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Are You Fit for Fertility? An Integrated Approach to Boost Fertility

One of the problems with treating infertility in Britain is that infertile couples are often sent straight to IVF clinics. They come to expect the need for IVF. Instead, we need to get them thinking in a different, much more positive way rather than scheduling them in for three rounds of expensive treatment as soon as they've walked through the door. It is not all about IVF.

When it comes to maximising your chances of giving birth to a healthy baby I can't stress enough how important it is to consider all of your options to maximise your chance of success.

IVF is certainly not needed by everyone. One of the problems with treating infertility in Britain is that infertile couples are often sent straight to IVF clinics. They come to expect the need for IVF. Instead, we need to get them thinking in a different, much more positive way rather than scheduling them in for three rounds of expensive treatment as soon as they've walked through the door. It is not all about IVF. Even if you do need IVF time spent on preparing the body will be very valuable and can improve your success.

I believe that the best treatment for any kind of condition is one that treats the individual as an individual. This often means looking at how a combination of management plans will better suit the person. By integrating a cross section of approaches you will increase your chances of the right treatment package to suit you.

Integrated care allows all the different elements of the couples care to be working together pointing in the right direction and providing an individual holistic approach. When I was a Team Doctor for one of the Great Britain Olympic squads the aim was to win gold. I use the same philosophy for the couples who are trying to get pregnant. I want to leave no stone unturned, achieve their goal and win gold.

The most important thing which is often neglected is to initially make a good diagnosis as to why the couples are not conceiving.

In parallel I have ten areas that need to be addressed to boosting fertility naturally. However it is very important to keep things simple and not become obsessed.

G K Chesterton the English poet (1874-1936) said "the trouble about always trying to preserve the health of the body is that it is so difficult to do without destroying the health of the mind".

1. Stress

Stress can take its toll on the reproductive system and having problems conceiving can add to existing stress. This can create a vicious cycle. In women stress can disrupt the ovulation cycle (1) (2) (3) (4). In men, stress can lower sperm count and raise the number of abnormal sperm.

2. Happiness

We do not know whether it is the infertility that causes the unhappiness or the unhappiness that causes the infertility (3), (4). A happy, positive relationship is important in the fertility story. Interestingly, I once asked a successful thoroughbred stud owner "Apart from nutrition what is the most important feature for your mares?" He answered without hesitation, "They have to be happy".

3. Exercise

Never underestimate the benefits of exercise. Without overdoing it, exercise not only increases fertility but is known to reduce dementia, osteoporosis, anxiety, depression and fatigue as well as improve cardiovascular health and quality of life (5). Yoga in particular is an excellent stress buster! (6). Excessive exercise with a reduction in body fat can have a negative effect on fertility by upsetting ovulation (7).

4. Diet

A balanced diet is essential for overall good pre-conceptual health. Foods high in folic acid, such as broccoli, spinach, collard greens, kale, turnip greens and romaine lettuce should be incorporated into your daily diet. Vitamin B12, found in beef, soya products and all bran cereal has also been found to reduce the incidence of neural tube defects. Antioxidants, including coenzyme Q10, found in nuts, fruits and vegetables may be beneficial in combating age-related fertility struggles. Supplementation with folic acid reduces neural tube defects with 400mg being advised for all and a higher dose of 5mg to reduce recurrence (8).

Conception is more likely to occur with a normal body mass index (MI kg/m2). The ideal BMI is between 20-25kg/m2. Women who are underweight (≤ 20kg/m2 have an increased risk of not ovulating and having no period. A BMI of less than 19 has been stated to increase the time to conception fourfold (11).

A BMI of greater than 35 increases the time to conception twofold and also carries a greater risk of miscarriage and complications during pregnancy, delivery and post- partum (8) (11) (12).

5. Smoking

Smoking is detrimental to oocytes, sperm and embryos. Kick the habit once and for all. Research has found that smoking not only reduced the possibility of getting pregnant it also reduces the chances of fertility treatment working (8) (8a). Smoking also increases the risk of miscarriage in both naturally occurring pregnancies and those resulting from IVF (9) (10).

6. Caffeine and alcohol consumption

Excessive alcohol can affect hormone production in both males and females in men, alcohol excess can cause erectile problems and may have a negative effect on sperm production (8). There is no evidence to suggest moderate alcohol consumption affects fertility (10). High levels of caffeine consumption (500mg: ≥ 5 cups of coffee per day) have been associated with decreased fertility (10).

7. Post trauma

Past problems associated with a pregnancy may affect fertility. Situations that may lead to problems include previous sexual abuse, a previous difficult delivery, or a past history of postnatal depression, stillbirth and neonatal complications, (MD personal communication). One patient came to see me after three years of unsuccessful pregnancy. It came to light that her mother had given birth to a stillborn baby. This had a profound effect on her psychological state when it came to her own fertility. I encouraged hypnotherapy and after five sessions she was able to conceive naturally.

8. Complementary care

Many complementary practitioners are willing to offer advice, guidance and even treatment (13). These include acupuncture, traditional Chinese or western medical herbalists, nutritionists, hypnotherapists and reflexologists. Couples should be encouraged to seek help only from appropriately trained and qualified practitioners and to avoid treatment fads. Infertility, in particular, is very exposed to this with potentially very vulnerable people being totally exploited. I also think it is essential that communication occurs between all practitioners so that everybody is working together in an integrated way.

9. Creation of a road map

Any management programme requires some form of roadmap. This will mean exploring all treatment options available and figuring out which works best for you, without it becoming an obsession. Making informed choices will make the journey easier and ideally allow most couples to arrive at the hoped for destination. The creation of a roadmap must include time frames and review dates (8). But I cannot stress the importance of not creating an obsessive atmosphere with unachievable targets that will then become destructive.

And last but not least................

10. Don't forget to have sex

The most important thing is do not forget romance. Be careful to not allow the stress of trying to conceive to reduce sexual esteem, satisfaction and frequency. Reproduction efficiency increases with frequency of intercourse but the optimal frequency is best defined by the couples own preference (10).

I suggest two to three times a week and to make a love across the week - not just at weekends. At the very least, aim to have sex during your most fertile time of the month - about five days before, and one day after ovulation. In a 28-day cycle, this happens between day 10 and 17.

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.

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