From 10th to 16th April, we are in World Homeopathy Awareness Week. I thought I’d do my bit to help raise awareness.

This year, the focus of WHAW is infertility. There’s no good reason to think that homeopathy can help with infertility. Or with anything else, for that matter. As Steven Novella wrote in response to an article by an advocate of alternative therapies:

We agree that homeopathy is not a drug or chemical – it’s literally nothing. Homeopaths would have you believe that complete absence of any possibility of an effect is an advantage. In fact what it means is that homeopathy cannot work. And, in fact, when studied clinically it does not work – for anything. So if homeopathy cannot work by any established laws of physics, chemistry, or biology, how do homeopaths say it works? The answer – by magic. Of course they disguise the word “magic” in a Gish Gallop of scientific-sounding gobbledigook.

Here is another comment in an article titled “homeopathy and science”:

If homeopathic remedies are effective, there is a mechanism by which they work. It is a fact that the mechanism of action by which they might work has not been established. If the remedies do work, they must do so in a manner which would appear to violate established principles of physics, chemistry and pharmacology or they must work in a manner which is yet to be discovered. As one early critic of homeopathy wrote, “Either Hahnemann is right, in which case our science and the basis of our thinking is nonsense, or he is wrong, in which case this teaching is nonsense.”

As the Skeptic’s Dictionary puts it:

the known laws of physics and chemistry would have to be completely revamped if a tonic from which nearly every molecule of the active ingredient were removed could be shown to be effective

Despite homeopathy being incompatible with the laws of physics, chemistry and biology, researchers have spent (or wasted, depending on your perspective) time, effort, and research funding on studying it. Randomised controlled trials, meta analyses, and systematic reviews (even systematic reviews of systematic reviews) have found that homeopathic remedies are no better than placebo. See, for example, Shang et al.

Let’s take a look at the available evidence relating specifically to homeopathy and infertility.

Searching for homeopathy and fertility finds just nine papers in pubmed.

Here’s a quick summary: these papers do not show that the highly diluted remedies most often used in homeopathy can help infertility. They don’t even come close. The best evidence is the single RCT that has been conducted into homeopathy for infertility. This trial was tiny and looked at an atypical homeopathic remedy (i.e. it was not a highly dilute remedy containing not a single molecule of the purported active ingredient, rather it contained a mixture of herbs).

This paper looks at personal attitudes and contact with the Norwegian health service. This paper is interesting but does not look at whether homeopathy works, it simply notes that some male partners in infertile couples have used alternative medicine such as homeopathy.

This looks a lot like an opinion piece. In fact, it’s not dissimilar to this opinion piece. I’m not sure it’s right to post this link, given that I have written above “let’s take a look at the available evidence“.

This paper claims to review three alternative therapies. It’s not clear from the abstract whether this is a systematic review or an opinion piece. Given that I can find no trials of homeopathy for infertility on pubmed that were published prior to this review, I can’t imagine what evidence the author would have been able to review.

This looks like another opinion piece. One which begins with the contentious and, frankly, rather revealing statement: “Complementary therapists take a more holistic view of inferitility treatment than do allopathic health professionals.”

Here, at last, we have a trial. It appears to be a trial of a mixture of herbs at a D5 dilution. A D5 dilution is one part per hundred thousand and, unlike the most popular (and allegedly most potent) homeopathic remedies, is likely to contain some amount of active ingredient (bizarrely, such remedies are referred to by homeopaths as ‘low potency’ and more diluted remedies containing no active ingredient are ‘higher potency’). The abstract appears to be positive, although the authors note that “there was no significant effect when viewing the whole group” and they appear to be basing their positive comments on a sub-group analysis of “women with oligomenorrhea in the Phyto Hypophyson L group compared to the placebo group”. There were only 67 participants in the entire trial, and the abstract fails to make clear how many were in each group (or subgroup). So we have a small trial with an unclear abstract and a mixture of results claimed to be significant or not significant (it is also unclear whether the authors made adjustments for the number of comparisons they made), and the therapy in question is not a typical homeopathic remedy.

Next, we have a paper that reports on a trial of individualized homeopathic therapy. This is a prospective observational pilot study that can do no more than recommend a controlled trial is conducted.

Here we have an overview of various alternative treatments. How they can give us an overview of homeopathy in infertility, I don’t know. There’s scarcely any evidence to look at. At the time this overview was published, there were only two trials on homeopathy and fertility indexed on Pubmed. Neither of which (as far as I can tell) looked at endometriosis.

This paper looks at the British Homeopathy Journal in 1985 and can therefore be safely ignored (given the chronology of the papers above).

Here, we have a paper that looks at homeopathy for infertility in a single bull. I kid you not: link.

That’s all there is. Opinion pieces, a pilot study, a case study involving a bull, and one small controlled trial. Call me demanding, but for a treatment that is incompatible with the laws of physics, chemistry and biology I’d want a bit more evidence than that before I seriously considered whether there might be some point in using homeopathy for infertility. Despite the lack of evidence, the World Homeopathy Awareness Organisation chose homeopathy for infertility to be the focus of their World Homeopathy Awareness Week.