Islamic traditions and modern medicine meet to assist fertility.

"Do you have children?" The question always seemed to sting. There is never a need to ask because a woman who has children will inevitably offer that information, and those who don't, won't. In the Islamic tradition, the place of a mother is an honored one. As a little girl, I remember looking at the bottom of my mother's feet to find Jannah¹. The Qu'ran itself reminds us of the pain and sacrifices a woman makes in pregnancy and childbirth². Even the Arabic word for womb is honored by sharing its root letters with one of the attributes of Allah: رحم. But for some, the journey to motherhood is often one ending in an empty heart. Therefore, the question is yet another reminder of that sorrow.

As a midwife, I've seen a number of clients struggle and succeed at becoming parents. The most reassuring sound for these couples is the first time they hear the heartbeat of their new love. There are many milestones on the road to becoming a biological parent, the first being conception. This article will focus on only a small subset of the many remedies to promote fertility from an Islamic as well as a scientific perspective. It's not intended as medical advice, but some ideas to consider or perhaps discuss with your health care provider on your journey to parenthood.

First and foremost, we must have faith in Allah's plan. In the words of Tony Robbins, life coach and entrepreneur, "God's delays are not God's denials. You might be in lag time." Sometimes the biggest test is patience. One mother texted me saying: "My infertility journey was a long one. I felt really alone for 17 years in it." After finding out she was expecting: " He [God] is the Most Merciful. The biggest lesson for me is that we plan and He plans better and his mercy is truly infinite. We are so grateful.". After giving birth she wrote: " Allah is the best of planners. Trust He will answer your dua and what is in your heart…our worship is to submit to Allah while believing Allah will respond…God is Great. We place our trust in Him." Whatever happens after confiding your cause to Allah, the Most Gracious and Kind, know He has not forsaken you.

Next, we can also look towards the Qu'ran and Sunnah for guidance. In addition to the making the intention towards building a family, there are many hadiths regarding the etiquette of intercourse including recommended du'as³. Black seed (nigella sativa), raw honey, dates, figs, and olive (oil) are all mentioned in hadith or Qu'ran⁴. Modern science has revealed that black seed oil significantly improves male reproductive characteristics⁵. There are laboratory studies showing a promising impact on women's fertility as well⁶. Ongoing research has shown possible benefits from honey, dates, and olive oil in reproductive health^7,8. Having a healthy diet including foods from the Sunnah may be beneficial in increasing fertility rates.

We know that the Prophet Muhammadﷺ encouraged Hijama (cupping) and said it is one of the best remedies⁹. Although modern research is inconclusive in its ability to enhance fertility, it is one of the prescribed Sunnahs. Results might be tied to the experience and expertise of the practitioner as well as following the etiquettes of Hijama.

In addition to du'a and following the Sunnah, Islam also encourages us to help ourselves by using practical knowledge to achieve our goals. We are reminded of this in the hadith where the Prophet Muhammad ﷺ told a Bedouin to tie his camel and trust in Allah¹⁰.  Therefore, we can integrate practical knowledge with Islamic practice.

For Husbands:

In terms of infertility, approximately 30% of cases can be attributed to men. It's less invasive to test men for possible reasons; therefore, it is a good place to start. If there are no issues requiring medical intervention, then there are some changes that can boost male fertility. Note that it takes about three months to improve sperm quality so stay committed for best results.

Preexisting health conditions can interfere with successful conception. For example, studies show a noticeable decrease in sperm quality plus decreased libido in smokers. Therefore, smokers should stop smoking, at least until after the postpartum period¹¹. Interestingly, smokers also have a higher rate of fathering daughters. There are a number of smoking cessation products on the market to help break the addiction. Some have also had success with homeopathic lobelia or acupuncture to quit.

Research studies also link diabetes to a negative impact on spermatogenesis (the process of creating sperm)¹². Therefore, controlling diabetes is an important part of male fertility. Type 2 can be corrected by lifestyle changes such as exercise and dietary changes. Ask your provider if supplementing with astragalus or chromium would help with blood sugar regulation.

Along the same lines of a healthy diet, one study showed a correlation between obesity and decreased fertility¹³. More specifically, it estimated a 10% decline in fertility for every 20 pounds a man was overweight. Incorporating exercise daily plus dietary changes can help keep the weight off.

Although more common in women, thyroid dysfunction has been linked to reduced fertility in men. Hypothyroidism, for example, can cause a decrease in the hormones that affect semen quality¹⁴. It's worth getting thyroid levels checked. Sometimes simple supplementation can be a viable solution, or pharmaceuticals might be necessary.

Dr. Schultz, based in Montpelier, VA, noted that sperm is also heat sensitive¹⁵. He recalled one patient struggling to conceive who was fond of the hot tub. "I asked him to stop and they were pregnant the next [ovulation] cycle." Presumably, saunas would also have the same effect.

In some instances, there is no specific medical diagnosis for sub-optimal fertility in men. One study suggests that environmental toxins could be disrupting endocrine function leading to decreased semen quality¹⁶. Minimizing exposure to man-made chemicals such as pesticides might be beneficial to health overall as well. However, there is promising research showing improvements in both sperm and egg quality by supplementation with L-glutathione (typically it's taken with B6, B12, and Vitamin C for best results¹⁷.) It reduces oxidation stress as well as provides liver support for detoxification. It's important to note that some supplements can interact with medications, so best to consult with your care provider to see if it makes sense for you before starting a detoxification regime.

Wives:

Most of the practical tips that apply to men also apply to women; especially a nutritious diet with an emphasis on eating sufficient protein. Before conceiving consider starting a prenatal vitamin. Folate is an essential nutrient that prevents neural tube defects. The recommendation is to start it at least 12 weeks prior to conceiving.

Conception occurs at the time of ovulation so understanding your menstrual cycle is important. There are a number of free phone apps, such as Clue, that can assist you in tracking your cycle. There are additional tracking methods called the Billing Method, Creighton Method, and Basal Body Temperature (BTT)¹⁸. Understanding cervical mucous and body temperature changes, along with tracking the length of your cycles, can help you better predict when you are ovulating. Also, a provider will ask you for about three months of this information so having it collected ahead of time is helpful.

Since women's reproductive systems are complex, there are many possible reasons why someone may struggle with getting pregnant. Consider consulting with a medical provider and taking the menstrual cycle history with you. Janna Grapperhaus, the owner of the Birth Centre of Charlottesville, suggests finding a provider who specializes in NaPro (Natural Procreative) Technology (https://naprotechnology.com/). "[An NaPro trained] provider is definitely our choice for couples struggling to conceive."

A provider may recommend an ultrasound to assess the health of a women's reproductive health. It can rule out preexisting structural anomalies or other treatable conditions. For example, an ultrasound revealed that there was a fibroid blocking the cervix (the opening to the uterus) for one couple that had been trying for about ten years. After removal, they now have four children.

Although not widely acknowledged, sexual abuse is prevalent across all socio-economic classes around the world. It can be detrimental to a survivor since the incidence could possibly expose her to a sexually transmitted infection (STI). If left untreated, it might lead to sterility or scarring which could make it difficult to conceive. Often girls and women won't disclose it, whether it's due to shame, threats, or to avoid accusing someone known to the family. But it's critical to get medical attention as soon as possible to prevent reproductive health problems later; especially if there is any pain in the pelvic area.

One of the most common conditions that decrease fertility rates in women is Polycystic Ovarian Syndrome (PCOS). 70-80% of women diagnosed with PCOS will face struggles with conception. If you have signs such as hair loss, facial/chest hair, weight gain, painful or irregular periods, then you may have PCOS. The main obstacle from PCOS is the lack of, or inconsistent, ovulation. Women with PCOS also often show signs of insulin resistance. In addition to exercise, a naturopathic approach to treatment includes an anti-inflammatory diet (i.e. gluten free, dairy free, and eliminating sugars) and may include supplementation with chromium, inositol, or other medication¹⁹. Ayurvedic remedies may also provide support and are worth exploring. Work with your provider to see what is right for you based on hormone levels and other blood work. Thyroid issues are also more common with women with PCOS so getting levels checked along with iodine levels is a good idea (In general, checking thyroid levels for women is important since there are also links to recurrent miscarriage).

Another common diagnosis in women struggling to conceive is endometriosis²⁰. Approximately 30-50% of women with endometriosis report trouble with conception. There are various medical interventions such as tubal flushing that can be discussed with your provider. Research the short and long term side effects of any medical intervention before deciding if it's right for your situation. Herbal and ayurvedic traditions look to reduce inflammation and strengthen the uterus²¹. Also, as part of an anti-inflammatory diet, vitamin B6 may assist fertility for women who suffer from endometriosis as well as fertility in general.

Dr. Schultz also noted that some women can have an allergic reaction to semen. "The body can create antibodies making an unfavorable environment for sperm to survive." Using Alka Seltzer Gold according to the directions (important note: it must be the Gold not regular!) prior to intercourse can minimize the reaction allowing sperm to live long enough to fertilize the ovum.

What if after going through evaluations, the diagnosis is that nothing is wrong? Some estimates say that 30% of infertility is unexplained. That doesn't mean there isn't a reason, but just that it's not yet known²². For example, a condition called MTHFR impacts folate methylation causing difficulties with getting pregnant. Other causes might include auto-immune or clotting disorders. It's worthwhile to get checked to see if this could be part of the issue or to at least rule it out.

There are also lots of herbs used to support reproductive health in both men and women. Depending on what aspect needs support will depend on which herb may help. See https://natural-fertility-info.com/fertility-herbs for more information²³. Generally speaking, a gentle herb such as red clover which supports reproductive health for women and maca root for men are nice options. Acupuncture is also another anecdotal method used to support fertility by releasing blocked energy along different meridian lines. With both herbs or acupuncture, seek out a qualified and trained professional just as you would for hijama.

Sometimes the intense desire to conceive can create enough stress to interfere. Find a way to distract yourself. Maybe plant a garden, adopt a cat, take up artwork or henna, foster a child, learn a language, or try something you have wanted to do for yourself. Sometimes focusing your energy elsewhere can ease the pressure enough to allow your body to do what it needs to do.

Some couples will end up choosing Assisted Reproductive Therapy (ART) which includes in-vitro fertilization (IVF) or intrauterine insemination (IUI). The generally accepted fatwah is that ART is allowed in Islam²⁴. If choosing ART, keep in mind that one study showed greater success for IVF with vitamin D supplementation²⁵. Whether or not you are planning to conceive naturally or using ART, having adequate vitamin D and Vitamin E levels have shown improved fertility by reducing oxidation stress in both men and women²⁶.

During the preparation for IVF, a provider may recommend medicines to improve the quality of the egg to increase success. Inquire about the short and long term side effects of these pharmaceuticals. There is a supplement called Coenzyme Q10 which can improve egg quality. It requires adequate levels of vitamin B2 to maintain its anti-oxidant abilities. Discuss with your provider to see if it is right for you and dosage recommendations.

Although at times it's difficult to remember, Allah ﷻ is the best of planners. We can plan, but He can have a better plan for us. We sometimes forget that our beloved mother of the believers, Aisha رَضِيَ ٱللَّٰهُ عَنْهَا, was childless, but we see her as a respected and honored woman who contributed to our ummah in other ways. Allah ﷻ tells us that prayers are always answered: we are given for what we ask for, we are given something better, or given in the hereafter. Continue to supplicate in obligatory and optional prayers such as tahajud. Allah ﷻ tells us "Call unto Me, [and] I shall respond to you!" (40:60)

Remember: God's delays are not God's denials. Finding a way to grow, flourish, and help others from your experience is a beautiful way to use the gifts that God has already bestowed upon you.

Romy Sharieff, a licensed midwife and former ambassador for Midwives For Haiti, is the founding contributor of the Bryan J Westfield Scholarship

1- Hadith on Mothers

2 - 31:14

3 - Bukhari:5165 and Bukhari:6388 retrieved from https://sunnah.com/bukhari:5165; https://sunnah.com/bukhari:6388

4 - Surah Tin; Sahih al Bukhari 5688, Book 76, Hadith 11. Black seed retrieved from https://sunnah.com/bukhari:5688; Sahih Al Bukhari Book 71, hadith 587/588 honey retrieved from  https://sunnah.com/bukhari:5680; Sahih al Bukhari 5779 (date); Sunan Ibn Majah 3319 olive oil;

5 - https://pubmed.ncbi.nlm.nih.gov/24680621/

6 - https://www.mattioli1885journals.com/index.php/progressinnutrition/article/view/7088

7 - https://www.mdpi.com/2072-6643/13/6/1784/htm

8 - https://www.tandfonline.com/doi/full/10.1080/10942912.2017.1357044

9 - https://sunnah.com/abudawud:3861

10 – https://www.abuaminaelias.com/dailyhadithonline/2012/11/17/trust-allah-tie-your-camel/

11- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4639396/

12 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4814953/

13 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4408383/

14 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3826086/

15 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737001/

16 - Ravitsky, Kimmins. (2019). The forgotten men: rising rates of male infertility urgently require new approaches for its prevention, diagnosis and treatment. Biology of reproduction doi:10.1093/biolre/ioz161

17 - https://www.healthoverall.ca/blog/gain-the-benefits-of-glutathione-for-fertility/

18 - https://www.uofmhealth.org/health-library/hw214032#hw214035, https://creightonmodel.com/background/

19 - https://www.endeavour.edu.au/about-us/blog/holistic-management-polycystic-ovarian-syndrome-pcos/

20 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941592/?ncid=txtlnkusaolp00000618

21- https://www.naturopathy-uk.com/news/news-cnm-blog/blog/2021/02/15/how-to-manage-endometriosis-naturally/ ; https://www.slucare.edu/ob-gyn/center-for-endometriosis/endometriosis-diet-booklet.pdf

22 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322174/

23 - https://natural-fertility-info.com/fertility-herbs

24 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836012/

25 - https://pubmed.ncbi.nlm.nih.gov/24717915/

26 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836012/