Medical Weblog

What is it?

Primary infertility (as opposed to secondary infertility which occurs in couples who have already had a baby but have trouble conceiving again) is present when a couple cannot conceive after a year of unprotected, unlimited intercourse. Almost one in seven of all couples in the West are infertile and the number is growing.

What causes it?

• Putting off having babies until the woman is past her peak fertility. The average couple is at peak fertility in their early twenties and most don’t start trying to have children until five to ten years after this. A woman’s eggs (ova) are all present at birth and age along with the rest of her body. By the time she is 30 some of the eggs are already of poor quality and so do not result in a fetus, or are aborted spontaneously very early. About seven or eight out of every ten conceptions in human beings end up being wasted naturally. Well over 30 per cent of women aged 40-45 are infertile and one UK study found that three-quarters of mothers having a baby when they were 30 or more had been having unprotected intercourse for two years or more before they conceived.

• VD is now a real epidemic, especially in the form of gonorrhea. Its growth is exceptionally high among teenagers. A substantial proportion of females with gonorrhea have no symptoms and by the time they know they have it their fallopian tubes have been irreparably damaged and so cannot allow an egg to pass from the ovaries to the uterus.

• Prolonged use of the Pill can delay the return of ovulation after stopping the drug in about 2 per cent of women. This is a very small proportion but the number of individuals is large because of the numbers of women on the Pill – nearly 3 million in the UK.

• The IUDs (intrauterine device currently used can delay the return of conception and older women seem to fare especially badly in this respect. Also, IUD are often associated with subclinical pelvic infections which can cause infertility in their own right.

• Abortions are followed by infections and damage to the cervix in a small number of women. These effects are very uncommon, but given the increasing numbers of women involved the numbers of individuals with such problems are building up.

• Exposure to drugs, pollutants, food additives and so on is rising and some undoubtedly play a part in the increasing toll of infertility.

• Not making love around the time of ovulation. Many infertile couples attending clinics are having intercourse only once a month and then not around ovulation time.

• Using lubricants, jellies, etc. All such creams, jellies and lubricants kill sperms, at least to some extent.

• Women who get up immediately after sex, so allowing the semen to run out. This is fine if the man has a large volume and she is very fertile but this may not be the case.

• The couple has sex problems which mean they rarely make love.

• The man’s scrotum is too hot. Sperms need to be kept at 2-3°C lower temperature than the rest of the body or they die or don’t even form properly. This is why the testes lie outside the body.

*181/72/5*

As a child develops, she passes through stages. At each stage the tasks that confront her increase in complexity. The challenges of one stage prepare her to tackle the next. The tasks of adolescence are to form an identity, to separate from the family, to develop more mature relationships outside the family, and to accept one’s growing and changing body.

Sometimes, however, family interactions combine with the fears of an eating disorder patient in a way that makes it difficult for her to face and overcome these developmental challenges. For example, when parents are overly critical of friendships outside the home, a child may limit the depth of her involvement with her friends. Later, as her friends grow and mature, she is left behind. To cope with abandonment, the girl retreats to a world focused on the things she can control -food and eating.

Family therapy identifies family problems that contribute to the child’s symptoms. Once they are identified, work begins to correct those problems and to help everyone, not just the patient, find other ways of interacting.

The key elements in any family structure, according to Minuchin, are hierarchy, subsystems, and boundaries. Hierarchy is the way tasks are assigned based on ability and maturity. In a normal hierarchy, leadership is shared jointly by the parents. Children take on roles that fit their age and development -helping around the house, caring for siblings, earning money. Subsystems are smaller units based on roles within the family: parents, spouses (not the same thing!), and siblings. Boundaries are the invisible, but very real, lines between subsystems, and between the family and the outside world. Proper boundaries allow each member the highest degree of freedom while providing safety and security. In some families, not only are boundaries between subsystems inadequate, but the boundaries between the family and the outside world are too rigid. Children can’t play with neighbors: “Not our kind, dear.” Dating is discouraged; a teenager may be told not to take a job: “We’ll give you more money, if that’s what you want.”

Minuchin’s approach to family therapy, which I have found helpful in my practice, changes these pathological interactions by firming up the boundaries between parents and child. We urge parents to take on their natural roles as family leaders and to collaborate with and support each other. We also work with all members to help the patient become more autonomous. The family members learn new ways to communicate, and pick up pointers on solving problems in more creative, effective ways. In the process, they lose the feeling of helplessness that drove them to seek help in the first place.

*102/35/5*

Healthy breakfast mix

1 cup oat bran

1 cup LSA mix (crushed linseed, sunflower seeds and almonds)

1 cup lecithin granules (unbleached)

1 cup psyllium husks

1/2 cup slippery elm

1/2 cup rice flakes (optional)

1/2 cup almonds, pecans, sunflower seeds and pumpkin seeds

A handful of dried apple, thinly sliced

Mix all of the ingredients together and keep in a sealed container in the fridge. Serve in a bowl with chopped fruit, fresh juice/soy milk/nut milk or low fat milk. Use manuka honey or brown rice syrup for extra flavouring, if desired.

Curried Mushroom and Tomato Omelette (serves one)

1/4 onion, finely chopped

25 ml of vegetable stock

20 grams mushrooms, chopped

1 tomato peeled and diced

1/4 capsicum, finely chopped

2 egg whites

2 teaspoons curry powder

2 tablespoons low fat milk

1/2 teaspoon of olive oil

Place the chopped onion and half of the vegetable stock into a fry pan. Simmer until the onions become soft, adding extra stock if necessary. Add the mushrooms and cook until stock has almost evaporated. Dice the tomato and capsicum, and add to the pan. Cook for 1 minute and then set the mixture aside.

Now beat the egg whites and milk together until they are well combined, but not too frothy. Add the curry powder to this mix. Lightly oil the pan with the olive oil. Pour the mixture into the hot pan and cook until almost set. Pile the filling into the centre of the omelette and gently fold over. Turn the omelette out onto a plate and serve immediately.

*221/34/5*

This acts on the ovary and triggers the ripening of follicles that contain eggs, thus setting the stage for ovulation during the fertile years. FSH is not one substance but a group of more than twenty similar substances produced by the pituitary gland of the brain. Scientists are only just starting to study the multiple forms of FSH and to assess their roles at different stages of life. In the fertile years, high levels of oestradiol and inhibin (described later) suppress the brain’s output of FSH. When the output of oestradiol and inhibin declines after menopause, there is less suppression of FSH production and its level in the

bloodstream increases to ten or fifteen times that seen in the early part of the premenopausal menstrual cycle. The rise is gradual at first, then reaches a peak at which it stays for three to five years after menopause. It returns to the premenopausal range twenty or so years later.

*138\38\8*

Vitamin A in tablet form is considered by many naturopaths to be useful in treating vaginal dryness and bladder irritability. The usual recommendation is to take it for six to eight weeks and then to have a two-week break. Alternatively they may recommend a vaginal ointment made from English marigolds (Calendula officinalis). This is credited with oestrogen-like properties and an ability to prevent and treat vaginal infections.

The pelvic floor muscles are like a safety net supporting all the organs of the lower abdomen. When the muscles are weak, any form of stress exerted on the bladder – such as a sudden jump, cough, laugh or lifting motion — can result in an outflow of urine. Increasing numbers of women are taught pelvic floor (Kegel) exercises, which they are encouraged to do daily. These exercises are designed to strengthen themuscles that support the bladder, uterus and bowel, in order to control stress incontinence and prolapse. You can alternate the exercises and use triggers, such as stops at red traffic lights or brushing your teeth, to remind you to do themmuscles that support the bladder, uterus and bowel, in order to control stress incontinence and prolapse. You can alternate the exercises and use triggers, such as stops at red traffic lights or brushing your teeth, to remind you to do them.

*101\38\8*

A problem with much of the evidence about the benefits and risks of HRT is that the early research was into oestrogens alone, not the combination with progestogen. For women who don’t have a uterus, and who therefore do not take a progestogen, this is not important. But the concern for the much larger number of women who take a combination of hormones is that the long-term effects on heart disease, blood vessel disorders needed before we can tell women which progestogens are least disadvantageous, in what dose, and combined with what oestrogen.

Many studies show that women with a uterus who use oestrogen on its own for longer than six months experience an increased risk of cancer of the endometrium (lining of the uterus). By adding an adequate amount of progestogen for ten to fourteen days a month, we can make sure that the endometrium is protected.

Other concerns relevant to all women include the following.

The apparent benefit of oestrogen in reducing the risk of heart disease may be due, partly at least, to bias in the selection of the women studied. All the studies of the risks and benefits of HRT are overshadowed by a big question mark. Are women who use it somehow different from the remainder of the female population, and if so might this skew the results? Are they healthier and at less risk of heart disease to start with, for example? Are they more health-conscious at the outset? Are they careful about eating nutritious foods, not smoking, exercising regularly? And are they more likely to follow their doctor’s suggestions? To be sure that HRT really benefits the heart it would be necessary to give HRT to one group of women selected from the general population and a placebo (a harmless and inert substitute) to a comparable group. The results of three such trials, which are at an early stage in the US, will be of interest.

*67\38\8*

Oestrogen-containing vaginal preparations are often used by women in whom vaginal dryness makes sex distressingly painful. You may also benefit from these preparations if you have urinary symptoms such as a need to urinate frequently, or you experience recurrent urinary tract infections. Severe symptoms of this kind may need more far-reaching hormone therapy.

The oestrogen is absorbed into the bloodstream through the cells lining the vagina, and its major effect is in the immediate vicinity of the vagina and bladder. It is also carried to other parts of the body, including the uterus. For this reason, if you have an intact uterus and use vaginal creams, tablets or pessaries more than three times a week, you should probably be taking an oral progestogen for ten to fourteen days every three months. This ensures that any build-up of endometrial tissue is shed as a withdrawal bleed or, if no bleeding occurs, it provides reassurance that the endometrium is not in any danger.

Hormone rings, which sit in the top of the vagina for three months before needing to be replaced, release a small and constant stream of oestrogen that is absorbed by the cells of the vagina and cervix. Once again, if your uterus is intact you should take a ten-to-fourteen-day course of progestogen every three months to ensure that stimulation of the endometrium does not occur. These devices are on trial in Australia at the time of writing.

Advantages of these forms of local therapy include a concentrated dose of oestrogen at the site of the symptom rather than its widespread dispersal through the body.

Disadvantages include the lack of effect on other menopausal symptoms (such as hot flushes and night sweats); the rare occurrence of unexpected spotting or bleeding or endometrial hyperplasia (excessive thickening of the uterine lining) if used too frequently without added progestogen; their messiness; and the embarrassment felt by some women about putting things into their vaginas.

*32\38\8*

Although the blood vessels play an important part in migraines, many doctors believe that they are not the whole story. Some things are difficult to explain on the basis of blood vessels alone – why the pain is usually on one side of the head, for example, or why bright lights should trigger migraine off. These facts suggest that the nervous system is involved as well, but exactly how is not known.

The conventional view of migraine is that it cannot be cured, except in rare instances where a misaligned vertebra, usually in the neck, is at the root of the problem – and this may not be true migraine anyway. For such patients, treatment by an osteopath may be effective. (How a misaligned vertebra might cause migraine in the first place is something of a puzzle, but one that we will return to at the end of this section.) Given that there is no ‘cure’, the main form of conventional treatment is drug therapy, using drugs that can stop an attack, or at least alleviate it. Patients are also advised to identify their particular ‘triggers’ and avoid them.

The relevance of food intolerance to migraine is hotly debated. The conventional wisdom is that certain foods (chocolate, cheese etc) can act as triggers but that commonly eaten foods, such as wheat and milk, are unlikely to play a part in migraine. However, several carefully conducted scientific trials have produced good results, using elimination diets to treat migraine sufferers. One of these studies, involving children with severe migraine, is described on p91. Studies with adults have shown that about 70 per cent of patients recover very well when treated in this way. Doctors working in this field in fact achieve a better success rate than this, because patients who do not respond to a simple elimination diet often turn out to have chemical sensitivities or other problems, such as Candida overgrowth. If these problems can be resolved, then the success rate rises to 80 or 90 per cent.

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Great care should be taken that someone suffering from Graves’ disease (exophthalmic goitre) and others with an increased heart beat are only exposed to soft harmonious music, which will be of greater benefit to them than fast, exciting sounds. On the other hand, a slow heart that can do with perking up will benefit from a little more movement and rhythm, so as to catch a little of the enlivening spirit.

As with all biological methods of treatment, it is necessary to apply intuition, understanding and feeling. Those who lack such sensitivity and do not have the ability to develop it, should at least be considerate and spare the patient at home or in the neighbourhood from the worst of the blaring noises that go under the name of ‘music’ today. It is sad to see the abuse that has been inflicted on us since radio has been invented.

In summary, try the influence of some healing music with your family, friends and acquaintances, at the same time not forgetting to show consideration for your neighbours and especially those who are ill.

*1238/28/1*

If you have been so infected by a hurried pace of life that it becomes a habit and you cannot even slow down when you should rest and relax, the end result of rushing about will not be what you expect. It will not save time and enable you to relax for longer. If the spare time is not devoted to relaxation but sacrificed to other business activity or intense efforts, do not be surprised to find your interest in work declining.

Our ancestors used to start the day at 4 a.m. in the summer and, as the poet Johann Peter Hebel wrote: ‘The work you do at four in early morning light, will not affect your health and rest at nine at night.’ A working day was not an eight-hour period in which certain work had to be done; but rather, the day was long enough to make work a pleasure and the evening hours a time for ‘recharging one’s batteries’. Because people today want to get more out of life and enjoy it in a different way, all these former pleasures have gone. However, the calculation has misfired. The outcome has not provided a beneficial basis for relaxation. On the contrary, a shorter working week has demanded greater effort from us, often taxing the energy reserves beyond capacity.

An overtired person derives less benefit from a longer period of inactivity than those who work steadily, without hurrying and feeling under pressure, because they prefer to spread their workload over a longer period of time.

*1169/28/1*