For three years, Sarah, a 36-year-old medical doctor, and her husband, Ray, had 1 been trying to start a family-but each month brought disappointment. Conventional medical testing found no reason why she or her husband would be infertile (defined medically as being unable to achieve pregnancy after a year of unprotected intercourse). After in vitro fertilization failed, they consulted me.

First, we reviewed how to time sexual relations to maximize the chances of conception.

Optimal: One day before or on the day of ovulation, when an egg is released from the ovary, Sarah had been using an at-home urine test (sold in drugstores) that detects a surge in luteinizing hormone, indicating that ovulation is imminent. I recommended that she also pay attention to her cervical mucus, because fertility rises when there is an increase in its amount, slipperiness and stretchiness.

Some studies suggest that caffeine decreases female fertility, for unknown reasons. Also, regular and decaf coffee, as well as black and green tea, contain tannic acid, which may decrease sperm production. I advised Sarah and Ray to avoid coffee, cola, chocolate and tea (except herbal).

Wisely, Sarah had eliminated alcohol from her diet. Alcohol can sporadically halt ovulation (and contribute to birth defects). I suggested that Ray also avoid alcohol, because it can reduce sperm count and quality. I was pleased that Sarah's weight was normal. Being overweight raises levels of the hormone estrogen and may lead to irregular ovulation. Being underweight inhibits production of the hormones required to stimulate ovulation. I also was glad that neither partner smoked, because toxins in tobacco can damage eggs and sperm.

Sarah was unaware that nutritional and herbal therapies can help a woman get pregnant. I told her to take a daily multivitamin to guard against nutritional deficiencies that impair fertility. In addition, I suggested supplementing with the herb Vitex (chasteberry), which stimulates the pituitary gland to release luteinizing turn increasing the ovaries' release of progesterone, a hormone that prepares the uterine lining for implantation of a fertilized egg.

A longstanding naturopathic treatment for female infertility is to enhance the level of thyroid hormone, because even a minor deficiency can prevent ovulation and increase the risk for miscarriage. Blood testing revealed that Sarah had a very low level of the most potent thyroid hormone, T3. I prescribed Armour Thyroid, a natural brand that contains T3 and other thyroid hormones found in the human body. Synthetic brands usually contain T4, the less potent form of the hormone.

Two months after her first visit, Sarah phoned and exclaimed, "I'm pregnant!" After congratulating her, I recommended that Sarah stop taking chasteberry, which was no longer needed ...continue her thyroid medication and switch to a prenatal multivitamin that provided more folic acid, vitamin B-12 and iron. A few weeks later, Sarah came to my clinic again-this time, for morning sickness.

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