Review Article

A Review of the Gastrointestinal Causes of Infertility from the Perspective of Persian Medicine


Infertility affects about 10-15% of couples in reproductive age, and puts a lot of economic burden on communities. Persian Medicine (PM) introduces perspectives on causes of infertility that can be useful in prevention and treatment of this common healthcare problem. Gastrointestinal problems are one of the causes of infertility based on PM literature. The purpose of this study was to collect evidence of gastrointestinal problems associated with infertility in conventional medicine, and ultimately compare the results with the viewpoints of PM. By reviewing literature on PM, we classified the digestive causes of infertility and then, by searching the keywords "infertility" and "gastrointestinal disorders" and symptoms such as, "dueodenal ulcer", "pepticulcer", "dyspepsia","fatty liver","maldigestion", "H. Pylori infection", "celiac", "inflammatory bowel disease", and "obesity" in databases of SCOPUS, PubMed, Web of Science. Based on the review of the literature on PM, gastrointestinal causes of infertility include digestive failure, liver weakness, and inappropriate eating habits. There is also a growing scientific evidence of this connection in modern medicine. Attention to the treatment of gastrointestinal disorders in patients with infertility can help to treat unknown causes of infertility.

Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology. Definitions of infertility and recurrent pregnancy loss: a committee opinion. Fertil Steril 2013;99:63.

Organization WH. Recent advances in medically assisted conception: report of a WHO scientific group [meeting held in Geneva from 2 to 6 April 1990]. 1992.

Collins JA, Crosignani P. Unexplained infertility: a review of diagnosis, prognosis, treatment efficacy and management. Int J Gynaecol Obstet 1992;39:267-275.

Katz P, Showstack J, Smith JF, Nachtigall RD, Millstein SG, Wing H. Costs of infertility treatment: results from an 18-month prospective cohort study. Fertil Steril 2011;95:915-921.

Organization WH. WHO traditional medicine strategy 2002-2005.

Landis ET, Davis SA, Feldman SR, Taylor S. Complementary and alternative medicine use in dermatology in the United States. J Altern Complement Med 2014;20:392-398.

Barnes PM, Powell-Griner E, McFann K, Nahin RL. Complementary and alternative medicine useamong adults: United States, 2002. Semin Integr Med; 2004: Elsevier.

Rezaeizadeh H, Alizadeh M, Naseri M, Ardakani MS. The Traditional Iranian Medicine Point of View on Health and Disease. Iran J Public Health 2009;38:169-172.

Aghili Shirazi MH. Kholase al hekmah (Persian). Esmailian. Vol 1. Quom 2006. p. 91.

Azdi A. Ketab-o- almaa Vol 3. Iran University of medical science. Tehran 2008. p. 1298.

Hall J. Guyton and Hall textbook of medical physiology. Elsevier. 13rd ed. Philadelphia 2016. pp. 881-886.

Avicenna. Qanun fi al Tib [Canon of Medicine] Vol 3. Ehyaol Toras al-Arabi Press. Beiruot 2010. pp. 404,444,479.

Heravi M. Bahr al-Jawaher. Jalaluddin Publications. Qom 2008. p. 125 [in Arabic].

Tabarrai M, Eftekhar T, Nazem E. Etiology of the Vaginal, Cervical, and Uterine Laceration on Avicenna Viewpoints. Iran J Public Health 2013;42:927-928.

Moayyedi P. Dyspepsia. Curr Opin Gastroenterol 2012;28:602-607.

Tack J, Bisschops R, Sarnelli G. Pathophysiology and treatment of functional dyspepsia. Gastroenterology. 2004;127:1239-1255.

Razi B. Kholasat al-Tajarob. Iran University of medical science. Tehran 2003. p. 358. [In Persian].

Fosol alaaraz. Iran University of medical science. Tehran 2008. p. 225.

Azam Khan M. Exir Azam (Persian). Institute of Meical History, Islamic Medicine and Complementary Medicine. Vol 3. Tehran 2008. p. 423.

Qaraaty M, Tabarrai M, Mamaghani JA, Ghorbanifar Z, Latifi M. The role of the Iranian Traditional Medicine in the development of impoverished areas in Iran. Adv Environ Bio 2014:1564-1569.

Juárez-Rojas L, Vigueras-Villaseñor RM, Casillas F, Retana-Márquez S. Gradual decrease in spermatogenesis caused by chronic stress. Acta Histochem 2017;119:284-291.

Medicine PCotASfR. Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril 2012;98:302-307.

Arzani MA. In: Teb-e-Akbari [Akbari's Medicine]. Jalaleddin Press. Tehran 2008. pp. 641–642.

Parsonnet J, Hansen S, Rodriguez L, Gelb AB, Warnke RA, Jellum E. Helicobacter pylori infection and gastric lymphoma. N Engl J Med 1994;330:1267-1271.

Talley NJ, Hunt RH. What role does Helicobacter pylori play in dyspepsia and nonulcer dyspepsia? Arguments for and against H. pylori being associated with dyspeptic symptoms. Gastroenterology 1997;113:S67-S77.

Figura N, Piomboni P, Ponzetto A, Gambera L, Lenzi C, Vaira D. Helicobacter pylori infection and infertility. Eur J Gastroenterol Hepatol 2002;14:663-669.

Moretti E, Collodel G, Mazzi L, Campagna M, Figura N. CagA-positive Helicobacter pylori infection and reduced sperm motility, vitality, and normal morphology. Dis Markers 2013;35:229-234.

Karaca N, Yilmaz R, Aktun LH, Batmaz G, Karaca C. Is there any relationship between unrecognized Celiac disease and unexplained infertile couples? Turk J Gastroenterol 2015;26:484-486.

Sher K, Jayanthi V, Probert C, Stewart C, Mayberry J. Infertility, obstetric and gynaecological problems in coeliac sprue. Dig Dis 1994;12:186-190.

Özgör B, Selimoğlu MA. Coeliac disease and reproductive disorders. Scand J Gastroenterol 2010;45:395-402.

Munkholm P, Binder V. Clinical features and natural history of Crohn’s disease. Kirsner’s Inflammatory Bowel Diseases. Edinburgh. 6th ed. Saunders 2004; p. 289.

Silverberg MS, Satsangi J, Ahmad T, Arnott ID, Bernstein CN, Brant SR. Toward an integrated clinical, molecular and serological classification of inflammatory bowel disease: report of a Working Partyof the 2005 Montreal World Congress of Gastroenterology. Can J Gastroenterol Hepatol 2005;19:5A-36A.

Alstead E, Nelson-Piercy C. Inflammatory bowel disease in pregnancy. Gut 2003;52:159-161.

Ban L, Tata LJ, Humes DJ, Fiaschi L, Card T. Decreased fertility rates in 9639 women diagnosed with inflammatory bowel disease: a United Kingdom population-based cohort study. Aliment Pharmacol Ther 2015;42:855-866.

Miller J. Inflammatory bowel disease in pregnancy: a review. J R Soc Med 1986;79:221-225.

Li Y, Liu L, Wang B, Chen D, Wang J. Nonalcoholic fatty liver disease and alteration in semen quality and reproductive hormones. Eur J Gastroenterol Hepatol 2015;27:1069-1073.

Della Torre S, Rando G, Meda C, Stell A, ChambonP, Krust A. Amino acid-dependent activation of liver estrogen receptor alpha integrates metabolic and reproductive functions via IGF-1. Cell Metab 2011;13:205-214.

Setji TL, Holland ND, Sanders LL, Pereira KC, Diehl AM, Brown AJ. Nonalcoholic steatohepatitis and nonalcoholic fatty liver disease in young women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2006;91:1741-1747.

Brzozowska MM, Ostapowicz G, Weltman MD. An association between non‐alcoholic fatty liver disease and polycystic ovarian syndrome. Gastroenterol Hepatol 2009;24:243-247.

Liu Y, Ding ZD. Obesity, a serious etiologic factor for male subfertility in modern society. Reproduction 2017;154:R123-R131.

Catalano PM, Shankar K. Obesity and pregnancy: mechanisms of short term and long term adverse consequences for mother and child. BMJ 2017;356:j1.

Feagins LA, Kane SV. Sexual and reproductive issues for men with inflammatory bowel disease. Am J Gastroenterol 2009;104:768-773.

Tremellen K, Syedi N, Tan S, Pearce K. Metabolic endotoxaemia - a potential novel link between ovarian inflammation and impaired progesterone production. Gynecol Endocrinol 2015;31:309-312.

Stazi A, Mantovani A. Celiac disease and its endocrine and nutritional implications on male reproduction. Minerva Med 2004;95:243-254.

Collin P, Kaukinen K, Valimaki M, Salmi J. Endocrinological disorders and celiac disease. Endocr Rev 2002;23:464-483.

Burra P. Liver abnormalities and endocrine diseases. Best Pract Res Clin Gastroenterol 2013;27:553-563.

Karagiannis A, Harsoulis F. Gonadal dysfunction in systemic diseases. Eur J Endocrinol 2005;152:501-513.

Sinclair KD, Watkins AJ. Parental diet, pregnancy outcomes and offspring health: metabolic determinants in developing oocytes and embryos. Reprod Fertil Dev 2013;26:99-114.

Tremellen K. GutEndotoxin Leading to a Decline IN Gonadal function (GELDING) - a novel theory for the development of late onset hypogonadism in obese men. Basic Clin Androl 2016;26:7.

Bausenwein J, Serke H, Eberle K, Hirrlinger J, Jogschies P, Hmeidan FA. Elevated levels of oxidized low-density lipoprotein and of catalase activity in follicular fluid of obese women. Mol Hum Reprod 2009;16:117-124.

La Vignera S, Condorelli R, Bellanca S, La Rosa B, Mousavi A, Busa B. Obesity is associated with a higher level of pro-inflammatory cytokines in follicular fluid of women undergoing medically assisted procreation (PMA) programs. Eur Rev Med Pharmacol Sci 2011;15:267-273.

Savini I, Catani MV, Evangelista D, Gasperi V, Avigliano L. Obesity-associated oxidative stress: strategies finalized to improve redox state. Int J Mol Sci 2013;14:10497-10538.

Broughton DE, Moley KH. Obesity and female infertility: potential mediators of obesity's impact. Fertil Steril 2017.

Garcia-Diaz EC, Gomez-Quiroz LE, Arenas-Rios E, Aragon-Martinez A, Ibarra-Arias JA, del Socorro IR-MM. Oxidative status in testis and epididymal sperm parameters after acute and chronic stress bycold-water immersion in the adult rat. Syst Biol Reprod Med 2015;61:150-160.

Juarez-Rojas L, Vigueras-Villasenor RM, Casillas F, Retana-Marquez S. Gradual decrease in spermatogenesis caused by chronic stress. Acta Histochem 2017;119:284-291.

Ferramosca A, Moscatelli N, Di Giacomo M, Zara V. Dietary fatty acids influence sperm quality and function. Andrology 2017;5:423-430.

Jorjani E. Zakhireye Kharazm Shahi (Treasure of Kharazm Shah). Vol 6. Iranian Medical Academy. Tehran 2001; p. 569

IssueVol 4, No 1, 2019 QRcode
SectionReview Article(s)
Persian medicine; Avecinna; Digestion; Gasterointestinal; Infertility

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How to Cite
Noroozi S, Zarei A, Tabarrai M. A Review of the Gastrointestinal Causes of Infertility from the Perspective of Persian Medicine. Trad Integr Med. 2019;4(1):47-55.