Infertility is defined as not being able to conceive after at least one year of unprotected sex. The CDC (Centers for Disease Control and Prevention) tells us that 1 in 8 couples struggle with fertility issues; that is more than 200,000 cases per year in the US. 

To conceive a woman must be able to release an egg from one of her ovaries. A man’s sperm must join with that egg to fertilize it. The fertilized egg must then travel through the fallopian tube towards the uterus or womb. The fertilized egg must be able to attach to the inside of the uterus. Infertility may be the result of a problem with any of these steps along the way, and all steps must be taken into consideration when analyzing the root cause of infertility. 

Both parties must first be considered, and a visit to a reproductive endocrinologist to begin investigation can rule out some, by evaluating a semen sample to check the number of viable sperm, motility (movement) and morphology (shape). This will determine if, and how, male factors are contributing to infertility. Many factors, such as unhealthy habits - smoking, anabolic steroids, heavy alcohol, drug or medication use can affect the outcome. Trauma or varicoceles can also cause issues, as well as autoimmune disorders and genetic or hormonal imbalances.

Women need functioning ovaries, fallopian tubes and uterus to become pregnant. Conditions affecting any one of these organs can contribute to female infertility. Regular predictable menstrual cycles are generally a good indication of healthy ovaries. Ovulation can be predicted by using an ovulation predictor kit and a blood test can determine the woman’s progesterone level on day 21 of her menstrual cycle. No single test is a perfect predictor, however, so eliminating other most common factors including follicle stimulating hormone (FSH) value on day 3 and 5 of the menstrual cycle using ultrasound checks the health and condition necessary to conceive.

Women are born with all of the eggs that they will ever have, and a woman’s egg count decreases over time. Diminished ovarian reserve is a condition in which there are fewer eggs remaining than normal. Age is a factor, also congenital, medical, surgical, or other contributing causes can have an effect. Eating disorders, excessive exercise, stress or low body weight are additional factors that may diminish a woman’s conceptive success rate. Chemotherapy or radiation may bring about premature menopause before the age of 40.

Fallopian tube obstruction can be another possible reason for infertility. Evaluation may be performed using X-ray equipment to evaluate the viability and health of the tubes, which are an important part of the process to a successful pregnancy. 

Abnormal uterine contour may be another factor; evaluation by ultrasound is advised, to check for fibroids or other abnormalities in the uterine environment.

Preparing for a successful outcome, when planning to start a family, helps eradicate some of the issues that couples may face on their journey. If issues arise after months of trying to conceive, there are many ways couples can still have a planned, healthy pregnancy, with the assistance of evaluation and medical assistance where necessary.

Dr. Sally WarrenTraditional Naturopath
Metro Integrative Pharmacy


Notes from a Naturopath:


Plan ways to increase fertility using supplemental herbs and vitamins, and improve diet and lifestyle habits. Add extra herbs and vitamins which have long been recognized as natural hormone boosters to balance estrogen and progesterone rations and stimulates ovaries and increase sperm viability. Metro Integrative stocks a wide variety of combinations, and single items, such as Red Raspberry and Nettle Leaf, Alfalfa and and Vitamin C. Introduce healthy Omega-3 fats and foods rich in folic acid or folate, this is a B vitamin which helps to build new cells. Foods like green leafy vegetables, citrus fruits and beans help to provide healthy amounts of folic acid, while pumpkin seeds provide zinc, important to men for reproduction. Avoid alcohol, processed foods, sugar and caffeine (the American Pregnancy Association claims that more than 200-300 mgs of caffeine per day may reduce fertility by up to 27%.), and reduce stress. Try stress-reducing exercise, like yoga. Ask Metro Practitioners for personalized advice for your individual situation, and check out a huge selection of integrative products to help both men and women.

Dr. Sally Warren, PhD
Board Certified Traditional Naturopathic Doctor, Metro Integrative Pharmacy


Notes from Metro Drugs Fertility Pharmacy:


Metro Drugs is a full-service fertility pharmacy, specializing in infertility and fertility compounding medications in New York City. Metro Drugs serves many other states as well, where they are licensed to provide 24/7 support and mail order services. The pharmacy has an expert team of pharmacists, technician, and support staff to assist and provide care. There are many different types of fertility treatments available, and Metro Drugs offers advice and support with quality 24 hour customer services. Advances in science and medicine have had a positive effect on the diagnosis and treatment of infertility and approximately two-thirds of those couples who participate in treatments are able to conceive.

212-794-7200 or 888-258-0106


Notes from the Registered Nutritionist:


●    Maintain a healthy weight

Being of too little (BMI <18.5) or too much weight (BMI >25.0) can directly impact fertility.

Underweight individuals may not be producing enough estrogen or may not contain enough body fat to conceive.

Being overweight or obese can cause irregular cycle and anovulation preventing successful implantation in the uterus.

Being of normal weight (BMI 18.5-25.0), consuming a whole-foods diet (fruits, vegetables, beans, nuts, lean proteins and minimal processed foods) and regularly engaging in physical activity (the CDC recommends at least 150 minutes per week) all support an optimal environment for pregnancy.

Avoid trans fats.

Trans fats interfere with cell receptors involved in inflammation, glucose metabolism and insulin sensitivity which can greatly impair normal hormone regulation and fertility.

Read food labels/ingredient lists and avoid trans fats (which include hydrogenated/partially hydrogenated oils).

Avoid fried and fatty foods such as french fries, hamburgers and fried chicken.

When eating out, ask that foods be prepared with olive oil.

●    Use unsaturated vegetable oils

Choose healthy oils including olive, avocado, walnut and flaxseed.

Read up on the smoke points of specific oils to use when cooking at different temperatures to prevent the consumption of oxidized fats!

●    Opt for the right proteins

Chicken, turkey and fish are great sources of protein, zinc and iron which are all important building blocks for a healthy pregnancy.

Plant-based proteins such as beans, peas, nuts, seeds, soy and lentils are associated with a lower risk of ovulatory infertility.

●    Choose whole grains instead of refined

Complex carbohydrates can help stabilize blood sugar and regulate a woman’s cycle.

Replace refined white grains with whole grains such as quinoa, brown rice, millet, kasha, bulgur, farro, teff and barley.

●    Take a multivitamin that contains folic acid and other B-vitamins

Scientific research has shown that certain vitamins and minerals can increase chances of getting and staying pregnant.

Folic acid, iodine and vitamin D are three vitamins/minerals which are important to positive reproductive outcomes.

Additionally, supplementing your diet with vitamin B6 and vitamin B12 have been shown to increase fertility in women and improve low sperm counts.

Overall, it is advised to take a multivitamin to help eliminate underlying nutritional deficiencies that may be interfering with your optimal health and fertility - ask our practitioners for help in finding the right vitamin combination to support your needs!

●    Increase your intake of good bacteria

Yogurt (ideally homemade or Greek-style), raw sauerkraut, kim chi, kombucha all contain probiotic microbes that can be instrumental in boosting fertility and supporting your future child's health.

Probiotic supplements are also recommended to boost the numbers of good bacteria in your gut - ask our practitioners for help in finding the ideal product for your needs!

●    If you aren’t physically active, start a daily plan

Regular exercise is important for fertility, however it needs to be low-impact, moderate and done on a consistent basis.

Include activities such as brisk walking, zumba, leisurely bike riding, light jogging or swimming.

Extreme exercise and fitness training should be avoided when trying to conceive

Avoid running for several miles per day, “boot camp” style training or bikram yoga which can all negatively impact your fertility.

●    Support uterine health with specific fertility friendly foods

When possible, add berries (specifically red raspberries), pumpkin seeds, wild salmon, leafy greens, citrus fruits and avocados which have all been shown to support the health of the uterus.

Kelly Johnston, MS, RDN, CDN


Notes from the Pharmacist:


Metro Integrative Pharmacy carries a number of products that can help different issues related to infertility problems.

To help with sperm quality, count and motility:

1.    ZINC – 100-200 mg daily for 3 months to boost testosterone levels: Zinc Picolinate by Thorne Research.

2.    VITAMIN C500-1500 mg daily to reduce DNA damage in sperm, sperm stickiness, and other abnormalities. Buffered C by Thorne Research.

3.    VITAMIN E 400-800 IU daily showed in studies to increase success rates by 20% in previously infertile men. Aids in balancing female hormones too. Famil-E by Jarrow, E+Selenium by Metagenics and Ultimate-E by Thorne Research.

4.    SELENIUM100-200 mcg daily (no more than 200 mcg) improves sperm quality. Available from Thorne Research and Metagenics.

5.    B-COMPLEX with B12 can help to balance testosterone levels as well as female LH/FSH hormones. Methyl B12 by Jarrow or B-Complex #12 by Thorne Research.

6.    COENZYME Q10 (active form Ubiquinole 30-100 mg daily) helps to increase sperm count and fights free radicals. Available from Blue Bonnet, Natural Factors, Jarrow and other manufacturers.

7.    L-CARNITINE – 3000 mg daily, L-Arginine – 2000-4000 mg daily, to improve sperm count and mobility as well as energy and performance. Available from Thorne Research, Jarrow and Metagenics.

8.    MULTIVITAMINS with VITAMIN A, which improves sperm production. PhytoMulti by Metagenics and Extra Nutrients by Thorne research for both men and women. Men can benefit from Al’s Formula by Thorne Research and women from Nutri-Fem also by Thorne.

9.    TRIBULUS COMPLEX by Jarrow , Male Response by Source Naturals and Libido-M by Gaia are specialty formulas for men and Libido-F and Female Hormone Support by Gaia for women.

Make sure to ask our practitioners to help you select the right products for your individual circumstance.

Yeva Pisarevsky R.Ph.
Nutritional Pharmacist


Metro Integrative Pharmacy

This information is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health provider with any questions about your medical condition. The information in this article is for educational purposes only.