Zita West’s Guide to Getting Pregnant

At our clinic we also make an assessment of how long a couple have been trying based on age and how often they are having sex, and also give them guidelines for further medical tests they may need alongside the treatments we suggest. At this stage, as far as we know there is no reason why the couple should not get pregnant. Detailed questions can help to pinpoint any lifestyle or nutritional changes that need to be made to enhance fertility, as well as integrating other therapies that might be helpful such as nutrition, acupuncture or hypnotherapy. It might be advantageous to lose some weight, to get your cycle regular using acupuncture, or to assess any emotional issues. Often these quite simple measures make all the difference, and I have seen case after case of straightforward conception in couples who have been trying for some years, and failing, just because of some basic misconceptions that can be readily corrected.

Men are just as important, even in these apparently straightforward cases. If a couple have visited their GP, the man has often had a semen analysis, but seldom understands the implications of the results – not least if they are apparently ‘normal’. Not only that, but often semen analyses are done, not in a laboratory, but in a fertility unit and just given a quick check. This is not adequate. A semen analysis should be done under laboratory conditions, assessed by experts and subject to a full analysis, which may include DNA fragmentation (see page 287) and prostatic massage (see page 277) as part of a full sexual health screen. Often a sub-clinical infection with no discernible symptoms is detected that requires antibiotic treatment. Only when there has been an adequate analysis, with the proper explanations, is the man likely to take the steps necessary to improve his sperm quality.

Individual fertility cycles

So many couples just don’t have sex often enough to get pregnant! However, I don’t advocate sex just for the sake of getting pregnant; it should be part of every couple’s normal, loving relationship, a way of sharing intimacy and having fun together. That way, sex doesn’t become an issue or a chore – where the man thinks the woman is only interested in sex as a means to an end, and not as an expression of her feelings for him. Women, in turn, can become fixated on their fertile time, and only want sex at this time. Prior to this, a couple’s rate of sex may have dropped to once week, or a couple of times a month, which may suit them fine – but it’s probably not happening enough for a pregnancy to result!

Sex can steadily become mechanical for so many couples; it is so hard for it not to. Many men suffer from ‘performance anxiety’ around sex if it seems that their partners are only interested in having sex around the time of ovulation. This puts a huge pressure on them. I have heard stories of women emailing their husbands at work, driving to their offices and demanding sex, which inevitably ends in a row and no sex.

If you have been trying for a while, a few basic questions:

• Are you sure you have been having sex at the right time and often enough?

• Are you only interested in sex at the right time of the month and not at any other time?

• Are you still making an effort with your relationship?

Plan ahead; make some of the changes specified in this book before moving on.

If a couple can keep their lines of sexual communication open, and enjoy this aspect of their relationship for its own sake, and not just as a means to pregnancy, then the process will be less stressful all round.

Contrary to popular belief, having sex often does NOT weaken sperm. Research has shown that the more a couple have sex, the more fertility is improved. Here are the figures for women aged 20–30:

A plan of action

I like couples to leave my clinic with a sense that they have a plan of action, specific to them, and to feel optimistic about it. Together we formulate a four- to six-month action plan, so there is room for a relaxed approach, with the view that the action plan will be reviewed after that. This serves two purposes: it provides both a positive structure and a timescale that takes the pressure off in the short term. This allows a couple to relax, knowing that they have positive steps to take with the opportunity for reviewing the situation in six months’ time.

I find that with people in this situation, because the couple have every reason to believe they can get pregnant, they usually do!

If You Have Been Trying for a While

If I could say to couples who have been trying for some time that, by such and such a date, they would be pregnant – they would skip out of my office in delight. But unfortunately there just are no guarantees, and the apparently ‘unexplained’ causes of infertility are of course the hardest to accept. I often hear women say how difficult they find it when all around them their friends are getting pregnant and having babies. They describe the news of a friend’s pregnancy with phrases like ‘a knife going through my heart’ and find it really difficult to express pleasure or smile at other women’s good fortune. Social gatherings become a nightmare, with others asking tactless questions such as, ‘When are you starting a family, then?’ Nor is it helpful to hear advice such as ‘Just relax’ or ‘Let nature take its course.’

Comments like this may be well meaning, but can result in anger, envy and jealousy, which can in turn lead to feelings of self-hatred. And the stress of it all can lead to quite severe anxiety and depression. Men can be equally affected by these feelings. It’s hard on both partners, but women in particular can become obsessed with their monthly cycle, focusing every aspect of their lives on getting pregnant.

Telling a woman not to get obsessive isn’t helpful. What is helpful is providing a structure for dealing with the reasons behind the obsession, and finding tactics for managing the feelings of frustration, anxiety and sadness that arise.

If couples have been trying for anything from six to 18 months, a lot of emotional and relationship factors start to come into play. For some couples, they find that this shared aim brings them closer together, but often couples can start to feel demoralized and pretty hopeless.

The knock-on effect of this can be detrimental to a couple’s sex life. Sex is no longer about intimacy, it has become associated with ‘getting pregnant’. Yet, when asked, it can still turn out that the couple are not having sex anything near as often enough to get pregnant. Sex becomes mechanical, with all activity focused on when a woman thinks she’s ovulating, so her partner becomes fed up, or afraid that he might not be up to the job when necessary.

This can be further aggravated if a problem has been identified in the man. Coming to see a fertility specialist may be the first time this is openly discussed, and for some men a poor sperm test result makes them feel like a complete failure. The great thing is that there is so much that a man can do to improve the quality and quantity of his sperm production. I would also like to reassure you that, even with a less-than-optimum sperm result, if everything else is going well, conception is still possible. This is important because some couples give up trying at this stage, assuming there is no point. I always encourage couples to keep trying. Many couples go on to conceive, even with a poor sperm result. Nevertheless I do understand that in cases like this it’s very hard to be positive.

Sometimes couples become so involved in each other’s biological details that all the mystique goes out of the relationship. I saw one couple where the man had taken to examining the cervical secretions in his wife’s pants! Another knew every detail of his partner’s periods, right down to the consistency of the flow and the amount of blood clots. No wonder some couples’ sex lives take a turn for the worse!

A couple’s sex life is very important, whatever the circumstances. It is one of the best forms of physical and sensual communication, and can be enormously restorative to a relationship under strain. For those women obsessing about ovulation and insisting on sex there and then, I tell them to stop, throw away the ovulation kits and temperature charts, take a break and put some energy into the relationship, for its own sake. Get romantic, be seductive and take time out together for a walk, a nice meal, a massage, anything shared that can lead to sex within the context of a loving relationship – the same relationship into which you want to bring a baby. The two are not separate, and are paramount to keeping a sense of balance – which is what pregnancy is all about. Creating a family takes energy, a sense of humour, time and love. The other thing about having a good, regular sex life is that it creates a natural high, releasing mood-enhancing endorphins and the bonding hormone oxytocin. I encourage couples to use aromatherapy oils, for massage or in candles – essential oils such as jasmine and ylang ylang stimulate the secretion of endorphins. We all need a little help when times are stressful, so utilize what’s available to set the scene and enhance the mood.

The options available

Ultimately you can’t control your fertility or when you will get pregnant. But I tell couples that they can control the options available to them, and the path they take to get there. It takes a degree of patience to seek out opinions you trust, rather than flit from one fertility plan to another. You need to do the research and then take a step back. Learning to keep a perspective on the situation takes practice – though, naturally enough, many couples find this almost impossible. I find that there is sometimes a tendency for partners to blame one another – even if this is unspoken. This is sometimes not even apparent to the partners themselves, but if I am aware of it I can help diffuse any tension by explaining things and providing a structure for the steps that can be taken.

Another problem can arise when the woman starts to feel she is the one making all the effort. I often find that women drive everything when it comes to trying for a baby: they buy the books, the vitamins, etc., and expect their partner to follow suit. She may try forcing every available vitamin or dietary supplement down her partner’s throat, plus enforcing changes in diet and lifestyle, etc. Her partner, meanwhile, may have come to his own conclusions, and very often will only make changes if he has been convinced there is really a problem. Some women make their partners give up absolutely everything, and get fixated about helping their partners make healthy sperm within a precise, limited timeframe. Then if the man lapses, say has a few drinks, the woman gets angry and feels they have to start all over again.

So, for you women: Don’t nag. Put time and effort into your relationship and accept that men see it from a different perspective. Be kind to one another. Women can feel extremely angry if they have given up alcohol, or smoking, and their partner hasn’t or won’t. It feels very unfair, and as if they are making all the sacrifices. Men, for their part, can start to feel very guilty. Obviously, none of this is conducive to success!

For women, with the highs and lows of anticipation during the month, and disappointment if a period arrives, it can be all too easy to get into the blame cycle while forgetting that their partner, too, may be living in dread of a period arriving. Some men start to dread going home, and to feel hopeless about what they can do. Blame can arise from the feeling that ‘If only I had done this or hadn’t done that’ or ‘If only he had drunk less or not been on that business trip when I was ovulating …’ The permutations are endless.

I know it can be hard, but please try not to start the blame game. Instead, it’s important to be kind to each other and remember to share those things that brought you together in the first place.

Keep communicating

It is essential to keep talking. Often things come up in the safety of the consulting room that have been bothering one or other partner. As I’ve said earlier, trying to get pregnant – especially if it’s not happening as expected – is inevitably emotional, and ignoring this can create problems. So I look for opportunities to encourage couples to share their feelings, ideas, and even their resentments! It’s much better that these are aired, addressed and resolved than left to fester. I can provide the space for this.

I often recommend couples-counselling for those for whom the situation has become too difficult to deal with. It is far too easy to become estranged through the process of trying to get pregnant. In some cases, I have found that men seem to accept the situation more readily than women. The man may be more relaxed about getting on with life, while his partner may interpret this as a lack of commitment, especially if she is researching on the Internet, seeking out opinions and information, and wanting to focus on getting pregnant almost to the exclusion of everything else. Understandably, many men get fed up, and this can exacerbate the situation still further.

Very often, a few sessions of skilled couples-counselling is all that is needed to bridge the gap, allowing partners to express their feelings and their views, relieve tensions, reduce blame and establish a united platform from which to proceed.

Men need to express how they are feeling, and in the right setting it is amazing what comes out between a couple, especially when a man feels safe about being able to express what he is truly feeling about the situation.

Case History

Linda was 38 and had been trying to get pregnant for two years. She was tearful, angry and upset about her situation. She was on the Internet for up to four hours a day, plus all day at weekends. In the consultation with me, when I asked how it was affecting their relationship, her husband Paul said he had started to dread coming home – Linda would have inevitably found another treatment to pursue, another pill he was going to have to take. He felt completely unable to get through to her; any suggestion he made would get shot down. He felt that Linda was in a total spin; he felt depressed, isolated and fed up of constantly trying to please her. He felt inadequate, and that Linda resented this. His deep, deep concern, which he only felt able to voice in consultation, was that as much as he loved her, he felt that the drive to achieve a pregnancy was becoming destructive for the relationship. Paul had tried to understand Linda’s burning desire to have a baby, but he wanted their old life back together where when he came home they had a drink, a chat, a laugh, not him spending time on his own while she was on the Internet.

Linda was able to express that, on her part, she felt panicky that she was running out of time. She felt very stressed and was waking at 4 in the morning and grieving about the child she might never have.

The plan we came up with was to set an absolute limit on Linda’s Internet searches and work on getting her internal environment back into balance by doing some yoga and meditation. We did a detox with her to help her lose some weight and we changed the IVF clinic that she was currently attending. Linda got back in contact with me later, to say that our consultation had really been a turning-point. She had not really been aware of the impact her pursuit to have a baby was having on her relationship. Her interpretation of Paul’s behaviour was that he wasn’t interest ed in any suggestion she made about treatments, and she felt that he was blocking her at every point. After our consultation she felt she really understood where he was coming from and felt much calmer as a result.

Women in their late thirties/early forties

This age group accounts for a large percentage of the women I see. Often they are career women who have got used to high degrees of control over their environment, and are in uncharted territory when they can’t control their own fertility.

Although some come just for a pre-conception ‘check’, many have been trying for a while. Some have been down the IVF route unsuccessfully; often there is a history of ‘unexplained’ infertility or recurrent miscarriage, or some anxiety about their fertility cycle. Some couples are taking ovulation-stimulating drugs such as Clomid, or doing intrauterine insemination, and want to improve the chances of conception by supporting and preparing their bodies. Some have been recommended for egg donation without having had a full, clinical work-up or assessment. Very often they have been to only one clinic and were told they have had a poor response and no eggs. Going to another clinic might have meant a better result. In short, there are many factors to consider.

If you have been trying for a while:

• Have you had a diagnosis and have you both been tested?

• How is it affecting you emotionally?

• Are you nagging or resentful of each other?

• Is your relationship starting to suffer?

• Are you losing the balance in your life?

• Are you giving up everything?

• Has your sex life been affected?

• Are you ready to move on to assisted fertility?

The starting-place for these couples has to be an in-depth analysis and discussion with the couple about where they currently feel themselves to be, covering any anxieties or misunderstandings. Without this, there isn’t an adequate baseline from which to work. Some couples, especially those who have been round the infertility block a few times, feel that this is unnecessary, as they have already had many medical interviews and tests. In my experience, however, many clinics are not thorough enough when it comes to identifying what the problem might be. Often I find that couples have not even been asked how frequently they have sex! All the medical tests in the world will make no difference if a couple are having sex only twice a month. If the length of a woman’s cycle hasn’t been worked out properly, any chance of getting the timing of ovulation right is unlikely. As I mentioned earlier, a lot of couples get fast-tracked into assisted conception without a proper assessment. I am sure that this is key to the success we have in helping couples achieve happy, healthy pregnancies.

My Programme

The programme I have devised to help couples always works alongside Western medicine while incorporating complementary therapies and Traditional Chinese Medicine. Looking at the whole picture enables me to come up with an appropriate plan. The main message I try to get across is keep it simple. So many couples are running down too many routes with no focus. The initial consultation enables me to look at lifestyle factors and the range of treatments on offer – fertility awareness, nutrition, detox, acupuncture, hypnotherapy, abdominal massage, deep breathing, manual lymphatic drainage (MLD) and counselling. There’s more about all of these later in the book. Depending on what suits the couple, usually there are two or three treatments undertaken over a period of four to six weeks, with a review every three months.

The most important thing we offer is support and advice. I believe you can get through anything if you feel supported.

Right from the start, when I first see a couple I stress that they must be flexible in their thinking and not become obsessive. I advise against information overload: endlessly trawling the Internet investigating other people’s experiences or solutions may not be relevant, and can even be unhelpful. I recommend trying to keep things in perspective – although many couples feel they have had to give up a lot in order to achieve conception, there is still room to enjoy life as a couple. This should never be forgotten.

I also advise couples to keep in mind that their difficulties with conception, if they arise, are relatively temporary. Actually starting a family may seem like a long haul, but in the greater scheme of things this will represent only a short period in your relationship – it’s important to keep this in mind. Long after your fertility problems are resolved, your relationship will still be there – so it’s worth nurturing and making time for. A good relationship will also sustain you when things get difficult.

part one the basics

understanding female fertility

This may sound strange, but many women today have no idea what a normal menstrual cycle is – many of them have been on the Pill for 15 years or more, so this is hardly surprising. Women often feel embarrassed that they don’t know everything about their fertility, and this lack of basic knowledge isn’t helped by the numerous myths out there about what they should and should not be doing in order to conceive successfully!

I am very fortunate to work alongside Jane Knight, who has done so much to raise awareness for women in this area of fertility. I encourage all women to attend a fertility awareness session, because even if you understand the basics, your cycle is unique to you. At our clinic, the aim is to make it easy to understand when and how ovulation occurs, without getting obsessed about it – which months of ‘charting’ can do to you. As Jane says:

An understanding of fertility – fertility awareness – is an important life skill and is every woman’s right. My work involves providing fertility – awareness sessions for both men and women. During a consultation I explain how a woman can identify the fertile ‘window’ during her menstrual cycle. I also help men to understand their own reproductive potential. Couples who understand the key concepts of fertility are in a much better position to understand how fertility declines with age and how factors may damage, reduce, enhance or optimize fertility.

Female Reproductive Organs

The primary indicator of fertility for a woman is her cervical secretions – because this relates so closely to oestrogen levels and ovulation – so we encourage women to focus on this, alongside ovulation-predictor kits or temperature charting, because it is just as important as good nutrition, relaxation and you and your partner’s health in your efforts to conceive.

A Woman’s Fertility

At birth, every baby girl is born with a full complement of immature eggs in her ovaries – around 2 million, although only between 300–400 will mature during her lifetime – which sounds as if the whole process should be pretty straightforward. But it is the maturation, release (at ovulation), fertilization and implantation of one of these eggs that results in pregnancy. No new egg cells are produced after you are born, so it’s worth thinking about what those egg cells need in order to mature successfully and produce an egg capable of being fertilized. A woman’s eggs are her most precious reserve, and need looking after.

Up until puberty, the egg cells lie dormant in the ovaries, waiting for a shift in the hormonal patterns of a girl’s body to ‘switch on’ her fertility. At what age this starts is largely influenced by genetics – if your mother started her periods early, then it’s likely you will have done, too. Starting menstrual periods is the marker of the beginning of a woman’s fertility, and is known as menarche.

In Western countries, the average age of menarche is between 12 and 14, but can be as early as 10 and as late as 16. All are completely normal. Ovulation can occur before the first period, but a girl’s early menstrual cycles can be erratic, and often without ovulation. Over the next few months, or sometimes longer, the pattern of cycles settles down to what is normal for that girl, as regular ovulation establishes itself.