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Fertility 360

A Day In The Life Of A Fertility Counsellor

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Fertility Counsellor

Ruth WideWe continue our series that uncovers the daily processes for those working within the fertility sector by following the incredible work of a fertility counsellor, with Fertility Road again being granted exclusive access behind the scenes at some of the leading UK facilities. Ruth Wilde guides us through an average day.

I have a look at the system to check who I have on my list for the day. I normally see four or five patients each day. Some people may be coming for a follow-up session if I have seen them before, so I remind myself where we got to in the last session.

9am – I arrive at the clinic after driving into work. Most of the other staff will have been there since 8am, so when I get in the nurses are already busy scanning patients and there are egg collections going on as well.

I’ll check in on our donor co-ordinator to see how her diary is looking for the day, and to enquire as to whether there is anything particular I need to know about any of the patients or donors who are coming through.

My station at the centre is with the nurses in their office, so when I arrive I have a chance to catch up with them. In between answering phone calls from patients, they’ll update me on any news or pregnancy test results, and if a patient I’ve been working with has had a failed cycle, I will give them a quick call or send an email to ask if I can help. Sometimes the nurses may need me to call someone or fit a patient in at short notice.

I have a look at the system to check who I have on my list for the day. I normally see four or five patients each day. Some people may be coming for a follow-up session if I have seen them before, so I remind myself where we got to in the last session.

9.15am – I go into my infertility counselling training room. It’s a very comfortable, private place with a sofa, two chairs and a plant. Staff know they can’t disturb me once I am in the room as counselling is much respected in the clinic.

My first patients come in and will sit in the waiting room. I get a note from reception on my computer to let me know when they arrive, so I can go out and collect them. We have a policy at Compete Fertility Centre of only using first names in case other patients might know them… it’s also much more personal. I offer them a drink, and then bring them into the counselling room.

There are two routes for patients to see me. They can refer themselves if they need some support – cards with my contact details are freely available in the clinic and anyone who wants to is welcome to contact me, either by phone or on email. The other route is for people to be referred to see me if they are using donor eggs, sperm or embryos, or if they themselves are donating. At the centre, counselling for infertile couples is a routine part of treatment and is seen by all staff members as an important process for preparing people for treatment.

We have up to an hour for each appointment, so my second appointment is at 10.30am and then another at 11.45am. There are all kinds of reasons why patients may come to see me. Quite often it’s around decision-making, perhaps about whether to have more treatment, especially for women who are deciding whether to carry on with their own eggs or to use those of a donor.

Fertility Consultation

Sometimes there are people who have had to stop treatment for financial reasons and want help with putting some sort of line under treatment. On other occasions patients are simply finding treatment very stressful and we encourage them to pop in and offload on the counsellor in order to help clear their heads so that they are in a better place to carry on. Often patients lose hope when they have had failed cycles and are trying to find ways of being more positive for the next. In myself, I have to prepare differently depending on whether it has been a miscarriage or a biochemical pregnancy, knowing that I can also provide information to patients on the process of treatment, NHS funding, what appointments they will need to make and more. And, of course, in many instances I may be the first person a couple sees if they are embarking on treatment with donor eggs or sperm.

I meet all the egg sharers, altruistic egg donors and sperm donors about the implications of donating. They have decided on a course of action, but I can add a touch of objectivity and I describe myself as ‘the pause button’. When they sign on the dotted line we want them to know all there is to know about treatment or donation. We want a good outcome for everyone, including the donor, and that’s our aim.

Every single person I see is told about confidentiality when I see them. All fertility counselling questions are confidential. People know that I write one line on their medical notes to say that I have seen them, but that’s all it says. I only ever discuss something with the rest of the team if the patient wants me to raise it – it can only ever be with their permission.

At the centre, patients who may need donor eggs or sperm see me before they meet a doctor as they need to understand the implications; they need to have had a chance to talk about it and decide that they definitely want to go ahead. I see them early on, and sometimes I may spend four or five sessions with them before they feel ready for donor sperm or eggs. A lot of it is about helping them to talk about it. With men particularly there can be a lot of shutting off because it is so painful. There can be grief work helping them to deal with the loss of their genetic child and then moving gently through the implications of treatment with a donor, working through the legal and ethical aspects.

For same sex couples and single women, the implications of treatment with donor sperm are different but equally important and, at the end of the day, all potential parents of donor-conceived children need to consider how they will manage disclosure to the child and wider social networks. I can help them to prepare for this.

What it’s important to understand is that an implications counselling session isn’t about running through the sort of information you can read on a website or in written information – it’s about how it will affect this particular person or couple and their family and friends. It’s a very personal session which is why it is done with a counsellor.

One of the first things I say to anyone is that it’s not an assessment; I am not there to make a decision or to say whether or not they should have a child. I make it clear that it’s for them. I don’t have a tick list for the clinic; it’s not like that at all. It’s about what it’s going to be like for the couple or single woman in front of me.

Counselling isn’t necessarily a comfortable experience of just being listened to. It can be a challenging interaction. My job is to help people think about things they may not want to think about, especially with implications and especially with couples who may find it difficult to talk about differences between them. Done well, counselling is supportively challenging!

12.45pm – After my last appointment of the morning I am meant to have about an hour-and-a-quarter before the first appointment in the afternoon to offer time to do all the necessary admin, and then an hour for lunch.

1pm – This should be the start of my lunch break, but in fact there are often counselling emergencies where people need to be seen urgently and this is a time to fit them in. It might be someone whose treatment has just failed, or a woman who had no eggs collected, or where there were no embryos to transfer, or perhaps it may be a man who has been unable to produce a sample on the day. This time is often for dealing with crises that can arise and also for seeing cancer patients who have to make quick decisions about preserving their fertility.

One of the first things I say to anyone is that it’s not an assessment; I am not there to make a decision or to say whether or not they should have a child. I make it clear that it’s for them. I don’t have a tick list for the clinic; it’s not like that at all. It’s about what it’s going to be like for the couple or single woman in front of me.

2pm – Sometimes I will see another patient or I may do some training for the nurses and trainee embryologists, for example about breaking bad news. It can be hard for the nurses if things don’t work out for a patient, and the embryologists get very involved as they have to let people know about the development of their embryos. We may rehearse how to deal with a difficult phone call as they may need some support. Training is often done where we can fit it in, as all the staff are very busy and no one can be spared for too long.

3pm – We have our weekly clinical meeting. Everyone from the team who is available – consultants, specialist registrars, nursing and scientific staff – gets together once a week to discuss failed cycles. We go through each case individually and look at what to do next, making decisions as a whole team. I may contribute if a couple have asked me to say something or to find something out for them.

4pm – I have some admin time. This is important as I manage the counselling service at Complete Fertility Centre so I don’t just turn up and see patients. I also have to perform audits of the service to ensure I am up to date with organisations to refer people for further information or support.

During this time I might have some calls to make to patients about arranging appointments and may need to email a few of them. I may have to take the time to support other members of the team if, for example, they have been involved with a lot of bad news that day. We all get upset when cycles don’t work and it’s particularly hard when people have had two or three failed cycles.

5pm – I take a break. Sometimes I have private clients in the evenings who I see in practice rooms in Salisbury, but I only usually see one per night. If we have our support group meeting in the evening, I don’t go home as I don’t live close enough. I’ll often nip out to the supermarket round the corner and get a sandwich or some soup to heat up in the microwave, and I’ll buy some fruit and biscuits for the group. I’ll sit and have a cup of coffee and often do a trawl of the journals for the latest research articles to see if there’s anything new and interesting that I want to share with patients. I may do some photocopying of articles for the group, or sort out slides if I am doing a presentation.

7pm – I have a helper from another clinic who assists me with the group and she arrives to put out the chairs and get ready. Our support group is open to everyone, not just people from our clinic.

7.30pm – The support group members arrive. We usually have around 14 people there and more who are wanting to join all the time. We advertise the group through flyers in the clinic or on our website and the Infertility Network UK website. It’s a very informal group and the people who are there set the agenda. We sometimes have people to talk, but mostly it’s about giving quite a bit of input on coping.

9pm – The group ends and I clear up before driving home. When I get home I relax and catch up reading the paper from the weekend. It usually takes me the whole week to get through the Saturday Guardian!

Midnight – It is often midnight before I go to bed. I like to stay up and have some peace and quiet at the end of the day. It’s also really important that I get some time on my own as I will have absorbed quite a lot during the day and need to recharge my batteries with some quiet time before I finally go to sleep.

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Fertility 360

NEWS: Get access to adult photos of the Cryos sperm donors

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Adult Cryos Sperm Donors Photos

Viewing adult photos of Cryos sperm donors is now a reality. Visit dk.cryosinternational.com today and get access to the new feature.

At Cryos it is now possible to access adult photos of sperm donors on our website, thus adding another dimension to your search for the perfect donor.

The unique chance to see both childhood and adult photos of your sperm donor, provides you with a more comprehensive idea of who your sperm donor is and moreover of the features of your future child. We hope that this extra dimension will upgrade your experience making your decision of a sperm donor easier.

The 5-6 adult photos are taken by a professional photographer and are a part of the donors extended profile where you also have access to childhood photos, an audio recording of the donor’s voice, a handwritten message, an emotional intelligence profile, and finally our staff impressions of the donor, amongst other exclusive features.

The adult photos require special access on our website. Visit our website and find out more and get access to this new feature now.

Please note that the person in the photos is a model and not a Cryos donor.
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Fertility 360

Fertility And Sex: Why Her Orgasm Matters

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Why her orgasm matters

For many couples, trying to conceive can make sex feel less fun and more pressured. Instead of being an intimate and enjoyable experience, baby-making sex can start to seem like a finely choreographed routine. Often, the female orgasm is one of the first things to go, but the maleorgasm is not the only orgasm that matters when it comes to fertility.

Before I dive into discussing the potential benefits of the female orgasm for fertility, it’s important to note that reaching climax is not technically essential for conception. If you never, or rarely, achieve orgasm, don’t worry, you can still get pregnant! Around 1 in 10 women don’t experience orgasm, ever. What’s more, the exact nature of the female orgasm remains somewhat elusive. Some experience orgasm through clitoral stimulation, some through vaginal intercourse, some through both, and others through something else entirely, or not at all.

Even without reaching orgasm, sexual arousal is itself beneficial to fertility. Like an orgasm, arousal is, first and foremost, a good indication that sex is enjoyable. Sexual arousal and climax causes significant changes in your levels of neurotransmitters including noradrenaline, oxytocin, prolactin, dopamine, and serotonin. These ‘reward’ neurohormones help you bond to a sexual partner and make it more likely that you’ll have sex more often, thereby increasing your chances of conception.

Second, orgasm and arousal have a range of physiological effects that might aid conception, which I’ll discuss in a moment. And, third, sexual arousal and orgasms for everyone can help sperm-producing partners avoid feeling like they’re being used just for their sperm. In fact, some studies show that male partners who engage in cunnilingus prior to vaginal intercourse have greater sexual arousal and produce more semen!

HOW ORGASMS ENHANCE FERTILITY

The female orgasm can help relieve stress, and promote healthy circulation and balance in the body. Stress is a key cause of diminished libido and may also reduce the chances of conception by raising levels of the stress hormone cortisol. Conversely, good sex can help raise levels of oxytocin and the other neurohormones mentioned above. These help you to relax and bond to your partner.

Published in 1967, the author even went as far as suggesting that the increase in these hormones after orgasm help support conception by temporarily incapacitating you. Put simply, this ‘poleax’ effect means you’ll feel so relaxed that you’ll stay lying down, which may increase your chance of conceiving. Whether staying supine does make conception more likely is still under debate, but I’m all for promoting relaxation, so if this theory provides added motivation, go for it!

CERVICAL TENTING

There is some suggestion that orgasm affects the shape and function of the cervix. These effects, which may include cervical ‘tenting could enhance the likelihood of conception by promoting the movement of sperm into the uterus and beyond. If you are curious as to what your cervix looks like during different stages of your cycle, check out these photos.

THE ‘UP-SUCK’ THEORY

One of the main ways in which female orgasm has been linked to fertility is something called the ‘upsuck’ theory (or, sometimes, the ‘insuck’ theory). This theory proposes that the female orgasm causes uterine and vaginal contractions that actively draw semen up into the uterus and towards the fallopian tubes, thereby increasing the chances of an egg being fertilized.

Scientific evidence to support this theory is rather inconsistent, but there’s certainly no harm in trying! One proposed underlying mechanism of this theory is oxytocin-mediated uterine peristalsis, i.e. the same mechanism that causes uterine contractions during labour could be partially responsible for increasing the likelihood of conception. Indeed, some research has found higher pregnancy rates in women shown to experience this ‘insuck’ phenomenon.

SPERM RETENTION AND FERTILITY

More recently, one small study found that orgasm may increase sperm retention. This study involved women using a syringe to insert a sperm simulant (lube) prior to external stimulation to orgasm. As such, the study’s findings may be especially applicable to anyone undergoing artificial insemination (IUI).

The take-away: Chances are that if you orgasm 1 minute before or up to 45 minutes after insemination (whether artificial or otherwise), you will probably retain more sperm, which may increase your chance of conceiving.

IN CONCLUSION

To sum up, the female orgasm might enhance fertility in a variety of ways, but it isn’t essential to conception.

The take home message is that orgasm and sexual arousal itself have many benefits to fertility, partner relationships and stress relief. Don’t worry though, if you have a low libido, conception can still happen even in the absence of arousal and orgasm!

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Fertility 360

What Is Polycystic Ovary Syndrome (PCOS)?

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Polycystic Ovary Syndrome

Polycystic Ovary Syndrome or PCOS is a hormonal imbalance that affects 5 to 10 percent of women of reproductive age across the world, and results in irregular or absent periods, acne, excess body hair and weight gain. It is also a major cause of infertility and yet is frequently misdiagnosed and often missed completely.

PCOS gets its name because under an ultrasound scan, the ovaries can look like a bunch of grapes, each one covered in what look like multiple cysts. In fact, these aren’t cysts at all, but are small, undeveloped follicles.

Symptoms

Not every woman with PCOS will get the same symptoms, but common signs to look out for include:

  • Few or no periods
  • Excess hair on the face or breasts or inside of the legs or around the nipples
  • Acne
  • Oily skin
  • Scalp hair thinning or loss (male pattern baldness)
  • Skin tags (known as acrochordons)
  • Skin discolouration (known as acanthosis nigricans) where the skin looks ‘dirty’ on the arms, around the neck and under the breasts
  • Mood swings
  • Depression
  • Lack of sex drive
  • Weight gain especially around the middle of the body
  • Difficulty in losing weight
  • Cravings and binges
  • Irregular or no ovulation
  • Difficulty in becoming pregnant
  • Recurrent miscarriages

PCOS creates a vicious cycle of hormone imbalances, which has huge knock-on effects throughout the rest of your body. With PCOS, the problem often starts with the ovaries, which are unable to produce the hormones they should, and in the correct proportions. But linked to this is the very common problem of insulin resistance. Women with PCOS very often have difficulties with blood sugar levels which can cause weight gain and the excess insulin can stimulate your ovaries to produce yet more testosterone. Half of all women with PCOS do not have any problems with their weight, yet they can still have higher insulin levels than normal.

How is Polycystic Ovary Syndrome diagnosed?

The most widely accepted criteria for the diagnosis of PCOS says that you should have two out of these three problems:

  • Infrequent or no ovulation
  • Signs (either physical appearance – hirsutism or acne – or blood tests) of high levels of male hormones
  • Polycystic ovaries as seen on an ultrasound scan

The Seven Nutritional Steps to beat Polycystic Ovary Syndrome

Good nutrition is the foundation of your health and you should never underestimate how powerful it can be. It is the fuel that provides you with the energy to live your life and it gives your body the nutrients it needs to produce your hormones in the correct balance. The better the supply of those nutrients, the more healthily your body will function.

The fundamental aim of my nutritional approach to PCOS is to target a number of areas simultaneously so that you get the maximum effect in the minimum amount of time.

Here’s how:

  1. Switch to unrefined carbohydrates (eaten with protein) and never go more than 3 hours without food to keep your blood sugar levels balanced
  2. Eat oily fish and foods rich in Omega 3s to help your body to become more sensitive to insulin so it can overcome insulin resistance
  3. Cut out all dairy products for 3 months to bring levels of male hormones under control
  4. Eat more vegetables and pulses to which helps control male hormones
  5. Cut right back on or cut out alcohol for 12 weeks to allow your liver function to improve
  6. Cut down on caffeine to give your adrenal glands a rest
  7. Cut down on saturated fats and eliminate trans fats to help control the potentially damaging inflammatory processes PCOS causes in the body

PCOS Symptons

Best Supplements for PCOS

The use of certain vitamins and minerals can be extremely useful in helping to correct Polycystic Ovary Syndrome, along with a good diet.

Chromium

Chromium helps to encourage the formation of glucose tolerance factor (GTF), which is required to make insulin more efficient. A deficiency of chromium can lead to insulin resistance.  It also helps to control cravings and reduces hunger. Can help to reduce insulin resistance associated with PCOS

B vitamins

The B vitamins are very important in helping to control the symptoms of PCOS. Vitamin B2 helps to burn fat, sugar and protein into energy. B3 is a component of GTF which is released every time blood sugar rises, and vitamin B3 helps to keep the levels in balance. Vitamin B5 has been shown to help with weight loss and B6 is also important for maintaining hormone balance and, together with B2 and B3, is necessary for normal thyroid function.

Zinc

Zinc helps with PCOS as it plays a crucial role in the production of your reproductive hormones and also regulates your blood sugar.

Magnesium

Magnesium is an important mineral for dealing with PCOS because there is a strong link between magnesium levels and insulin resistance – the higher your magnesium levels the more sensitive you are likely to be to insulin.

Co-Enzyme Q10

Co-Q10 is a substance that your body produces in nearly every cell.  It helps to balance your blood sugar and lowering both glucose and insulin.

Alpha lipoic acid

This powerful antioxidant helps to regulate your blood sugar levels because it releases energy by burning glucose and it also helps to make you more insulin sensitive. It also has an effect on weight loss because if the glucose is being used for energy, your body releases less insulin and you then store less fat.

Omega 3 fatty acids

Omega 3 fatty acids taken in supplement form have been found to reduce testosterone levels in women with Polycystic Ovary Syndrome.

Amino Acids

Certain amino acids can be very helpful for PCOS as they can improve your insulin sensitivity and also can have an effect on weight loss.

N-Acetyl cysteine

In women with PCOS this amino acid helps reduce insulin levels and makes your body more sensitive to insulin. Study using NAC in women who were clomiphene resistant and had ovarian drilling.  After ovarian drilling, the women given NAC compared to a placebo showed a significantly higher increase in both ovulation and pregnancy rates and lower incidence of miscarriage.

Arginine

Arginine can be helpful in reversing insulin resistance. In one study, a combination of both arginine and N-acetyl cysteine were given to women with Polycystic Ovary Syndrome.  The two amino acids help to improve blood sugar and insulin control and also increased the number of menstrual cycles and ovulation with one women becoming pregnant on the second month.

Carnitine

Carnitine helps your body break down fat to release energy and can help improve insulin sensitivity.

Tyrosine

Tyrosine is helpful for women with PCOS who are overweight as it helps to suppress the appetite and burn off fat.

Glutamine

This amino acid is useful for helping with sugar cravings as it can be converted to sugar for energy and so takes away the need to eat something sweet.  It also helps to build and maintain muscle which is important for fat burning.

Branched Chain Amino Acids (BCAAs)

BCAAs include three amino acids leucine, isoleucine and valine. They are important in PCOS because they help to balance blood sugar and having good levels of these BCAAs can have a beneficial effect on your body weight

Inositol

A study used inositol (2,000mg) in combination with NAC (600mg), a significant increase in ovulation rates.

Having a good diet, regular exercise, controlling stress and taking key nutrients will help in getting your hormones back in balance and reducing the negative symptoms associated with PCOS.

More information can be found on www.naturalhealthpractice.com

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