Challenge of infertility: How protective the yoga therapy is?

Sir,

Infertility and problems in conception have been a concern through the ages, and is also a significant clinical problem of today, which affects 8-10% of couples worldwide, 7-15% of couples in United States.[1] This is also very common in Indian population (4-6%, according to 1981 census). Both male and female factors contribute to cause this problem. A global review of infertility from the World Fertility Survey and others estimated similar rates of infertility in other settings in South Asia, such as 4% in Bangladesh, 6% in Nepal, 5% in Pakistan, and 4% in Sri Lanka.[1,2,3]

Approximately, 30-40% of all infertility is due to a ‘male’ factor. Clinicians had earlier found that while the sperm count of a normal Indian adult male used to be 60 million per ml around 3 decades ago, today, it stands at around 20 million per ml. Not only has the quantity of sperm production declined in males across the world, there has been a decrease in motility and morphology of the sperms. There has been a 2% reduction in the quality of male sperm annually. Also, 40% men in reproductive age group are reported to have a quantitative and a qualitative decline in sperm quality in India.[4] Stress also diminishes hormonal profiles that stimulate spermatogenesis.[5,6] A recent study reported that the percentage of semen ejaculation, which is considered less than normal volume (<4 ml), increased from 34% to 65% and most suitable ejaculation volume (>4 ml) went down from 15% to 3%. As far as morphology of sperm was concerned, in 2001, 26% of the sperms showed more than 60% normality, whereas in 2011 this was reduced to 7%. University of Copenhagen recently concluded a significant decline in seminal quality in men between 1938 and 1991, due to environmental pollution. That study confirmed a 28% increase between the 1960s and 1990s in the number of men who had hypospermia.[7] On the other hand, the ‘female’ factor in infertility is basically diagnosed with the occurrence of amenorrhea. Other causes may include polycystic ovarian syndrome (PCOS, the most common cause), hyperprolactinemia, Mullerian anomalies (congenital developmental abnormalities of the uterus), decreased secretion of hormones by the hypothalamus or pituitary glands, and blockage of the cervix. Statistics indicate that the number of women aged 15-44 with impaired fecundity in US is about 6.7 million (10.9%), among them, number of married women is 1.5 million (6.0%). On the basis of women at the end of their reproductive lives, in the age group 45-49 years, suggests an infertility rate of approximately 10% worldwide, 8% in India, 10% in Pakistan, 11% in Sri Lanka, 12% in Nepal, and 15% in Bangladesh.[2,8]

Since the beginning of time, to solve the problems of conception and infertility, humans have employed folk medicine, and other healers to enhance the ability to conceive. Today, complementary and alternative medicine/therapy (CAM) is often utilized for the same purpose. Because of the expense associated with assisted reproductive technologies (ART), some infertile couples may turn to CAM in an attempt to become pregnant using treatment that they may perceive as being lower cost, safer, or more effective. Examples of CAM that have been described as treatments for infertility include homeopathy, spiritual healing, herbal therapy, and, ‘yoga’, which has been part of the health system in India for more than 7,000 years.[7,9]

Yoga therapies have found to improve reproductive functions both in men and women by improving the overall integration of physiological systems. Studies have shown that yoga therapy orchestrates fine tuning and modulates neuroendocrine axis which results in beneficial changes. It mainly improves reproductive functions by reducing stress and balancing the neurohormonal profile. It also reduces urinary excretion of catecholamines, and aldosterone, decreases serum testosterone and luteinizing hormone (LH) levels and an increases cortisol excretion, indicating optimal changes in hormonal profiles.[9] Alterations in brain waves (basically an increase in alpha waves) and decrease in serum cortisol level was observed during yoga therapy.[7,9]

Yoga practices including physical postures, breathing, and meditation in pregnant women are found to cause an increase in child birth weight, decrease in preterm labor, and decrease in intrauterine growth restriction (IUGR).[9] Women practicing yoga in their second trimester reported significant reductions in physical pain from baseline to post intervention and in their third trimester showed greater reductions in perceived stress and trait anxiety.[9,10,11] Thus, it is clear that yoga can be used to prevent or reduce obstetric complications.

Along with better management of stress, yoga therapy also helps to improve circulation, promote proper functioning of the internal organs. In men, practicing moola bandha has been associated with relieving spermatorrhea, preventing inguinal hernia, and controlling testosterone secretion. The practice of moola bandha is used to enhance awareness of genital arousal sensations, and in this way, may be a helpful adjunct for improving sexual desire and arousal.[7] In addition, as men age, their production of dehydroepiandrosterone (DHEA), as well as testosterone and other androgens or sex hormones decline. It has been estimated that for every year over the age of forty, men's testosterone level drops by one percent.[9] About 20% of men in their 60's have significantly reduced testosterone levels. As testosterone is a key hormone in men's sexual functions, aging-related decline in testosterone levels has a negative impact on men's sexual performance. Yoga therapy, by improving and integrating neuroendocrine axes, improves hormonal secretion. Thus, it improves sexual desire and overall reproductive health.[7]

Yoga for fertility improves both female and male infertility by minimizing stress, which consecutively balances the hormones of the body with improvement in mental health; thereby increasing a couple's ability to conceive. However, persuasive research in this scientific field is still unmapped. Hence, this virgin territory of research may explore a new dimension of scientific research which is a reliable avenue to have holistic health.