Sugary drinks impair your fertility

by dee armstrong


A new study by researchers at Boston University has shown that sugary drinks - including fizzy drinks, energy drinks and sports drinks - can have a detrimental impact on fertility. The study of over 3000 women and 1000 of their male partners, who were trying to get pregnant naturally, was published in the journal, Epidemiology, in January 2018.

The research was carried out as part of PRESTO, the Pregnancy Study Online, an ongoing web based prospective study of couples in North America and Canada. Participants completed a comprehensive baseline survey on medical history, lifestyle factors, and diet, including their intake of sugar-sweetened beverages. Female participants then completed a follow-up questionnaire every two months for up to 12 months or until pregnancy occurred.

Intake of sugary drinks was associated with reduced fertility for both men and women in the study and this effect was consistent after controlling for other factors including obesity, alcohol, smoking, caffeine and diet.

Researchers were looking at ‘fecundability’, which is the average monthly probability of conception. Intake of one or more sugary drinks a day by women was associated with a 25% reduction in fecundability; the same level of intake by men was associated with a reduction of 33%. The effect was worsened in people who drank more than one sugary drink a day and energy drinks had an even more pronounced effect, though the study sample size for those was smaller.

Sugar affects fertility through its negative impact on your hormones. When you consume something sugary - and drinks have a very fast impact - the amount of sugar in your bloodstream skyrockets. This causes your body to release insulin to get your blood sugar levels back under control. Too many peaks and troughs in your blood sugar cause your body to release the stress hormones, adrenaline and cortisol, which have a detrimental effect on the balance of your reproductive hormones, progesterone, oestrogen and testosterone. Sugary drinks are also full of empty calories which cause weight gain, which has been shown to impact fertility in both men and women.

This study did not show a correlation between consumption of diet fizzy drinks and fertility. However, at our clinic, we recommend that you try to cut the fizzy drinks out altogether rather than switch to diet versions. The artificial sweeteners in diet drinks still raise your blood sugar and have a detrimental impact on your gut bacteria, leading to greater sugar intolerance and inflammation. These things all impact your reproductive hormones. I once met a couple who each took a pint of Diet Coke to bed with them every night to put on their nightstand and sip through the night! They had no idea of the impact that was having on their bodies. Within 3 months of stopping that habit they had both lost loads of weight and were pregnant shortly afterwards.

If you can’t bear the thought of life without a sweet drink try making your own at home with some sparkling water, a little fruit juice and some stevia or xylitol, which are sweeteners that have a much lower impact on your blood sugar. Or check out the recipe using raw honey in this funny short video that explains what diet drinks do to your body in 1 hour.


What is sperm DNA fragmentation and how does it affect your fertility?

by dee armstrong

Any couple who has been struggling to get pregnant for a while will be familiar with the various fertility tests that are usually offered. For her it's a blood test to check for ovulation, a hysterosalpinogram to check to see whether the fallopian tubes are clear and sometimes an AMH test to check her ovarian reserve. For him it's usually just a semen analysis.

The standard semen analysis has been around ever since IVF was invented and it hasn't been improved on since. There are quite a few things measured in the semen analysis but the main ones that couples will be familiar with are sperm count (the total number of sperm), motility (their swimming ability) and morphology (the shape and size of the sperm).

Actually, by 21st century standards, a semen analysis is a pretty crude test - it just looks at the outside of the sperm and tells you little about the intrinsic quality of the sperm DNA or its healthy baby-making abilities.  Certainly if a man's sperm count is very low, or they're not good swimmers, or if most of them have some abnormality (like two tails!) then, yes, that man's fertility is going to be compromised. But what about men whose semen analysis is OK but still their partner isn't getting pregnant naturally or by IVF? What about the couples who try round after round of IVF and are unsuccessful?  What about the couples who have repeated miscarriages?

Sperm DNA fragmentation might be the missing link and testing for it adds new information to help explain these situations.  It has been around as a research tool for 20 years, but it's only relatively recently that couples have been able to get the test done as part of their treatment.  When you get pregnant, the baby inherits some DNA from Mum and some from Dad.  Sometimes the DNA becomes damaged or fragmented - with strands breaking into smaller pieces.  Even healthy sperm may have some degree of DNA damage, as they can't repair themselves.  It's still being researched, but scientists think most damage is caused by the oxidative stress created by things like smoking, alcohol, environmental pollution, being overweight, and eating processed foods with poor nutrition.  Sometimes, if there is too much sperm DNA damage, that can prevent fertilisation taking place at all.  Amazingly, sometimes the egg is actually able to repair some of the sperm's DNA damage and fertilisation can take place. But when there is too much sperm DNA damage for the egg to repair, that can lead to the pregnancy stalling almost immediately, or you do get pregnant, but some time further down the line, suffer a miscarriage.

Professor Sheena Lewis, emeritus professor from Queen's University Belfast, is the UK's leading expert in sperm DNA fragmentation, and for 25 years she and her team have been working on new tests for the diagnosis of male infertility. They call the test the 'sperm comet' test because undamaged DNA bunches together and shines brightly, while damaged DNA fans out and glows weakly, looking like a celestial comet. The test is so sensitive that it detects damage in 80% of men with 'unexplained infertility', who seem to have normal semen by traditional tests.

I asked Professor Lewis why DNA damage was so important?

Sperm DNA damage is often a factor when couples have been trying for a baby for some time without success and where there is no obvious explanation why. It can also be a major factor where couples have been successful in conceiving, but have suffered a number of miscarriages. The important thing for men is to find out what their sperm quality is like. If we find there is a lot of sperm DNA damage, we can help couples make better choices about the right lifestyle choices and the best fertility treatment for them. For example, with moderate damage, IVF might be the best treatment to try first. If the damage is higher, then the best chance of success might be going straight to ICSI treatment.

If sperm can't repair themselves, what can men do?

Men are lucky.  Unlike women who have all their eggs at birth, men make a new batch of sperm every 3 months. If they test high for sperm DNA damage, they can take control by improving their lifestyle and DNA damage levels can decrease within within 3 -4 months.

A couple who consulted us at the Natural Fertility Centre recently had experienced 3 miscarriages in 18 months. They were feeling hopeless and had no idea that the man might be involved. Then they heard about DNA fragmentation. In this case, despite a relatively fit and healthy lifestyle, his DNA damage was high at 40%. He cleaned up his diet and started to take a  anti-oxidants from our NFC Essential range including coenzyme Q10, Vitamins C, D & E and bioflavonoids, amongst others. After 3 months his DNA fragmentation had reduced by 20% and they are now 7 months pregnant.  

Another couple had gone through 4 failed cycles of IVF.  They had never been told about DNA fragmentation and so spent £20,000 having treatment that was never likely to work.  They heard about sperm DNA testing and his test results came back with 56% DNA damage. He went on a lifestyle improvement regime, three months later had reduced the damage to 24% and the couple went on to have a successful cycle of IVF. 

Many of the couples I meet are relieved just to hear that there is more they can find out about why they are not getting (or staying) pregnant. Unfortunately, some doctors are still prone to telling men that there's nothing much they can do to improve their sperm. In fact, that's not the case at all. Getting good advice from an experienced nutritionist and supplementing with high quality antioxidants can make all the difference in the world.  In my view fertility specialists have also been slow to recommend the DNA fragmentation test to patients about to undergo assisted conception treatments. In the world of 'unexplained infertility' especially, it can make an enormous difference to find out that it's not unexplained at all and that information has to be a good thing.  

The spermcomet test can be booked at the Edinburgh branch of the Natural Fertility Centre - clinics are held on the last Sunday of each month. The test costs £450 and results are usually back within 7-10 days.  Get in touch with us if you have any other questions about it. 

Fertility education in schools is a no-brainer

by dee armstrong

There has been heated debate in the last week about Professor Geeta Nargund's leaked email to the Education Secretary calling for fertility education in schools, with accusations of scaremongering and arguments about fertility statistics.  Some women feel they are having the call to breed shoved down their throats on a daily basis and that the result is the ideal fertility window has essentially been reduced to just a couple of years between 28 and 30.  Certainly that's the case if you combine it with the advice of many of our mothers not to settle down before our late twenties. In the last nine years that I have been running a fertility clinic I have met about 1000 women who are trying to conceive.  I can honestly say that fewer than 20 of them made a conscious decision to delay pregnancy - the vast majority were in a very similar position to me. 

I met a lovely chap at university and amazingly we stayed together for six whole years after that, surviving for a good while after our first jobs took us to different parts of the country.  I thought he was The One. We talked in a dim and distant way about marriage and kids, and we were sincere, but it would no more have occurred to us to actually get married and have a baby at the age of 25 than book a one way ticket to Mars.  In the 70's and 80's it was drummed into me constantly by my mother, "wait until you're 30 before you even think of having babies". She had had three by the age of 29 and she knew how hard that had been. She wanted me to have a career and, above all, independence, and everyone thought at the time that we could have it all. Declining fertility wasn't mentioned - ever.  

Unfortunately, during the long distance phase University Boyfriend met someone else and there followed 3 years of frog kissing. I met a good contender at 29 and we stuck it for 3 years, with me regularly and surreptitiously surfing the HR pages on my company's intranet, calculating maternity benefits. But his heart wasn't in it and at the grand old age of 33, I found myself back on the starting blocks.  

I definitely felt panic. My younger sister had beaten me to it and had a baby by this stage - I couldn't believe I would ever be able to meet Mr Right, let alone have it all come together 'in time'. It caused me real anguish.  A year later, however, I met my husband at a mutual friend's wedding and it was love at first sight, whatever that means.  It's not that I was a raging impregnate-me-now-harpie, but I made no bones about the fact that I wanted a family and I certainly encouraged him not to waste my time. 

Luckily he felt the same way - 18 months later we were married and I was pregnant with twins two months after that.  A good friend counselled us just before the wedding, please don't get pregnant straight away - get to know each other, be a couple for a while, build resilience. She knew how stressful it is adding a baby into the equation. But by that stage my biological clock was in overdrive.  With hindsight I'm glad I didn't wait and would do the same thing again.  I consider myself very lucky indeed to have had twins at the age of 36. I now know that they were probably due to the last surge of hormones before my ovaries started a gentle decline towards my 40's. We tried again for a while but I had early miscarriages at 41 and 42 and after that we called it a day.  

It's so much harder for young people these days. I bought my first house at the age of 27, a two-up two-down in Cambridge for £65,000 on a salary of £25k.  I would have been relatively well set up if pregnancy had happened.  Imagine being able to get your first home so easily now!  It's not about haranguing young women to get on and breed earlier – what actual difference can that make when these decisions are so much more complex than scheduling a baby into your Google calendar?   

It is about giving young women and men all the accurate information so that their long term choices are more informed. More subtle than that, I believe it's about creating an atmosphere where starting a family earlier is seen as sensible and understandable in the great scheme of things rather than rash and precocious.  I don't know whether I would have made different decisions if we'd known then what we know about fertility. But I think if there had been more of a climate of acceptance about starting a family in our 20's I might well have done.  Hardly anyone I knew had babies in their twenties - you really had to be quite a renegade to do it.  

I don't have daughters and I’m certainly no Kirstie Allsopp.  But to my sons I will be saying, "when you find a good woman and she thinks it's time to have a baby, listen to her.  If she's The One, don't run screaming for the hills in a panic".  I will be encouraging them to think that starting a family is every bit one of life's great adventures as much as flinging themselves off a bridge on a bungee rope. Victoria Falls will still be there when they're 45.  

On the other hand, we may have to accept that despite the fact that we want our daughters to do things differently, the rubicon has been crossed in terms of what women want and expect for their lives.  And it is pretty tricky to get a decent education and a career well enough established before you're 30, without adding in the complication of finding the right man.  We end up saying to women yes, concentrate on career and money between 20 and 30 if you're sensible, and then, oh quick, get pregnant in a tiny window before you hit about 32/33 otherwise it's going to be really hard! All this means that education about fertility and contraception and good healthy lifestyle choices in youth is a no-brainer. It has to be better to know what you're up against.   

Nargund’s subsequent letter to the Guardian in response to all the furore (and her interview today on Woman’s Hour) actually sums it up better than the original piece:

“I am not in the business of proscribing life choices to anyone. The myriad circumstances of individuals and families who seek to start a family make nonsense of the idea that one size (or age) will ever fit all. What I absolutely do stand for is the power of education and knowledge. With accurate data on fertility, women can make informed choices at every stage of their life and career.Women do not wish to be fobbed off with lies and half-truths. The only way they can make educated choices is to be educated.” 

Professor Dr Geeta Nargund


Five things you can do to improve your cervical fluid

by dee armstrong

When you're trying to get pregnant, having a good quantity of fertile cervical fluid every month is very important to help keep sperm alive. If you don't know what cervical fluid is look here for a basic introduction. A woman in her early thirties should really be seeing at least 3 to 4 days of fertile cervical fluid each month in the run up to ovulation. If you want to improve your cervical fluid here are 5 things you can do:

1. Drink plenty of water. Yep, the boring old 'drink more water' command. Cervical fluid is 98% water. You need to drink 1.5 to 2 litres a day. Your reproductive system is pretty much at the bottom of the pecking order when it comes to scarce water resources and if you're a bit dehydrated there won't be enough left once your body has allocated what it needs to your vital organs. You can also try drinking unsweetened grapefruit juice and green tea - there's no hard scientific data but lots of anecdotal evidence from women to say they can help.

2. Try taking a chesty cough mixture with the active ingredient guaifenesin. (Be sure to avoid brands with any other active ingredients as these can be harmful in pregnancy). The idea is that the cough mixture loosens chest mucus making it easier to cough. In some women it can also help them produce greater quantities of wet and stretchy cervical fluid.

3. Both acupuncture and Chinese herbs can be great at balancing hormones and helping to improve cervical fluid production.

4. Avoid thongs and G-strings - they can lead to a disruption in the healthy balance of bacteria in the vulval and vaginal area which can interfere with your cervical fluid.

5. Avoid over-using tampons. They sit at the top of the vagina, right next to the delicate tissue that contains the cells that produce cervical fluid. Only use the minimum absorbency tampon you need and only use them on the days of heavier flow to avoid that uncomfortable pulling sensation you sometimes feel on removing a tampon.

Embarrassing Fat Bodies & Fertility - embarrassingly outdated advice

by dee armstrong

I stumbled across Embarrassing Fat Bodies on the telly last night - they were focusing on the impact obesity has on fertility.  It's great to see airtime being given to the issues that weight can have on fertility but I was amazed to hear the advice given to the overweight women on the show.

The first, who suffered from PCOS, was put on a prescription medication that stops you from absorbing fat. You have to eat a low fat diet while on this medication otherwise the side effects  - uncontrollable diarrhoea - are truly horrific.  Aside from the side effects, the problem with this approach is that most people when going low fat will inadvertently end up consuming loads more sugar, because manufacturers add it to low fat foods to make it more palatable. And sugar is a demon.  Sugar messes with your hormones and makes you fat.  

The second overweight woman had no particular infertility diagnosis and was packed off to the gym and dietician, but not before Dr Christian had given her his oft repeated patronising lecture "it's just about calories in, calories out". Unfortunately it's just not as simple as that and we need to be asking why it is that people are driven to eat so much of the wrong foods. It may well be that it was all the fault of the editing and these two women were indeed given cutting edge advice on nutrition - but that doesn't really help those of us watching.

I recommend this talk given by Prof Robert Lustig at the University of California for the full low down on sugar and a very good explanation of why a calorie is not just a calorie - there's a briefer and less detailed version here.  In addition, recent research on nutrition and PCOS shows that meal timing can have a significant effect - loading more of your calorie intake earlier in the day can improve hormones and help women with PCOS to ovulate. A low fat diet is not something we advocate at the Natural Fertility Centre - yes, if you fill up on burgers and chips it's not going to do you any good but most of you aren't doing that and you need good fats and you need to know how to incorporate them into your diet - not a pill that will stop you absorbing them.  If you have PCOS consulting a good nutritionist is vital. As well as that you might find this website and these books helpful - The Hormone Cure and The Sugar Impact Diet.


Is it the end for baby-making sex?

by dee armstrong


In yesterday's Telegraph, Professor Carl Djerassi claims that in just over 30 years' time sex will be redundant as the main means of having a baby and we will all be using IVF as our 'go to' method instead.  If I wasn't so helpless laughing as I read that, I'd be crying.  Djerassi has a new autobiography out,  which I suppose explains the attention grabbing headlines. He says that by 2050 he expects that men and women will choose to freeze their eggs and sperm when young before being sterilised. He says that advances in fertility treatment make it much safer for patients without fertility problems to consider and that progress will give rise to a 'manana' generation who are safe in the knowledge that parenthood can be delayed without repercussions.

Image: Alamy

Image: Alamy

The fact is that IVF isn't all that effective even though it's almost 40 years since the first IVF baby was born in 1978.  Average success rates across the UK still  languish down at the 25% mark. Yes, some clinics achieve better rates than that but many couples are still unaware that they are more likely to walk away from an IVF clinic without a baby than with one, certainly at the first attempt. One woman I met recently said that her husband sat in shocked silence all the way home from their fertility clinic booking-in appointment because it had only just hit home that their chances were only 40%. (She thought on the other hand that 40% was actually quite good odds but then she had been doing the background reading.)

As well as the relatively low success rates of IVF, there are the risks to consider. Professor Geeta Nargund summarised these at The Fertility Show recently, where she discussed the increased risks of pre-term labour and low birthweight of babies born after IVF and the risks of ovarian hyperstimulation syndrome (OHSS).  According to HFEA data over 18,000 women produced more than 20 eggs in one IVF cycle in the last 5 years.   Producing more than 15 eggs per cycle increases the risk of OHSS with no related increase in the pregnancy rate. It's one thing to weigh these risks if you have diagnosed infertility and quite another if you don't. Djerassi is completely out of touch with normal people if he thinks they would rather go the medical route- the vast majority of well informed couples I see would do anything to avoid IVF if they could.

It is true to say that egg freezing has recently become 'a thing' with egg freezing parties in New York (and surely coming to London any day soon). You can go along with your friends, have a few drinks and canapes and listen to Eggbanxx's sales pitch about why you should be freezing your eggs now. The trouble is the technology is really very new and not very effective, with only a 25% success rate if you freeze your eggs before the age of 30, and that was for those who had three embryos transferred. Indeed according to Dr John Waterstone only 20 babies have been born in the UK so far after egg freezing.

As Rachael Forrest, Fertility Acupuncturist, says "It's ridiculous to think that instead of rearranging society so that couples are supported in having children earlier when the odds are with them, they're making medicine all powerful and trying to gain even more control of people's lives."  My prediction is that there will be a swing back in terms of the relatively recent trend to have babies later. Those of us who were raised in the 70's and 80's, whose mothers warned against the perils of 'early' pregnancy, will be saying something different to our own kids.  I, for one, will be telling my boys that when they find a good woman they should listen when she says it's time for babies - even if that's when they're still in their 20's. I hate to nail my colours to the Kirstie Allsopp mast but I do think it's important that boys get positive messages about embracing fatherhood early. 

Who knows - maybe fertility medicine will transform to such a rapid degree in the next 30 years that we will be living in a world previously only imagined by sci-fi writers, where pregnancy is hyper-managed, as Djerassi describes. I think it's far more likely that we will continue to want to have our babies the old fashioned way, that young women and men will make more informed choices in the next generation and that the fertility fashion pendulum will swing back the other way.



Shopping for a Baby at The Fertility Show

by dee armstrong

In a few weeks' time it's the annual Fertility Show at London's Kensington Olympia.  I have to admit, the first time I went I was impressed and appalled in equal measure.  You arrive on a Saturday morning at the slightly surreal, end of the tracks Kensington Olympia Station.  It's packed almost exclusively with other women. Just across the road and three quarters of them peel off and head into the Spirit of Christmas exhibition, the home of 'extraordinary gifts of style, design and elegance'.  The rest of us are looking for what we hope will be a slightly more discreet entrance round the corner to The Fertility Show.

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Time for some Vitamin Dee!

by dee armstrong

The summer will soon be drawing to a close and that means the number of Vitamin D boosting sunshine hours will be reducing over the autumn and winter.  Vitamin D deficiency is a big issue in Scotland  - one study estimates that almost 50% of the UK's under 40's are deficient - the incidence was double that in Scotland participants.   It's becoming increasingly more apparent that Vitamin D is hugely important for fertility, as well as a host of other health issues.  It helps balance your reproductive hormones, and is thought to improve egg quality and aid implantation of the embryo. It's so important that a recently published study found that women who were deficient in Vitamin D were half as likely to conceive after IVF than those whose levels were normal.  At the Natural Fertility Centre we recommend the  Better You D-Lux 3000 spray, which is good quality vitamin D3, in an easy to absorb format - a quick scoosh of its fresh mintiness under the tongue is easy to incorporate into your morning routine.  I leave ours by the toothbrushes to remind us.  I will leave you with the fabulous Christiane Northrup. For those of you who don't know her, she's an American OB-GYN as they call 'em, and has been a fantastic advocate for women's health for years.  In this snippet of her at a conference a few years ago she rants on about Vitamin D, amongst other things - up to 6'30 is the relevant bit, but if you like her you can stay online and hear what she has to say about mid-life crises, women's power and the daft things some doctors say - enjoy!


A right royal knicker fuss

by dee armstrong

Yep. I've jumped on the bandwagon and am shamelessly using a right-royal-knicker-fuss to teach a good fertility lesson.  Kate Middleton, along with millions of you, clearly likes to rule out the possibility of a VPL by wearing the skimpiest of - I hesitate to even call them knickers -underwear. Which is all well and good, but knew there was a but coming (no pun intended). Women are often really surprised when I tell them that thongs are not really the best for their fertility.  As well as making it harder for you to get rid of urinary and vaginal infections, they can transmit bugs and bacteria from your backside to your nethers which can disrupt the delicate balance in the vaginal area and have a detrimental effect on your cervical fluid. Which as we know is essential for conception. Here's a good Huffington post article about it. So what I tell my clients is go for granny knickers or no knickers!  And Kate should get her Bridget Jones's out if she wants a spare after her heir.

Vitamins & supplements for fertility - yay or nay?

by dee armstrong

I spent last Saturday at the second annual Scottish Information Day organised by the Infertility Network - it was a great opportunity for couples dealing with fertility problems to come to one venue and meet lots of people who may be able to help, to hear about treatment advances and how other patients who have trodden the path before them have coped.  

In the morning a fertility consultant and IVF expert gave a run-down of what couples could expect from their first appointment at a fertility clinic - the various investigations on offer and how their treatment might progress from there.  So far so good.  Towards the end of his presentation he put up a slide about what people could do to help themselves, which was, after all, why they were here. (In Scotland we're still catching up with London in terms of 'coming out' as far as infertility is concerned and this was by no means The Fertility Show - thank goodness, some might say!)  Anyway his slide said: stop smoking, cut back on alcohol, get your BMI into a healthy range.  But it said nothing about food and nutrition and the final bullet point was "no need to take vitamins or supplements", with the consultant dismissing the notion, saying "there's no evidence that they will help you" and then swiftly moving on.  

In the afternoon, however, Dr Marilyn Glenville, a famous and very well respected nutritionist who has years of experience dealing with infertility, stood up and gave a convincing and comprehensive talk about the importance of nutrition, pointing out where she thought supplementation was warranted and presenting a plethora of research evidence.  So why the mismatch?  The case for Vitamin D supplementation alone can hardly be disputed and I heard Prof Iwan Lewis-Jones stand up at The Fertility Show at least three years ago and say that the first thing he does with a man who has poor sperm parameters is put him on Vitamin C & E supplements.  Because there is good evidence that they help!  Indeed there was also an excellent presentation on Saturday from Prof Sheena Lewis about her research on DNA fragmentation in sperm - she concluded by saying she is trying to get government funding to pay for research into the food / vitamins / antioxidants link.  Because that's the next obvious step.

So, of course I couldn't keep quiet and stuck my hand up at the question panel at the end to ask what on earth patients are supposed to think?  Their doctor tells them one thing and we tell them another - time and again couples from all over the UK tell me that when they asked the consultant what they could do to help improve things they are told "nothing".     In answering me, Glenville pointed to the fact that whilst there is plenty of research evidence, (e.g. the 2013 Cochrane review on anti-oxidants and male subfertility) not much of it is of the gold standard randomised controlled trial variety.  And why not?  Because Big Pharma pays for a lot of that research and food and vitamins cannot be patented.  

Unfortunately the doctor who had given the morning presentation had had to leave before the final question panel.  Another IVF doctor present, Dr Marco Gaudoin, said that doctors are taught, based on Hippocrates' teachings, "first do no harm"  - he went on to say that a lack of evidence is not the same as a lack of benefit, just a lack of evidence for that benefit so far.  So he tells his patients to go ahead if they feel it will help.  

But, Doctors, why not go a step further?  You need to keep up with some of this basic 'boring' stuff as well as the sexy IVF stuff.   It wouldn't do any of you any harm to read Glenville's book, Getting Pregnant Faster - you'll have it done and dusted in a weekend I promise.  And if a patient asks you what can they do to help themselves, instead of saying "nothing", why not say "well, the gold standard research isn't there yet but some studies have shown x, y or z and you could read more about it if you're interested". Or, and here's a radical thought, "I don't know - some researchers think this and some researchers think that".  And remember, that as well as saying "first ,do no harm", Hippocrates also said "let food be thy medicine".



Chemical pregnancy - an unhelpful term

by dee armstrong

I'd love to ban the term chemical pregnancy. So many women misunderstand what it means and if I had £1 for every time someone's asked me to explain it I'd be very well off.

A chemical pregnancy is a proper conception and a proper pregnancy - just one that sadly ends in a very early miscarriage. It's not a false pregnancy or a false positive on a pregnancy test. And contrary to what you will read on some websites it doesn't mean that implantation did not take place.  Implantation did take place because it is only after implantation that the pregnancy hormone HCG starts to be produced.  It's a term that's there to distinguish between a pregnancy that has only been confirmed with a pregnancy test and one where a gestational sac or heartbeat has been seen on a scan - then doctors use the term clinical pregnancy.

Many women have asked me whether they were actually pregnant after being given the diagnosis "chemical pregnancy" and others only mention it as an afterthought when giving their history in appointments.  There are important differences between a couple who have never conceived and one who have had several chemical pregnancies and we will plan their care in different ways so it's important to know.

Women tell me that they are often made to feel by medical and nursing staff that these very early losses are trivial mishaps and lesser somehow than miscarriages that happen at a later stage. There's a distinct whiff of impatience, even from staff in early pregnancy units -  "well, a quarter of pregnancies will end this way so you just need to pull yourself together and get on with it" or "if you hadn't tested for pregnancy so early you'd probably never have known".  We are where we are with super-sensitive pregnancy tests - we can't wind the clock back and get rid of them despite the fact that they may be responsible for making us consume more NHS resources or "upsetting ourselves" with knowledge we wouldn't have had 20 years ago.

And the thing is, for the woman who has only been trying to get pregnant for a few months a chemical pregnancy is bad enough.  But for someone who has been trying to get pregnant for two years, who has seen the unwelcome streak of red, with her stomach swooping with crushing disappointment month after month after month, or who has been through the battlefied of infertility investigations and IVF treatment, then a chemical pregnancy is utterly devastating. 

The Mumsnet campaign for better miscarriage care highlights the profound upset caused by "the 'official' language of miscarriage, which failed to distinguish between a miscarriage and a termination, or to acknowledge the loss of a baby with whom they already felt a profound emotional connection. Some felt that they were grieving for a whole set of hopes and plans for the future, but that the emotional impact of miscarriage was pushed to one side."

Maybe it's time to call time on 'chemical pregnancies' and refer only to early miscarriages instead.

Step away from the Nurofen

by dee armstrong

Every week I meet new patients in my clinic who are trying to conceive and run through a detailed assessment with them.  And every week I am surprised by the number of women who don't know of the risks of ibuprofen (and other non-steroidal anti inflammatory drugs or NSAIDS) while trying to conceive and during pregnancy.  

The vast majority of them have not been asked whether they are taking these drugs and have not been told either by their GP or by staff in fertility clinics that they should not be using them for backache, headaches, menstrual cramps or indeed any aches and pains.  

I have noticed when talking to people about painkillers how ibuprofen seems to be by far the most popular choice - probably this is down to packaging, advertising and marketing, with the leading brand, Nurofen, having a far sexier image than boring old paracetamol.  There are exceptions but usually people say they just reach for whatever's in the cupboard rather than maintaining that ibuprofen actually works better.

The studies on NSAIDs and infertility suggest that they may impair ovulation (by leading to greater incidence of luteinizing unruptured follicle syndrome - where the egg is not successfully released from the follicle) and interfere with the implantation process.  In addition, other studies suggest that their use in early pregnancy leads to double the risk of miscarriage.  As far as infertility goes the majority of studies do relate to women who have been using NSAIDS long term (sometimes for conditions like rheumatoid arthritis) but even so it would seem wise to avoid them. This is all the more important since you can find stories all over the internet about women who have successfully become pregnant after starting to take aspirin - if you've been trying for a while it's easy to think that anything's worth a shot and anyway what harm is a little aspirin going to do?   Aspirin or other blood thinning drugs can be very helpful for some women who have been diagnosed with blood clotting issues and are usually used in conjunction with steroids, however, this should only be done after the appropriate blood tests and under the supervision of a consultant.


Reproductive immunology - who to believe?

by dee armstrong

Couples could be forgiven for not knowing which way to turn when it comes to the debate around the controversial new field of reproductive immunology - in other words can you be 'allergic' to pregnancy as it were, causing your body to reject an embryo?  On the one hand a range of new tests and treatments are offered by elite fertility clinics with seemingly high success rates and on the other experts such as Prof Robert Winston and Prof Lesley Regan are sceptical to say the least, saying that the treatments are based on poor science.

Natural killer cell

Natural killer cell

It's important to remember that scientific progress is often a bumpy road and change can be glacial.  Profs Barry Marshall & Robin Warren discovered the link between stomach ulcers and a specific bacteria in the late 1980's but were shouted down by scientist colleagues around the world who clung to the long held view that ulcers were caused by stress - it took ten years for their discovery to begin to change the way ulcers were treated and another ten years before Marshall was awarded the Nobel Prize for Medicine.

Dr David Servan-Schreiber, writer of the amazing book Anti-Cancer, makes points that are just as relevant in the ever changing field of fertility.  He says that physicians are constantly looking for scientific advances, they go to conferences, read journals and meet drug company representatives to find out the latest new advances that are on the market.  "They feel they are aware of everything going on in their field and generally they are.  But in medical culture, changes in recommendations given to patients are allowable in one case and one case alone: when there has been a series of 'double blind' studies demonstrating the effectiveness of a treatment in humans. This is called, legitimately, 'evidence based medicine'."  However, he goes on to point out that experts often don't agree amongst themselves, especially during the research phase in a particular area.  In addition he says that one of a physician's "greatest worries is not to give false hopes.  We have all learned that nothing is more painful for a patient than the feeling of having been betrayed by ill-considered promises."  Because of all these legitimate concerns, he says, "my colleagues are sometimes tempted to refuse out of hand all approaches outside the confines of existing conventional practices."   

When I first went to The Fertility Show in London five years ago, women who raised their hands to ask whether natural killer cells could be playing a part in their infertility were swiftly dismissed by the expert speakers and advised not to spend too much time looking up outlandish theories on the internet. Two years later and the immunology proponents were sharing a platform with the naysayers and speaking to packed out seminars.   At the Natural Fertility Centre, we are open to the idea that immunology may play a part, and patients of ours have been successful after consulting doctors like Dr Mohamed Taranissi and Dr Amin Gorgy in London. We also have a great deal of respect for Jill Blakeway who runs the very successful Yin Ova Centre in New York  - Blakeway says she has "been in practice for many years. Long enough to notice trends, and one of the things that I have noticed is a rise in autoimmune problems (allergies, lupus, Crohn’s disease, rheumatoid arthritis, chronic fatigue and some kinds of thyroid disorders). What concerns me about this rise in immune system dysfunction is the effect it has on fertility. Endometriosis, recurrent miscarriage and failed IVF are common problems for women who have autoimmune issues and in our book Making Babies: A Proven 3-Month Program for Maximum Fertility Dr. David and I talked about how we thought immunity issues were the third most commonly overlooked cause of infertility, after endometriosis and infections..."

"... Chinese medicine, when applied correctly can be very helpful in treating a misbehaving immune system... You may think that the best way to handle an immune issue is to boost the immune system. That’s what a practitioner would do if you caught colds all the time or had some other sign of immune deficiency. But simply making the immune system stronger when it’s already hyperactive, is a mistake. What we really aim to do is to bring your immune system back into balance, not turbocharge it. This is a job for an experienced herbalist, who has the skills to adapt a herbal formula as your internal landscape shifts. "

The HFEA has put together a helpful page about Reproductive Immunology. I would endorse their suggested list of questions to discuss with your doctor before embarking on a course of immunology treatment: 

  • Why do you think I need this treatment - can you explain what you think is happening in my body? 
  • What data or evidence do you have to prove that this treatment will improve my chance of having a baby?
  • What will the treatment involve for me?
  • How much difference do you think having this treatment will make for me? 
  • What are the side effects and risks of the treatment?
  • How much will the tests and treatment cost me?



Infertility, feeling like a leper and true empathy

by dee armstrong

In the Edinburgh support group I run on behalf of Infertility Network UK, sooner or later we end up talking about how friends and family handle the whole infertility conversation.  It's a very tricky thing to get right.  Some people are quietly hoping you will ask about the progress of their latest IVF cycle because it's the elephant in the room and others just want to get on with it in peace without having to handle other people's reactions and emotions.  One woman I was talking to recently had found out at the age of 29 that she had already had the menopause - no eggs left, none - and after she broke the news, clearly devastated, to her parents, they didn't mention it once again in the next 6 months!  It sounds like an extreme example but that sort of thing is not uncommon.

The marvellous Brene Brown talks about empathy in this great little video and the nub of it is when she says, "one of the things we do sometimes in the face of difficult conversations is we try to make things better ... and the truth is rarely can a response make something better":

On the whole I'd say that most will appreciate it if you can properly empathise.  It's a bit like the first conversation you have when you see a friend who's been recently bereaved - you know that nothing you say can alleviate her loss but you acknowledge her pain.  Jessica Hepburn puts it very well in her new book The Pursuit of Motherhood

Whenever I visit friends and family with babies I never ask to pick them up and, as if sensing my unease, they never offer. I have this paranoia that they think I might burst into tears or run off with them because I haven’t got one of my own. I don’t want to risk any embarrassment. In fact, I’ve started to notice that everyone is feeling more and more uncomfortable even mentioning babies around me. I know it’s because they don’t want to hurt my feelings but it actually makes things worse. They worry about telling me when someone gets pregnant because it will highlight that I’m not, and they’ve stopped inviting me to things where there will be children because they assume I won’t enjoy it. Of course they’re right. It does hurt. It hurts a lot. But, on balance, that’s probably better than feeling like a leper.
— Jessica Hepburn, The Pursuit of Motherhood

Book review: The Pursuit of Motherhood by Jessica Hepburn

by dee armstrong

In The Pursuit of Motherhood, Jessica Hepburn has written a really important book about infertility and modern fertility treatment in the UK.  It's her compelling story of the heartache of being unable to get pregnant with the devastating 'non-diagnosis' of unexplained infertility and what it's like to undergo multiple rounds of IVF.  Not for the fainthearted, it's brutally honest at times and the effects on her physical and mental health, her relationship and her bank balance are all laid bare.  Having said all that it's an amazingly easy book to read which is testament to how well it's written  - it's a real page turner and I found myself staying awake till the wee small hours to finish it in just over 24 hours.  It will be fascinating for anyone who has struggled with infertility themselves and indeed should be compulsory reading for all fertility clinicians. I thoroughly recommend it. 

Everything you never knew you needed to know about cervical fluid

by dee armstrong

The snail trail, fanny snot, the slippery wipe - call it what you like, if you're finding it trickier than you hoped to get pregnant, getting to grips (literally) with your cervical fluid is going to be really important.  Toni Weschler, writer of Taking Charge of Your Fertility and the ultimate fertility awareness guru, tells a funny story in her book about being invited onto an American radio show to discuss her work.  When the producer heard she wanted to talk about 'cervical mucus' he turned up his nose  - she had to change her phraeseology to 'cervical fluid' before she passed the yuck test and was allowed on!  I've lost count of the number of women in my clinic who turn and apologise to their man when we start to discuss their menstrual cycles in detail, "Sorry darling, this is all a bit too much gruesome detail, isn't it?" One woman even asked her husband to leave the room !

So yes, it's a bit yucky.  But come on girls, if you can deal with your own snot and your periods, and you're planning to deal with all manner of messiness a baby can produce, there's really no need to be squeamish about cervical fluid.   And knowing what's what in that department can be the difference between getting pregnant and not.  

Fertile cervical fluid gets produced by cells near your cervix in response to hormonal changes shortly before ovulation. Its job is to help keep sperm alive and to help to transport it safely to the egg.  Sperm is quite delicate and would be dead within a very short space of time if there wasn't fertile cervical fluid to keep it going.  The idea is that you have plenty of sex when you are producing fertile cervical fluid (an article on timing sex to follow soon) - the sperm can then make it into your fallopian tubes and hang out there, bathed in the juicy cervical fluid, so that they are ready and waiting to fertilise the egg when it pops into the tube.   

The type of cervical discharge you produce changes throughout your cycle.  There is no better description of what to look out for than in Weschler's book and I do one to one sessions at The Natural Fertility Centre or via Skype if you want to be taught individually. It's not complicated and is very important for pinpointing your most fertile days in each cycle without the need for peeing on expensive ovulation predictor kit sticks and works even if your cycle is irregular.  The most fertile cervical fluid is the stuff that looks like raw egg white, sometimes clear, sometimes a bit more streaky - (there are some amazing photos at - see in particular Day 19 as this woman has a longer than usual cycle).  The key characteristic of fertile cervical fluid (or egg white cervical mucus, often abbreviated to EWCM) is it's stretch.  It will stretch for several cms between finger and thumb without snapping.  When you see that it's time to get busy.  

Hopefully you will notice several days of EWCM in each cycle but sometimes it's in short supply and as we get into our late thirties and early forties the quantity can certainly decline.  When that happens paying close attention to what little you have will be key and a top tip is to look out for it especially when you have just opened your bowels.  The 'bearing down' action during a poo helps to push EWCM out and sometimes women are surprised when I explain to them that it's EWCM and not something that's appeared from their bottom!  

If you do find that you are not producing much EWCM there's a load of anecodotal evidence out there about things that can help. The #1 most important thing is to make sure you're getting enough fluids (and no, Diet Coke doesn't count.)   EWCM is 98% water and if you're dehydrated that won't help.  Other than that women who have consulted me have tried green tea, unsweetened grapefruit juice and guafenesin (the active ingredient in some chesty cough syrups) with some success and in the clinic we also find that acupuncture and Chinese herbs seem to help.  You can also try some of the fertility friendly lubricants such as Pre-Seed and Zestica but if you have no EWCM at all it can be tricky to know when to use them - give me a call and I'll help!