaneous activity before dosing. A slightly higher success rate was observed with two successive doses or with improved experimental skill in later cases. Ergonovine (0.2 mg i.m.) scored a success rate of 61%. Therefore, yi mu cao’s decoction appeared to have a relative potency of 91% compared with ergonovine when the highest success rate (55.5%) of the former is considered. Blank control with water yields a positive response rate of 2.7%. There are no observable side effects apart from diuresis. 2
Contraindications: Due to its ability to stimulate the uterus, it should not be used in pregnancy, including after an IVF transfer.
Man Jing Zi, Vitex, Agnus Castus
In a study done by the Department of Medicinal Chemistry and Pharmacognosy, UIC/NIH Center for Botanical Dietary Supplements Research, College of Pharmacy, M/C 781, University of Illinois at Chicago on the estrogenic activity of plant extracts found that chaste berry (Vitex agnus-castus L.) showed significant competitive binding to estrogen receptors alpha (ER alpha) and beta (ER beta).
In another randomized, placebo-controlled, clinical double-blind study the effects of Mastodynon(R), a Vitex containing preparation, were investigated in 96 women with fertility disorders. 38 women with secondary amenorrhoea, 31 women with luteal insufficiency and 27 women with idiopathic infertility received 30 drops of Mastodynon or placebo twice a day over a period of three months. The outcome measure, which was pregnancy or spontaneous menstruation in women with amenorrhea and pregnancy or improved concentrations of luteal hormones in both other groups, was achieved in 31 out of 66 women. It was achieved more often in the Mastodynon group compared to the placebo group (57.6% versus 36.0). 15 women conceived during the observation period (seven with amenorrhea, four with idiopathic infertility, and four with luteal insufficiency). In women with amenorrhea or luteal insufficiency, pregnancy occurred in the Mastodynon group more than twice as often as in the placebo group. Under therapy no hormonal changes were found at a 5% significance level. Only very few undesirable drug effects were observed. Treatment with Mastodynon is recommended for 3-6 months.
A group of 52 women with luteal phase defects due to latent hyperprolactinaemia took part in a study whose aim was to prove whether the elevated pituitary prolactin reserve can be reduced and deficits in luteal phase length and luteal phase progesterone synthesis be normalized by taking Vitex. Blood for hormonal analysis was taken at days 5-8 and day 20 of the menstrual cycle before and after three months of therapy. The prolactin release was reduced after three months, shortened luteal phases were normalized and deficits in the luteal progesterone synthesis were eliminated. These changes were significant and occurred only in the verum group. All other hormonal parameters did not change with the exception of 17 beta-estradiol which rouse up in the luteal phase in patients receiving verum. Side effects were not seen, two women treated with the Vitex agnus castus preparation got pregnant.
Contraindications: Do not use with hormone therapy or while on oral contraceptives.
Sheng Ma, Black Cohosh, Cimicifuga
In the present study, therapeutic effects of the Cimicifuga racemosa preparation CR BNO 1055 (Klimadynon/Menofem) on climacteric complaints, bone metabolism and endometrium will be compared with those of conjugated estrogens (CE) and placebo. The question whether CR BNO 1055 contains substances with selective estrogen receptor modulator (SERM) activity will be investigated. METHODS: 62 postmenopausal women were included in the double blind, randomized, multicentre study, and treated either with CR BNO 1055 (daily dose corresponding to 40 mg herbal drug), 0.6 mg CE, or matching placebo, for three months. Menopausal symptoms were assessed by the menopause rating scale (MRS) and a diary. Levels of CrossLaps (marker of bone degradation) were determined by ELECSYS system and bone-specific alkaline phosphatase (marker of bone formation) by an enzymatic assay. Endometrial thickness was measured via transvaginal ultrasound; vaginal cytology was also studied. The primary efficacy criterion was the change from baseline to end point in the MRS. Change from baseline was analyzed for the secondary variables too. RESULTS: CR BNO 1055 proved to be equipotent to CE and superior to placebo in reducing climacteric complaints. Under both verum preparations, beneficial effects on bone metabolism have been observed in the serum. CR BNO 1055 had no effect on endometrial thickness, which was significantly increased by CE. Vaginal superficial cells were increased under CE and CR BNO 1055 treatment. CONCLUSION: The results concerning climacteric complaints and on bone metabolism indicate an equipotent effect of CR BNO 1055 in comparison to 0.6 mg CE per day. It is proposed that CR BNO 1055 contains substances with SERM activity, i.e. with desired effects in the brain/hypothalamus, in the bone and in the vagina, but without exerting uterotrophic effects. 3
Contraindications: Not to be taken with birth control pills or stimulatory hormones.
Red Clover, Trifolium Pratense
Two double-blind studies, both funded by the manufacturer of Promensil, found no difference between red clover and a placebo for treating menopausal symptoms such as hot flashes and vaginal dryness. The studies tested daily doses of 40mg or 60mg of red clover administered for 12 weeks.
However, another study found that red clover may increase blood flow in arteries, which diminishes with menopause. Patients were given 40mg of red clover for five weeks followed by 80mg for five weeks. Note that red clover may stimulate breast cancer cells. It also contains coumarin.
Contraindications: Not to be taken with anticoagulants.
Red Raspberry, Rubus idaeus
Red raspberry is high in tannins. The constituents that affect the smooth muscles, such as in the uterus, have not yet been clearly identified.4
Contraindications: Red raspberry may decrease the absorption and/or activity of several classes of medications in the body.
- Atropine – used to help restore or control heart function. It is used in combination with other drugs to treat other health problems including diarrhea and excessive salivation. Atropine drops (Isopto® Atropine and others) are used to dilate pupils for eye exams.
- Cardec – antihistamine, hay fever
- Codeine – pain and cough suppressant
- Ephedrine and Psuedoephedrine – asthma, flu, hay fever
- Lomotil, Lonox – antidiarrheal
- Theophylline, Aminophylline – used for asthma
Soy Products¸ Isoflavones/Genistein
Genistein has been classified by some as a phytoestrogen. This term is somewhat misleading, in that genistein neither has a chemical structure like estrogen nor does it act in the body in the same way as estrogen. It does interact with estrogen receptor sites, but it appears to interact preferentially with a subclass of estrogen receptors that will alleviate some estrogen-deficiency symptoms (e.g., hot flashes) with little stimulus to the receptors that affect tumors. In addition, it appears that genistein can inhibit the growth of breast cancer cells by promoting the internally programmed cell death, which is otherwise halted by the cancerous condition. 5
Contraindication: Do not take while on birth control pills and stimulatory hormones.
Rhodiola Rosea, Goldenroot
This has been well documented as an adaptogen (an endurance enhancer). In this capacity, it appears to help the body stay healthy and perform in top-notch condition despite physical exhaustion or environmental stresses, such as high heat or pollutants in the air and water. Rhodiola appears to work by influencing key central nervous system chemicals–neurotransmitters called monoamines (dopamine and serotonin are examples). By balancing monoamines it is believed it can ameliorate symptoms associated with difficult to treat illnesses such as; chronic fatigue, fibromyalgia and SAD (seasonal affective disorder). In contrast, most other adaptogens, such as Siberian ginseng, seem to boost the body’s reserves by enhancing the output of stress-fighting hormones from the adrenal glands. Rhodiola does not do this thereby having a gentler effect on the body.
Other studies on rhodiola have shown benefits in such varied areas as increased learning capacity and memory enhancement, regulation of menstrual periods and infertility, reduction of side effects from cancer chemotherapy, increased sexual libido and erectile dysfunction, enhancement of thyroid gland function, increased capacity for work and endurance, and protection from environmental toxins.
Due to its capacity to help deal with stressors and infertility without affecting hormones or competing with receptor sites for them, this is one of the herbs used in all ART phases and is recommended for people to take on their own.
Caution: Because of its stimulating nature, rhodiola should be avoided by individuals with bipolar (manic-depressive) disorder.
In my practice I have successfully treated many women undergoing IVF and IUI, whose outcomes were greatly enhanced by the use of herbs during all phases of the cycle and resulted in pregnancies. All the formulas I use are multiple herb formulas that are custom made for each individual.
1 Jones TK, Lawson BM, Profound neonatal congestive heart failure caused by maternal consumption of blue cohosh herbal medication, Department of Pediatrics, University of Washington School of Medicine, Seattle, USA.
2 Chan WC, Wong YC, Kong YC, Chun YT, Chang HT, Chan WF, Clinical observation on the uterotonic effect of I-mu Ts’ao (Leonurus artemisia).
3 Wuttke W, Seidlova-Wuttke D, Gorkow C, The Cimicifuga preparation BNO 1055 vs. conjugated estrogens in a double-blind placebo-controlled study: effects on menopause symptoms and bone markers, Department of Clinical and Experimental Endocrinology, University of Gottingen, Robert-Koch-Strasse 40, 37075 Gottingen, Germany. firstname.lastname@example.org
4 Blumenthal M, Busse WR, Goldberg A, et al. (eds). The Complete Commission E Monographs: Therapeutic Guide to Herbal Medicines, Boston, MA: Integrative Medicine Communications, 1998, 366.
5 Peterson G and Barnes S, Genistein inhibits both estrogen and growth factor-stimulated proliferation of human breast cancer cells, Cell Growth and Differentiation 1996; 7: 1345-1351.
Anca is an INCIID Professional Member.
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Anca Sira, L.Ac
1299 Fourth Street, 208
San Rafael, CA 94901
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