Chapter 15 Yoga to Support Fertility Lisa Attfield BTEC, HND, BWY Dip 1. Introduction to yoga Yoga is both a physical and a spiritual practice. There are many types of yoga but the most popular style practised in the UK is Hatha Yoga, which is differentiated into many forms including Iyengar, Bikram, Ashtanga and Vinyasa. These consist of elements of yoga postures (asana), breath awareness (pranayama) and relaxation and meditation. The meaning of the word yoga is to join, derived from the Sanskrit verb yuj ~ to join. It is believed that yoga practice helps people make connections between the mind, body and soul and that this helps to provide overall harmony and balance. Yoga is one of the orthodox systems of Indian philosophy, systematised by Patanjali in his classical work the Yoga Sutras, written in Sanskrit dating from 200 bc. Important authoritative texts include the Bhagavad Gita, where Sri Krishna explains to Arjuna the meaning of yoga philosophy. Other texts include the Upanishads and Hatha Yoga Pradipika (Light on Hatha Yoga) complied by Yogi Swatmarama. The Hatha Yoga Pradipika explains that Hatha Yoga is not only for health and fitness but for awakening the vital energies: pranas, chakras and kundalini shakti. Yogic practice has direct physical benefits, regardless of any spiritual aims. Physical and mental therapy are both important 345
INTEGRATED APPROACHES TO INFERTILITY, IVF AND RECURRENT MISCARRIAGE achievements of yoga as it works on the holistic principles of harmony and unification. 1.1 Asana Prior to everything, asana is spoken of as the first part of Hatha Yoga. Having done asana, one attains steadiness of the body and mind, freedom from disease and lightness of the limbs (Muktibodhananda 2002). Asana is a state of being in which one can remain mentally and physically calm, steady, quiet and comfortable. The mind and body are not separate entities, as the practice of asana integrates and harmonises the connection of body and mind. Both the body and the mind can harbour tension so the aim of asana is to release mental tension by dealing with it on a physical level acting somato-psychically, through the body to the mind. Muscular knots can occur anywhere in the body and through yoga asana, combined with other yoga practices pranayama and meditation, it is believed the tightness can be effectively eliminated, tackling it on both a physical and a mental level. 1.2 Prana Prana, the vital energy, corresponds to chi in Chinese medicine and it is believed to pervade the whole body following flow patterns called nadis (Muktibodhananda 2002). It is thought that nadis are responsible for maintaining all individual cellular activity, and if the prana is blocked then toxins can accumulate in the body. The belief is that when prana begins to flow the toxins are removed from the system, ensuring health of the body as a whole. 1.3 Kundalini and chakras The purpose of yoga is to awaken the kundalini shakti, defined as the evolutionary energy of a human being. By practising asana the chakras are stimulated, distributing the generated kundalini energy around the body. Once balance is created between interacting processes and activities of mental and pranic forces then the central pathway in the spine awakens the sushumna nadi, through which kundalini shakti rises to the highest chakra sahasrara, thought to be the highest centre of human consciousness. 346
Yoga to Support Fertility There are seven major chakras located along the pathway of the sushumna, originating in the perineum then flowing through the spinal cord to the top of the head. The chakras are connected to the network of nadis and they correspond with nerves on a more subtle level. In yogic terms chakras are vortices of pranic energy at specific areas of the body, which control the circulation of prana. On a physical level, chakras are associated with the major endocrine glands and nerve plexuses in the body. Specific asanas have a particularly beneficial effect on one or more of these glands or plexuses. Yoga asana also promotes the general health of specific areas of the body. Each type of chakra energy vibrates at a different rate and is associated with specific psychosomatic functions and correlates with the nerve plexuses of the physical body. The second chakra, Svadhisthana, is located in the area of the sacrum and relates to male and female reproductive organs and hormones. The chakra is depicted with a symbol of fertility in the formation of an aquatic creature resembling a crocodile (Feuerstein 2001). 2. Yoga s links to anatomy and physiology B.K.S. Iyengar, the man who helped bring yoga to the West (British Wheel of Yoga 2014), published the best-seller Light of Yoga in 1966. This book is still in print and the Open University s Suzanne Newcombe (British Wheel of Yoga 2014) explains that it contains a systemic and rigorous attention to detail of yoga postures (asana). Iyengar details the techniques and effects of over 200 Hatha Yoga postures and provides a section on curative asana for various diseases based on over 25 years of experience with his pupils (Iyengar 1991). In Dr H.D. Coulter s book Anatomy of Hatha Yoga (2001) he explains Hatha Yoga in demystified, scientific terms. The book has become a modern authoritative source that correlates the study of Hatha Yoga with anatomy and physiology. The text outlines specific yoga postures and explains the effects these have on the body from an anatomical and physiological view. Dr Coulter explains the connections to the nervous system throughout the body. He examines the effect of the breath on the functions of the somatic and autonomic nervous system. The somatic nervous system controls the skeletal muscle action, whilst 347
INTEGRATED APPROACHES TO INFERTILITY, IVF AND RECURRENT MISCARRIAGE the autonomic nervous system looks at the internal function of the body glands, body pressure, digestive system and so on. Breathing techniques play a part in relaxation on the autonomic nervous system (Coulter 2001). Fight or flight responses, known as acute stress, refers to the physiological reaction of a threat of danger triggering the sympathetic nervous system to release hormones stimulating the adrenal glands, preparing the body for emergencies. Trying to conceive naturally, especially at a more advanced age, can prove to be stressful and patients may experience a rollercoaster of different emotions. Yoga can help a person to relax, and so works to help alleviate stress. This can help to provide inner strength and confidence to continue a journey to parenthood, either with or without assisted reproductive techniques (ART) such as IVF. The author of this chapter has developed a series of asanas and produced a DVD, called Fertility Yoga. This is designed to reduce stress, and focuses on therapeutic yoga postures to benefit reproductive health. It concentrates on specific yoga postures to encourage blood flow to the reproductive area and relaxation techniques that de-stress the mind and body. BOX 15.1 FERTILITY YOGA The author s system of Fertility Yoga is designed to: increase energy and blood flow to the pelvic area stimulate the reproductive system balance hormones reduce stress and calm negative thinking enhance connections between mind and body. Scientists have been studying the positive impact of yoga as a therapy on various health conditions; for example: Practicing yoga can improve better cardiovascular health, stronger nervous and immune system and has a positive effect on the reproductive system (Trimarchi n.d.). It is important to mention that yoga used as a therapy for infertility cannot treat medical infertility problems such as blocked tubes, but can help infertility issues caused by stress and the stress 348
Yoga to Support Fertility associated with conditions such as cysts and endometriosis. Chronic psychological stress can alter the body s ability to regulate hormones, which in turn may cause problems with ovulation, sperm quality, egg fertilisation and other complications that may affect the reproductive system. See Chapters 4, 5 and 6 for further details about this. 3. Yoga and female infertility Asanas working the area of the pelvis create energy and blood circulation for the reproductive system and may help strengthen the abdominal region and protect the back. There are some postures involving inversion, where the legs are elevated or the body is lowered; these are thought to be beneficial, as inverted yoga postures stimulate the pituitary gland and in turn the reproductive system, and forward bend asanas have a positive effect in supplying pure blood to the pelvic organs (Iyengar 2005). Iyengar (2005) also explains that asanas prove to be beneficial to helping with infertility, menstrual disorders and miscarriage as they strengthen the pelvic muscles, improve blood circulation in the pelvic region, strengthen the reproductive area and exercise the spine (the channel for the chakras). BOX 15.2 OTHER BENEFITS OF YOGA Yoga may aid the healing process by playing an active role in the journey towards positive mind state healing (Woodyard 2001): The practice of yoga generates balance energy which is vital to the function of the immune system. Yoga is recognised as a form of mind body medicine that integrates an individual s physical, mental and spiritual components to improve aspects of health, particularly stress-related illness. Yoga increases blood flow and levels of haemoglobin and red blood cells which allows for oxygen to reach the body cells, enhancing their function. 349
INTEGRATED APPROACHES TO INFERTILITY, IVF AND RECURRENT MISCARRIAGE BOX 15.3 CASE STUDY A 31-year-old female living in the UK in generally good physical health. She had a very stressful job with long hours and travel. She had a slight scoliosis of the spine affecting general back health; this was aggravated by stress and time spent sitting at a desk using a computer. She was managing this with ongoing physiotherapy and acupuncture. Her menstrual cycle was a regular 28 30 days. She had been trying to conceive for six years and had been through a gynaecology referral, but there had been no investigations. She had six-monthly reviews where the specialist confirmed that lifestyle factors were the main issues (principally stress and diet). Along with changes to her diet and a reduction in alcohol the client managed stress and increased physical activity with yoga to improve spine mobility and strength. She also used deep breathing techniques. After two further years of good health, regular yoga practice and changes in lifestyle, the NHS finally undertook investigations and confirmed that IVF was the only option due to blocked fallopian tubes. She left her job and used yoga and relaxation to manage the stress and anxiety associated with the IVF processes. The first cycle of IVF was a success but unfortunately ended in a miscarriage at 11 weeks. The second IVF produced a chemical pregnancy resulting in hcg blood testing over a period of time, which the client found very stressful. Next a frozen transfer was undertaken; this was successful but initial bleeding meant that she had to take progesterone injections until 12 weeks pregnant. The client practised yoga during pregnancy and used postnatal yoga to aid a return to good physical shape. She embarked on another frozen embryo transfer three years later aged 38, but sadly this was unsuccessful. A fifth IVF cycle produced a successful twin pregnancy. Modified yoga and deep relaxation were used during the multiple pregnancy. 4. Male reproductive health and yoga It is claimed that regular yoga practice in men may also be beneficial to enhance male reproductive health to produce the probability 350
Yoga to Support Fertility of successful conception (Sengupta, Chaudhuri and Bhattacharya 2013). As well as the positive effects yoga has on stress reduction and wellbeing, the authors report that regular yoga practice can improve the quality of sperm if one has an issue with sperm count or motility (Sengupta et al. 2013). If men practice yoga asanas it is thought they work to activate the second chakra in the pelvic area and that this can release energy blockages relating to sensual or sexual issues. This is thought to be important as the links between infertility and stress are complex and not fully understood, but cortisol, the so-called stress hormone, can interfere with normal reproductive functions (Sengupta et al. 2013). It has also been claimed that reducing stress through yoga can boost fertility: In 2000 Domar found 55 per cent of infertility patients had a baby within one year of practicing yoga and meditation along with other relaxation techniques (Sengupta et al. 2013). References British Wheel of Yoga (2014) B.K.S. Iyengar: The Man Who Helped Bring Yoga to the West. Available at www.bwy.org.uk/bks-iyengar-the-man-who-helped-bring-yoga-to-thewest, accessed on 12 June 2015. Coulter, H.D. (2001) Anatomy of Hatha Yoga. Honesdale, PA: Body and Breath. Feuerstein, G. (2001) The Yoga Tradition. Prescott, AZ: Hohm Press. Iyengar, B. (1991) Light of Yoga. London: Thorsons/HarperCollins. Iyengar, G. (2005) Yoga: A Gem for Women. Kootenay, Canada: Timeless Books. Muktibodhananda, S. (2002) Hatha Yoga Pradipika. Munger, Bihar: Yoga Publications Trust. Sengupta, P., Chaudhuri, P., and Bhattacharya, K. (2013) Male reproductive health and yoga. International Journal of Yoga 6, 2, 87 95. Trimarchi, M. (n.d.) How Can Yoga Increase Fertility? Available at http://health.howstuffworks. com/pregnancy-and-parenting/pregnancy/fertility/yoga-increase-fertility1.htm, accessed on 12 June 2015. Woodyard, C. (2001) Exploring the therapeutic effects of yoga and its ability to increase quality of life. International Journal of Yoga 4, 2, 49 54. 351