Alcohol and Conception

There’s been alot of published research looking at the impact of drinking alcohol on conception.  The headline is that drinking doesn’t stop you from becoming pregnant but it can prolong time to conceive and this increase with the amount of alcohol you consume.   Too much acohol disrups your reproductive hormones (again the degree of disruption depends on the amount of alchol consumed) and may lower progesterone (the hormone secreted after ovulation which helps maintain the womb lining and assist with implantation of an embryo).  In men, too much alcohol can lower testosterone and both men and women can experience a lower sex drive if they drink too much.  Alcohol can also have a detrimental effect on the development of your baby and can cause harm that maybe lifelong for the child.  The NHS in England advise that if you’re trying to become pregnant, the safest route is to avoid drinking alcohol altogether if you’re female, and limit the amount of alcohol you consume (<14 units per week) in men.

Basal Body Temperature BBT (charting)

Your body temperature changes throughout the menstrual cycle;  you’re cooler in the first half of the cycle (where oestrogen is dominant) and hotter in the second (where progesterone takes the lead).  Tracking your basal body temperature is a great way to determine how healthy your menstrual cycle is and can unearth problems in the cycle (like irregular ovulation, low progesterone for example) that might be holding you back from conceiving.    BBT charting can be very low tech (you just need an inexpensive fertility thermomter and a chart – you can download here) to record the results;  or it can be very high tech using wearable devices that continuously monitor your temperature and ping it to an app.  Whichever method you use, be sure to follow the instruction until you’re comfortable with how to do it.  We are big fans of BBT charting here in the clinic because they give such valuable information on the cycle, and enable us to give you more specific advice, referrals and / or treatment.

Cervical (Fertile) Mucus

This is amazing stuff that’s produced around ovulation by specialist cells in the neck of the womb (cervix) that are activated in the prescence of high oestrogen levels (themselves signalling a thick womb lining and ripe ready-to-be-released egg.  As such, you’ll be producing this only around the midpoint of the cycle. Fertile mucus resembles uncooked egg-white in texture and consistency and is stretchy, slippery, wet-feeling and ideally there should be lots of it.  The structure of this mucus is such that it provides tiny tubules for the sperm to swim up and into the womb as well as nourishing the sperm on their journey.

Cervical Mucus

Outside of the fertile window, the cervical mucus changes in structure, appearance and consistency.  It thickens up and becomes drier after ovulation making it more difficult for the sperm to gain entry to the womb.  It is likely that through out your cycle you will notice some or all of the following types of mucus:

  • Dry or no cervical fluid.
  • Sticky like paste. It can be white or yellow.
  • Creamy like yogurt. Smooth in texture and usually white.
  • Slippery, stretchy. Resembling raw egg whites.
  • Wet, watery and clear in color.

Doctor – when do I need to see mine

If you’ve been trying in earnest to conceive for a year or more, now is the time to book in to see your GP who will be able to run some basic fertility tests (bloods, sperm and possibly even an ultrasound scan) to see if there are any obvious issues.  If you’re 40 or over, don’t wait more than 6 months before turing to your GP for some input, as natural fertility declines with age.

If your periods have stopped, become unusually painful, intercourse is painful or you notice any unusual, smelly vaginal discharge, it’s best to check in with your doctor.

Remember that it can take normal, healthy couples a year of trying before they become pregnant and this is not at all unusual.  The chances of becoming pregnant naturally in any given cycle are comparatively low at between 15-25%.  Of course, we all know couples who get pregnant after a single month of trying, but this is very much the exception and not the rule.

Endometriosis

Endometriosis is a condition where tissue similar to the lining of the womb starts to grow in other places, such as the ovaries and fallopian tubes. Endometriosis can affect women of any age. It’s a long-term condition that can have a significant impact on your life. It’s not clearly understood why endometriosis develops and it’s a complex condition, although there are many theories (such as retrograde menstruation, problems with the immune system, heredity, or endometrial cells spreading throughout the body via the lymphatic and blood system) – it’s probable that endometriosis is caused by more than one thing.  Although it is perfectly possible to become pregnant naturally if you suffer with endometriosis (even severe endo), it often has an adverse effect on fertility and can affect your ability to conceive in several ways

  • distorted anatomy of the pelvis due to formation of scar tissue (adhesions) making it difficult for an egg to enter or travel along the fallopean tube (due to scarring)
  • inflammation of the pelvic structures
  • altered functioning of the immune system
  • changes in the hormonal environment of the eggs
  • altered egg quality
  • impaired implantation of a pregnancy

Having endometriosis also slighlty increases the chance of miscarriage and of having an ectopic pregnancy. Endometriosis can cause painful periods and make having intercourse painful – although this is not always the case and rather curiously, the severity of endometriosis does not always tally with the severity pain around the period or while having sex.

Medical treatments for endometriosis centre around managing the symptoms associated with the condition rather than providing a cure.  Current treatments available include taking painkillers, hormone medications (like the contraceptive pill, or hormone coated IUD), or surgery to remove pelvic adhesions and free up the reproductive organs.  Treatment with acupuncture can help with period pain and we feel that acupuncture can help overall pelvic circulation.  There is emerging work being done to look at nutritional therapy and endometriosis management, in particular anti-inflammatory diets.  Our nutritional therpaist has much more information about how this might help.

Hormones (Reproductive)

Womens’ reproductive health is depend on a merry, cyclical dance between key hormones throughout the menstrual cycle.  The key reproductive hormones for women are: follicle stimulating hormone (FSH), leutinizing hormone (LH) oestrogen and progresterone.  See Menstrual Cycle for more infomation on how this all works.

Male reproductive hormones are primarily follicle stimulating hormone (FSH), leutinizing hormone (LH) and testosterone.  See sperm.

Menstrual Cycle

The first day of your period is the first day of a brand new menstrual cycle (cycle day [CD]1).  Even though the old womb lining in being shed, in the background there’s lots of things happening.   Your levels of follicle stimulating hormone (FSH) begin to rise encouraging a selection of follicles in the ovaries to be stimulated.   As the follicles mature, they compete with each other for dominance and the one that emerges most dominant will begin to secrete large amounts of oestrogen.  Oestrogen then stops the growth of the other follicles so the dominant one can continue to develop to full maturity. Oestrogen also encourages the lining of the womb to become thick,  generates the secretion of fertile mucus and eventually, a spike in the secretion of luteinising hormone (LH) which thins the follicle allowing the egg to release.  This is ovulation.  Once the egg is released, the follicle transforms into a temporary structure called the corpus lutem which secretes progesterone (to maintain the lining of the womb and support the early stages of pregnancy – if this has occurred – until the placenta develops). If the egg remains unfertilised, eventually the levels of FSH and LH will fall causing degeneration of the corpus luteum and falling progesterone levels.  The fall in progesterone will trigger the menstrual cycle bringing you back to cycle day 1 where the process begins anew.  Charting your basal body temperature can give valuable insight into how well the menstrual cycle is working as the first half of the cycle, where oestrogen is dominant, is relatively cool compared with the second half of the cycle where progesterone is dominant, and the body is measurably warmer.

Polycystic Ovarian Syndrome

Polycystic ovary syndrome (PCOS) is a condition in which the ovaries produce an abnormal amount of male sex hormones (androgens) that are usually only present in women in small amounts.  It is very common condition and thought to affect 1 in 10 women in the UK. The name polycystic ovary syndrome describes the numerous small cysts (fluid-filled sacs) that form in the ovaries. However, some women with this disorder do not have cysts, while some women without the disorder do develop cysts.

In health, ovulation occurs when a mature egg is released from an ovary. This happens so it can be fertilized by a male sperm. If the egg is not fertilized, it is sent out of the body during your period.

In some cases, a woman doesn’t make enough of the hormones needed to ovulate. When ovulation doesn’t happen, the ovaries can develop many small cysts. These cysts make hormones called androgens. Women with PCOS often have high levels of androgens. This can cause more problems with a woman’s menstrual cycle. And it can cause many of the symptoms of PCOS.

Treatment for PCOS is often done with medication. This can’t cure PCOS, but it helps reduce symptoms and prevent some health problems.

The exact cause of PCOS is not clear. Many women with the condition have insulin resistance;  meaning the body can’t use insulin well. In these circumstances, this can cause higher androgen levels. Being overweight can also increase insulin levels and make PCOS symptoms worse.

PCOS seems to run in families. It’s common for sisters or a mother and daughter to have the condition.

The symptoms of PCOS can include: missed periods, irregular periods, or very light periods; enlarged ovaries; ovaries with lots of cysts visible on ultrasound (often referred to as being like a ‘string of pearls’ in appearance;  excess body hair, including the chest, stomach, and back (hirsutism);  weight gain, especially around the abdomen;  acne or oily skin;  male-pattern baldness or thinning hair; infertility.

Women with PCOS can struggle to become pregnant but it is still possible to get pregnant naturally if you have PCOS and treatment such as acupuncture has been shown in published research to regulate the menstrual cycle in women with this condition.  Nutritional therapy and advice can also help manage the symptoms of this condition.

Sex

If you’re trying naturally to conceive, you’re going to need to have lots of sex.  Ideally aim for every other day from about cycle day 8 (where cycle day 1 is the start of your period) through to about cycle day 24 (if you have a normal 28-day cycle).  You’ll need to have sperm waiting in the fallopean tubes in order to greet the emerging egg remembering that eggs last on average 24 hours, while sperm can survive for 5 (sometimes even more) days.   Although many sperm are ejaculated in a single male orgasm, only about 100 of the millions released will make it to where they are needed for conception, this is why you need to keep ‘topped up’ with sperm to increase your chances of conception.

We are pragmatic here and completely understand that if you’ve been TTC for a long time, the thought of having so much sex can become demoralising and be physically and mentally exhausting.  The days of having sex for fun can seem like a distant memory and the sheer functionality of so much intercourse can, paradoxically, be a real turn off.  If this sounds like you, give yourself a break.  Take a month off trying for a baby, this will help relieve the pressure a bit.  If your partner is running into difficulty getting or maintaining an erection talk to your GP;  some men take short term medication to help with erection issues and some of these medicines are available over the counter.  We have worked with couples who have used devices like The Stork Cap to help where there are issues with sex and this is worth looking it.  The book The Fertile Fizz by Jannie White is also a useful manual that directly tackles intimacy when trying to conceive and is a worthwhile read.

Sperm

Adult men produce about 1500 sperm per second!  The process of sperm formation (spermatogenesis) takes an average of three months, predominantly happening in the testicles and under the influence of male hormones.  Sperm can be sensitive to heat (which is why the testicles are outside the body) so it’s a good idea to avoid hot tubs, saunas or the wearing of tight lycra / nylon underpants or cycling gear.  It’s also worth considering sleeping in the nude to allow the testicles to keep cool and avoid having your laptop over the groin.  Sperm are sensitive to the effects of recreational drugs (including cannabis and cocaine – both of which can impact the quality of the sperm), and tobacco / cigarettes, which have a profoundly negative effect on sperm.  Vaping is emerging in the scientific literature as at best unhelpful to sperm health, and possibly even toxic, so should not be considered a benign alternative to smoking.  We strongly advocate that men trying to conceive take a male preconception vitamin as soon as the decision to try for a baby has been made.  Since it takes 3 months for the sperm to mature, taking a vitamin today will only have a material impact on the sperm in 3 months – so the sooner you start the better.

Regular ejaculation is also helpful for sperm health, ideally every other day.  This helps to keep the sperm ‘production line’ in good order.