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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

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