The facts and statistics are enough to scare anyone. It is estimated one in six couples in the UAE have fertility issues and some experts believe the proportion here may be as high as one in five due to the prevalence of male-factor problems, polycystic ovaries and obesity. One course of IVF, a time-consuming and emotionally challenging procedure, can cost around Dh20,000 to Dh30,000, with no guarantee of success. It’s no wonder so many couples feel daunted in the early stages of trying to start a family. It’s not all bad news, however.
Doctors generally advise that, unless there are known physical reasons for concern, couples need to seek help only after one year of regular unprotected intercourse, or after six months in the case of those over the age of 35. In addition, even if there are medical reasons behind fertility issues, Dr Mazen Altaruti, Managing Director of MSD in the Gulf, points out the vast majority of infertility cases are treated through conventional therapies. In fact, according to the American Society for Reproductive Medicine, despite the high degree of media attention given to IVF, around 80-95 per cent of cases are treated through means like drug treatment or surgical repair of reproductive organs, rather than IVF.
The pressure to fall pregnant can be counterproductive according to Dr Rajool Matkar of Dubai-based Life Medical Centre. She says many of her clients face inordinate amounts of pressure from their families to conceive as soon as they get married, which can lead to a sense of desperation. She, and other experts, warned of the overuse of fertility medicines here, often prescribed without proper supervision. Dr Altaruti points out that one of the most widely prescribed fertility pills can be helpful if a woman is not ovulating, but actually reduces fertility in a woman who is.
So what can be done to improve your chances of conceiving if you’re not yet read to take a medical route?
1. Lifestyle changes
Most doctors we spoke to stressed the importance of maintaining a healthy weight (both being underweight and overweight can have a negative impact on fertility) and that both partners should avoid tobacco and alcohol to maximise fertility. As far as diet is concerned, Dr Altaruti points to an eight-year Harvard University study that concluded there is a strong link between diet and fertility rates. The study, whose results were later developed into The Fertility Diet* found that avoiding trans-fats, increasing unsaturated vegetable oils and replacing meat proteins with vegetable ones can all contribute to improving a couple’s chances of getting pregnant. While iron is also thought to promote fertility, Dr Altaruti says it’s advisable to try to get these from natural food.
Dr David Robertson, medical director of Dubai’s Bourn Hall Clinic, stresses that a healthy diet is more important than supplements, but women should take folic acid. He advises women who are trying to get pregnant to take 400 micrograms daily, as this will help to protect the future baby against some spinal and brain defects. He adds that there is no benefit in taking a bigger dose unless there is a history of a previously affected baby and that high doses of folic acid can have an adverse effect.
Regarding other lifestyle changes, Dr Matkar advises women stay away from douching and sprays, as well as scented feminine products as these can affect vaginal acidity levels.
2. Medical kits
According to fertility website www.babycenter.com, if you are waiting to have sex until your most fertile time, make sure you haven’t gone through too long of a dry spell beforehand. The website advises that your partner should ejaculate at least once in the days before your most fertile period to avoid a build-up of dead sperm in his semen.
While gynaecologists can determine when you will be most fertile through ultrasound scanning and hormone blood tests, ovulation kits can be helpful for women with regular periods. (If periods are irregular, prediction of ovulation is more difficult and may not be happening so it’s best to seek professional advice as a simple solution may be available).
Ovulation kits work on the basis of detecting when a woman’s Luteinizing Hormones (LH) are at their highest; which occurs around 36 hours before ovulation. Dr Altaruti points out that the kits can only provide an indication of when you should ovulate, but don’t confirm actual ovulation. “Occasionally an egg may not be produced from the follicle even after the LH process has begun. Additionally, it cannot tell you whether your cervical mucus is conducive to fertilization and provide the correct environment in which the sperm can survive long enough to reach the egg.” He adds that the kit will be ineffective if a woman is taking certain fertility drugs and that the accuracy of the kit is significantly reduced in women over 40.
Dr Robertson says of the kits, “I often suggest that patients use them for 2 months and if a regular pattern emerges, they can then just count the days.” He cautions, “I think it is best if couples can try to avoid focusing too much on the right time of the month. Sex can then become a bit of a chore, with extra pressure to “perform” at the right time. If a couple have regular intercourse 2-3 times per week, that will be fine.”
3. Fertility – hypnotherapy
A pioneer in the use of hypnotherapy to treat infertility, London-based psychologist Dr Elizabeth Muir believes that “in many cases, the subconscious can alter the body’s biochemistry and while a woman might consciously want a baby, her subconscious may be stopping her from getting pregnant.”** Hypnotherapy is also promoted as a means to eliminate stress, which can have a negative effect on fertility. The UK’s Natural Council for Hypnotherapy website explains stress hormones affect the hypothalamus and pituitary glands and reproductive organs. In women under stress, the reproductive hormone prolactin is overproduced, which can interfere with ovulation. The hypothalamus stops secreting gonadotrophin hormone, which in turn affects the release of both the luteinizing hormone and follicle-stimulating hormone. As these hormones stimulate ovulation, fertility is affected.
In addition, according to London-based psychotherapist and clinical hypnotherapist Sjanie Hugo Wurlitzer, during times of stress a hyper-stimulated nervous system will send less blood to the uterus and ovaries, thereby impairing their optimal functioning. She says the body’s natural fight or flight response will trigger the release of adrenaline which also inhibits the production of progesterone. Wurlitzer, who developed The Fertile Body method (98 pounds from amazon), explains how hypnotherapy can help: “When we enter a state of hypnosis ... the parasympathetic nervous system is activated, giving rise to what is known as the relaxation response... Whilst in this state there is a measurable decrease in heart rate, blood pressure, breathing rate, stress hormone levels and muscle tension and people experience a wonderful feeling of relaxation. So simply being in the state of hypnosis can help to increase fertility.”
According to Dr Maria Ridao Alonso, Medical Director of Dubai Herbal and Treatment Centre, special acupuncture point combinations and techniques have been shown to increase blood flow to the reproductive organs. She says, “Healthy blood that is supported by a healthy diet will provide the ovaries and uterus with more nourishment. The increase in healthy blood flow can increase follicle and egg health and also encourage the lining of the uterus to make a more hospitable environment for an embryo to implant and grow.” She adds that acupuncture can also strengthen the immune system which also plays an important role in conception. “This becomes important when there are immunological causes for fertility or failed implantation issues. An overactive immune system can also cause unwanted inflammation in the reproductive organs. This is particularly true for women with endometriosis.”