Key Takeaways From This Article:
- By 2020, anywhere between 5.4 and 7.7 million women will experience some form of infertility
- Women are waiting longer than ever to have children, and this will increase demand for fertility treatments in the future
- Two of the most common forms of modern fertility treatments are in vitro fertilization (IVF) and intrauterine insemination (IUI)
- These treatments are often administered in concert with medications to stimulate ovulation
- History has a range of strange fertility treatments, from drinking boiled puppy to consuming the liver and testicles of a small pig to calling upon the gods for divine intervention
- Research indicates that some ancient Chinese treatments for infertility show potential in increasing fertility among both women and men
- Research also indicates that some medieval infertility treatments, like fumigation may also be effective
In the process of trying to conceive, many have ventured into the realm of the mystical, spiritual, and esoteric. Only recently have we begun to explore the various methods that have been used to treat infertility, and in some cases, doctors and researchers are taking a second look at ancient treatments. More couples than ever are seeking fertility treatment, and more may need fertility treatment in the future. According to the Journal of Fertility and Sterility, it is estimated that by 2025, anywhere between 5.4 and 7.7 million women will experience some form of infertility. The reasons for this are complex. While some women and men suffer from health and reproductive conditions that impact fertility, more women are waiting longer than ever to have children, which also can impact fertility.
While some claim that infertility treatment is a modern invention that began with in vitro fertilization (IVF), the real story of fertility treatment goes as far back to the time of the ancient Greeks, and to the writings of Hippocrates, which date to the late fifth and early fourth centuries B.C. In fact, the human imagination has been fascinated with the mysteries and challenges of conception for thousands of years, with treatments for fertility spanning countries and continents.
Today, couples enjoy a range of fertility treatment options, or Assistive Reproductive Technology. Two of the most common forms of Assistive Reproductive Technology are intrauterine insemination IUI and in vitro fertilization or IVF. With intrauterine insemination, healthy sperm is inserted into the uterus during ovulation. With in vitro fertilization, or IVF, eggs are removed from the ovaries and are then fertilized in a laboratory. The embryos are then placed in the uterus. Most couples start with IUI because it is less invasive, though some women with low egg counts or blocked fallopian tubes may not be candidates for IUI. Many of these methods are used in concert with medications to stimulate ovulation. Other treatments might include surgery of the uterus to remove polyps or scar tissue, for women, or surgery for men to remove blockages.
Rebecca Flemming, writing in the Bulletin of the History of Medicine, notes that modern fertility treatments can trace their origins to the successful in vitro fertilization (IVF) and birth of baby Louise in 1978. Because many consider IVF to be the primary infertility technology, many trace the history of infertility treatment to the development of IVF. However, the history of infertility treatment is far richer, and more nuanced. For centuries, humans have struggled to find solutions to their difficulties of conceiving children. The recorded history of infertility treatment goes back to ancient Greece in the west, and, in the east, infertility treatments see their origins in ancient Chinese medicine.
Issues of female reproductive failure were first discussed in the west in the Greek writings of Hippocrates (the ancient Greek physician often credited as being the “father of medicine”) (Flemming). The Greek words for this condition were aphoros, meaning “nonbearing” or atokos, meaning “not bringing forth.” Atokos generally referred to a woman who had not yet borne a child, meaning that a woman referred to as atokos still had the potential to bear children and therefore might respond to treatment if she struggled to conceive.
Treatments for those who were atokos were the concern of the Hippocratic texts on infertility. For obstructions of the uterus and maladies of the womb, physical approaches included inflating the womb or using probes to remove the blockages. For other types of imbalances, there were medicinal treatments that instructed women to drink “boiled pine twigs and white wine…cumin seed, and frankincense” to stranger prescriptions that included consuming “boiled puppy and octopus” (Flemming). Men who wanted to bear a male child were recommended to bind their left testicles during intercourse, and if they wanted to bear a female child, they were recommended to bind their right testicle. Of course, if apothecary or physical approaches didn’t work, there was always the option to appeal to divine intervention, by calling upon Asclepius, the divine physician.
In the Medieval and Renaissance era, bearing legitimate male heirs was incredibly important (think Henry VIII and his six marriages). “Barren” was the Renaissance word used to describe an infertile woman and childbearing (as well as its difficulties) clearly captivated the Renaissance imagination. The word “barren” can be found in the Shakespearean cannon 43 times, in 41 speeches, and across 23 works.
Besides prayer, there appear to have been medical options available as well. According to On the Diseases of Women, written by a mysterious figure known as Trotula who lived in the eleventh or twelfth century, one remedy for infertility in the middle ages was to take the “liver and testicles of a small pig . . . dried and reduced to a powder . . . in a potion.” Another option was for a woman to take “damp wool dipped in ass’s milk and let her tie it upon her navel and let it stay there until she has intercourse” Another remedy offered for infertility involved a “fumigation” using “marshmallow and mugwort.” Interestingly, the Trotula notes that “conception is impeded as much by the fault of the man as by the fault of the woman.” Modern medicine focuses primarily on female infertility, while male infertility can warrant a closer look.
Ancient treatments might sound laughable today. (Eating puppies? Drinking octopus? Testicles of pigs?) But doctors and researchers are starting to take a closer look at ancient and medieval treatments for a variety of maladies—and in some cases, they are finding that these remedies work.
According to the Smithsonian, some ancient treatments are proving to be effective. For example, a recipe for Bald’s eyesalve from an Old English medical text called Bald’s Leechbook was found to be effective in killing some kinds of bacteria, a discovery which might help doctors who are looking for alternative treatment methods when they encounter drug-resistant bacteria. And the Chemist Tu Youyou received a Nobel Prize in Physiology or Medicine after finding a new treatment for malaria. She studied over 2,000 herbal recipes from ancient Chinese literature while searching for her new treatment method. When it comes to ancient medicines, the combination of ingredients is important. Bald’s eyesalve contains only wine, garlic, and onion, but when combined properly and allowed to sit in an appropriate container, doctors have found it to be effective in fighting bacterial infections.
Does ancient Chinese medicine offer wisdom that can be used in concert with modern fertility treatment? For example, acupuncture, an ancient Chinese treatment that involves the placement of tiny needles on energy points on the body, has been found to release opioid peptides in the central nervous system, particularly endorphins, which can have an impact on gonadotropin secretion, which can then have an impact on the menstrual cycle—according to Raymond Chang, M.D. writing in the journal of Fertility and Sterility. All of that is a mouthful, but basically, endorphins are the body’s “feel good” chemicals, and they can produce feelings in the body similar to that one experiences while on morphine. Ancient Chinese theory holds that the placement of needles on the body restores the movement of Qi, or life energy, throughout the body.
The reality is that we know so little about conception. With IVF, the embryos are implanted into the uterus. Why some implant and why others don’t continues to remain a mystery. Could acupuncture have a positive effect on conception? According to the Current Opinion in Obstetrics and Gynecology, recent studies do indicate that Chinese medicine could help regulate the “gonadotropin-releasing hormone to induce ovulation,” but more research needs to be done. Ancient eastern medicinal treatments for infertility also include the use of ginseng. According to the Chinese Journal of Integrative Medicine, male patients who took ginseng saw increases in their sperm counts.
The 11th century Trotula mentions a fertility method known as fumigating, where the vagina and uterus were flushed with various substances. This method may have some scientific validity today when it comes to treating infertility. Researchers from the University of Adelaide found that by using what they noted was a “100-year old medical technique,” known today as Hysterosalpingography (in the 11th century, it was known as fumigation), they were able to see increased fertility. The method involved flushing the fallopian tubes with iodized poppy seed oil. The research was published in the New England Journal of Medicine.
Could other such ancient and medieval medicines be effective in treating infertility? Only time and further research will tell. Until then, treatments for infertility vary. For women, there are a range of fertility medications available in concert with IVF. For men, surgery, medication, and sperm retrieval are options available. Alternative remedies that draw on more ancient traditions, like acupuncture are among the alternative therapies available. But perhaps a closer look at things that worked in the past is worth a look?
Raymond Chang, M.D. “Role of Acupuncture in the Treatment of Female Infertility.” Fertility and Sterility. Volume 78, Issue 6, December 2002.
Erin Connelly, “Medieval Medical Books Could Hold the Recipe for New Antibiotics.” Smithsonian. (https://www.smithsonianmag.com/innovation/medieval-medical-books-could-hold-recipe-new-antibiotics-180962947/)
Dreyer, Kim, van Rijswijk, Joukje, et al. “Oil-Based or Water-Based Contrast for Hysterosalpingography in Infertile Women.” New England Journal of Medicine, 2017. 376: 2043-2052.
Rebecca Flemming. “The Invention of Infertility in the Classical Greek World: Medicine, Divinity, and Gender.” Bulletin of the History of Medicine. 2013 Winter: 585-590.
Monica H. Green, editor and translator. The Trotula: A Medieval Compendium of Women’s Medicine. University of Pennsylvania. 2001.
Sheng-Teng Huang and Annie Pei-Chun Chen. “Traditional Chinese Medicine and Infertility.” Current Opinion in Obstetrics and Gynecology. June 2008. Volume 20. Issue 3. P. 211-215.
Hyun Jun Park, et al. “Effects of Korean red ginseng on semen parameters in male infertility patients: A randomized, placebo-controlled, double-blind study.” Chinese Journal of Integrative Medicine. July 2016, Volume 22, Issue 7, pp. 490-495.
Elizabeth Hervey Stephen, Ph.D. “Updated Projections of Infertility in the United States: 1995-2025.” Fertility and Sterility.