Kitabı oku: «Zita West’s Guide to Getting Pregnant»

the way I work

Planning to get pregnant often follows other life plans – getting a longed-for job, finding a life partner, buying a first home – then comes having a baby. For some there comes a period in their lives where all the pieces of the jigsaw are in place, and the timing is right for having a baby. For others, there is an emphasis on getting everything ‘just perfect’ before ever considering having a baby.

Working with couples who are trying for a baby is multifaceted. Couples trying for a baby have many issues that are unique to them. I try and work with a couple to see their individual and unique whole picture.

Having said this, I believe there is no point in our lives when the timing is just right, and I wish I could encourage more couples not to set themselves unrealistic goals. Now I am a mother with a teenage daughter, it’s only natural that I want her to get a good university degree, find a rewarding job and a steady relationship. I was 27 when I found myself pregnant with her, and was devastated at first. I did six pregnancy tests to check, because I had not ‘planned’ on having children until my thirties. Although I had been married for a while, my husband and I had no money and were working abroad, and I thought the timing was terrible. Now, I wouldn’t have done it any other way!

Having been doing this work for the last 15 years, I found in the first few years that it was very much the woman in a partnership who would come along for the initial consultation; I would never see the partner. Nowadays I am delighted to say that I see couples together all the time – which is only as it should be, as the problem, statistically, usually has to do with women 50 per cent of the time and with men the other 50 per cent of the time.

The majority of couples don’t have a problem conceiving, but if you have bought this book, maybe getting pregnant isn’t happening for you as quickly as you would like and you are looking for some information and answers. No matter what route you take, I believe that you can take control of your own fertility – not hand it over to a doctor or fertility clinic. This is how I work with the women and men who come to see me. I don’t give them a pre-set, ‘one size fits all’ formula. Each couple is unique, and while their emotional and physical well-being is my main concern, I don’t tell them what to do. Together we work out what will work best for them. It is my hope that this book will help you do the same. I am really delighted that more and more clinics are starting to take on my work, particularly as of course not everyone can come to our clinic. My aim in this book is to help you to plan the best course of action for you, and to indicate the kind of treatments you should try to find in your own locality.

Keeping It Simple

Day after day I sit with couples who have experienced difficulties at every stage of the fertility process, from the pre-conceptual check-up to those who have battled with miscarriage or assisted conception. Each of these couples has the same goal: they want to have a baby. Some are more desperate than others, and with desperation comes a kind of vulnerability. Many couples are running down endless routes, trying every available therapy without any real focus.

Many come to me just as they are about to embark on their goal. They are still optimistic – and usually with good reason – and want reassurance about their approach to conception and what steps to take in adjusting their lifestyle, diet or activities. They prove how starting off on the right foot can make all the difference; I have seen the results, and have a clinic full of photos of smiling mothers and babies to prove it.

Others who come to see me have already pursued all sorts of ways to get pregnant, and know they are having problems. Sometimes just the process of being listened to and being asked the appropriate questions elicits that nugget of information that may be key to the outcome (which is why the questionnaire I use is so detailed).

For example, I see many, many couples who are just not having sex often enough. It’s as simple as that, but just saying ‘have more sex’ wouldn’t be helpful. Helping a couple take a really good look at their lifestyle can be a real turning-point in their whole approach to having a baby, demonstrating the need for a radical change in their priorities and for unqualified commitment. The baby is not just another ‘must do’ item to fit into their life-plan.

There are so many myths around nutrition, intimacy and sex (see Male and Female Fertility chapters). Many GPs and clinics don’t ask enough about couples’ sex lives; the usual question is ‘Are you having regular sex?’ But what is regular sex? Once every Sunday morning may be regular sex to you, but it doesn’t help if you are ovulating on a Wednesday. Also, couples who are on different schedules, do shift work, travel a lot-these are all huge factors when you are trying to conceive. There can also be psychosexual problems, and naturally many couples are embarrassed to discuss such matters, particularly if their GP or clinician is not asking the right questions, of if he is not making them feel comfortable or even worthy of his complete attention.

It Takes Two

Basic knowledge about anatomy and physiology is one area that inevitably needs to be explored. Not the nuts and bolts of what goes where, but the details of a woman’s fertility cycle, and what the implications are for ovulation and possible conception. This is why fertility awareness is so integral to the way I work. Spending a king’s ransom on ovulation-predictor tests won’t help if you think your cycle is 28 days when what is normal for you is a 35-day cycle. Many women have been on the Pill for a long time and have no idea what their normal cycle is; nevertheless they often feel embarrassed by discussions around basic biology, as they feel they ought to know all about it.

In my experience of looking after couples who are trying to get pregnant, I am convinced that the neglect of the man’s role in conception has also confounded many of their attempts to have a baby. The man is very often badly neglected when it comes to assessing a couple’s fertility. A quick, cursory look at the quality and quantity of his sperm is about all that’s done in most fertility clinics, with all the emphasis focused – often wrongly – on the woman. There may also be a notion that the whole of a man’s ego and masculinity is bound up in his sperm, making any possible criticism – or even discussion – of his effectiveness in this area an attack on his masculinity. Neglecting a man’s role in the scheme of things is not helpful. The way I work places as much importance on the man’s role in conception as the woman’s, which is why the questionnaire I supply for men is just as detailed as the one for women.

A Holistic Approach

Many couples find my approach to be very different from a consultation with their GP or a fertility clinic. The physical checks they give to patients’ reproductive organs, systems and processes are, of course, invaluable, but there is often more to it than this. I take a holistic approach, taking into account the social, emotional and lifestyle context of the couple as well as the pure mechanics of reproduction. The pre-consultation questionnaire provides me with an invaluable tool for assessing this wide range of issues, and also helps many couples to think about their lifestyle and their true aspirations.

Prior to the first consultation, couples who come to my clinic are given a detailed questionnaire, one for women and one for men. This covers:

• the main reason they are seeking a consultation

• fertility history

• contraceptive history

• sexual history

• sexual issues

• general medical history

• family history

• diet and exercise diary

• blood sugar profile

• digestion and elimination profile

• immune profile

• pollution profile

• vitamin and mineral status

• food allergy profile

• details about other hormonal-related conditions that may exist

These questionnaires are long and detailed, to provide, in conjunction with consultation, a full profile on which decisions about the way a couple can choose to proceed can be based.

The questionnaire helps pinpoint areas that may be affecting fertility: factors to do with nutrition and exercise are often highlighted. These may be associated with emotional or lifestyle issues. In this way I try to help couples focus on their situation, so that together we can work out a plan of action. After the initial assessment, we consider what tests, treatments or therapies might be necessary along with the steps a couple need to take for themselves to make conception more possible.

For example, a couple may use cocaine at weekends to relax and chill out. That is their choice, and it is essential that they do relax, but the effects are very serious and if they want to conceive a baby they must stop. I try and keep things very simple, with explanations – as you will see in this book – about why change may be necessary. In this way I encourage couples to take responsibility for their own fertility.

It’s self-evident that, if you want to improve your likelihood of achieving a successful pregnancy, you have to be willing to make changes. There is often an instinctive reaction against change, but, in truth, the necessary changes are likely to be in areas of your life that you recognize are causing you stress and difficulty. Getting things into perspective for pregnancy is likely to result in a much more balanced, well-managed and satisfactory lifestyle all round – but you need support, advice and encouragement to make this happen.

I see many couples who have already taken steps for themselves along these lines, but this often takes the form of a random blitz of nutritional supplements, complementary therapies, weight-loss regimes, high-protein diets, etc. undertaken without any real knowledge of how these measures will affect their ability to get pregnant. Inevitably, some of these efforts can be unhelpful or even counter-productive.

This problem is not helped by the fragmented nature of available advice. Medical specialists, including obstetricians and gynaecologists, may be engrossed in the mechanics of conception but have little awareness of the patient’s emotional or personal situation. Complementary practitioners may have a more holistic view, but are unlikely to be fertility specialists with the appropriate technical knowledge. And nothing in the plethora of highly focused and specialist diets on the shelves of your local bookshop is likely to have been devised with the vital nutritional needs and sensitivities of pregnancy in mind.

Crucial Questions

One way I help couples to understand the need for taking a close look at their lives and finding a way to make the changes necessary to achieve more balance is by asking them to sit down and write out how much time they spend on each area of their lives. You might find this helpful, too, and may want to take a moment to do this for yourself.

In my first session with each couple I always ask a crucial question: How far are you prepared to go to have a baby? Couples just starting out do not realize how important this question is. When you first start trying, you’re probably only looking ahead six months or so, and are still very optimistic. The hard thing is that as time goes on there are many things you may have to negotiate: IVF, egg donation, adoption, for example. Where you are on the road now, and the effort you’ve already spent getting here, will make a difference to the outcome and how far you are prepared to go. Just as you have to be prepared to make changes at the outset, you must also be ready to alter your course as you proceed, as there will be obstacles to encounter and overcome with every success and failure.

This initial, important question makes couples think realistically, often for the first time, about what the quest for a baby might really mean. Sometimes there is a difference of opinion, which can come as a surprise – and is important to discuss. Without agreement on how far a couple want to go to achieve a pregnancy, issues arising from any difference of opinion between partners can lead to tension later on.

There is also a need for flexibility. Minds can be changed, and having opened up the area for discussion it’s important for couples to continue to be able to do so.

For those who have reason to suspect they have a problem, there is often little idea of the maze into which the first step to their doctor can take them. Often, in particular if the woman is over 35 and a couple has been trying for a year, there is a tendency to fast-track them into assisted conception – without properly assessing the fertility of either partner.

There is so much that needs to be looked at before assisted conception is even considered, and unless there is significant reason to know that natural conception will be unlikely, this needs to be done before catapulting a couple into assisted conception. And again, so often too much focus is put on the woman, when the man very often has the problem. I have seen many valuable months of fertility lost in this way. That said, a lot of couples I see do need assisted conception, but they also need holistic care and support to help ensure that they are physically and emotionally prepared for the process.

Your individual needs

At the end of the first consultation, I draw up a relevant action plan for a couple. Depending on what the consultation has highlighted, this can vary – but it is always specific to the couple. It may include referral for further tests from a gynaecologist and a specialist in male fertility. It is entirely up to a couple how they wish to proceed, but the majority can see that taking a holistic approach is beneficial. Sometimes the action plan is very specific – for example if there is a need to boost the body in preparation for IVF – and sometimes it’s more general, where there is a need for fertility awareness and lifestyle changes to improve the chance of conceiving.

I can’t stress strongly enough that every couple is a unique combination of needs – both physical and emotional. The way I work is to address that individuality. That said, experience has shown me that when couples have the benefit of a holistic approach – which may encompass medical treatment, nutritional supplementation, relaxation and distressing techniques, detoxifying, acupuncture and massage – the personal outcome for the couple is always positive.

Today’s Choices

The difficult choices couples are faced with today are new ones. Years ago, you either had a baby or you didn’t. Now the length of time you try can go on almost indefinitely – you start off trying naturally, then perhaps try IVF or egg donation or surrogacy.

Very often I see couples trying for years when certain problems, procedures or decisions could have been reached or ironed out earlier. All this has to be done in the context of a good understanding of a couple’s fertility, shared between them and their clinic. It really is a team effort, and one in which the couple are equal partners with the rest of the team.

First Impressions

The process of diagnosis starts the moment a couple walk through my door. I can tell a great deal from the way people walk, their handshake, their posture while seated. For instance, I can tell immediately if a man is inclined to think it is not ‘his problem’: If he walks in with his head down and arms folded, and avoids eye contact.

As a qualified and practising Five Element Acupuncturist, I use my classical Five Element training to begin assessing each person’s constitutional type (see page 223). I look at a person’s colouring – not just eye and hair colour, but the texture and hue of his or her skin tone – and I start to build up a picture of an individual’s emotional and physical strengths and weaknesses, and in which organs any weakness may be lying. I look at what the general emotion is – worry, anger, grief, fear. Sometimes it’s very positive and joyful. I need to understand each person’s individual circumstances, and how they are affecting him or her – individually and as part of a couple. I also look for the dynamic between the couple, how vital their relationship is, how close they are, and how they communicate – verbally and non-verbally.

Obviously I take into account that this is an incredibly personal and intimate experience they are sharing with me, which can make many people feel vulnerable. Often they can react defensively, sometimes aggressively, to mask their anxiety. Couples often want me to provide answers, when what I do – and what I hope this book will do for you – is help them find the answers in themselves. Only a full understanding of what you are facing will make it possible for you to make choices, effect any necessary changes and feel positively involved with the process.

I believe that a positive attitude affects the mind and body hugely. The couples I see fall into many categories: those who are starting to try, couples just about to embark on IVF, couples who have had multiple failures, women who have miscarried, couples considering moving on to egg donation, sperm donation, surrogacy or adoption. Help is available to you at every stage of this journey.

If You Are Just Starting Out

Couples in this place tend to be at the end of their twenties or in their early thirties. In many cases the woman has come off the Pill and has no idea what her normal fertility cycle is. It is worth saying here that I don’t hold with the belief that a woman shouldn’t try to conceive when she first comes off the Pill. The research shows that a woman actually has much more chance of conceiving when she first comes off the Pill. Very often, however, women rely on ovulation kits since they don’t yet know how to work out their most fertile time. Ovulation kits are fine, but need to be used in conjunction with a knowledge of your cycle. A good biology lesson, as given in Part 1 of this book, removes the element of panic and can put you on the right track. Very often all you need is a fertility awareness session to get you to understand your individual cycle.

At our clinic we also make an assessment of how long a couple have been trying based on age and how often they are having sex, and also give them guidelines for further medical tests they may need alongside the treatments we suggest. At this stage, as far as we know there is no reason why the couple should not get pregnant. Detailed questions can help to pinpoint any lifestyle or nutritional changes that need to be made to enhance fertility, as well as integrating other therapies that might be helpful such as nutrition, acupuncture or hypnotherapy. It might be advantageous to lose some weight, to get your cycle regular using acupuncture, or to assess any emotional issues. Often these quite simple measures make all the difference, and I have seen case after case of straightforward conception in couples who have been trying for some years, and failing, just because of some basic misconceptions that can be readily corrected.

Men are just as important, even in these apparently straightforward cases. If a couple have visited their GP, the man has often had a semen analysis, but seldom understands the implications of the results – not least if they are apparently ‘normal’. Not only that, but often semen analyses are done, not in a laboratory, but in a fertility unit and just given a quick check. This is not adequate. A semen analysis should be done under laboratory conditions, assessed by experts and subject to a full analysis, which may include DNA fragmentation (see page 287) and prostatic massage (see page 277) as part of a full sexual health screen. Often a sub-clinical infection with no discernible symptoms is detected that requires antibiotic treatment. Only when there has been an adequate analysis, with the proper explanations, is the man likely to take the steps necessary to improve his sperm quality.

Individual fertility cycles

So many couples just don’t have sex often enough to get pregnant! However, I don’t advocate sex just for the sake of getting pregnant; it should be part of every couple’s normal, loving relationship, a way of sharing intimacy and having fun together. That way, sex doesn’t become an issue or a chore – where the man thinks the woman is only interested in sex as a means to an end, and not as an expression of her feelings for him. Women, in turn, can become fixated on their fertile time, and only want sex at this time. Prior to this, a couple’s rate of sex may have dropped to once week, or a couple of times a month, which may suit them fine – but it’s probably not happening enough for a pregnancy to result!

Sex can steadily become mechanical for so many couples; it is so hard for it not to. Many men suffer from ‘performance anxiety’ around sex if it seems that their partners are only interested in having sex around the time of ovulation. This puts a huge pressure on them. I have heard stories of women emailing their husbands at work, driving to their offices and demanding sex, which inevitably ends in a row and no sex.

If you have been trying for a while, a few basic questions:

• Are you sure you have been having sex at the right time and often enough?

• Are you only interested in sex at the right time of the month and not at any other time?

• Are you still making an effort with your relationship?

Plan ahead; make some of the changes specified in this book before moving on.

If a couple can keep their lines of sexual communication open, and enjoy this aspect of their relationship for its own sake, and not just as a means to pregnancy, then the process will be less stressful all round.

Contrary to popular belief, having sex often does NOT weaken sperm. Research has shown that the more a couple have sex, the more fertility is improved. Here are the figures for women aged 20–30:

A plan of action

I like couples to leave my clinic with a sense that they have a plan of action, specific to them, and to feel optimistic about it. Together we formulate a four- to six-month action plan, so there is room for a relaxed approach, with the view that the action plan will be reviewed after that. This serves two purposes: it provides both a positive structure and a timescale that takes the pressure off in the short term. This allows a couple to relax, knowing that they have positive steps to take with the opportunity for reviewing the situation in six months’ time.

I find that with people in this situation, because the couple have every reason to believe they can get pregnant, they usually do!

If You Have Been Trying for a While

If I could say to couples who have been trying for some time that, by such and such a date, they would be pregnant – they would skip out of my office in delight. But unfortunately there just are no guarantees, and the apparently ‘unexplained’ causes of infertility are of course the hardest to accept. I often hear women say how difficult they find it when all around them their friends are getting pregnant and having babies. They describe the news of a friend’s pregnancy with phrases like ‘a knife going through my heart’ and find it really difficult to express pleasure or smile at other women’s good fortune. Social gatherings become a nightmare, with others asking tactless questions such as, ‘When are you starting a family, then?’ Nor is it helpful to hear advice such as ‘Just relax’ or ‘Let nature take its course.’

Comments like this may be well meaning, but can result in anger, envy and jealousy, which can in turn lead to feelings of self-hatred. And the stress of it all can lead to quite severe anxiety and depression. Men can be equally affected by these feelings. It’s hard on both partners, but women in particular can become obsessed with their monthly cycle, focusing every aspect of their lives on getting pregnant.

Telling a woman not to get obsessive isn’t helpful. What is helpful is providing a structure for dealing with the reasons behind the obsession, and finding tactics for managing the feelings of frustration, anxiety and sadness that arise.

If couples have been trying for anything from six to 18 months, a lot of emotional and relationship factors start to come into play. For some couples, they find that this shared aim brings them closer together, but often couples can start to feel demoralized and pretty hopeless.

The knock-on effect of this can be detrimental to a couple’s sex life. Sex is no longer about intimacy, it has become associated with ‘getting pregnant’. Yet, when asked, it can still turn out that the couple are not having sex anything near as often enough to get pregnant. Sex becomes mechanical, with all activity focused on when a woman thinks she’s ovulating, so her partner becomes fed up, or afraid that he might not be up to the job when necessary.

This can be further aggravated if a problem has been identified in the man. Coming to see a fertility specialist may be the first time this is openly discussed, and for some men a poor sperm test result makes them feel like a complete failure. The great thing is that there is so much that a man can do to improve the quality and quantity of his sperm production. I would also like to reassure you that, even with a less-than-optimum sperm result, if everything else is going well, conception is still possible. This is important because some couples give up trying at this stage, assuming there is no point. I always encourage couples to keep trying. Many couples go on to conceive, even with a poor sperm result. Nevertheless I do understand that in cases like this it’s very hard to be positive.

Sometimes couples become so involved in each other’s biological details that all the mystique goes out of the relationship. I saw one couple where the man had taken to examining the cervical secretions in his wife’s pants! Another knew every detail of his partner’s periods, right down to the consistency of the flow and the amount of blood clots. No wonder some couples’ sex lives take a turn for the worse!

A couple’s sex life is very important, whatever the circumstances. It is one of the best forms of physical and sensual communication, and can be enormously restorative to a relationship under strain. For those women obsessing about ovulation and insisting on sex there and then, I tell them to stop, throw away the ovulation kits and temperature charts, take a break and put some energy into the relationship, for its own sake. Get romantic, be seductive and take time out together for a walk, a nice meal, a massage, anything shared that can lead to sex within the context of a loving relationship – the same relationship into which you want to bring a baby. The two are not separate, and are paramount to keeping a sense of balance – which is what pregnancy is all about. Creating a family takes energy, a sense of humour, time and love. The other thing about having a good, regular sex life is that it creates a natural high, releasing mood-enhancing endorphins and the bonding hormone oxytocin. I encourage couples to use aromatherapy oils, for massage or in candles – essential oils such as jasmine and ylang ylang stimulate the secretion of endorphins. We all need a little help when times are stressful, so utilize what’s available to set the scene and enhance the mood.

The options available

Ultimately you can’t control your fertility or when you will get pregnant. But I tell couples that they can control the options available to them, and the path they take to get there. It takes a degree of patience to seek out opinions you trust, rather than flit from one fertility plan to another. You need to do the research and then take a step back. Learning to keep a perspective on the situation takes practice – though, naturally enough, many couples find this almost impossible. I find that there is sometimes a tendency for partners to blame one another – even if this is unspoken. This is sometimes not even apparent to the partners themselves, but if I am aware of it I can help diffuse any tension by explaining things and providing a structure for the steps that can be taken.

Another problem can arise when the woman starts to feel she is the one making all the effort. I often find that women drive everything when it comes to trying for a baby: they buy the books, the vitamins, etc., and expect their partner to follow suit. She may try forcing every available vitamin or dietary supplement down her partner’s throat, plus enforcing changes in diet and lifestyle, etc. Her partner, meanwhile, may have come to his own conclusions, and very often will only make changes if he has been convinced there is really a problem. Some women make their partners give up absolutely everything, and get fixated about helping their partners make healthy sperm within a precise, limited timeframe. Then if the man lapses, say has a few drinks, the woman gets angry and feels they have to start all over again.

So, for you women: Don’t nag. Put time and effort into your relationship and accept that men see it from a different perspective. Be kind to one another. Women can feel extremely angry if they have given up alcohol, or smoking, and their partner hasn’t or won’t. It feels very unfair, and as if they are making all the sacrifices. Men, for their part, can start to feel very guilty. Obviously, none of this is conducive to success!

For women, with the highs and lows of anticipation during the month, and disappointment if a period arrives, it can be all too easy to get into the blame cycle while forgetting that their partner, too, may be living in dread of a period arriving. Some men start to dread going home, and to feel hopeless about what they can do. Blame can arise from the feeling that ‘If only I had done this or hadn’t done that’ or ‘If only he had drunk less or not been on that business trip when I was ovulating …’ The permutations are endless.

I know it can be hard, but please try not to start the blame game. Instead, it’s important to be kind to each other and remember to share those things that brought you together in the first place.

Keep communicating

It is essential to keep talking. Often things come up in the safety of the consulting room that have been bothering one or other partner. As I’ve said earlier, trying to get pregnant – especially if it’s not happening as expected – is inevitably emotional, and ignoring this can create problems. So I look for opportunities to encourage couples to share their feelings, ideas, and even their resentments! It’s much better that these are aired, addressed and resolved than left to fester. I can provide the space for this.

I often recommend couples-counselling for those for whom the situation has become too difficult to deal with. It is far too easy to become estranged through the process of trying to get pregnant. In some cases, I have found that men seem to accept the situation more readily than women. The man may be more relaxed about getting on with life, while his partner may interpret this as a lack of commitment, especially if she is researching on the Internet, seeking out opinions and information, and wanting to focus on getting pregnant almost to the exclusion of everything else. Understandably, many men get fed up, and this can exacerbate the situation still further.

Very often, a few sessions of skilled couples-counselling is all that is needed to bridge the gap, allowing partners to express their feelings and their views, relieve tensions, reduce blame and establish a united platform from which to proceed.

Men need to express how they are feeling, and in the right setting it is amazing what comes out between a couple, especially when a man feels safe about being able to express what he is truly feeling about the situation.

Case History

Linda was 38 and had been trying to get pregnant for two years. She was tearful, angry and upset about her situation. She was on the Internet for up to four hours a day, plus all day at weekends. In the consultation with me, when I asked how it was affecting their relationship, her husband Paul said he had started to dread coming home – Linda would have inevitably found another treatment to pursue, another pill he was going to have to take. He felt completely unable to get through to her; any suggestion he made would get shot down. He felt that Linda was in a total spin; he felt depressed, isolated and fed up of constantly trying to please her. He felt inadequate, and that Linda resented this. His deep, deep concern, which he only felt able to voice in consultation, was that as much as he loved her, he felt that the drive to achieve a pregnancy was becoming destructive for the relationship. Paul had tried to understand Linda’s burning desire to have a baby, but he wanted their old life back together where when he came home they had a drink, a chat, a laugh, not him spending time on his own while she was on the Internet.

Linda was able to express that, on her part, she felt panicky that she was running out of time. She felt very stressed and was waking at 4 in the morning and grieving about the child she might never have.

The plan we came up with was to set an absolute limit on Linda’s Internet searches and work on getting her internal environment back into balance by doing some yoga and meditation. We did a detox with her to help her lose some weight and we changed the IVF clinic that she was currently attending. Linda got back in contact with me later, to say that our consultation had really been a turning-point. She had not really been aware of the impact her pursuit to have a baby was having on her relationship. Her interpretation of Paul’s behaviour was that he wasn’t interest ed in any suggestion she made about treatments, and she felt that he was blocking her at every point. After our consultation she felt she really understood where he was coming from and felt much calmer as a result.

Women in their late thirties/early forties

This age group accounts for a large percentage of the women I see. Often they are career women who have got used to high degrees of control over their environment, and are in uncharted territory when they can’t control their own fertility.

Although some come just for a pre-conception ‘check’, many have been trying for a while. Some have been down the IVF route unsuccessfully; often there is a history of ‘unexplained’ infertility or recurrent miscarriage, or some anxiety about their fertility cycle. Some couples are taking ovulation-stimulating drugs such as Clomid, or doing intrauterine insemination, and want to improve the chances of conception by supporting and preparing their bodies. Some have been recommended for egg donation without having had a full, clinical work-up or assessment. Very often they have been to only one clinic and were told they have had a poor response and no eggs. Going to another clinic might have meant a better result. In short, there are many factors to consider.

If you have been trying for a while:

• Have you had a diagnosis and have you both been tested?

• How is it affecting you emotionally?

• Are you nagging or resentful of each other?

• Is your relationship starting to suffer?

• Are you losing the balance in your life?

• Are you giving up everything?

• Has your sex life been affected?

• Are you ready to move on to assisted fertility?

The starting-place for these couples has to be an in-depth analysis and discussion with the couple about where they currently feel themselves to be, covering any anxieties or misunderstandings. Without this, there isn’t an adequate baseline from which to work. Some couples, especially those who have been round the infertility block a few times, feel that this is unnecessary, as they have already had many medical interviews and tests. In my experience, however, many clinics are not thorough enough when it comes to identifying what the problem might be. Often I find that couples have not even been asked how frequently they have sex! All the medical tests in the world will make no difference if a couple are having sex only twice a month. If the length of a woman’s cycle hasn’t been worked out properly, any chance of getting the timing of ovulation right is unlikely. As I mentioned earlier, a lot of couples get fast-tracked into assisted conception without a proper assessment. I am sure that this is key to the success we have in helping couples achieve happy, healthy pregnancies.

My Programme

The programme I have devised to help couples always works alongside Western medicine while incorporating complementary therapies and Traditional Chinese Medicine. Looking at the whole picture enables me to come up with an appropriate plan. The main message I try to get across is keep it simple. So many couples are running down too many routes with no focus. The initial consultation enables me to look at lifestyle factors and the range of treatments on offer – fertility awareness, nutrition, detox, acupuncture, hypnotherapy, abdominal massage, deep breathing, manual lymphatic drainage (MLD) and counselling. There’s more about all of these later in the book. Depending on what suits the couple, usually there are two or three treatments undertaken over a period of four to six weeks, with a review every three months.

The most important thing we offer is support and advice. I believe you can get through anything if you feel supported.

Right from the start, when I first see a couple I stress that they must be flexible in their thinking and not become obsessive. I advise against information overload: endlessly trawling the Internet investigating other people’s experiences or solutions may not be relevant, and can even be unhelpful. I recommend trying to keep things in perspective – although many couples feel they have had to give up a lot in order to achieve conception, there is still room to enjoy life as a couple. This should never be forgotten.

I also advise couples to keep in mind that their difficulties with conception, if they arise, are relatively temporary. Actually starting a family may seem like a long haul, but in the greater scheme of things this will represent only a short period in your relationship – it’s important to keep this in mind. Long after your fertility problems are resolved, your relationship will still be there – so it’s worth nurturing and making time for. A good relationship will also sustain you when things get difficult.

part one the basics

understanding female fertility

This may sound strange, but many women today have no idea what a normal menstrual cycle is – many of them have been on the Pill for 15 years or more, so this is hardly surprising. Women often feel embarrassed that they don’t know everything about their fertility, and this lack of basic knowledge isn’t helped by the numerous myths out there about what they should and should not be doing in order to conceive successfully!

I am very fortunate to work alongside Jane Knight, who has done so much to raise awareness for women in this area of fertility. I encourage all women to attend a fertility awareness session, because even if you understand the basics, your cycle is unique to you. At our clinic, the aim is to make it easy to understand when and how ovulation occurs, without getting obsessed about it – which months of ‘charting’ can do to you. As Jane says:

An understanding of fertility – fertility awareness – is an important life skill and is every woman’s right. My work involves providing fertility – awareness sessions for both men and women. During a consultation I explain how a woman can identify the fertile ‘window’ during her menstrual cycle. I also help men to understand their own reproductive potential. Couples who understand the key concepts of fertility are in a much better position to understand how fertility declines with age and how factors may damage, reduce, enhance or optimize fertility.

Female Reproductive Organs

The primary indicator of fertility for a woman is her cervical secretions – because this relates so closely to oestrogen levels and ovulation – so we encourage women to focus on this, alongside ovulation-predictor kits or temperature charting, because it is just as important as good nutrition, relaxation and you and your partner’s health in your efforts to conceive.

A Woman’s Fertility

At birth, every baby girl is born with a full complement of immature eggs in her ovaries – around 2 million, although only between 300–400 will mature during her lifetime – which sounds as if the whole process should be pretty straightforward. But it is the maturation, release (at ovulation), fertilization and implantation of one of these eggs that results in pregnancy. No new egg cells are produced after you are born, so it’s worth thinking about what those egg cells need in order to mature successfully and produce an egg capable of being fertilized. A woman’s eggs are her most precious reserve, and need looking after.

Up until puberty, the egg cells lie dormant in the ovaries, waiting for a shift in the hormonal patterns of a girl’s body to ‘switch on’ her fertility. At what age this starts is largely influenced by genetics – if your mother started her periods early, then it’s likely you will have done, too. Starting menstrual periods is the marker of the beginning of a woman’s fertility, and is known as menarche.

In Western countries, the average age of menarche is between 12 and 14, but can be as early as 10 and as late as 16. All are completely normal. Ovulation can occur before the first period, but a girl’s early menstrual cycles can be erratic, and often without ovulation. Over the next few months, or sometimes longer, the pattern of cycles settles down to what is normal for that girl, as regular ovulation establishes itself.

If you think back to GCSE biology, you will remember the term ‘secondary sex characteristics’, which are the outward, visible signs of puberty and the onset of a woman’s fertile life. In a woman, increasing levels of FSH (follicle – stimulating hormone) and LH (luteinizing hormone) and the beginnings of oestrogen and progesterone production lead to the development of breast tissue, pubic and underarm hair, and a different distribution of body fat, all of which are designed to create a body capable of nourishing a growing baby, both before and after birth. These changes begin before the first menstrual period occurs, and can happen slowly over a couple of years, or relatively quickly. Again, this depends in part on genetics, and a mother’s experience of puberty will give some insight into what her daughter might expect.

Remember how you were warned in your sex education classes at school that sex inevitably led to pregnancy? Remember, too, all the efforts you took in the past not to get pregnant, not to mention all those false alarms? So it may feel a bit of a mystery as to why getting pregnant is now so elusive. This chapter is designed to help you understand your own fertility cycle, and how to work with it to achieve pregnancy.

Understanding Your Own Fertility

With so much misinformation about how, where, why and when, it’s always best to start with the basics. Once you are informed and familiar with your own body’s fertility indicators, you will feel more confident about managing to get pregnant.

And there is a lot of confusion out there! According to research carried out by Unipath (who produce Persona – the personal hormone-monitoring system), while 92 per cent of women accurately described ovulation, a third of them thought it occurred during a period! Out of six European countries covered in the research, the UK women surveyed had the worst knowledge of when their fertile days were: 21 per cent thought they were fertile for more than 21 days a month. And while 72 per cent of women knew that the fertile time was mid – cycle, one – third thought it possible to get pregnant at any time during their cycle.

It is essential to remember that every woman is different. Although the basic principles remain the same, what is true of your friend is unlikely to be true of you – from your cycle length to how your body indicates its fertility, to how you react physically and emotionally. This is why it is so useful to understand your own fertility.

Most women seldom think about their fertility, or menstrual cycles, but most women – when they do stop and think about it – are aware of cyclical changes to their skin, appetite, mood – all of which are indicators of their individual cycle.

The Menstrual Cycle

Most of us have learned to live with certain symptoms in our cycle, but it’s also important to remember that our fertility cycle is controlled by the pituitary gland, located deep within the brain and influenced by all activity there. Hormones, which are chemical messengers, are primarily controlled by the brain’s activity – it’s like a constant conversation that occurs between the hormones of the brain and the ovaries, sending messages back and forth (see page 8).

The pituitary gland is often referred to as the ‘master gland’ of the body, because it secretes at least nine major hormones designed to stimulate the ovaries, adrenals and thyroid, amongst others (including the testes in men), which all have a role to play in fertility. When we are producing the right amount and blend of hormones, we feel fine. When there is an imbalance, these chemical messengers can make us feel pretty lousy. We talk about having ‘hormones from hell’ when we, as women, feel imbalanced at certain times of the month. PMS is a clear indicator that hormones are out of balance. The hormones are doing their job, and the body is reacting as it should, but because the balance is out, then the effects are negative.

Each of the fertility signals that you observe when you begin to chart your own fertility corresponds to a hormonal process and the presence of hormones in your bloodstream. The hormones oestrogen and progesterone are particularly important, and both affect the body in a number of ways that are easy to note.

The menstrual cycle is a constantly changing hormonal environment, but oestrogen influences the first part of the cycle – up to ovulation – and then progesterone exerts its influence. Some women would probably prefer not to be so influenced by the ups and downs that a cycle brings, but these changing hormonal events will help you to know when your chances of conceiving are best.

Few women have a 28-day cycle, but we can say that the average length is around 28 days. For some women their normal cycle can be short (around 25 days) or long (around 35 days). Provided there is a regular pattern, this is normal for you, and you can be relatively sure that ovulation is occurring. It is when cycle length fluctuates from 25 days one month to 30 another, or 42 another, that ovulation is likely to be haphazard, or even non – existent during some cycles.

The fertility, or menstrual, cycle starts on the first day of menstruation or a ‘period’. Sometimes on medical forms women are asked to give the date of their ‘last menstrual period’ or ‘LMP’ – this would be the date on which you started to bleed.

Oestrogens are the dominant hormones during the first part of the cycle – the time before ovulation, also known as the follicular phase (see page 8) – while progesterone takes over during what is known as the luteal phase (see page 31) and also during pregnancy, should conception occur. Your cervical secretions are linked to oestrogen secretion, and can give a good indication of the availability of oestrogen.

Menstruation, or a ‘period’, is the bleeding with which every woman is familiar. It heralds the end of one cycle and the beginning of another. The hormones responsible for the activity of ovulation and womb – preparation effectively ‘take a break’ at this stage, in order to activate the next cycle. Many women are quite susceptible to the effects of this hormonal switch.

Women often ask me what’s ‘normal’ for a period: how long it should last and how much blood should be lost. The average period lasts for between 3 and 5 days, and the total blood loss is between 30 and 80 ml (6 to 16 teaspoons). However, this is only the average; each woman’s experience of her period will be unique to her. Some women seem to have a lot of abdominal cramping (caused by contractions in the womb) when they have a period, or back pain, while others have none. For some, the bleeding happens in a flood at the beginning, while for others it’s a slow, continuous bleed.

Hormones and the Phases of Your Cycle

A question I get asked all the time is, ‘How do I know if my hormones are balanced?’ Hormone balance is such an important part of a woman’s fertility, and so easily influenced by poor diet, stress, lack of sleep and environmental factors, that assessing a woman’s hormone levels – and addressing any rebalancing that needs to be done to help her achieve optimum fertility – are important aspects of the work I do. And although there are sometimes quite clear indicators of hormone imbalance, often a bit of detective work is needed.

The one major thing that will help balance hormones is a well-balanced lifestyle – which seems to be increasingly difficult for many of us to achieve these days.

A well – balanced lifestyle is important for hormonal balance because all hormone activity is an interplay between different hormones, which are the body’s chemical messengers: for example, secretion of fertility hormones will be affected if the body is producing too many stress hormones. Understanding the inter – relationship between all the hormones in the body is the first step towards achieving a positive balance.

Like all hormones, oestrogen and progesterone operate as chemical messengers, in this case controlling the length of a cycle, and ovulation, while also having an impact on other body systems. When in perfect balance, their effects are hardly noticeable, but most women have a degree of hormonal imbalance within the normal range, which makes these hormonal fluctuations more noticeable. Although the effects can vary – not just between women but also from month to month in the same woman – knowing about them and recognizing your own emotional and physical response to them are helpful when you are trying to understand your own cycle.

The Follicular (pre – ovulation) Phase

On Day 1 of the cycle, which is the first day of a period, the brain releases GnRH (gonadotrophin – releasing hormone) from the hypothalamus, which in turn tells the pituitary gland to release FSH (follicle – stimulating hormone). The levels of FSH in the bloodstream build over the next couple of weeks, stimulating follicles in the ovaries to start growing.

The follicle grows and starts to secrete oestrogen from the granulosa cells. It is the rising level of oestrogen that inhibits the secretion of FSH, while also causing ovulation. At this point, LH (luteinizing hormone) is secreted.

This first part of the cycle, the follicular or pre – ovulation phase, can vary in length. This explains why some women have longer cycles than others, and also why their cycles can sometimes be irregular.

The interplay of hormones throughout a woman’s fertile life forms the basis of her cycle. Not only do these hormones have a crucial role to play in fertility, they also have other effects on the body, which can be extremely useful when trying to define and assess your own levels of fertility. For example, progesterone has an effect on body temperature (as it’s designed to keep a fertilized egg warm in the incubator of the womb), while oestrogen has an effect on cervical secretions, which are so essential to helping achieve pregnancy.

Looking at oestrogen and progesterone individually, and also at how the subtle interplay between them and other hormones affects fertility, is the first step to understanding what is necessary for a pregnancy to happen.

Oestrogen

During the first part of the menstrual cycle, when the levels of oestrogen are rising, endorphins are also released, which are your body’s natural painkillers and ‘feel – good’ hormones, elevating mood. Many women say they feel very energized and creative during this phase.

While oestrogen has an effect on the internal reproductive organs, making the womb receptive to a fertilized egg, bringing the top of the Fallopian tube closer to the ovary and increasing its contractions to help the egg move down towards the womb, it also has other effects.

There are highly specialized cells in the cervix, for example, which produce cervical secretions, and their increased activity is directly caused by increased oestrogen. (The importance of these secretions and their role in conception is crucial, and is explained in more detail on page 18.)

Oestrogen also has an effect on libido, your sex drive. As oestrogen levels rise, so does libido – nature’s way of ensuring that sexual intercourse is welcomed close to ovulation. And when an animal is in oestrus, i.e. fertile, we refer to them as being ‘on heat’. This recognition of a link between oestrogen and heat comes partly from the effect of oestrogen on the blood vessels, causing a degree of dilation and increasing the flow of blood and its heat.

A good blood supply helps the organs of the body function properly, as nutrients are brought to cells and waste products removed. The transportation of oxygen in the blood is also important to developing cells, not least the maturing egg in the ovary. This blood supply also keeps tissues plump and supple, whether in the vagina or the tissues of the face. It is this effect that is lost after the menopause, when the lack of oestrogen causes the thinning of the skin and other tissues.

A good blood flow is beneficial to other organs, too, including the brain. Some women’s experience of increased productivity and creativity around ovulation may be explained as their own particular response to oestrogen. On the other hand, for some women this same effect provokes feelings of irritation. It just depends on how your body reacts to and copes with this powerful hormone.

Oestrogen is also essential for maintaining strong bones, as it provides the chemical ‘bridge’ that allows calcium from the diet to be used by the bones, keeping them dense and reducing porosity.