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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.
