mineral status
• food allergy profile
• details about other hormonal-related conditions that may exist
These questionnaires are long and detailed, to provide, in conjunction with consultation, a full profile on which decisions about the way a couple can choose to proceed can be based.
The questionnaire helps pinpoint areas that may be affecting fertility: factors to do with nutrition and exercise are often highlighted. These may be associated with emotional or lifestyle issues. In this way I try to help couples focus on their situation, so that together we can work out a plan of action. After the initial assessment, we consider what tests, treatments or therapies might be necessary along with the steps a couple need to take for themselves to make conception more possible.
For example, a couple may use cocaine at weekends to relax and chill out. That is their choice, and it is essential that they do relax, but the effects are very serious and if they want to conceive a baby they must stop. I try and keep things very simple, with explanations – as you will see in this book – about why change may be necessary. In this way I encourage couples to take responsibility for their own fertility.
It’s self-evident that, if you want to improve your likelihood of achieving a successful pregnancy, you have to be willing to make changes. There is often an instinctive reaction against change, but, in truth, the necessary changes are likely to be in areas of your life that you recognize are causing you stress and difficulty. Getting things into perspective for pregnancy is likely to result in a much more balanced, well-managed and satisfactory lifestyle all round – but you need support, advice and encouragement to make this happen.
I see many couples who have already taken steps for themselves along these lines, but this often takes the form of a random blitz of nutritional supplements, complementary therapies, weight-loss regimes, high-protein diets, etc. undertaken without any real knowledge of how these measures will affect their ability to get pregnant. Inevitably, some of these efforts can be unhelpful or even counter-productive.
This problem is not helped by the fragmented nature of available advice. Medical specialists, including obstetricians and gynaecologists, may be engrossed in the mechanics of conception but have little awareness of the patient’s emotional or personal situation. Complementary practitioners may have a more holistic view, but are unlikely to be fertility specialists with the appropriate technical knowledge. And nothing in the plethora of highly focused and specialist diets on the shelves of your local bookshop is likely to have been devised with the vital nutritional needs and sensitivities of pregnancy in mind.
Crucial Questions
One way I help couples to understand the need for taking a close look at their lives and finding a way to make the changes necessary to achieve more balance is by asking them to sit down and write out how much time they spend on each area of their lives. You might find this helpful, too, and may want to take a moment to do this for yourself.
In my first session with each couple I always ask a crucial question: How far are you prepared to go to have a baby? Couples just starting out do not realize how important this question is. When you first start trying, you’re probably only looking ahead six months or so, and are still very optimistic. The hard thing is that as time goes on there are many things you may have to negotiate: IVF, egg donation, adoption, for example. Where you are on the road now, and the effort you’ve already spent getting here, will make a difference to the outcome and how far you are prepared to go. Just as you have to be prepared to make changes at the outset, you must also be ready to alter your course as you proceed, as there will be obstacles to encounter and overcome with every success and failure.
This initial, important question makes couples think realistically, often for the first time, about what the quest for a baby might really mean. Sometimes there is a difference of opinion, which can come as a surprise – and is important to discuss. Without agreement on how far a couple want to go to achieve a pregnancy, issues arising from any difference of opinion between partners can lead to tension later on.
There is also a need for flexibility. Minds can be changed, and having opened up the area for discussion it’s important for couples to continue to be able to do so.
For those who have reason to suspect they have a problem, there is often little idea of the maze into which the first step to their doctor can take them. Often, in particular if the woman is over 35 and a couple has been trying for a year, there is a tendency to fast-track them into assisted conception – without properly assessing the fertility of either partner.
There is so much that needs to be looked at before assisted conception is even considered, and unless there is significant reason to know that natural conception will be unlikely, this needs to be done before catapulting a couple into assisted conception. And again, so often too much focus is put on the woman, when the man very often has the problem. I have seen many valuable months of fertility lost in this way. That said, a lot of couples I see do need assisted conception, but they also need holistic care and support to help ensure that they are physically and emotionally prepared for the process.
Your individual needs
At the end of the first consultation, I draw up a relevant action plan for a couple. Depending on what the consultation has highlighted, this can vary – but it is always specific to the couple. It may include referral for further tests from a gynaecologist and a specialist in male fertility. It is entirely up to a couple how they wish to proceed, but the majority can see that taking a holistic approach is beneficial. Sometimes the action plan is very specific – for example if there is a need to boost the body in preparation for IVF – and sometimes it’s more general, where there is a need for fertility awareness and lifestyle changes to improve the chance of conceiving.
I can’t stress strongly enough that every couple is a unique combination of needs – both physical and emotional. The way I work is to address that individuality. That said, experience has shown me that when couples have the benefit of a holistic approach – which may encompass medical treatment, nutritional supplementation, relaxation and distressing techniques, detoxifying, acupuncture and massage – the personal outcome for the couple is always positive.
Today’s Choices
The difficult choices couples are faced with today are new ones. Years ago, you either had a baby or you didn’t. Now the length of time you try can go on almost indefinitely – you start off trying naturally, then perhaps try IVF or egg donation or surrogacy.
Very often I see couples trying for years when certain problems, procedures or decisions could have been reached or ironed out earlier. All this has to be done in the context of a good understanding of a couple’s fertility, shared between them and their clinic. It really is a team effort, and one in which the couple are equal partners with the rest of the team.
First Impressions
The process of diagnosis starts the moment a couple walk through my door. I can tell a great deal from the way people walk, their handshake, their posture while seated. For instance, I can tell immediately if a man is inclined to think it is not ‘his problem’: If he walks in with his head down and arms folded, and avoids eye contact.
As a qualified and practising Five Element Acupuncturist, I use my classical Five Element training to begin assessing each person’s constitutional type (see page 223). I look at a person’s colouring – not just eye and hair colour, but the texture and hue of his or her skin tone – and I start to build up a picture of an individual’s emotional and physical strengths and weaknesses, and in which organs any weakness may be lying. I look at what the general emotion is – worry, anger, grief, fear. Sometimes it’s very positive and joyful. I need to understand each person’s individual circumstances, and how they are affecting him or her – individually and as part of a couple. I also look for the dynamic between the couple, how vital their relationship is, how close they are, and how they communicate – verbally and non-verbally.