From the book
How to Have a Baby: Overcoming Infertility
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani, MD.
Why are some couples unhappy with modern infertility treatment ?
What can alternative medicine offer infertile couples ?
How can you protect yourself from quacks ?
How can you use alternative medicine intelligently ?
There is no doubt that modern medicine inspires awe. IVF laboratories and sophisticated ultrasound scanning machines appear very impressive and reassuring when you are infertile. However, paradoxically, even though the effectiveness of reproductive technology has improved dramatically, more infertile patients than ever before have become dissatisfied with their medical care today. This situation has resulted in a move towards 'alternative' medicine, which has become increasingly popular all over the world. Even in the United States of America (the bastion of high-tech scientific medicine), more than 20 per cent of infertile couples have consulted an alternative medicine practitioner, mainly because they were unhappy with modern medical care.
There are many reasons for this unhappiness with modern medicine. Patients increasingly feel that medicine has become too commercial and that doctors are too busy to spend time with them. They are unhappy with the impersonal nature of modern medicine, especially when the doctor spends more time looking at their lab reports and ultrasound scans, rather than with them. While it is true that patients need technology, they also need tender, loving care; after all, doctors need to look after not only their medical problems, but also their emotional needs!
Alternative medicine, on the other hand, offers a markedly different perspective. Rather than focussing on the infertility in isolation, alternative medicine treats the patient as a whole; hence the popular term, holistic medicine. Doctors practicing alternative medicine sit down and talk to the patient; they touch and feel him and ask many questions. And such attention feels good, in refreshing contrast to the modern doctor who rarely has even 15 minutes to spend with the patient. (Often, tender loving care and personal attention are all that alternative medicine practitioners have to offer, but they offer it very well indeed!) There is no doubt of the efficacy of the placebo effect, and even the simple act of touching the patient, can have a therapeutic effect. Also, alternative medicine doctors are very good at reassuring patients, as contrasted with the coldly scientific approach of western medicine.
Many patients (usually those with unexplained infertility or with ovulatory disorders) do conceive when they use alternative medicine. However, the practice of alternative medicine in India today leaves a lot to be desired. For one, such medicine does not have a universally accepted scientific basis; hence, it is difficult to rigorously analyze its claims. Since there is no need for formal publication or peer review in alternative systems of medicine, there is little scientific documentation available about their efficacy or side-effects, so that it becomes difficult to confirm claims or dispute them. Consequently, one has to blindly trust the doctor.
Authoritative journals or texts are difficult to find; and most publications use little scientific rigour, being based mostly on anecdotal case reports, with little documentation or proof. Moreover, since there is no official monitoring of the practitioners of alternative medicine, anyone can make tall claims and get away with them! Also, since there are few formal training requirements, anyone can practice alternative medicine, with minimal skills or qualifications. Unfortunately, unscrupulous practitioners have mushroomed, who are out to make a quick buck, and malpractices and quackery flourish, which is why most infertility specialists distrust alternative medicine practitioners today.
How can you protect yourself from quacks ? Remember that quackery is not an all-or-nothing phenomenon. Some products can be useful for some purposes, but worthless for others. For example, while certain ayurvedic herbs can be very useful, often the mass-manufactured ayurvedic medicines available in chemists' shops are completely useless, because they do not contain what they are supposed to! While there is no doubt that homoeopathic medicines can be helpful, the concept of a standard homoeopathic remedy for common illnesses such as headaches and colds flouts a basic homoeopathic principle, which states that remedies need to be tailor made for a particular person and only a skilled homoeopathic physician can identify the required medicines properly.
Unproven methods are not necessarily quackery. Those consistent with scientific concepts may be considered to be experimental, but legitimate practitioners do not go around promoting unproven procedures in the marketplace. Instead, they engage in responsible, properly designed research studies to prove or disprove their claims.
Quackery can harm individuals in many ways. First, is the loss of a tremendous amount of money which patients invest in pursuing this treatment, and many unscrupulous practitioners can bleed patients and their relatives dry - a little at a time. Also, many of the quack therapies can cause direct harm. It is a common misconception that 'natural medicines' have no harmful side- effects - but anything which can have an effect, by definition, also has the potential to cause harmful effects (after all, the desired effects of a medicine are what we call its therapeutic action and undesirable effects are labeled 'side-effects'!). The indirect harm they cause can also be enormous: for example, patients may pursue 'alternative medicine' for treating their infertility and may deprive themselves of the opportunity of getting effective state-of-the-art medical treatment.
Quackery flourishes even in the USA where people are much more sophisticated, and the US Food and Drug Administration (FDA) provides effective policing. Therefore, it is hardly surprising that in India this menace is rampant, and there are far more quacks than regular medical practitioners. Faith healing, for example, is an integral part of Indian traditions, especially in villages where educated priests take advantage of people's ignorance and blind faith.
How can you save yourself from being quacked? Here are some useful pointers by Dr. Stephen Barrett from his Quackwatch Web site (at http://www.quackwatch.com/.)
- Forget about 'secret cures'. True scientists share their knowledge as part of the process of scientific development. Quacks often keep their methods secret to prevent others from decisively demonstrating that they don't work. No one who actually discovered a cure for infertility would have reason to keep it secret. If a method really works, the discoverer would gain enormous fame, fortune and personal satisfaction by sharing the discovery with others.
- Remember that quackery often garbs itself in a cloak of pseudo-scientific respectability and its promoters often use scientific terms and quote (or misquote) from scientific references. Be equally wary of pseudo-medical jargon. Instead of offering to treat your infertility, some quacks will promise to 'detoxify' your body, 'balance' its chemistry, release its 'nerve energy' or 'bring it in harmony with nature'. The use of concepts that are impossible to measure or quantify enables success to be claimed even though nothing has actually been accomplished.
- Ignore any practitioner who says that infertility is caused by faulty nutrition or can be remedied by taking supplements. Although some diseases are related to diet, most are not. Moreover, in most cases where diet actually is a factor in a person's health problem, the solution is not to take vitamins but to alter the diet.
- Be wary of catchy anecdotes and testimonials. If someone claims to have conceived after using an unorthodox remedy, there is often a rational explanation. Some patients with long-standing unexplained infertility do get pregnant on their own - and they may erroneously give credit to the treatment. Some testimonials, of course, are complete fabrications!
- Don't let desperation cloud your judgment! It is true that infertile couples are very susceptible to being quacked, but if you feel that your doctor isn't doing enough to help you, don't stray from scientific health care in a desperate attempt to find a solution. Instead, discuss your feelings with your doctor and consider a consultation with a recognized expert.
The best way you can protect yourself from being taken for a ride, is to make sure you are well informed about your infertility. The 'take-home message' is simple: if it sounds too good to be true, it probably isn't!
Unfortunately, because of widespread quackery in the field of alternative medicine, most infertility specialists today have a poor opinion of what alternative medicine can offer their patients. This often means that doctors end up throwing the baby out with the bath water! There are many areas for which Western medicine today has little to offer the patient. Examples include: medical treatment for a low sperm count, or treatment for a thin endometrial lining. It is possible that alternative medical systems may have effective techniques for treating these conditions - and if we research these, and show that they are effective, we may be able to make significant progress in our ability to help infertile couples.
Amongst the various options available, acupuncture has become quite popular, and the theory behind this is that it can re-balance the bioenergy of the body that runs in the Meridian pathways, and this helps to improve tissue function. The "scientific" explanation is that it changes levels of neurotransmitters, the chemicals that nerve cells use to communicate. Herbalists may recommended ginseng as a "tonic" for men and women ; and a combination of false unicorn root (helonias) and vitex tinctures for women. This realm of herbal practice is probably for experts only, as we still do not know all the side effects of these herbs. In general, it's best to take as little medication as possible when you are trying to get pregnant. Nutritionist therapists suggest using supplements which contain arginine, beta carotene, zinc, and Vitamin C and Vitamin E. Aromatherapists may give a clary sage oil massage which is said to improve estrogen levels; and rosemary, tea tree, lavendar and other anti-infective oils for an abdominal massage.
For patients with poor ovarian reserve ( oopause), we will advise they try taking DHEA and wheat germ. When modern medicine has nothing better to offer, we encourage our patients to explore alternatives !
An important area to consider is the mind/body connection. There are now clinics in the USA that claim to have good pregnancy results with meditation, yoga, relaxation and visualization techniques. Again, solid documentation of these results is lacking, but you may want to try these out.
For options like ayurveda and homeopathy, it is important that you go to a reliable practitioner, because these are complex sciences, and you need expert guidance to achieve the best results. We feel that diverse modalities such as massage, Reiki, yoga, ayurveda, acupressure, acupuncture, hypnosis, homeopathy, naturopathy and many others can work in conjunction with each other as part of a unified team rather than in competition.
We need to learn to combine the best of both worlds - high technology with high touch - and this is called integrative medicine, as pioneered by Dr Andrew Weil of the USA. Integrative medicine neither rejects conventional medicine nor embraces alternative medicine uncritically - just because most alternative medicine systems are 'natural' does not automatically make them better! The most important requirement is that you need to find a good doctor, no matter what system of medicine you choose to follow.
It is equally important that you understand the limits and the rationale of the system, so that you are not taken for a ride. Thus, if you have blocked tubes, remember that it is very unlikely that herbal medicine will help you open them. Also, do remember that infertility is a heterogeneous problem - and some modes of therapy may be better for treating certain problems, rather than others! A good doctor will be able to guide you, so that you are aware of the strengths and limitations of each approach.
As a patient, you should feel free to explore all possible options - remember that they are not competitive, and should be seen to be complementary to each other - after all, the goal for all of them is to help you to have a baby! Thus, if you find that Reiki helps you, you can combine Reiki treatment with IVF if you so desire! There is no harm in going to an alternative medicine doctor - but do let your infertility specialist know what other treatments you are taking. The combined knowledge of both old and new healing modalities is ultimately superior than a single-model approach - and you can learn to combine the best of both worlds!