Planning to get pregnant often follows other life plans – getting a longed-for job, finding a life partner, buying a first home – then comes having a baby. For some there comes a period in their lives where all the pieces of the jigsaw are in place, and the timing is right for having a baby. For others, there is an emphasis on getting everything ‘just perfect’ before ever considering having a baby. Working with couples who are trying for a baby is multifaceted. Couples trying for a baby have many issues that are unique to them. I try and work with a couple to see their individual and unique whole picture. Having said this, I believe there is no point in our lives when the timing is just right, and I wish I could encourage more couples not to set themselves unrealistic goals. Now I am a mother with a teenage daughter, it’s only natural that I want her to get a good university degree, find a rewarding job and a steady relationship. I was 27 when I found myself pregnant with her, and was devastated at first. I did six pregnancy tests to check, because I had not ‘planned’ on having children until my thirties. Although I had been married for a while, my husband and I had no money and were working abroad, and I thought the timing was terrible. Now, I wouldn’t have done it any other way! Having been doing this work for the last 15 years, I found in the first few years that it was very much the woman in a partnership who would come along for the initial consultation; I would never see the partner. Nowadays I am delighted to say that I see couples together all the time – which is only as it should be, as the problem, statistically, usually has to do with women 50 per cent of the time and with men the other 50 per cent of the time. The majority of couples don’t have a problem conceiving, but if you have bought this book, maybe getting pregnant isn’t happening for you as quickly as you would like and you are looking for some information and answers. No matter what route you take, I believe that you can take control of your own fertility – not hand it over to a doctor or fertility clinic. This is how I work with the women and men who come to see me. I don’t give them a pre-set, ‘one size fits all’ formula. Each couple is unique, and while their emotional and physical well-being is my main concern, I don’t tell them what to do. Together we work out what will work best for them. It is my hope that this book will help you do the same. I am really delighted that more and more clinics are starting to take on my work, particularly as of course not everyone can come to our clinic. My aim in this book is to help you to plan the best course of action for you, and to indicate the kind of treatments you should try to find in your own locality. Keeping It Simple Day after day I sit with couples who have experienced difficulties at every stage of the fertility process, from the pre-conceptual check-up to those who have battled with miscarriage or assisted conception. Each of these couples has the same goal: they want to have a baby. Some are more desperate than others, and with desperation comes a kind of vulnerability. Many couples are running down endless routes, trying every available therapy without any real focus. Many come to me just as they are about to embark on their goal. They are still optimistic – and usually with good reason – and want reassurance about their approach to conception and what steps to take in adjusting their lifestyle, diet or activities. They prove how starting off on the right foot can make all the difference; I have seen the results, and have a clinic full of photos of smiling mothers and babies to prove it. Others who come to see me have already pursued all sorts of ways to get pregnant, and know they are having problems. Sometimes just the process of being listened to and being asked the appropriate questions elicits that nugget of information that may be key to the outcome (which is why the questionnaire I use is so detailed). For example, I see many, many couples who are just not having sex often enough. It’s as simple as that, but just saying ‘have more sex’ wouldn’t be helpful. Helping a couple take a really good look at their lifestyle can be a real turning-point in their whole approach to having a baby, demonstrating the need for a radical change in their priorities and for unqualified commitment. The baby is not just another ‘must do’ item to fit into their life-plan. There are so many myths around nutrition, intimacy and sex (see Male and Female Fertility chapters). Many GPs and clinics don’t ask enough about couples’ sex lives; the usual question is ‘Are you having regular sex?’ But what is regular sex? Once every Sunday morning may be regular sex to you, but it doesn’t help if you are ovulating on a Wednesday. Also, couples who are on different schedules, do shift work, travel a lot-these are all huge factors when you are trying to conceive. There can also be psychosexual problems, and naturally many couples are embarrassed to discuss such matters, particularly if their GP or clinician is not asking the right questions, of if he is not making them feel comfortable or even worthy of his complete attention. It Takes Two Basic knowledge about anatomy and physiology is one area that inevitably needs to be explored. Not the nuts and bolts of what goes where, but the details of a woman’s fertility cycle, and what the implications are for ovulation and possible conception. This is why fertility awareness is so integral to the way I work. Spending a king’s ransom on ovulation-predictor tests won’t help if you think your cycle is 28 days when what is normal for you is a 35-day cycle. Many women have been on the Pill for a long time and have no idea what their normal cycle is; nevertheless they often feel embarrassed by discussions around basic biology, as they feel they ought to know all about it. In my experience of looking after couples who are trying to get pregnant, I am convinced that the neglect of the man’s role in conception has also confounded many of their attempts to have a baby. The man is very often badly neglected when it comes to assessing a couple’s fertility. A quick, cursory look at the quality and quantity of his sperm is about all that’s done in most fertility clinics, with all the emphasis focused – often wrongly – on the woman. There may also be a notion that the whole of a man’s ego and masculinity is bound up in his sperm, making any possible criticism – or even discussion – of his effectiveness in this area an attack on his masculinity. Neglecting a man’s role in the scheme of things is not helpful. The way I work places as much importance on the man’s role in conception as the woman’s, which is why the questionnaire I supply for men is just as detailed as the one for women. A Holistic Approach Many couples find my approach to be very different from a consultation with their GP or a fertility clinic. The physical checks they give to patients’ reproductive organs, systems and processes are, of course, invaluable, but there is often more to it than this. I take a holistic approach, taking into account the social, emotional and lifestyle context of the couple as well as the pure mechanics of reproduction. The pre-consultation questionnaire provides me with an invaluable tool for assessing this wide range of issues, and also helps many couples to think about their lifestyle and their true aspirations. Prior to the first consultation, couples who come to my clinic are given a detailed questionnaire, one for women and one for men. This covers: • the main reason they are seeking a consultation • fertility history • contraceptive history • sexual history • sexual issues • general medical history • family history • diet and exercise diary • blood sugar profile • digestion and elimination profile • immune profile • pollution
