Terra Sigillata

As cited by news services and the original source yesterday,

In a survey of 97 new patients being seen at an infertility clinic, reported in the Australia & New Zealand Journal of Obstetrics and Gynecology [April 2007 issue], Stankiewicz and colleagues discovered that two-thirds reported using complementary medicine.

Nearly half of them said they had consulted with a complementary therapy provider, such as a chiropractor, acupuncturist, or naturopath.

Over three-quarters of the patients reported taking over-the-counter multivitamins, and about a quarter to one-third used herbal remedies including chamomile, echinacea, peppermint, and chaste tree berry.

I know of no scientific association for the use of most of these herbs in infertility except perhaps for chaste tree berry, Vitex agnus castus.

Traditionally used by monks and the clergy to promote celebacy, Vitex has been shown to contain at least one compound with dopamine D2 agonist activity. This is similar to a drug called bromocriptine (Parlodel), whose action on the anterior pituitary gland suppresses production of prolactin. Hyperprolactinemia interferes with ovulation by suppressing release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Bromocriptine, also used to treat Parkinson’s disease, is not as widely used for infertility as it once was, but it is thought to restore the balance between prolactin, LH, and FSH and increasing the chance of proper ovulation.

A well-recognized German endocrine research group isolated dopamine agonists from chasteberry extracts, but this botanical has been studied primary to treat premenstrual syndrome and not as a fertility agent. One concern with its use as a fertility agent is that while Vitex extracts suppress prolactin release in cell culture, the same group has shown there is no resultant effect on LH or FSH.

The authors do have the usual concerns, however,

It’s possible that these therapies may interact with each other and impact the odds of a woman becoming pregnant, experts say, as the safety and efficacy of complementary medicines used to treat infertility or in conjunction with established treatments is unclear.

[...]

It’s been shown that the hormonal effects of chaste tree berry may promote the development of a serious condition called “ovarian hyperstimulation syndrome” in women having in vitro fertilization, Stankiewicz pointed out.

Vitex/chasteberry/chaste tree berry is not an herb whose use is restricted to South Australia and at least one German botanical manufacturer makes a well-characterized and standardized extract and they seem to support clinical trials of their products. However, my primary question in these cases is what might an herbal product offer that other similarly-acting therapies don’t?

In any case, a German-trained MD/PhD family medicine doc at the University of Medicine and Dentistry of New Jersey has a nice, concise, free-access review of chasteberry here.

Comments

  1. #1 Joe
    March 13, 2007

    A german company offers “… a well-characterized and standardized extract …”

    How do they do that without knowing the active ingredient(s) (if any)? In your post on the recent, clinical failure of echinacea you make that point. How is this different?

  2. #2 Abel Pharmboy
    March 14, 2007

    Joe, in this case the science for Zeller’s Ze440 extract is further along than with Echinacea as ligand binding has been shown for dopamine D2 receptors (with very low affinity at mu opioid receptors). However, these studies were only done in vitro and there’s no data I know of showing that the compounds actually cross the blood-brain barrier. I was merely noting that at least one manufacturer is trying to do good science with their product.

  3. #3 Hyperion
    March 15, 2007

    Wouldn’t a D2 agonist also have the potential to induce psychosis? After all, aren’t most anti-psychotics D2 antagonists? Or do these substances simply not have much mesolimbic affinity?

    (also…am I the only one who thinks taking a dopaminergic compound should have made that celibacy thing more difficult?)

  4. #4 Marilyn
    May 9, 2007

    Hi everyone, I notice there was a medical study of 18 women with abnormally low progesterone levels who were given vitex (chasteberry) daily. After 3 months of treatment, 13 showed increases in progesterone and 2 became pregnant. I got this information from: http://www.ovarian-cysts-pcos.com/vitex.

  5. #5 Abel Pharmboy
    May 9, 2007

    I’d tend to exercise great caution with any supplement intended for use to get pregnant, mostly because of concerns about adulteration with substances that could harm the developing fetus (as one could be pregnant for weeks before knowing for sure).

    In fact, the site that Marilyn cites issues the caution, “It’s advisable to not take vitex if you are pregnant.”