Fertility Road Magazine 46 - September/October 2018

SUPPORTING EACH OTHER THROUGH INFERTILITY • FOOD PORN

FERTILITY JOURNEYS UPDATE • THE ART OF MALE FERTILITY TESTING

FertilityRoad

ONE SECRET

TO SHIFT

YOUR ENERGY

Learn how to balance

your positive energy.

SEPTEMBER/OCTOBER 2018

NATURAL

APPROACHES

TO HELPING

ENDOMETRIOSIS

The emotional

strain of trying

to get pregnant

SUCCESS

RATES

EGG FREEZING

Is it a fertility

insurance policy?

The recommendations for

reducing your stress levels

IT’S ME OR

THE BABY

hertsandessexfertility.com

01992 78 50 50

World Class Fertility Centre

Outstanding Success Rates

With 29 years experience we know what matters to you

The most successful fertility clinic in the East of England* offers:

• A truly personalised service

• An independently owned clinic managed by leading experts

• A cost effective fertility treatment with outstanding results

No need to travel the world, for world class fertility treatment

Fertility Assessment & Treatment|Egg/Sperm Donation & Sharing Programme|Surrogacy

If you need help to fund your IVF

ask about our no cost option

www.eggshare.co.uk

| fertilityroadmag | follow us @fertilityroad

*HFEA verified results for 2015. The most successful fertility clinic in the East of England

and one of the top IVF clinics in the UK in terms of live birth per embryo transfer.

fertilityroad.com | 03

FertilityRoad ISSUE 46 fertilityroad fertilityroadmag

Contents

LEGAL

08 EGG FREEZING

Is it a fertility insurance policy?

BODY

MIND

22 STRESS & FERTILITY

The infertility roller coaster can

be a stressful journey.

26 One secret you need

to know to shift your

fertility energy

HINT... It takes more than

positive thoughts.

FERTILITY

JOURNEYS

38 IVF SPAIN

Claire & David discuss their

recent visit and embryo transfer.

40 REDIA IVF & MEDITERRANEAN

FERTILITY INSTITUTE

Meet Kirstie & Christopher

who are preparing for their visit

to Greece.

42 OREGON REPRODUCTIVE

MEDICINE

Heather & Brandon are starting

their their third trimester of

Heather’s pregnancy.

FERTILITY

360

44 THE VALUE OF SUCCESS RATES

Understand success rates and

help keep your surrogacy

journey on track.

56 ITS ME OR THE BABY

The struggle to start a family

can put a strain on the best of

relationships.

10 FOOD PORN

Do men need to be aware of what

they are eating?

14 NATURAL APPROACHES TO

ENDOMETRIOSIS

With endometriosis affecting 10-

15% of women can a more natural

approach help?

30 THE EMOTIONAL STRAIN OF

TRYING TO GET PREGNANT

Why reducing stress levels can

have a positive outcome for you.

34 CONCEIVE PLUS

MEN ONLY

60 SUPPORTING EACH OTHER

THROUGH INFERTILITY

Some helpful advice for men on

supporting their partner.

18 WHY WEIGHT CAN MATTER

Being over or underweight can

affect your chances of getting

pregnant.

04 | fertilityroad.com


Contributors

The people who made this issue happen…

Michelle Mulliss BSc (Hons)

MBAcC

Michelle specialises in natural and

assisted fertility and provides a unique

approach of integrated medicine.

Liz Bottrill

Liz Bottrill is a Partner in the Family

Law Team at Laytons Solicitors with

over 25 years’ experience in the

field. She has a particular interest

and expertise in the law relating to

children and fertility.

Cassie Everett

Cassie has practised Homeopathy

for the last 11 years, first in London

and now in Bristol.

Bryan Woodward

Bryan is co-editor of the book

‘Male Infertility: Sperm Diagnosis,

Management and Delivery’ which

covers all aspect of male fertility for

professionals and patients.

Colette Assor

Colette is a fertility acupuncturist

with 20 years clinical experience.

A’ndrea Reiter

A’ndrea is a Reiki Master and

Holistic Fertility Specialist.

Sarah Banks

Sarah is a Fertility coach and

mentor who works with fertility

professionals to enhance their

patient experience and success rates.

Dr Jodie Peacock ND

Jodie is a Naturopathic doctor

in Canada who runs the online

program, Enhance Fertility

Bootcamp.

Craig Reisser

Craig is a father through donor egg

surrogacy and IVF. Craig works with

Oregon Reproductive Medicine,

the clinic that helped him become a

father, to help other intended parents

building their families.

Kathy Payne

Kathy is a women’s health coach

online and in Norwich UK, offering

bespoke programmes for women

and couples, as well as online classes

and courses.

Russell Davis

Russell is a fertility coach

supporting couples on their journey.

FertilityRoad

Publisher

PJ Jarvis-Mack

pj@fertilityroad.com

Managing Editor

Tone Jarvis-Mack

tone@fertilityroad.com

Art Editor

Richard Porter

Ad Sales

Tone Jarvis-Mack

tone@fertilityroad.com

020 7183 9882

Accounts Manager

Lynsey Jackman

lynsey@fertilityroad.com

Distribution

UK Distribution

Goldkey Media Ltd

0207 491 4065

UK/US Distribution

PineApple Media Ltd

01245 600368

Print Subscriptions

fertilityroadsubscribe.co.uk

Social Media Marketing

Clinics Go Social

clinicsgosocial.com

020 7183 9882

Licensing enquiries

licensing@fertilityroad.com

Legal

Laytons LLP

2 More London Riverside

London

SE1 2AP

Published by

Mack Publishing Ltd

12a Fawkon Walk

Hoddesdon

EN11 8TJ

UK 020 7183 9882

US (323) 892-8486

SUBSCRIBE

Take out an annual subscription to Fertility Road.

PRINTED IN THE UK

For more information or to subscribe visit fertilityroad.com UK £3.95 ,US $10.99, CAN $10.99

Fertility Road is now

available to read across all

tablets and mobile devices

fertilityroad.com/digital



FR News & Views

FERTILITY APP NATURAL

CYCLES HAS BEEN TOLD TO

STOP CLAIMING IT IS A ‘HIGHLY

ACCURATE’ CONTRACEPTIVE

THE APP CLAIMS TO SHOW YOU WHEN YOU CAN HAVE

SEX *WITHOUT* GETTING PREGNANT BUT THERE’S

CONTROVERSY OVER ITS EFFECTIVENESS.

Natural Cycles, the fertility app, will no longer

be allowed to claim it is a "highly accurate" and

"clinically tested alternative to birth control"

by the Advertising Standards Authority (ASA).

The ASA has banned a Facebook ad which

made the claims on the grounds they were

“misleading” and has told Natural Cycles not to

repeat them.

The ASA received three complaints about the

ad, which was shown in July 2017 and read:

“Natural Cycles is a highly accurate, certified,

contraceptive app that adapts to every woman’s

unique menstrual cycle. Sign up to get to know

your body and prevent pregnancies naturally.”

It also claimed the app was a “clinically tested

alternative to birth control methods”.

Natural Cycles said the claims were based

on clinical studies. It said when a person

used the app exactly as instructed it had 99%

effectiveness. But the ASA pointed out that the

app requires users to input accurate information

including hormone levels – which could lead

to errors – and said that taking into account

“imperfect” use of the app brought it to around

91.7% effectiveness in preventing pregnancy.

While some feel it has revolutionised

contraception by freeing women from needing

to take hormonal contraception, there have

been widely-reported concerns over the

accuracy of the app. In Stockholm, 37 women

reportedly fell pregnant while using it.

“We told Natural Cycles not to state or imply

that the app was a highly accurate method

of contraception and to take care not to

exaggerate the efficacy of the app in preventing

pregnancies,” the ASA said.

The Family Planning Association also expressed

concerns about the app. A spokeswoman said:

“The use of the word ‘certified’ suggests that

there is independent evidence supporting these

claims, whereas in fact the only evidence is

from the company itself. It has amassed a vast

database, which is very interesting, but that is

not the same as verified independent evidence.

“Many other apps focus on getting to know your own

body, but Natural Cycles is specifically targeting itself

as a contraceptive, which is concerning.”

Bekki Burbidge, Deputy Chief Executive at FPA

aded that while apps are incredibly popular,

they’re also “fairly unregulated” and it can be

hard “to sort the good, evidence and researchbased

apps from the bad”.

She said: “Fertility apps can be particularly

helpful for planning a pregnancy, but we’re

still cautious about using them to prevent

a pregnancy without initial support from a

trained fertility awareness teacher. A teacher

can support you while you learn to track your

cycle and can help you understand the things

that can make fertility awareness less effective.

Things like travel, alcohol, stress or just not

having enough sleep, can all affect temperature

readings for apps like Natural Cycles.

“At the moment there’s not enough

independent evidence available about the

reliability and effectiveness of apps. To use

fertility awareness as effective contraception,

whether you’re using an app or not, you need

to be motivated and understand the advantages

and disadvantages, especially the things that

can make it less effective.”

“Natural Cycles has been independently evaluated

and cleared by regulators in Europe and the US

based on clinical evidence demonstrating its

effectiveness as a method of contraception.”



Sponsored by

BOOK REVIEW: REVIEWED BY ANDREW COUTTS

Against the Odds:

A journey through

the minefield of

infertility

By Sam Osborn

As the author herself

rightly states at the

beginning of this

diary-based account of

her fertility struggle,

subsequent pregnancy, and subsequent birth,

it is "not the most dramatic or remarkable"

story. It is however one, that many can

empathise with and although not all of us can

claim to have won the fertility battle the story

does provide hope and represents an honest

account of a period which is fraught with fear,

frustration, anxiety, excitement (and for Sam

Osborn), ultimately happiness.

The book starts with a familiar account of how the

birth pill was both a blessing and a curse. Having

supported her through her young, free and single

days the pill brought Osborn to the very edge of

a sheer cliff, “The overriding feeling I had was of

falling down a huge black hole - I was being sucked

in and was having difficulty catching my breath”.

Following unfruitful visits to unsympathetic GP’s

Osborn recounts long periods of self-doubt and

depression which lead ultimately to a physician

recommending the use of the drug Zoladex

which, while addressing the acute symptoms

caused by the pill would have meant an early

menopause and hysterectomy. This proves to be

the watershed moment for the author who has to

make a momentous decision between drug or a

potential family of her own. Osborn decides upon

the latter.

A chance visit to a Chinese herbalist sorted out

her irregular and painful cycle; reflexology helped

balance her hormones and the adoption of a range

of other complimentary therapies did the rest.

Next up a partner to fill the ‘baby shaped void’

and another problem. Osborn’s new man had

fathered a child in a previous relationship but

had a vasectomy sometime before.

There follows an intense period in the story

when Osborn wrestles with her FSH/AMH levels;

challenges the pessimism adopted by some of

her medical team and embraces the positivism

of others; undertakes her own research and

adopts an holistic approach alongside traditional

medicine. In parallel, her partner has a reversal

of his vasectomy and finally overcomes the

complications associated with it.

An open mind, a favourable physical response and of

course a lot of determination in the face of comments

such as, “If it’s not in the medical journal, then I’m

not interested” eventually channels success.

The diary format then becomes testament to

an anxiety ridden nine months peppered with

moments of great happiness and ultimately joy

with the birth of a healthy baby.

The book is a good read for anyone embarking

on a fertility journey or anticipating the birth

of a long-awaited son or daughter. One of the

main things I took from it was the fact that those

of us on the journey have been increasingly

educated and empowered about fertility and our

own bodies. Increased access to educational and

medical information; treatment options and

holistic support have strengthened our arm – our

fertility destiny, or a large part of it, is moving

slowly into our own hands. We are empowered

patients and our fertility options are to a large

degree considered and ultimately decided by us.

Osborn sums this up perfectly. Whilst accepting

she did not always receive the responses she desired

from her consultants, nurses and GP she appreciated

all their help and guidance in hindsight.

However, as a final caveat she says;

“There is a wealth of information ‘out there’ so you

also need to consider how you feel and what is right

for you. Knowledge is power and even if it doesn’t

work out, knowing you have done everything in

your power can give some comfort to you”.

'Against the Odds: A journey through the

minefield of infertility' is available from

Amazon, ISBN: 1973300109. Cost £6.49

Infertility, IVF and

Miscarriage – The

Simple Truth By Dr

Sean Watermeyer

Ask the average lay

person about the

prospect of reading

a book regarding

infertility, IVF and

miscarriage and no

doubt it wouldn't be top of their Christmas

list. If, however, you are one of the increasing

numbers of people affected by infertility it is

very likely that you will want to consume as

much information, advice and sign posting as

you can possibly grab hold of.

Many people who find themselves in the fertility

wilderness wonder where to turn first. There are

a mountain of online and hard copy resources,

guides, podcasts, vlogs and blogs to access but at a

time of vulnerability, confusion and even panic it

is difficult to know where to start.

‘Infertility, IVF and Miscarriage – The Simple

Truth’ by Dr Sean Watermeyer successfully opens

the debate for those struggling to conceive and

offers a step by step guide to IVF and examines the

causes of infertility, investigations, treatment and

miscarriage. As a Consultant Gynaecologist and

Obstetrician, Watermeyer combines his extensive

knowledge, practical application and quite obvious

clinical success in this short, snappy, jargon free

and sometimes light hearted guide – and before

you say anything, why can’t we laugh in the face of

infertility sometimes?!

The guide is extremely comprehensive and

Watermeyer discusses every point of the fertility

journey from when to seek advice; the female and

male physiological perspective; investigations

and treatments including ‘add ons’; miscarriage

through to the consideration of lifestyle,

complementary and medical interventions to

improve the chances of a successful pregnancy.

In the world of fertility information which is

so diverse and fragmented Watermeyer offers

bite sized chapters each with a clear aim and a

very useful, ’So the message is..’ section which

summarises the main elements of each chapter.

Using anonymous case studies of real patients’

Dr Watermeyer achieves his goal of delivering

a refreshing, insightful and clear guide for the

general public.

For anyone who is starting or at the early stages of

their fertility journey this guide is a must. It will

equip you with the information and knowledge to

enable you to take an active and empowered role in

your own journey. In Dr Watermeyer’s own words,

“Don’t be fobbed off”- use this guide to learn more

about your particular situation, options and choices

and use it to direct your own journey.

‘The Simple Truth’ is much more than a guide

– it is a blueprint for your future and I would

wholeheartedly recommend it.

'Infertility, IVF and Miscarriage - The Simple

Truth, A guide for the General Public' by

Dr Sean Watermeyer is available from

parthiabooks.com; price £8.99



LEGAL

EXPERT: Liz Bottrill

EGG FREEZING:

IS IT A FERTILITY INSURANCE POLICY?

"Should I freeze my eggs" is a question many

women consider and for many different

reasons. Perhaps they have not found the right

partner or they are at a particular stage in

their life when they are simply not ready for

a child, but at the same time, do not wish to

miss the opportunity of producing and storing

eggs before their biological clock gets the best

of them, or before the quality of their eggs

degrade making it harder to become pregnant

in the future.

With many clinics offering egg freezing to

their patients, the procedure has transformed

from one only undertaken if there is a medical

need (perhaps before embarking on a course

of treatment which is likely to affect fertility)

to what has been termed by some as a fertility

‘insurance policy’ allowing women the

opportunity to take steps now in an attempt to

preserve their fertility just in case they are unable

to produce viable eggs in the future. However, the

value of that ‘insurance policy’ continues to be

a matter for debate with wildly varying quoted

success rates, which remain relatively low, and at

a not unsubstantial cost. Yet many take the view

that a backup plan is better than nothing at all,

even if it offers no guarantees.

However, the decision to freeze is only the first

of many decisions to be taken which can have

significant consequences in the future. For

example, should the egg be frozen on its own, or

should it be frozen as a fertilised embryo? The

embryo is thought to be more robust than the egg

increasing the prospects that it would survive the

freezing process but comes with less flexibility

to meet changes in the woman’s circumstances.

The genetic makeup of an embryo is set by the

choice of sperm used to create it (whether known

or through anonymous donor sperm) and cannot

be changed if, for example, the woman meets a

new partner before she is ready to have children.

Furthermore, if a woman and her partner

separate before the embryo is implanted and the

partner withdraws his consent for the embryo to

be stored or used, it may have to be destroyed.

The decision of when to freeze the eggs is also

an important one. From a medical perspective,

the advice seems to be to freeze early on rather

than waiting till you are in your mid to late 30s

and 40s and using egg freezing as a last-ditch

attempt to preserve fertility. Whilst this may

well be sound medical advice, there can be legal

ramifications. That is because in the UK, it is

only possible to store eggs for a maximum of 10

years after which they must be destroyed. The

only exception to that rule is if the woman, or

in the case of freezing embryos, her partner, are

or are likely to become prematurely infertile. In

that case, if the correct steps are taken before the

10 year time limit expires, the time for storage

can be extended.

The choices that freezing offers are undoubtedly

beneficial – but in making decisions about what

and when to freeze guidance should be taken from

both your medical and legal team. As with all

forms of insurance, a full assessment of the risks

and the possible future consequences is needed to

ensure the choice you finally make is the one most

likely to provide you with the best outcome in

your particular circumstances in the future.

Liz Bottrill is a Partner in the Family Law

Team at Laytons Solicitors with over 25 years’

experience in the field. She has a particular

interest and expertise in the law relating to

children and fertility.



Get A one year

Sponsored by

subscription

for £10

(including P&P)

SAVING

£13.70

6 issues delivered

to your door

Sign up at fertilityroadsubscribe.co.uk



BODY

EXPERT: Michelle Mulliss

FOOD PORN

It’s a Man’s World

Parenthood is something that not just the

mother needs to get ready for; dads need to be

prepared too. Infertility is on the rise in our

modern world. According to statistics, there has

been almost a 20-30% rise in infertility in the

last five years.

In men, the quality of semen is the main reason

of failing to impregnate the partner with 35% of

male infertility issues are due to low sperm count

and motility.

Common reasons for male infertility are low

sperm concentration (oligospermia), poor

sperm motility (asthenospermia), and abnormal

sperm morphology (teratospermia). The exact

reason for the decline in semen quality is

not clear, but environmental, nutritional,

socioeconomic and other factors are starting to

come into focus, but what can you do to help

improve your sperm health?

Stock up on fruits and vegetables: A study

conducted by the Harvard University found that

eating yellow and orange coloured vegetables

and fruits had a profound effect on the health

of the sperm. Yellow and orange colour in fruits

and vegetables have an abundant amount of

“carotenoids” including beta carotene which is

converted to Vitamin A in the body. It is one of the

most potent antioxidants. Sweet Potato and melon

were found to improve both the quantity and

quality of sperms while red vegetables particularly

tomatoes, which contains lycopene, improved the

quantity of abnormally shaped sperms by 8-10%.

Break on the processed food: Processed and take

away fast foods are known to be detrimental to

our health. A young men’s study carried out at

the University of Rochester took a group that

was fed a diet high in processed and red meat,

refined grains, fast foods, high energy drinks

and fast food. Another group were put on a

healthy diet of chicken, fish, fruits, vegetables,

whole grains and legume beans. It was no

surprise that those on the healthy diet had

better sperm motility which has been supported

by various studies of the positive role of diets

high in whole grains, legumes, fruits vegetables

and fatty acids on sperm health and fertility.

Manage the cholesterol: We have seen

that couples with a high levels of

cholesterol take longer to conceive.

A study published in the Journal

of Clinical Endocrinology &

Metabolism concluded that

couples or either of the partner

with high cholesterol found it difficult to

conceive as compared to other couples. So, ensure

to get in those fibres, whole fruits and lean plant

proteins into your daily diet and keep a check on

your lipid profile.

Ditch saturated fats: Saturated fats do not only

have an adverse effect on your heart and waist

line but are also major contributory factors for

low sperm count. Studies have suggested that

even a 5% increase in saturated fat intake could

result in a decrease in sperm count.

Protect against oxidative stress (OS): OS is

directly related to cellular damage which

is caused by free radicals known as reactive

oxygen species (ROS). Small amounts of ROS

are needed for functioning of the sperms,

however when their number increases, and

our antioxidant defences are overwhelmed

impacting on the quality of sperm.

Weight in check

Obesity is a health target for the NHS,

and research has shown that obesity

has an impact on reproductive health

with reducing sperm concentration

and delaying conception. Increased



BODY

BMI is also associated with decreased levels of

testosterone and an increase in oestrogens – causing

low sperm counts and infertility.

Nutrition can be a minefield when it

comes to fertility which to some can be

overwhelming with the marketing of

supplements. It’s important to reiterate

that to maintain health, a varied

and balanced diet is key. However,

certain nutrients have been shown

to increase sperm count, motility

and quality which include;

Vitamins

Vitamin A deficiencies have been

linked to sluggish sperm and motility

issues. Eat plenty of red peppers, oats,

carrots, dried apricots, sweet potatoes, spinach

and broccoli to give you a vitamin A boost.

Vitamin C, found in good amounts in

strawberries, asparagus, fruit and yellow veggies,

has a positive effect on sperm viability and

motility (the swimming ability of sperm).

Vitamins C, E and B12 are also great antioxidants

that can help boost sperm production and

motility by fighting harmful free radicals.

Minerals

Inadequate levels of zinc can cause lowered

sperm counts. Natural sources of this

mineral can be found in oysters,

eggs, turkey, seafood, pumpkin

seeds, liver, beef, oats, lamb,

yoghurt, nuts and barley.

Selenium is also thought

to be beneficial to sperm

motility and health.

You can get it by eating

Brazil nuts, red meat,

cottage cheese, poultry

and eggs. If you don’t think

you are getting enough zinc

or selenium, a multivitamin may

help. However, be sure to stick within

the recommended dose, as high levels of both

these minerals can become toxic.

Fatty Acids

Studies have shown that fertile men’s sperm tend

to contain greater amounts of polyunsaturated

fats (many unsaturated fats), specifically omega-3

and omega-6 fatty acids, than that of infertile men.

They’re found in walnuts, chia seeds, omega-3

supplements like krill oil but can be found in oily

fish like anchovies, sardines and salmon.

Folic Acid

It is well known now that

women should take folic

acid when preparing for

pregnancy. This I believe

should be extended to men

as I see in clinic which is

also supported with recent

research that some men

who have been taking dietary

supplements containing folic

acid in combination with zinc have

experienced increases in sperm counts of as

much as 70% and research suggests that men with

low folic acid levels tend to have more sperm cells

with chromosomal (genetic) abnormalities. Keep

your levels up by eating leafy green veggies, whole

grain foods, avocados, beans and fruit.

Lycopene

Lycopene, has been shown to help increase sperm

count and can be found in tomatoes, carrots,

watermelons and paw paw fruit.

Water

Many of us get caught up with such busy lifestyles

that water intake can be forgotten. However,

drinking plenty of water throughout the day you

can counteract dehydration, which is one of the

main factors associated with low semen volume.

Food Porn

Cooking and presenting

food that is not

only appealing but

tastes great can be

challenging, and

many couples often

ask for advice on

how to cook the foods

recommended in my

clinics. It was through

this concept and my love

of cooking I created Fertile

Foods cooking workshops. These

workshops help encourage the understanding of

nutrition in all areas of reproductive health and

have helped couples embrace nutrition to add

splash of fun in the pan.



BODY

Here are some recipes to help boost sperm and

most of all taste great.

Persian Pomegranate Chicken

Try this tasty recipe with walnuts and

pomegranate which are great for sperm health.

Walnuts are bursting with essential omega-3 fatty

acids and antioxidants to help in boosting sperm

volume and production by increasing blood flow

to the testicles. Whilst the delicious pomegranate

fruit is known as a powerful food that helps in

increasing sperm count and improves semen

quality. It is full of antioxidants that help in

fighting against free radicals in the blood stream.

Ingredients

• 1 to 2 large yellow onions, chopped, (3 cups)

• 2 Tbsp unsalted butter

• 3 Tbsp olive oil

• 5 Tbsp pomegranate molasses (simmer 1 cup

of pomegranate juice until it reduces to 5 Tbsp

of syrup)

• 1/2lb walnut halves (about 2 cups)

• 2 lbs boneless skinless chicken thighs and/or

breasts, trimmed of excess fat, cut into medium

size pieces, patted dry and salted

• 2 cups chicken stock

• 2 Tbsp plus 2 teaspoons of sugar

• 1/2 teaspoon turmeric

• 1/4 teaspoon cinnamon

• 1/4 teaspoon ground nutmeg

• 1/4 teaspoon ground black pepper

• Salt

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

Method

You can toast the walnuts in one of two ways. You

can either spread them out in a single layer in a

large skillet, and toast them on medium high heat,

stirring frequently until lightly toasted, OR you

can spread them out in a single layer in a baking

rimmed baking sheet, and toast at 350°F in the

oven for 8 to 10 minutes.

In either case, once toasted, remove from heat and

allow to cool. Once cool enough to handle, pulse in

a food processor or blender until finely ground.

In a large pan, heat 1 tablespoon of butter and 2

tablespoon of olive oil over medium-high heat.

When the butter has melted, pat the chicken pieces

dry again and place the chicken pieces in the pan,

working in batches if necessary to not crowd the pan,

and cook until golden brown on all sides. Sprinkle

the chicken with salt while they are cooking.

Remove the chicken from the pan, set aside. Add a

tablespoon of butter and a tablespoon of oil to the

pan. Lower the heat to medium low. Add chopped

onions to the pan and sauté until translucent,

stirring on occasion to release the browned bits

from the bottom of the pan.

Return the chicken pieces to the pan with the

onions. Pour 2 cups of chicken stock over the

chicken and onions. Bring to a boil, reduce to a

simmer, cover and simmer gently for 30 minutes.

Stir in the ground walnuts, pomegranate molasses,

sugar, and spices. Cover and cook on very low

heat for 1 hour, stirring every 20 minutes or so to

prevent the walnuts from sticking to the bottom

of the pan.

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

this point the chicken should be fall apart tender.



BODY

Ginseng Chicken

Ginseng has been known for its health benefits

and is a powerful herb known for improving

male fertility by increasing the number of

sperms, sex drive and also enhances the sexual

performance. It also helps in fighting erectile

dysfunction, increasing semen volume and

sperm production.

Garlic contains a chemical compound called

allicin, that helps in improving the flow of

blood to the genitals and boosts the strength

and endurance of the sperm. They are also

power-packed with selenium and vitamin B6

which helps in preventing sperm damage and

hormone regulation.

This recipe combines ginseng and garlic in this

tasty chicken ginseng broth soup.

Ingredients

• 4 cups boiling water

• 5 oz Korean red ginseng tea

• 2 small chickens (poussin) or Cornish hens,

(about 2lb each)

• 4 large cloves garlic

• 15 goji berries

• 3 pieces dried Korean red ginseng (optional)

• 2 cooked chestnuts, peeled (optional)

• 1 cup uncooked sweet rice

• 2 pinches dried chili threads

• Handful fresh pea shoots

• 1 tablespoon roasted sesame oil

• 1 teaspoon black sesame seeds

• Sea salt

• Freshly ground black pepper

Method

Brew the ginseng tea by mixing together

the boiling water and the ginseng tea until

dissolved. Set aside. Rinse the chickens with

cold water. Place 2 of the garlic cloves, goji

berries, 1 piece of ginseng, a chestnut, and 2

tablespoons of rice into the cavity of each bird.

Skewer each closed with a toothpick. Place the

remaining rice in a double layer piece of muslin

or cheesecloth with of the remaining ginseng

and date. Tie the cloth closed tightly but leave

a little bit of extra space for the rice to expand.

Place the chickens and rice bag into a large wide

heavy-bottomed pot. Cover with the tea, and

top off with water to cover, if necessary. Bring

to a boil over high heat. Reduce the heat and

simmer, occasionally skimming away any fat

that comes to the surface, until cooked through,

about 2 hours.

When done, the chickens should be very soft

and fall apart easily when tugged at. Carefully

transfer the chickens to two bowls and divide

the broth between them. Top the chickens

with chili threads, garnish with pea shoots,

and a sprinkle of black sesame seeds. Drizzle

with sesame oil. Unwrap the rice package in a

separate bowl and sprinkle with black sesame

seeds, if you like. Serve with salt and pepper on

the side.

Should you want to know more about how

you can improve your fertile health with

food, visit michellemulliss.com or email

info@michellemulliss.com



BODY

EXPERT:

Dr Jodie Peacock BSc, ND

Naturopathic doctor - The Root of Health

Founder of Enhance Fertility Bootcamp program enhancefertilitybootcamp.com

NATURAL APPROACHES TO

HELPING ENDOMETRIOSIS

Endometriosis is a common condition affecting

between 10-15% of women. It is a condition where

the cells that should only be found within your

uterine lining migrate and are found in other

areas within your abdominal cavity. The growth

of these cells outside the uterus can cause a host

of different symptoms depending on the location

the tissue is growing on. These cells respond the

same way as your normal endometrial tissue

to hormone stimulation. This means that they

grow and bleed in the same cyclical pattern as the

tissue in your uterus. This internal bleeding can

lead to areas of scar tissue development, regions

of inflammation and pain.

Symptoms of endometriosis will vary from

women to women but can include painful and

heavy periods, painful intercourse, pain with

urination or bowel movements, low energy and

concerns with fertility. It is thought that up

to 60% of women with fertility concerns have

some degree of endometriosis. The diagnosis of

endometriosis can be quite difficult and the only

way to get a true diagnosis is by doing a surgical

procedure called laparoscopy.

The precise cause of endometriosis is still yet to

be determined. There appears to be an increase in

immune activity in the uterus, with a correlation

between supressed immune functions and an

increased number and size of lesions. There is a type

of immune cell called a natural killer cell. These

cells help to keep abnormal cells in check and are

suppressed in some women with endometriosis.

A different immune cell called macrophages also

plays a role in endometriosis. Macrophages have

a job to clean up any general debris. There is an

increase in macrophage activity seen in the uterus

of women with endometriosis. This may lead to

a women’s body identifying sperm as foreign and

therefore contributing to infertility. In

terms of fertility, endometriosis

can lead to scarring on

fallopian tubes, adhesions

and unruptured follicles in

the ovaries are often seen.

What are the

risk factors

for developing

endometriosis?

The most common risk factor is

genetic. If your mother has endometriosis

there is an 8% higher chance of you having it

and about a 5% higher chance if your sister has

endometriosis. Women with shorter periods

and women with more frequent periods (with

shorter time in between) have a higher risk.

From a lifestyle standpoint, low activity levels

from a young age, high fat diets and the use

of intrauterine devices (IUDs) have all been

demonstrated to increase the risk. From a

It is thought that

up to 60% of women

with fertility concerns

have some degree of

endometriosis

hormonal standpoint, having elevated or

unbalanced levels of estrogen have been shown

to make symptoms worse.

Your liver has the task of breaking down

hormones including your estrogens. This

includes both your natural estrogens, synthetic

estrogens (medications) as well as

environmental toxins that can

mimic estrogens. As the

liver breaks down 80-

90% of your estrogens,

optimizing its ability

to function will help

support your treatment.

Your liver metabolizes

estrogen by attaching

it to glucuronic acid and

excreting the combo into

your intestinal system for

removal. The health of your

intestinal flora is imperative to your

body being able to eliminate the estrogen. If

you have an abundance of healthy bacteria in

your gut, you can rid your liver of the estrogen

it has just worked to detoxify. If, however, you

have an abundance of unhealthy bacteria, they

can break the bond between the estrogen and

glucuronic acid and allow the estrogen to be

reabsorbed into your blood stream. Your liver

then must work double time to get rid of this

same estrogen again.



BODY

As you can see endometriosis is a complex multifactorial

condition. To minimize symptoms and

further growth we need to address the health

of your liver, intestines, immune function and

estrogen balance.

Where to begin?

1. Nutrition and diet will play

a huge role in managing

endometriosis.

High fibre foods can provide significant benefit

by helping support the healthy bacteria in the

gut and crowd out the harmful ones. Increasing

fibre by focusing on vegetables, legumes and

beans can help improve digestion as well as reduce

inflammation which will help reduce pain levels.

Reducing the amount of red meats in your

diet. Red meats, when consumed, release a

substance called arachidonic acid that promotes

inflammation contributing to pain levels.

Including plant-based protein sources such

as soy, nuts, seeds, beans or legumes in your

meals, will assist your body in lowering levels of

inflammation. You can also look to substitute

fish for meats, as fish contains a type of fatty acid

called omega 3s that work to reduce inflammation.

Limit your caffeine intake. Women who have

less than the equivalent caffeine of about 6

cups of coffee per month had on average 40%

improvement in symptoms compared to women

who consumed over this amount. There is

approximately 120mg of caffeine in a cup of

coffee, so keeping total intake under 7g is optimal.

Some patients I find do significantly better with

eliminating caffeine entirely from their diet. Try it

for one full cycle and see if you notice a difference.

Or as another option I find for some women even

it they stop for the week before their period this

can have a positive impact.

Focus on including more liver supporting foods

and herbs. The family of vegetables known as

brassicas includes broccoli, cauliflower, kale,

brussel sprouts, cabbage, bok choy and turnips.

These vegetables contain a nutrient called

indole-3-carbinol or I3C. I3C helps the liver to

metabolise estrogens, so can be helpful to assist

in the balance of estrogen in the body. Root

vegetables such as beets, sweet potatoes, radishes,

and artichokes are very nourishing for the liver

to also assist in overall function. In general,

making sure you are getting a minimum of 5

servings of vegetables per day will go a long way

to ensuring you are getting adequate fibre and

nutrients to support detoxification.

2. Supporting your stress and

nervous system.

When your body is under higher levels of

constant stress your adrenal gland makes more

of a hormone called cortisol. The body uses your

progesterone to make cortisol, so with higher

stress levels your progesterone levels can drop

leaving the ratio of estrogen to progesterone

imbalanced. This allows for higher levels of

estrogen that can stimulate endometrial tissue.

As well contributing to pain in endometrial

tissues, this can also affect the length of a

women’s cycle and the heaviness of period

flow. Elevated levels of cortisol can also have a

negative impact on immune function which also

isn’t helpful when it comes to endometriosis.

There are several ways to help your body

regulate stress more effectively. One is to add

(or continue) regular daily exercise. Doing any

type of activity that you enjoy is fine. This could

range from walking, biking, dancing, swimming

or weights and classes at the gym.

Breathing properly is also critically important to

keeping cortisol levels in a good range. Doing either

diaphragm or yoga breathing each day, helps keep

your body in its relaxation nervous system.



BODY

3. Reducing exposure to

estrogenic or hormone

disrupting toxins.

Hormone disrupting toxins will have the largest

impact on hormonal based concerns such as

endometriosis as well an on overall fertility and

reproductive health. Some examples of common

places we will find these chemicals include lotions,

makeup, soaps, cleaning products, food storage

containers, water supply. The Environmental

Working Group (EWG) published a list of the 12

top hormone disrupting chemicals and includes:

1. Bisphenol- A (BPA)

2. Dioxin

3. Atrazine

4. Phthalates

5. Perchlorate

6. Fire retardants

7. Lead

8. Mercury

9. Arsenic

10. Per fluorinated chemicals (PFCs)

11. Organophosphate pesticides

12. Glycol ethers

We know we have exposure to the majority of

these chemicals on a daily basis. Some are easier to

avoid than others. This list is not meant to make

you panic but to begin to draw awareness to the

exposures that we can control.

Why are these types of toxins so problematic?

Some of the hormone disrupting toxins will bind

to the same receptors that your hormones bind to.

This means your body can think you have more

or less circulating hormones than you actually

do. Some hormone disrupting chemicals will

increase the amounts of hormones your body

High fibre

foods can provide

significant benefit

by helping support the

healthy bacteria in the

gut and crowd out the

harmful ones

secretes, others will decrease

amounts, and some will

even mimic the function

of the hormones. As your

body’s levels of certain

hormones change, this

can lead to changes in

the menstrual cycle,

immune function and

how your body responds

to stress. Some of these

chemicals, for example phalates,

link directly to endometriosis.

Toxins are ubiquitous in our environment, so

we are never going to be able to get away from

exposure. We can however do things to minimize

exposure and encourage the body to eliminate and

excrete the toxins instead of storing them. One

of the best ways to encourage toxins from your

body is through sweating. This can be done either

through exercise or the use of saunas.

Visit ewg.org for more information on where to

find these toxins and ways to reduce exposures.

Optimizing your digestion and liver function

are two of the most important ways to not only

improve your endometriosis but also to optimize

your overall health. There are also other nutrients

and herbal medicines that can be used to assist

with pain so please speak to your Naturopathic

doctor or other health provider to see what makes

the most sense for you.



BODY



BODY

Why Weight

Can Matter

It’s Best to Lose Weight

Before Trying For a Baby

EXPERT: Kathy Payne

It's best to manage weight at a healthy level

when planning a baby, either naturally or via

IVF. It's also best to do it before trying to fall

pregnant. That's because being overweight

or underweight can affect fertility. Let's talk

about weight management for fertility.

Weight Can Affect Hormones

Women’s hormones need to be in balance for

a regular and healthy menstrual cycle. Being

overweight or underweight risks hormone

imbalances and we start to notice signs, like cycle

irregularities and fertility challenges.

Fertility and Being Overweight

Some studies show that overweight women

are more likely to encounter fertility issues.

Generally speaking, the more overweight we are,

the higher the risk of problems. This is simply

because overweight women tend to have more

fat cells, than those women who are classed as

normal weight.

Fat cells produce oestrogen; it’s not just our ovaries!

Because fat cells produce oestrogen, overweight

women are at higher risk of what’s commonly

called “oestrogen dominance”. Oestrogen

dominance means too much oestrogen in

relation to progesterone i.e. a hormone

imbalance. Oestrogen dominance can impact

cycle health, ovulation and fertility.

Some common signs of too much oestrogen/ not

enough progesterone include:

• Brain fog and memory issues

• Mood swings, irritability and depression

• Sleeplessness

• Tiredness

• Hormonal migraines and other headaches

• Hair loss

• Thyroid problems

• Cold hands and feet

• Sore and tender breasts

• Abdominal bloating

• Weight gain and slower metabolism

• Low libido

• Period problems

• Endometriosis

• Fibroids

• Infertility and miscarriage

Fertility and Being Underweight

Being underweight can also be a factor to consider

when you’re planning a baby. Underweight

women tend to have a lower percentage body fat

than women classed as normal weight.

Women need a certain amount of body fat to

ensure hormone balance and ovulation. If we’re



BODY

underweight, our bodies “think” there

are not enough fat stores for pregnancy, so we

are less likely to conceive and run higher risk

of miscarriage.

It’s not only the underweight who should watch

out however, it’s possible for a woman to be

average or even above average weight, but still

have a low body fat percentage. As an example,

let’s look at female elite athletes or women who

exercise a lot and hard. Their low body fat and

high muscle percentage can cause their periods to

become irregular or even stop altogether.

BMI is only one measure of weight and health.

It’s a useful indicator but it’s not the only

measurement to consider because it doesn’t

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

It’s possible to measure that and I’ve found that

many gyms have machines to measure fat/muscle;

alternatively you could ask your doctor instead.

Accepted reference ranges suggest that underweight

is a BMI lower than 20. Normal BMI is 20-15.

Overweight is a BMI of 25-30. Obese is a BMI of 30-

40 and morbidly obese is over a BMI 40.

If weight is a factor for you, there are some things

I suggest before trying to conceive.

Here are some suggestions:

Tips for Managing Weight

It's best not to go on a weight loss diet when

you're trying to conceive.

Sorry, but it much better to lose excess

weight first and then try for a baby.

Many of my clients, ask me

why. The imbalance is usually

temporary and maintaining

a healthy weight and eating

healthily should rebalance

any issues over time.

Slimming diets - especially very

restrictive ones - can cause periods to

become irregular and ovulation to stop,

because hormone levels drop.

Wait until 3-4 months AFTER losing weight

to start trying for a baby, if you can.

Weight can be a

fertility factor for

women, because it

impacts hormone

balance

I know this can sound like a very long wait when

you really want a baby. I suggest this as a precaution

when time is on a woman’s side. Sometimes nutrient

levels - including all the really key fertility fuelling

nutrients - can be lower after a slimming diet.

I therefore recommend boosting nutrient levels

if you’ve been on a slimming diet.

In my clinic, I use hair mineral tests from a

respected Laboratory to help couples

identify any mineral deficiencies

and also exposure to toxic metals

which also impact fertility.

I work out what foods and

supplements they may need,

based on those test results.

No faddy diets, please.

That’s because you risk robbing your

body of nutrients, including the ones

needed for fertility and a healthy pregnancy and

bouncing baby. It is best to gradually lose weight

through a healthy, varied and balance diet. And

that includes plenty of healthy fats!



BODY

It doesn’t include “diet” or lite products. They

can be packed with health and hormone harming

chemicals, sugar or artificial sweeteners. In fact,

the basics of a fertility friendly diet will help you

lose weight.

1-2lbs a week is a steady, healthy and brilliant

weight loss.

The aim is to lose weight to become a healthy

weight for fertility, not skinny-down as much

as you possibly can. Even losing a small amount

of weight can make a big difference to general

health and fertility.

The basics of a fertility friendly diet

1. Balance blood sugar by having good quality

protein with every meal and snack. Good

protein sources include nuts, seeds, legumes,

eggs, fish, poultry, meat, dairy. For other

fertility-protecting reasons, go easy on the

red meat and cow’s dairy. Eat breakfast and

another two good meals. Only snack if you’re

really hungry or feeling whoozy/hangry.

2. Choose organic food as far as possible -

certainly for any meat or poultry, dairy and

the “dirty dozen” veggies and fruits. See the

EWG’s list of the worst pesticide residue

covered veggies and fruits. ewg.org/foodnews/

dirty_dozen_list.php

3. Eat a rainbow and plenty of vegetables and

fruits - much more veggies than fruits and

include leafy greens. Have at least seven

portions of veggies and fruits daily. Yes, SEVEN.

4. Eat good fats - nuts, seeds, avocados, oily fish,

extra virgin olive oil, coconut oil, grass-fed

butter and ghee and grass-fed red meat. Reduce

saturated fats from factory farmed meats

and trans fats from processed, packaged and

takeaway foods.

5. Choose unrefined carbs for fibre and nutrition

- brown rice, quinoa, chia seed, oats, rye, spelt,

buckwheat, legumes, starchy veggies and if you

have wheat eat sparingly and have wholegrain.

You need LOTS of fibre for digestive

and hormonal health.

6. Avoid - or vastly reduce

- caffeine, alcohol,

sugar and artificial

sweeteners, processed

and refined foods.

Don't start binge

eating sugary or

junk food to gain any

weight.

Please don’t start binge eating

pasties, shovelling in chocolate

and crisps or troughing takeaways!

They are simply NOT fertility-fuelling foods.

Eat more nutritious, calorie-dense foods - nuts

and seeds, avocado, eggs, brown rice, oily fish and

healthy fats and oils. Increase your number of

healthy snacks as well.

CROWD IN healthy foods to lose weight.

I know that losing or gaining weight is not

always straightforward and habits can be tough

to break. In my clinic, some people have seemed

daunted. I start with the simple practice of

crowding in what you do want and to crowd out

what you don’t want.

Slimming diets

- especially very

restrictive ones - can

cause periods to become

irregular and ovulation to

stop, because hormone

levels drop.

As an example, if you’re trying to cut down on

sugar, crowd in more protein and soon you’ll be

eating more protein, feel fuller for longer and

less likely to be eating a doughnut at elevenses.

Give it a go and see how it works for you.

If you have a male partner, check his weight too

Men’s weight matters too. Being overweight can

affect male fertility. It’s been linked

to poor sperm quantity and

quality. One of my mantras

is it takes two to tango

and two to make a baby.

Both women and

men should tackle

weight issues as part

of their preconception

care plan.

Weight and BMI can

affect chances of getting

pregnant - that’s women

and men.

I work with women and couples who

want babies. Sometimes those people are

struggling to conceive. I suggest food and lifestyle

changes tailored for them and I practice natural

therapies to support them

And I know that sometimes people feel a little

daunted and wonder how they’ll stick with my

new suggestions. Of course, it’s easier when

you’re working with someone to support and

encourage you, but for everyone I’d say it’s

a matter of giving yourself the best chance

you can of natural conception or IVF success.

And maximising your chances of a healthy

pregnancy and happy, bouncing baby, through

your diet and lifestyle choices.

It’s about taking control of all the fertility factors

that you can control and that includes weight

and BMI.

Love, Kathy x

Kathy Payne is a Booster of Fertility, Balancer

of Hormones and Soother of Modern Life

Madness, naturally. She is a women’s health

coach online and in Norwich UK, offering

bespoke programmes for women and couples,

as well as online classes and courses.

If you’d like to protect, nurture and boost

your fertility naturally, sign up for her

weekly newsletter and occasional offers with

this link. As a FREE GIFT you will receive

the popular, online course 7 Steps to Boost

Fertility http://bit.ly/7Steps-FertilityRoad



BODY

Olympia London 3 - 4 November

Book

tickets

now

The UK’s biggest fertility event

Find out more at fertilityshow.co.uk



MIND



MIND

STRESS &

FERTILITY

EXPERT: Colette Assor

Our clinic is seeing an increased number of

women with a diagnosis of unexplained infertility.

Tests and scan results come back as normal,

but women are still struggling to conceive. The

infertility roller coaster can be a stressful journey.

What is unexplained infertility?

Unexplained infertility is diagnosed when a

couple has been unsuccessfully trying to conceive

for 12 months or more and all investigations

have ruled out all other known explanations.

Living with a medically unexplained diagnosis can

be both a relief and a cause of anxiety for patients.

On one hand, your specialists have effectively ruled

out several undesirable causes for your symptoms

but on the other hand, you are still living with those

symptoms. For couples who have been diagnosed

with unexplained infertility, this can be particularly

frustrating as it gives you no explanation as to why

you’re struggling to start a family.

How Specialists Reach a Diagnosis

of Unexplained Infertility

There are many causes and risk factors related to

infertility and your doctor will explore all of these

pathways when making a diagnosis. In general,

infertility can be defined as the inability to get

pregnant, carry a pregnancy to term and deliver a baby.

Male Infertility Tests

For male infertility specialists will look at

factors that include:

• sperm size, shape, number and mobility

• the presence of varicoceles (enlarged veins in

the scrotum)

• blockages of sperm-carrying ducts

• the presence of infections, cancer and STIs

• hormonal imbalances

• risk factors such as excessive weight, smoking,

alcohol and drug abuse and a history of

fertility disorders

Female Infertility Tests

To diagnose female infertility your specialist

may look for:

• polycystic ovarian syndrome

• premature ovarian failure

• blocked or damaged fallopian tubes

• the presence of polyps or fibroids in the uterus

• endometriosis

• an abnormally shaped uterus

• period irregularity and irregular menstrual

cycle length

• weight gain, facial hair growth and lifestyle factors



MIND

Is Stress Affecting Your Fertility?

The journey through infertility can be a

stressful path, how much do we know about the

impact of stress on fertility?

There has been ongoing debate within the

scientific community about whether stress may

influence fertility and pregnancy outcomes.

Doctors are once more looking at the idea that

stress may actually play a role in infertility

problems. Studies are focusing more on the

physiological effects of stress and how they may

play a role in conception. In the UK 25 % of

couples have been diagnosed with unexplained

infertility. For these couples the effects of stress

can be most profound.

Whilst there is not enough data to draw a

clear conclusion, what is apparent is that when

stress reduction techniques are employed

something happens in some women that allows

them to get pregnant when they were not able to

previously conceive.

What is Stress?

Stress is a normal psychological and

physiological reaction to changes in

someone’s environment.

When most people talk about stress,

however, they are usually referring to

chronic and/or negative forms of stress,

such as having too many demands at work,

relationships or the death of a loved one.

People experiencing chronic stress may

feel that they are unable to handle daily

life tasks, have limited-to-no control over

the direction of their life or more easily

become angry or irritated. This type of

chronic stress can negatively affect a

person’s short-term and long-term health.

When Stress Can Lead to Trouble

Getting Pregnant

Stress can lead to toward unhealthy behaviours

and non-fertility friendly lifestyles. For

example, when you’re stressed out, you may:

• Sleep too much or sleep too little

• Give into emotional eating or not eat right.

• Not find enough time for exercise or push

yourself to exercise too hard

• Drink one too many alcoholic drinks

• Smoke, or, if you quit smoking, start smoking again



MIND

• Drink too much coffee, especially if you’re

sleep deprived

• Lose interest in having sex

How Stress, Sleep, and Fertility

Are Connected

If your work schedule or

lifestyle leads to late

nights with early wakeup

calls, the constant

lack of sleep can affect

your body, and hence,

affect your fertility.

Research has shown

that people who get less

than five hours of sleep

are more likely to suffer

from obesity, and obesity can

lead to fertility problems.

How Stress and Emotional

Eating May be harming

your Fertility

When people are stressed, they tend to eat in

less than healthy ways. Constant stress has been

shown to lead to weight gain, and weight gain

and obesity have in turn been linked to fertility

problems. Just as eating too much junk food or

being overweight can cause fertility problems,

weighing too little or not eating enough can

affect your reproductive potential.

Work out Mindfully

Getting a healthy amount of exercise can

help lower stress and lead to a

healthier body. It is important

to exercise. However, the type,

frequency and intensity

of exercise is variable

dependent on age, lifestyle

and most importantly

stress levels. Mindful

exercise is best, i.e.,

listening to your body. A

slow gentle walk has amazing

health benefits and will aid

body systems. Gentle walking in

nature at least 30 minutes per day will

benefit health and well being.

When Stress Gets in the Way of

Sex and Fertility

Sex can be a stress reliever, something to relax

with at the end of a long day. However, crazy work

Stress can hamper

ovulation. No amount

of sperm will make a

difference if the woman’s

body hasn’t released

an egg

schedules, not to mention feeling exhausted, can

make it difficult to find time for sex

A stress-filled life can also lower your libido, so you

might not be in the mood often. It seems logical to

say that if you want to get pregnant, you need to

have sex. Some couples are too stressed

to have sex and do not have sex

enough during ovulation to

get pregnant.

Hormone mixup

– Stress

impact on

ovulation

Stress can hamper ovulation.

No amount of sperm will make

a difference if the woman’s body

hasn’t released an egg. A woman’s body is

involved in a constant monthly dance of hormones,

for which ovulation is key to conception.

When a woman is stressed, other hormones

are released in the brain, which can disrupt the

hormone cycle.

Without ovulation, any eager sperm that arrives

on the scene will find no egg to fertilise.

How does stress impact on the

reproductive system?

Everyone experiences stress, and for many it’s

not an enjoyable experience. It isn’t inherently

bad, although research suggests that depending

on the type and timing of the stressor (i.e. the

reason for stress) it can cause changes

to a person’s menstrual cycle.

Recent research tells us

that stress boosts levels of

stress hormones, such as

adrenaline, cortisol, which

can inhibit the release of

the body’s main hormone,

GnRH (gonadotropin

releasing hormone), which is

responsible for the release of sex

hormones. Subsequently this may

suppress ovulation in women, reduce

sperm count in men and lower libido in both

women and men.

Any disruption to GnRH may cause insufficient

release of hormones from the pituitary gland

which can cause their target organs to no longer

work as they once did and in extreme cases,

atrophy over time and no longer function.

Stress impact on Sperm Quality

Although mechanisms are not fully understood,

there is a link between anxiety and sperm

quality. A recent research study of 29,914

participants found that psychological stress

lowers sperm concentration and progressive

motility and increases the amount of abnormal

forms of sperm.

How does stress impact on IVF?

An area that has received growing interest

in recent years is the potential role that

psychological stress may play in determining

in vitro fertilisation (IVF) treatment outcomes.

At least anecdotally, many infertile women

and health care professionals alike believe that

the experience of stress may play an important

role in the difficulties that infertile patients

face, and thus may be a contributing factor in

determining the eventual outcome of IVF.

Research in this area is mixed, one study

showed that elevated levels of stress hormones

measured in hair were associated with a third

less chance of conceiving.

These facts are very important to consider if you

have been trying to conceive without success. It

also shows that stress relief should be a part of

every couple’s conception plan even if they are

going through IVF.

Colette Assor Lic Ac MBAcC is a fertility

acupuncturist with 20 years clinical

experience. Colette runs Acupuncture Works

clinics in Hendon & Finchley North London.

acupunctureworkslondon.co.uk



MIND



MIND

EXPERT: A’ndrea Reiter

One secret you need

to know to shift your

fertility energy

Energy is a term that is becoming a little more

comfortable for people. But other than maybe

The Secret, they don't have much experience

with it, much less how to control it. From

everything we initially learn about the Law of

Attraction and positivity, we think we need to

just say positive things and focus on it all the

time and then the baby materializes. But that's

not the case.

Like energy attracts like energy. So, the Universe

is responding with a match to the energy that we

are putting out. Unfortunately, it can be tricky

to catch when we are truly being being positive,

versus being in need and lack (which brings more

need and lack).

When it comes to energy, the more weight

we put on a situation, the heavier it is. Even

though we are focused on being a mother

because it’s a great thing and we really want

it; when we make one area of our lives seem

heavier and harder than others, the Universe

has to bring a match to that and things stay

heavier and harder. The cycle just keeps

repeating because our brain is taking our past

experience with that area, and chucking it into

the future. The brain assumes that because it’s

always been hard, it always will be, and so the

cycle repeats. The energy doesn’t change, so we

are met with more of the same.

Here’s the exciting thing though:

The energy in all areas of your life is the same.

I know it feels like they’re different, but they’re

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

more difficult than relationships,” or “Fertility

is harder than career.” We give different areas of

our lives different names, but it is essentially our

energy and what we are aligned or not aligned

with. Fertility may be blue frosting, Career may

be yellow frosting, and Relationships may be red

frosting; but it’s all buttercream frosting in the

end- just tinted to look different. As long as we

think fertility is harder it will be, thanks to the

Law of Attraction, but once you realize it’s the

same as other areas and treat it as such, things get



MIND

a whole lot easier. The brain can’t help but think,

“But it IS difficult!” Again, what’s happening is

your brain taking past experiences and assigning

it to the future. It’s not a true statement on its

own that, “Getting pregnant is hard,” but when

we believe and expect it to be, that’s what we are

met with a match to from the Universe. So, it

seems like things just keep happening to prove

your point, but it’s literally only because we are

assigning weight and meaning to it.

What do I mean by assigning meaning to it? The

situation as it is, is not stressful. It’s when you

make it mean something, that it’s stressful. So, it’s

the thought- not the situation that’s causing you

pain. For example, if you’re still getting a cycle

and have at least one ovary and a uterus- you’re

fine. It’s when you think it should have happened

by now, or it’s not fair, or too late, that you stress

yourself out.

It’s a belief that fertility is harder than other areas

in your life. From an energy perspective, it’s not. I

know that can be tough to wrap our heads around

sometimes, but it’s true. And it’s necessary to

begin shifting your energy if you want to get out

of the pattern. We must take some of the weight

off of this idea of infertility so that it doesn’t feel

so heavy energetically. It’s hard not to constantly

focus on the lack and what’s going wrong with

your fertility, but here are three simple things you

can do to start shifting the tide.

1) Make a list of why it could be easy to get

pregnant. What DO you have going for you (ex:

supportive spouse, taking care of self, regular cycle,

had sex this month, etc.). We need to stop focusing

on the problem, and focus on the solution and

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

actually work? Feel into that daily.

2) Pick relief. Sometimes it can be hard to make

the energetic leap from fear of losing your dream,

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

middle of those two, and once we can feel that,

it’s easier for the brain to entertain the positive

thoughts. What’s one thing that makes you feel

relief about your current situation? What’s one

thing YOU can do for yourself that makes you feel

relief? Why in THIS moment right now, are you

OK? (Because you are. I promise!)

3) Look at other areas in your life where you’ve

achieved something you never had before/didn’t

know if you could. Remind yourself that energy in

one area of your life isn’t different than another,

so if you’ve achieved things in career, family,

money, etc.; Then it is possible in this area as well.

Write them down, close your eyes, put one hand

on your solar plexus and say those things aloud

daily. Make a list of all your victories because it

makes you feel capable- and that’s the energy you

need to make a human.

A’ndrea is a Reiki Master and Holistic

Fertility Specialist. She uses a combination

of reiki, intuition and mindset coaching to

move women through the emotional and

physical blocks that are impeding them

from conceiving naturally. Her book, How

to Get Pregnant, Even When You’ve Tried

Everything: A Mind-Body Guide to Fertility

is available on Amazon and Llewellyn

Worldwide. Though based in New York City,

she helps clients all over the world achieve

their dream of motherhood.



MIND

YOUR FAVOURITE

FERTILITY MAGAZINE

COLLECTION

IN ONE PLACE



AmazonKindleHalfPageAdvert.indd 1 30/12/2016 10:10

MIND

EXPERT: Cassie Everett

THE EMOTIONAL

STRAIN OF

TRYING TO GET

PREGNANT

When I talk to my clients about how they

are feeling, the immense emotional strain of

trying to get pregnant is often a big topic of

conversation. Sometimes it's hard to cope when

you feel that something may be wrong with

you. Perhaps you don't feel normal and are

angry that you are finding something difficult

that others seem to find easy. You may be

experiencing grief from a previous miscarriage,

or anxiety and worry about losing future

pregnancies. You might feel left out when your

friends and family are having children.

Many of my clients speak about the injustice of

seeing pregnant women and babies everywhere,

as well as the hurtful words of people who mean

well, but can be insensitive.

For those of you who have decided to embark

on IVF treatment, you will be coping with lots

of tests and procedures, as well as the additional

financial strain.

It may be that stress is making it harder for you

to conceive due to the effect of stress hormones

on your reproductive system, so every monthly

disappointment becomes a vicious cycle. This can

lead to issues between partners, with the pressure

to perform sexually in a scheduled and clinical

way exacerbating an already strained relationship.

However you are feeling, it’s important

to remember that these feelings are

understandable and natural, and that you are

not alone. It’s also a good idea to try and reduce

your general stress levels. Here are some of my

top tips on how to do just that.

RECOMMENDATIONS

FOR REDUCING YOUR

STRESS LEVELS

Talk it through

There are many things you can do to try and

reduce your stress levels. Most important is

having someone to talk to – maybe a friend



MIND



MIND

or family member. If this makes you feel

uncomfortable then you might like to consider

counselling, attending a fertility support group

or chatting anonymously on an online forum.

This can help you feel less isolated

and provide support. Remember

that there are probably people

you know going through

the same thing as you.

One in four couples have

problems conceiving and

finding other people who

are experiencing the same

as you can really help.

Consider your own

feelings

It’s a good idea to avoid situations that upset

you, and remember, don’t feel guilty about it! If

you don’t want to go to a friend’s baby shower,

don’t go. If you don’t want to go in to the baby

shop, get a present online. Consider your own

feelings and don’t put unnecessary pressure

on yourself to do the so called ‘right thing’. Do

what’s right for you.

Do a stress audit

Ask yourself if you have the right work/life

balance. Are you working too much or taking

on too much responsibility? Look at the

different areas of stress in your life and think

about whether any of these stresses can be

reduced or removed, as the cumulative effect

may be taking its toll on your fertility. The

Many of my clients

speak about the

injustice of seeing

pregnant women and

babies everywhere

more stress hormones are circulating

round your body, the more disruption is

caused to your reproductive hormones and

hence your fertility.

Do things you love – and

look

after yourself

If you don’t have interests

or hobbies, find something

you love and do it. You

should also build in

daily relaxation to your

schedule. This could be

going for walks, doing yoga,

visualisation, meditation or

having a regular massage. Gentle

exercise is also important. It helps alleviate

anxiety and tension plus releases happy, calming

hormones into your system. A good book that

I often recommend my clients to read

is, The Inside Out Revolution by

Michael Neill as this helps us to

see how our thoughts affect

our feelings. Many of my

clients feel that they will

only be truly happy when

they have a baby. This

book really helps you

to appreciate that it is

you, and you alone that

can create your happiness;

no external influence can

do that, not even a baby, even

though it really looks like that!

Above all, make sure you have some play

time – schedule it in if you must, as it’s easy to

forget the importance of fun while your life

seems dominated by trying to conceive. Research

has even shown that feelings of joy help us

create more of the hormone DHEA in the body.

DHEA is a luxury hormone, that means that

the body can convert it into other hormones

like Progesterone. As women age progesterone

naturally declines and when women are stressed

progesterone levels are often lower. Progesterone

is THE pregnancy hormone and without enough

of it we cannot hold a pregnancy, so any extra

DHEA could make an important difference to

your Progesterone levels.

Invest in your relationship

Remember that

there are probably

people you know going

through the same

thing as you

As you know, many relationships suffer when

fertility issues arise, so make time to focus on

your relationship, and friendship, with

your partner. This is a good time

for romantic dinners and

weekends away to help

keep the spark alive.

Be honest with

yourself about your

feelings

Some of my clients

write their thoughts

and feelings down

in a diary. This helps

them release anxieties and

frustrations without worrying

that they are burdening someone else

with them or being judged, and it’s a great way to

free up some emotional space inside.

Take a break

If you feel like your fertility issues are taking

over your life, why not take a break from trying

for a few months to remove the issue and escape

the vicious cycle for a while? Clear your head

and allow your life, your relationship and your

hormones to rebalance before you think about

trying again.

Use Australian Bush Flower Essences

You might find the following combinations useful:

• “Calm & Clear Essence” is great for relaxing

and unwinding

• “Dynamis Essence” is useful if you are feeling

exhausted from stress and anxiety

• “Relationship Essence” can help enhance the

quality of intimate relationships



MIND

You can buy Australian Bush Flower Essences from

a good health food store such as: revital.co.uk/

catalogsearch/result/?q=australian+bush+flower

+essences

Take as directed on the bottle.

Put essential oils in the bath

Not only is the very act of making time for

a bath a great form of relaxation and creates

‘me time’, but some essential oils can be used

to induce a deeper sense of relaxation. A

combination of rose, jasmine and neroli is

ideal. These will help you to relieve stress and

for women they will also enhance feminine

qualities necessary for improving fertility.

Alternatively, you can buy ready-made essential

oil blends from nealsyardremedies.com

which are more cost-effective than buying

individual oils.

Try homeopathic remedies

The following homeopathic remedies can

be taken for acute anxiety and emotional

upsets. Select the remedy that most closely

matches your thoughts and feelings. Buy it in

30c potency from a pharmacy or health food

store and take one pill when needed, up to a

maximum of three a day for three days, leaving

at least a week before repeating:

• Arg Nit: for anticipatory anxiety, worrying

about the baby during pregnancy or before

doing a pregnancy test

• Gelsemium: for anxiety especially after a

shock or bad news e.g. from a miscarriage or

diagnosis from the doctor

• Ignatia: for the emotional roller coaster,

feeling very tearful and even hysterical,

embarrassed about emotions

• Natrum Mur: for repeated grief and

disappointment, want to be on your own, can’t

cry any more

• Pulsatilla: for feeling weepy all the time, don’t

want to be alone, feel better after a good cry

If your symptoms persist, always seek professional

advice from a qualified homeopath.

I really hope this has given you some useful

suggestions as to how you can relax and destress,

and cope with the emotional strain of

trying to get pregnant. For more information

on tailor-made natural solutions which could

help you get pregnant please visit my website:

cassieeverett.com or call on 07588 820 409.



MIND

Conceive Plus helping

couples conceive naturally

When it comes to getting pregnant the path can be challenging.

There are many challenges faced by couples

who want to get pregnant naturally to start, or

extend their existing family. Busy lifestyles,

careers, buying a home, as well as everyday

health concerns such as lack of sleep, poor

diet and lack of exercise can create emotional

stress or stress on the body, either of which can

negatively affect the chance of conception.

Even the process of conception itself, the journey

of the sperm to the egg is a complex feat of

biology fraught with variables. Despite the stories

we read of how easy it is to get pregnant (and for

some it is) statistically a couple in their twenties

has a 20 to 25 percent chance of pregnancy each

month. By 30, the chance of becoming pregnant

in a given month lowers to around 15 percent

and by 35, the likelihood is can be as low as 10

percent in any month.

When pregnancy does not occur as planned many

couples can stress unnecessarily especially if

there is a lack of education or understanding of

fertility, such as the fertility period, the process of

ovulation and the days that conception can occur.

Stress can also lead to or exacerbate vaginal

dryness and as a result many trying to conceive

couples experience a lack of natural fertile fluid

(Cervical mucus). Cervical mucus plays an vital

role in the process of conception by creating the

optimal vaginal environment as well as facilitating

the movement of sperm to the egg. Trying to

conceive couples are 50% more likely than couples

that are not trying to pregnant to experience

Vaginal dryness and 75% couples experience

vaginal dryness when trying to conceive.

Vaginal dryness is a cause of subfertility yet

many couples do not even notice or understand

that this can be a barrier to natural conception,

traditionally a regular personal lubricant is

used however these have been shown to damage

sperm, are the formulated with the wrong PH

(to acid) and wrong osmolarity (to thick), either

damaging or creating a barrier to sperm and

should not be used.

Studies also indicate that a man’s health affects

his sperm in both quality and quantity, and low

sperm counts and poor quality have a negative

effect on the chance of conception.

Conceive Plus is isotonic formulated with the

optimal PH and osmolarity to mimic natural

cervical mucus with the added benefit of Calcium

and Magnesium ions essential to support

sperm cell motility and viability. The patented

Conceive Plus formula matches natural fertile

fluids, supplements moisture to support the

viability and motility of sperm, and bonding of

the sperm to the egg.

In independent studies Conceive Plus is shown

to be compatible with sperm and egg making

it the lubricant of choice for couples who are

trying to conceive.

Through an intimate understanding of personal

lubricants, optimal vaginal health and fertility

Sasmar’s team has developed the Conceive

Plus range, a selection of products specially

formulated for couples who have just started

trying as well as those who have been trying to

get pregnant for a while.

The newest edition Conceive Plus Fertility Support

contains essential nutrients that prepare the body

for conception including zinc, folic acid, iron,

multivitamins and antioxidants in two specialty

formulations for men and women.

See website for information and retailers. Always

read the label.

Available from Lloyds Pharmacy,

Amazon & Chemists conceiveplus.com



MIND



FERTILITY JOURNEYS 2018

TRIPLE YOUR CHANCES

OF HAVING A BABY.

FREE SKYPE WITH

IVF SPECIALIST

FREE USE OF TIME-

LAPSE SYSTEM

SURGICAL SPERM

RETRIEVAL

UK BASED CLIENTS

SINCE 2006

NETWORK OF 4

CERTIFIED CLINICS

STATE OF THE

ART IVF LAB


www.klinikkhausken.no



FERTILITY

JOURNEYS 2018

Welcome back to the Fertility Journeys.

We’re nearly at the end of another year and we’ve been busy working with our new

couples and clinics making sure they are getting the support they need to start

their fertility journeys.

Herts & Essex Fertility Centre are contacting all of the couples who applied for the

free IVF treatment and the 40 free fertility consultations. In the November issue

we’ll be announcing the couples that have been selected.

We welcome IVF Spain’s couple Claire and David who have already visited the IVF

Spain team at their clinic in Alicante for the first embryo transfer.

Redia IVF and Mediterranean Fertility Institute’s couple Kirstie and Christopher tell

us about their journey so far as they prepare to travel to Greece in September for

their treatment.

Also Heather and Brandon who are working with our US partners Oregon

Reproductive Medicine are expecting TWINS and Heather is in her third Trimester.

We’re really looking forward to meeting the twins very soon.

But we’re not stopping there as we have two new clinics joining us in September

and November.

Keep an eye out for our newsletter with the news.

Good luck to all of our couples on their journeys.




FERTILITY JOURNEYS:

EGG DONATION WITH IVF SPAIN

Exclusive

Spanish

Partner

During the first week of August, Claire (42) and David (35), the winners of this year’s

Fertility Journey, visited our clinic for their first embryo transfer.

When we discovered that Claire didn’t have a single

positive pregnancy test, we suggested to carry out an

endometrial biopsy to analyse the sample by means

of the ER Map® test (Endometrial Receptivity Map)

in order for us to being able to accurately determine

the receptivity of Claire’s endometrium during the

window of implantation (the moment when the

endometrial lining is receptive).

”The test results showed that Claire’s endometrium

was post-receptive, meaning that a transfer

performed on day 5.5 of progesterone (like in 70%

of cases) would not end up in a successful pregnancy”

explains Dr Natalia Szlarb.

They were pleased to share with us the emotion and

joy created by their short stay in Spain;

“We have spent some time in Alicante ahead of the

transfer, relaxing in the area and preparing for our

next visit to IVF Spain. Our experience with previous

treatments with UK clinics has been very stressful

but in Alicante, we have spent most of our time

preparing for treatment by relaxing on the beach!”

Claire and David arrived at IVF Spain after

having been trying to get pregnant for 7 long

years and 3 failed ICSI treatments with their

own eggs. IVF Spain discovered that the embryos

were of poor quality and that they had always

been transferred on day 3 of their development

with a bad morphology. In order to increase

their chances of getting pregnant the clinic

recommended an egg donation treatment, which

greatly depends on matching the perfect donor

to the patient.

To protect both patients and donors, Spanish

law requires that the donation process must be

completely anonymous. In addition, donors

must be in good condition and younger than 35.

Dr Szlarb with

2018 winners

Claire and David

Moreover, both donor and patient must share a

phenotypical resemblance: hair and eye color,

BMI, and so on.

Claire and David were grateful that so many women in

Spain were willing to donate their own eggs, enabling

others less fortunate, the chance of forming a family.

“We are really grateful that there are people willing

to donate eggs. If we are being honest, it has taken a

while for us to understand the Spanish anonymity

rules for egg donors, but we have taken the time to

consider this. It’s hard not having control or letting

another person being in charge for something

related to your baby. However, we even think now it

is better that way, because the more you know, the

more you want to know and we do prefer knowing

nothing and leaving it in the clinic’s hands.”

There are other factors, however, that are crucial

to achieving a successful pregnancy such as the

quality of the embryo and the microenvironment

of the endometrial lining. This means that a

successful pregnancy also depends on the successful

communication between the embryo and end the

endometrial lining.

“Before coming to IVF Spain, we had never heard

of an endometrial study or ER Map. The fact that

the endometrial study analyses the best time to

transfer the embryo could make a big difference to

our treatment. We were really impressed with the

accuracy of the test. Our ER Map test result was postreceptive

and although this was initially a concern,

we later came around to the view that knowing the

best time to transfer the embryo would increase the

chances of success, and this might have been the

reason our other treatments in the UK had failed” -

Claire and David.

Another key aspect to achieve a successful pregnancy

is the male factor. David suffers from teratospermia

which implies that 96% of the ejaculate sperm cells

have an abnormal morphology. Luckily, we were able

to improve David’s sperm quality and fertilize the

retrieved eggs.

We now wish them the best of luck!

Although it will not be until mid-September when

the 2018 runner-ups Laura (41) and Ian (44) visit

us in Alicante for their embryo transfer, they

already talked about the differences between IVF

Spain and former clinics. They were impressed at

how extensively their case had been studied by our

fertility specialists.




Laura and Ian

Immunologically speaking, finding a matching

donor for Laura is certainly a challenging task, which

is why IVF Spain suggested that we find out her KIR

via a blood test. Ian was also tested for his HLA-C in

order to determine whether the maternal – foetal

interaction will be optimal or not.

“I think the longer you have treatment the more

difficult it becomes. When you begin there’s a

naivety along the lines of, ‘we’ll have one, maybe

two goes at IVF and have a baby in our arms’.

After 7 treatments (and lots of add-ons) the

feelings completely change. You feel terrified

that it won’t work, and you’ll never become

parents. You’re scared it will work and you’ll lose

the baby again (Laura and Ian have experienced

5 losses).

You’re scared of physically going through the

treatment as you’ve had so much. Each test and

treatment creates fear – fear that it will hurt, be

traumatizing, that it will give you more bad news.

Then there’s the impact on your own mental

health and emotional well-being. Can I handle

this? What if the results say something’s wrong

with me? Will I blame myself? It starts to really

damage your mental health and well-being.

Financially you start to feel that you’re risking

everything, and it may not pay off.

For us we have renewed hope with IVF Spain. We

have undergone tests that we’ve never had before

(ERA, NK biopsy and KIR). We have paid for

lots of very expensive blood tests and drugs but

never received this kind of analysis. So, we feel as

though the treatment is now specifically for us.

This creates more positivity, a feeling of being

cared for and that maybe, just maybe, we’ll get to

be parents.

Plus, we’re now using donor eggs. The hope starts to

soar and with that comes excitement. Hope is the

only thing that keeps you going and overcoming the

fears I mentioned. This opportunity with IVF Spain

has given us hope that we thought we’d lost.”

Laura is 41 years old and has already been through

traumatic losses including an ectopic pregnancy.

Due to this and to the fact that Laura suffers from

trisomy 22 syndrome, our medical team at IVF

Spain recommended an egg donation treatment to

increase their chances.

The couple is thankful for the egg donation process

being anonymous, as otherwise it would be really

difficult to find a donor:

“For us, it’s taken some of the pressure away. I can’t

imagine how difficult it would be to choose a donor

ourselves. But putting your complete trust into

someone else’s hands is hard.

We’ve explored whether it would be better for

our future child to know the donor. I think that’s

something we’ll never know. But we hope that he/she

will understand our decision to choose an anonymous

donor. It would be good to know a little more about the

heritage of the donor but then we also know that we

often don’t even know our own heritage. We’ll make

sure Spain is a key part of their story.

It’s also really odd to not know who this person

is. What they look like and personality. What’s

motivating them to help us. One of the things I’ve

been really consumed with is the gratitude you have

for this person. I’d like to thank them but can’t.

Anonymity means we have a chance to become

parents. Without it there’d be a shortage of donors

like there is in the UK. For us, this makes it a

wonderful gift – a chance to hopefully find a donor

that is perfectly matched to us genetically (due to the

KIR tests) as well as in physical looks.

I can’t stop thinking about what our future child will

look like – but I think that’s quite normal” says Laura.

Thanks to the KIR-HLA-C genotyping test it is

possible to determine if the uterine KIR and the

embryonic HLA-C will both be compatible. If so,

the pregnancy will carry on successfully; if not, then

the most probable outcome will be an unviable

pregnancy and subsequent miscarriage.

“We carried out the KIR-HLA-C genotyping and

concluded that the patient had a KIR AA. It is

known that KIR expressed by the natural killer

cells present in the maternal part and the HLA

presented by the trophoblastic cells together will

influence the outcome of the pregnancy. With

Laura’s KIR AA variant, the sperm would have to

be HLA C1 C1 and the HLA of the donor should be

as well HLA C1 C1; as her husband has a HLA C1

C2 variant, we will treat her with a medication that

reduces her immune-genetic reaction. We believe

that not paying attention to this issue in the past

is what may have caused the implantation to fail”

suspects fertility specialist Dr Isabel Herrera.

We tend to recommend a single embryo

transfer, as it has been proven that on patients

with an immunological profile such as Laura’s,

a double embryo transfers would increase

the immunogenetic reaction, hindering the

achievement of a pregnancy” says Dr. Herrera.

It is also known that these cases tend to have a

higher risk of pre-eclampsia, late spontaneous

abortion or miscarriage.

Until their transfer day the couple will try to enjoy

summer just as any other couple would;

“I’ve tried to just carry on as normal. Remain

healthy, take pre-conception vitamins. Reach out

and get support through the Donor Conception

Network in the UK and connect with other people

going down the DE route via online forums. It’s

quite isolating and scary so it’s important to reach

out and not feel so alone.

I’m trying to relax a little – not so easy with work but

it’s a work in progress. I need to get that bit sorted

now treatment is on the horizon.”

Dr Isabelle Herrera




FERTILITY JOURNEYS:

OUR FERTILITY JOURNEY –

KIRSTIE DOWNEY & CHRISTOPHER HANSON

Around Christmas time of 2015, we met with

the Sunday Life journalist in Belfast to discuss

infertility and our journey towards finding an

egg donor. We openly discussed our journey

to date with the journalist and had some

photographs taken for the newspaper. A few

weeks later our story featured in the newspaper

seeking an anonymous egg donor.

In May 2016 we received a call from the Regional

Fertility Centre at the Royal Victoria Hospital in

Belfast. Allison McKee from the Centre informed us

that an anonymous donor had come forward after

seeing our advertisement and wished to donate her

eggs to help us fulfil our dream of having a family.

We thought it was amazing that we received this

news less than 48 hours after we had got engaged.

At 16 years old I was still waiting for my first

period and was advised to visit my GP. After

many blood tests, scans, and open key hole

surgery I was diagnosed with premature ovarian

failure. My consultant advised me at this young

age that my only chances of ever conceiving a

child would be through egg donation. I would be

able to carry a child but unfortunately, I would

have no eggs to conceive naturally.

This was shattering news to receive at such

a young age for me and my family. I did not

really understand the implications of this

condition and always held onto the hope that I

would conceive children naturally. As the years

progressed I gained a better understanding of

my condition, but it only really started to sink in

when I met my partner Chris in October 2012.

I had spoken to Chris early on in our relationship

about my condition and he was understanding

and supportive; fully aware of the difficulties we

might face to have our own family. Chris decided

to get his sperm tested early on in our relationship

to ensure he had good quality sperm for whenever

we would go through fertility treatments. We were

delighted when Chris’s results came back as normal

and his GP advised that he had no fertility issues.

Our fertility journey began in

2015 at the Grove Wellbeing

Centre in Belfast where

we met Gillian about

advertising for an egg

donor. Gillian discussed

during our appointment

the possibility of doing

an advertisement in the

local Sunday Life newspaper

in Northern Ireland. We

were very open to this idea and

received contact from the editor of

the newspaper, Angela, very shortly after our

appointment with Gillian.

I had spoken to

Chris early on in our

relationship about my

condition and he was

understanding and

supportive

Chris & I would do anything to have a child and

following the phone call with Allison I started to

make some life changes. I changed my diet, ate

healthy foods, took folic acid daily and started fertility

acupuncture with Sharon Campbell, a renowned

fertility acupuncturist in Northern Ireland.

In July I received my medication to prepare my

body for pregnancy. In subsequent appointments

my bloods were normal, and my womb lining

was thick for egg transfer. I was visiting Sharon

once a week which I believed helped

towards the thickening of my womb

lining and helped my mental

state during this emotional

roller coaster.

The day before the embryo

transfer I received a call

from the laboratory to

inform me that 2 donor

eggs had fertilised and they

would be transferred the

next morning. On 4th August

our transfer took place and two 6

cell embryos were transferred into my

womb with no complications. Now it was the 2

weeks wait before I took a pregnancy test.




I took 2 weeks off work to give the embryo the

best possible chance to implant and followed all

guidelines given to me by the professionals.

give anything to have our own child to love and

protect and hopefully someday soon, with the help

of yourselves, you can make our dreams come true.

•Can we afford the travel & test costs?

•Can we get the time off work?

On 18th August we did our pregnancy test. Our

dreams were shattered when the result came back

negative, it was the worst feeling in the world. We

had believed because we were so young we would

have a better chance of a positive result.

During and after the procedure we attended

counselling and eventually came to terms with

the negative result. This was our only free cycle

of egg donation available here.

We have been together now for

nearly 6 years. We have built

a loving home together. I am

a full time childcare worker

which has always been my

passion. Chris is a full-time

manager in Tesco.

Despite all this, there is one

thing missing from our lives

and that is the dream of having a

child. We are both young, fit, healthy,

hardworking individuals and have so much

love to give a child. I have a big family and have

grown up with children my whole life. We are

happy to share our story with others facing similar

scenarios to demonstrate that wherever you are in

your particular fertility journey there are always

options – options to consider, and support to help

you make the right decisions for you. We would

We literally could

not believe it and had to

read the email numerous

times in floods of happy

tears to check this was

actually real

We received the email to say we were the lucky

winners on 20th June. It is very difficult to put into

words how we felt. To be the selected couple is very

hard to believe and we count ourselves so lucky to

have been given this amazing opportunity.

We literally could not believe it and had to read the

email numerous times in floods of happy tears to

check this was actually real. Eventually we were able

to write a response obviously accepting the

offer. Finally, when the news had

sunk in we started to ask ourselves

questions about travelling to

Greece and researching the

clinic and island etc.

Over the next 2 weeks

we acted very quickly

in getting all our tests

together, sorting time off

work, arranging flights &

accommodation and getting

the required medication. We went

through a number of stumbling blocks.

With the amazing Shirley supporting us via email

we were able to sort everything very quickly and

her advice was invaluable during this period.

Despite all this we were naturally worried about

travelling to Crete for this treatment. We asked

ourselves many questions

•Where will we stay in Crete?

•Is my body going to respond to the medication?

When we went through our free cycle of

treatment with the NHS over here in Northern

Ireland, the success rates were only 24%. To

know that the success rate in Crete is almost 3

times that gives us massive hope and we would

obviously not be travelling to Crete and putting

ourselves through all this if we didn’t think it

was going to work.

Everything is arranged, booked and paid for. I

am currently on the Microgynon pill on my first

cycle. My first uterus scan is on 20th August. We

depart for Crete from Dublin on 12th September,

we are staying for 2 weeks and are so excited to

undergo the treatment and meet all the team in

the Mediterranean Fertility Institute. A special

mention must go to Shirley who has helped us

out so much over the past few weeks with our

endless questions and emails. She has made this

experience a lot easier.

We are both super excited and hopefully our

story will encourage other young couples like

ourselves to take the step of travelling abroad for

treatment. It seems scary preparing to go abroad

for treatment but with the help of your chosen

clinic everything runs smoothly.

We sincerely hope that the team in Crete can

make our dream come true. It is impossible to

put into words how much we want a baby and to

be taking this step now in travelling abroad is

so surreal. We never seen ourselves at 25 years

old travelling to Crete for egg donation. At this

moment in time and certainly in the foreseeable

future there is no chance we would be able to

afford the treatment anywhere, so this feels like

our only hope of having a bundle of joy.




FERTILITY JOURNEYS:

DONOR EGG IVF WITH GENOMIC SCREENING...

WITH OREGON REPRODUCTIVE MEDICINE

After nearly ten years trying to build their family, Heather and Brandon are starting the

third trimester of Heather’s pregnancy. Their 20-week scan has given them a good look

at their baby girl and boy who are continuing to develop well.

Heather writes…

We’ve made it to the start of my third trimester

and are all smiles right now!

While nausea has continued to pay a significant

role in my journey, anti-nausea medications

have become my best friend. I‘ve been needing

to take anti-nausea medication once every eight

hours (three times a day) to help avoid constant

vomiting. Food has become challenging. There are

very few foods I enjoy with the exception of fruit,

smoothies, lemonade and tart candy.

Importantly though, the babies are doing well and

both are maintaining an above average heart rate. I

cannot feel them moving just yet but have been told

by my doctors that they are actively moving and

kicking each other. I was told that it is normal for

them to kick each other in order to start developing

basic capacity for their limbs.

My daily routine is waking up, going to work, coming

home to nap, eating take out - because the smell of

food lingering in the house makes me nauseous -and

heading back to sleep by 10:30 p.m. I will be honest

that I have never felt so tired in my life.

I do not feel at all in control of my own body and

many of the basic tasks I used to do on a consistent

basis seem impossible (washing clothes, tidying up

the house, etc.).

Brandon is doing a lot of the research that I am

too tired to do. He sends me, on a consistent basis,

helpful tips and bits of information and weekly

“what to expect” updates.

After much

anticipation, our

20-week ultrasound

went well and it was

amazing to see our

babies right there in

front of us.




Through these updates we are following the size

of each baby and what parts of the anatomy they

are starting to develop at each stage. They are

also helping us focus on the things we should

start to prepare for so that we are properly pacing

ourselves through this journey.

As an example, we were given the suggestion of

talking about how we will handle life after the birth,

making sure I invest in flats for the remainder of

my pregnancy and knowing the symptoms and

risks of preeclampsia.

After much anticipation, our 20-week ultrasound

went well, and it was amazing to see our babies right

there in front of us. Because we are having fraternal

twins our ultrasound took more time to complete.

Baby A is our girl and she is located closest to my

waist. Baby B is our boy and he is higher up and

above my belly button.

Our baby girl has been diagnosed with a two-vessel

umbilical cord instead of a three vessel cord. Our

baby boy has a three-vessel umbilical cord and is

the most active.

Most babies’ umbilical cords have three blood vessels:

one vein, which brings nutrients from the placenta

to the baby, and two arteries that bring waste back

to the placenta. But a two-vessel cord has just one

vein and one artery — that’s why the condition is also

referred to as having a single umbilical artery (SUA).

It’s more common than you might think and is the

most common abnormality of the umbilical cord.

Our doctor informed us that in most cases, the

one artery just makes up for what the missing one

would do. However, there’s a slight increase in risk

of growth problems and a minimal increase in risk

of stillbirth. Our doctor has informed us that her

weight is currently as should be expected and they

will monitor our baby girl closely.

I have been scheduled for several ultrasound

follow-ups to ensure they are both doing well. Thus

far, they are both flourishing and maintaining an

above average weight. We are happy campers!

We are currently in the process of making

arrangements for a close to home babymoon with

a car ride that will not exceed two and a half hours.

Our goal is to stay close to home, enjoy a massage or

two and have some time to lounge in a nice pool!

In addition, we are awaiting the invitations for our

upcoming baby shower which will take place around

the corner from our house on the day of my birthday!

We are excited to send out invitations in the

coming days and share my birthday with one of the

best gifts we have ever received.

Dr Barbieri comments on Heather and Brandon's journey

The 20-week scan is almost always a much anticipated point

in every pregnancy. Not only is it an important milestone for

being able to check on foetal development, but also modern

ultrasound technology gives expecting parents a good peak at

their growing babies.

The precision of modern ultrasounds will have enabled the

diagnosis at the 20-week scan of single umbilical artery (SUA)

for Heather and Brandon’s baby girl. Heather is correct that

SUA is the most common congenital abnormality of the

umbilical cord. The cause of SAU is a not fully known and

there is no scientific consensus on the incidence and clinical

significance of SUA in twin compared to singleton pregnancies.

Generally diagnosis of SUA is made during the third trimester. The earlier awareness of SUA for

their baby girl will allow Heather’s OB/GYN to formulate a protocol for monitoring both babies’

development and managing Heather’s pregnancy. I am glad that Heather has a schedule for regular

ultrasound monitoring.

There is generally a growth in the size of the single artery for an affected baby near the start of the third

trimester. Heather’s OB/GYN will be watching for this change, and their baby girl’s continued increase

in weight and a strong heartbeat as key indicators of her healthy development.

I am comforted to know that Heather’s OB/GYN has personal experience with twins. A twin pregnancy

carries higher risks, so expertise with twin pregnancies and enhanced monitoring is called-for, even

more so with the diagnosis of SUA for their baby girl.

We are honoured to have been able to help Heather and Brandon and will be continuing to follow

their journey closely. Along with them, we are counting the days now that they are in their third and

final trimester.



FERTILITY 360

EXPERT: Craig Reisser

THE

VALUE

OF

SUCCESS

RATES

Understand Success Rates and Help

Keep Your Surrogacy Journey on Track



FERTILITY 360

Craig Reisser, a parent via egg donation and

surrogacy in the USA, shares some advice for

intended parents on how to use success rates

when planning your surrogacy journey.

When it comes to choosing an IVF clinic a

discussion of success rates is sure to be one of the

key considerations.

Success rates can be a notoriously complicated area

for intended parents, not only because there can be

so many factors that play a part in them, but also

because clinics may report them in any number of

ways. I certainly found this to be true when I was

undertaking my own journey.

Because your IVF clinic will play a pivotal role in

shaping your journey, understanding how to make

sure you are focussing on the right success rates

for the specific IVF procedure you are planning, as

well as how to apply them in a practical manner to

your decision making is essential.

In my view, your ideal goal with IVF should be

to have the best chance of success and a healthy

baby on your first attempt. Or in other words

minimising the risk that you will have to repeat

any aspect of the IVF process. This is the best way

to keep your budget and timetable under control

and your stress levels to a minimum.

While my focus here is on IVF for a surrogacy

journey, as this was my own personal experience,

this same objective can apply equally to anyone

undergoing IVF – whether using her own eggs or

donor eggs, working with a surrogate or planning

to carry the pregnancy herself.

In an ideal world, first time success would mean

two things. Firstly, only needing one egg retrieval

and embryology cycle (including embryo testing

if applicable) to obtain all the viable embryos

that you will need to build your family. Secondly

only needing a single embryo transfer for the live

birth of a healthy baby.

For many intended parents their actual IVF

experience does not reflect this ideal and they

may require more than one egg retrieval and

embryology cycle and/or more than one embryo

transfer to achieve their dream of a healthy baby.

Each time that you need to repeat either of these

steps in the IVF process there are real implications

for you in terms of higher costs, a longer timetable,

and added emotional stress.

The real "value of success" is therefore that higher

success rates can help you avoid costs, keep your

timeline to a minimum, and your stress levels in check.

Intended parents therefore need to know which

success rates to focus on, how to apply them to make

practical choices, and what they mean in terms of

the likely number of times they will have to undergo

each step of the IVF process to reach their goal.

With this in mind, I focus on two key elements of

the IVF process where achieving first time success

can make a real difference in your journey: the

egg retrieval and embryology cycle and the

embryo transfer. These steps are distinct but

intimately connected.

My focus on these two aspects is not meant to

diminish the importance of other elements of the

IVF process that can play a part in having a healthy

baby, such as genetic screening and the choice

regarding the number of embryos to transfer, and

which intended parents should also consider.

Egg Retrieval and

Embryology Cycle

In my view, the real measure of success for an egg

retrieval and embryology cycle is the number of

viable embryos obtained, and whether this meets

or exceeds the number that you can expect you

may need.

The number of viable embryos that you may need

depends on how many children, over time, you

hope to have multiplied by the number of transfers

you can expect will be required to achieve a live

birth. If you plan to transfer more than one embryo

at a time then this needs to be factored in as well.

It’s certainly true that you only need one viable

embryo to have a child and success on the first

embryo transfer can absolutely happen. However,

the reality is that that embryo transfer success

rates are not 100%. Therefore, there is a potential

risk that you may need to repeat the egg retrieval

and embryology cycle if you only have a single

embryo at the end of this step in the IVF process.

For example, if you hope for one child and can

expect that you may need to undergo two transfers

to achieve a live birth, then you will hope to have

at least two viable embryos. If say however, you

hope to also have a sibling in the future for your

first child (and can expect that again you may

need to undergo two transfers to achieve a live

birth) then you will hope to have obtained at least

four viable embryos from your egg retrieval and

embryology cycle in order to minimise the risk of

needing to repeat this step to create more embryos.

The egg retrieval and embryology cycle is the most

expensive part of the IVF process to have to repeat.

It may represent some 75-80% percent of the IVF

costs of a single successful journey. In addition to

the medical costs you may incur for a repeat cycle, it

you are using an egg donor there will also be donor



FERTILITY 360

compensation and potentially travel reimbursement,

as well as possibly egg donor agency fees and

screening costs that may need to be paid again.

Depending on when this step would need to be

repeated, and possible scheduling considerations,

(e.g. egg donor availability) it could lengthen your

timeline from a few to several months.

Unfortunately, for intended parents, the public

databases for clinic success rates (such as SART and

the CDC in the USA) do not report the statistics,

namely the average number of viable embryos

that each cycle type has achieved at a clinic, which

could help inform intended parents’ decisions.

Though each cycle is unique and some factors

cannot be controlled, IVF clinics should have this

type of success data, particularly in the case of egg

donor cycles. You should be sure to ask about this,

as well as the factors that contribute to successful

egg retrieval and embryology cycles, including

stimulation and egg retrieval medical protocols,

the quality of the embryology laboratory, and

the role of ovarian reserve. This will help you in

making decisions that may help you increase the

chance of first time success.

Embryo Transfer

Beneficially for intended parents, the public

databases for clinic success rates generally

focus on the statistics that help them

understand the chance of success with an

individual embryo transfer.

Live Birth Rate Per Transfer, is the relevant success

rate to focus on as it represents your ultimate

goal. Where more than one embryo has been

transferred, a Live Birth Rate Per Transfer will

refer to the birth of at least one child.

Sometimes, clinics may instead quote Pregnancy

Rate Per Transfer. This represents the percentage

of embryo transfers that had an ongoing

pregnancy when the rate was calculated. This is

not the same as Live Birth Rate Per Transfer as

some pregnancies that were ongoing when the

success rate was calculated will not progress. As a

result, this measure will be a few to several points

higher than the one that matters most for you.

Occasionally some clinics may report their

success rates on a cumulative rather than a per

transfer basis. Cumulative success rates calculated

over multiple embryo transfers will be higher in

comparison to per transfer success rates.

Cumulative rates can be helpful if understood

correctly, but intended parents may be confused

in thinking that a Live Birth Rate presented on a

cumulative basis is comparable to one presented

on a per transfer basis. For example, a 67% Live

Birth Rate Per Transfer will represent a much

greater chance of success on the first transfer

attempt (and therefore a lower cost and shorter

timeframe) than a 67% Cumulative Live Birth

Rate calculated over say three transfers.

Generally speaking it takes more than one

embryo transfer to achieve a live birth. So

from a practical point of view you may want to

translate the Live Birth Rate Per Transfer into

an estimation of the number of embryo transfer

attempts you may actually need in order to

achieve a live birth. It is this number of expected

embryo transfer attempts that will influence the

number of viable embryos you should hope to

obtain from your egg retrieval and embryology

cycle. It will also impact how you plan your

budget and timetable.

If an embryo transfer needs to be repeated then

this will add to your timeline and costs. Extra

costs may include the transfer procedure itself

and related medications, pre and post transfer

monitoring, as well as other costs such as travel.

You can estimate the potential number of embryo

transfers you may need to achieve a live birth. Using

the Live Birth Rate Per Transfer, you can calculate

the cumulative probability that you will have a live

birth within a certain number of transfers.

In the example below, using a Live Birth Rate

Per Transfer of 50%, intended parents would

have a 88% chance of having a live birth within

3 transfers. They may get lucky and have a live

birth on the first or second transfer, and there

still remains a small chance that they will not

have been successful by the third transfer. This

type of calculation can help intended parents

plan for the possible implications to their budget

and timeline of their IVF clinic’s success rate.



FERTILITY 360

Indicative Added Costs of Having to Repeat an Embryo Transfer

Live Birth Within n

Embryo Transfers

Cumulative Probability

of Live Birth 1

Indicative Added

Months 2 Indicative Added Cost 3

1 50% -

2 75% +2-4 $3,000 – 5,000

3 88% +4-8 $6,000 – 10,000

4 94% +6-12 $9,000 – 15,000

1. Based on the SART-reported US National Live Birth Rate Per Transfer in 2016 for all donor egg + surrogacy frozen embryo transfers.

2. 2-4 months in an indicative period of time to prepare for and undergo a repeat embryo transfer.

3. $3,000 – 5,000 is an indicative additional cost of elements associated with a repeat embryo transfer. If an additional egg retrieval

and embryology cycle were needed these costs would be extra.

Success the First Time

In my family’s own journey, we found that this

type of understating of success rates helpful.

It focussed us on the factors that would help

keep our journey on track, namely obtaining

the highest number of viable embryos and

minimising the number of required transfers.

It also allowed us to plan our budget and

timeline, accounting for the probability that

we might have to repeat either step in the IVF

process. Thankfully, we had the first-time

success that we were hoping for and I believe

that the decisions we made, armed with this

understanding, played a big part in this.

US IVF Success Rate Resources

For those intended parents looking at IVF

treatment in the USA, there are two online,

public databases that contain national and

individual US IVF clinic success rates - The US

Society for Assisted Reproductive Technology

(SART) at SART.org and the US Centers for

Disease Control (CDC) at cdc.gov/art.

SART has been recording US IVF clinic

success rates since 1988. Additionally, since

1992 all US IVF clinics have been mandated

by the US government to report their success

rate data to the CDC. SART membership is

voluntary for US IVF clinics. About 80% of

US IVF clinics are SART members and about

95% of US IVF cycles are captured in the

SART success rate database.

Both SART and the CDC have now released

the 2016 live birth success rates for US IVF

procedures and this represents the most

current US live birth success rates. The 2016

data is available alongside the 2015 data for

year-on-year comparisons. The 2017 live birth

rate data will be known and reported in the

Spring of 2019.

The SART database allows for easy filtering

by clinic for specific procedure types –

surrogacy, egg donation, PGS/PGD testing,

and more – as well as for the specific number

of embryos transferred.

Craig is a regular contributor to Fertility

Road on third party reproduction.

Look for his upcoming articles on egg

donation and surrogacy in future issues

of Fertility Road or contact him at

oregonreproductivemedicine.com.

This functionality is a real benefit for

intended parents considering US IVF

clinics as they can now search for live birth

success rates for the exact procedure they

are seeking to undergo by clinic, as well

as US national averages for comparison.

It also allows them to view consistently

prepared and presented data and live birth

success rates for every clinic they may be

considering. It allows them to reference a

clinic’s 2016 data to its 2015 results as well

to national statistics for both periods.



FERTILITY 360



FERTILITY 360

What Women Need To

Know About Polycystic

Ovary Syndrome

By Michael Ah-Moye FRCOG, CEO and Consultant Gynaecologist

What are polycystic ovaries?

The term Polycystic ovaries was coined in the

1930’s because it was thought that the ovaries

contained many cysts, which was incorrect as

the “cysts” are in fact just follicles. A follicle is

where an egg develops. Polycystic ovaries are

usually larger in size and contain more follicles

than normal.

What is polycystic ovary

syndrome?

It is important to know that having polycystic

ovaries does not necessarily mean that the woman

has Polycystic Ovary syndrome. Some women

have polycystic ovaries without any symptoms.

Only women manifesting symptoms are classified

as having the syndrome. Studies show that 20 –

25% of all women have polycystic ovaries, but less

than 10% will have the syndrome.

Polycystic ovary syndrome (known as PCOS) is,

therefore, a common hormone disorder. It can

cause a woman’s menstrual cycle to be longer

than normal, be irregular and infrequent, and

in severe forms, there may be no periods at all.

PCOS can affect a woman’s ability to conceive

and may affect her appearance with excess

body and facial hair, acne and oily skin, and a

tendency to be overweight.

What causes PCOS?

There is no known cause for PCOS and why some

women develop it while others don’t. However, we

do know that it often runs in the family, so there

may be a genetic link to the condition.

What are the symptoms of

PCOS?

•Irregular periods where there are longer gaps in

between periods or no periods at all

• Increase in facial and body hair known as

hirsutism

• Loss of hair on the head

• Oily skin and acne

• Problem with fertility

• Overweight

Most of the symptoms of PCOS are due to the

abnormal hormone levels associated with the

condition and can vary tremendously from

woman to woman. The hormones that are

abnormal, are raised levels of the male hormone

testosterone and also insulin which is a hormone

linked to diabetes.

Women trying to fall pregnant may also face

difficulties, due to ovulatory problems associated

with PCOS. There also appears to be an increased

risk of miscarriages.

Mood swings and depression

Women with PCOS are more likely to experience

higher levels of depression and low self-esteem,

caused both by the hormonal imbalances of the

condition or by the symptoms it presents. If

you are experiencing mood swings, do get help

from your doctor for both your PCOS and your

depression, even if it means a referral to a mental

health specialist.

Diagnosis

As already mentioned some women with

polycystic ovaries do not have the syndrome and

therefore do not have any symptoms. Many are

diagnosed when they seek help for their infertility.

Others have symptoms but are unaware of what

causes them. Symptoms to look out for: irregular,

infrequent periods and an increase in facial or

body hair.

The best investigations to diagnose polycystic

ovaries are ultrasound scan of the ovaries and

hormone tests to check the levels of Anti-

Mullerian Hormone (AMH) and testosterone.

What are the long-term

consequences of PCOS?

Irregular periods can increase the risk of uterine

cancer, acne can cause scarring, and weight can

become harder to manage. Getting diagnosed and

treated sooner rather than later is the best way to

lower the risk of these problems.

Insulin resistance and

diabetes

In PCOS the body responds less well to insulin

which leads to a higher level of insulin and

increased glucose level. Raised insulin may

lead to irregular periods, weight gain, increased

testosterone and fertility problems. It is estimated

that 10-20% of women with PCOS go on to develop

diabetes in later life. Furthermore, women with

PCOS have an increased risk of diabetes if they are

over 40 years old, have a family history of diabetes,

have developed gestational diabetes in previous

pregnancies and those who are obese.



FERTILITY 360

Cancer

A very small number of PCOS women who have

significantly fewer periods per year than normal

are at risk of developing endometrial cancer due

to the womb lining remaining thicker. There

are means of reducing the risk which involve

hormones and depends whether the woman is

trying to conceive or not.

Hypertension

PCOS women are more prone to raised blood

pressure which may be linked to obesity and

insulin resistance.

Snoring and drowsiness

There appears to a link between PCOS and snoring

leading to tiredness and drowsiness.

What can be done to reduce

the long-term consequences

of PCOS?

Diet and Weight loss

A healthy lifestyle is important to help reduce the

symptoms of PCOS. First of all, a healthy balanced

diet is strongly advised. This should include

plenty of fruits and vegetables and whole food

e.g. wholemeal bread, brown rice and whole grain

cereals, lean meat, fish and chicken. Consume less

carbohydrates and salt, avoid alcohol and exercise

regularly.

If you are overweight it is advisable to lose weight.

The benefits of losing weight are:

• Lower risk of developing diabetes and insulin

resistance

• Lower risk of heart problems

• Lower risk of cancer of the womb

• Improving your fertility and the chance of

pregnancy

• Improve regularity of your periods

• Improve skin condition with less acne and

hirsutism

• Less depression and mood swings

It is important to note that losing a small amount

of weight can make a significant difference to the

symptoms of PCOS and at the same time make

you healthier.

Regular health checks

Make sure you have your blood pressure and blood

sugar checked by your GP regularly, at least once

a year especially if you are overweight and have a

family history of diabetes.

How to get pregnant

with PCOS?

Most women with the milder form of PCOS do

conceive naturally, though in general, it takes them

longer to do so than average. On the other hand,

women with the moderate to severe form of PCOS

will have more difficulty conceiving naturally and

often require help from fertility specialists. They

have what is termed “ovulatory disorders.”

For women with ovulatory disorders, the first

line treatment is trying fertility tablets such as

clomifene citrate which stimulates ovulation

although the tablets themselves can reduce

conception as they adversely affect the womb

lining (endometrium) where embryos implant.

This is why there is no benefit in taking fertility

tablets if a woman is already ovulating on her own.

An alternative is to use fertility injections which are

more powerful and works differently to the tablets

in that they do not affect the womb lining. There

is, however, a higher risk of multiple births and

requires ultrasound monitoring to reduce the risk.

Another option is In-Vitro Fertilisation (IVF)

should the above be unsuccessful. Whereas women

with PCOS have a problem conceiving naturally,

their chance of being successful through IVF is the

same as other women without PCOS.

It is pertinent to note that because women with

PCOS have more follicles than normal, there

is a tendency to produce more eggs during

IVF leading to a condition known as Ovarian

Hyperstimulation Syndrome (OHSS).

Our fertility experts at Herts & Essex Fertility

Centre have devised a protocol to treat PCOS

patients with a special trigger to ripen the eggs.

This is designed to reduce many times the risk of

OHSS in patients with too many eggs, as opposed

to the standard trigger which itself initiates the

whole process of OHSS in those particular women.

Finally, is there a cure

for PCOS?

Unfortunately, there is no cure for PCOS.

Medical treatments are aimed to manage and

reduce the symptoms or consequences of having

PCOS. Medication alone has not been shown

to be any better than healthy lifestyle changes

(weight loss and exercise). Many women with PCOS

successfully manage their symptoms and longterm

health risks without medical intervention.

They do this by eating a healthy diet, exercising

regularly and maintaining a healthy lifestyle.



FERTILITY 360

MORE WAYS TO ENJOY

YOUR FAVOURITE

FERTILITY MAGAZINE

fertilityroadsubscribe.co.uk



FERTILITY 360

Taking

Time Out

ALPHAZITA True Holistic Fertility

Care and Fertility Retreats



FERTILITY 360

By adopting this

holistic approach,

couples can lay down

the foundations, not just

for conception but for

healthy uncomplicated

pregnancies

A new series of articles looking at initiatives;

innovation and development in international

fertility begins with an exploration of

AlphaZita, a new concept which uses a multidisciplinary

approach to stimulate positive

fertility health.

Fertility Road’s Editor, Andrew Coutts went to

hear a little more from the AlphaZita team.

‘Wellness Tourism’ involves people who travel

to follow activities that maintain or enhance

their physical, Psychological and Physiological

wellbeing. According to the Global Wellness

Institute, the total expenditure from both

international inbound and domestic

tourists defined as ‘wellness tourists’

is expected to grow to $808 billion

by 2020. They estimate that

nearly 700 million trips that

incorporated some aspect of

wellness were made in the last

year. International wellness is

becoming big business.

ALPHAZITA takes an innovative

approach to wellness tourism and

combines it with more traditional

types of medical support which is provided

by experts representing different countries and

different specialisms. A team of acclaimed and

experienced Doctors, Acupuncturists, Fertility

Massage Therapists, Nutritionists and Fertility

coaches have been brought together with the aim

of promoting natural fertility and optimizing

physically, emotionally and spiritually patients’

status during their fertility journey.

The philosophy of AlphaZita is summed up by

its founder, Dr Elias Tsakos, fertility specialist

and Fellow of the Royal College of Obstetricians

& Gynaecologists, “patients are treated

individually by a team of Specialists in a unique

and true holistic manner. Our aim is to educate,

support, encourage and empower our patients in

their fertility journey”



FERTILITY 360

Patients receive valuable

treatments and consultations

in a relaxed non-clinical

environment and they increase

their fertility awareness and

their overall natural fertility.

“A fertility retreat is an amazing experience; it’s an

opportunity to come and meet Therapists bringing

a fusion together of Complementary Medicine

with Conventional Medicine. At the AlphaZita

Fertility Retreats, patients have the opportunity to

spend 2-3 days together with all the Therapists, all

being one, all communicating, all connecting. It’s a

life changing experience” added Miss Clare Blake,

Fertility Massage Therapist and Founder of Fertility

Massage Therapy.

At AlphaZita you get a feeling that education,

understanding, flexibility and mindfulness

underpins much of what they do. Miss Gordana

Petrovic, Fertility Acupuncturist points out,

“the benefits of Holistic Fertility Coaching

are multiple. Education is key for all

Fertility patients and as long

as patients know what

therapies exist and what

help is available,

they will be more

reassured and

more relaxed.

The AlphaZita

programme

provides a

continuity of care

of step of the way”

What was refreshing

to hear from the team

was the belief that their

intervention would help support

and maintain good health prior,

during and after patients’ fertility journey;

“By adopting this holistic approach, couples can lay

down the foundations, not just for conception but

for healthy uncomplicated pregnancies. We care

about every aspect of your physical and emotional



FERTILITY 360

help and as we teach you to improve balance in

your body. Participants are aware that their general

health improves alongside their fertility and they are

encouraged to carry these benefits throughout life” -

Miss Rosie Letts, Fertility & Pregnancy Nutritionist.

From a patient’s point of view, I can see the very

real benefits of access to diverse specialists in a

safe and comfortable environment. It is the level

of access which is not ordinarily available in

clinics and one which is recognised by Dr Tsakos;

“Fertility education, fertility awareness,

pre-conception care and fertility coaching

are important areas supported by substantial

scientific evidence. During a technical and

clinical appointment at a fertility clinic there is

usually limited time, resources and expertise to

explore vital areas of fertility care for everyone.

As a fertility specialist, I often felt that I was

failing my patients for being unable to address

their stress levels, their nutrition, their emotions,

their mindset and for strictly dealing with

the medical part of their care. Most Medical

specialties offer a multidisciplinary approach

to their patients and it seems that Fertility care

would perhaps be more complete, if it regularly

embraced other disciplines as well, maintaining

the wellbeing of the patient as the main focus.”

Retreat participants from the UK, Europe and the

US have benefitted from the events which have

been hosted in 5-star resorts across Greece. The

informal schedule on offer includes individual

bespoke treatment sessions, lectures and group

sessions. Post retreat, care and support is

maintained via individually designed packages

and the delivery team are available to respond to

any medical, emotional and spiritual needs.

The retreats are offered (attendance does cost)

to single men and women; couples with (or

without) fertility issues who wish to enhance

their natural and/or assisted fertility. Females,

males and couples with fertility issues who wish

to enhance their natural and assisted fertility.

Fertility professionals (Doctors, Nurses/Midwives,

Acupuncturists, Massage Therapists, Nutritionists,

Coaches, Councillors, Coordinators, Health Care

Assistants, and Volunteers) who wish to familiarize

themselves with holistic fertility care. A Certificate

of attendance is offered if individual professionals

wish to use their participation as CPD evidence.

Feedback from those who have participated in the

retreats is very positive with many agreeing that

“the experience has been very different to what we

have experienced so far”. Many others point out

that the unique atmosphere created away from

clinics allows them to take time out, to understand

and appreciate their own fertility journey. The

informality of the retreat allows unparalleled

access to the specialist team and enables

participants to forge relationships with others who

our on the same journey – I am sure relationships

that will last well beyond the AlphaZita retreat.

On a personal level the benefits are tangible;

patients receive valuable treatments and

consultations in a relaxed non-clinical environment

and they increase their fertility awareness and

their overall natural fertility. Retreats can increase

general physical and emotional wellbeing; lower

stress levels and allow participants to stay focused

while exploring all fertility options available, both

conventional and complementary.

AlphaZita seem to get it. Patients receive

personalized care with respect and honesty,

consistency and communication, understanding

and trust. A unique true holistic retreat of

fertility care. The retreat opportunity presents

a life changing and life creating experience. The

Fertility Retreat I believe, has a future and the

AlphaZita blueprint is a good example to follow.

The next AlphaZita Fertility retreat is

scheduled for 11-14 October 2018, at 5 Star

SaniResort.com, Greece. Limited places

available on alphazita.com



FERTILITY 360



FERTILITY 360

EXPERT: Russell Davis

It’s Me or

Baby

Infertility can put a strain on the best of

relationships. It is never something a couple

expects to go through or can imagine how it

will be when they start out. You can quickly

go from deciding it's time to start trying for

a baby to it impacting every area of your life,

talking to clinics about treatments you never

dreamed you would need and wonder how you

got to this place.

Over time, ‘Project Baby’ can become allconsuming.

It can infiltrate all aspects of life. From

lovemaking, the food you eat, whether or how

much alcohol you drink, what social events you do

or don’t go to and even the size of your friendship

circle as more and more friends have children. As

time goes by, the intensity can increase as the fear

of time running out gets grows.

Having a baby is supposed to come from a

place of deep love and connection but can often

become the source of a wedge between a couple.

It can go from something that you expect would

give such great joy to be the kill-joy.



FERTILITY 360

Sarah came to see me to help her be in the best

place possible to get pregnant. However, she was

frustrated her partner wasn’t making any effort.

He didn’t seem to care how much he was drinking

or whether he smoked or not even though there

was a problem with his sperm quality. She said it’s

like he’s given up, he can’t be bothered with it any

more. This hurt her. She felt he didn’t care about

her and them having a family together.

What if one partner says ‘enough is enough’?

What if it comes to the situation of being ‘me or

baby’? Or more accurately me or Project Baby?

Dealing with infertility can be tough enough on

its own. Unfortunately, a study found that the

pain of infertility can cause even more pain and

heartache. Couples who didn’t have a baby after

fertility treatment were more likely to break up.

For the study, which was published in the journal

Acta Obstetricia et Gynecologica Scandinavica,

Danish researchers tracked

47,515 women who were

evaluated for infertility over

12 years. After the 12-year

follow-up period, it turns

out that the women who

didn’t have a child were up

to three times more likely to

have divorced or ended their

relationship with the person they

were with at the time of the study than

the women who gave birth.

This shows the need to ensure Project Baby doesn’t

become the sole focus in the relationship at any

time; open and honest communication and

connection is the priority. This creates the glue

and also keeps both parties on the same page.

If one of you has had enough, the first thing

to explore is what have they had enough of. I

would suggest is not the idea of having a baby

Over time,

‘Project Baby’

can become allconsuming

but the impact that it’s having

on the relationship and life as

a whole.

They probably resent that

Project Baby has crawled

its way into every area of

life with what appears to be

negative consequences. The

carefree fun-loving times have

seemed to be replaced by regimes,

timetables, rules about what you can or can’t

eat, not being able to have a drink and a partner,

who is more often than not, anxious, distressed

or depressed.

Do these experiences have to go with the

territory? Is it possible to continue trying to

have a baby as well as living life to the full in the

now? Is it really ‘me or the baby’ or ‘me or the

all-consuming, partner-imploding, fun-zapping

Project Baby?



FERTILITY 360

If it is the former, then open and honest conversations

need to take place about the future of the relationship

and where your lives are going. Keep reading and you’ll

find something to help you with that.

If it is the latter, then I have some good news.

It is possible to continue to explore having a

baby without all the distress and for it to come

all-consuming. In fact, you are more likely to be

successful that way.

Project Baby takes over when it is founded on

fear. Fear of not being successful. Fear of not

having what you think a baby will give you. I

have asked many people what they think having

a baby will give them. More often than not the

answer is something like fulfilment, purpose

or happiness. I genuinely believed we would be

happier with a baby than without.

This is living ‘outside-in’. This is thinking I’ll be

happy when… or I’ll be happy if… people do this

with all sorts of things. ‘I can relax and be happy

when I have more money’. ‘I’m okay if people

don’t think badly of me’. ‘I’m okay I’ve proved

myself to be okay’. The thing is it’s just not true.

Nothing has the power to make us feel anything.

100% of our experience comes from thought. Our

perception of the situation, not the situation itself.

I was very much in this place. It wasn’t until the

middle of our fertility journey I realised this

was the case. I’d been like it all my life. I’ll be

OK when I’ve proved to my parents I am good

enough, then my teachers, then it

became my employer. I was a

people pleaser. It wasn’t until

I let go of this and KNEW

I was OK for who I was

that I needed nothing

to be OK, that I found

peace of mind on

our fertility journey.

It wasn’t until we

realised we could create

a life that is inspiring

and fulfilling with or

without children than things

happened for us, naturally

against all odds. The underlying fear

of not having a baby was impacting our fertility

as well as day to day happiness in life.

If you feel like this I recommend you look

at exploring some therapy or counselling to

help you let go of the fear of not having a

baby. For you to know you are OK now, there’s

nothing you need to be OK. The fear of not

having a baby is usually fuelled by a fear of

failure or fear of not being good enough or

not deserving. The emotional roller coaster of

infertility can shine a spotlight on these things.

They are not really about having a baby but

are contaminating your experience of trying

to have a baby. Thee can create psychological

blocks to getting pregnant.

Whatever the specifics of the situation if

one partner decides enough is enough there

needs to be some open and honest dialogue in

order to understand how each other feels; not

what anyone thinks. Not to fix each other’s

feelings or change their thinking about it. To

understand how they feel. To get into their head

and understand it from their perspective. Their

perspective on whether you think it’s right or

wrong. Too often we communicate to defend

our position, to tell our partner where they

are wrong if we feel criticised, to fix problems

and make them feel better rather than to truly

seek to understand them. To understand how

they feel about things. Men are often a little

rusty at communicating feelings but quick to

fix problems and not hear what their partner is

wanting them to hear, how they feel about it.

I recommend you

look at exploring some

therapy or counselling

to help you let go of the

fear of not having a

baby

I suggest in this situation each person writes

down how they feel about the situation. Not what

they think, how they feel. This process can help

men to be more aware of the feeling within them,

especially if they keep the pen moving..

Writing can also help each other identify the

feelings the other person is communicating. I

found when I read something my wife had written

it stopped me interrupting to fix the problem. It

helped me focus on the feelings she wanted me to

hear and understand. I would read it twice to make

sure I’d really ‘heard’ them.

Once you have both written

how you feel about the

situation you can take

turns in talking about

what each other has

written. The listener/

reader can ask

questions to ensure

they’ve understood,

what they think is

being communicated. To

understand what is meant

behind the words. If someone

says they feel angry what does that

really mean? How angry? What’s that

anger like? A word can mean different things to

different people so it’s important to understand

the experience behind the words that are being

communicated.

All too often we hear what we think we’ve heard

and not really heard what was being said. This

is about really understanding each other and

where each other are at on this journey. It’s can

be a long and tough journey. Sometimes people

want to give up. Sometimes this is a passing

experience, sometimes it goes deeper.

Don’t jump to conclusions about what the other

person is saying. Don’t make it into what you think

it is or means. Listen. Seek to understand. From that

place, there is no situation you cannot deal with.

At the end of the day, whatever happens, you

are going to be OK. Whatever happens. Our

psychological well-being is within us. You may

not feel OK at any time but underneath the

emotional experience is a soul that’s got this and

whatever happens covered. Emotions come and

go, you cannot hold on to them forever even if

you wanted to.

Take a breath, come back to the here and now

and seek to connect, understand and you may

find it’s not what you think it is.

Russell is a fertility coach supporting

couples on their journey. You can contact

him via his website thefertilemind.net



MEN ONLY

EXPERT: Sarah Banks



MEN ONLY

How fertility treatment may

aect your partner

Stress: Fertility treatment can amplify anything

stressful in a couple’s life, and simple daily things

can just be too much for your partner to handle

at the minute. Try to be considerate to see if

there is anything you can to do help take the

weight off of her shoulders.

Insecurities: Fertility treatment can intensify

your partners sensitivities and triggers, making it

difficult to be around babies and pregnant women

(including family members). Be understanding

and try not to question these emotions.

Depression: It is extremely common for women

to feel low and depressed while going through

fertility treatment. Watch outs are: loss of appetite,

inability to sleep, excess sleeping, eating a lot,

and generally feeling very sad. If your partner is

showing any of these signs you should encourage

her to talk to her fertility specialist or a fertility

counsellor (usually available through your clinic).

ow can you support her

through treatment

There are four main ways you can support

your partner:

Emotional support (listening, empathising, hugs)

Self-esteem support (telling her you love, admire

and respect her)

Informational support (doing research, asking

questions)

Practical support (take on responsibilities,

planning logistics)

motional Support e there

for her

One of the best things you can do during IVF

treatment is to listen. Don’t try to fix it or suggest

solutions. Just listen with empathy. She doesn’t

expect you to make things better, she knows you

can’t fix the problem. She just wants to know you

hear her and that you sympathise.

Sometimes just giving her a hug will help you

show your support and make her feel loved.

Holding her hand, letting her cry on your

shoulder, and just being there (not on your

phone) is all she needs.

It may be difficult to know how to best help her,

so ask her how she wants you to help her. All the

hormones play havoc on the emotions and your

partner may be fine one minute and floods of tears

the next. Similarly, she may want to talk about

everything one minute and the next not want to

talk about anything to do with treatment.

I know this makes it hard to know what to do for

the best. Cut her some slack, she’s pumping herself

full of hormones every day and ask her how she

wants you to help her. She can tell you what she

needs at that exact moment and you can help her.



MEN ONLY

Selfesteem support

e her biggest cheerleader

Your wife’s self-esteem may be suffering, and

the indignities and side effects of IVF treatment

don’t help. Try to keep any criticism and sarcasm

to a minimum and think about whether it is wise

to make jokes at inappropriate times (even if it is

to lighten the mood).

Compliment her on how she looks as she is likely

to be feeling bloated and not her usual self – be

genuine with your compliments so she believes

you. Any little boosts to her

confidence will put a smile

on her face and make her

day a bit brighter.

t’s really

important that you

don’t blame each other

for the fertility issues

and don’t blame yourself

you are in this as

a team

Show her you admire

her for what she

is going through,

that you think she’s

great and handling

everything really well.

Show her you love and

appreciate her – it doesn’t

have to be big gestures,

something as simples as flowers,

chocolates, a hug, or saying ‘I love you’, just to

show you understand what she is going through

physically and emotionally – trust me, she’ll thank

you for it.

nformational Support

Do our esearch

The man’s role in fertility treatments is different

from his partners in that he will mainly play a

support role as his partner does the physical side

of treatment. You can help by doing research

on treatment – clinics, add ons, side effects, the

process, finances, payment plans – so you can

support your partner through the process.

Understanding the impact of treatment on your

partner’s body and the way infertility in general

makes her feel can help you support her better

– it will show your partner that you are

interested in her well-being.

You can also research other

lifestyle factors that may help

with conception and feeling

prepared for treatment.

Look in to ways that you

and your partner can relieve

stress, nutritional advice and

emotional support.

ractical support

rganise all the dull bits

Between the stress and the physical effects of fertility

treatment, your wife may be feeling more tired than

usual, and all the hormones can cause some side

effects such as nausea, fatigue and even pain.

Taking on some of the day to day chores that you

don’t normally do will ease the pressure on her

and show that you appreciate that she is taking the

brunt of the physical side of treatment.

You could take on all the logistics and planning

side of fertility treatment – timings of journeys,

booking hotels, picking up medication.

You could also offer practical support in terms of

nutrition – buying healthy snacks and cutting out/

down alcohol as a support to her.

It’s really important that you don’t blame each

other for the fertility issues and don’t blame

yourself – you are in this as a team, it is a joint

issue that you will work through together.

Supporting yourself through

Fertility treatment

We can’t get away from the fact that most of the

pain of treatment is felt by women (physically and

emotionally), but it is often forgotten that men

experience emotional stress, they have to watch

their partner go through the gruelling process of

IVF, have to go through invasive procedures and

they also long for the family they want to create.

Many men feel hopeless during this period as there is

nothing they can physically do to take the pain and

stress off their wife. They empathise with how their

wife is feeling, but they may also feel overwhelmed by

the depth of their wife’s emotion and pain.



MEN ONLY

partner) a fertility professional (Counsellor,

fertility Coach) or a support group where it is

more anonymous.

hink about the things you want

to do and achieve

Infertility and going through treatment can

make you put plans you have on hold. Write a

list of things you’ve always wanted to do and

achieve and create a plan to start doing some of

them. There may be time and money constraints

around treatment, but it will give you a sense of

achievement and something to focus on outside

of treatment.

Do things you enoy

Men and women deal with

the stress of infertility

in very different ways,

and it is important to

remember that no way

is right or wrong. Each

person processes their

pain in a way that works

for them, and it’s important

to find what works for you.

Communication is so important

in couples struggling with fertility, and

honesty and openness can save marriages.

Supporting your partner through IVF is so

important, but it’s also really important to look

after yourself through the process and get the

support you need.

There are lots of ways to help cope with infertility

and IVF:

ake control of the things you can

Infertility can make you feel out of control of your

life and your future, and when you go through IVF

it can feel like the process is out of your control,

with all the timings, hospital visits and medications.

However, there are things that you can control;

Lifestyle – you can make sure you are eating

healthily, avoiding alcohol, reducing/stopping

caffeine. These things are important for your body

to be in the optimum state for sperm production,

but you will also feel better in yourself.

Mindset – you may feel that you don’t have

any control over how you feel, but you do have

full control. You can make a choice to be in the

right mindset for going through treatment and

supporting your partner.

en and women

deal with the stress of

infertility in very dierent

ways, and it is important to

remember that no way is

right or wrong.

Practical – although a lot

of the process is out of

your control, control

the things you can –

research treatment so

you can ask informed

questions, research add on

treatments, so you are clear

on what you do/don’t want,

organise logistics and plan

treats around procedures to give

you both something to look forward to.

Don’t bottle it up

Its normal to feel that you need to be a rock

for your partner and that you can’t show your

emotions, but it’s important that you address your

feelings and have a way to cope.

Everyone copes differently, and there is no right

or wrong way, it’s just important to have an outlet

for your feelings:

Write in a journal – you can write freely without

worry of someone reading it. Use it to scribble

down your feelings, worries and frustrations. It

can be quite therapeutic!

Write a blog – this is a good way to talk through

your feelings anonymously, and it may help

others in the same situation if you choose to

share it.

alk it out

You may find it difficult to talk about what

you are going through and how you are feeling,

but it’s important that your feelings are heard.

There are lots of options for people you can talk

to – either someone you know (friend, family,

Plan things that you enjoy, so that infertility isn’t

your only focus - gym, exercise, walking, reading,

computer games, seeing friends.

Spend time as a couple

It’s really important to remember why you are

together as a couple and spend quality time

together. You need this, so you don’t feel the

focus is only on having a baby and that you’re

only needed for your swimmers. Spending time

together gives you chance to talk openly if you

want to about how you are both feeling and

anything about treatment.

Set time limits for how long you talk about the

treatment and infertility, so your conversations

don’t just revolve around trying for a baby.

This can add to the stress and pressure in the

relationship. Also set times when you don’t discuss

it – for example if you’re out for a meal, so it gives

you time to focus on the other good things in your

life and each other.

Remember to look after yourself and get the

support you need, you will be better able to support

your partner through treatment and both be in a

better state as a couple to cope on this journey.

Sarah Banks is a Fertility coach and mentor

who works with fertility professionals to

enhance their patient experience and success

rates. She helps them understand how

patients feel, the emotional support they need

and helps implement support structures.

She also works on a 1-to-1 basis with women

struggling to conceive, to improve their

emotional state and increase their chances of

getting pregnant.

For further information contact her on

sarahsarahbanks.coach or via her website

sarahbanks.coach.



MEN ONLY

A F

A F

TESTINGryan oodward

is the erson esponsible at

Fertility, a new fertility clinic in eicester

specialising in male fertility, and lowtech

fertility treatments such as and D. ryan

is coeditor of the book ale nfertility

Sperm Diagnosis, anagement and Delivery’

which covers all aspect of male fertility for

professionals and patients.



MEN ONLY

EXPERT: Bryan Woodward

When it comes to fertility problems, it is a

sad fact that some GPs, will go gung-ho into

investigating the female partner, whilst the

male is often left on the side-lines with no

investigations. As a result, he may watch whilst

his wife has numerous blood tests to check her

various hormone levels throughout

her menstrual cycle; some

women are even admitted

to hospital to have their

Fallopian tubes checked

out, to ensure they

aren't blocked, and

this is all before the

man has any questions

raised about his

fertility status

Yet, nowadays, fertility

problems are attributed more

or less equally between the male

and the female. Therefore, one of the first

tests to perform for a couple who experience

trouble conceiving is a semen test for the man.

Please note, this is called a ‘semen test’, rather

than a ‘sperm test’. Yes, we will be looking for

sperm – after all we need to find sperm so that we

know there is a chance of this cell fertilising an

egg. However, a semen test is so much more than

just looking for sperm, as I’ll explain later.

To assess semen, the first step is to ask the man

to produce a sample. For some, this is a simple

process, over in less than 5 minutes. For others,

this can be a source of great anxiety. Some men

may not be able to masturbate, whilst for others

the act of masturbation may be contrary to their

religious belief or way of life. If this is the case,

then condoms can be used, to obtain the semen

sample by sexual intercourse. However, use of

a condom can cause complications; firstly, it is

important to check that the condom material

is not toxic to sperm, and secondly, much

t is a sad fact

that some s, will go

gungho into investigating

the female partner, whilst

the male is often left on

the sidelines with no

investigations.

care is needed to ensure that the sample isn’t

contaminated by any other cells during the

withdrawal process, such as cells from the vagina,

as these may affect the sperm.

There is also the question of whether the man should

produce the sample ‘on-site’ at the clinic, or whether

he should produce it ‘off-site’, for example at home.

Specialist fertility clinics usually have specific rooms

for on-site production, although the quality of the

room is variable. Oddly, the name for this room also

varies, from the basic “Male production room” to the

more Latin-sounding “Masturbatorium” (this word

has made it into Google’s Wiktionary but has yet to

be included in the Oxford English Dictionary!).

There are many advantages to producing a

semen sample on-site, since the environment

and timing can be better controlled. Ideally the

specimen container should be pre-warmed to body

temperature (37C) and then placed into an incubator

at the same temperature immediately after the

sample is collected. Off-site production inevitably

runs the risk of variations in temperature during the

journey to the clinic (may be not so much

in the recent summer heat-wave, but

certainly in during the colder

months. There is also the

time-factor to consider: the

semen needs to be analysed

within 60 minutes of

production, to ensure an

accurate assessment of

the swimming ability of

any sperm. Many clinics

will reject a semen sample if

it arrives even 1 minute later,

which can add to the stress for the

man who produces ‘off-site’.

Once the sample is safely in the andrology lab, the

semen analysis can begin. The first test is to assess

the colour, which optimally should be an opalescent

grey. An opaquer sample may indicate a low sperm

count, whereas a more yellow sample may indicate a

possible infection, jaundice, or that the man may be

taking some form of drugs. A reddish-brown colour

usually indicates that red blood cells are present. In

this case, it is essential to check how this might have

been caused – was it by the masturbation process,

or is the man’s natural ejaculate colour? If the latter,

then further testing should be sought as soon as

possible to rule out any internal problems with any

of the reproductive system or the prostate.

We then test the volume of the ejaculate. In 2010,

the World Health Organisation (WHO) stated that

the lower limit of fertility was a volume of 1.5ml.

This means that if the volume of the sample is

less than 1.5ml, then there could be a problem. If

a man produces an ejaculate with a small volume

or even no volume at all, then retro-ejaculation

is a possibility. Retro-ejaculation is a condition

where, at the point of orgasm, the semen passes

backwards into the bladder rather than out of

the penis. It should be noted that this is a rare

condition, affecting 1% couples undergoing fertility

investigations, and is more common in men who

have had prostate surgery, suffer from diabetes, or

take medication for high blood pressure.

The next parameter to be tested is semen pH, a

test of alkalinity and acidity. Semen is made up

of secretions from various glands which support

the sperm when it is deposited at the top of the

vagina during intercourse. Secretions from the

prostate are acidic, whilst those from other glands,

such as the seminal vesicles, are more alkaline. If

there is an obstruction or problem with any of the

ducts, then this can affect the pH. Semen should be

slightly alkaline (above pH7.2). However, sample pH

increases with time from production, as the sample

is exposed to air in the container. This is another

reason why it is important to control the time from

production to analysis. If the pH is too high, then

this could indicate an infection, possibly due to

decreased secretions from the prostate.

The final test that is performed, before looking down

the microscope, is the liquefaction and viscosity of

the sample. The reason Mother Nature made semen

viscous immediately after ejaculation, is to keep the

semen within the vagina to allow the sperm to start

swimming towards the egg. The medical term for the

semen at this stage is a coagulum. If it wasn’t viscous

coagulum, the semen would immediately fall out

after intercourse! A normal sample should liquefy

within 30-60 minutes, although liquefaction is often

completed within 20 minutes. If a sample doesn’t

liquefy after 60 minutes, this could compromise

sperm motility, hence the importance of the test.

At the same time as assessing liquefaction, the

general consistency of the semen is also assessed

for anything unusual, such as the presence of

crystals. These could be caused by uric acid, but

if crystals are present, regardless of the cause,

then further investigation by a urologist is

recommended, as ejaculation may also be painful.

Once these ‘macroscopic’ tests (visual tests

without use of a microscope) are complete, it is

time to begin the ‘microscopic’ tests.

he Shape of Sperm

In fertile men, and even super-fertile sperm donors,

the majority of sperm are not the correct shape.

The WHO has put a lower limit of just 4% sperm

needing to be the correct shape for fertility. The

grading of each sperm follows strict criteria, and a

full assessment requires the grading of at least 400

sperm. Of particular importance is detecting if a



MEN ONLY

man just has ‘round-headed’ sperm. This indicates a

condition called ‘globozoospermia’, whereby all the

sperm lack a sperm cap on the top of the head called

an ‘acrosome’. It is the acrosome that is essential

for fertilisation, as this helps the sperm penetrate

the egg. Even if there are lots of fast moving sperm,

if the sperm are round-headed, then natural

fertilisation is highly unlikely.

he ovement of Sperm

A sperm needs to swim forward to have a chance

of fertilisation. If we consider the journey that

the sperm has to make naturally, it is quite an

ordeal. Firstly, it has to swim towards the cervix,

then through the cervical mucus to enter the

uterus. Many sperm are naturally filtered out

at this point. The next journey is to find the

Fallopian tube and swim through the ciliated

cells that line this structure. Fertilisation takes

place at the top of the Fallopian tube, where

the ovulated egg is hopefully waiting. This

progressive movement, termed ‘motility’ is

essential. The WHO has put a lower limit of 32%

for sperm moving progressively forward to be

classed as fertile.

Please note though, even if a sample has no

moving sperm, it is still possible to achieve

a pregnancy, provided the sperm are alive.

There are various lab tests for sperm ‘vitality’.

Once a sperm is checked to ensure it is alive,

then the assisted conception technique called

‘intracytoplasmic sperm injection’ (ICSI) will

be needed to try to achieve fertilisation. The

ICSI process is highly skilled, and involves an

embryologist selecting the best-shaped living

sperm (usually at a magnification of 600x), then

carefully picked up into a needle, which has a tip

size which is the tenth of the width of a human

hair! The sperm is then carefully injected into

the egg.

he Sperm Concentration

level of fragmentation

in the sperm DNA,

often called a ‘DNA

Fragmentation Index’’

or ‘DFI’, which looks at

the level of integrity of the

genetic components within

the sperm. Another test looks at

the level of ‘Reactive Oxygen Species’

or ‘ROS’, which gives an indication of the

amount of oxidative stress the sperm might be

subjected to within the semen sample.

hilst shape, motility

and count are the three

main microscopic tests

of sperm, there are a

multitude of other tests

available.

most scenarios. Like

everything in biology,

there are extremes.

Some men produce a

thick sample of semen

that contains so many

millions of sperm, that

there are simply too many

to be functional unless they can

swim out of the seminal plasma as soon as

possible. Other men produce a watery fluid, that

is completely void of sperm.

As a general rule, the sperm count is the number

of sperm in the sample, expressed in millions

per millilitre. The WHO sets a lower limit of

15 million/ml for fertility. The actual test is

again quite detailed, as a specialised microscope

slide called a counting chamber is needed. This

ensures a fixed volume of semen is held over a

microscopic grid. The number of sperm in the

grid are then counted to estimate the number of

sperm present in the whole semen sample.

Additional test for sperm

Whilst shape, motility and count are the three main

microscopic tests of sperm, there are a multitude

of other tests available. These include assessing the

However, caution should be considered when

thinking of having these additional tests. They

are usually only recommended once the results

of a conventional semen analysis are known, and

most likely after a repeat semen analysis has been

performed to confirm the values of each tested

parameter. Before embarking on additional tests,

it is recommended that you ask your fertility

specialist to explain what the value these test

results will bring. This is also important if these

tests come at an additional charge!

n a personal note

I have been looking at sperm for over a quarter

of a century, so it is fair to say I have seen

Provided the semen analysis is performed

by a reputable clinic, then the results should

be accurate and the staff should take time

to explain exactly what each result for each

parameter means.

With the vast number of assisted conception

treatments on offer, there is always a way

forward to achieve a pregnancy. And for

me, there is nothing better than to receive a

call from a patient to tell me his partner is

pregnant, even though he had a poor prognosis

semen analysis. The couple will have been

given the facts, but fertility has always been an

enigmatic area of medicine - after all, it only

takes one sperm to make it!



Fertility Road Magazine 46 - September/October 2018

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?