Content uploaded by Mahsa & Sara Darbandi
Author content
All content in this area was uploaded by Mahsa & Sara Darbandi on Feb 15, 2018
Content may be subject to copyright.
Darbandi—Improving ART Outcomes
ALTERNATIVE THERAPIES, [E-PUB AHEAD OF PRINT]
is article is protected by copyright. To share or copy this article, please visit copyright.com. Use ISSN#1078-6791. To subscribe, visit alternative-therapies.com
Yoga Can Improve Assisted Reproduction
Technology Outcomes in Couples With Infertility
Sara Darbandi, PhD(c); Mahsa Darbandi, PhD(c); Hamid Reza Khorram Khorshid, MD, PhD;
Mohammad Reza Sadeghi, PhD
REVIEW ARTICLE
ABSTRACT
Context • Depending on the cause of the infertility,
nonsurgical or surgical treatments may be used to treat
men and women with infertility. Despite improved
outcomes due to medical advances, assisted reproductive
technology (ART) for couples with infertility is sometimes
unsuccessful. Success may be aected by the patient’s
social, psychological, and physical status.
Objective • e study examined the eects of yoga—
including asanas (yoga poses), pranayama
(proper breathing), shavasana, and meditation—on male
and female fertility and ART outcomes.
Design • e research team performed a literature review,
electronically searching for articles published between
January 1978 and January 2016 in the PubMed, Scopus,
ScienceDirect, and Google Scholar databases.
Setting • e study took place at the Reproductive
Biotechnology Research Center at the Avicenna Research
Institute at the Academic Center for Education, Culture,
and Research (Tehran, Iran).
Participants • Participants were couples with infertility
taking part in 87 reviewed studies.
Intervention • Yoga was the intervention.
Outcome Measures • e outcome measures comprised
fertility factors in males and females, fertility rate, and
ART success rate.
Results • e reviewed studies showed that yoga can
provide stress management for patients with infertility,
with benecial eects on fertility, helping couples give
birth. ey found that yoga also could reduce pain;
decrease depression, anxiety, and stress; reduce the rate of
assisted vaginal delivery; and improve fetal outcomes.
Conclusions • Yoga can help couples overcome infertility
and increase the ART success rate by improving the
physiological and psychological states of both men and
women. (Altern er Health Med. [E-pub ahead of print.])
Sara Darbandi, MSc, is a PhD student; Mahsa Darbandi, MSc, is
a PhD student; and Hamid Reza Khorram Khorshid, MD, PhD,
is a full professor at the Genetics Research Center, University
of Social Welfare and Rehabilitation Sciences, in Tehran,
Iran. Mohammad Reza Sadeghi, PhD, is a full professor at
the Reproductive Biotechnology Research Center, Avicenna
Research Institute, Academic Center for Education, Culture,
and Research, in Tehran, Iran.
Corresponding author: Mahsa Darbandi, PhD(c)
E-mail address: mahsadarbandi@hotmail.com
Corresponding author: Mohammad Resa Sadeghi, PhD
E-mail address: sadeghi@avicenna.ac.ir
Fertilization is viewed as a simple notion, wherein
sperm and ova join and the result is a new life, but the
process is actually a series of long and complex events
that must take place in a certain order. Infertility occurs in
8% to 12% of the world’s couples because of genetic,
psychological, anatomical, endocrinological, and
immunological problems that aect both female and male
reproductive health.1,2
Infertility rates vary signicantly among countries and
regions, based on the prevalence of disease leading to
infertility.2 General factors aecting female infertility
(ie, the ability to ovulate, conceive, or deliver a child
successfully) include age, endometriosis, polycystic ovarian
syndrome (PCOS), chronic diseases, hormonal imbalance,
environmental factors, excessive or very low body fat, sexually
Darbandi—Improving ART Outcomes ALTERNATIVE THERAPIES, [E-PUB AHEAD OF PRINT]
is article is protected by copyright. To share or copy this article, please visit copyright.com. Use ISSN#1078-6791. To subscribe, visit alternative-therapies.com
transmitted diseases, mullerian anomalies, fallopian tube
disease, blockage of the cervix, multiple miscarriages, and
amenorrhea.2-6
Although women’s infertility is the greater focus of
research and attention in health care, male infertility is the
cause in or contributing factor to infertility in approximately
half of couples with infertility.1 Nearly 30% to 40% of all
infertility is a result of male factors, and approximately 8% of
men request medical help for problems associated with
fertility.1,7,8 Some risk factors that can result in a decline in a
man’s seminal quality include a history of prostatitis, genital
infections, sexually transmitted diseases, oxidative stress,
hernia repair, undescended testicles, and mumps aer
pu ber ty.2,6,9,10 Investigators have found that a 2% reduction in
the quality of male sperm occurs annually.2,11
Environmental stress and pollution are important
parameters that can reduce hormonal proles that stimulate
spermatogenesis.2 Recently, infertility rates have been
growing throughout the world, and the need for infertility
treatments and assisted reproductive technologies (ARTs)
has increased.1,7 Accordingly, nonsurgical or surgical
treatments, including hormone therapy, in vitro fertilization
(IVF), and intracytoplasmic sperm injection, may be used to
treat men and women with infertility. Despite these medical
improvements, treatment remains largely unsuccessful.
Studies have shown that patients’ social, mental, and
physical states can strongly aect ART’s success.12-15 Although
antianxiety and antidepressant medications can reduce stress,
they have side eects, such as a decrease in sexual drive, an
inability to orgasm, and erectile dysfunction.16,17
Complementary approaches to reproductive wellness,
such as the methods of traditional Chinese medicine,
ayurveda, yoga, and mind-body techniques for stress reduction
have recently been introduced in the ART eld.7,18-21 Yoga is a
form of alternative medicine that claims to improve a person’s
health by reducing stress and regulating hormonal
secretions.18,19,21-23
e aim of the current study was to review the eects of
yoga—including asanas (yoga poses), pranayama
(proper breathing), shavasana, and meditation—on couples’
fertility and on ART outcomes.
METHODS
Procedures
In this review, the research team searched the following
electronic databases between January 1978 and January 2016.
e documents were obtained from PubMed, Scopus, Science
Direct, and Google Scholar using the keywords yoga, fertility,
infertility, and reproduction. Two members of the research
team evaluated the studies. e study included articles if the
studies evaluated the eects of yoga on fertility factors and
pregnant women who were randomized to yoga and control
groups. ere were no severe limits on control groups.
erefore, any trials that compared yoga to usual care or any
other physical or mental care were qualied. Today, there are
dierent types of yoga. Some included only physical exercise,
such as stretching, shavasana, or other asana postures. Other
kinds of yoga also included pranayama, meditation, or deep
relaxation. e research team included all types of studies
and all types of yoga and reviewed only studies in English.
e search provided 43 169 articles. Nonrandomized or
uncontrolled trials, irrelevant articles, duplicated articles, or
articles with duplicated data were excluded, and the remaining
87 articles were evaluated.
Participants
Participants were couples with infertility taking part in
the 87 reviewed studies. Couples with infertility were married
couples not being able to get pregnant aer trying for 1 year.
e present study comprised couples who were aged 18 to 45
years and evidence was from 5 continents.
Intervention
is study included all types of yoga as the intervention.
Yoga combines breathing, meditation, and postures to bring
harmony to the chakra system. It is also used to awaken the
essential life force, known as kundalini energy, which is
housed in the root base chakra at the base root of spine. e
studies generally were between 6 and 20 weeks in duration.
Outcome Measures
e outcome measures comprised fertility factors in
males such as sperm count, sperm motility, prostate
secretion, genital inammatory, varicocele, intravaginal
ejaculation time, testosterone secretion, sexual desire and
arousal, and DNA integrity of sperm. In females, fertility
factors measured may include ovulation management and
oocytes improvement; the serum levels of cortisol,
adrenaline, noradrenaline, dopamine, testosterone,
luteinizing hormone (LH), and antimullerian hormone
(AMH); fertility rate; ART success rate; back, lumbopelvic,
and other physical pain; satisfaction with pain relief;
depression; anxiety; and stress.
RESULTS
In total, 87 articles were evaluated in the review.
Women With Infertility
Stress Relief. e reviewed studies supported the
hypothesis that yoga could help couples give birth24-31 by
(1) reducing their anxiety and depression31-57; (2) improving
their sleep58; (3) helping them manage the stresses of pregnancy,
labor, and birth32-42,44,45,47,48,55,59-68; and (4) improving their
quality of life during pregnancy or aer stillbirth for women.55,69
Yoga also was found to (1) reduce back, lumbopelvic,
and other physical pain51,53,56,70-73 and (2) increase satisfaction
with pain relief.70
Investigators also reported that stress management in
patients with infertility had benecial eects on fertility.74-78
In couples with infertility, yoga could (1) manage ovulation
and oocytes improvement for fertility79,80 and (2) decrease
depression, anxiety, and stress.53,81,82
Darbandi—Improving ART Outcomes
ALTERNATIVE THERAPIES, [E-PUB AHEAD OF PRINT]
is article is protected by copyright. To share or copy this article, please visit copyright.com. Use ISSN#1078-6791. To subscribe, visit alternative-therapies.com
Yoga Types and Poses
Qualied breathing can help the body’s organs receive
proper oxygen and energy for full functionality.19,104,105 For
people dealing with infertility, studies have found that the
benecial yoga asanas for strengthening core, legs, and feet
and can help to move energy in the sacral chakra area, while
being rmly rooted through the feet and balanced throughout
the root chakra. ese poses are (1) Standing Forward Bend
(Uttanasana), (2) Garland (Malasana), (3) Head-to-Knee
Forward Bend (Janu Sirsasana), (4) Reclining Bound Angle
(Supta Baddha Konasana), (5) Wide-Legged Forward Bend
(Prasarita Padottanasana), (6) Warrior II (Virabhadrasana II),
(7) Mountain Pose (Tadasana), (8) Warrior One Pose
(Virabhadrasana 1), and (9) Bridge Pose
(Setu Bhandasana).19,28,106 Other poses that could be useful
are (1) Pigeon, (2) Wide-Angle Seated Forward Bend
(Upavistha Konasana), (3) Cow Face (Gomukhasana),
(4) One-Legged King Pigeon (Eka Pada Rajakapotasana),
(5) Bound Angle (Baddha Konasana), (6) Revolved Triangle
(Parivrtta Trikonasana), (7) Full Boat (Paripurna Navasana),
(8) Chair (Utkatasana), (9) Triangle Pose (Trikonasana),
(10) Child Pose (Balasana), (11) Cobra Pose (Bhujangasana),
(12) Dancer’s Pose (Natarajasana), and (13) Sun Salutation
(Surya Namaskar),19,28,106 which benets the whole body and
all of the chakras.
DISCUSSION
e reviewed studies provide evidence that yogacan help
couples overcome infertility and improve the ART success rate
by reducing anxiety and depression,40,107,108 decreasing stress,107
regulating 8 hormonal secretions, increasing quality of life, and
raising fertility rates.10,18,19,22,23,104,105,109-111
Following stress, the endocrinal organ system releases
stress-related hormones, such as cortisol and adrenalin.15,112
Smith et al113 showed that the LH hormone levels decreased
in female ovaries as a result, and ovulation was disrupted or
even paused.
High levels of cortisol have been found to be strongly
associated with miscarriage.15,112 Studies from the past several
decades have demonstrated that high stress levels are strongly
correlated to infertility.74,114-116 In IVF patients, some studies
have shown that the rates of implantation increased when
daily adrenalin levels were lower.19,114,115 Other studies have
shown a similar correlation when measuring cortisol
levels.19,114,115
ese results indicate that couples with infertility can
be more successful at reproduction when they lead less
stressful lives.117,118 Frederiksen et al119 showed that
chronically stressed women produced less of the
gonadotropin-releasing hormone, which prevented
ovulation by starting a cascade of hormonally related
changes. One study showed that women who are very
underweight or overweight do not ovulate normally and
also have hormonal imbalances.120
In men, stress was shown to aect fertility both by
lowering sperm volume and by raising the percentage of
Hormonal Changes. Two studies found that alpha
brain waves increased and serum cortisol signicantly
decreased during yoga.10,83 Schmidt et al found the 3 months
of yoga could decrease the rate of urinary excretion of
adrenaline, noradrenaline, dopamine, and aldosterone as
well as improve the serum levels of testosterone and LH and
increase cortisol excretion.84 Other researchers have
conrmed that yoga can reduce cortisol levels in
women.46,50,85-87
Exercise via 30 minutes per day of asanas, pranayama,
meditation, and shavasana helped patients with PCOS lose
weight and manage stress, which ultimately stabilizes the
normal function of the hypothalamic-pituitary-ovarian
axis.88 Also, in 3 studies,89,90,91,92 a 12-week yoga program
helped participants reduce their levels of AMH, LH, and
testosterone, and one of those studies found improved
menstrual frequency90; one found lower anxiety90; and one
increased the quality of life of adolescents with PCOS.91
Pregnancy. Yoga was found to (1) reduce hypertensive-
related pregnancies,62,92 (2) improve fetal outcomes,62,92
(3) increase the infants’ birth weights,61 (4) decrease
intrauterine growth retardation,61,62 and (5) reduce the rate of
assisted vaginal delivery.70
One study found that women who were more distressed
than other women were more likely to accept psychological
support before starting an IVF cycle.93 A study of
143 women with infertility demonstrated that yoga could
decrease distress in women before they started their rst
IVF cycle93 and showed that it was better to start its practice
at least 6 weeksbefore starting the cycle.94 In addition, for
women who become pregnant via IVF, yoga decreased
stress, anxiety, and labor pains and increased delivery
condence.39,95
Men With Infertility
e benets of regular yoga practice were not limited to
women with infertility; men with infertility also
beneted.11,96-99 Sperm count, sperm motility, and prostate
secretion showed improvement in men who practiced yoga.10
Some investigators indicated that yoga could improve genital
inammatory conditions, in addition to increasing sperm
parameters and motility, and also could improve immune
system disorders, varicocele,96 and intravaginal ejaculation
time and decrease sexual dysfunction.100
Hu et al96 also found that yoga could help regulate
endocrinal glands and the autonomic nervous system (ANS).
In men, practicing the Root Bond pose (Mula Bandha) was
found to be correlated with relieving spermatorrhea,
preventing inguinal hernia and regulating testosterone
secretion,10 whereas the Mula Bandha pose could increase
genital arousal sensations for improving sexual desire and
arousal.10 Other ndings showed that yoga could aect the
DNA integrity of sperm and reduce some markers of oxidative
stress, such as telomerase activity, telomere length, and DNA
fragmentation,101,102 and also could delay aging, which can be
applied for women, too.101,103
Darbandi—Improving ART Outcomes ALTERNATIVE THERAPIES, [E-PUB AHEAD OF PRINT]
is article is protected by copyright. To share or copy this article, please visit copyright.com. Use ISSN#1078-6791. To subscribe, visit alternative-therapies.com
15. Chandra AK, Sengupta P, Goswami H, Sarkar M. Excessive dietary calcium in the
disruption of structural and functional status of adult male reproductive system in
rat with possible mechanism. Molec Cell Biochem. 2012;364(1-2):181-191.
16. Serretti A, Chiesa A. Sexual side effects of pharmacological treatment of
psychiatric diseases. Clin Pharmacol erapeut. 2011;89(1):142-147.
17. Gitlin M. Sexual dysfunction with psychotropic drugs. Expert Opin
Pharmacother. 2003;4(12):2259-2269.
18. Smith C, Hancock H, Blake-Mortimer J, Eckert K. A randomised comparative
trial of yoga and relaxation to reduce stress and anxiety. Complement er Med.
2007;15(2):77-83.
19. Stiles M. Structural Yoga erapy: Adapting to the Individual. Boston, MA: Weiser
Books; 2000.
20. Weiss DA, Harris CR, Smith JF. The use of complementary and alternative
fertility treatments. Curr Opin Obstet Gynecol. 2011;23(3):195-199.
21. Smith JF, Eisenberg ML, Millstein SG, et al. The use of complementary and
alternative fertility treatment in couples seeking fertility care: Data from a
prospective cohort in the United States. Fertility and Sterility. 2010;93(7):2169-2174.
22. Tooley GA, Armstrong SM, Norman TR, Sali A. Acute increases in night-time
plasma melatonin levels following a period of meditation. Biologic Psychol.
2000;53(1):69-78.
23. Harinath K, Malhotra AS, Pal K, et al. Effects of hatha yoga and omkar
meditation on cardiorespiratory performance, psychologic prole, and melatonin
secretion. J Alternat Complement Med. 2004;10(2):261-268.
24. Kessler C, Stapelfeldt E, Michalsen A, et al. The effect of a complex multi-
modality ayurvedic treatment in a case of unknown female infertility. Forsch
Komplementmed. 2015;22(4):251-258.
25. Fields N. Yoga: Empowering women to give birth. Pract Midwife. 2008;11(5):30-32.
26. Berk B. Yoga for ,oms: Building core stability before, during and aer pregnancy.
Midwifery Today Internat Midwife. 2001;59:27-29.
27. Weller S. Yoga and pregnancy: Unbending thoughts. Nursing Mirror.
1981;152(18):20-22.
28. Hookway F. Which course? Introduction to yoga-based exercises for pregnancy.
Pract Midwife. 1998;1(12):36-37.
29. Gaffney L, Smith CA. Use of Complementary therapies in pregnancy: The
perceptions of obstetricians and midwives in South Australia. Austral New
Zealand J Obstet Gynaecol. 2004;44(1):24-29.
30. Kinser P, Williams C. Prenatal yoga: Guidance for providers and patients. Adv
Nurse Pract. 2008;16(5):59-60.
31. Bala K. Pregnancy & yoga. Midwifery Today Internat Midwife. 2012;103:38-39.
32. Battle CL, Uebelacker LA, Magee SR, Sutton KA, Miller IW. Potential for prenatal
yoga to serve as an intervention to treat depression during pregnancy. Wom
Health Issue. 2015;25(2):134-141.
33. Gong H, Ni C, Shen X, Wu T, Jiang C. Yoga for prenatal depression: A systematic
review and meta-analysis. BMC Psychiatry. 2015;15(14):15-393.
34. Huberty J, Leiferman JA, Gold KJ, et al. Physical activity and depressive
symptoms after stillbirth: Informing future interventions. BMC Pregnancy
Childbirth. 2014;14(391):14-391.
35. Kinser P, Masho S. ‘I Just start crying for no reason’: e experience of stress and
depression in pregnant, urban, African-American Adolescents and their perception
of yoga as a management strategy. Wom Health Issue. 2015;25(2):142-148.
36. Tung CT, Lee CF, Lin SS, Lin HM. e exercise patterns of pregnant women in
Taiwan. J Nurs Res. 2014;22(4):242-249.
37. Stewart D, Pallivalappila AR, Shetty A, Pande B, McLay JS. Healthcare
professional views and experiences of complementary and alternative therapies
in obstetric practice in North East Scotland: A prospective questionnaire survey.
Bjog. 2014;121(8):1015-1019.
38. Steel A, Adams J, Sibbritt D, et al. Relationship between complementary and
alternative medicine use and incidence of adverse birth outcomes: An
examination of a nationally representative sample of 1835 Australian women.
Midwifery. 2014;30(12):1157-1165.
39. Shim CS, Lee YS. Eects of a yoga-focused prenatal program on stress, anxiety,
self condence and labor pain in pregnant women with in vitro fertilization
treatment. J Korean Acad Nurs. 2012;42(3):369-376.
40. Satyapriya M, Nagarathna R, Padmalatha V, Nagendra HR. Eect of integrated
yoga on anxiety, depression & well being in normal pregnancy. Complement er
Clin Pract. 2013;19(4):230-236.
41. Reis PJ, Alligood MR. Prenatal yoga in late pregnancy and optimism, power, and
well-being. Nurs Sci Quart. 2014;27(1):30-36.
42. Newham JJ, Wittkowski A, Hurley J, Aplin JD, Westwood M. Eects of antenatal
yoga on maternal anxiety and depression: A randomized controlled trial. Depress
Anx. 2014;31(8):631-640.
43. Muzik M, Hamilton SE, Lisa Rosenblum K, Waxler E, Hadi Z. Mindfulness Yoga
during pregnancy for psychiatrically at-risk women: Preliminary results from a
pilot feasibility study. Complement er Clin Pract. 2012;18(4):235-240.
44. Field T, Diego M, Hernandez-Reif M, et al. Yoga and massage therapy reduce
prenatal depression and prematurity. J Bodyw Mov er. 2012;16(2):204-209.
45. Field T, Diego M, Delgado J, Medina L. Tai Chi/yoga reduces prenatal
depression, anxiety and sleep disturbances. Complement Ther Clin Pract.
2013;19(1):6-10.
46. Field T, Diego M, Delgado J, Medina L. Yoga and social support reduce prenatal
depression, anxiety and cortisol. J Bodyw Mov er. 2013;17(4):397-403.
47. Sun YC, Hung YC, Chang Y, Kuo SC. Eects of a prenatal yoga programme on
the discomforts of pregnancy and maternal childbirth self-ecacy in Taiwan.
Midwifery. 2010;26(6):25.
abnormal sperm.119 ree studies have found that men who
were underweight or overweight had imbalanced levels of
testosterone and lower sperm count and concentrations.121-123
Incorporating yoga into a daily routine has been found
to be a great way to balance the body in both genders.10,104,105,124
Prior et al86 found it could be benecial to do yoga to reduce
stress and increase the fertility rate, because cortisol levels
can have a signicant eect on fertility. From the current
review, it is clear that yoga can be used to prevent or reduce
obstetric complications53 and improve sexual functions in
women.125 Researchers have suggested that asanas, pranayama,
shavasana, and meditation are related to the cerebrospinal
uid, endocrinal secretion, and the ANS.2,104,105,126-128
CONCLUSIONS
Yoga can help couples experiencing the challenges of
infertility by increasing clarity of mind, maintaining
homeostasis, and giving them real power while undergoing
the therapeutic rigors of ART. When patients recognize the
state of their bodies, they can achieve physical relaxation,
have a better sense of themselves and begin to treat their
problems with more interest and strength. Patients can
report to their doctors more easily about the state of their
bodies and their sensations in ART cycles. Yoga can also
improve fertility rates in ART by diminishing stress and
modifying the body’s hormonal secretions, ANS, genital
health, and sexual arousal. However, these ndings should be
reconrmed by future well-designed, randomized clinical
studies.
AUTHOR DISCLOSURE STATEMENT
No competing nancial interests exist for the authors.
REFERENCES
1. Vayena E, Organization WH. Current Practices and Controversies in Assisted
Reproduction. Geneva, Switzerland: World Health Organization; 2002.
2. Sengupta P. Challenge of infertility: How protective is yoga therapy? Anc Science
Life. 2012;32(1):61.
3. Roupa Z, Polikandrioti M, Sotiropoulou P, et al. Causes of infertility in women at
reproductive age. Health Sci J. 2009;3(2):80-87.
4. Pathak G, Nichter M. Polycystic ovary syndrome in globalizing India: An ecosocial
perspective on an emerging lifestyle disease. Soc Sci Med. 2015;146:21-28.
5. Healy DL, Trounson AO, Andersen AN. Female infertility: Causes and
treatment. Lancet. 1994;343(8912):1539-1544.
6. Gardner DK, Weissman A, Howles CM, Shoham Z. Textbook of Assisted
Reproductive Techniques. Boca Raton, FL: CRC Press; 2012.
7. Kessler C, Stapelfeldt E, Michalsen A, et al. The effect of a complex multi-
modality ayurvedic treatment in a case of unknown female infertility. Forschende
Komplementärmedizin. 2015;22(4):251-258.
8. Martinez GM, Chandra A, Abma JC, Jones J, Mosher WD. Fertility,
contraception, and fatherhood: Data on men and women from cycle 6 (2002) of
the 2002 National Survey of Family Growth. Vital Health Stat. 2006;23(26):1-142.
9. Dohle G. Male Factors in Couple’s Infertility. New York, NY: Springer; 2015.
10. Sengupta P, Chaudhuri P, Bhattacharya K. Male reproductive health and yoga. Int
J Yoga. 2013;6(2):87-95.
11. Sengupta P. Environmental and occupational exposure of metals and their role in
male reproductive functions. Drug Chem Toxicol. 2013;36(3):353-368.
12. Zaig I, Azem F, Schreiber S, et al. Psychological response and cortisol reactivity to
in vitro fertilization treatment in women with a lifetime anxiety or unipolar
mood disorder diagnosis. J Clin Psychiatry. 2013;74(4):386-392.
13. An Y, Sun Z, Li L, Zhang Y, Ji H. Relationship between psychological stress and
reproductive outcome in women undergoing in vitro fertilization treatment:
Psychological and neurohormonal assessment. J Assist Reprod Genet.
2013;30(1):35-41.
14. Martins MV, Costa P, Peterson BD, Costa ME, Schmidt L. Marital stability and
repartnering: Infertility-related stress trajectories of unsuccessful fertility
treatment. Fertil Steril. 2014;102(6):1716-1722.
Darbandi—Improving ART Outcomes
ALTERNATIVE THERAPIES, [E-PUB AHEAD OF PRINT]
is article is protected by copyright. To share or copy this article, please visit copyright.com. Use ISSN#1078-6791. To subscribe, visit alternative-therapies.com
83. Kamei T, Toriumi Y, Kimura H, et al. Decrease in serum cortisol during yoga
exercise is correlated with alpha wave activation. Percept Motor Skill. 2000;90(3 Pt
1):1027-1032.
84. Schmidt T, Wijga A, Von Zur Muhlen A, Brabant G, Wagner TO. Changes in
cardiovascular risk factors and hormones during a comprehensive residential
three month kriya yoga training and vegetarian nutrition. Acta Physiologica
Scandinavica. Supplementum. 1997;640:158-162.
85. Michalsen A, Grossman P, Acil A, et al. Rapid stress reduction and anxiolysis
among distressed women as a consequenceof a three-month intensive yoga
program. Am J Case Report. 2005;11(12):CR555-CR61.
86. Prior JC, Naess M, Langhammer A, Forsmo S. Ovulation prevalence in women
with spontaneous normal-length menstrual cycles: A population-based cohort
from HUNT3, Norway. PLoS One. 2015;10(8):e0134473.
87. Field T. Prenatal exercise research. Infant Behav Dev. 2012;35(3):397-407.
88. Verma A, Kumar S, Dei L, Dhiman K. Management of PCOS: A psychosomatic
disorder by yoga practice. Interna J Innovat Res Develop. 2015;4(1):1.
89. Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R. Eects of a holistic yoga
program on endocrine parameters in adolescents with polycystic ovarian syndrome:
A randomized controlled trial. J Alern Complement Med. 2013;19(2):153-160.
90. Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R. Eect of holistic yoga
program on anxiety symptoms in adolescent girls with polycystic ovarian
syndrome: A randomized control trial. Intern J Yoga. 2012;5(2):112.
91. Nidhi R, Padmalatha V, Nagarathna R, Amritanshu R. Eect of yoga program on
quality of life in adolescent polycystic ovarian syndrome: A randomized control
trial. Applied Res Qual Life. 2013;8(3):373-383.
92. Rakhshani A, Nagarathna R, Mhaskar R, et al. e eects of yoga in prevention
of pregnancy complications in high-risk pregnancies: A randomized controlled
trial. Prevent Med. 2012;55(4):333-340.
93. Valoriani V, Lotti F, Vanni C, et al. Hatha-yoga as a psychological adjuvant for
women undergoing IVF: A pilot study. Eur J Obstet Gynecol Reprod Biol.
2014;176:158-162.
94. Oron G, Allnutt E, Lackman T, et al. A prospective study using hatha yoga for
stress reduction among women waiting for IVF treatment. Reprod Biomed
Online. 2015;30(5):542-548.
95. Shim CS, Lee Y-S. Eects of a yoga-focused prenatal program on stress, anxiety,
self condence and labor pain in pregnant women with in vitro fertilization
treatment. J Korean Acad Nurs. 2012;42(3):369-376.
96. Hu M, Zhang Y, Ma H, Ng EH, Wu XK. Eastern medicine approaches to male
infertility. Semin Reprod Med. 2013;31(4):301-310.
97. Sharma RK, Pasqualotto FF, Nelson DR, omas AJ, Jr, Agarwal A. e reactive
oxygen species-total antioxidant capacity score is a new measure of oxidative
stress to predict male infertility. Hum Reprod. 1999;14(11):2801-2807.
98. Khalsa HK. Yoga: An adjunct to infertility treatment. Fertil Steril. 2003;4:46-51.
99. Sreejith V, Prathibha K. Healthy lifestyle modication: An ayurvedic outlook to
prevent male infertility. Intern J Yoga Allied Sci. 2014;2(12):153-147.
100. Patil P, Makwana JJ, akare GV, Patil SP. Eect of sitting & nonsitting yoga
asanas on premature ejaculation. Inventi Impact Sex Reproduct. 2012;1(1):1.
101. Kumar SB, Yadav R, Yadav RK, Tolahunase M, Dada R. Telomerase activity and
cellular aging might be positively modied by a yoga-based lifestyle intervention.
J Altern Complement Med. 2015;21(6):370-372.
102. Dada R, Kumar S, Tolahunase M, Mishra S, Mohanty K. Yoga and meditation as
a therapeutic intervention in oxidative stress and oxidative DNA damage to
paternal genome. J Yoga Phys er. 2015;5(217):2.
103. Kumar SB, Chawla B, Bisht S, Yadav RK, Dada R. Tobacco use increases oxidative
DNA damage in sperm: Possible etiology of childhood cancer. Asian Pac J Cancer
Pre v. 2015;16(16):6967-6972.
104. Cross JR. Acupuncture and the Chakra Energy System: Treating the Cause of
Disease. Berkely, CA: North Atlantic Books; 2012.
105. Eliade M, Trask WR, White DG. Yoga: Immortality and Freedom. Princeton, NY:
Princeton University Press; 2009.
106. Gaware VM, Dolas RT, Kotade KB, et al. Promotion and improvement of fertility
by yoga. Intern J Drug Form Res. 2011;2(3):1.
107. Regan M. Yoga for prenatal depression: A systematic review and meta-analysis.
Pract Midwife. 2015;18(5):38-41.
108. Shannahoff-Khalsa DS, Beckett LR. Clinical case report: Efficacy of yogic
techniques in the treatment of obsessive compulsive disorders. Int J Neurosci.
1996;85(1-2):1-17.
109. Vempati RP, Telles S. Yoga-based guided relaxation reduces sympathetic activity
judged from baseline levels. Psychological Reports. 2002;90(2):487-494.
110. Lim SA, Cheong KJ. Regular yoga practice improves antioxidant status, immune
function, and stress hormone releases in young healthy people: A randomized,
double-blind, controlled pilot study. J Altern Complement Med. 2015;21(9):530-538.
111. Siedentopf F, Utz-Billing I, Gairing S, et al. Yoga for patients with early breast
cancer and its impact on quality of life: A randomized controlled trial.
Geburtshilfe und Frauenheilkunde. 2013;73(4):311-317.
112. Selvamurthy W, Sridharan K, Ray US, et al. A new physiological approach to
control essential hypertension. Indian J Physiol Pharmacol. 1998;42(2):205-213.
113. Smith V, Osianlis T, Vollenhoven B. A review of luteinizing hormone and its role
in ovarian reserve testing. Intern J Reproduct Contracept Obstet Gynecol.
2014;3(1):11-18.
114. Crump C, Chevins P. Prenatal stress reduces fertility of male ospring in mice,
without affecting their adult testosterone levels. Hormone Behav.
1989;23(3):333-343.
48. Satyapriya M, Nagendra HR, Nagarathna R, Padmalatha V. Eect of integrated
yoga on stress and heart rate variability in pregnant women. Internat J Gynaecol
Obstet. 2009;104(3):218-222.
49. Marc I, Toureche N, Ernst E, et al. Mind-body interventions during pregnancy
for preventing or treating women’s anxiety. Cochrane Database Syst Rev.
2011;7:CD007559.
50. Field T. Yoga clinical research review. Complement er Clin Pract. 2011;17(1):1-8.
51. Field T. Pregnancy and Labor alternative therapy research. Altern er Health
Med. 2008;14(5):28-34.
52. Bershadsky S, Trumpfheller L, Kimble HB, Pipaloff D, Yim IS. The effect of
prenatal hatha yoga on aect, cortisol and depressive symptoms. Complement
er Clin Pract. 2014;20(2):106-113.
53. Beddoe AE, Paul Yang CP, Kennedy HP, Weiss SJ, Lee KA. The effects of
mindfulness-based yoga during pregnancy on maternal psychological and
physical distress. J Obstet Gynecol Neonat Nurs. 2009;38(3):310-319.
54. Beddoe AE, Lee KA. Mind-body interventions during pregnancy. J Obstet
Gynecol Neonat Nurs. 2008;37(2):165-175.
55. Babbar S, Parks-Savage AC, Chauhan SP. Yoga during pregnancy: A review. Am J
Perinatol. 2012;29(6):459-464.
56. Chattha R, Raghuram N, Venkatram P, Hongasandra NR. Treating the
climacteric symptoms in Indian women with an integrated approach to yoga
therapy: A randomized control study. Menopause. 2008;15(5):862-870.
57. Battle CL, Uebelacker LA, Howard M, Castaneda M. Prenatal yoga and
depression during pregnancy. Birth. 2010;37(4):353-354.
58. Beddoe AE, Lee KA, Weiss SJ, Kennedy HP, Yang CP. Eects of mindful yoga on
sleep in pregnant women: A pilot study. Biol Res Nurs. 2010;11(4):363-370.
59. Oakley S, Evans E. e role of yoga: Breathing, meditation and optimal fetal
positioning. Pract Midwife. 2014;17(5):30-32.
60. Nguyen-Feng VN, Feng SL, Babbar S, Rankins NC, Blando JD. Hot yoga
establishments in local communities serving pregnant women: A pilot study on
the health implications of its practice and environmental conditions. J Environ
Health. 2014;77(3):8-12.
61. Narendran S, Nagarathna R, Narendran V, Gunasheela S, Nagendra HR. Ecacy
of yoga on pregnancy outcome. J Altern Complement Med. 2005;11(2):237-244.
62. Narendran S, Nagarathna R, Gunasheela S, Nagendra HR. Ecacy of yoga in
pregnant women with abnormal Doppler study of umbilical and uterine arteries.
J Indian Med Assoc. 2005;103(1):12-14.
63. Kim HH, Nava-Ocampo AA, Kim SK, et al. Is prenatal childbirth preparation
effective in decreasing adverse maternal and neonatal response to labor? A
nested case-control study. Acta Biomed. 2008;79(1):18-22.
64. Doran F, Hornibrook J. Women’s experiences of participation in a pregnancy and
postnatal group incorporating yoga and facilitated group discussion: A
qualitative evaluation. Women Birth. 2013;26(1):82-86.
65. Chuntharapat S, Petpichetchian W, Hatthakit U. Yoga during pregnancy: Eects
on maternal comfort, labor pain and birth outcomes. Complement er Clin
Pract. 2008;14(2):105-115.
66. Weller S. Preparing for childbirth the yoga way. Austral Nurs J. 1981;10(11):37-39.
67. Balasinor N, Bhan A, Paradkar NS, et al. Postnatal development and reproductive
performance of F1 progeny exposed in utero to an ayurvedic contraceptive:
Pippaliyadi yoga. J Ethnopharmacol. 2007;109(3):406-411.
68. Remer M. Incorporating prenatal yoga into childbirth education classes.
Midwifery Today Internat Midwife. 2007;84(23):66.
69. Rakhshani A, Maharana S, Raghuram N, Nagendra HR, Venkatram P. Eects of
Integrated yoga on quality of life and interpersonal relationship of pregnant
women. Qual Life Res. 2010;19(10):1447-1455.
70. Smith CA, Levett KM, Collins CT, Crowther CA. Relaxation techniques for pain
management in labour. Cochrane Database Syst Rev. 2011;12:CD009514.
71. Wang SM, DeZinno P, Fermo L, et al. Complementary and alternative medicine
for low-back pain in pregnancy: A cross-sectional survey. J Altern Complement
Med. 2005;11(3):459-464.
72. Sharma R, Kumar A. Clomiphene vs clomiphene and yoga for infertile women: A
comparative study. Intern J Sci Study. 2015;95(5):1720-1724.
73. Martins RF, Pinto e Silva JL. Treatment of pregnancy-related lumbar and pelvic
girdle pain by the yoga method: A randomized controlled study. J Altern
Complement Med. 2014;20(1):24-31.
74. Cousineau TM, Domar AD. Psychological impact of infertility. Best Pract Res
Clin Obstet Gynaecol. 2007;21(2):293-308.
75. Chaudhari VM, Avlaskar AD. Role of shivlingi in infertility. J Homeopath Ay urv
Med. 2013;2013:1.
76. Koopman J. The Experimental effects of stress on fertility. Berkeley Sci J.
2013;18(1):1.
77. Domar AD, Benson H. Application of behavioral medicine techniques to the
treatment of infertility. In Seibel M, Bernstein J, eds. Technology and Infertility.
New York, NY: Springer; 1993:355-360.
78. Bennington LK. Can complementary/alternative medicine be used to treat
infertility? MCN: \American J Matern/Child Nurs. 2010;35(3):140-147.
79. Pandya S, Dhiman K. Role of Pippalyadi yoga in infertility caused by anovulatory
factor. J Homeopath Ayurved Med. 2014;3(1):2167-1206.
80. Rani SV, Ravinder C. Efficacy of yoga vasti in anovulation: A pilot study.
Ayushdhara. 2015;2(1):1.
81. Jasani S, Heller B, Juarez L, et al. e impact of yoga on anxiety in infertility
patients. Fertil Steril. 2015;104(3):e355.
82. Psaros C, Kagan L, Shifren JL, et al. Mind-body group treatment for women
coping with infertility: A pilot study. J Psychosom Obstet Gynecol. 2014;0:1-9.
Darbandi—Improving ART Outcomes ALTERNATIVE THERAPIES, [E-PUB AHEAD OF PRINT]
is article is protected by copyright. To share or copy this article, please visit copyright.com. Use ISSN#1078-6791. To subscribe, visit alternative-therapies.com
115. Lane EA, Hyde TS. Eect of maternal stress on fertility and sex ratio: A pilot
study with rats. J Abnorm Psychol. 1973;82(1):78.
116. Lynch C, Sundaram R, Maisog J, Sweeney A, Louis GB. Preconception Stress
increases the risk of infertility: Results from a couple-based prospective cohort
study—the Life Study. Hum Reproduct. 2014;29(5):1067-1075.
117. Facchinetti F, Volpe A, Matteo ML, Genazzani AR, Artini GP. An increased
vulnerability to stress is associated with a poor outcome of in vitro fertilization-
embryo transfer treatment. Fertil Steril. 1997;67(2):309-314.
118. Csemiczky G, Landgren B, Collins A. e inuence of stress and state anxiety on
the outcome of IVF treatment: Psychological and endocrinological assessment of
Swedish women entering IVF treatment. Acta Obstetricia et Gynecologica
Scandinavica. 2000;79(2):113-118.
119. Frederiksen Y, Farver-Vestergaard I, Skovgard NG, Ingerslev HJ, Zachariae R.
Ecacy of psychosocial interventions for psychological and pregnancy outcomes
in infertile women and men: A systematic review and meta-analysis. BMJ Open.
2015;5(1): e006592.
120. Mortada R, Williams T. Metabolic syndrome: Polycystic ovary syndrome. FP
Essent. 2015;435:30-42.
121. Griebling TL. Re: e relationship between health-related quality of life, obesity
and testosterone levels in older men. J Urol. 2015;194(2):18.
122. Yanase T, Tanabe M, Nomiyama T. Sex hormones and metabolic function. Nihon
Rinsho. 2015;73(4):571-575.
123. Zitzmann M. Testosterone deficit: What’s new? Deutsche Medizinische
Wochenschri. 2015;140(3):160-162.
124. Grindler NM, Santoro NF. Menopause and exercise. Menopause.
2015;22(12):1351-1358.
125. Dhikav V, Karmarkar G, Gupta R, et al. Yoga in female sexual functions. J Sex
Med. 2010;7(2 Pt 2):964-970.
126. Sengupta P. Health impacts of yoga and pranayama: A state-of-the-art review. Int
J Prev Med. 2012;3(7):444-458.
127. Kaduskar P, Suryanarayana KM. Yoga: An endocrine therapy. Indian J Endocrinol
Metab. 2015;19(3):437-438.
128. Whedon JM, Glassey D. Cerebrospinal uid stasis and its clinical signicance.
Altern er Health Med. 2009;15(3):54-60.