There have been some tremendous scientific developments over the last three decades in the realm of assisted conception, opening a great number of doors for women and transforming the way we think about fertility. However, I still believe that self-care needs to be front of mind for couples that are trying to conceive.
Paracelsus, the sixteenth century healer, said that the good doctor's therapeutic success largely depends on his ability to mobilise his patients' will to help themselves. So to provide a comprehensive self-care programme, I have developed a five arm approach designed to help boost your fertility naturally.
Arm 1: Lifestyle
When making adjustments to your lifestyle, it is vital to keep the changes simple and not to set unrealistic targets.
Weight can be a major factor in your fertility, with conception more likely to occur with a normal body mass index (BMI kg/ m2), with the ideal BMI sitting between 20 and 25kg/ m2. Women who are underweight have increased risk of anovulation, while obesity can also be a major obstacle to successful conception. A BMI over 35 doubles the amount of time to conception and increases the chance of complications during pregnancy and below 19 has a fourfold increased risk of fertility issues (Hassan and Killick 2004).
An excellent stress buster, exercise, can help those struggling with weight issues as well as those suffering with fatigue, depression, anxiety. However, please remember to do everything in moderation, as excessive exercise can be negative if it reduces your weight, below a BMI of 19 kg/m2.
A balanced diet is also essential for protecting and promoting your fertility. I recommend folic acid supplements to reduce neural tube defects, and eating foods high in antioxidants, including coenzyme Q10 - think broccoli, dark leafy greens and olives.
Research has found that women who have experienced difficulty in getting pregnant are adding 10 years to their reproductive age by smoking (Howe et al 1985). It not only reduces the chances of getting pregnant, but it also reduces the chances of any fertility treatment actually working. Meanwhile, men who smoke have a lower sperm count (Dooley 2006). So if you are a smoker and you're thinking about starting a family, this is perhaps a starting point.
Arm 2: Emotional
Unlike the more measurable, quantifiable habits that make up your lifestyle, this arm includes the more subjective, emotional factors in your life that in my opinion play just as important a role in conceiving.
Stress can really take its toll on the reproductive system, cause hormonal changes, and disrupt ovulatory cycles and really upset relationships.
For males, stress can have a detrimental effect on sperm as well as sexual function (Scheiner et al 2003). Experts in animal husbandry know very well that fertility in mares is much reduced in a stressful environment, and many farmers have told me that they encourage their ewes and cows to be as stress free as possible in order to achieve a higher fertility rate.
Directly related to your stress levels is your level of happiness, which is a vital part of the fertility story. Going back to animal husbandry - a successful thoroughbred stud owner was asked, 'Apart from nutrition, what is the most important feature for your mares?' and he answered without hesitation, 'They have to be happy.'
Another important consideration is the impact of your history on your current emotions and state of mind. Past problems associated with a pregnancy, sexual abuse, or a previous difficult delivery can have a real impact on your ability to fall pregnant.
Arm 3: Education
It is also vitally important to educate oneself about any potential obstacles to conception and to know the warning signs so that you can seek professional help when required.
Sexually transmitted diseases, for example, can have long-term effects, as can a previous termination of pregnancy, past surgeries, chemotherapy, past illnesses or ongoing conditions such as diabetes. In men, a history of undescended testes or testicular surgery can also affect their fertility.
An awareness of your own and your family's medical history is the key here, and as soon as you are aware of a potential problem you have the opportunity to educate yourself about it and seek professional advice, the earlier the better.
Arm 4: Self proactive diagnosis
In order to manage a medical condition, self-diagnosis of basic problems can be a helpful way to raise concerns and seek assistance. Monitoring ovulation is common practice and over the counter products are increasingly becoming available to detect ovulation and to investigate sperm quality. However, more extensive testing, validation and modification will be needed before we can be certain they have real clinical use. I always ask my patients to view the results with caution, as they can increase stress and be expensive.
Consulting complementary care practitioners - including acupuncture, traditional Chinese or western medical herbalists, nutritionists, hypnotherapists, reflexologists may be beneficial. You should be encouraged to seek help only from appropriately trained and qualified practitioners who have recognised codes of practice and who have a good dialogue with your western practitioner and vice versa.
Arm 5: Creation of Road Map
To build an effective road-map, one must look at all the arms and ensure that they are all addressed in reasonable timeframes, and always bear in mind that most of the issues mentioned are not absolute roadblocks to conception.
I would recommend for your road map to be a one year plan that takes into consideration your age, as well as the medical, emotional, ethical, legal, and financial factors at play.
When making the map, you should think about your concerns, set achievable goals for changes to your lifestyle, use an integrated approach, and seek the help of qualified practitioners where required. It is so important to keep open lines of communication between the professionals that you consult, so that all the pieces of the jigsaw fit together.
The natural approach and seeking professional help need not be independent and exclusive - keep all your options open. Fertility is a journey that requires self-help, care and planning. Making informed choices can make the journey that much easier and hopefully more successful. So before you look to IVF or other assisted conception treatments, I would encourage you to look inwards and consider the ways that you can help yourself and boost your fertility naturally.
Mr Michael Dooley runs the Poundbury Fertility Clinic in King Edward VII's Hospital in London. This clinic provides a bespoke and integrated service for fertility patients.
For more information visit www.kingedwardvii.co.uk.
Agrawal R, Burt E, Gallagher AM, Butler L, Venkatakrishnan R, Peitsidis P (2012). Prospective randomized trial of multiple micronutrients in subfertile women undergoing ovulation induction: a pilot study. Reprod Biomed Online 24 (1) pp 54-60.
Balen AH, Jacobs HS (2003). Infertility in Practice (2nd edition). London: Elsevier.
Bonde JPE (1993). The risk of male subfecundity attributable to welding of metals: studies of semen quality, infertility, fertility adverse pregnancy outcome and childhood malignancy. Int J Andrology 16 pp 1-29.
Callan VJ, Hennessey JF (1988). The psychological adjustments of women experiencing infertility. BJ Med Psychology 61 pp 137-14.
Clark AM, Thornley B, Tomlinson L, Galletley C, Norman RJ (1998). Weight loss in infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum Reprod 13 pp 1502-1505.
Dooley M (2006). Fit for Fertility. Overcoming infertility and preparing for pregnancy. London: Hodder Mobius.
Gaarder J (1995). Sophie's world. London: Weidenfeld and Nicolson.
Hassan MA, Killick SR (2004). Negative lifestyle is associated with a significant reduction in fecundity. Fertil Steril 81 pp 384-92.
Howe G, Westhoff C, Vessey M, Yeates D (1985). Effects of age, cigarette smoking and other factors on infertility: findings in a large prospective study. Br Med J 290 pp 1697-1700.
Meldrum DR (2013). Aging gonads, glands and gametes: immutably or partially reversible changes. Fertil Steril 99 pp 1-4.
Norman RJ, Davies MJ, Lord J, Moran LJ (2002). The role of lifestyle modification in polycystic ovarian syndrome. Trends Endocrinol. Metab 13 pp 251-257.
Palmer S, Barnhart K (2013). Biomarkers in reproductive medicine: the promise, and can it be fulfilled. Fert Steril 9 pp 954-62.
Practice Committee of the American Society for Reproductive Medicine in collaboration with the Society of Reproductive Endocrinolgy and Infertility (2008). Optimising natural fertility. Fertil Steril 90 S1-6.
Rebuffe-Scrive M, Cullberg G, Lundberg PA, Lindsted TG, Bjorntorp P (1989). Anthropometric variables and metabolism in polycystic ovarian disease. Horm Metab Res 21 pp 391-397.
Sharara FI, Seifer DB, Flaws JA (1998). Enviornmental toxicants and female reproduction. Fert Steril 70 pp 613-622.
Sheiner E, Sheiner EK, Postashnik G, Carel R, Shoham-Vardi I (2003). The relationship between occupational psychological stress and female fertility. Occupational Medicine 53 pp 265-9.
Sievert JB, Dubois CA (2005). Validating signals of ovulation. Do women who think they know, really know? Am J Hum Biol 17 pp310-20.
The Prince of Wales (2012). Integrated health and post modern medicine. J R Soc Med 105 496 -498.