Fertility Road Magazine 46 - September/October 2018

The latest issue of Fertility Road Magzine brings you our latest Fertility Journeys update, a closer look at stress and infertility, natural approaches to endometriosis and a how your weight can affect your chances of getting pregnant plus lots, lots more.

The latest issue of Fertility Road Magzine brings you our latest Fertility Journeys update, a closer look at stress and infertility, natural approaches to endometriosis and a how your weight can affect your chances of getting pregnant plus lots, lots more.


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<strong>Fertility</strong><strong>Road</strong><br />


TO SHIFT<br />


Learn how to balance<br />

your positive energy.<br />

SEPTEMBER/OCTOBER <strong>2018</strong><br />





The emotional<br />

strain of trying<br />

to get pregnant<br />


RATES<br />


Is it a fertility<br />

insurance policy?<br />

The recommendations for<br />

reducing your stress levels<br />

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fertilityroad.com | 03

<strong>Fertility</strong><strong>Road</strong> ISSUE <strong>46</strong> fertilityroad fertilityroadmag<br />

Contents<br />

LEGAL<br />


Is it a fertility insurance policy?<br />

BODY<br />

MIND<br />


The infertility roller coaster can<br />

be a stressful journey.<br />

26 One secret you need<br />

to know to shift your<br />

fertility energy<br />

HINT... It takes more than<br />

positive thoughts.<br />



38 IVF SPAIN<br />

Claire & David discuss their<br />

recent visit and embryo transfer.<br />



Meet Kirstie & Christopher<br />

who are preparing for their visit<br />

to Greece.<br />



Heather & Brandon are starting<br />

their their third trimester of<br />

Heather’s pregnancy.<br />


360<br />


Understand success rates and<br />

help keep your surrogacy<br />

journey on track.<br />


The struggle to start a family<br />

can put a strain on the best of<br />

relationships.<br />

10 FOOD PORN<br />

Do men need to be aware of what<br />

they are eating?<br />



With endometriosis affecting 10-<br />

15% of women can a more natural<br />

approach help?<br />



Why reducing stress levels can<br />

have a positive outcome for you.<br />


MEN ONLY<br />



Some helpful advice for men on<br />

supporting their partner.<br />


Being over or underweight can<br />

affect your chances of getting<br />

pregnant.<br />

04 | fertilityroad.com<br />

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Contributors<br />

The people who made this issue happen…<br />

Michelle Mulliss BSc (Hons)<br />

MBAcC<br />

Michelle specialises in natural and<br />

assisted fertility and provides a unique<br />

approach of integrated medicine.<br />

Liz Bottrill<br />

Liz Bottrill is a Partner in the Family<br />

Law Team at Laytons Solicitors with<br />

over 25 years’ experience in the<br />

field. She has a particular interest<br />

and expertise in the law relating to<br />

children and fertility.<br />

Cassie Everett<br />

Cassie has practised Homeopathy<br />

for the last 11 years, first in London<br />

and now in Bristol.<br />

Bryan Woodward<br />

Bryan is co-editor of the book<br />

‘Male Infertility: Sperm Diagnosis,<br />

Management and Delivery’ which<br />

covers all aspect of male fertility for<br />

professionals and patients.<br />

Colette Assor<br />

Colette is a fertility acupuncturist<br />

with 20 years clinical experience.<br />

A’ndrea Reiter<br />

A’ndrea is a Reiki Master and<br />

Holistic <strong>Fertility</strong> Specialist.<br />

Sarah Banks<br />

Sarah is a <strong>Fertility</strong> coach and<br />

mentor who works with fertility<br />

professionals to enhance their<br />

patient experience and success rates.<br />

Dr Jodie Peacock ND<br />

Jodie is a Naturopathic doctor<br />

in Canada who runs the online<br />

program, Enhance <strong>Fertility</strong><br />

Bootcamp.<br />

Craig Reisser<br />

Craig is a father through donor egg<br />

surrogacy and IVF. Craig works with<br />

Oregon Reproductive Medicine,<br />

the clinic that helped him become a<br />

father, to help other intended parents<br />

building their families.<br />

Kathy Payne<br />

Kathy is a women’s health coach<br />

online and in Norwich UK, offering<br />

bespoke programmes for women<br />

and couples, as well as online classes<br />

and courses.<br />

Russell Davis<br />

Russell is a fertility coach<br />

supporting couples on their journey.<br />

<strong>Fertility</strong><strong>Road</strong><br />

Publisher<br />

PJ Jarvis-Mack<br />

pj@fertilityroad.com<br />

Managing Editor<br />

Tone Jarvis-Mack<br />

tone@fertilityroad.com<br />

Art Editor<br />

Richard Porter<br />

Ad Sales<br />

Tone Jarvis-Mack<br />

tone@fertilityroad.com<br />

020 7183 9882<br />

Accounts Manager<br />

Lynsey Jackman<br />

lynsey@fertilityroad.com<br />

Distribution<br />

UK Distribution<br />

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0207 491 4065<br />

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Print Subscriptions<br />

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Social Media Marketing<br />

Clinics Go Social<br />

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Licensing enquiries<br />

licensing@fertilityroad.com<br />

Legal<br />

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London<br />

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fertilityroad.com | 05

FR News & Views<br />








Natural Cycles, the fertility app, will no longer<br />

be allowed to claim it is a "highly accurate" and<br />

"clinically tested alternative to birth control"<br />

by the Advertising Standards Authority (ASA).<br />

The ASA has banned a Facebook ad which<br />

made the claims on the grounds they were<br />

“misleading” and has told Natural Cycles not to<br />

repeat them.<br />

The ASA received three complaints about the<br />

ad, which was shown in July 2017 and read:<br />

“Natural Cycles is a highly accurate, certified,<br />

contraceptive app that adapts to every woman’s<br />

unique menstrual cycle. Sign up to get to know<br />

your body and prevent pregnancies naturally.”<br />

It also claimed the app was a “clinically tested<br />

alternative to birth control methods”.<br />

Natural Cycles said the claims were based<br />

on clinical studies. It said when a person<br />

used the app exactly as instructed it had 99%<br />

effectiveness. But the ASA pointed out that the<br />

app requires users to input accurate information<br />

including hormone levels – which could lead<br />

to errors – and said that taking into account<br />

“imperfect” use of the app brought it to around<br />

91.7% effectiveness in preventing pregnancy.<br />

While some feel it has revolutionised<br />

contraception by freeing women from needing<br />

to take hormonal contraception, there have<br />

been widely-reported concerns over the<br />

accuracy of the app. In Stockholm, 37 women<br />

reportedly fell pregnant while using it.<br />

“We told Natural Cycles not to state or imply<br />

that the app was a highly accurate method<br />

of contraception and to take care not to<br />

exaggerate the efficacy of the app in preventing<br />

pregnancies,” the ASA said.<br />

The Family Planning Association also expressed<br />

concerns about the app. A spokeswoman said:<br />

“The use of the word ‘certified’ suggests that<br />

there is independent evidence supporting these<br />

claims, whereas in fact the only evidence is<br />

from the company itself. It has amassed a vast<br />

database, which is very interesting, but that is<br />

not the same as verified independent evidence.<br />

“Many other apps focus on getting to know your own<br />

body, but Natural Cycles is specifically targeting itself<br />

as a contraceptive, which is concerning.”<br />

Bekki Burbidge, Deputy Chief Executive at FPA<br />

aded that while apps are incredibly popular,<br />

they’re also “fairly unregulated” and it can be<br />

hard “to sort the good, evidence and researchbased<br />

apps from the bad”.<br />

She said: “<strong>Fertility</strong> apps can be particularly<br />

helpful for planning a pregnancy, but we’re<br />

still cautious about using them to prevent<br />

a pregnancy without initial support from a<br />

trained fertility awareness teacher. A teacher<br />

can support you while you learn to track your<br />

cycle and can help you understand the things<br />

that can make fertility awareness less effective.<br />

Things like travel, alcohol, stress or just not<br />

having enough sleep, can all affect temperature<br />

readings for apps like Natural Cycles.<br />

“At the moment there’s not enough<br />

independent evidence available about the<br />

reliability and effectiveness of apps. To use<br />

fertility awareness as effective contraception,<br />

whether you’re using an app or not, you need<br />

to be motivated and understand the advantages<br />

and disadvantages, especially the things that<br />

can make it less effective.”<br />

“Natural Cycles has been independently evaluated<br />

and cleared by regulators in Europe and the US<br />

based on clinical evidence demonstrating its<br />

effectiveness as a method of contraception.”<br />

06 | fertilityroad.com<br />

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An open mind, a favourable physical response and of<br />

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Infertility, IVF and<br />

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Many people who find themselves in the fertility<br />

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time of vulnerability, confusion and even panic it<br />

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‘Infertility, IVF and Miscarriage – The Simple<br />

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the debate for those struggling to conceive and<br />

offers a step by step guide to IVF and examines the<br />

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The guide is extremely comprehensive and<br />

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In the world of fertility information which is<br />

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‘The Simple Truth’ is much more than a guide<br />

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| fertilityroadmag | follow us @fertilityroad<br />

fertilityroad.com | 07

LEGAL<br />

EXPERT: Liz Bottrill<br />



"Should I freeze my eggs" is a question many<br />

women consider and for many different<br />

reasons. Perhaps they have not found the right<br />

partner or they are at a particular stage in<br />

their life when they are simply not ready for<br />

a child, but at the same time, do not wish to<br />

miss the opportunity of producing and storing<br />

eggs before their biological clock gets the best<br />

of them, or before the quality of their eggs<br />

degrade making it harder to become pregnant<br />

in the future.<br />

With many clinics offering egg freezing to<br />

their patients, the procedure has transformed<br />

from one only undertaken if there is a medical<br />

need (perhaps before embarking on a course<br />

of treatment which is likely to affect fertility)<br />

to what has been termed by some as a fertility<br />

‘insurance policy’ allowing women the<br />

opportunity to take steps now in an attempt to<br />

preserve their fertility just in case they are unable<br />

to produce viable eggs in the future. However, the<br />

value of that ‘insurance policy’ continues to be<br />

a matter for debate with wildly varying quoted<br />

success rates, which remain relatively low, and at<br />

a not unsubstantial cost. Yet many take the view<br />

that a backup plan is better than nothing at all,<br />

even if it offers no guarantees.<br />

However, the decision to freeze is only the first<br />

of many decisions to be taken which can have<br />

significant consequences in the future. For<br />

example, should the egg be frozen on its own, or<br />

should it be frozen as a fertilised embryo? The<br />

embryo is thought to be more robust than the egg<br />

increasing the prospects that it would survive the<br />

freezing process but comes with less flexibility<br />

to meet changes in the woman’s circumstances.<br />

The genetic makeup of an embryo is set by the<br />

choice of sperm used to create it (whether known<br />

or through anonymous donor sperm) and cannot<br />

be changed if, for example, the woman meets a<br />

new partner before she is ready to have children.<br />

Furthermore, if a woman and her partner<br />

separate before the embryo is implanted and the<br />

partner withdraws his consent for the embryo to<br />

be stored or used, it may have to be destroyed.<br />

The decision of when to freeze the eggs is also<br />

an important one. From a medical perspective,<br />

the advice seems to be to freeze early on rather<br />

than waiting till you are in your mid to late 30s<br />

and 40s and using egg freezing as a last-ditch<br />

attempt to preserve fertility. Whilst this may<br />

well be sound medical advice, there can be legal<br />

ramifications. That is because in the UK, it is<br />

only possible to store eggs for a maximum of 10<br />

years after which they must be destroyed. The<br />

only exception to that rule is if the woman, or<br />

in the case of freezing embryos, her partner, are<br />

or are likely to become prematurely infertile. In<br />

that case, if the correct steps are taken before the<br />

10 year time limit expires, the time for storage<br />

can be extended.<br />

The choices that freezing offers are undoubtedly<br />

beneficial – but in making decisions about what<br />

and when to freeze guidance should be taken from<br />

both your medical and legal team. As with all<br />

forms of insurance, a full assessment of the risks<br />

and the possible future consequences is needed to<br />

ensure the choice you finally make is the one most<br />

likely to provide you with the best outcome in<br />

your particular circumstances in the future.<br />

Liz Bottrill is a Partner in the Family Law<br />

Team at Laytons Solicitors with over 25 years’<br />

experience in the field. She has a particular<br />

interest and expertise in the law relating to<br />

children and fertility.<br />

08 | fertilityroad.com<br />

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fertilityroad.com | 09

BODY<br />

EXPERT: Michelle Mulliss<br />


It’s a Man’s World<br />

Parenthood is something that not just the<br />

mother needs to get ready for; dads need to be<br />

prepared too. Infertility is on the rise in our<br />

modern world. According to statistics, there has<br />

been almost a 20-30% rise in infertility in the<br />

last five years.<br />

In men, the quality of semen is the main reason<br />

of failing to impregnate the partner with 35% of<br />

male infertility issues are due to low sperm count<br />

and motility.<br />

Common reasons for male infertility are low<br />

sperm concentration (oligospermia), poor<br />

sperm motility (asthenospermia), and abnormal<br />

sperm morphology (teratospermia). The exact<br />

reason for the decline in semen quality is<br />

not clear, but environmental, nutritional,<br />

socioeconomic and other factors are starting to<br />

come into focus, but what can you do to help<br />

improve your sperm health?<br />

Stock up on fruits and vegetables: A study<br />

conducted by the Harvard University found that<br />

eating yellow and orange coloured vegetables<br />

and fruits had a profound effect on the health<br />

of the sperm. Yellow and orange colour in fruits<br />

and vegetables have an abundant amount of<br />

“carotenoids” including beta carotene which is<br />

converted to Vitamin A in the body. It is one of the<br />

most potent antioxidants. Sweet Potato and melon<br />

were found to improve both the quantity and<br />

quality of sperms while red vegetables particularly<br />

tomatoes, which contains lycopene, improved the<br />

quantity of abnormally shaped sperms by 8-10%.<br />

Break on the processed food: Processed and take<br />

away fast foods are known to be detrimental to<br />

our health. A young men’s study carried out at<br />

the University of Rochester took a group that<br />

was fed a diet high in processed and red meat,<br />

refined grains, fast foods, high energy drinks<br />

and fast food. Another group were put on a<br />

healthy diet of chicken, fish, fruits, vegetables,<br />

whole grains and legume beans. It was no<br />

surprise that those on the healthy diet had<br />

better sperm motility which has been supported<br />

by various studies of the positive role of diets<br />

high in whole grains, legumes, fruits vegetables<br />

and fatty acids on sperm health and fertility.<br />

Manage the cholesterol: We have seen<br />

that couples with a high levels of<br />

cholesterol take longer to conceive.<br />

A study published in the Journal<br />

of Clinical Endocrinology &<br />

Metabolism concluded that<br />

couples or either of the partner<br />

with high cholesterol found it difficult to<br />

conceive as compared to other couples. So, ensure<br />

to get in those fibres, whole fruits and lean plant<br />

proteins into your daily diet and keep a check on<br />

your lipid profile.<br />

Ditch saturated fats: Saturated fats do not only<br />

have an adverse effect on your heart and waist<br />

line but are also major contributory factors for<br />

low sperm count. Studies have suggested that<br />

even a 5% increase in saturated fat intake could<br />

result in a decrease in sperm count.<br />

Protect against oxidative stress (OS): OS is<br />

directly related to cellular damage which<br />

is caused by free radicals known as reactive<br />

oxygen species (ROS). Small amounts of ROS<br />

are needed for functioning of the sperms,<br />

however when their number increases, and<br />

our antioxidant defences are overwhelmed<br />

impacting on the quality of sperm.<br />

Weight in check<br />

Obesity is a health target for the NHS,<br />

and research has shown that obesity<br />

has an impact on reproductive health<br />

with reducing sperm concentration<br />

and delaying conception. Increased<br />

10 | fertilityroad.com<br />

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BODY<br />

BMI is also associated with decreased levels of<br />

testosterone and an increase in oestrogens – causing<br />

low sperm counts and infertility.<br />

Nutrition can be a minefield when it<br />

comes to fertility which to some can be<br />

overwhelming with the marketing of<br />

supplements. It’s important to reiterate<br />

that to maintain health, a varied<br />

and balanced diet is key. However,<br />

certain nutrients have been shown<br />

to increase sperm count, motility<br />

and quality which include;<br />

Vitamins<br />

Vitamin A deficiencies have been<br />

linked to sluggish sperm and motility<br />

issues. Eat plenty of red peppers, oats,<br />

carrots, dried apricots, sweet potatoes, spinach<br />

and broccoli to give you a vitamin A boost.<br />

Vitamin C, found in good amounts in<br />

strawberries, asparagus, fruit and yellow veggies,<br />

has a positive effect on sperm viability and<br />

motility (the swimming ability of sperm).<br />

Vitamins C, E and B12 are also great antioxidants<br />

that can help boost sperm production and<br />

motility by fighting harmful free radicals.<br />

Minerals<br />

Inadequate levels of zinc can cause lowered<br />

sperm counts. Natural sources of this<br />

mineral can be found in oysters,<br />

eggs, turkey, seafood, pumpkin<br />

seeds, liver, beef, oats, lamb,<br />

yoghurt, nuts and barley.<br />

Selenium is also thought<br />

to be beneficial to sperm<br />

motility and health.<br />

You can get it by eating<br />

Brazil nuts, red meat,<br />

cottage cheese, poultry<br />

and eggs. If you don’t think<br />

you are getting enough zinc<br />

or selenium, a multivitamin may<br />

help. However, be sure to stick within<br />

the recommended dose, as high levels of both<br />

these minerals can become toxic.<br />

Fatty Acids<br />

Studies have shown that fertile men’s sperm tend<br />

to contain greater amounts of polyunsaturated<br />

fats (many unsaturated fats), specifically omega-3<br />

and omega-6 fatty acids, than that of infertile men.<br />

They’re found in walnuts, chia seeds, omega-3<br />

supplements like krill oil but can be found in oily<br />

fish like anchovies, sardines and salmon.<br />

Folic Acid<br />

It is well known now that<br />

women should take folic<br />

acid when preparing for<br />

pregnancy. This I believe<br />

should be extended to men<br />

as I see in clinic which is<br />

also supported with recent<br />

research that some men<br />

who have been taking dietary<br />

supplements containing folic<br />

acid in combination with zinc have<br />

experienced increases in sperm counts of as<br />

much as 70% and research suggests that men with<br />

low folic acid levels tend to have more sperm cells<br />

with chromosomal (genetic) abnormalities. Keep<br />

your levels up by eating leafy green veggies, whole<br />

grain foods, avocados, beans and fruit.<br />

Lycopene<br />

Lycopene, has been shown to help increase sperm<br />

count and can be found in tomatoes, carrots,<br />

watermelons and paw paw fruit.<br />

Water<br />

Many of us get caught up with such busy lifestyles<br />

that water intake can be forgotten. However,<br />

drinking plenty of water throughout the day you<br />

can counteract dehydration, which is one of the<br />

main factors associated with low semen volume.<br />

Food Porn<br />

Cooking and presenting<br />

food that is not<br />

only appealing but<br />

tastes great can be<br />

challenging, and<br />

many couples often<br />

ask for advice on<br />

how to cook the foods<br />

recommended in my<br />

clinics. It was through<br />

this concept and my love<br />

of cooking I created Fertile<br />

Foods cooking workshops. These<br />

workshops help encourage the understanding of<br />

nutrition in all areas of reproductive health and<br />

have helped couples embrace nutrition to add<br />

splash of fun in the pan.<br />

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Here are some recipes to help boost sperm and<br />

most of all taste great.<br />

Persian Pomegranate Chicken<br />

Try this tasty recipe with walnuts and<br />

pomegranate which are great for sperm health.<br />

Walnuts are bursting with essential omega-3 fatty<br />

acids and antioxidants to help in boosting sperm<br />

volume and production by increasing blood flow<br />

to the testicles. Whilst the delicious pomegranate<br />

fruit is known as a powerful food that helps in<br />

increasing sperm count and improves semen<br />

quality. It is full of antioxidants that help in<br />

fighting against free radicals in the blood stream.<br />

Ingredients<br />

• 1 to 2 large yellow onions, chopped, (3 cups)<br />

• 2 Tbsp unsalted butter<br />

• 3 Tbsp olive oil<br />

• 5 Tbsp pomegranate molasses (simmer 1 cup<br />

of pomegranate juice until it reduces to 5 Tbsp<br />

of syrup)<br />

• 1/2lb walnut halves (about 2 cups)<br />

• 2 lbs boneless skinless chicken thighs and/or<br />

breasts, trimmed of excess fat, cut into medium<br />

size pieces, patted dry and salted<br />

• 2 cups chicken stock<br />

• 2 Tbsp plus 2 teaspoons of sugar<br />

• 1/2 teaspoon turmeric<br />

• 1/4 teaspoon cinnamon<br />

• 1/4 teaspoon ground nutmeg<br />

• 1/4 teaspoon ground black pepper<br />

• Salt<br />

• 1/2 cup fresh pomegranate arils for garnish (optional)<br />

Method<br />

You can toast the walnuts in one of two ways. You<br />

can either spread them out in a single layer in a<br />

large skillet, and toast them on medium high heat,<br />

stirring frequently until lightly toasted, OR you<br />

can spread them out in a single layer in a baking<br />

rimmed baking sheet, and toast at 350°F in the<br />

oven for 8 to 10 minutes.<br />

In either case, once toasted, remove from heat and<br />

allow to cool. Once cool enough to handle, pulse in<br />

a food processor or blender until finely ground.<br />

In a large pan, heat 1 tablespoon of butter and 2<br />

tablespoon of olive oil over medium-high heat.<br />

When the butter has melted, pat the chicken pieces<br />

dry again and place the chicken pieces in the pan,<br />

working in batches if necessary to not crowd the pan,<br />

and cook until golden brown on all sides. Sprinkle<br />

the chicken with salt while they are cooking.<br />

Remove the chicken from the pan, set aside. Add a<br />

tablespoon of butter and a tablespoon of oil to the<br />

pan. Lower the heat to medium low. Add chopped<br />

onions to the pan and sauté until translucent,<br />

stirring on occasion to release the browned bits<br />

from the bottom of the pan.<br />

Return the chicken pieces to the pan with the<br />

onions. Pour 2 cups of chicken stock over the<br />

chicken and onions. Bring to a boil, reduce to a<br />

simmer, cover and simmer gently for 30 minutes.<br />

Stir in the ground walnuts, pomegranate molasses,<br />

sugar, and spices. Cover and cook on very low<br />

heat for 1 hour, stirring every 20 minutes or so to<br />

prevent the walnuts from sticking to the bottom<br />

of the pan.<br />

Remove from heat and adjust sugar/salt to taste. At<br />

this point the chicken should be fall apart tender.<br />

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Ginseng Chicken<br />

Ginseng has been known for its health benefits<br />

and is a powerful herb known for improving<br />

male fertility by increasing the number of<br />

sperms, sex drive and also enhances the sexual<br />

performance. It also helps in fighting erectile<br />

dysfunction, increasing semen volume and<br />

sperm production.<br />

Garlic contains a chemical compound called<br />

allicin, that helps in improving the flow of<br />

blood to the genitals and boosts the strength<br />

and endurance of the sperm. They are also<br />

power-packed with selenium and vitamin B6<br />

which helps in preventing sperm damage and<br />

hormone regulation.<br />

This recipe combines ginseng and garlic in this<br />

tasty chicken ginseng broth soup.<br />

Ingredients<br />

• 4 cups boiling water<br />

• 5 oz Korean red ginseng tea<br />

• 2 small chickens (poussin) or Cornish hens,<br />

(about 2lb each)<br />

• 4 large cloves garlic<br />

• 15 goji berries<br />

• 3 pieces dried Korean red ginseng (optional)<br />

• 2 cooked chestnuts, peeled (optional)<br />

• 1 cup uncooked sweet rice<br />

• 2 pinches dried chili threads<br />

• Handful fresh pea shoots<br />

• 1 tablespoon roasted sesame oil<br />

• 1 teaspoon black sesame seeds<br />

• Sea salt<br />

• Freshly ground black pepper<br />

Method<br />

Brew the ginseng tea by mixing together<br />

the boiling water and the ginseng tea until<br />

dissolved. Set aside. Rinse the chickens with<br />

cold water. Place 2 of the garlic cloves, goji<br />

berries, 1 piece of ginseng, a chestnut, and 2<br />

tablespoons of rice into the cavity of each bird.<br />

Skewer each closed with a toothpick. Place the<br />

remaining rice in a double layer piece of muslin<br />

or cheesecloth with of the remaining ginseng<br />

and date. Tie the cloth closed tightly but leave<br />

a little bit of extra space for the rice to expand.<br />

Place the chickens and rice bag into a large wide<br />

heavy-bottomed pot. Cover with the tea, and<br />

top off with water to cover, if necessary. Bring<br />

to a boil over high heat. Reduce the heat and<br />

simmer, occasionally skimming away any fat<br />

that comes to the surface, until cooked through,<br />

about 2 hours.<br />

When done, the chickens should be very soft<br />

and fall apart easily when tugged at. Carefully<br />

transfer the chickens to two bowls and divide<br />

the broth between them. Top the chickens<br />

with chili threads, garnish with pea shoots,<br />

and a sprinkle of black sesame seeds. Drizzle<br />

with sesame oil. Unwrap the rice package in a<br />

separate bowl and sprinkle with black sesame<br />

seeds, if you like. Serve with salt and pepper on<br />

the side.<br />

Should you want to know more about how<br />

you can improve your fertile health with<br />

food, visit michellemulliss.com or email<br />

info@michellemulliss.com<br />

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EXPERT:<br />

Dr Jodie Peacock BSc, ND<br />

Naturopathic doctor - The Root of Health<br />

Founder of Enhance <strong>Fertility</strong> Bootcamp program enhancefertilitybootcamp.com<br />



Endometriosis is a common condition affecting<br />

between 10-15% of women. It is a condition where<br />

the cells that should only be found within your<br />

uterine lining migrate and are found in other<br />

areas within your abdominal cavity. The growth<br />

of these cells outside the uterus can cause a host<br />

of different symptoms depending on the location<br />

the tissue is growing on. These cells respond the<br />

same way as your normal endometrial tissue<br />

to hormone stimulation. This means that they<br />

grow and bleed in the same cyclical pattern as the<br />

tissue in your uterus. This internal bleeding can<br />

lead to areas of scar tissue development, regions<br />

of inflammation and pain.<br />

Symptoms of endometriosis will vary from<br />

women to women but can include painful and<br />

heavy periods, painful intercourse, pain with<br />

urination or bowel movements, low energy and<br />

concerns with fertility. It is thought that up<br />

to 60% of women with fertility concerns have<br />

some degree of endometriosis. The diagnosis of<br />

endometriosis can be quite difficult and the only<br />

way to get a true diagnosis is by doing a surgical<br />

procedure called laparoscopy.<br />

The precise cause of endometriosis is still yet to<br />

be determined. There appears to be an increase in<br />

immune activity in the uterus, with a correlation<br />

between supressed immune functions and an<br />

increased number and size of lesions. There is a type<br />

of immune cell called a natural killer cell. These<br />

cells help to keep abnormal cells in check and are<br />

suppressed in some women with endometriosis.<br />

A different immune cell called macrophages also<br />

plays a role in endometriosis. Macrophages have<br />

a job to clean up any general debris. There is an<br />

increase in macrophage activity seen in the uterus<br />

of women with endometriosis. This may lead to<br />

a women’s body identifying sperm as foreign and<br />

therefore contributing to infertility. In<br />

terms of fertility, endometriosis<br />

can lead to scarring on<br />

fallopian tubes, adhesions<br />

and unruptured follicles in<br />

the ovaries are often seen.<br />

What are the<br />

risk factors<br />

for developing<br />

endometriosis?<br />

The most common risk factor is<br />

genetic. If your mother has endometriosis<br />

there is an 8% higher chance of you having it<br />

and about a 5% higher chance if your sister has<br />

endometriosis. Women with shorter periods<br />

and women with more frequent periods (with<br />

shorter time in between) have a higher risk.<br />

From a lifestyle standpoint, low activity levels<br />

from a young age, high fat diets and the use<br />

of intrauterine devices (IUDs) have all been<br />

demonstrated to increase the risk. From a<br />

It is thought that<br />

up to 60% of women<br />

with fertility concerns<br />

have some degree of<br />

endometriosis<br />

hormonal standpoint, having elevated or<br />

unbalanced levels of estrogen have been shown<br />

to make symptoms worse.<br />

Your liver has the task of breaking down<br />

hormones including your estrogens. This<br />

includes both your natural estrogens, synthetic<br />

estrogens (medications) as well as<br />

environmental toxins that can<br />

mimic estrogens. As the<br />

liver breaks down 80-<br />

90% of your estrogens,<br />

optimizing its ability<br />

to function will help<br />

support your treatment.<br />

Your liver metabolizes<br />

estrogen by attaching<br />

it to glucuronic acid and<br />

excreting the combo into<br />

your intestinal system for<br />

removal. The health of your<br />

intestinal flora is imperative to your<br />

body being able to eliminate the estrogen. If<br />

you have an abundance of healthy bacteria in<br />

your gut, you can rid your liver of the estrogen<br />

it has just worked to detoxify. If, however, you<br />

have an abundance of unhealthy bacteria, they<br />

can break the bond between the estrogen and<br />

glucuronic acid and allow the estrogen to be<br />

reabsorbed into your blood stream. Your liver<br />

then must work double time to get rid of this<br />

same estrogen again.<br />

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As you can see endometriosis is a complex multifactorial<br />

condition. To minimize symptoms and<br />

further growth we need to address the health<br />

of your liver, intestines, immune function and<br />

estrogen balance.<br />

Where to begin?<br />

1. Nutrition and diet will play<br />

a huge role in managing<br />

endometriosis.<br />

High fibre foods can provide significant benefit<br />

by helping support the healthy bacteria in the<br />

gut and crowd out the harmful ones. Increasing<br />

fibre by focusing on vegetables, legumes and<br />

beans can help improve digestion as well as reduce<br />

inflammation which will help reduce pain levels.<br />

Reducing the amount of red meats in your<br />

diet. Red meats, when consumed, release a<br />

substance called arachidonic acid that promotes<br />

inflammation contributing to pain levels.<br />

Including plant-based protein sources such<br />

as soy, nuts, seeds, beans or legumes in your<br />

meals, will assist your body in lowering levels of<br />

inflammation. You can also look to substitute<br />

fish for meats, as fish contains a type of fatty acid<br />

called omega 3s that work to reduce inflammation.<br />

Limit your caffeine intake. Women who have<br />

less than the equivalent caffeine of about 6<br />

cups of coffee per month had on average 40%<br />

improvement in symptoms compared to women<br />

who consumed over this amount. There is<br />

approximately 120mg of caffeine in a cup of<br />

coffee, so keeping total intake under 7g is optimal.<br />

Some patients I find do significantly better with<br />

eliminating caffeine entirely from their diet. Try it<br />

for one full cycle and see if you notice a difference.<br />

Or as another option I find for some women even<br />

it they stop for the week before their period this<br />

can have a positive impact.<br />

Focus on including more liver supporting foods<br />

and herbs. The family of vegetables known as<br />

brassicas includes broccoli, cauliflower, kale,<br />

brussel sprouts, cabbage, bok choy and turnips.<br />

These vegetables contain a nutrient called<br />

indole-3-carbinol or I3C. I3C helps the liver to<br />

metabolise estrogens, so can be helpful to assist<br />

in the balance of estrogen in the body. Root<br />

vegetables such as beets, sweet potatoes, radishes,<br />

and artichokes are very nourishing for the liver<br />

to also assist in overall function. In general,<br />

making sure you are getting a minimum of 5<br />

servings of vegetables per day will go a long way<br />

to ensuring you are getting adequate fibre and<br />

nutrients to support detoxification.<br />

2. Supporting your stress and<br />

nervous system.<br />

When your body is under higher levels of<br />

constant stress your adrenal gland makes more<br />

of a hormone called cortisol. The body uses your<br />

progesterone to make cortisol, so with higher<br />

stress levels your progesterone levels can drop<br />

leaving the ratio of estrogen to progesterone<br />

imbalanced. This allows for higher levels of<br />

estrogen that can stimulate endometrial tissue.<br />

As well contributing to pain in endometrial<br />

tissues, this can also affect the length of a<br />

women’s cycle and the heaviness of period<br />

flow. Elevated levels of cortisol can also have a<br />

negative impact on immune function which also<br />

isn’t helpful when it comes to endometriosis.<br />

There are several ways to help your body<br />

regulate stress more effectively. One is to add<br />

(or continue) regular daily exercise. Doing any<br />

type of activity that you enjoy is fine. This could<br />

range from walking, biking, dancing, swimming<br />

or weights and classes at the gym.<br />

Breathing properly is also critically important to<br />

keeping cortisol levels in a good range. Doing either<br />

diaphragm or yoga breathing each day, helps keep<br />

your body in its relaxation nervous system.<br />

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3. Reducing exposure to<br />

estrogenic or hormone<br />

disrupting toxins.<br />

Hormone disrupting toxins will have the largest<br />

impact on hormonal based concerns such as<br />

endometriosis as well an on overall fertility and<br />

reproductive health. Some examples of common<br />

places we will find these chemicals include lotions,<br />

makeup, soaps, cleaning products, food storage<br />

containers, water supply. The Environmental<br />

Working Group (EWG) published a list of the 12<br />

top hormone disrupting chemicals and includes:<br />

1. Bisphenol- A (BPA)<br />

2. Dioxin<br />

3. Atrazine<br />

4. Phthalates<br />

5. Perchlorate<br />

6. Fire retardants<br />

7. Lead<br />

8. Mercury<br />

9. Arsenic<br />

10. Per fluorinated chemicals (PFCs)<br />

11. Organophosphate pesticides<br />

12. Glycol ethers<br />

We know we have exposure to the majority of<br />

these chemicals on a daily basis. Some are easier to<br />

avoid than others. This list is not meant to make<br />

you panic but to begin to draw awareness to the<br />

exposures that we can control.<br />

Why are these types of toxins so problematic?<br />

Some of the hormone disrupting toxins will bind<br />

to the same receptors that your hormones bind to.<br />

This means your body can think you have more<br />

or less circulating hormones than you actually<br />

do. Some hormone disrupting chemicals will<br />

increase the amounts of hormones your body<br />

High fibre<br />

foods can provide<br />

significant benefit<br />

by helping support the<br />

healthy bacteria in the<br />

gut and crowd out the<br />

harmful ones<br />

secretes, others will decrease<br />

amounts, and some will<br />

even mimic the function<br />

of the hormones. As your<br />

body’s levels of certain<br />

hormones change, this<br />

can lead to changes in<br />

the menstrual cycle,<br />

immune function and<br />

how your body responds<br />

to stress. Some of these<br />

chemicals, for example phalates,<br />

link directly to endometriosis.<br />

Toxins are ubiquitous in our environment, so<br />

we are never going to be able to get away from<br />

exposure. We can however do things to minimize<br />

exposure and encourage the body to eliminate and<br />

excrete the toxins instead of storing them. One<br />

of the best ways to encourage toxins from your<br />

body is through sweating. This can be done either<br />

through exercise or the use of saunas.<br />

Visit ewg.org for more information on where to<br />

find these toxins and ways to reduce exposures.<br />

Optimizing your digestion and liver function<br />

are two of the most important ways to not only<br />

improve your endometriosis but also to optimize<br />

your overall health. There are also other nutrients<br />

and herbal medicines that can be used to assist<br />

with pain so please speak to your Naturopathic<br />

doctor or other health provider to see what makes<br />

the most sense for you.<br />

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Why Weight<br />

Can Matter<br />

It’s Best to Lose Weight<br />

Before Trying For a Baby<br />

EXPERT: Kathy Payne<br />

It's best to manage weight at a healthy level<br />

when planning a baby, either naturally or via<br />

IVF. It's also best to do it before trying to fall<br />

pregnant. That's because being overweight<br />

or underweight can affect fertility. Let's talk<br />

about weight management for fertility.<br />

Weight Can Affect Hormones<br />

Women’s hormones need to be in balance for<br />

a regular and healthy menstrual cycle. Being<br />

overweight or underweight risks hormone<br />

imbalances and we start to notice signs, like cycle<br />

irregularities and fertility challenges.<br />

<strong>Fertility</strong> and Being Overweight<br />

Some studies show that overweight women<br />

are more likely to encounter fertility issues.<br />

Generally speaking, the more overweight we are,<br />

the higher the risk of problems. This is simply<br />

because overweight women tend to have more<br />

fat cells, than those women who are classed as<br />

normal weight.<br />

Fat cells produce oestrogen; it’s not just our ovaries!<br />

Because fat cells produce oestrogen, overweight<br />

women are at higher risk of what’s commonly<br />

called “oestrogen dominance”. Oestrogen<br />

dominance means too much oestrogen in<br />

relation to progesterone i.e. a hormone<br />

imbalance. Oestrogen dominance can impact<br />

cycle health, ovulation and fertility.<br />

Some common signs of too much oestrogen/ not<br />

enough progesterone include:<br />

• Brain fog and memory issues<br />

• Mood swings, irritability and depression<br />

• Sleeplessness<br />

• Tiredness<br />

• Hormonal migraines and other headaches<br />

• Hair loss<br />

• Thyroid problems<br />

• Cold hands and feet<br />

• Sore and tender breasts<br />

• Abdominal bloating<br />

• Weight gain and slower metabolism<br />

• Low libido<br />

• Period problems<br />

• Endometriosis<br />

• Fibroids<br />

• Infertility and miscarriage<br />

<strong>Fertility</strong> and Being Underweight<br />

Being underweight can also be a factor to consider<br />

when you’re planning a baby. Underweight<br />

women tend to have a lower percentage body fat<br />

than women classed as normal weight.<br />

Women need a certain amount of body fat to<br />

ensure hormone balance and ovulation. If we’re<br />

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underweight, our bodies “think” there<br />

are not enough fat stores for pregnancy, so we<br />

are less likely to conceive and run higher risk<br />

of miscarriage.<br />

It’s not only the underweight who should watch<br />

out however, it’s possible for a woman to be<br />

average or even above average weight, but still<br />

have a low body fat percentage. As an example,<br />

let’s look at female elite athletes or women who<br />

exercise a lot and hard. Their low body fat and<br />

high muscle percentage can cause their periods to<br />

become irregular or even stop altogether.<br />

BMI is only one measure of weight and health.<br />

It’s a useful indicator but it’s not the only<br />

measurement to consider because it doesn’t<br />

show us the fat/muscle make-up of our bodies.<br />

It’s possible to measure that and I’ve found that<br />

many gyms have machines to measure fat/muscle;<br />

alternatively you could ask your doctor instead.<br />

Accepted reference ranges suggest that underweight<br />

is a BMI lower than 20. Normal BMI is 20-15.<br />

Overweight is a BMI of 25-30. Obese is a BMI of 30-<br />

40 and morbidly obese is over a BMI 40.<br />

If weight is a factor for you, there are some things<br />

I suggest before trying to conceive.<br />

Here are some suggestions:<br />

Tips for Managing Weight<br />

It's best not to go on a weight loss diet when<br />

you're trying to conceive.<br />

Sorry, but it much better to lose excess<br />

weight first and then try for a baby.<br />

Many of my clients, ask me<br />

why. The imbalance is usually<br />

temporary and maintaining<br />

a healthy weight and eating<br />

healthily should rebalance<br />

any issues over time.<br />

Slimming diets - especially very<br />

restrictive ones - can cause periods to<br />

become irregular and ovulation to stop,<br />

because hormone levels drop.<br />

Wait until 3-4 months AFTER losing weight<br />

to start trying for a baby, if you can.<br />

Weight can be a<br />

fertility factor for<br />

women, because it<br />

impacts hormone<br />

balance<br />

I know this can sound like a very long wait when<br />

you really want a baby. I suggest this as a precaution<br />

when time is on a woman’s side. Sometimes nutrient<br />

levels - including all the really key fertility fuelling<br />

nutrients - can be lower after a slimming diet.<br />

I therefore recommend boosting nutrient levels<br />

if you’ve been on a slimming diet.<br />

In my clinic, I use hair mineral tests from a<br />

respected Laboratory to help couples<br />

identify any mineral deficiencies<br />

and also exposure to toxic metals<br />

which also impact fertility.<br />

I work out what foods and<br />

supplements they may need,<br />

based on those test results.<br />

No faddy diets, please.<br />

That’s because you risk robbing your<br />

body of nutrients, including the ones<br />

needed for fertility and a healthy pregnancy and<br />

bouncing baby. It is best to gradually lose weight<br />

through a healthy, varied and balance diet. And<br />

that includes plenty of healthy fats!<br />

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It doesn’t include “diet” or lite products. They<br />

can be packed with health and hormone harming<br />

chemicals, sugar or artificial sweeteners. In fact,<br />

the basics of a fertility friendly diet will help you<br />

lose weight.<br />

1-2lbs a week is a steady, healthy and brilliant<br />

weight loss.<br />

The aim is to lose weight to become a healthy<br />

weight for fertility, not skinny-down as much<br />

as you possibly can. Even losing a small amount<br />

of weight can make a big difference to general<br />

health and fertility.<br />

The basics of a fertility friendly diet<br />

1. Balance blood sugar by having good quality<br />

protein with every meal and snack. Good<br />

protein sources include nuts, seeds, legumes,<br />

eggs, fish, poultry, meat, dairy. For other<br />

fertility-protecting reasons, go easy on the<br />

red meat and cow’s dairy. Eat breakfast and<br />

another two good meals. Only snack if you’re<br />

really hungry or feeling whoozy/hangry.<br />

2. Choose organic food as far as possible -<br />

certainly for any meat or poultry, dairy and<br />

the “dirty dozen” veggies and fruits. See the<br />

EWG’s list of the worst pesticide residue<br />

covered veggies and fruits. ewg.org/foodnews/<br />

dirty_dozen_list.php<br />

3. Eat a rainbow and plenty of vegetables and<br />

fruits - much more veggies than fruits and<br />

include leafy greens. Have at least seven<br />

portions of veggies and fruits daily. Yes, SEVEN.<br />

4. Eat good fats - nuts, seeds, avocados, oily fish,<br />

extra virgin olive oil, coconut oil, grass-fed<br />

butter and ghee and grass-fed red meat. Reduce<br />

saturated fats from factory farmed meats<br />

and trans fats from processed, packaged and<br />

takeaway foods.<br />

5. Choose unrefined carbs for fibre and nutrition<br />

- brown rice, quinoa, chia seed, oats, rye, spelt,<br />

buckwheat, legumes, starchy veggies and if you<br />

have wheat eat sparingly and have wholegrain.<br />

You need LOTS of fibre for digestive<br />

and hormonal health.<br />

6. Avoid - or vastly reduce<br />

- caffeine, alcohol,<br />

sugar and artificial<br />

sweeteners, processed<br />

and refined foods.<br />

Don't start binge<br />

eating sugary or<br />

junk food to gain any<br />

weight.<br />

Please don’t start binge eating<br />

pasties, shovelling in chocolate<br />

and crisps or troughing takeaways!<br />

They are simply NOT fertility-fuelling foods.<br />

Eat more nutritious, calorie-dense foods - nuts<br />

and seeds, avocado, eggs, brown rice, oily fish and<br />

healthy fats and oils. Increase your number of<br />

healthy snacks as well.<br />

CROWD IN healthy foods to lose weight.<br />

I know that losing or gaining weight is not<br />

always straightforward and habits can be tough<br />

to break. In my clinic, some people have seemed<br />

daunted. I start with the simple practice of<br />

crowding in what you do want and to crowd out<br />

what you don’t want.<br />

Slimming diets<br />

- especially very<br />

restrictive ones - can<br />

cause periods to become<br />

irregular and ovulation to<br />

stop, because hormone<br />

levels drop.<br />

As an example, if you’re trying to cut down on<br />

sugar, crowd in more protein and soon you’ll be<br />

eating more protein, feel fuller for longer and<br />

less likely to be eating a doughnut at elevenses.<br />

Give it a go and see how it works for you.<br />

If you have a male partner, check his weight too<br />

Men’s weight matters too. Being overweight can<br />

affect male fertility. It’s been linked<br />

to poor sperm quantity and<br />

quality. One of my mantras<br />

is it takes two to tango<br />

and two to make a baby.<br />

Both women and<br />

men should tackle<br />

weight issues as part<br />

of their preconception<br />

care plan.<br />

Weight and BMI can<br />

affect chances of getting<br />

pregnant - that’s women<br />

and men.<br />

I work with women and couples who<br />

want babies. Sometimes those people are<br />

struggling to conceive. I suggest food and lifestyle<br />

changes tailored for them and I practice natural<br />

therapies to support them<br />

And I know that sometimes people feel a little<br />

daunted and wonder how they’ll stick with my<br />

new suggestions. Of course, it’s easier when<br />

you’re working with someone to support and<br />

encourage you, but for everyone I’d say it’s<br />

a matter of giving yourself the best chance<br />

you can of natural conception or IVF success.<br />

And maximising your chances of a healthy<br />

pregnancy and happy, bouncing baby, through<br />

your diet and lifestyle choices.<br />

It’s about taking control of all the fertility factors<br />

that you can control and that includes weight<br />

and BMI.<br />

Love, Kathy x<br />

Kathy Payne is a Booster of <strong>Fertility</strong>, Balancer<br />

of Hormones and Soother of Modern Life<br />

Madness, naturally. She is a women’s health<br />

coach online and in Norwich UK, offering<br />

bespoke programmes for women and couples,<br />

as well as online classes and courses.<br />

If you’d like to protect, nurture and boost<br />

your fertility naturally, sign up for her<br />

weekly newsletter and occasional offers with<br />

this link. As a FREE GIFT you will receive<br />

the popular, online course 7 Steps to Boost<br />

<strong>Fertility</strong> http://bit.ly/7Steps-<strong>Fertility</strong><strong>Road</strong><br />

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BODY<br />

Olympia London 3 - 4 November<br />

Book<br />

tickets<br />

now<br />

The UK’s biggest fertility event<br />

Find out more at fertilityshow.co.uk<br />

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STRESS &<br />


EXPERT: Colette Assor<br />

Our clinic is seeing an increased number of<br />

women with a diagnosis of unexplained infertility.<br />

Tests and scan results come back as normal,<br />

but women are still struggling to conceive. The<br />

infertility roller coaster can be a stressful journey.<br />

What is unexplained infertility?<br />

Unexplained infertility is diagnosed when a<br />

couple has been unsuccessfully trying to conceive<br />

for 12 months or more and all investigations<br />

have ruled out all other known explanations.<br />

Living with a medically unexplained diagnosis can<br />

be both a relief and a cause of anxiety for patients.<br />

On one hand, your specialists have effectively ruled<br />

out several undesirable causes for your symptoms<br />

but on the other hand, you are still living with those<br />

symptoms. For couples who have been diagnosed<br />

with unexplained infertility, this can be particularly<br />

frustrating as it gives you no explanation as to why<br />

you’re struggling to start a family.<br />

How Specialists Reach a Diagnosis<br />

of Unexplained Infertility<br />

There are many causes and risk factors related to<br />

infertility and your doctor will explore all of these<br />

pathways when making a diagnosis. In general,<br />

infertility can be defined as the inability to get<br />

pregnant, carry a pregnancy to term and deliver a baby.<br />

Male Infertility Tests<br />

For male infertility specialists will look at<br />

factors that include:<br />

• sperm size, shape, number and mobility<br />

• the presence of varicoceles (enlarged veins in<br />

the scrotum)<br />

• blockages of sperm-carrying ducts<br />

• the presence of infections, cancer and STIs<br />

• hormonal imbalances<br />

• risk factors such as excessive weight, smoking,<br />

alcohol and drug abuse and a history of<br />

fertility disorders<br />

Female Infertility Tests<br />

To diagnose female infertility your specialist<br />

may look for:<br />

• polycystic ovarian syndrome<br />

• premature ovarian failure<br />

• blocked or damaged fallopian tubes<br />

• the presence of polyps or fibroids in the uterus<br />

• endometriosis<br />

• an abnormally shaped uterus<br />

• period irregularity and irregular menstrual<br />

cycle length<br />

• weight gain, facial hair growth and lifestyle factors<br />

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Is Stress Affecting Your <strong>Fertility</strong>?<br />

The journey through infertility can be a<br />

stressful path, how much do we know about the<br />

impact of stress on fertility?<br />

There has been ongoing debate within the<br />

scientific community about whether stress may<br />

influence fertility and pregnancy outcomes.<br />

Doctors are once more looking at the idea that<br />

stress may actually play a role in infertility<br />

problems. Studies are focusing more on the<br />

physiological effects of stress and how they may<br />

play a role in conception. In the UK 25 % of<br />

couples have been diagnosed with unexplained<br />

infertility. For these couples the effects of stress<br />

can be most profound.<br />

Whilst there is not enough data to draw a<br />

clear conclusion, what is apparent is that when<br />

stress reduction techniques are employed<br />

something happens in some women that allows<br />

them to get pregnant when they were not able to<br />

previously conceive.<br />

What is Stress?<br />

Stress is a normal psychological and<br />

physiological reaction to changes in<br />

someone’s environment.<br />

When most people talk about stress,<br />

however, they are usually referring to<br />

chronic and/or negative forms of stress,<br />

such as having too many demands at work,<br />

relationships or the death of a loved one.<br />

People experiencing chronic stress may<br />

feel that they are unable to handle daily<br />

life tasks, have limited-to-no control over<br />

the direction of their life or more easily<br />

become angry or irritated. This type of<br />

chronic stress can negatively affect a<br />

person’s short-term and long-term health.<br />

When Stress Can Lead to Trouble<br />

Getting Pregnant<br />

Stress can lead to toward unhealthy behaviours<br />

and non-fertility friendly lifestyles. For<br />

example, when you’re stressed out, you may:<br />

• Sleep too much or sleep too little<br />

• Give into emotional eating or not eat right.<br />

• Not find enough time for exercise or push<br />

yourself to exercise too hard<br />

• Drink one too many alcoholic drinks<br />

• Smoke, or, if you quit smoking, start smoking again<br />

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• Drink too much coffee, especially if you’re<br />

sleep deprived<br />

• Lose interest in having sex<br />

How Stress, Sleep, and <strong>Fertility</strong><br />

Are Connected<br />

If your work schedule or<br />

lifestyle leads to late<br />

nights with early wakeup<br />

calls, the constant<br />

lack of sleep can affect<br />

your body, and hence,<br />

affect your fertility.<br />

Research has shown<br />

that people who get less<br />

than five hours of sleep<br />

are more likely to suffer<br />

from obesity, and obesity can<br />

lead to fertility problems.<br />

How Stress and Emotional<br />

Eating May be harming<br />

your <strong>Fertility</strong><br />

When people are stressed, they tend to eat in<br />

less than healthy ways. Constant stress has been<br />

shown to lead to weight gain, and weight gain<br />

and obesity have in turn been linked to fertility<br />

problems. Just as eating too much junk food or<br />

being overweight can cause fertility problems,<br />

weighing too little or not eating enough can<br />

affect your reproductive potential.<br />

Work out Mindfully<br />

Getting a healthy amount of exercise can<br />

help lower stress and lead to a<br />

healthier body. It is important<br />

to exercise. However, the type,<br />

frequency and intensity<br />

of exercise is variable<br />

dependent on age, lifestyle<br />

and most importantly<br />

stress levels. Mindful<br />

exercise is best, i.e.,<br />

listening to your body. A<br />

slow gentle walk has amazing<br />

health benefits and will aid<br />

body systems. Gentle walking in<br />

nature at least 30 minutes per day will<br />

benefit health and well being.<br />

When Stress Gets in the Way of<br />

Sex and <strong>Fertility</strong><br />

Sex can be a stress reliever, something to relax<br />

with at the end of a long day. However, crazy work<br />

Stress can hamper<br />

ovulation. No amount<br />

of sperm will make a<br />

difference if the woman’s<br />

body hasn’t released<br />

an egg<br />

schedules, not to mention feeling exhausted, can<br />

make it difficult to find time for sex<br />

A stress-filled life can also lower your libido, so you<br />

might not be in the mood often. It seems logical to<br />

say that if you want to get pregnant, you need to<br />

have sex. Some couples are too stressed<br />

to have sex and do not have sex<br />

enough during ovulation to<br />

get pregnant.<br />

Hormone mixup<br />

– Stress<br />

impact on<br />

ovulation<br />

Stress can hamper ovulation.<br />

No amount of sperm will make<br />

a difference if the woman’s body<br />

hasn’t released an egg. A woman’s body is<br />

involved in a constant monthly dance of hormones,<br />

for which ovulation is key to conception.<br />

When a woman is stressed, other hormones<br />

are released in the brain, which can disrupt the<br />

hormone cycle.<br />

Without ovulation, any eager sperm that arrives<br />

on the scene will find no egg to fertilise.<br />

How does stress impact on the<br />

reproductive system?<br />

Everyone experiences stress, and for many it’s<br />

not an enjoyable experience. It isn’t inherently<br />

bad, although research suggests that depending<br />

on the type and timing of the stressor (i.e. the<br />

reason for stress) it can cause changes<br />

to a person’s menstrual cycle.<br />

Recent research tells us<br />

that stress boosts levels of<br />

stress hormones, such as<br />

adrenaline, cortisol, which<br />

can inhibit the release of<br />

the body’s main hormone,<br />

GnRH (gonadotropin<br />

releasing hormone), which is<br />

responsible for the release of sex<br />

hormones. Subsequently this may<br />

suppress ovulation in women, reduce<br />

sperm count in men and lower libido in both<br />

women and men.<br />

Any disruption to GnRH may cause insufficient<br />

release of hormones from the pituitary gland<br />

which can cause their target organs to no longer<br />

work as they once did and in extreme cases,<br />

atrophy over time and no longer function.<br />

Stress impact on Sperm Quality<br />

Although mechanisms are not fully understood,<br />

there is a link between anxiety and sperm<br />

quality. A recent research study of 29,914<br />

participants found that psychological stress<br />

lowers sperm concentration and progressive<br />

motility and increases the amount of abnormal<br />

forms of sperm.<br />

How does stress impact on IVF?<br />

An area that has received growing interest<br />

in recent years is the potential role that<br />

psychological stress may play in determining<br />

in vitro fertilisation (IVF) treatment outcomes.<br />

At least anecdotally, many infertile women<br />

and health care professionals alike believe that<br />

the experience of stress may play an important<br />

role in the difficulties that infertile patients<br />

face, and thus may be a contributing factor in<br />

determining the eventual outcome of IVF.<br />

Research in this area is mixed, one study<br />

showed that elevated levels of stress hormones<br />

measured in hair were associated with a third<br />

less chance of conceiving.<br />

These facts are very important to consider if you<br />

have been trying to conceive without success. It<br />

also shows that stress relief should be a part of<br />

every couple’s conception plan even if they are<br />

going through IVF.<br />

Colette Assor Lic Ac MBAcC is a fertility<br />

acupuncturist with 20 years clinical<br />

experience. Colette runs Acupuncture Works<br />

clinics in Hendon & Finchley North London.<br />

acupunctureworkslondon.co.uk<br />

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EXPERT: A’ndrea Reiter<br />

One secret you need<br />

to know to shift your<br />

fertility energy<br />

Energy is a term that is becoming a little more<br />

comfortable for people. But other than maybe<br />

The Secret, they don't have much experience<br />

with it, much less how to control it. From<br />

everything we initially learn about the Law of<br />

Attraction and positivity, we think we need to<br />

just say positive things and focus on it all the<br />

time and then the baby materializes. But that's<br />

not the case.<br />

Like energy attracts like energy. So, the Universe<br />

is responding with a match to the energy that we<br />

are putting out. Unfortunately, it can be tricky<br />

to catch when we are truly being being positive,<br />

versus being in need and lack (which brings more<br />

need and lack).<br />

When it comes to energy, the more weight<br />

we put on a situation, the heavier it is. Even<br />

though we are focused on being a mother<br />

because it’s a great thing and we really want<br />

it; when we make one area of our lives seem<br />

heavier and harder than others, the Universe<br />

has to bring a match to that and things stay<br />

heavier and harder. The cycle just keeps<br />

repeating because our brain is taking our past<br />

experience with that area, and chucking it into<br />

the future. The brain assumes that because it’s<br />

always been hard, it always will be, and so the<br />

cycle repeats. The energy doesn’t change, so we<br />

are met with more of the same.<br />

Here’s the exciting thing though:<br />

The energy in all areas of your life is the same.<br />

I know it feels like they’re different, but they’re<br />

not. It’s a self-made construct to say, “Money is<br />

more difficult than relationships,” or “<strong>Fertility</strong><br />

is harder than career.” We give different areas of<br />

our lives different names, but it is essentially our<br />

energy and what we are aligned or not aligned<br />

with. <strong>Fertility</strong> may be blue frosting, Career may<br />

be yellow frosting, and Relationships may be red<br />

frosting; but it’s all buttercream frosting in the<br />

end- just tinted to look different. As long as we<br />

think fertility is harder it will be, thanks to the<br />

Law of Attraction, but once you realize it’s the<br />

same as other areas and treat it as such, things get<br />

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MIND<br />

a whole lot easier. The brain can’t help but think,<br />

“But it IS difficult!” Again, what’s happening is<br />

your brain taking past experiences and assigning<br />

it to the future. It’s not a true statement on its<br />

own that, “Getting pregnant is hard,” but when<br />

we believe and expect it to be, that’s what we are<br />

met with a match to from the Universe. So, it<br />

seems like things just keep happening to prove<br />

your point, but it’s literally only because we are<br />

assigning weight and meaning to it.<br />

What do I mean by assigning meaning to it? The<br />

situation as it is, is not stressful. It’s when you<br />

make it mean something, that it’s stressful. So, it’s<br />

the thought- not the situation that’s causing you<br />

pain. For example, if you’re still getting a cycle<br />

and have at least one ovary and a uterus- you’re<br />

fine. It’s when you think it should have happened<br />

by now, or it’s not fair, or too late, that you stress<br />

yourself out.<br />

It’s a belief that fertility is harder than other areas<br />

in your life. From an energy perspective, it’s not. I<br />

know that can be tough to wrap our heads around<br />

sometimes, but it’s true. And it’s necessary to<br />

begin shifting your energy if you want to get out<br />

of the pattern. We must take some of the weight<br />

off of this idea of infertility so that it doesn’t feel<br />

so heavy energetically. It’s hard not to constantly<br />

focus on the lack and what’s going wrong with<br />

your fertility, but here are three simple things you<br />

can do to start shifting the tide.<br />

1) Make a list of why it could be easy to get<br />

pregnant. What DO you have going for you (ex:<br />

supportive spouse, taking care of self, regular cycle,<br />

had sex this month, etc.). We need to stop focusing<br />

on the problem, and focus on the solution and<br />

what feels good/capable. Why is it likely this could<br />

actually work? Feel into that daily.<br />

2) Pick relief. Sometimes it can be hard to make<br />

the energetic leap from fear of losing your dream,<br />

to “I’m pregnant!” So, relief is an emotion in the<br />

middle of those two, and once we can feel that,<br />

it’s easier for the brain to entertain the positive<br />

thoughts. What’s one thing that makes you feel<br />

relief about your current situation? What’s one<br />

thing YOU can do for yourself that makes you feel<br />

relief? Why in THIS moment right now, are you<br />

OK? (Because you are. I promise!)<br />

3) Look at other areas in your life where you’ve<br />

achieved something you never had before/didn’t<br />

know if you could. Remind yourself that energy in<br />

one area of your life isn’t different than another,<br />

so if you’ve achieved things in career, family,<br />

money, etc.; Then it is possible in this area as well.<br />

Write them down, close your eyes, put one hand<br />

on your solar plexus and say those things aloud<br />

daily. Make a list of all your victories because it<br />

makes you feel capable- and that’s the energy you<br />

need to make a human.<br />

A’ndrea is a Reiki Master and Holistic<br />

<strong>Fertility</strong> Specialist. She uses a combination<br />

of reiki, intuition and mindset coaching to<br />

move women through the emotional and<br />

physical blocks that are impeding them<br />

from conceiving naturally. Her book, How<br />

to Get Pregnant, Even When You’ve Tried<br />

Everything: A Mind-Body Guide to <strong>Fertility</strong><br />

is available on Amazon and Llewellyn<br />

Worldwide. Though based in New York City,<br />

she helps clients all over the world achieve<br />

their dream of motherhood.<br />

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MIND<br />

EXPERT: Cassie Everett<br />





When I talk to my clients about how they<br />

are feeling, the immense emotional strain of<br />

trying to get pregnant is often a big topic of<br />

conversation. Sometimes it's hard to cope when<br />

you feel that something may be wrong with<br />

you. Perhaps you don't feel normal and are<br />

angry that you are finding something difficult<br />

that others seem to find easy. You may be<br />

experiencing grief from a previous miscarriage,<br />

or anxiety and worry about losing future<br />

pregnancies. You might feel left out when your<br />

friends and family are having children.<br />

Many of my clients speak about the injustice of<br />

seeing pregnant women and babies everywhere,<br />

as well as the hurtful words of people who mean<br />

well, but can be insensitive.<br />

For those of you who have decided to embark<br />

on IVF treatment, you will be coping with lots<br />

of tests and procedures, as well as the additional<br />

financial strain.<br />

It may be that stress is making it harder for you<br />

to conceive due to the effect of stress hormones<br />

on your reproductive system, so every monthly<br />

disappointment becomes a vicious cycle. This can<br />

lead to issues between partners, with the pressure<br />

to perform sexually in a scheduled and clinical<br />

way exacerbating an already strained relationship.<br />

However you are feeling, it’s important<br />

to remember that these feelings are<br />

understandable and natural, and that you are<br />

not alone. It’s also a good idea to try and reduce<br />

your general stress levels. Here are some of my<br />

top tips on how to do just that.<br />




Talk it through<br />

There are many things you can do to try and<br />

reduce your stress levels. Most important is<br />

having someone to talk to – maybe a friend<br />

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or family member. If this makes you feel<br />

uncomfortable then you might like to consider<br />

counselling, attending a fertility support group<br />

or chatting anonymously on an online forum.<br />

This can help you feel less isolated<br />

and provide support. Remember<br />

that there are probably people<br />

you know going through<br />

the same thing as you.<br />

One in four couples have<br />

problems conceiving and<br />

finding other people who<br />

are experiencing the same<br />

as you can really help.<br />

Consider your own<br />

feelings<br />

It’s a good idea to avoid situations that upset<br />

you, and remember, don’t feel guilty about it! If<br />

you don’t want to go to a friend’s baby shower,<br />

don’t go. If you don’t want to go in to the baby<br />

shop, get a present online. Consider your own<br />

feelings and don’t put unnecessary pressure<br />

on yourself to do the so called ‘right thing’. Do<br />

what’s right for you.<br />

Do a stress audit<br />

Ask yourself if you have the right work/life<br />

balance. Are you working too much or taking<br />

on too much responsibility? Look at the<br />

different areas of stress in your life and think<br />

about whether any of these stresses can be<br />

reduced or removed, as the cumulative effect<br />

may be taking its toll on your fertility. The<br />

Many of my clients<br />

speak about the<br />

injustice of seeing<br />

pregnant women and<br />

babies everywhere<br />

more stress hormones are circulating<br />

round your body, the more disruption is<br />

caused to your reproductive hormones and<br />

hence your fertility.<br />

Do things you love – and<br />

look<br />

after yourself<br />

If you don’t have interests<br />

or hobbies, find something<br />

you love and do it. You<br />

should also build in<br />

daily relaxation to your<br />

schedule. This could be<br />

going for walks, doing yoga,<br />

visualisation, meditation or<br />

having a regular massage. Gentle<br />

exercise is also important. It helps alleviate<br />

anxiety and tension plus releases happy, calming<br />

hormones into your system. A good book that<br />

I often recommend my clients to read<br />

is, The Inside Out Revolution by<br />

Michael Neill as this helps us to<br />

see how our thoughts affect<br />

our feelings. Many of my<br />

clients feel that they will<br />

only be truly happy when<br />

they have a baby. This<br />

book really helps you<br />

to appreciate that it is<br />

you, and you alone that<br />

can create your happiness;<br />

no external influence can<br />

do that, not even a baby, even<br />

though it really looks like that!<br />

Above all, make sure you have some play<br />

time – schedule it in if you must, as it’s easy to<br />

forget the importance of fun while your life<br />

seems dominated by trying to conceive. Research<br />

has even shown that feelings of joy help us<br />

create more of the hormone DHEA in the body.<br />

DHEA is a luxury hormone, that means that<br />

the body can convert it into other hormones<br />

like Progesterone. As women age progesterone<br />

naturally declines and when women are stressed<br />

progesterone levels are often lower. Progesterone<br />

is THE pregnancy hormone and without enough<br />

of it we cannot hold a pregnancy, so any extra<br />

DHEA could make an important difference to<br />

your Progesterone levels.<br />

Invest in your relationship<br />

Remember that<br />

there are probably<br />

people you know going<br />

through the same<br />

thing as you<br />

As you know, many relationships suffer when<br />

fertility issues arise, so make time to focus on<br />

your relationship, and friendship, with<br />

your partner. This is a good time<br />

for romantic dinners and<br />

weekends away to help<br />

keep the spark alive.<br />

Be honest with<br />

yourself about your<br />

feelings<br />

Some of my clients<br />

write their thoughts<br />

and feelings down<br />

in a diary. This helps<br />

them release anxieties and<br />

frustrations without worrying<br />

that they are burdening someone else<br />

with them or being judged, and it’s a great way to<br />

free up some emotional space inside.<br />

Take a break<br />

If you feel like your fertility issues are taking<br />

over your life, why not take a break from trying<br />

for a few months to remove the issue and escape<br />

the vicious cycle for a while? Clear your head<br />

and allow your life, your relationship and your<br />

hormones to rebalance before you think about<br />

trying again.<br />

Use Australian Bush Flower Essences<br />

You might find the following combinations useful:<br />

• “Calm & Clear Essence” is great for relaxing<br />

and unwinding<br />

• “Dynamis Essence” is useful if you are feeling<br />

exhausted from stress and anxiety<br />

• “Relationship Essence” can help enhance the<br />

quality of intimate relationships<br />

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MIND<br />

You can buy Australian Bush Flower Essences from<br />

a good health food store such as: revital.co.uk/<br />

catalogsearch/result/?q=australian+bush+flower<br />

+essences<br />

Take as directed on the bottle.<br />

Put essential oils in the bath<br />

Not only is the very act of making time for<br />

a bath a great form of relaxation and creates<br />

‘me time’, but some essential oils can be used<br />

to induce a deeper sense of relaxation. A<br />

combination of rose, jasmine and neroli is<br />

ideal. These will help you to relieve stress and<br />

for women they will also enhance feminine<br />

qualities necessary for improving fertility.<br />

Alternatively, you can buy ready-made essential<br />

oil blends from nealsyardremedies.com<br />

which are more cost-effective than buying<br />

individual oils.<br />

Try homeopathic remedies<br />

The following homeopathic remedies can<br />

be taken for acute anxiety and emotional<br />

upsets. Select the remedy that most closely<br />

matches your thoughts and feelings. Buy it in<br />

30c potency from a pharmacy or health food<br />

store and take one pill when needed, up to a<br />

maximum of three a day for three days, leaving<br />

at least a week before repeating:<br />

• Arg Nit: for anticipatory anxiety, worrying<br />

about the baby during pregnancy or before<br />

doing a pregnancy test<br />

• Gelsemium: for anxiety especially after a<br />

shock or bad news e.g. from a miscarriage or<br />

diagnosis from the doctor<br />

• Ignatia: for the emotional roller coaster,<br />

feeling very tearful and even hysterical,<br />

embarrassed about emotions<br />

• Natrum Mur: for repeated grief and<br />

disappointment, want to be on your own, can’t<br />

cry any more<br />

• Pulsatilla: for feeling weepy all the time, don’t<br />

want to be alone, feel better after a good cry<br />

If your symptoms persist, always seek professional<br />

advice from a qualified homeopath.<br />

I really hope this has given you some useful<br />

suggestions as to how you can relax and destress,<br />

and cope with the emotional strain of<br />

trying to get pregnant. For more information<br />

on tailor-made natural solutions which could<br />

help you get pregnant please visit my website:<br />

cassieeverett.com or call on 07588 820 409.<br />

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MIND<br />

Conceive Plus helping<br />

couples conceive naturally<br />

When it comes to getting pregnant the path can be challenging.<br />

There are many challenges faced by couples<br />

who want to get pregnant naturally to start, or<br />

extend their existing family. Busy lifestyles,<br />

careers, buying a home, as well as everyday<br />

health concerns such as lack of sleep, poor<br />

diet and lack of exercise can create emotional<br />

stress or stress on the body, either of which can<br />

negatively affect the chance of conception.<br />

Even the process of conception itself, the journey<br />

of the sperm to the egg is a complex feat of<br />

biology fraught with variables. Despite the stories<br />

we read of how easy it is to get pregnant (and for<br />

some it is) statistically a couple in their twenties<br />

has a 20 to 25 percent chance of pregnancy each<br />

month. By 30, the chance of becoming pregnant<br />

in a given month lowers to around 15 percent<br />

and by 35, the likelihood is can be as low as 10<br />

percent in any month.<br />

When pregnancy does not occur as planned many<br />

couples can stress unnecessarily especially if<br />

there is a lack of education or understanding of<br />

fertility, such as the fertility period, the process of<br />

ovulation and the days that conception can occur.<br />

Stress can also lead to or exacerbate vaginal<br />

dryness and as a result many trying to conceive<br />

couples experience a lack of natural fertile fluid<br />

(Cervical mucus). Cervical mucus plays an vital<br />

role in the process of conception by creating the<br />

optimal vaginal environment as well as facilitating<br />

the movement of sperm to the egg. Trying to<br />

conceive couples are 50% more likely than couples<br />

that are not trying to pregnant to experience<br />

Vaginal dryness and 75% couples experience<br />

vaginal dryness when trying to conceive.<br />

Vaginal dryness is a cause of subfertility yet<br />

many couples do not even notice or understand<br />

that this can be a barrier to natural conception,<br />

traditionally a regular personal lubricant is<br />

used however these have been shown to damage<br />

sperm, are the formulated with the wrong PH<br />

(to acid) and wrong osmolarity (to thick), either<br />

damaging or creating a barrier to sperm and<br />

should not be used.<br />

Studies also indicate that a man’s health affects<br />

his sperm in both quality and quantity, and low<br />

sperm counts and poor quality have a negative<br />

effect on the chance of conception.<br />

Conceive Plus is isotonic formulated with the<br />

optimal PH and osmolarity to mimic natural<br />

cervical mucus with the added benefit of Calcium<br />

and Magnesium ions essential to support<br />

sperm cell motility and viability. The patented<br />

Conceive Plus formula matches natural fertile<br />

fluids, supplements moisture to support the<br />

viability and motility of sperm, and bonding of<br />

the sperm to the egg.<br />

In independent studies Conceive Plus is shown<br />

to be compatible with sperm and egg making<br />

it the lubricant of choice for couples who are<br />

trying to conceive.<br />

Through an intimate understanding of personal<br />

lubricants, optimal vaginal health and fertility<br />

Sasmar’s team has developed the Conceive<br />

Plus range, a selection of products specially<br />

formulated for couples who have just started<br />

trying as well as those who have been trying to<br />

get pregnant for a while.<br />

The newest edition Conceive Plus <strong>Fertility</strong> Support<br />

contains essential nutrients that prepare the body<br />

for conception including zinc, folic acid, iron,<br />

multivitamins and antioxidants in two specialty<br />

formulations for men and women.<br />

See website for information and retailers. Always<br />

read the label.<br />

Available from Lloyds Pharmacy,<br />

Amazon & Chemists conceiveplus.com<br />

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MIND<br />

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FERTILITY JOURNEYS <strong>2018</strong><br />










SINCE 2006<br />

NETWORK OF 4<br />




36 | fertilityroad.com<br />

www.klinikkhausken.no<br />

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FERTILITY JOURNEYS <strong>2018</strong><br />


JOURNEYS <strong>2018</strong><br />

Welcome back to the <strong>Fertility</strong> Journeys.<br />

We’re nearly at the end of another year and we’ve been busy working with our new<br />

couples and clinics making sure they are getting the support they need to start<br />

their fertility journeys.<br />

Herts & Essex <strong>Fertility</strong> Centre are contacting all of the couples who applied for the<br />

free IVF treatment and the 40 free fertility consultations. In the November issue<br />

we’ll be announcing the couples that have been selected.<br />

We welcome IVF Spain’s couple Claire and David who have already visited the IVF<br />

Spain team at their clinic in Alicante for the first embryo transfer.<br />

Redia IVF and Mediterranean <strong>Fertility</strong> Institute’s couple Kirstie and Christopher tell<br />

us about their journey so far as they prepare to travel to Greece in <strong>September</strong> for<br />

their treatment.<br />

Also Heather and Brandon who are working with our US partners Oregon<br />

Reproductive Medicine are expecting TWINS and Heather is in her third Trimester.<br />

We’re really looking forward to meeting the twins very soon.<br />

But we’re not stopping there as we have two new clinics joining us in <strong>September</strong><br />

and November.<br />

Keep an eye out for our newsletter with the news.<br />

Good luck to all of our couples on their journeys.<br />

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FERTILITY JOURNEYS <strong>2018</strong><br />



Exclusive<br />

Spanish<br />

Partner<br />

During the first week of August, Claire (42) and David (35), the winners of this year’s<br />

<strong>Fertility</strong> Journey, visited our clinic for their first embryo transfer.<br />

When we discovered that Claire didn’t have a single<br />

positive pregnancy test, we suggested to carry out an<br />

endometrial biopsy to analyse the sample by means<br />

of the ER Map® test (Endometrial Receptivity Map)<br />

in order for us to being able to accurately determine<br />

the receptivity of Claire’s endometrium during the<br />

window of implantation (the moment when the<br />

endometrial lining is receptive).<br />

”The test results showed that Claire’s endometrium<br />

was post-receptive, meaning that a transfer<br />

performed on day 5.5 of progesterone (like in 70%<br />

of cases) would not end up in a successful pregnancy”<br />

explains Dr Natalia Szlarb.<br />

They were pleased to share with us the emotion and<br />

joy created by their short stay in Spain;<br />

“We have spent some time in Alicante ahead of the<br />

transfer, relaxing in the area and preparing for our<br />

next visit to IVF Spain. Our experience with previous<br />

treatments with UK clinics has been very stressful<br />

but in Alicante, we have spent most of our time<br />

preparing for treatment by relaxing on the beach!”<br />

Claire and David arrived at IVF Spain after<br />

having been trying to get pregnant for 7 long<br />

years and 3 failed ICSI treatments with their<br />

own eggs. IVF Spain discovered that the embryos<br />

were of poor quality and that they had always<br />

been transferred on day 3 of their development<br />

with a bad morphology. In order to increase<br />

their chances of getting pregnant the clinic<br />

recommended an egg donation treatment, which<br />

greatly depends on matching the perfect donor<br />

to the patient.<br />

To protect both patients and donors, Spanish<br />

law requires that the donation process must be<br />

completely anonymous. In addition, donors<br />

must be in good condition and younger than 35.<br />

Dr Szlarb with<br />

<strong>2018</strong> winners<br />

Claire and David<br />

Moreover, both donor and patient must share a<br />

phenotypical resemblance: hair and eye color,<br />

BMI, and so on.<br />

Claire and David were grateful that so many women in<br />

Spain were willing to donate their own eggs, enabling<br />

others less fortunate, the chance of forming a family.<br />

“We are really grateful that there are people willing<br />

to donate eggs. If we are being honest, it has taken a<br />

while for us to understand the Spanish anonymity<br />

rules for egg donors, but we have taken the time to<br />

consider this. It’s hard not having control or letting<br />

another person being in charge for something<br />

related to your baby. However, we even think now it<br />

is better that way, because the more you know, the<br />

more you want to know and we do prefer knowing<br />

nothing and leaving it in the clinic’s hands.”<br />

There are other factors, however, that are crucial<br />

to achieving a successful pregnancy such as the<br />

quality of the embryo and the microenvironment<br />

of the endometrial lining. This means that a<br />

successful pregnancy also depends on the successful<br />

communication between the embryo and end the<br />

endometrial lining.<br />

“Before coming to IVF Spain, we had never heard<br />

of an endometrial study or ER Map. The fact that<br />

the endometrial study analyses the best time to<br />

transfer the embryo could make a big difference to<br />

our treatment. We were really impressed with the<br />

accuracy of the test. Our ER Map test result was postreceptive<br />

and although this was initially a concern,<br />

we later came around to the view that knowing the<br />

best time to transfer the embryo would increase the<br />

chances of success, and this might have been the<br />

reason our other treatments in the UK had failed” -<br />

Claire and David.<br />

Another key aspect to achieve a successful pregnancy<br />

is the male factor. David suffers from teratospermia<br />

which implies that 96% of the ejaculate sperm cells<br />

have an abnormal morphology. Luckily, we were able<br />

to improve David’s sperm quality and fertilize the<br />

retrieved eggs.<br />

We now wish them the best of luck!<br />

Although it will not be until mid-<strong>September</strong> when<br />

the <strong>2018</strong> runner-ups Laura (41) and Ian (44) visit<br />

us in Alicante for their embryo transfer, they<br />

already talked about the differences between IVF<br />

Spain and former clinics. They were impressed at<br />

how extensively their case had been studied by our<br />

fertility specialists.<br />

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FERTILITY JOURNEYS <strong>2018</strong><br />

Laura and Ian<br />

Immunologically speaking, finding a matching<br />

donor for Laura is certainly a challenging task, which<br />

is why IVF Spain suggested that we find out her KIR<br />

via a blood test. Ian was also tested for his HLA-C in<br />

order to determine whether the maternal – foetal<br />

interaction will be optimal or not.<br />

“I think the longer you have treatment the more<br />

difficult it becomes. When you begin there’s a<br />

naivety along the lines of, ‘we’ll have one, maybe<br />

two goes at IVF and have a baby in our arms’.<br />

After 7 treatments (and lots of add-ons) the<br />

feelings completely change. You feel terrified<br />

that it won’t work, and you’ll never become<br />

parents. You’re scared it will work and you’ll lose<br />

the baby again (Laura and Ian have experienced<br />

5 losses).<br />

You’re scared of physically going through the<br />

treatment as you’ve had so much. Each test and<br />

treatment creates fear – fear that it will hurt, be<br />

traumatizing, that it will give you more bad news.<br />

Then there’s the impact on your own mental<br />

health and emotional well-being. Can I handle<br />

this? What if the results say something’s wrong<br />

with me? Will I blame myself? It starts to really<br />

damage your mental health and well-being.<br />

Financially you start to feel that you’re risking<br />

everything, and it may not pay off.<br />

For us we have renewed hope with IVF Spain. We<br />

have undergone tests that we’ve never had before<br />

(ERA, NK biopsy and KIR). We have paid for<br />

lots of very expensive blood tests and drugs but<br />

never received this kind of analysis. So, we feel as<br />

though the treatment is now specifically for us.<br />

This creates more positivity, a feeling of being<br />

cared for and that maybe, just maybe, we’ll get to<br />

be parents.<br />

Plus, we’re now using donor eggs. The hope starts to<br />

soar and with that comes excitement. Hope is the<br />

only thing that keeps you going and overcoming the<br />

fears I mentioned. This opportunity with IVF Spain<br />

has given us hope that we thought we’d lost.”<br />

Laura is 41 years old and has already been through<br />

traumatic losses including an ectopic pregnancy.<br />

Due to this and to the fact that Laura suffers from<br />

trisomy 22 syndrome, our medical team at IVF<br />

Spain recommended an egg donation treatment to<br />

increase their chances.<br />

The couple is thankful for the egg donation process<br />

being anonymous, as otherwise it would be really<br />

difficult to find a donor:<br />

“For us, it’s taken some of the pressure away. I can’t<br />

imagine how difficult it would be to choose a donor<br />

ourselves. But putting your complete trust into<br />

someone else’s hands is hard.<br />

We’ve explored whether it would be better for<br />

our future child to know the donor. I think that’s<br />

something we’ll never know. But we hope that he/she<br />

will understand our decision to choose an anonymous<br />

donor. It would be good to know a little more about the<br />

heritage of the donor but then we also know that we<br />

often don’t even know our own heritage. We’ll make<br />

sure Spain is a key part of their story.<br />

It’s also really odd to not know who this person<br />

is. What they look like and personality. What’s<br />

motivating them to help us. One of the things I’ve<br />

been really consumed with is the gratitude you have<br />

for this person. I’d like to thank them but can’t.<br />

Anonymity means we have a chance to become<br />

parents. Without it there’d be a shortage of donors<br />

like there is in the UK. For us, this makes it a<br />

wonderful gift – a chance to hopefully find a donor<br />

that is perfectly matched to us genetically (due to the<br />

KIR tests) as well as in physical looks.<br />

I can’t stop thinking about what our future child will<br />

look like – but I think that’s quite normal” says Laura.<br />

Thanks to the KIR-HLA-C genotyping test it is<br />

possible to determine if the uterine KIR and the<br />

embryonic HLA-C will both be compatible. If so,<br />

the pregnancy will carry on successfully; if not, then<br />

the most probable outcome will be an unviable<br />

pregnancy and subsequent miscarriage.<br />

“We carried out the KIR-HLA-C genotyping and<br />

concluded that the patient had a KIR AA. It is<br />

known that KIR expressed by the natural killer<br />

cells present in the maternal part and the HLA<br />

presented by the trophoblastic cells together will<br />

influence the outcome of the pregnancy. With<br />

Laura’s KIR AA variant, the sperm would have to<br />

be HLA C1 C1 and the HLA of the donor should be<br />

as well HLA C1 C1; as her husband has a HLA C1<br />

C2 variant, we will treat her with a medication that<br />

reduces her immune-genetic reaction. We believe<br />

that not paying attention to this issue in the past<br />

is what may have caused the implantation to fail”<br />

suspects fertility specialist Dr Isabel Herrera.<br />

We tend to recommend a single embryo<br />

transfer, as it has been proven that on patients<br />

with an immunological profile such as Laura’s,<br />

a double embryo transfers would increase<br />

the immunogenetic reaction, hindering the<br />

achievement of a pregnancy” says Dr. Herrera.<br />

It is also known that these cases tend to have a<br />

higher risk of pre-eclampsia, late spontaneous<br />

abortion or miscarriage.<br />

Until their transfer day the couple will try to enjoy<br />

summer just as any other couple would;<br />

“I’ve tried to just carry on as normal. Remain<br />

healthy, take pre-conception vitamins. Reach out<br />

and get support through the Donor Conception<br />

Network in the UK and connect with other people<br />

going down the DE route via online forums. It’s<br />

quite isolating and scary so it’s important to reach<br />

out and not feel so alone.<br />

I’m trying to relax a little – not so easy with work but<br />

it’s a work in progress. I need to get that bit sorted<br />

now treatment is on the horizon.”<br />

Dr Isabelle Herrera<br />

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FERTILITY JOURNEYS <strong>2018</strong><br />




Around Christmas time of 2015, we met with<br />

the Sunday Life journalist in Belfast to discuss<br />

infertility and our journey towards finding an<br />

egg donor. We openly discussed our journey<br />

to date with the journalist and had some<br />

photographs taken for the newspaper. A few<br />

weeks later our story featured in the newspaper<br />

seeking an anonymous egg donor.<br />

In May 2016 we received a call from the Regional<br />

<strong>Fertility</strong> Centre at the Royal Victoria Hospital in<br />

Belfast. Allison McKee from the Centre informed us<br />

that an anonymous donor had come forward after<br />

seeing our advertisement and wished to donate her<br />

eggs to help us fulfil our dream of having a family.<br />

We thought it was amazing that we received this<br />

news less than 48 hours after we had got engaged.<br />

At 16 years old I was still waiting for my first<br />

period and was advised to visit my GP. After<br />

many blood tests, scans, and open key hole<br />

surgery I was diagnosed with premature ovarian<br />

failure. My consultant advised me at this young<br />

age that my only chances of ever conceiving a<br />

child would be through egg donation. I would be<br />

able to carry a child but unfortunately, I would<br />

have no eggs to conceive naturally.<br />

This was shattering news to receive at such<br />

a young age for me and my family. I did not<br />

really understand the implications of this<br />

condition and always held onto the hope that I<br />

would conceive children naturally. As the years<br />

progressed I gained a better understanding of<br />

my condition, but it only really started to sink in<br />

when I met my partner Chris in <strong>October</strong> 2012.<br />

I had spoken to Chris early on in our relationship<br />

about my condition and he was understanding<br />

and supportive; fully aware of the difficulties we<br />

might face to have our own family. Chris decided<br />

to get his sperm tested early on in our relationship<br />

to ensure he had good quality sperm for whenever<br />

we would go through fertility treatments. We were<br />

delighted when Chris’s results came back as normal<br />

and his GP advised that he had no fertility issues.<br />

Our fertility journey began in<br />

2015 at the Grove Wellbeing<br />

Centre in Belfast where<br />

we met Gillian about<br />

advertising for an egg<br />

donor. Gillian discussed<br />

during our appointment<br />

the possibility of doing<br />

an advertisement in the<br />

local Sunday Life newspaper<br />

in Northern Ireland. We<br />

were very open to this idea and<br />

received contact from the editor of<br />

the newspaper, Angela, very shortly after our<br />

appointment with Gillian.<br />

I had spoken to<br />

Chris early on in our<br />

relationship about my<br />

condition and he was<br />

understanding and<br />

supportive<br />

Chris & I would do anything to have a child and<br />

following the phone call with Allison I started to<br />

make some life changes. I changed my diet, ate<br />

healthy foods, took folic acid daily and started fertility<br />

acupuncture with Sharon Campbell, a renowned<br />

fertility acupuncturist in Northern Ireland.<br />

In July I received my medication to prepare my<br />

body for pregnancy. In subsequent appointments<br />

my bloods were normal, and my womb lining<br />

was thick for egg transfer. I was visiting Sharon<br />

once a week which I believed helped<br />

towards the thickening of my womb<br />

lining and helped my mental<br />

state during this emotional<br />

roller coaster.<br />

The day before the embryo<br />

transfer I received a call<br />

from the laboratory to<br />

inform me that 2 donor<br />

eggs had fertilised and they<br />

would be transferred the<br />

next morning. On 4th August<br />

our transfer took place and two 6<br />

cell embryos were transferred into my<br />

womb with no complications. Now it was the 2<br />

weeks wait before I took a pregnancy test.<br />

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FERTILITY JOURNEYS <strong>2018</strong><br />

I took 2 weeks off work to give the embryo the<br />

best possible chance to implant and followed all<br />

guidelines given to me by the professionals.<br />

give anything to have our own child to love and<br />

protect and hopefully someday soon, with the help<br />

of yourselves, you can make our dreams come true.<br />

•Can we afford the travel & test costs?<br />

•Can we get the time off work?<br />

On 18th August we did our pregnancy test. Our<br />

dreams were shattered when the result came back<br />

negative, it was the worst feeling in the world. We<br />

had believed because we were so young we would<br />

have a better chance of a positive result.<br />

During and after the procedure we attended<br />

counselling and eventually came to terms with<br />

the negative result. This was our only free cycle<br />

of egg donation available here.<br />

We have been together now for<br />

nearly 6 years. We have built<br />

a loving home together. I am<br />

a full time childcare worker<br />

which has always been my<br />

passion. Chris is a full-time<br />

manager in Tesco.<br />

Despite all this, there is one<br />

thing missing from our lives<br />

and that is the dream of having a<br />

child. We are both young, fit, healthy,<br />

hardworking individuals and have so much<br />

love to give a child. I have a big family and have<br />

grown up with children my whole life. We are<br />

happy to share our story with others facing similar<br />

scenarios to demonstrate that wherever you are in<br />

your particular fertility journey there are always<br />

options – options to consider, and support to help<br />

you make the right decisions for you. We would<br />

We literally could<br />

not believe it and had to<br />

read the email numerous<br />

times in floods of happy<br />

tears to check this was<br />

actually real<br />

We received the email to say we were the lucky<br />

winners on 20th June. It is very difficult to put into<br />

words how we felt. To be the selected couple is very<br />

hard to believe and we count ourselves so lucky to<br />

have been given this amazing opportunity.<br />

We literally could not believe it and had to read the<br />

email numerous times in floods of happy tears to<br />

check this was actually real. Eventually we were able<br />

to write a response obviously accepting the<br />

offer. Finally, when the news had<br />

sunk in we started to ask ourselves<br />

questions about travelling to<br />

Greece and researching the<br />

clinic and island etc.<br />

Over the next 2 weeks<br />

we acted very quickly<br />

in getting all our tests<br />

together, sorting time off<br />

work, arranging flights &<br />

accommodation and getting<br />

the required medication. We went<br />

through a number of stumbling blocks.<br />

With the amazing Shirley supporting us via email<br />

we were able to sort everything very quickly and<br />

her advice was invaluable during this period.<br />

Despite all this we were naturally worried about<br />

travelling to Crete for this treatment. We asked<br />

ourselves many questions<br />

•Where will we stay in Crete?<br />

•Is my body going to respond to the medication?<br />

When we went through our free cycle of<br />

treatment with the NHS over here in Northern<br />

Ireland, the success rates were only 24%. To<br />

know that the success rate in Crete is almost 3<br />

times that gives us massive hope and we would<br />

obviously not be travelling to Crete and putting<br />

ourselves through all this if we didn’t think it<br />

was going to work.<br />

Everything is arranged, booked and paid for. I<br />

am currently on the Microgynon pill on my first<br />

cycle. My first uterus scan is on 20th August. We<br />

depart for Crete from Dublin on 12th <strong>September</strong>,<br />

we are staying for 2 weeks and are so excited to<br />

undergo the treatment and meet all the team in<br />

the Mediterranean <strong>Fertility</strong> Institute. A special<br />

mention must go to Shirley who has helped us<br />

out so much over the past few weeks with our<br />

endless questions and emails. She has made this<br />

experience a lot easier.<br />

We are both super excited and hopefully our<br />

story will encourage other young couples like<br />

ourselves to take the step of travelling abroad for<br />

treatment. It seems scary preparing to go abroad<br />

for treatment but with the help of your chosen<br />

clinic everything runs smoothly.<br />

We sincerely hope that the team in Crete can<br />

make our dream come true. It is impossible to<br />

put into words how much we want a baby and to<br />

be taking this step now in travelling abroad is<br />

so surreal. We never seen ourselves at 25 years<br />

old travelling to Crete for egg donation. At this<br />

moment in time and certainly in the foreseeable<br />

future there is no chance we would be able to<br />

afford the treatment anywhere, so this feels like<br />

our only hope of having a bundle of joy.<br />

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FERTILITY JOURNEYS <strong>2018</strong><br />




After nearly ten years trying to build their family, Heather and Brandon are starting the<br />

third trimester of Heather’s pregnancy. Their 20-week scan has given them a good look<br />

at their baby girl and boy who are continuing to develop well.<br />

Heather writes…<br />

We’ve made it to the start of my third trimester<br />

and are all smiles right now!<br />

While nausea has continued to pay a significant<br />

role in my journey, anti-nausea medications<br />

have become my best friend. I‘ve been needing<br />

to take anti-nausea medication once every eight<br />

hours (three times a day) to help avoid constant<br />

vomiting. Food has become challenging. There are<br />

very few foods I enjoy with the exception of fruit,<br />

smoothies, lemonade and tart candy.<br />

Importantly though, the babies are doing well and<br />

both are maintaining an above average heart rate. I<br />

cannot feel them moving just yet but have been told<br />

by my doctors that they are actively moving and<br />

kicking each other. I was told that it is normal for<br />

them to kick each other in order to start developing<br />

basic capacity for their limbs.<br />

My daily routine is waking up, going to work, coming<br />

home to nap, eating take out - because the smell of<br />

food lingering in the house makes me nauseous -and<br />

heading back to sleep by 10:30 p.m. I will be honest<br />

that I have never felt so tired in my life.<br />

I do not feel at all in control of my own body and<br />

many of the basic tasks I used to do on a consistent<br />

basis seem impossible (washing clothes, tidying up<br />

the house, etc.).<br />

Brandon is doing a lot of the research that I am<br />

too tired to do. He sends me, on a consistent basis,<br />

helpful tips and bits of information and weekly<br />

“what to expect” updates.<br />

After much<br />

anticipation, our<br />

20-week ultrasound<br />

went well and it was<br />

amazing to see our<br />

babies right there in<br />

front of us.<br />

42 | fertilityroad.com<br />

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FERTILITY JOURNEYS <strong>2018</strong><br />

Through these updates we are following the size<br />

of each baby and what parts of the anatomy they<br />

are starting to develop at each stage. They are<br />

also helping us focus on the things we should<br />

start to prepare for so that we are properly pacing<br />

ourselves through this journey.<br />

As an example, we were given the suggestion of<br />

talking about how we will handle life after the birth,<br />

making sure I invest in flats for the remainder of<br />

my pregnancy and knowing the symptoms and<br />

risks of preeclampsia.<br />

After much anticipation, our 20-week ultrasound<br />

went well, and it was amazing to see our babies right<br />

there in front of us. Because we are having fraternal<br />

twins our ultrasound took more time to complete.<br />

Baby A is our girl and she is located closest to my<br />

waist. Baby B is our boy and he is higher up and<br />

above my belly button.<br />

Our baby girl has been diagnosed with a two-vessel<br />

umbilical cord instead of a three vessel cord. Our<br />

baby boy has a three-vessel umbilical cord and is<br />

the most active.<br />

Most babies’ umbilical cords have three blood vessels:<br />

one vein, which brings nutrients from the placenta<br />

to the baby, and two arteries that bring waste back<br />

to the placenta. But a two-vessel cord has just one<br />

vein and one artery — that’s why the condition is also<br />

referred to as having a single umbilical artery (SUA).<br />

It’s more common than you might think and is the<br />

most common abnormality of the umbilical cord.<br />

Our doctor informed us that in most cases, the<br />

one artery just makes up for what the missing one<br />

would do. However, there’s a slight increase in risk<br />

of growth problems and a minimal increase in risk<br />

of stillbirth. Our doctor has informed us that her<br />

weight is currently as should be expected and they<br />

will monitor our baby girl closely.<br />

I have been scheduled for several ultrasound<br />

follow-ups to ensure they are both doing well. Thus<br />

far, they are both flourishing and maintaining an<br />

above average weight. We are happy campers!<br />

We are currently in the process of making<br />

arrangements for a close to home babymoon with<br />

a car ride that will not exceed two and a half hours.<br />

Our goal is to stay close to home, enjoy a massage or<br />

two and have some time to lounge in a nice pool!<br />

In addition, we are awaiting the invitations for our<br />

upcoming baby shower which will take place around<br />

the corner from our house on the day of my birthday!<br />

We are excited to send out invitations in the<br />

coming days and share my birthday with one of the<br />

best gifts we have ever received.<br />

Dr Barbieri comments on Heather and Brandon's journey<br />

The 20-week scan is almost always a much anticipated point<br />

in every pregnancy. Not only is it an important milestone for<br />

being able to check on foetal development, but also modern<br />

ultrasound technology gives expecting parents a good peak at<br />

their growing babies.<br />

The precision of modern ultrasounds will have enabled the<br />

diagnosis at the 20-week scan of single umbilical artery (SUA)<br />

for Heather and Brandon’s baby girl. Heather is correct that<br />

SUA is the most common congenital abnormality of the<br />

umbilical cord. The cause of SAU is a not fully known and<br />

there is no scientific consensus on the incidence and clinical<br />

significance of SUA in twin compared to singleton pregnancies.<br />

Generally diagnosis of SUA is made during the third trimester. The earlier awareness of SUA for<br />

their baby girl will allow Heather’s OB/GYN to formulate a protocol for monitoring both babies’<br />

development and managing Heather’s pregnancy. I am glad that Heather has a schedule for regular<br />

ultrasound monitoring.<br />

There is generally a growth in the size of the single artery for an affected baby near the start of the third<br />

trimester. Heather’s OB/GYN will be watching for this change, and their baby girl’s continued increase<br />

in weight and a strong heartbeat as key indicators of her healthy development.<br />

I am comforted to know that Heather’s OB/GYN has personal experience with twins. A twin pregnancy<br />

carries higher risks, so expertise with twin pregnancies and enhanced monitoring is called-for, even<br />

more so with the diagnosis of SUA for their baby girl.<br />

We are honoured to have been able to help Heather and Brandon and will be continuing to follow<br />

their journey closely. Along with them, we are counting the days now that they are in their third and<br />

final trimester.<br />

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FERTILITY 360<br />

EXPERT: Craig Reisser<br />

THE<br />

VALUE<br />

OF<br />


RATES<br />

Understand Success Rates and Help<br />

Keep Your Surrogacy Journey on Track<br />

44 | fertilityroad.com<br />

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FERTILITY 360<br />

Craig Reisser, a parent via egg donation and<br />

surrogacy in the USA, shares some advice for<br />

intended parents on how to use success rates<br />

when planning your surrogacy journey.<br />

When it comes to choosing an IVF clinic a<br />

discussion of success rates is sure to be one of the<br />

key considerations.<br />

Success rates can be a notoriously complicated area<br />

for intended parents, not only because there can be<br />

so many factors that play a part in them, but also<br />

because clinics may report them in any number of<br />

ways. I certainly found this to be true when I was<br />

undertaking my own journey.<br />

Because your IVF clinic will play a pivotal role in<br />

shaping your journey, understanding how to make<br />

sure you are focussing on the right success rates<br />

for the specific IVF procedure you are planning, as<br />

well as how to apply them in a practical manner to<br />

your decision making is essential.<br />

In my view, your ideal goal with IVF should be<br />

to have the best chance of success and a healthy<br />

baby on your first attempt. Or in other words<br />

minimising the risk that you will have to repeat<br />

any aspect of the IVF process. This is the best way<br />

to keep your budget and timetable under control<br />

and your stress levels to a minimum.<br />

While my focus here is on IVF for a surrogacy<br />

journey, as this was my own personal experience,<br />

this same objective can apply equally to anyone<br />

undergoing IVF – whether using her own eggs or<br />

donor eggs, working with a surrogate or planning<br />

to carry the pregnancy herself.<br />

In an ideal world, first time success would mean<br />

two things. Firstly, only needing one egg retrieval<br />

and embryology cycle (including embryo testing<br />

if applicable) to obtain all the viable embryos<br />

that you will need to build your family. Secondly<br />

only needing a single embryo transfer for the live<br />

birth of a healthy baby.<br />

For many intended parents their actual IVF<br />

experience does not reflect this ideal and they<br />

may require more than one egg retrieval and<br />

embryology cycle and/or more than one embryo<br />

transfer to achieve their dream of a healthy baby.<br />

Each time that you need to repeat either of these<br />

steps in the IVF process there are real implications<br />

for you in terms of higher costs, a longer timetable,<br />

and added emotional stress.<br />

The real "value of success" is therefore that higher<br />

success rates can help you avoid costs, keep your<br />

timeline to a minimum, and your stress levels in check.<br />

Intended parents therefore need to know which<br />

success rates to focus on, how to apply them to make<br />

practical choices, and what they mean in terms of<br />

the likely number of times they will have to undergo<br />

each step of the IVF process to reach their goal.<br />

With this in mind, I focus on two key elements of<br />

the IVF process where achieving first time success<br />

can make a real difference in your journey: the<br />

egg retrieval and embryology cycle and the<br />

embryo transfer. These steps are distinct but<br />

intimately connected.<br />

My focus on these two aspects is not meant to<br />

diminish the importance of other elements of the<br />

IVF process that can play a part in having a healthy<br />

baby, such as genetic screening and the choice<br />

regarding the number of embryos to transfer, and<br />

which intended parents should also consider.<br />

Egg Retrieval and<br />

Embryology Cycle<br />

In my view, the real measure of success for an egg<br />

retrieval and embryology cycle is the number of<br />

viable embryos obtained, and whether this meets<br />

or exceeds the number that you can expect you<br />

may need.<br />

The number of viable embryos that you may need<br />

depends on how many children, over time, you<br />

hope to have multiplied by the number of transfers<br />

you can expect will be required to achieve a live<br />

birth. If you plan to transfer more than one embryo<br />

at a time then this needs to be factored in as well.<br />

It’s certainly true that you only need one viable<br />

embryo to have a child and success on the first<br />

embryo transfer can absolutely happen. However,<br />

the reality is that that embryo transfer success<br />

rates are not 100%. Therefore, there is a potential<br />

risk that you may need to repeat the egg retrieval<br />

and embryology cycle if you only have a single<br />

embryo at the end of this step in the IVF process.<br />

For example, if you hope for one child and can<br />

expect that you may need to undergo two transfers<br />

to achieve a live birth, then you will hope to have<br />

at least two viable embryos. If say however, you<br />

hope to also have a sibling in the future for your<br />

first child (and can expect that again you may<br />

need to undergo two transfers to achieve a live<br />

birth) then you will hope to have obtained at least<br />

four viable embryos from your egg retrieval and<br />

embryology cycle in order to minimise the risk of<br />

needing to repeat this step to create more embryos.<br />

The egg retrieval and embryology cycle is the most<br />

expensive part of the IVF process to have to repeat.<br />

It may represent some 75-80% percent of the IVF<br />

costs of a single successful journey. In addition to<br />

the medical costs you may incur for a repeat cycle, it<br />

you are using an egg donor there will also be donor<br />

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FERTILITY 360<br />

compensation and potentially travel reimbursement,<br />

as well as possibly egg donor agency fees and<br />

screening costs that may need to be paid again.<br />

Depending on when this step would need to be<br />

repeated, and possible scheduling considerations,<br />

(e.g. egg donor availability) it could lengthen your<br />

timeline from a few to several months.<br />

Unfortunately, for intended parents, the public<br />

databases for clinic success rates (such as SART and<br />

the CDC in the USA) do not report the statistics,<br />

namely the average number of viable embryos<br />

that each cycle type has achieved at a clinic, which<br />

could help inform intended parents’ decisions.<br />

Though each cycle is unique and some factors<br />

cannot be controlled, IVF clinics should have this<br />

type of success data, particularly in the case of egg<br />

donor cycles. You should be sure to ask about this,<br />

as well as the factors that contribute to successful<br />

egg retrieval and embryology cycles, including<br />

stimulation and egg retrieval medical protocols,<br />

the quality of the embryology laboratory, and<br />

the role of ovarian reserve. This will help you in<br />

making decisions that may help you increase the<br />

chance of first time success.<br />

Embryo Transfer<br />

Beneficially for intended parents, the public<br />

databases for clinic success rates generally<br />

focus on the statistics that help them<br />

understand the chance of success with an<br />

individual embryo transfer.<br />

Live Birth Rate Per Transfer, is the relevant success<br />

rate to focus on as it represents your ultimate<br />

goal. Where more than one embryo has been<br />

transferred, a Live Birth Rate Per Transfer will<br />

refer to the birth of at least one child.<br />

Sometimes, clinics may instead quote Pregnancy<br />

Rate Per Transfer. This represents the percentage<br />

of embryo transfers that had an ongoing<br />

pregnancy when the rate was calculated. This is<br />

not the same as Live Birth Rate Per Transfer as<br />

some pregnancies that were ongoing when the<br />

success rate was calculated will not progress. As a<br />

result, this measure will be a few to several points<br />

higher than the one that matters most for you.<br />

Occasionally some clinics may report their<br />

success rates on a cumulative rather than a per<br />

transfer basis. Cumulative success rates calculated<br />

over multiple embryo transfers will be higher in<br />

comparison to per transfer success rates.<br />

Cumulative rates can be helpful if understood<br />

correctly, but intended parents may be confused<br />

in thinking that a Live Birth Rate presented on a<br />

cumulative basis is comparable to one presented<br />

on a per transfer basis. For example, a 67% Live<br />

Birth Rate Per Transfer will represent a much<br />

greater chance of success on the first transfer<br />

attempt (and therefore a lower cost and shorter<br />

timeframe) than a 67% Cumulative Live Birth<br />

Rate calculated over say three transfers.<br />

Generally speaking it takes more than one<br />

embryo transfer to achieve a live birth. So<br />

from a practical point of view you may want to<br />

translate the Live Birth Rate Per Transfer into<br />

an estimation of the number of embryo transfer<br />

attempts you may actually need in order to<br />

achieve a live birth. It is this number of expected<br />

embryo transfer attempts that will influence the<br />

number of viable embryos you should hope to<br />

obtain from your egg retrieval and embryology<br />

cycle. It will also impact how you plan your<br />

budget and timetable.<br />

If an embryo transfer needs to be repeated then<br />

this will add to your timeline and costs. Extra<br />

costs may include the transfer procedure itself<br />

and related medications, pre and post transfer<br />

monitoring, as well as other costs such as travel.<br />

You can estimate the potential number of embryo<br />

transfers you may need to achieve a live birth. Using<br />

the Live Birth Rate Per Transfer, you can calculate<br />

the cumulative probability that you will have a live<br />

birth within a certain number of transfers.<br />

In the example below, using a Live Birth Rate<br />

Per Transfer of 50%, intended parents would<br />

have a 88% chance of having a live birth within<br />

3 transfers. They may get lucky and have a live<br />

birth on the first or second transfer, and there<br />

still remains a small chance that they will not<br />

have been successful by the third transfer. This<br />

type of calculation can help intended parents<br />

plan for the possible implications to their budget<br />

and timeline of their IVF clinic’s success rate.<br />

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FERTILITY 360<br />

Indicative Added Costs of Having to Repeat an Embryo Transfer<br />

Live Birth Within n<br />

Embryo Transfers<br />

Cumulative Probability<br />

of Live Birth 1<br />

Indicative Added<br />

Months 2 Indicative Added Cost 3<br />

1 50% -<br />

2 75% +2-4 $3,000 – 5,000<br />

3 88% +4-8 $6,000 – 10,000<br />

4 94% +6-12 $9,000 – 15,000<br />

1. Based on the SART-reported US National Live Birth Rate Per Transfer in 2016 for all donor egg + surrogacy frozen embryo transfers.<br />

2. 2-4 months in an indicative period of time to prepare for and undergo a repeat embryo transfer.<br />

3. $3,000 – 5,000 is an indicative additional cost of elements associated with a repeat embryo transfer. If an additional egg retrieval<br />

and embryology cycle were needed these costs would be extra.<br />

Success the First Time<br />

In my family’s own journey, we found that this<br />

type of understating of success rates helpful.<br />

It focussed us on the factors that would help<br />

keep our journey on track, namely obtaining<br />

the highest number of viable embryos and<br />

minimising the number of required transfers.<br />

It also allowed us to plan our budget and<br />

timeline, accounting for the probability that<br />

we might have to repeat either step in the IVF<br />

process. Thankfully, we had the first-time<br />

success that we were hoping for and I believe<br />

that the decisions we made, armed with this<br />

understanding, played a big part in this.<br />

US IVF Success Rate Resources<br />

For those intended parents looking at IVF<br />

treatment in the USA, there are two online,<br />

public databases that contain national and<br />

individual US IVF clinic success rates - The US<br />

Society for Assisted Reproductive Technology<br />

(SART) at SART.org and the US Centers for<br />

Disease Control (CDC) at cdc.gov/art.<br />

SART has been recording US IVF clinic<br />

success rates since 1988. Additionally, since<br />

1992 all US IVF clinics have been mandated<br />

by the US government to report their success<br />

rate data to the CDC. SART membership is<br />

voluntary for US IVF clinics. About 80% of<br />

US IVF clinics are SART members and about<br />

95% of US IVF cycles are captured in the<br />

SART success rate database.<br />

Both SART and the CDC have now released<br />

the 2016 live birth success rates for US IVF<br />

procedures and this represents the most<br />

current US live birth success rates. The 2016<br />

data is available alongside the 2015 data for<br />

year-on-year comparisons. The 2017 live birth<br />

rate data will be known and reported in the<br />

Spring of 2019.<br />

The SART database allows for easy filtering<br />

by clinic for specific procedure types –<br />

surrogacy, egg donation, PGS/PGD testing,<br />

and more – as well as for the specific number<br />

of embryos transferred.<br />

Craig is a regular contributor to <strong>Fertility</strong><br />

<strong>Road</strong> on third party reproduction.<br />

Look for his upcoming articles on egg<br />

donation and surrogacy in future issues<br />

of <strong>Fertility</strong> <strong>Road</strong> or contact him at<br />

oregonreproductivemedicine.com.<br />

This functionality is a real benefit for<br />

intended parents considering US IVF<br />

clinics as they can now search for live birth<br />

success rates for the exact procedure they<br />

are seeking to undergo by clinic, as well<br />

as US national averages for comparison.<br />

It also allows them to view consistently<br />

prepared and presented data and live birth<br />

success rates for every clinic they may be<br />

considering. It allows them to reference a<br />

clinic’s 2016 data to its 2015 results as well<br />

to national statistics for both periods.<br />

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FERTILITY 360<br />

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FERTILITY 360<br />

What Women Need To<br />

Know About Polycystic<br />

Ovary Syndrome<br />

By Michael Ah-Moye FRCOG, CEO and Consultant Gynaecologist<br />

What are polycystic ovaries?<br />

The term Polycystic ovaries was coined in the<br />

1930’s because it was thought that the ovaries<br />

contained many cysts, which was incorrect as<br />

the “cysts” are in fact just follicles. A follicle is<br />

where an egg develops. Polycystic ovaries are<br />

usually larger in size and contain more follicles<br />

than normal.<br />

What is polycystic ovary<br />

syndrome?<br />

It is important to know that having polycystic<br />

ovaries does not necessarily mean that the woman<br />

has Polycystic Ovary syndrome. Some women<br />

have polycystic ovaries without any symptoms.<br />

Only women manifesting symptoms are classified<br />

as having the syndrome. Studies show that 20 –<br />

25% of all women have polycystic ovaries, but less<br />

than 10% will have the syndrome.<br />

Polycystic ovary syndrome (known as PCOS) is,<br />

therefore, a common hormone disorder. It can<br />

cause a woman’s menstrual cycle to be longer<br />

than normal, be irregular and infrequent, and<br />

in severe forms, there may be no periods at all.<br />

PCOS can affect a woman’s ability to conceive<br />

and may affect her appearance with excess<br />

body and facial hair, acne and oily skin, and a<br />

tendency to be overweight.<br />

What causes PCOS?<br />

There is no known cause for PCOS and why some<br />

women develop it while others don’t. However, we<br />

do know that it often runs in the family, so there<br />

may be a genetic link to the condition.<br />

What are the symptoms of<br />

PCOS?<br />

•Irregular periods where there are longer gaps in<br />

between periods or no periods at all<br />

• Increase in facial and body hair known as<br />

hirsutism<br />

• Loss of hair on the head<br />

• Oily skin and acne<br />

• Problem with fertility<br />

• Overweight<br />

Most of the symptoms of PCOS are due to the<br />

abnormal hormone levels associated with the<br />

condition and can vary tremendously from<br />

woman to woman. The hormones that are<br />

abnormal, are raised levels of the male hormone<br />

testosterone and also insulin which is a hormone<br />

linked to diabetes.<br />

Women trying to fall pregnant may also face<br />

difficulties, due to ovulatory problems associated<br />

with PCOS. There also appears to be an increased<br />

risk of miscarriages.<br />

Mood swings and depression<br />

Women with PCOS are more likely to experience<br />

higher levels of depression and low self-esteem,<br />

caused both by the hormonal imbalances of the<br />

condition or by the symptoms it presents. If<br />

you are experiencing mood swings, do get help<br />

from your doctor for both your PCOS and your<br />

depression, even if it means a referral to a mental<br />

health specialist.<br />

Diagnosis<br />

As already mentioned some women with<br />

polycystic ovaries do not have the syndrome and<br />

therefore do not have any symptoms. Many are<br />

diagnosed when they seek help for their infertility.<br />

Others have symptoms but are unaware of what<br />

causes them. Symptoms to look out for: irregular,<br />

infrequent periods and an increase in facial or<br />

body hair.<br />

The best investigations to diagnose polycystic<br />

ovaries are ultrasound scan of the ovaries and<br />

hormone tests to check the levels of Anti-<br />

Mullerian Hormone (AMH) and testosterone.<br />

What are the long-term<br />

consequences of PCOS?<br />

Irregular periods can increase the risk of uterine<br />

cancer, acne can cause scarring, and weight can<br />

become harder to manage. Getting diagnosed and<br />

treated sooner rather than later is the best way to<br />

lower the risk of these problems.<br />

Insulin resistance and<br />

diabetes<br />

In PCOS the body responds less well to insulin<br />

which leads to a higher level of insulin and<br />

increased glucose level. Raised insulin may<br />

lead to irregular periods, weight gain, increased<br />

testosterone and fertility problems. It is estimated<br />

that 10-20% of women with PCOS go on to develop<br />

diabetes in later life. Furthermore, women with<br />

PCOS have an increased risk of diabetes if they are<br />

over 40 years old, have a family history of diabetes,<br />

have developed gestational diabetes in previous<br />

pregnancies and those who are obese.<br />

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FERTILITY 360<br />

Cancer<br />

A very small number of PCOS women who have<br />

significantly fewer periods per year than normal<br />

are at risk of developing endometrial cancer due<br />

to the womb lining remaining thicker. There<br />

are means of reducing the risk which involve<br />

hormones and depends whether the woman is<br />

trying to conceive or not.<br />

Hypertension<br />

PCOS women are more prone to raised blood<br />

pressure which may be linked to obesity and<br />

insulin resistance.<br />

Snoring and drowsiness<br />

There appears to a link between PCOS and snoring<br />

leading to tiredness and drowsiness.<br />

What can be done to reduce<br />

the long-term consequences<br />

of PCOS?<br />

Diet and Weight loss<br />

A healthy lifestyle is important to help reduce the<br />

symptoms of PCOS. First of all, a healthy balanced<br />

diet is strongly advised. This should include<br />

plenty of fruits and vegetables and whole food<br />

e.g. wholemeal bread, brown rice and whole grain<br />

cereals, lean meat, fish and chicken. Consume less<br />

carbohydrates and salt, avoid alcohol and exercise<br />

regularly.<br />

If you are overweight it is advisable to lose weight.<br />

The benefits of losing weight are:<br />

• Lower risk of developing diabetes and insulin<br />

resistance<br />

• Lower risk of heart problems<br />

• Lower risk of cancer of the womb<br />

• Improving your fertility and the chance of<br />

pregnancy<br />

• Improve regularity of your periods<br />

• Improve skin condition with less acne and<br />

hirsutism<br />

• Less depression and mood swings<br />

It is important to note that losing a small amount<br />

of weight can make a significant difference to the<br />

symptoms of PCOS and at the same time make<br />

you healthier.<br />

Regular health checks<br />

Make sure you have your blood pressure and blood<br />

sugar checked by your GP regularly, at least once<br />

a year especially if you are overweight and have a<br />

family history of diabetes.<br />

How to get pregnant<br />

with PCOS?<br />

Most women with the milder form of PCOS do<br />

conceive naturally, though in general, it takes them<br />

longer to do so than average. On the other hand,<br />

women with the moderate to severe form of PCOS<br />

will have more difficulty conceiving naturally and<br />

often require help from fertility specialists. They<br />

have what is termed “ovulatory disorders.”<br />

For women with ovulatory disorders, the first<br />

line treatment is trying fertility tablets such as<br />

clomifene citrate which stimulates ovulation<br />

although the tablets themselves can reduce<br />

conception as they adversely affect the womb<br />

lining (endometrium) where embryos implant.<br />

This is why there is no benefit in taking fertility<br />

tablets if a woman is already ovulating on her own.<br />

An alternative is to use fertility injections which are<br />

more powerful and works differently to the tablets<br />

in that they do not affect the womb lining. There<br />

is, however, a higher risk of multiple births and<br />

requires ultrasound monitoring to reduce the risk.<br />

Another option is In-Vitro Fertilisation (IVF)<br />

should the above be unsuccessful. Whereas women<br />

with PCOS have a problem conceiving naturally,<br />

their chance of being successful through IVF is the<br />

same as other women without PCOS.<br />

It is pertinent to note that because women with<br />

PCOS have more follicles than normal, there<br />

is a tendency to produce more eggs during<br />

IVF leading to a condition known as Ovarian<br />

Hyperstimulation Syndrome (OHSS).<br />

Our fertility experts at Herts & Essex <strong>Fertility</strong><br />

Centre have devised a protocol to treat PCOS<br />

patients with a special trigger to ripen the eggs.<br />

This is designed to reduce many times the risk of<br />

OHSS in patients with too many eggs, as opposed<br />

to the standard trigger which itself initiates the<br />

whole process of OHSS in those particular women.<br />

Finally, is there a cure<br />

for PCOS?<br />

Unfortunately, there is no cure for PCOS.<br />

Medical treatments are aimed to manage and<br />

reduce the symptoms or consequences of having<br />

PCOS. Medication alone has not been shown<br />

to be any better than healthy lifestyle changes<br />

(weight loss and exercise). Many women with PCOS<br />

successfully manage their symptoms and longterm<br />

health risks without medical intervention.<br />

They do this by eating a healthy diet, exercising<br />

regularly and maintaining a healthy lifestyle.<br />

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FERTILITY 360<br />




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FERTILITY 360<br />

Taking<br />

Time Out<br />

ALPHAZITA True Holistic <strong>Fertility</strong><br />

Care and <strong>Fertility</strong> Retreats<br />

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FERTILITY 360<br />

By adopting this<br />

holistic approach,<br />

couples can lay down<br />

the foundations, not just<br />

for conception but for<br />

healthy uncomplicated<br />

pregnancies<br />

A new series of articles looking at initiatives;<br />

innovation and development in international<br />

fertility begins with an exploration of<br />

AlphaZita, a new concept which uses a multidisciplinary<br />

approach to stimulate positive<br />

fertility health.<br />

<strong>Fertility</strong> <strong>Road</strong>’s Editor, Andrew Coutts went to<br />

hear a little more from the AlphaZita team.<br />

‘Wellness Tourism’ involves people who travel<br />

to follow activities that maintain or enhance<br />

their physical, Psychological and Physiological<br />

wellbeing. According to the Global Wellness<br />

Institute, the total expenditure from both<br />

international inbound and domestic<br />

tourists defined as ‘wellness tourists’<br />

is expected to grow to $808 billion<br />

by 2020. They estimate that<br />

nearly 700 million trips that<br />

incorporated some aspect of<br />

wellness were made in the last<br />

year. International wellness is<br />

becoming big business.<br />

ALPHAZITA takes an innovative<br />

approach to wellness tourism and<br />

combines it with more traditional<br />

types of medical support which is provided<br />

by experts representing different countries and<br />

different specialisms. A team of acclaimed and<br />

experienced Doctors, Acupuncturists, <strong>Fertility</strong><br />

Massage Therapists, Nutritionists and <strong>Fertility</strong><br />

coaches have been brought together with the aim<br />

of promoting natural fertility and optimizing<br />

physically, emotionally and spiritually patients’<br />

status during their fertility journey.<br />

The philosophy of AlphaZita is summed up by<br />

its founder, Dr Elias Tsakos, fertility specialist<br />

and Fellow of the Royal College of Obstetricians<br />

& Gynaecologists, “patients are treated<br />

individually by a team of Specialists in a unique<br />

and true holistic manner. Our aim is to educate,<br />

support, encourage and empower our patients in<br />

their fertility journey”<br />

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FERTILITY 360<br />

Patients receive valuable<br />

treatments and consultations<br />

in a relaxed non-clinical<br />

environment and they increase<br />

their fertility awareness and<br />

their overall natural fertility.<br />

“A fertility retreat is an amazing experience; it’s an<br />

opportunity to come and meet Therapists bringing<br />

a fusion together of Complementary Medicine<br />

with Conventional Medicine. At the AlphaZita<br />

<strong>Fertility</strong> Retreats, patients have the opportunity to<br />

spend 2-3 days together with all the Therapists, all<br />

being one, all communicating, all connecting. It’s a<br />

life changing experience” added Miss Clare Blake,<br />

<strong>Fertility</strong> Massage Therapist and Founder of <strong>Fertility</strong><br />

Massage Therapy.<br />

At AlphaZita you get a feeling that education,<br />

understanding, flexibility and mindfulness<br />

underpins much of what they do. Miss Gordana<br />

Petrovic, <strong>Fertility</strong> Acupuncturist points out,<br />

“the benefits of Holistic <strong>Fertility</strong> Coaching<br />

are multiple. Education is key for all<br />

<strong>Fertility</strong> patients and as long<br />

as patients know what<br />

therapies exist and what<br />

help is available,<br />

they will be more<br />

reassured and<br />

more relaxed.<br />

The AlphaZita<br />

programme<br />

provides a<br />

continuity of care<br />

of step of the way”<br />

What was refreshing<br />

to hear from the team<br />

was the belief that their<br />

intervention would help support<br />

and maintain good health prior,<br />

during and after patients’ fertility journey;<br />

“By adopting this holistic approach, couples can lay<br />

down the foundations, not just for conception but<br />

for healthy uncomplicated pregnancies. We care<br />

about every aspect of your physical and emotional<br />

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FERTILITY 360<br />

help and as we teach you to improve balance in<br />

your body. Participants are aware that their general<br />

health improves alongside their fertility and they are<br />

encouraged to carry these benefits throughout life” -<br />

Miss Rosie Letts, <strong>Fertility</strong> & Pregnancy Nutritionist.<br />

From a patient’s point of view, I can see the very<br />

real benefits of access to diverse specialists in a<br />

safe and comfortable environment. It is the level<br />

of access which is not ordinarily available in<br />

clinics and one which is recognised by Dr Tsakos;<br />

“<strong>Fertility</strong> education, fertility awareness,<br />

pre-conception care and fertility coaching<br />

are important areas supported by substantial<br />

scientific evidence. During a technical and<br />

clinical appointment at a fertility clinic there is<br />

usually limited time, resources and expertise to<br />

explore vital areas of fertility care for everyone.<br />

As a fertility specialist, I often felt that I was<br />

failing my patients for being unable to address<br />

their stress levels, their nutrition, their emotions,<br />

their mindset and for strictly dealing with<br />

the medical part of their care. Most Medical<br />

specialties offer a multidisciplinary approach<br />

to their patients and it seems that <strong>Fertility</strong> care<br />

would perhaps be more complete, if it regularly<br />

embraced other disciplines as well, maintaining<br />

the wellbeing of the patient as the main focus.”<br />

Retreat participants from the UK, Europe and the<br />

US have benefitted from the events which have<br />

been hosted in 5-star resorts across Greece. The<br />

informal schedule on offer includes individual<br />

bespoke treatment sessions, lectures and group<br />

sessions. Post retreat, care and support is<br />

maintained via individually designed packages<br />

and the delivery team are available to respond to<br />

any medical, emotional and spiritual needs.<br />

The retreats are offered (attendance does cost)<br />

to single men and women; couples with (or<br />

without) fertility issues who wish to enhance<br />

their natural and/or assisted fertility. Females,<br />

males and couples with fertility issues who wish<br />

to enhance their natural and assisted fertility.<br />

<strong>Fertility</strong> professionals (Doctors, Nurses/Midwives,<br />

Acupuncturists, Massage Therapists, Nutritionists,<br />

Coaches, Councillors, Coordinators, Health Care<br />

Assistants, and Volunteers) who wish to familiarize<br />

themselves with holistic fertility care. A Certificate<br />

of attendance is offered if individual professionals<br />

wish to use their participation as CPD evidence.<br />

Feedback from those who have participated in the<br />

retreats is very positive with many agreeing that<br />

“the experience has been very different to what we<br />

have experienced so far”. Many others point out<br />

that the unique atmosphere created away from<br />

clinics allows them to take time out, to understand<br />

and appreciate their own fertility journey. The<br />

informality of the retreat allows unparalleled<br />

access to the specialist team and enables<br />

participants to forge relationships with others who<br />

our on the same journey – I am sure relationships<br />

that will last well beyond the AlphaZita retreat.<br />

On a personal level the benefits are tangible;<br />

patients receive valuable treatments and<br />

consultations in a relaxed non-clinical environment<br />

and they increase their fertility awareness and<br />

their overall natural fertility. Retreats can increase<br />

general physical and emotional wellbeing; lower<br />

stress levels and allow participants to stay focused<br />

while exploring all fertility options available, both<br />

conventional and complementary.<br />

AlphaZita seem to get it. Patients receive<br />

personalized care with respect and honesty,<br />

consistency and communication, understanding<br />

and trust. A unique true holistic retreat of<br />

fertility care. The retreat opportunity presents<br />

a life changing and life creating experience. The<br />

<strong>Fertility</strong> Retreat I believe, has a future and the<br />

AlphaZita blueprint is a good example to follow.<br />

The next AlphaZita <strong>Fertility</strong> retreat is<br />

scheduled for 11-14 <strong>October</strong> <strong>2018</strong>, at 5 Star<br />

SaniResort.com, Greece. Limited places<br />

available on alphazita.com<br />

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EXPERT: Russell Davis<br />

It’s Me or<br />

Baby<br />

Infertility can put a strain on the best of<br />

relationships. It is never something a couple<br />

expects to go through or can imagine how it<br />

will be when they start out. You can quickly<br />

go from deciding it's time to start trying for<br />

a baby to it impacting every area of your life,<br />

talking to clinics about treatments you never<br />

dreamed you would need and wonder how you<br />

got to this place.<br />

Over time, ‘Project Baby’ can become allconsuming.<br />

It can infiltrate all aspects of life. From<br />

lovemaking, the food you eat, whether or how<br />

much alcohol you drink, what social events you do<br />

or don’t go to and even the size of your friendship<br />

circle as more and more friends have children. As<br />

time goes by, the intensity can increase as the fear<br />

of time running out gets grows.<br />

Having a baby is supposed to come from a<br />

place of deep love and connection but can often<br />

become the source of a wedge between a couple.<br />

It can go from something that you expect would<br />

give such great joy to be the kill-joy.<br />

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FERTILITY 360<br />

Sarah came to see me to help her be in the best<br />

place possible to get pregnant. However, she was<br />

frustrated her partner wasn’t making any effort.<br />

He didn’t seem to care how much he was drinking<br />

or whether he smoked or not even though there<br />

was a problem with his sperm quality. She said it’s<br />

like he’s given up, he can’t be bothered with it any<br />

more. This hurt her. She felt he didn’t care about<br />

her and them having a family together.<br />

What if one partner says ‘enough is enough’?<br />

What if it comes to the situation of being ‘me or<br />

baby’? Or more accurately me or Project Baby?<br />

Dealing with infertility can be tough enough on<br />

its own. Unfortunately, a study found that the<br />

pain of infertility can cause even more pain and<br />

heartache. Couples who didn’t have a baby after<br />

fertility treatment were more likely to break up.<br />

For the study, which was published in the journal<br />

Acta Obstetricia et Gynecologica Scandinavica,<br />

Danish researchers tracked<br />

47,515 women who were<br />

evaluated for infertility over<br />

12 years. After the 12-year<br />

follow-up period, it turns<br />

out that the women who<br />

didn’t have a child were up<br />

to three times more likely to<br />

have divorced or ended their<br />

relationship with the person they<br />

were with at the time of the study than<br />

the women who gave birth.<br />

This shows the need to ensure Project Baby doesn’t<br />

become the sole focus in the relationship at any<br />

time; open and honest communication and<br />

connection is the priority. This creates the glue<br />

and also keeps both parties on the same page.<br />

If one of you has had enough, the first thing<br />

to explore is what have they had enough of. I<br />

would suggest is not the idea of having a baby<br />

Over time,<br />

‘Project Baby’<br />

can become allconsuming<br />

but the impact that it’s having<br />

on the relationship and life as<br />

a whole.<br />

They probably resent that<br />

Project Baby has crawled<br />

its way into every area of<br />

life with what appears to be<br />

negative consequences. The<br />

carefree fun-loving times have<br />

seemed to be replaced by regimes,<br />

timetables, rules about what you can or can’t<br />

eat, not being able to have a drink and a partner,<br />

who is more often than not, anxious, distressed<br />

or depressed.<br />

Do these experiences have to go with the<br />

territory? Is it possible to continue trying to<br />

have a baby as well as living life to the full in the<br />

now? Is it really ‘me or the baby’ or ‘me or the<br />

all-consuming, partner-imploding, fun-zapping<br />

Project Baby?<br />

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FERTILITY 360<br />

If it is the former, then open and honest conversations<br />

need to take place about the future of the relationship<br />

and where your lives are going. Keep reading and you’ll<br />

find something to help you with that.<br />

If it is the latter, then I have some good news.<br />

It is possible to continue to explore having a<br />

baby without all the distress and for it to come<br />

all-consuming. In fact, you are more likely to be<br />

successful that way.<br />

Project Baby takes over when it is founded on<br />

fear. Fear of not being successful. Fear of not<br />

having what you think a baby will give you. I<br />

have asked many people what they think having<br />

a baby will give them. More often than not the<br />

answer is something like fulfilment, purpose<br />

or happiness. I genuinely believed we would be<br />

happier with a baby than without.<br />

This is living ‘outside-in’. This is thinking I’ll be<br />

happy when… or I’ll be happy if… people do this<br />

with all sorts of things. ‘I can relax and be happy<br />

when I have more money’. ‘I’m okay if people<br />

don’t think badly of me’. ‘I’m okay I’ve proved<br />

myself to be okay’. The thing is it’s just not true.<br />

Nothing has the power to make us feel anything.<br />

100% of our experience comes from thought. Our<br />

perception of the situation, not the situation itself.<br />

I was very much in this place. It wasn’t until the<br />

middle of our fertility journey I realised this<br />

was the case. I’d been like it all my life. I’ll be<br />

OK when I’ve proved to my parents I am good<br />

enough, then my teachers, then it<br />

became my employer. I was a<br />

people pleaser. It wasn’t until<br />

I let go of this and KNEW<br />

I was OK for who I was<br />

that I needed nothing<br />

to be OK, that I found<br />

peace of mind on<br />

our fertility journey.<br />

It wasn’t until we<br />

realised we could create<br />

a life that is inspiring<br />

and fulfilling with or<br />

without children than things<br />

happened for us, naturally<br />

against all odds. The underlying fear<br />

of not having a baby was impacting our fertility<br />

as well as day to day happiness in life.<br />

If you feel like this I recommend you look<br />

at exploring some therapy or counselling to<br />

help you let go of the fear of not having a<br />

baby. For you to know you are OK now, there’s<br />

nothing you need to be OK. The fear of not<br />

having a baby is usually fuelled by a fear of<br />

failure or fear of not being good enough or<br />

not deserving. The emotional roller coaster of<br />

infertility can shine a spotlight on these things.<br />

They are not really about having a baby but<br />

are contaminating your experience of trying<br />

to have a baby. Thee can create psychological<br />

blocks to getting pregnant.<br />

Whatever the specifics of the situation if<br />

one partner decides enough is enough there<br />

needs to be some open and honest dialogue in<br />

order to understand how each other feels; not<br />

what anyone thinks. Not to fix each other’s<br />

feelings or change their thinking about it. To<br />

understand how they feel. To get into their head<br />

and understand it from their perspective. Their<br />

perspective on whether you think it’s right or<br />

wrong. Too often we communicate to defend<br />

our position, to tell our partner where they<br />

are wrong if we feel criticised, to fix problems<br />

and make them feel better rather than to truly<br />

seek to understand them. To understand how<br />

they feel about things. Men are often a little<br />

rusty at communicating feelings but quick to<br />

fix problems and not hear what their partner is<br />

wanting them to hear, how they feel about it.<br />

I recommend you<br />

look at exploring some<br />

therapy or counselling<br />

to help you let go of the<br />

fear of not having a<br />

baby<br />

I suggest in this situation each person writes<br />

down how they feel about the situation. Not what<br />

they think, how they feel. This process can help<br />

men to be more aware of the feeling within them,<br />

especially if they keep the pen moving..<br />

Writing can also help each other identify the<br />

feelings the other person is communicating. I<br />

found when I read something my wife had written<br />

it stopped me interrupting to fix the problem. It<br />

helped me focus on the feelings she wanted me to<br />

hear and understand. I would read it twice to make<br />

sure I’d really ‘heard’ them.<br />

Once you have both written<br />

how you feel about the<br />

situation you can take<br />

turns in talking about<br />

what each other has<br />

written. The listener/<br />

reader can ask<br />

questions to ensure<br />

they’ve understood,<br />

what they think is<br />

being communicated. To<br />

understand what is meant<br />

behind the words. If someone<br />

says they feel angry what does that<br />

really mean? How angry? What’s that<br />

anger like? A word can mean different things to<br />

different people so it’s important to understand<br />

the experience behind the words that are being<br />

communicated.<br />

All too often we hear what we think we’ve heard<br />

and not really heard what was being said. This<br />

is about really understanding each other and<br />

where each other are at on this journey. It’s can<br />

be a long and tough journey. Sometimes people<br />

want to give up. Sometimes this is a passing<br />

experience, sometimes it goes deeper.<br />

Don’t jump to conclusions about what the other<br />

person is saying. Don’t make it into what you think<br />

it is or means. Listen. Seek to understand. From that<br />

place, there is no situation you cannot deal with.<br />

At the end of the day, whatever happens, you<br />

are going to be OK. Whatever happens. Our<br />

psychological well-being is within us. You may<br />

not feel OK at any time but underneath the<br />

emotional experience is a soul that’s got this and<br />

whatever happens covered. Emotions come and<br />

go, you cannot hold on to them forever even if<br />

you wanted to.<br />

Take a breath, come back to the here and now<br />

and seek to connect, understand and you may<br />

find it’s not what you think it is.<br />

Russell is a fertility coach supporting<br />

couples on their journey. You can contact<br />

him via his website thefertilemind.net<br />

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MEN ONLY<br />

EXPERT: Sarah Banks<br />

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MEN ONLY<br />

How fertility treatment may<br />

aect your partner<br />

Stress: <strong>Fertility</strong> treatment can amplify anything<br />

stressful in a couple’s life, and simple daily things<br />

can just be too much for your partner to handle<br />

at the minute. Try to be considerate to see if<br />

there is anything you can to do help take the<br />

weight off of her shoulders.<br />

Insecurities: <strong>Fertility</strong> treatment can intensify<br />

your partners sensitivities and triggers, making it<br />

difficult to be around babies and pregnant women<br />

(including family members). Be understanding<br />

and try not to question these emotions.<br />

Depression: It is extremely common for women<br />

to feel low and depressed while going through<br />

fertility treatment. Watch outs are: loss of appetite,<br />

inability to sleep, excess sleeping, eating a lot,<br />

and generally feeling very sad. If your partner is<br />

showing any of these signs you should encourage<br />

her to talk to her fertility specialist or a fertility<br />

counsellor (usually available through your clinic).<br />

ow can you support her<br />

through treatment<br />

There are four main ways you can support<br />

your partner:<br />

Emotional support (listening, empathising, hugs)<br />

Self-esteem support (telling her you love, admire<br />

and respect her)<br />

Informational support (doing research, asking<br />

questions)<br />

Practical support (take on responsibilities,<br />

planning logistics)<br />

motional Support e there<br />

for her<br />

One of the best things you can do during IVF<br />

treatment is to listen. Don’t try to fix it or suggest<br />

solutions. Just listen with empathy. She doesn’t<br />

expect you to make things better, she knows you<br />

can’t fix the problem. She just wants to know you<br />

hear her and that you sympathise.<br />

Sometimes just giving her a hug will help you<br />

show your support and make her feel loved.<br />

Holding her hand, letting her cry on your<br />

shoulder, and just being there (not on your<br />

phone) is all she needs.<br />

It may be difficult to know how to best help her,<br />

so ask her how she wants you to help her. All the<br />

hormones play havoc on the emotions and your<br />

partner may be fine one minute and floods of tears<br />

the next. Similarly, she may want to talk about<br />

everything one minute and the next not want to<br />

talk about anything to do with treatment.<br />

I know this makes it hard to know what to do for<br />

the best. Cut her some slack, she’s pumping herself<br />

full of hormones every day and ask her how she<br />

wants you to help her. She can tell you what she<br />

needs at that exact moment and you can help her.<br />

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Selfesteem support <br />

e her biggest cheerleader<br />

Your wife’s self-esteem may be suffering, and<br />

the indignities and side effects of IVF treatment<br />

don’t help. Try to keep any criticism and sarcasm<br />

to a minimum and think about whether it is wise<br />

to make jokes at inappropriate times (even if it is<br />

to lighten the mood).<br />

Compliment her on how she looks as she is likely<br />

to be feeling bloated and not her usual self – be<br />

genuine with your compliments so she believes<br />

you. Any little boosts to her<br />

confidence will put a smile<br />

on her face and make her<br />

day a bit brighter.<br />

t’s really<br />

important that you<br />

don’t blame each other<br />

for the fertility issues<br />

and don’t blame yourself<br />

you are in this as<br />

a team<br />

Show her you admire<br />

her for what she<br />

is going through,<br />

that you think she’s<br />

great and handling<br />

everything really well.<br />

Show her you love and<br />

appreciate her – it doesn’t<br />

have to be big gestures,<br />

something as simples as flowers,<br />

chocolates, a hug, or saying ‘I love you’, just to<br />

show you understand what she is going through<br />

physically and emotionally – trust me, she’ll thank<br />

you for it.<br />

nformational Support <br />

Do our esearch<br />

The man’s role in fertility treatments is different<br />

from his partners in that he will mainly play a<br />

support role as his partner does the physical side<br />

of treatment. You can help by doing research<br />

on treatment – clinics, add ons, side effects, the<br />

process, finances, payment plans – so you can<br />

support your partner through the process.<br />

Understanding the impact of treatment on your<br />

partner’s body and the way infertility in general<br />

makes her feel can help you support her better<br />

– it will show your partner that you are<br />

interested in her well-being.<br />

You can also research other<br />

lifestyle factors that may help<br />

with conception and feeling<br />

prepared for treatment.<br />

Look in to ways that you<br />

and your partner can relieve<br />

stress, nutritional advice and<br />

emotional support.<br />

ractical support <br />

rganise all the dull bits<br />

Between the stress and the physical effects of fertility<br />

treatment, your wife may be feeling more tired than<br />

usual, and all the hormones can cause some side<br />

effects such as nausea, fatigue and even pain.<br />

Taking on some of the day to day chores that you<br />

don’t normally do will ease the pressure on her<br />

and show that you appreciate that she is taking the<br />

brunt of the physical side of treatment.<br />

You could take on all the logistics and planning<br />

side of fertility treatment – timings of journeys,<br />

booking hotels, picking up medication.<br />

You could also offer practical support in terms of<br />

nutrition – buying healthy snacks and cutting out/<br />

down alcohol as a support to her.<br />

It’s really important that you don’t blame each<br />

other for the fertility issues and don’t blame<br />

yourself – you are in this as a team, it is a joint<br />

issue that you will work through together.<br />

Supporting yourself through<br />

<strong>Fertility</strong> treatment<br />

We can’t get away from the fact that most of the<br />

pain of treatment is felt by women (physically and<br />

emotionally), but it is often forgotten that men<br />

experience emotional stress, they have to watch<br />

their partner go through the gruelling process of<br />

IVF, have to go through invasive procedures and<br />

they also long for the family they want to create.<br />

Many men feel hopeless during this period as there is<br />

nothing they can physically do to take the pain and<br />

stress off their wife. They empathise with how their<br />

wife is feeling, but they may also feel overwhelmed by<br />

the depth of their wife’s emotion and pain.<br />

62 | fertilityroad.com<br />

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MEN ONLY<br />

partner) a fertility professional (Counsellor,<br />

fertility Coach) or a support group where it is<br />

more anonymous.<br />

hink about the things you want<br />

to do and achieve<br />

Infertility and going through treatment can<br />

make you put plans you have on hold. Write a<br />

list of things you’ve always wanted to do and<br />

achieve and create a plan to start doing some of<br />

them. There may be time and money constraints<br />

around treatment, but it will give you a sense of<br />

achievement and something to focus on outside<br />

of treatment.<br />

Do things you enoy<br />

Men and women deal with<br />

the stress of infertility<br />

in very different ways,<br />

and it is important to<br />

remember that no way<br />

is right or wrong. Each<br />

person processes their<br />

pain in a way that works<br />

for them, and it’s important<br />

to find what works for you.<br />

Communication is so important<br />

in couples struggling with fertility, and<br />

honesty and openness can save marriages.<br />

Supporting your partner through IVF is so<br />

important, but it’s also really important to look<br />

after yourself through the process and get the<br />

support you need.<br />

There are lots of ways to help cope with infertility<br />

and IVF:<br />

ake control of the things you can<br />

Infertility can make you feel out of control of your<br />

life and your future, and when you go through IVF<br />

it can feel like the process is out of your control,<br />

with all the timings, hospital visits and medications.<br />

However, there are things that you can control;<br />

Lifestyle – you can make sure you are eating<br />

healthily, avoiding alcohol, reducing/stopping<br />

caffeine. These things are important for your body<br />

to be in the optimum state for sperm production,<br />

but you will also feel better in yourself.<br />

Mindset – you may feel that you don’t have<br />

any control over how you feel, but you do have<br />

full control. You can make a choice to be in the<br />

right mindset for going through treatment and<br />

supporting your partner.<br />

en and women<br />

deal with the stress of<br />

infertility in very dierent<br />

ways, and it is important to<br />

remember that no way is<br />

right or wrong.<br />

Practical – although a lot<br />

of the process is out of<br />

your control, control<br />

the things you can –<br />

research treatment so<br />

you can ask informed<br />

questions, research add on<br />

treatments, so you are clear<br />

on what you do/don’t want,<br />

organise logistics and plan<br />

treats around procedures to give<br />

you both something to look forward to.<br />

Don’t bottle it up<br />

Its normal to feel that you need to be a rock<br />

for your partner and that you can’t show your<br />

emotions, but it’s important that you address your<br />

feelings and have a way to cope.<br />

Everyone copes differently, and there is no right<br />

or wrong way, it’s just important to have an outlet<br />

for your feelings:<br />

Write in a journal – you can write freely without<br />

worry of someone reading it. Use it to scribble<br />

down your feelings, worries and frustrations. It<br />

can be quite therapeutic!<br />

Write a blog – this is a good way to talk through<br />

your feelings anonymously, and it may help<br />

others in the same situation if you choose to<br />

share it.<br />

alk it out<br />

You may find it difficult to talk about what<br />

you are going through and how you are feeling,<br />

but it’s important that your feelings are heard.<br />

There are lots of options for people you can talk<br />

to – either someone you know (friend, family,<br />

Plan things that you enjoy, so that infertility isn’t<br />

your only focus - gym, exercise, walking, reading,<br />

computer games, seeing friends.<br />

Spend time as a couple<br />

It’s really important to remember why you are<br />

together as a couple and spend quality time<br />

together. You need this, so you don’t feel the<br />

focus is only on having a baby and that you’re<br />

only needed for your swimmers. Spending time<br />

together gives you chance to talk openly if you<br />

want to about how you are both feeling and<br />

anything about treatment.<br />

Set time limits for how long you talk about the<br />

treatment and infertility, so your conversations<br />

don’t just revolve around trying for a baby.<br />

This can add to the stress and pressure in the<br />

relationship. Also set times when you don’t discuss<br />

it – for example if you’re out for a meal, so it gives<br />

you time to focus on the other good things in your<br />

life and each other.<br />

Remember to look after yourself and get the<br />

support you need, you will be better able to support<br />

your partner through treatment and both be in a<br />

better state as a couple to cope on this journey.<br />

Sarah Banks is a <strong>Fertility</strong> coach and mentor<br />

who works with fertility professionals to<br />

enhance their patient experience and success<br />

rates. She helps them understand how<br />

patients feel, the emotional support they need<br />

and helps implement support structures.<br />

She also works on a 1-to-1 basis with women<br />

struggling to conceive, to improve their<br />

emotional state and increase their chances of<br />

getting pregnant.<br />

For further information contact her on<br />

sarahsarahbanks.coach or via her website<br />

sarahbanks.coach.<br />

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MEN ONLY<br />

A F<br />

A F<br />

TESTINGryan oodward<br />

is the erson esponsible at<br />

<strong>Fertility</strong>, a new fertility clinic in eicester<br />

specialising in male fertility, and lowtech<br />

fertility treatments such as and D. ryan<br />

is coeditor of the book ale nfertility<br />

Sperm Diagnosis, anagement and Delivery’<br />

which covers all aspect of male fertility for<br />

professionals and patients.<br />

64 | fertilityroad.com<br />

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MEN ONLY<br />

EXPERT: Bryan Woodward<br />

When it comes to fertility problems, it is a<br />

sad fact that some GPs, will go gung-ho into<br />

investigating the female partner, whilst the<br />

male is often left on the side-lines with no<br />

investigations. As a result, he may watch whilst<br />

his wife has numerous blood tests to check her<br />

various hormone levels throughout<br />

her menstrual cycle; some<br />

women are even admitted<br />

to hospital to have their<br />

Fallopian tubes checked<br />

out, to ensure they<br />

aren't blocked, and<br />

this is all before the<br />

man has any questions<br />

raised about his<br />

fertility status<br />

Yet, nowadays, fertility<br />

problems are attributed more<br />

or less equally between the male<br />

and the female. Therefore, one of the first<br />

tests to perform for a couple who experience<br />

trouble conceiving is a semen test for the man.<br />

Please note, this is called a ‘semen test’, rather<br />

than a ‘sperm test’. Yes, we will be looking for<br />

sperm – after all we need to find sperm so that we<br />

know there is a chance of this cell fertilising an<br />

egg. However, a semen test is so much more than<br />

just looking for sperm, as I’ll explain later.<br />

To assess semen, the first step is to ask the man<br />

to produce a sample. For some, this is a simple<br />

process, over in less than 5 minutes. For others,<br />

this can be a source of great anxiety. Some men<br />

may not be able to masturbate, whilst for others<br />

the act of masturbation may be contrary to their<br />

religious belief or way of life. If this is the case,<br />

then condoms can be used, to obtain the semen<br />

sample by sexual intercourse. However, use of<br />

a condom can cause complications; firstly, it is<br />

important to check that the condom material<br />

is not toxic to sperm, and secondly, much<br />

t is a sad fact<br />

that some s, will go<br />

gungho into investigating<br />

the female partner, whilst<br />

the male is often left on<br />

the sidelines with no<br />

investigations.<br />

care is needed to ensure that the sample isn’t<br />

contaminated by any other cells during the<br />

withdrawal process, such as cells from the vagina,<br />

as these may affect the sperm.<br />

There is also the question of whether the man should<br />

produce the sample ‘on-site’ at the clinic, or whether<br />

he should produce it ‘off-site’, for example at home.<br />

Specialist fertility clinics usually have specific rooms<br />

for on-site production, although the quality of the<br />

room is variable. Oddly, the name for this room also<br />

varies, from the basic “Male production room” to the<br />

more Latin-sounding “Masturbatorium” (this word<br />

has made it into Google’s Wiktionary but has yet to<br />

be included in the Oxford English Dictionary!).<br />

There are many advantages to producing a<br />

semen sample on-site, since the environment<br />

and timing can be better controlled. Ideally the<br />

specimen container should be pre-warmed to body<br />

temperature (37C) and then placed into an incubator<br />

at the same temperature immediately after the<br />

sample is collected. Off-site production inevitably<br />

runs the risk of variations in temperature during the<br />

journey to the clinic (may be not so much<br />

in the recent summer heat-wave, but<br />

certainly in during the colder<br />

months. There is also the<br />

time-factor to consider: the<br />

semen needs to be analysed<br />

within 60 minutes of<br />

production, to ensure an<br />

accurate assessment of<br />

the swimming ability of<br />

any sperm. Many clinics<br />

will reject a semen sample if<br />

it arrives even 1 minute later,<br />

which can add to the stress for the<br />

man who produces ‘off-site’.<br />

Once the sample is safely in the andrology lab, the<br />

semen analysis can begin. The first test is to assess<br />

the colour, which optimally should be an opalescent<br />

grey. An opaquer sample may indicate a low sperm<br />

count, whereas a more yellow sample may indicate a<br />

possible infection, jaundice, or that the man may be<br />

taking some form of drugs. A reddish-brown colour<br />

usually indicates that red blood cells are present. In<br />

this case, it is essential to check how this might have<br />

been caused – was it by the masturbation process,<br />

or is the man’s natural ejaculate colour? If the latter,<br />

then further testing should be sought as soon as<br />

possible to rule out any internal problems with any<br />

of the reproductive system or the prostate.<br />

We then test the volume of the ejaculate. In 2010,<br />

the World Health Organisation (WHO) stated that<br />

the lower limit of fertility was a volume of 1.5ml.<br />

This means that if the volume of the sample is<br />

less than 1.5ml, then there could be a problem. If<br />

a man produces an ejaculate with a small volume<br />

or even no volume at all, then retro-ejaculation<br />

is a possibility. Retro-ejaculation is a condition<br />

where, at the point of orgasm, the semen passes<br />

backwards into the bladder rather than out of<br />

the penis. It should be noted that this is a rare<br />

condition, affecting 1% couples undergoing fertility<br />

investigations, and is more common in men who<br />

have had prostate surgery, suffer from diabetes, or<br />

take medication for high blood pressure.<br />

The next parameter to be tested is semen pH, a<br />

test of alkalinity and acidity. Semen is made up<br />

of secretions from various glands which support<br />

the sperm when it is deposited at the top of the<br />

vagina during intercourse. Secretions from the<br />

prostate are acidic, whilst those from other glands,<br />

such as the seminal vesicles, are more alkaline. If<br />

there is an obstruction or problem with any of the<br />

ducts, then this can affect the pH. Semen should be<br />

slightly alkaline (above pH7.2). However, sample pH<br />

increases with time from production, as the sample<br />

is exposed to air in the container. This is another<br />

reason why it is important to control the time from<br />

production to analysis. If the pH is too high, then<br />

this could indicate an infection, possibly due to<br />

decreased secretions from the prostate.<br />

The final test that is performed, before looking down<br />

the microscope, is the liquefaction and viscosity of<br />

the sample. The reason Mother Nature made semen<br />

viscous immediately after ejaculation, is to keep the<br />

semen within the vagina to allow the sperm to start<br />

swimming towards the egg. The medical term for the<br />

semen at this stage is a coagulum. If it wasn’t viscous<br />

coagulum, the semen would immediately fall out<br />

after intercourse! A normal sample should liquefy<br />

within 30-60 minutes, although liquefaction is often<br />

completed within 20 minutes. If a sample doesn’t<br />

liquefy after 60 minutes, this could compromise<br />

sperm motility, hence the importance of the test.<br />

At the same time as assessing liquefaction, the<br />

general consistency of the semen is also assessed<br />

for anything unusual, such as the presence of<br />

crystals. These could be caused by uric acid, but<br />

if crystals are present, regardless of the cause,<br />

then further investigation by a urologist is<br />

recommended, as ejaculation may also be painful.<br />

Once these ‘macroscopic’ tests (visual tests<br />

without use of a microscope) are complete, it is<br />

time to begin the ‘microscopic’ tests.<br />

he Shape of Sperm<br />

In fertile men, and even super-fertile sperm donors,<br />

the majority of sperm are not the correct shape.<br />

The WHO has put a lower limit of just 4% sperm<br />

needing to be the correct shape for fertility. The<br />

grading of each sperm follows strict criteria, and a<br />

full assessment requires the grading of at least 400<br />

sperm. Of particular importance is detecting if a<br />

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MEN ONLY<br />

man just has ‘round-headed’ sperm. This indicates a<br />

condition called ‘globozoospermia’, whereby all the<br />

sperm lack a sperm cap on the top of the head called<br />

an ‘acrosome’. It is the acrosome that is essential<br />

for fertilisation, as this helps the sperm penetrate<br />

the egg. Even if there are lots of fast moving sperm,<br />

if the sperm are round-headed, then natural<br />

fertilisation is highly unlikely.<br />

he ovement of Sperm<br />

A sperm needs to swim forward to have a chance<br />

of fertilisation. If we consider the journey that<br />

the sperm has to make naturally, it is quite an<br />

ordeal. Firstly, it has to swim towards the cervix,<br />

then through the cervical mucus to enter the<br />

uterus. Many sperm are naturally filtered out<br />

at this point. The next journey is to find the<br />

Fallopian tube and swim through the ciliated<br />

cells that line this structure. Fertilisation takes<br />

place at the top of the Fallopian tube, where<br />

the ovulated egg is hopefully waiting. This<br />

progressive movement, termed ‘motility’ is<br />

essential. The WHO has put a lower limit of 32%<br />

for sperm moving progressively forward to be<br />

classed as fertile.<br />

Please note though, even if a sample has no<br />

moving sperm, it is still possible to achieve<br />

a pregnancy, provided the sperm are alive.<br />

There are various lab tests for sperm ‘vitality’.<br />

Once a sperm is checked to ensure it is alive,<br />

then the assisted conception technique called<br />

‘intracytoplasmic sperm injection’ (ICSI) will<br />

be needed to try to achieve fertilisation. The<br />

ICSI process is highly skilled, and involves an<br />

embryologist selecting the best-shaped living<br />

sperm (usually at a magnification of 600x), then<br />

carefully picked up into a needle, which has a tip<br />

size which is the tenth of the width of a human<br />

hair! The sperm is then carefully injected into<br />

the egg.<br />

he Sperm Concentration<br />

level of fragmentation<br />

in the sperm DNA,<br />

often called a ‘DNA<br />

Fragmentation Index’’<br />

or ‘DFI’, which looks at<br />

the level of integrity of the<br />

genetic components within<br />

the sperm. Another test looks at<br />

the level of ‘Reactive Oxygen Species’<br />

or ‘ROS’, which gives an indication of the<br />

amount of oxidative stress the sperm might be<br />

subjected to within the semen sample.<br />

hilst shape, motility<br />

and count are the three<br />

main microscopic tests<br />

of sperm, there are a<br />

multitude of other tests<br />

available.<br />

most scenarios. Like<br />

everything in biology,<br />

there are extremes.<br />

Some men produce a<br />

thick sample of semen<br />

that contains so many<br />

millions of sperm, that<br />

there are simply too many<br />

to be functional unless they can<br />

swim out of the seminal plasma as soon as<br />

possible. Other men produce a watery fluid, that<br />

is completely void of sperm.<br />

As a general rule, the sperm count is the number<br />

of sperm in the sample, expressed in millions<br />

per millilitre. The WHO sets a lower limit of<br />

15 million/ml for fertility. The actual test is<br />

again quite detailed, as a specialised microscope<br />

slide called a counting chamber is needed. This<br />

ensures a fixed volume of semen is held over a<br />

microscopic grid. The number of sperm in the<br />

grid are then counted to estimate the number of<br />

sperm present in the whole semen sample.<br />

Additional test for sperm<br />

Whilst shape, motility and count are the three main<br />

microscopic tests of sperm, there are a multitude<br />

of other tests available. These include assessing the<br />

However, caution should be considered when<br />

thinking of having these additional tests. They<br />

are usually only recommended once the results<br />

of a conventional semen analysis are known, and<br />

most likely after a repeat semen analysis has been<br />

performed to confirm the values of each tested<br />

parameter. Before embarking on additional tests,<br />

it is recommended that you ask your fertility<br />

specialist to explain what the value these test<br />

results will bring. This is also important if these<br />

tests come at an additional charge!<br />

n a personal note<br />

I have been looking at sperm for over a quarter<br />

of a century, so it is fair to say I have seen<br />

Provided the semen analysis is performed<br />

by a reputable clinic, then the results should<br />

be accurate and the staff should take time<br />

to explain exactly what each result for each<br />

parameter means.<br />

With the vast number of assisted conception<br />

treatments on offer, there is always a way<br />

forward to achieve a pregnancy. And for<br />

me, there is nothing better than to receive a<br />

call from a patient to tell me his partner is<br />

pregnant, even though he had a poor prognosis<br />

semen analysis. The couple will have been<br />

given the facts, but fertility has always been an<br />

enigmatic area of medicine - after all, it only<br />

takes one sperm to make it!<br />

66 | fertilityroad.com<br />

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