BY DR BENJAMIN ABRAMOV & DR MALINI UPPAL
One in 7 couples in the UK has trouble conceiving, and you may be concerned that you are one of them, especially if you or your partner are aged between 30 and 39. You might have also been exposed to the frequent media reports about the age-related drop in women’s fertility. Perhaps you have tried different methods of assisted conception already, but they have not yet been successful. Or maybe you are just beginning to consider seeking professional help.
Couples and individuals who approach a fertility clinic have already been through the realisation that they need some assistance to conceive. Sometimes the first steps in fertility care do not involve medical intervention. Information about the natural process of conception and guidance regarding the frequency and timing of intercourse may be helpful in some cases while others may benefit from psychosexual counselling or may require lifestyle or dietary advice. Many couples and individuals going through a fertility journey need an appropriate support system to be able to cope with this difficult and challenging time in their lives.
Many couples and individuals going through a fertility journey need an appropriate support system
A human body works as a circuit of interconnected synapses to carry out any function. Physical, mental and emotional wellbeing play a vital role in its efficient function.
We here at City Fertility understand our patients’ needs and make sure that appropriate support is provided. We offer preconception care and preconception advice and we provide couples and individuals with free counselling sessions which can be taken before, during and after undergoing treatment.
Stress and Timings
A woman is most fertile during the few days leading up to ovulation. Ovulation occurs 2 weeks before the start of her period which is usually day 14 of the cycle in a woman whose cycle is 28 days. In a woman whose cycle lasts 35 days ovulation occurs on day 21 of the cycle. There are several ways of tracking the ‘fertile window’ and the timing of ovulation. Ovulation is preceded by an increase in the secretion clear ‘egg white like’ mucous by the womb cervix. Ovulation is also associated with a very slight increase in body temperature. Finally, there are several home ovulation prediction kits which women can use to check their urine to track the ‘fertile window’ or the ovulation itself. However, strict timing of intercourse to coincide with ovulation is not necessary and may cause stress especially when both partners are working. Sperm cells can survive in the female genital tract for a few days and conceptions may happen even when intercourse occurs 4 days before ovulation. Therefore the best approach is to have frequent sexual intercourse (at least every two to three days).
Psychosexual difficulties can lead to subfertility and in some cases having subfertility may have an untoward effect on couples’ or individuals’ sex life. When the difficulty conceiving can be clearly related to challenges in the couple’s sexual relationship, psychosexual interventions can prove to be an effective first line of treatment. However, it is a lot more common to find that the stress and anxiety that fertility treatments are often associated with result is the development of sexual dysfunction and at times even in relationship breakdown or marital discord. Women trying to conceive often have depression rates that are similar to women who have heart disease or cancer. Emotional stress and marital difficulties are greater in couples with subfertility. An awareness of your medical team to these aspects of fertility treatment and their openness to discuss it with you can lead to timely referrals to a psychosexual counselor or a martial / relationship specialist. A few sessions with a counsellor can play an important role in making sure that your fertility treatment does not result in harm to other aspects of your well-being.
Diet and lifestyle
There is no need to say that a balanced diet and healthy lifestyle is always a good idea. Yet, it is perhaps the case that life style changes may be even more important if you are trying for a baby, both in terms of improving your fertility as well as contributing to the health of your future children. Giving up smoking and reducing alcohol intake are a couple of important first steps. Maintaining a healthy diet and addressing deficiencies in vitamins or trace elements are also of paramount importance and GENNET City-Fertility have an in-house Nutritionist to help you plan a healthy diet.
Diets high in unsaturated fats, whole grains, fish and vegetables rich in antioxidants (particularly vitamins C and E, selenium and beta carotene) have been associated with improved fertility in both women and men. While current evidence on the role of dairy, alcohol, and caffeine is inconsistent, saturated fats, and sugar have been associated with poorer fertility outcomes in women and men.
Vitamin D may be important for your fertility and we in the UK are more likely to have vitamin D deficiency due to restricted exposure to sunlight. To have adequate levels of vitamin D one must consume foods which are rich in vitamin-D such as oily fish and fortified breakfast cereals, and to have exposure to sunlight which activates the vitamin. With the limited exposure to sunlight in the UK, especially during the winter months, many individuals fail to maintain adequate levels of the vitamin through their diet and find themselves in need of vitamin – D supplement.
The department of health recommends you take a folic acid supplement for three months before conceiving and for the first 12 weeks of pregnancy. Folic acid greatly reduces the risk of your baby having a neural tube defect such a spina bifida.
Finally, women and men with obesity [body mass index (BMI) ? 30 kg/m2] have a higher risk of infertility. This risk is also higher in women who are underweight (BMI <20 kg/m2). Diet and BMI influence the outcome of fertility treatment too. If you have a body mass index of 29 or more, it may take you longer to conceive. This is because excess oestrogen (a female sex hormone) originating from your body fat can cause hormone imbalances that interfere with ovulation. If you are overweight and suffering with ovulation dysfunction, even losing 5-10 per cent of your body weight may at times restore ovulation and save you the need to take fertility drugs. Being underweight is also bad for your fertility. Fifty per cent of women with a BMI of 19 or less suffer from irregular periods.
Overweight men have a lower sperm count because their male hormone, testosterone, is converted by the cells in their fat tissue to the female sex hormone, oestrogen.
Patients diagnosed with polycystic ovarian syndrome greatly benefit from a good diet plan which can help them lose weight and even regulates ovulation.
Smoking can affect both sperm and egg quality and is one of the primary causes of having a low birth weight baby. It also brings the menopause forward and damages the ovaries.
Men who smoke have been shown to have abnormalities in sperm production. Cigarette smoking affects both sperm quality and quantity.
Counselling is a type of therapy that allows a person to talk about their problems and feelings in a confidential environment. It can help couples to understand the implications of treatment and offer support at a critical time, such as prior to starting an IVF cycle or when an IVF cycle has been unsuccessful. We have an in-house fertility counselling service to help you during these physically and emotional demanding times. Couples who have IVF, frozen thawed embryo replacement or IUI treatment are entitled to funding for 1-2 counselling sessions as part of their treatment package.
At City-Fertility we hold monthly fertility support group meetings. In many cases, friends, a partner or other members of the family can be a wonderful source of comfort and for some people that’s enough. However, some people find it helpful to get extra support from a counsellor or people who share the same experience. In a support group, members provide each other with various types of help, usually by sharing nonprofessional coping strategies. For many such support groups feel empowering and provide a sense of community. Meeting and talking to others who can relate to what you’re exactly going through is a type of support that your friends and family members might not be able to offer.
Visit the Gennet City Fertility website www.city-fertility.com