Interdisciplinary School
of Health Sciences, Faculty of Health Sciences, University of Ottawa, 25
University Private, Room 138, Ottawa, Ontario K1N 6N5, Canada
BMC Complementary and Alternative Medicine 2014, 14:394
doi:10.1186/1472-6882-14-394
The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1472-6882/14/394
The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1472-6882/14/394
| Received: | 13 August 2014 |
| Accepted: | 26 September 2014 |
| Published: | 14 October 2014 |
© 2014 O’Reilly et al.; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Abstract
Background
Infertility patients are increasingly using complementary and alternative medicine
(CAM) to supplement or replace conventional fertility treatments. The objective of
this study was to determine the roles of CAM practitioners in the support and treatment
of infertility.
Methods
Ten semi-structured interviews were conducted in Ottawa, Canada in 2011 with CAM practitioners
who specialized in naturopathy, acupuncture, traditional Chinese medicine, hypnotherapy
and integrated medicine.
Results
CAM practitioners played an active role in both treatment and support of infertility,
using a holistic, interdisciplinary and individualized approach. CAM practitioners
recognized biological but also environmental and psychosomatic determinants of infertility.
Participants were receptive to working with physicians, however little collaboration
was described.
Conclusions
Integrated infertility patient care through both collaboration with CAM practitioners
and incorporation of CAM’s holistic, individualized and interdisciplinary approaches
would greatly benefit infertility patients.
Keywords:
Infertility; Qualitative; Complementary and alternative medicine; Naturopathy; Traditional Chinese medicine; AcupunctureBackground
Infertility is a complex, multifactorial condition characterized by the absence of
conception following one year of unprotected sexual intercourse [1-3]. Biological, genetic [4], infectious [5], lifestyle [6-9] and environmental [10,11] risk factors are associated with both male and female infertility. Fertility issues
are primarily investigated by family practice physicians and gynecologists (i.e. diagnostic
investigations, endocrine disorders, anovulatory conditions) with unresolved infertility
ultimately treated by reproductive endocrinologists using assisted reproductive technologies
(ART) [2,3]. For some patients, ART presents significant financial, psychological, moral and
ethical challenges which may lead to discontinuation of treatment [12]. As medicine, in particular ART, becomes increasingly technological, patients are
choosing complementary and alternative medicine (CAM); perceived as more natural with
less side effects [13,14]. CAM provides non-mainstream approaches which complement or replace conventional
medicine [15]. Acupuncture, hypnotherapy, chiropractic and osteopathic manipulation, naturopathy,
homeopathy and traditional Chinese medicine (TCM) are examples of CAM [15].
In Canada, CAM use for all conditions is increasing, with the typical patient female
aged 20-64 years [16,17]. Treatment of infertility using CAM has been reported in studies from Australia [18-23], Canada [24], United Kingdom (UK) [25,26], United States (US) [27-29], Denmark [30], Jordan [31], Lebanon [32] and Turkey [33], reflecting patients’ acceptance and interest in alternative approaches to infertility
treatment. Herbal supplements and acupuncture, used to supplement or replace ART,
are perhaps the most studied infertility approaches [34,35]. The range of CAM modalities, treatments and emphasis on individualized therapies
however, limits assessment of the therapeutic efficacy of CAM to treat infertility
[13,33,34,36]. About 65-75% of Australian infertility patients report use of CAM [14,22], compared to 29% of US patients [27], and 40% of UK patients [25] indicating regional differences in CAM uptake. Use of herbal supplements during pregnancy
also exhibits regional variation, with use most common in Russia, Eastern Europe and
Australia [37]. In Canada, 9-23% women [37,38] report use of herbal supplements during pregnancy while 31% of male infertility patients
acknowledged use of alternative therapies including vitamins, minerals and herbal
remedies [24]. These studies indicate that Canadians are using CAM for reproductive health, however
the role of Canadian CAM practitioners in infertility treatment has not been examined.
Despite lack of evidence regarding CAM efficacy, patients are increasingly using CAM
to replace or supplement ART. CAM modalities may be useful to help patients mitigate
lifestyle risks to improve fertility and ART success. The attitudes and experiences
of CAM practitioners regarding their roles in infertility treatment and perspectives
on infertility patients’ motivations have not been well studied. To address these
gaps, we have examined the roles of CAM professionals, practicing in Ottawa, Canada,
in the treatment and support of infertility.
