Does it seem like ages since you’ve been trying? Has sex become more obligation than pleasure? Is everyone around you ‘falling’ pregnant? Lynda Mathewson sorts out the facts from the fiction surrounding infertility to help you decide when you really need to seek help.

The National Institute of Clinical Excellence (www.nice.org.uk) recommends that “infertility should be defined as failure to conceive after regular unprotected sexual intercourse for 2 years”.

84% of couples will conceive within 1 year if they do not use contraception and have regular sexual intercourse. Of those who do not conceive in the first year, about half will do so in the second year.

With regular unprotected sexual intercourse, 94% of fertile women aged 35 years, and 77% of those aged 38 years, will conceive after 3 years of trying.  So if it is taking you longer than a year, it’s not abnormal. But there are things you can do to help yourself before attempting assisted conception.

DO…

HAVE REGULAR SEX

Sunday mornings and his birthday may be regular to some couples but it will probably take 20 years to conceive. Regular sex is subjective but when it comes to conception the guidelines are clear. Couples are advised to have sex every 2 to 3 days, so no binge sex on the weekend. Reason for this is based on the life span of the egg (up to 12-24hrs after ovulation) and sperm (average 2 – 5 days, although super sperm can survive for up to 7 days). The sperm will survive within a woman prior to ovulation and seek out the egg when ovulation, reducing the need for the joyless ‘timed sex’. (www.hfea.gov.uk).

Don’t store up sex until the 10 days around ovulation as if ejaculation occurs more than 5 days apart, the number of dead sperm in the semen is increased. If sex is not possible then masturbation is required. Daily sex may be unsustainable over a number of months, and is no benefit to conception.

In conclusion, without sex all the lifestyle changes or investigations you do are academic. Immaculate conception only worked once (allegedly) so if you are trying unassisted conception – have sex.

KNOW WHEN YOU OVULATE

An average cycle is 28 – 29 day, and between 26 – 32 days is ok. Ovulation occurs mid cycle, usually 14 days before the period starts. Keep a diary of ovulation and menstruation to avoid any inaccuracies.

Ways to identify ovulation:

●         Cervical Mucus – usually detectable a couple of days to ovulation and is the best indicator. Some women detect a slippery feeling when wiping after going to the toilet, others can see excess slippery egg white like discharge in their pants. It should be clear and odourless.

●         Ovulation Predictor Kits (OPK) – such as Clearblue Digital. OPKs detect the Luteinising Hormone (LH) surge which occurs 12 – 48 hrs before ovulation.

●         Cervical position – This takes practice; the best description is “feeling the difference between your nose and your lips”. At the start of a cycle, your cervix is low, closed and firm. At ovulation it softens and feels more open, indicating it is more favorable to allowing sperm through to the uterus.

●         Basal Body Temperature charts – Useful at showing if OPK LH surge corresponds with the thermal shift, but indicates after ovulation has occurred. Some people find interpreting the subtle changes confusing, and late nights and some foods can cause fluctuation. It also has to taken on waking, at the same time of day, which can be a disadvantage to those with irregular waking times. It is best done in conjunction with cervical mucus and/or position checks, and stop if they cause stress.

SPERM TEST

Every test on a woman is a surrogate test, like reading the packet to establish what is inside. Sperm tests are direct, ie actually emptying the packet and seeing what is inside. A woman’s egg quality is hard to influence, but sperm takes 3 months to make and the quality can be effected (lifestyle, fevers, injury). The Doctors Laboratory (http://www.tdlpathology.com) offers a comprehensive sperm test for £135, available with a referral from a doctor or other therapists (including acupuncturists). As sperm quality can fluctuate a couple of tests will be required. If a man has a history of local injury, fevers, severe mumps or hormonal irregularities then it is worth contacting an andrologist for detailed investigations. Whereas women appear to take a pragmatic approach to fertility tests and investigations, men can be sensitive so address the situation cautiously.

CHECK YOUR WEIGHT

In women, being overweight can raise oestrogen levels and cause a greater chance of luteal phase defect (LPD) or polycystic ovary syndrome (PCOS).  In men, it can contribute to subfertility. http://www.nhs.uk/Tools/Pages/healthyweightcalculator.aspx

THE AGE FACTOR

Conception is not always an option for women under 30 years old; if that’s the case for you, and you are over 30 now, focus on what can be improved and don’t dwell on what cannot. Maternal age does affect quality of eggs and conception rates. Women are born with all the eggs they are going to produce throughout their life, and the quality does decline with age. There are significant drops in female fertility at 35 years, again at 38 years, and then at 40 years. Conception is possible, but maybe less predictable. Basic factors like reduced energy and sex drive occur as people get older, which do not help the situation.

TRY ACUPUNCTURE

Research has shown acupuncture:

●         Increases libido and energy

●         Regulates cycles

●         Increases blood flow to uterus

●         Improves sperm quality

●         Improves IVF success rates by up to 60%

●         Alleviates stress

– see www.thelittleclinic.co.uk

DON’T….

SMOKE OR TAKE RECREATIONAL DRUGS

I only forbid two things when trying to get pregnant, that is smoking and taking recreation drugs. Not negotiable.

BINGE DRINK

Consume in moderation (¼ bottle wine, or a beer 3-4 times per week).

WHEN SHOULD YOU START TESTING?

The older you are, the sooner you should start testing (not necessarily IVF). If you are:

●         Under 35 years old, after one year of regular, unprotected sex

●         Over 35 years, from 6 months

●         Over 38 years of age, consider testing sooner

If you suffer from other factors, such as amenorrhoea (no periods), oligomenorrhoea (abnormally light or infrequent periods), endometriosis, pelvic inflammatory disease infections, HIV+, undescended testes, diabetes and epilepsy medication, consider testing as soon as possible.

WHAT TYPE OF TEST?

●         Sperm test – 25% of infertility cases are due to sperm defects. At least two tests will be required.

●         Cycle Day 3 (CD3) – blood test for follicle stimulating hormone (FSH) and oestradiol (can indicate potential premature menopause)

●         Cycle Day 21 (CD21) – blood test to confirm ovulation occurred by measuring progesterone levels 7 days after ovulation.

●         AMH – anti-Mullerian hormone blood test. Establishes ovarian reserve (remaining eggs).

●         Thyroid Stimulating Hormone (TSH) and Luteinising Hormone (LH) levels – blood test.

●         Genito-urinary medicine– go to an NHS GUM clinic (www.nhs.uk ). Chlamydia can be symptomless and cause infertility. HIV, Hep B & C tests are required before IVF cycles.

●         Hysterosalpingogram (HSG) – Check uterus and fallopian tubes not blocked.

WHERE TO GO?

●         Easiest is your GP for blood & semen analysis and hysterosalpingogram (HSG) referral.

●         Go to a GUM clinic for chlamydia, and other sexually transmitted infections (STI).

●         Go private if you feel that your GP is not proactive, or you are aware of any existing menstrual, sperm or medical conditions.

Contact Lynda to discuss your options, at the www.chelseanaturalhealth.co.uk on 020 7352 3087 or use the form above to email Lynda directly. See also www.thelittleclinic.co.uk

by Philip Waldman, Registered Osteopath of Chelsea Natural Health, London, SW10

I have a special interest in antenatal and post natal osteopathic care and have been working in this field for nearly 20 years.   During that time I have been a lot of new mothers and more often than not, at some point during the first year of their child’s life, treated them for what I know as Mother’s shoulder.   I have also seen fathers with the same complaint , so maybe it should be called parent’s shoulder?

Typically they complain of pain under the shoulder blade and in the base of the neck, sometimes with pain further up the neck and / or into the upper arm.   If it is very bad they can get pins and needles and   / or numbness into the arm as far as the fingers, or if it is the neck, they can get bad headaches.   It is usually on the side opposite their dominant hand and come on gradually and continues to worsen.   It usually takes the form of a dull ache under the shoulder blade, like a tooth ache, and nothing really seems to shift it.     Massage can help for a while but the pain returns.   Often I hear of people pushing their mid-backs up against door frames to try and self-massage the knot of muscle that builds up by their shoulder blade.

After ruling out anything more serious, very often what is left is a musculo-skeletal strain pattern that I know as Mother’s Shoulder.   This involve a jamming of the joints between the ribs and the spine and the resulting muscle spasm that builds causes all the symptoms.   To cut the story short, basically what happens in that the ribs jam up due to the mechanical strain on them but the body still wants them to move (hey, we still have to breath).   Two different muscle groups battle it out, one saying to the ribs “Move”, the other saying “Stay still”.   They tussle and wrestle with each other and then get their mates involved, and before you know it the whole shoulder and neck musculature is involved.   This can be very painful and cause nerves to get squeezed (thus the pins and needles / numbness that can occur).   I have found that until the mechanics of the ribs are corrected the pattern will continue, and this is where I as an osteopath can help.   Patients have often reported great improvements soon after treatment.

Why? What?

The reason this all comes about in the 1st place is due to the combination of several mechanical factors at a time when the mother is undergoing great change.   In the post natal period the mothers body is having to adapt to not being pregnant any more.   All those postural changes during pregnancy have to be “undone” and the body has to re-organise, and all of this whilst raising a child.   This is a very physical task and mothers tend to carry their child over the shoulder of their less dominant hand so that their dominant hand is free (to write, use keys etc etc).   Another, and I think the most important factor is what mothers do when they feed their child, and what happens is very similar for both breast and bottle fed babies.   Mum sits down to feed, gets herself and her baby nicely positioned using pillows and alike and starts to feed.   All is well but then mum, as we all would do, looks down lovingly at the bundle of joy in her arms.   She spend the whole feed doing this but in doing so she places a postural and mechanical strain into her neck and shoulder (if the baby is feeding from say they left breast then looking down at it places a strain through the muscles on the back right of the neck into the right shoulder blade and mid-back – try mimicking this posture and see if you can feel what I am talking about).   It is this, along with the increased lifting and carrying that the mother does that kicks off this pattern. Bear in mind that all of this is happening at a time when the mothers ligaments are still soft as a result of the hormones in her body from when she was pregnant.   This is especially the case for breast-feeding mothers as the ligaments stay softer for longer in breast-feeding mothers.     If the ligaments are softer then the muscles have to work harder to support the joints, and this can exacerbate problems like this.

So what can be done about this?

Don’t get me wrong, I am not saying don’t look at your beautiful child, I am saying be aware of your posture when you do this and do some gentle shoulder rolls and stretches to keep your shoulders.   Flexibility is important, keeping the mid-back and shoulders mobile with greatly reduce the likelihood of this complaint.   Find a mother and baby yoga class to go to as here you will learn fun and safe techniques that will keep you moving, and be great for you baby as well.   If you start to suffer then some osteopathic treatment may well help.   If you would like to see an Osteopath then please consult http://www.findanosteopath.co.uk/ to find your local Registered Osteopath.   In treating complaints like this it is often a case of helping manage the situation.   Parents can’t stop being parents, so it is a case of offering treatment for the mechanical factors whilst advising on “lifestyle” changes that reduce the chance of it happening again.

If you have any questions about this, please do feel free to contact me using the form below.   However, please note that this article describes a pattern I often see, but that this may not be what you a suffering from if you have these or similar symptoms.   Please seek an appropriate medical opinion rather than consider this article definitive advice as there are other reasons why you could be suffering these symptoms and these will need to be ruled out.

AROMATHERAPY & MASSAGE for PREGNANCY at Chelsea Natural Health Clinic, Fulham Rd, SW10

Pregnancy Massage (Antenatal and Postnatal): is of wonderful benefit to treat and relieve the muscle tension and joint discomfort that can accompany pregnancy. Massage helps improve circulation with draining strokes and kneading eases muscle cramps, whilst oils help with regulating hormones and together provide nurturing and relaxation for mother and baby.

Reasons for massage in pregnancy:

• Backache often accompanies pregnancy, especially lower backache due to the increased weight of the baby and the changing shape of the body which increases the lumbar curvature of the spine. Lemon and Lavender essential oils
• To de-stress mind and body – stress increases all anxieties about a pregnancy and can lead to premature birth in some cases. Frankincense and Neroli essential oils
• Constipation and digestive upsets (indigestion) can occur due to intestinal displacement by the growing foetus. German Chamomile and Sweet Orange essential oils
• To identify and reduce tight muscles e.g. postural muscles, primary and accessory respiratory muscles – to bring awareness to breathing and posture. Sweet Marjoram essential oil.

Aromatherapy in pregnancy

Aromatherapy accompanying massage is highly effective and Aromatherapy is even more important when the heightened sense of smell during pregnancy is taken into consideration. If there are reasons contraindicating massage as above, essential oils can be used in different ways:
• Insomnia and fatigue can be eased by vapourising oils or using such as Roman Chamomile and Lavender in carrier oil in massage.
• Morning sickness can be treated with 4-5 drops of Ginger or Spearmint on compress over the abdomen or on a tissue.
• Oedema – swelling of the hands and feet – caused by a rise of oestrogen in the body can be relieved with a foot bath with 4-5 drops of Lime and Grapefruit in 1tsp full fat milk.
• Hormonal changes produce an ever fluctuating emotional state for most pregnant women. Even when a pregnancy is planned and welcomed women may experience mood swings and many anxieties. Geranium and Rose
• Stretch marks can be prevented by applying an oil blend (consult a professional aromatherapist) of avocado oil with jojoba wax, Neroli and Frankincense.
• Varicose veins can be alleviated or prevented with gentle massage in upward strokes to the legs using an oil blend including Geranium and Cypress
Aromatherapy in Labour (consult a professional aromatherapist)

• Aromatherapy can be used in labour to calm anxiety and facilitate easy breathing. Vapourise 4-5 drops of Rose and Neroli.
• Some essential oils strengthen and deepen contractions – uterine tonics – and ease the pain of childbirth. Lavender and Jasmine.

Post natal Care

• Breasts may be sore and nipples can crack. Avoid essential oils on the nipples, use a calendula infused sweet almond oil instead.
• Episiostomy/tearing. Healing Lavender (3 drops) and Cypress (2 drops) essential oils neat in a sitz bath.

Post Natal Depression

• Uplifting Bergamot, Anti-depressant Rose, Anxiolytic Frankincense – essential oils can help on all levels.
Reasons to avoid massage in pregnancy: *
Deep vein thrombosis – essential oils in a footbath, or in a compress may help, cardiac disorders (heart or pulmonary problems), chronic hypertension, severe anaemia, abnormal foetal heartbeat, lupus erythematosus, bloody discharge, continual abdominal pains, diabetes

Jenny James
Aromatherapist BA (Hons) PGCE NYR MIFPA
Email: jennyjamesiom@yahoo.co.uk
Mobile: 07931 349 125

*Always consult a trained aromatherapist before applying home blended essential oils. Never apply essential oils neat.

**Jenny is a member of IFPA (International Federation of Professional Aromatherapists) and trained with Neal’s Yard Remedies in Holistic Aromatherapy & Essential Oil Science, Advanced Massage Techniques and Advanced Pregnancy Massage.
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By Philip Waldman D.O., Registered Osteopath, Chelsea Natural Health Clinic, Fulham Rd, SW10

In the antenatal and post natal period an osteopath can be of much assistance.   Pregnancy is a wonderful and wondrous thing but it can be a very demanding time for the family. In it’s most “basic form” antenatal osteopathy can help prepare the mother’s body for the pregnancy and labour. For instance, making sure that the spine and pelvis are working to the best of their ability is of utmost importance.

During labour the pelvis must be able to move and pivot on the hips freely to allow the baby to pass. As the baby passes through the upper pelvis the upper pelvis spreads and the lower pelvis narrows. As the baby passes past the hips and through into the lower pelvis and birth canal, the lower pelvis spreads and the upper pelvis narrows. This rocking motion is likened to a pair of scissors opening and closing. The diagram shows the pelvis from the front and shows the forces that act on the pelvis in the early stages of labour. These forces reverse in late labour. If the hips and / or pelvis are tight or twisted this motion will be blocked, which can have dramatic effects on labour and can be a factor in babies not engaging properly or getting stuck.

Having the spine functioning well is also important because the spine houses the nerves that control everything. If the nerves that run from the low back to the pelvis are compromised by physical tension, it may well interfere with the contractions of the uterus. If the blood flow to and from the uterus is restricted by physical tension that can have a similar effect. These restrictions are normally quite subtle and won’t necessarily register as symptoms that the mother would be aware of, but they will mean that the contractions won’t be as efficient and effective as they could be.

Osteopathy is an ideal way to deal with all these factors. Through a rounded approach that takes into account the physical factors as well as others such as the emotional, nutritional and postural I aim to help the mother prepare for pregnancy and labour.

Osteopathy is safe during any stage of pregnancy. Normally I like to see mothers about once a month throughout pregnancy. This seems to have brought great benefit to many mothers, with a lot of my patients reporting that they seem to have had better pregnancies than others, or compared to their previous pregnancies. This all bodes well for their un-born child because the less traumatic the labour the better it is for the baby. Regardless, I always advocate a postnatal Cranial Osteopathic check-up with me for the little ones as they have been through a lot. This is the case even if they have been delivered by c-section.   Postnatal care for the mother is also very important.   There are many things osteopathy can do to help the mother recover from the birth process and pregnancy.     If you simply consider the dynamic role of the sacrum during the birth process and how is   moved you can appreciate how important it is to have it re-seat itself properly.   Cranial osteopathy is, in my opinion, uniquely placed to facilitate this process.   I see a lot of mothers suffering from what I call “Mother’s Shoulder”, a painful muscle and joint condition brought about by the physicality of motherhood.   For more information please see that article I have written in the post-natal sub-section of the pregnancy section of this site.

HOW OSTEOPATHY “WORKS”

Osteopaths believe that:-
The blood supply is the most important factor in health. Poor blood supply means tissue “dis-ease” and this can predispose to disease and hinder healing.

The shape of  the bits of the body determine the way in which they work. For example, if you are pregnant and you lie on your back, your womb presses on the blood vessels that lie behind the womb. This will change the amount of blood that can pass through the vessels. If you relate this back to the rule of blood supply being the most important factor, you can see how this might mean that the uterus can’t contract as strongly during labour. The message here is, ideally, don’t lie on your back when pregnant, and especially when in labour.

Everything is interconnected. Your stress levels affect your muscles and the rest of your body. Your kidneys affect the rest of your body, and so on. If you have a problem in one area, the whole body will be affected. When I am treating I have to consider this. Also by treating one area of the person I can potentially affect all other parts. It might sound far-fetched, but I often treat people’s bowels / stomachs to help them with a low back problem. This opens up a myriad of therapeutic possibilities.

Given the chance the body will heal itself. Take the stressors away and this process will speed up. A mechanical example is if you have a sprained ankle, would you expect it to heal if you kept running on it. By working to improve the blood flow to and from an area I can speed up healing and promote health in that area (rule of the artery). But I don’t just work on that area, I work globally to try and restore the whole person to health and promote well-being and increased vitality (body is a unit). This belief is particularly important in post-natal recovery for mother and child.

From these examples I hope you can see that osteopathy has much to offer the pregnant mother and child. I aim to work to prevent issues arising, deal with potential problems before they become an issue. I use a variety of techniques such as Osteopathy and Cranial Osteopathy and I work alongside my wife who is a pregnancy yoga teacher to provide a flexible, rounded, sympathetic and all-encompassing approach.

Philip Waldman, director of Chelsea Natural Health, is a Registered Osteopath with over 18 years of experience in this area of healthcare and he believes passionately in the benefits of antenatal and post natal osteopathy. For more information please visit

www.osteo.co.uk

or feel free to contact Philip directly using this form

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After providing antenatal care the team at Chelsea Natural Health strive to continue to provide help and support to postnatal mothers, their babies and the rest of the family. For instance, Cranial Osteopathy with Philip Waldman, Craig Coman and Cristabel Barbosa-Garciacan be very helpful in helping both mother and baby overcome the stresses and strains of birth and acupuncture can help resolve constitutional issues. Massage is wonderful for everyone, especially mother and baby, adn all of our massage therapists have a special interest in ante and postnatal care.  Jenny James is on hand to teach baby massage. Nirlipta Tuli specialises in pregnancy and birth hypnotherapy, which can be very helpful in dealing with the stress and trauma that childbirth can bring (birth trauma resolution and the release of fears and anxieties around childbirth). Acupuncture with Lynda, Craig or Leo can be very helpful in recovery period after giving birth, as can reflexology with Jenny, Shiatsu with Jan and nutritional therapy with Halina.  These are just some example of the treatments and care on offer at Chelsea Natural Health.

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Here at Chelsea Natural Health we have a special and deep passion for antenatal care. All of our practitioners are able to offer pregnant mothers support through their therapies. Philip Waldman and Craig Coman are both experienced and dedicated Osteopaths and Cranial Osteopaths that have a special interest in pregnancy and antenatal care. Craig also offers additional care and help via acupuncture (which is helpful when looking to turn babies for instance) and Naturopathy. Nirlipta Tuli provides perinatal hypnotherapy (pre and post pregnancy and birth related hypnotherapy).   All of our masseurs provide pregnancy massage and Jan provides pregnancy shiatsu.

We also work closely with the Women’s Wellness Centre that is located next door to provide a excellence in pregnancy care.

All of this follows through into the postnatal care we also offer, details of which can be found on this site.

For more information please visit the individual practitioners pages.

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