A male perspective The emotional impacts on men

Personal insight The importance of talking about it

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FERTILITY AND PREGNANCY

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Lord Robert Winston discusses the need for further research into improving fertility later in life

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CHALLENGES

Understand the reality of infertility

It is widely expected that we will be able to choose when to have a family, if that is our wish. And we don’t challenge this assumption until we fi nd ourselves struggling to conceive and the ‘I’ word is mentioned. Infertility.

Suddenly, choosing to have a family is a thing of the past as the horrible real-ity of infertility gets you in its grip. It’s a complex condition,

spanning the biological, emotional, physical, social and fi nancial aspects of lives and relationships. Prolonged fertility problems slowly invade eve-ry area of life, which becomes one long emotional rollercoaster for cou-ples living in month-by-month cy-cles of hope and despair.

It’s frustrating that our society is not more open about infertility because it is a massively misunderstood dis-ease that aff ects over 3 million people in the UK today who need help to deal with the consequences of this con-dition.These millions of women and men often choose to keep their ba-by-making challenges under wraps. Everyone has the right to privacy, but that secrecy leaves so many people to cope alone, feeling isolated.

Recognised as a diseaseBack in 2009, the World Health Organisation’s recognition of

infertility as “a disease of the repro-ductive system defi ned by the fail-ure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse” represented a signifi cant milestone for the condition.

So, far from being some self-infl ict-ed and shameful problem lurking in the shadows, it is a physical illness

that requires treatment. But sadly, society today often does not embrace this. There’s still a long way to go and we need to move with the times and raise much more awareness about the reality of infertility because it’s not going away. The more people put their names and faces to it, the more our society will understand.

Talking about tryingPeople need to know that it is good to talk about it. Everyone

has the right to privacy, but people shouldn’t feel ashamed about some-thing that is not their fault and they have no control over.

Patient charity, Infertility Net-work UK, has launched a campaign — Talking about Trying — to help raise awareness and get more people talk-ing. In 2013, it’s time for infertility to come out of the closet. It’s not always easy to get pregnant, and there’s no shame in that. Don’t let it be a lone-ly journey that’s travelled in silence.

Karen VenessInfertility Network UK

‘In IVF the woman takes all the pain — so it must be a doddle for the man? Well, no, it is tough. Because as a man you can do absolutely nothing all about it’

Peter Vasey, 41Went through IVF with his wife Beverley

PAGE 6

FERILITY AND PREGNANCY, 2ND EDITION, JUNE 2013

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LIFESTYLE, AGE AND FERTILITY “There is little rigorous scientifi c evi-dence that inactivity, eating certain foods, obesity, stress and other life-style factors can cause fertility prob-lems,” says Lord Winston, Professor of Science and Society at Imperial Col-lege, London, and Britain’s leading fer-tility expert. “Take excessive smoking. It can reduce men’s sperm count and prevent women from ovulating. Yet, women who smoke heavily fall preg-nant regularly. Lifestyle may make a diff erence, but only a trivial one.

“Fertility problems occur when eggs or sperms don’t produce vi-able embryos and are more like-ly with increasing age,” adds Lord Winston. “The average 22-year-old woman has an 18 per cent chance each month of getting pregnant. By the time she is 42 her chances have dropped to about 5 per cent.”

Increased childbearing ageEven so, data released in 2011 by the Of-fi ce for National Statistics (NOS) show

that, in England and Wales, the av-erage age of women giving birth has climbed steadily over the past four decades — from 26.4 in 1975 to 29.5 in 2010. More than 50 per cent of babies born in 2010 were from women aged 30 years or older. The average age of wom-en having their fi rst child has also ris-en — from 26.6 in 2001 to 27.9 in 2011.

A good thing“Women are postponing childbear-ing to later in life to go into further education and start a career,” says Lord Winston. “This in my view is a good thing. By delaying reproduc-tion, women have the opportunity to fulfi l their life goals and become in-dependent, in the same way as men do; all this while contributing to the economy. Further, at a later age wom-en — and men — are generally more mature as well as more likely to be in a stable relationship and fi nancially secure, which contributes to make them better parents.”

A social and political issue“As a doctor I think it is spurious to give any advice about what wom-en should do and when they should have children. It is the role of poli-tics and society to make it easier for women to work and have children. Medical research should be extend-ing fertility to fi t in with women’s de-sire to have their babies later in life.

Lord Robert Winston, Professor of Science and Society at Imperial College, London, and Britain’s leading fertility expert

IVF is rapidly evolvingThere have been exciting developments in IVF, says Professor Charles Kingsland, consultant in gynecology and reproductive medicine at the Hewitt Fertility Centre, Liverpool.

Recently time-lapse imaging has allowed the continuous monitor-ing of embryos in incubators to identify those more likely to devel-op into babies. Certainly, IVF tech-nology has developed faster than public opinion. The fi rst IVF baby caused a national outcry. Now soci-ety fully accepts IVF. In the future, women will be able to bank their eggs early in life, and use them when they want to start a family.

Professor Charles Kingsland was once asked whether, given a sum of money to fund a par-ticular medical disorder, would he fund cancer treatment, or in-fertility? This provokes a certain answer. However, if you asked the question diff erently, asking if a woman has cancer or a baby, which one would you take away? Then the argument becomes more diffi cult.

LORENA TONARELLI

info.uk@mediaplanet.com

Question: Unhealthy living increases the risk of disease. But can it cause fertility problems? Answer: No. But age can. We need more research into natural ways to improve fertility later in life, says Lord Robert Winston.

LORENA TONARELLI

info.uk@mediaplanet.com

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“I suffer from polycystic ovary syndrome so I always knew it might be hard to concei-ve — and it was! I was eventually referred for IVF and had my fi rst cycle in autumn 2012. Two embryos were successfully transferred but I suff ered a biochemical pregnancy which en-ded that dream and left us bereft and bewilde-red. We are now awaiting our second attempt at IVF in August as realistically this is our only hope of having a baby.

“I decided to tell people what we were going th-rough because I thought they might leave me alo-ne if they understood how much the pain of in-fertility takes over your life. It is all encompassing and has a huge eff ect on our day to day lives, espe-cially as the drugs turn you into a monster!

“I don’t regret being open about our infer-tility — I hate the secrecy and implied shame that seems to be part and parcel of struggling to conceive and at the end of the day it’s not our fault. Everyone just assumes you can have a baby and it feels like there is a lot of pressure when it just doesn’t happen. It hasn’t worked for us yet, but we will get there.”

INSPIRATION

“At the end of the day we just want a family. That’s all. I have managed to get pregnant both na-turally and with IVF but I don’t manage to stay preg-nant and it’s devastating.

“My husband and I have been together for 15 years and started trying for a family fairly soon af-ter we married in 2006. I miscarried 3 times over the next few years after becoming pregnant naturally, and I started to feel trapped in a cruel pattern of un-explained and recurring loss.

“We looked at our fertility options and were ad-vised to consider IVF. We had our fi rst cycle in 2010 and, once again, I found I was pregnant. Tragically, this time the foetus had Turner syndrome and died at 12 weeks. My second attempt at IVF a year later al-so failed and at this point tests showed that the qua-lity of my eggs was poor. We are living our lives in se-cond gear, all the time, as we now face the prospect of possible egg donation or adoption.

“The actress in you comes out as you struggle to cope, and cover up the overwhelming agony you are going through. I am convinced that one day it will be our turn but for now we just have to carry on, ha-ve a life — and hope.”

Elizabeth Lockwood, 29, a proof reader, and husband Paul, 31, a bank worker.

Katie Lawton, 37, a customer services manager & Chris Lawton, 35, an economic analyst

Don’t suffer in silence

1Talk about it. Patient charity Infertility Net-work UK has a nurse you can talk to, in confi -

dence, by calling the support line on 0121 323 5025.

Don’t blame yourself

2Infertility is a medical condition and needs treating like any other illness.

Stay educated

3The technologies behind the treatments are complicated and change quickly so you need

to understand what’s happening medically.

DEALING WITH FERTILITY PROBLEMS

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Search ‘fertility’ on Patient.co.uk patientuk@patientuk

8 million people a month trust our health information

couples can have some problems conceiving a baby

DISTRESSING TIMETrying for a baby and being unsuccessful can have major physical and emotional impacts, it is important to know how to managePHOTO: SHUTTERSTOCK

Addressing heavy metal toxicity

Kate Mead, of the charity Foresight, says: “Heavy metals such as lead, cadmium, alu-minium and mercury can be present in our body, and there has been some research that suggests high levels can aff ect the ability to conceive and have healthy babies. Some nu-tritionists believe heavy metals build-up can cause female and male infertility, miscarria-ge, and birth problems and defects; further, it is typically accompanied by defi ciencies in minerals like zinc, selenium, manganese and magnesium, which are essential for fertility. It might be benefi cial to re-establish a balan-ce by removing excess heavy metals through a detox programme and by increasing essen-tial minerals levels with supplements.

“We fi rst perform a hair analysis to measu-re the presence of metals and minerals in the body. As part of the detox programme, coup-les may need to eat more of certain foods, such as oily fi sh and fruit and vegetables; and cut down on alcohol and caff eine. In addition, they may need supplements to increase their levels of vitamins, zinc, iron, calcium, seleni-um and manganese. Detox and supplementa-tion must be implemented together because just removing the overload of heavy metals is insuffi cient and unsafe.

“We also look at sources of heavy metal

contamination, so they can be removed. For example, tap water often contains copper which is a trace mineral, but excessive levels can be toxic because these metals are widely used in household plumbing; that’s why we advise drinking fi ltered water. Antacids, deo-dorants and some cookware can cause alumi-nium toxicity. ”

A success storyAlison Denny, who had been trying for a baby for three years found she had high levels of cad-mium and lead, and that her partner had high levels of aluminium.

Denny says: “After the hair analysis we star-ted taking supplements and implemented diet and lifestyle changes. In addition, we had a 25m lead household water pipe replaced, as we thought it could be a major cause of my high le-vels of lead. Three months later I fell pregnant.

“Following the programme may require so-me eff ort and determination, but the rewards are priceless. We now have a healthy and happy baby boy and, because our lifestyle is healthier, we also enjoy an increased sense of wellbeing.”

LORENA TONARELLI

info.uk@mediaplanet.com

Question: Why should couples eliminate excess heavy metals from their body when trying to conceive?

Answer: To enhance their fertility and chances of having healthy pregnancies and babies.

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Male infertility does not need to stop you from starting a family

KNOW YOUR OPTIONSIt’s important to understand that there are many options available to combat fertility problems PHOTO: SHUTTERSTOCK

Dr Tim Child, consultant gynecolo-gist and director of the Oxford Fer-tility Unit, Oxford, explains: “A third of infertility is primarily male re-lated. Potential risk factors include undescended testicles at birth, dia-betes, obesity, being on certain pre-scription drugs, excessive smoking or alcohol consumption, and expo-sure to chemicals or heat. Erectile dysfunction and previous surgery in the groin can too contribute to male fertility issues.

“A semen analysis is the fi rst test to be performed. It can help detect abnormalities in sperm count or motility. If little or no sperm is pro-duced, a likely cause is testicular failure — when the testicles don’t make enough of the male sex hor-mone testosterone. A hormone anal-ysis can help determine whether the problem is in the testicles on in the hypothalamus, the part of the brain

that signals the testicles to produce testosterone. A blood genetic test is also useful to detect anomalies at the chromosomal level, which may indicate the presence of testicular failure. Further, advanced tests have recently become available that iden-tify problems in the chromosomes of the sperms themselves. However, these newer tests have not been vali-dated yet.”

Treating the couple“In most cases, it is not possible to fi nd and treat the cause of the male fertility problem, but we can ‘treat’ the couple in terms of helping them conceive,” says Dr Child. “If there is no signifi cant sperm abnormality, we encourage the couple to contin-ue to try for a pregnancy naturally, by making changes to their lifestyle and having regular unprotected in-tercourse around the time of ovula-tion. If there are sperm abnormali-ties, the best option is in vitro fer-tilisation (IVF). The procedure in-volves removing one or more eggs from the woman’s ovary and mixing them with a sperm sample provid-ed by the man to allow fertilisation in the laboratory. The fertilised eggs are then transferred to the woman’s

uterus. If the man doesn’t produce sperms we surgically retrieve a small sample from their testicles. In this case, we inject a single sperm into each of the retrieved eggs. Cou-ples who are unable to use the man’s sperm can utilize that of a donor. In vitro fertilisation is widely used and can be very eff ective.”

More awareness is needed“Most couples are unaware of the options available to them. That’s why the new 2013 National Institute for Health and Clinical Excellence (NICE) guidelines aim at improv-ing access to the various treatments for fertility problems,” says Dr Child, who was the IVF expert in the pan-el that produced the guidelines. “In this regard, a signifi cant eff ort has gone into trying to increase aware-ness among GPs because, while it is not up to them to arrange the provi-sion of fertility treatments, it is im-portant that they timely refer cou-ples to the right specialist. And time is of essence, because as a woman gets older the rate of success of fer-tility treatments diminishes.”

LORENA TONARELLI

info.uk@mediaplanet.com

NEWS

■ Question: Why is it so important that men who have a fertility problem seek prompt medical attention?

■ Answer: Because tests can identify the causes of the problem, and treatments can help couples get pregnant.

The highs and lows of IVF“Infertility and IVF are topics that most men don’t talk about. Only men who know other men who have been through the process may touch upon the subject. But outside of that you are pretty much going to be on your own,” says Peter Vasey, 41.

“After avoiding IVF for 8 years, try-ing almost every other route to conception open to us, in the end our options were made brutally clear: it was IVF or nothing.

“For me, there were several parts of it which were emotionally very tough. Watching the one you love deeply traumatised because she is unable to naturally conceive; watching her endure a barrage of invasive tests, injections and hor-mones and then watching her hopes build as the eggs are collect-ed and fertilised and the resultant embryos transferred.

“In IVF the woman takes all the pain — so it must be a doddle for the man? Well, no, it is tough. Be-cause as a man you can do abso-lutely nothing all about it. Men are fundamentally bystanders. I’m genuinely not looking for sympa-thy towards the male role here, I am just telling it like it is.

“All the weight of IVF falls upon the woman which is incredibly hard to bear. I am generalising here but men often aren’t good at show-ing emotions, and for once this is actually quite useful. You can’t get stressed and you can’t burden your emotions on to your wife or part-ner. The male role in this process is to grit your teeth and get on with it.

“Is IVF as bad as I have made it sound? Well, yes and no. The lows are of a level I would have never thought possible, but the highs are the most incredible, emotion-al and deeply joyous highs I could have ever wished to experience. When IVF works, the process be-comes utterly irrelevant.

“These days, I really have to think hard to recall the bad points. And if my wife asked to go through it all again tomorrow? Knowing all the pitfalls, risks and emotional strings, would I? Absolutely.

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