Female infertility, though not uncommon, is something many women do not feel comfortable talking about, or sharing with others, even close family and loved ones. Whether from a sense of personal failure for not being able to have children, a lack of health or financial resources, feelings of shame, or societal expectations around women’s roles and motherhood, many women who have been diagnosed as infertile — or who even have difficulty getting pregnant — often suffer in silence from this emotionally and financially demanding circumstance.
Former First Lady Michelle Obama reignited the conversation around female infertility in her book Becoming when she opened up about undergoing in vitro fertilization (IVF) to conceive her daughters, Sasha and Malia. It is estimated that about 10 percent of women in the United States between the ages of 15 and 44 have difficulty getting or staying pregnant. And the average age of the first time mother is older than ever, 26.3 years old, as of 2016.
Pregnancy-focused websites are replete with headlines discussing how to get pregnant fast, sex positions that are thought to improve the chance of conception, and what special foods a hopeful mother should eat. Trying to conceive (TTC) message boards, where women anonymously share advice on everything from their common hopes and dreams to the disappointment of a negative pregnancy test, are also discussing which supplements to take in order to boost their chances of getting pregnant.
Herbal medicines like chasteberry, false unicorn, raspberry leaf, red clover, and maca have been used traditionally to enhance or correct the hormonal balance needed for a healthy pregnancy. However, among notable herbs, cannabis has long been a topic of conversation specifically in regard to its role in infertility, especially in men.
The process of getting pregnant, in general, is such an exquisitely-timed dance that it seems practically miraculous that anyone gets pregnant at all. But what if cannabis, especially non-intoxicating cannabidiol (CBD), could help women achieve the delicate balance needed to achieve a successful and healthy pregnancy?
A woman’s ability to have a child really boils down to whether or not ovulation occurs each month. This critical time, when eggs are released from the ovaries, is the only time of month a woman can get pregnant. This process can be disrupted by ailments like polycystic ovarian syndrome (PCOS), endometriosis, pelvic inflammatory disease, uterine fibroids, and other conditions.
But the primary disruptor of ovulation is age. As a woman grows older, eggs may not be as healthy or plentiful. Additionally, the ovaries become less able to release eggs, and the woman is more likely to have other health conditions that may cause problems with fertility. Nonetheless, many women, especially those in more urban areas like New York City and San Francisco, are choosing to have children later, after completing educational pursuits and starting their careers.
Fertility treatments such as IVF, intrauterine insemination (IUI), and egg storage can be prohibitively expensive, especially for those who live in states that don't mandate some type of infertility coverage for insurance plans, thus leaving many scrambling to pay out-of-pocket for fertility medicines and treatments.
According to Dr. Michele Ross, Ph.D - a neuroscientist and CEO of Infused Health - the actions of one endocannabinoid in particular, anandamide, may help women achieve a healthy pregnancy. Anandamide is a neurotransmitter that is part of the body’s endocannabinoid system (ECS), and plays a key role in the body’s physiological systems to create homeostasis, to keep the body stable. Often called the “bliss molecule” because of its etymology from the Sanskrit word for joy, bliss, or happiness, anandamide binds to the body’s own cannabinoid receptors.
“In women, rapidly changing levels of anandamide are necessary for a successful pregnancy," Ross told Civilized. "High levels of anandamide occur at ovulation and are clinically associated with a successful pregnancy. Low levels of anandamide, or endocannabinoid deficiency, may interfere with ovulation or the ability to get pregnant.”
Clinical endocannabinoid deficiency, first proposed by cannabinoid researcher Dr. Ethan Russo, is a theory positing that when the ECS is out of balance, conditions, especially related to the immune system and inflammation (think fibromyalgia, irritable bowel syndrome, or migraines) can take hold in the body and disrupt other bodily systems.
Ross believes that CBD can help boost anandamide levels to support successful ovulation, and help with other factors related to infertility, like stress and anxiety. “Stress has a negative impact on fertility in both men and women, due to lower levels necessary for egg and sperm production and other steps in the fertility cycle," she said. "By relieving stress, CBD may have a positive impact on fertility.”
Hillary Wright, MEd - the director of nutrition counseling for the Domar Center Mind/Body Health at Boston IVF - says that she sees potential benefits to using CBD to enhance fertility, but there just is not any research to support it. “What people like to see when they look at [health] interventions, is whether it helps facilitate live birth,” she explained. “I personally don’t have a lot of concern around THC-free CBD oil, but I’m honest with people and say, ‘in theory, this is what I think, but lacking even basic clinical trials on this, we can’t say for sure what the pros and cons are.’”
Even so, she offers that CBD could support fertility by reducing oxidation or inflammation, enhancing hormone balance or egg quality, and acting as an adjunct to diet and lifestyle changes. “Taking CBD is not going to compensate for a lifestyle that’s not otherwise healthy,” she said. “There are no do-overs when it comes to conception and growing a baby. It’s important to acknowledge that we’re lacking clinical knowledge.”
Studies frequently indicate that women who are pregnant or are trying to become pregnant should stay away from THC, which has, in some studies, been correlated to low birth weight, neurodevelopmental disabilities, and preterm delivery. Dr. Nathaniel DeNicola, M.D. - assistant professor of obstetrics and gynecology at the George Washington University School of Medicine - acknowledges that the studies on cannabis and pregnancy are mixed, but he believes that the risks outweigh potential benefits. “We discourage the use of marijuana while trying to get pregnant, as we do with alcohol and tobacco," he said.
DeNicola would like to see the effects of CBD studied separately from THC when it comes to cannabis and fertility, in order to more accurately know whether or not there are any risks, since many women (likely more than are reported, he says) consume cannabis both before and during pregnancy. “Five percent of survey groups use cannabis [in non-legal states], and surveys in legal states are as high as 30 percent," he said.
Even though the 2018 Farm Bill was recently passed, legalizing hemp (which is from where most CBD products are derived), does not necessarily mean that the research to ascertain whether CBD could be beneficial for fertility will take place. DeNicola explains that pregnant women, and women trying to become pregnant, are held to the precautionary principle, which states that the introduction of a new product, in this case CBD, whose ultimate effects are unknown, should be resisted. But DeNicola believes that if research moved forward, patients could try CBD at their own discretion, as they do with other supplements that may play a role in achieving pregnancy.
While CBD’s ability to enhance fertility remains a mystery, Wright says that there is evidence behind the benefits of a healthy Mediterranean dietary pattern in supporting fertility, as well as evidence showing that physical activity and stress-reduction activities like yoga and meditation can smooth other obstacles to pregnancy.
“There are support groups for women who are doing fertility treatments and working through the stress of conception,” Wright said. "There’s a lot at risk both psychologically and financially, and women struggle to feel adequately supported around that," she added. "Absolutely, I could see that there are potential benefits [to CBD].”