Zita West’s Guide to Getting Pregnant - Zita WEST

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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.

      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

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