Few people are about on Dublin’s Merrion Square early on a Saturday morning but I have a bet with myself that I know where the couple hand-in-hand striding purposefully ahead of me is heading.
Sure enough, the man and woman turn into the doorway I predicted on Mount Street, as another couple approaches from the opposite direction. But this second couple’s body language couldn’t be more different – there’s no physical contact and they are wordlessly slowing down, as if willing the moment of arrival to be delayed.
The destination for both is a free "His and Hers Fertility Bootcamp" hosted by the Merrion Fertility Clinic, which is linked to the neighbouring National Maternity Hospital on Holles Street. The two couples' demeanour represent both ends of the spectrum of emotions that come with the prospect of needing assistance with reproduction – from embarrassment and fear of the unknown to new-found optimism and gratitude for what medical science can achieve.
However, the bootcamp is primarily about lifestyles changes that, as clinic director Dr Mary Wingfield explains, can help couples to achieve spontaneous pregnancy without intervention.
Or, if that still doesn’t happen, improve their chances of conception with fertility treatment.
As the lecture room fills up with about 100 people, there is a buzz of conversation even if many are feeling outside their comfort zone.
The majority are couples; some women have come alone, a few with their mothers, and there is at least one unaccompanied male.
By the end of the half-day programme they have heard different speakers on a range of factors affecting fertility and steps to take that could increase the odds of having a baby.
Meanwhile Declan Keane, senior embryologist and director of ReproMed fertility clinics in Dublin and Kilkenny, also highlights the importance of going back to the basics when it comes to fertility.
“Many people don’t realise that treatments such as IVF [in vitro fertilisation], IUI [intrauterine insemination] and ICSI [intra-cytoplasmic sperm injection] are a last resort in fertility treatment,” he says. “There are so many different things couples and individuals can do before they even get to that stage.”
Advice put out by ReproMed highlights how honey is “a natural fertility booster”; garlic can help women with endometriosis conceive naturally, tomatoes “can do wonders for your sperm health” and that couples using lubricants during intercourse should be aware that many contain spermicides, so they should use a natural alternative such as canola oil (also known as rapeseed oil).
While adjusting nutrition is, without a doubt, going to benefit couples struggling with infertility, if the woman has, say, a blocked Fallopian tube, no amount of lifestyle changes alone is going to sort the problem, points out counselling psychotherapist Ann Bracken, head of the Mind/Body programme at the Sims clinic in Dublin.
However, while she feels it would be “irresponsible” to say to people that improving their diet and taking more exercise will be enough to solve their fertility problems, at the same time going through expensive and emotionally draining treatments without improving lifestyle factors “is not giving yourself the best chance”.
So, if starting, or enlarging, a family is on your mind, here are some tips from those working in the field of fertility:
Ironically, perhaps, this is what Dr Wingfield kicks off her presentation with at the fertility bootcamp – as it is the one thing nobody in the room can do anything about. However, it's the big message that doctors like her want to get out, she explains, that "the age of the woman is critical in getting pregnant", acknowledging that "nobody likes talking about it".
No matter how unfair it seems, Mother Nature doesn’t abide by equality legislation; age 20-30 is the time of optimum female fertility and it declines sharply after the age of 35. The passing years do not have such a dramatic effect on men but their fertility does decline from the age of 45.
IVF will make up only half of the pregnancies that are lost through women postponing procreation from age 30 to age 35, Wingfield warns.
Men’s biological clocks may tick slower but male factors are the sole cause of infertility in 20 per cent of cases and a contributory factor to a further 25 per cent. So the man needs to look at his lifestyle too and also go for medical investigations if necessary.
Frequency of sex
Sex every two to three days optimises the chances of pregnancy – but that can be difficult, Wingfield acknowledges, for couples who spend a lot of time apart or are simply too tired.
“Get a balance between being too neurotic about it and making sure you are giving yourselves a chance,” she advises.
Watch your weight
Losing or gaining weight may boost your chances of conceiving, depending on your starting point.
A woman with a body mass index (BMI) of 19 or lower will have reduced hormone levels and may not have regular periods, so she would benefit from putting on weight.
On the other hand, a very high BMI may be the sole cause of infertility, because it can prevent ovulation, or it can complicate other problems and it can also make fertility treatment more difficult.
Being overweight may be linked to polycystic ovary syndrome (PCOS), which is a significant contributory factor to fertility issues (see panel).
The general advice for anybody trying to conceive is to try to keep your BMI within the normal range (19-25), as that will also benefit your health.
Exercise is a key factor for all – it has a proven effect on mood and stress, as well as general health.
Underweight women tend to have eating disorders and obsessive exercising may be part of this, so they need to correct their energy deficit to gain weight, sports and exercise medicine consultant Dr Noel McCaffery tells the bootcamp.
He quotes a US study in which 12 per cent of ovulatory infertility was associated with being underweight, while 25 per cent was linked to being overweight.
For those wanting to get into the habit of exercising regularly, he recommends at least 150 minutes of exercise a week; building it into the day; aiming for both aerobic and strength work; setting simple objectives to improve on a baseline – be it increasing distance or speed; keeping activities varied to avoid boredom and enlisting an exercise partner for motivation.
Cigarettes definitely need to go as they affect both male and female fertility. Smoking can lower sperm count and affect sperm mobility (the ability to move properly towards an egg). Women who smoke reduce their chances of getting pregnant by 10- 20 per cent.
While the focus tends to be on the danger of alcohol for a developing foetus, drinking by either the man or the woman – or both – can reduce her chances of getting pregnant in the first place. Even light drinking by women – between one and five drinks a week – was shown in a Danish study to reduce the chances of conception, while excess alcohol reduces men’s testosterone levels, affecting sperm quality and quantity.
Senior dietitian at the National Maternity Hospital, Sinéad Curran, recommends a balanced diet with a variety of foods at pre-conception. In addition, she advises women to take folic acid three to six months before trying to get pregnant, while men also need to have a balanced diet, rich in antioxidants, for optimum sperm production.
She is almost apologetic when outlining at the bootcamp well-known (albeit often ignored) dietary advice – eat regular meals, starting with breakfast; eat more fruit and vegetables, nuts and seeds; take wholegrain options where possible; cut down on added sugar; include calcium-rich foods such as milk, cheese and yogurt and eat moderate amounts of protein, looking to increase protein from vegetables (lentils, beans etc) and have one meat-free day a week, with red meat three times a week and oily fish at least once a week.
“Lifestyle changes do make a difference in outcomes, so are worth doing,” she adds.
Meanwhile, a nutritionist specialising in women's health, Marilyn Glenville, whose books include Getting Pregnant Faster , recommends that couples seek specialised nutritional advice for fertility problems, to ensure it is effective and individualised.
She works with the Positive Nutrition clinics in Dublin, Cork and Galway, as well as the Sims clinic in Dublin, and her programmes take a nutritionally focused approach to a couple over three months, during which the woman’s eggs will be maturing for ovulation and the man’s sperm quality and quantity can be improved.
“We cannot change a woman’s ovarian reserve because she is born with that number of eggs but we have the potential to change the quality,” she says.
While, theoretically, all necessary nutrients can be obtained from food, because time is short, supplements such as zinc, selenium and coenzyme Q10, which “can make a huge difference to both the man and the woman”, she explains, will be added over those three months, or during IVF.
Minding the mind
Michael Comyn gives a most entertaining, hour-long talk to the bootcamp about managing anxiety, reducing stress and building resilience. Outlining the basic "flight or fight" response, he points out that our bodies can't distinguish between having 450 emails in our inbox and a threat to life, so we tend to sit in a stew of stress "for things that are not really worth it".
Those experiencing fertility problems will have many moments of anxiety on their journey and how they respond to those triggers will affect both the physical and mental outcome. Comyn recommends a four-minute, daily meditation exercise to help build resilience (see 6dayreset.com for more information).
According to counselling psychotherapist Ann Bracken, head of the Mind/Body programme at the Sims clinic, research has shown that 37.4 per cent of people with fertility problems could meet a psychiatric diagnosis of depression or anxiety – compared to a rate of 4 per cent in the average population. So it’s clear that psychological support at this time is badly needed – indeed the Institute of Obstetricians and Gynaecologists says counselling should be mandatory for anybody undergoing assisted reproduction treatment.
Bracken runs one-day mind/body workshops, which are also open to non-Sims patients, that focus on cognitive behavioural, relaxation and healthy lifestyle techniques to help manage stress and promote conception.
The programme, she adds, helps couples “to make more empowering decisions around treatment and therefore you are more accepting and are much more likely to be in a really good space – either to have a baby in or to have closure in”.
For more information on the Merrion Fertility Clinic, see merrionfertility.ie or tel 01 6635000.
The Sims clinic in Clonskeagh, Dublin, runs regular free fertility information mornings and the next one is on Sunday, April 27th, 9.45am-1pm. For more details see sims.ie or tel 1800 497 777.
ReproMed will hold a public information meeting in its new clinic in Dundrum, Dublin on Thursday, May 15th. For more information see repromed.ie or tel 01 685 6755.
Small changes can have positive result
As soon as Nefissa Flood got married at the age of 23 in 2008, she wanted a baby – although friends and family said she was still so young, she should enjoy married life without the responsibility of children for a while.
However, she and her husband, Cormac, didn’t use contraception, with the attitude that if it happened, it happened.
"But it never did," she says. After three years, she went to see her GP and he suspected polycystic ovary syndrome (PCOS), referring her for tests that confirmed it. The condition occurs in 5 to 10 per cent of women and causes irregular menstrual periods; facial hair is often a symptom and those affected tend to be overweight or obese.
The GP said time was on her side and he prescribed Metformin, which lowers insulin and blood sugar levels, helping to regulate the menstrual cycle and start ovulation. But after nearly another year, she was referred to Dr Mary Wingfield at the Merrion Fertility Centre.
"She was very straight forward – she said to me, 'listen, you need to lose weight'," recalls Flood. Wingfield explained in detail what PCOS is and said she could do nothing for her while her body mass index was over 30.
At the time Flood, a native of Mauritius, smoked about 20 cigarettes a day, drank heavily – "not every day but I went out every weekend and they were heavy nights" – and weighed 95 kilo (14st . 9 lb). She was advised to start exercising to reduce her weight, also watching her food and alcohol consumption to maximise weight loss. "I stopped the drinking and I stopped going out."
Having been advised that smoking also affects fertility, she quit that too. “It was amazing. I stopped smoking and I was able to breathe properly and went for walks.”
Every day she walked for an hour – it was hard because she was dragging herself out of their home in Blackrock, Co Dublin, on her own at night in the dark. But it soon became a habit and she found it a useful way of de -stressing from her job as a social care worker.
“If you are going to pay a consultant to help you along and she is saying you have to change your life . . . you have to go with it.”
Flood devised her own eating regime and stuck to 1,400-1,500 calories a day, cutting out all take aways. As she doesn't like cooking, she opted mainly for ready-made, calorie-counted dishes and, if she had to take clients to restaurants, she chose soup or salad. Within four months, she had dropped four dress sizes, from 20 to 14, and by the time of her second visit to Wingfield she was already, it turned out later, in the first days of pregnancy.
Making all those lifestyle changes at once were quite a struggle, she says, and friends complained that she didn’t go out any more but the desire to be a mother drove her on.
Feeding her 14-week-old son Rehan as we talk, she adds with a laugh: “Now I need to get the same kind of motivation to lose the post-pregnancy weight.”