Zita West’s Guide to Getting Pregnant

ZITA WEST’S GUIDE

TO GETTING

PREGNANT

Zita West

dedication

I would like to dedicate this book to my mother for her help, guidance and support over the years in all I have achieved.

contents

Cover

Title Page

Dedication

Introduction

The way I work

Part 1: The Basics

Understanding Female Fertility

Understanding Male Fertility

Conception

Part 2: Preparing Your Body for Pregnancy

The Right Nutrition

Lifestyle Factors

Thoughts and Emotions

Traditional Chinese Medicine

Part 3: Fertility Problems And Solutions

Fertility Work-up

Miscarriage

Assisted Conception

Pregnancy

Useful Contacts

Index

Acknowledgments

Praise

Copyright

About the Publisher

introduction

Information Overload!

Having a child is the most creative thing you can imagine but, for so many, the balance between what we are told to do as responsible parents and what we need to do to maintain an effective and enjoyable life in work and leisure seems to have gone. There are self-help books, theories, courses, experts, gurus galore, all with something to say, demanding attention. The driving aim of my work is to help couples to make sense of the maze – to gain a better understanding of where they are and how to move forward, practically – and it gives me the greatest pleasure.

Let’s be realistic about modern life: Lots of men and women work long, stressful hours, particularly at the time of life when they are thinking of having children. They are bombarded with stimulation, information, expectations: it all leads to overload. So many couples have lost focus, running down many routes: Trying to conceive, undertaking all sorts of treatments, but often not looking at their everyday environment and things that they can do for themselves. Let’s keep it simple.

The focus of many clinics and books like this is often wholly on the woman and her situation. But, as I’ll point out, problems conceiving can equally be with the male partner. So in this book you will find me frequently talking about the health of both partners in a couple, and there is a lot of information about male fertility.

If you are going to take control of your own fertility, you need to understand it properly. This book offers you practical knowledge and information about how your fertility works, how to monitor it and how to help improve it. Many of my clients are extremely intelligent, high-achieving, successful people, but they are ignorant of the biological basics. It’s something they are often acutely embarrassed about, but it’s not entirely surprising – it’s easy to get lost in all the medical jargon. However, hidden in that jargon is important information. Don’t be tempted to just give up on it and flee to complementary treatments as an escape. The medicine we’ve got used to in Western countries is highly technical, and has perhaps become impersonal in its approach, but it can be used to extremely good effect. Good complementary approaches, particularly those that deal with the whole person – body, mind and spirit – can be very valuable, too, but it is important to choose the right ones, the right practitioners and, crucially, to combine them with a proper medical approach.

This book brings both approaches together, getting the best from each. It reflects the special aspect of the work I do every day in my own clinic – a truly integrated use of Western and complementary practice. Western medicine is evidence based and founded on proven measurable results. As far as possible, the treatments I advocate are equally evidence based, even in the area of complementary care.

More than that, I am interested in why couples want to have children; what else in their lives is making that possible or difficult; why perhaps they haven’t thought about it before.

It is a fact that women are leaving it later to have children. There are many reasons for this trend, but there is no getting away from the fact that the chances of conception diminish with age. Being realistic, I firmly believe that women in their thirties should be fast tracked for investigation. They do not have indefinite time left to keep trying, and there may be fertility problems to be addressed.

Perhaps one of the reasons couples delay pregnancy is an increasing need and expectancy for perfection. They think, ‘We’ll just wait until next year for a better income/home/lifestyle’ and so on. But of course the perfect moment never comes, even though there’s an industry of self-help programmes guiding you towards that perfect balance. And then, as with ‘perfect’ diets, when you stray from the path there’s often guilt and remorse to cope with and you have to start all over again. This book is not about being perfect, but about being practical.

the way I work

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 profile

• vitamin and 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.

Obviously I take into account that this is an incredibly personal and intimate experience they are sharing with me, which can make many people feel vulnerable. Often they can react defensively, sometimes aggressively, to mask their anxiety. Couples often want me to provide answers, when what I do – and what I hope this book will do for you – is help them find the answers in themselves. Only a full understanding of what you are facing will make it possible for you to make choices, effect any necessary changes and feel positively involved with the process.

I believe that a positive attitude affects the mind and body hugely. The couples I see fall into many categories: those who are starting to try, couples just about to embark on IVF, couples who have had multiple failures, women who have miscarried, couples considering moving on to egg donation, sperm donation, surrogacy or adoption. Help is available to you at every stage of this journey.

If You Are Just Starting Out

Couples in this place tend to be at the end of their twenties or in their early thirties. In many cases the woman has come off the Pill and has no idea what her normal fertility cycle is. It is worth saying here that I don’t hold with the belief that a woman shouldn’t try to conceive when she first comes off the Pill. The research shows that a woman actually has much more chance of conceiving when she first comes off the Pill. Very often, however, women rely on ovulation kits since they don’t yet know how to work out their most fertile time. Ovulation kits are fine, but need to be used in conjunction with a knowledge of your cycle. A good biology lesson, as given in Part 1 of this book, removes the element of panic and can put you on the right track. Very often all you need is a fertility awareness session to get you to understand your individual cycle.