Practical advice and a holistic approach to help you conceive, including simple dietary and lifestyle changes and do it yourself complementary therapies
In this accessible and informative guide, Sally Lewis explains how age, sexual infections, diet, excess weight, stress, and anxiety affect fertility. Teaching how to discover the best time for conception; understand the link between body, mind, and fertility; and manage stress and relax to prevent anxiety, this is the ultimate guide to increasing the likelihood of conception at any age.
About the Author
Sally Lewis is the author of a number of titles, including Back in Shape; Coping Successfully with Acne; and Shape Up, Size Down. Nim Barnes is the founder of Foresight, a charity dedicated to the promotion of preconceptual care.
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50 Things You Can Do Today To Manage Fertility
By Sally Lewis
Summersdale Publishers LtdCopyright © 2011 Sally Lewis
All rights reserved.
This chapter explains just what is meant by fertility, the menstrual cycle and ovulation, as well as the role of your reproductive hormones, your body's natural fertility signs and the best time for trying to conceive.
Understanding your monthly cycle and knowing exactly when you ovulate will increase your chances of conceiving, yet for many women this is not as easy as it seems.
According to the Human Fertilisation and Embryology Authority (HFEA), only 20 per cent of couples achieve pregnancy within the first month. In fact, it often takes numerous well-timed cycles before pregnancy is achieved and 10 per cent of women will not be pregnant after a year of trying.
1. Understand your fertility
Fertility is a natural, simple and yet complex series of events, which require a woman's egg and a man's sperm to make and produce a baby. A woman's fertility is based around her menstrual cycle, and although the average menstrual cycle is 28 days, this may not be the case for you. Knowing when you are most likely to be ovulating is one of the most important factors in determining when you are most fertile and likely to conceive. Given that there is a very limited period of time when you are actually fertile during your cycle, it is clear why understanding your menstrual cycle is so important. Some women may have a regular cycle of 20 days or less, others 21 or more, but as long as your cycle is regular and consistent, then ovulation and conception are much more likely. If your cycle is sporadic or fluctuates in length each month, you may find becoming pregnant is more difficult. If you have been on the pill for a considerable period of time, you may find it takes you longer to know what your regular menstrual cycle is; however, once you do, the likelihood is that you will improve your chances of conceiving.
Your menstrual cycle
The length of your menstrual cycle is measured from the first day of your period, which may be indicated by the first signs of spotting, to the day before your next period starts, and your fertility will vary depending on the length of your cycle. The time from ovulation to your next period is likely to be constant – usually 10-16 days – but the time before you ovulate can be variable. You can identify the fertile time in your cycle either by observing your cervical secretions or recording your temperature, or knowing the position of your cervix, which will be discussed in this chapter. Only if your cycle is a regular 28 days will you ovulate mid-cycle, around day 14; if your cycle is 25 days then ovulation is around day 11; and if your cycle is longer, ovulation will also be later. Very often, women mistake the middle of their cycle and miss the most fertile time for conception to occur.
Your eggs are created when you yourself are in the womb, and a woman's supply of eggs – initially several millions – is depleted by the time of puberty. During your fertile life approximately 400 eggs will be released through ovulation, and by the time of your menopause your egg supply will have been used up. The eggs are kept within your ovaries and, every month, several eggs develop although usually only one develops to maturity; the rest simply degenerate. The mature egg, also known as the ovum, is released from one ovary, and is ready for fertilisation within the next 12-24 hours. If the egg is successfully fertilised, it then has to implant itself into the wall of the uterus, which results in pregnancy.
Simply put, ovulation is the release of one or maybe two eggs (ova) from the ovarian follicle and is the most likely time in your menstrual cycle for you to become pregnant. Although approximately 15 eggs may mature inside the ovaries each month, generally only the largest is released from a follicle in the ovary and travels down the Fallopian tube. Ovulation does not follow a regular pattern between both ovaries every month: which ovary releases the egg is relatively arbitrary. Once released, the egg has to be fertilised within 12-24 hours before it begins to degenerate. The egg develops in a fluid-filled sac called the follicle following stimulation from oestradiol, the primary form of oestrogen.
If your cycle is regular, you will be able to work out when you are ovulating and you can certainly use an ovulation calendar or an ovulation predictor kit to help you out. However, there are also a number of physical changes that occur in your body during ovulation and these can be used to help identify when you are ovulating so that you can time intercourse accordingly. They include:
* Changes in your cervical mucus, which will be explained later in this chapter
* Breast tenderness
* Increased sex drive
* A rise in body temperature
* Mild abdominal pain
The role of your hormones
Your menstrual cycle is governed by your pituitary gland. Located in the brain, this important master gland secretes hormones (chemicals) that travel through your body in your bloodstream and control your temperature, growth, thyroid activity, urine and production of testosterone (in men), oestrogen and progesterone (in women). It is these hormones, which stimulate the ovaries, the adrenal glands and men's testes that play an important role in your fertility.
Phases of your menstrual cycle
Your cycle is split into two distinct phases, the follicular phase and the luteal phase.
On day one of your cycle, the first day of your period, the brain releases gonadotrophin, which in turn stimulates the pituitary gland to release follicle-stimulating hormone (FSH). This hormone does exactly as its name implies: it stimulates the immature eggs within the follicles to start growing.
The levels of FSH build up over the next couple of weeks. As the eggs grow and mature, they secrete oestrogen, one of the main female hormones that control the reproductive system, which stimulates the lining of the uterus, the endometrium, to thicken, preparing it for the onset of pregnancy. The oestrogen levels continue to rise as the eggs mature and FSH production decreases, ensuring only one egg continues to develop; the other eggs simply fade and die and, as you approach the middle of your cycle, a surge of lutenising hormone (LH) from the pituitary gland is released. This LH surge stimulates ovulation, causing the follicle to rupture, releasing the egg onto the surface of the ovary. Once the LH peaks, the corpus luteum begins to pump progesterone out, causing your body to heat up: your temperature rises as your body prepares a warm, welcoming environment for your baby. At the same time, your cervix is high, soft and open and changes occur in your cervical mucus so the sperm are able to pass through the cervix to reach the ovum.
Once the follicular phase is over, the reproductive hormone progesterone is produced by the corpus luteum, a part of the ovary from which the mature egg bursts during ovulation. The production of progesterone prevents LH and FSH production and continues to thicken the endometrium in preparation for a fertilised egg, developing the structures that provide nutrients to the embryo.
A fertilised egg will stay in your Fallopian tube for between six to eight days after conception and the developing embryo grows as it travels down the Fallopian tube. It is known as a blastocyst by the time it implants itself in the womb lining. Sometimes this can cause minor bleeding or spotting. Changes within the womb include the development of special protrusions known as chorionic villi. These villi produce the hormone human chorionic gonadotrophin (hCG), which increases the size of the corpus luteum and produces more progesterone, thus maintaining the pregnancy. It is hCG that pregnancy tests detect to determine if you are pregnant.
If pregnancy does not occur, then both oestradiol and progesterone production decline approximately seven days after ovulation, resulting in menstrual bleeding as the endometrium is shed, approximately two weeks after ovulation, and the cycle starts all over again.
Hormones are chemical messengers that are carried in the bloodstream and trigger activity in different organs of the body. The reproductive hormones control your monthly cycle and help to maintain pregnancy.
2. Keep your hormones balanced
Your reproductive hormones, namely oestrogen and progesterone for women and testosterone for men, play a very important role in fertility but can be easily affected by stress, lifestyle, lack of sleep, poor diet and other environmental factors, such as chemicals and toxins in food packaging and cosmetics. If these hormones become imbalanced, fertility can be adversely affected, lowering your chances of conceiving or staying pregnant once conception has occurred. It is helpful to try to recognise hormonal fluctuations during your cycle to increase your awareness of your fertility. Chapter 2 looks at foods that can help and Chapter 3 offers some practical solutions for dealing with some of these problems.
3. Recognise your fertile time
Your body will give you some clear signals when it is more fertile than at other times. Trying to interpret these signals can sometimes prove challenging so it is always worthwhile seeking medical advice. A fertility awareness nurse at a family planning clinic can help you to understand your monthly cycle, but there are several other factors, listed below, which may be used independently or in conjunction with each other. If you find you have difficulty interpreting them, ask a fertility nurse for advice.
Record your menstrual cycle
Keep a chart, record or diary of your menstrual cycle for several months before trying for a baby if you can, as this will help you identify ovulation. You can also write down your feelings during each month, looking for hormonal swings and mood changes that may indicate an imbalance in your hormones.
Use an ovulation calendar
Predicting your ovulation period can enhance your chances of becoming pregnant. The easiest and simplest method is to simply count the days leading to ovulation. It helps if you have a regular cycle, but also if you understand your cycle. You can use an online ovulation calendar, such as www.babyhopes.com/ovulation-calendar.html or www.ovulation-calendar.net, which will work it out for you.
Take your temperature
Your temperature rises in the middle of your cycle, confirming that ovulation has taken place. Taking your temperature can prove helpful for many women trying to identify their most fertile period and the easiest type of thermometer to use is an electronic digital thermometer, available from pharmacists.
Take your temperature first thing in the morning, before you get out of bed: this is your basal body temperature; your temperature naturally rises during the day. By taking your temperature at around the same time every day, you may be able to identify a rise resulting from ovulation. Just after ovulation there should be a rise of approximately 0.4-0.6°F (0.2°C). It may be necessary for you to chart several cycles so that you can see an emerging pattern. If your cycle is regular and based on 28 days, you should have a temperature rise around days 14-16, due to increased levels of progesterone; however, you will be most fertile just before this rise. Count the days from your last period and aim for intercourse every other day between days 11 and 16.
Several other factors can affect your temperature, particularly illness, alcohol, high stress levels, doing shift work, taking drugs and lack of sleep. These should be borne in mind if you decide to use temperature as a way of charting your cycle.
Basal body temperature
The average body temperature is 37°C (98.6°F), but anything from 36.5°C (97.7°F) to 37.2°C (99°F) is considered normal. A high temperature of 38°C (100°F) or above is considered likely to be a fever and should be measured again after two to three hours to see if you should seek medical attention.
Most fertility experts agree that your cervical secretions are the most accurate indicators of your most fertile time and Jane Knight, a fertility nurse specialist at the Zita West Clinic in London (see Directory), runs classes to teach women how to interpret the changes that take place in mucus secretions. According to research, the presence of cervical secretions is linked to a twofold increase in the probability of conception. For some women this self-inspection can be a little daunting and obviously to self-examine you must have clean hands and fingers, as you test the elasticity of the mucus between your thumb and forefinger (the fingertip test).
The mucus-secreting glands lining your cervical canal produce mucus continually, but these secretions alter as you approach ovulation. It is likely you will notice them as your vagina becomes more slippery and wet as ovulation approaches, although they can vary from one cycle to another, so it is worthwhile charting or recording them over a few cycles to be able to recognise the changes. There will be an increase in mucus which will become clear, stretchy or elastic, and will resemble egg white. This is fertile mucus and provides the ideal conditions for the sperm to reach its destination and fertilise an egg. Sperm can live in this mucus for up to seven days as it is much more alkaline at this time, protecting the sperm from the normal acidity of the vagina. Once ovulation is over, the secretions revert back to a thicker, creamier secretion that forms a seal over the cervix to prevent sperm or bacteria from entering.
If you cannot find any fertile mucus, you may be ovulating early; ovulation is affected by oestrogen levels, and low oestrogen levels, common in women during the lead up to the menopause, can begin any time during your mid-30s, but can also occur if your diet is too high in wheat fibre or if your body weight is too low. Other factors that can cause low oestrogen levels include too much exercise, smoking, taking antibiotics, a vitamin A deficiency and taking the contraceptive pill over a period of several years.
However, you can improve your mucus secretions by eating foods high in vitamin B (see Chapter 2) and drinking plenty of water.
Lower abdominal discomfort
It is thought that approximately one fifth (20 per cent) of fertile women actually feel ovulatory activity, which can range from mild aches to sharp pain on one side only. This ovulation symptom may last from a few minutes to a few hours.
Oestrogen and progesterone cause changes in your cervix, which you can learn to recognise by feeling your cervix with your fingers at the same time each day. When your fertility is at its highest your cervix will feel high, soft and open, as opposed to low, hard and closed at other times of the month. A fertility nurse at your local family planning clinic should be able to help you with this.
4. Get your timing right
It's not just a case of having sex when your fertility is at its peak; you can have sex as often as you like throughout your cycle, but if you are finding that your lovemaking is not hitting the right spot then you may find that your chances of getting pregnant will increase if you have unprotected sex during your peak fertility time; the ovulation period of your cycle. Aim to have sex, and lots of it, three to four days before ovulation, so that the sperm are ready and waiting. They can live in your body for this period and your egg can live for up to 40 hours after being released. Your most fertile period usually starts four to five days before ovulation and ends approximately 24-48 hours after ovulation.
How often should we try?
Guidance from NICE suggests you should have sex every two to three days throughout the month if you are trying to conceive.
5. Monitor your fertility
There are a number of products on the market these days to help you monitor your fertility, enabling you to plan ahead and schedule the right time for intercourse. They include the new DuoFertility monitor, a temperature sensor the size of a £1 coin, worn as a patch under the arm, that downloads data to a hand-held reader, revealing your fertility for the forthcoming week. The data is then downloaded to the company, where a fertility expert will analyse it for you. According to the company which makes the monitor, the device is so sensitive that it can be used to forecast fertile days for women with irregular cycles and could be useful for those suffering from polycystic ovary syndrome (PCOS). DuoFertility is available from www.duofertility.com. Other fertility monitors can be found at Boots (www.boots.com), and www.fertilityfriend.com offers support and advice.
Ovulation predictor kits
There are several types of do-it-yourself ovulation kits on the market to help you identify the most fertile period within your cycle. While there is no evidence that they will naturally improve your chances of success in becoming pregnant, they may help predict your ovulation, especially if your cycle is irregular. There are two types of these kits: one tests your urine and the other your saliva. They are available over the counter without the need for a prescription. They can also be bought online at www.clearblue.com or www.firstresponsefertility.com.
Excerpted from 50 Things You Can Do Today To Manage Fertility by Sally Lewis. Copyright © 2011 Sally Lewis. Excerpted by permission of Summersdale Publishers Ltd.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
Foreword by Nim Barnes, Founder of Foresight,
Chapter 1 – Fertility Matters,
Chapter 2 – Eat a Fertility-boosting Diet,
Chapter 3 – Natural Ways to Improve Your Fertility,
Chapter 4 – Preparing for Conception,
Chapter 5 – Testing Times,
Chapter 6 – Medical Treatment and Assisted Conception,
Chapter 7 – Complementary Therapies,