The Fertility Podcast

This week we have a bumper episode and have not one guest, but three! Our episode is all about the fact that infertility knows no colour, meaning that infertility doesn’t care about the colour of your skin – it impacts us all regardless but there are very unique challenges, and some similarities faced by differing communities.

First up we chat to Vanessa Hay

Talking about the issue of infertility within Black communities. Vanessa described how multi-layered up fertility issues were with other social-cultural things like faith

“When you are trying to build a family, you feel like everyone else is affected. Your whole family are invested and I felt it was too much pressure to go through, so it took me a while to talk about it. Then you have to deal with comments such as ‘Why you going through IVF it’s not something that we do’

Vanessa chose to only share her experience after she was pregnant, she was 27 when they were trying..

She spoke about how Infertility has no boundaries in terms of what you go through and how it feels and how she felt she couldn’t get anything from her community as she wasn’t sharing so she needs to go elsewhere. She went on chat rooms… and realising there was the Instagram community… However the nuances in her journey -such as how to approach nosey aunties and uncles / the faith-based / they weren’t being covered in this predominantly white community.

Vanessa spoke to Metro about her experience of going through IVF as a black woman had so much traction. People thanking her for sharing it. People saying they were also going through it.

Women were saying this is something I’m going through but don’t feel comfortable talking to my friends as it’s not something that happens with Black women - started the conversation to help us feel less alone.

Vanessa said how people talking back to her and she then seeing other black women bloggers starting the conversation helped her feel less alone. It was reciprocal and reassuring. She explained how ‘If there is already a perception in a community and you aren’t seeing people that look like you talking about it further breeds the idea that this isn’t the type of thing you might go through. ‘

There is still shame within Black communities assumption of virility

Vanessa spoke about Noni Martens who has been talking about how black women are raised to be Mother - which s something we spoke more with Christine about later in the episode. There is an assumption that black women are apparently ‘hyper fertile’ Vanessa also explained her concerns about celebrity - saying how ‘There is also the perception of IVF is also that people are choosing what babies they have due to the celebrity association. As people don’t understand it. If someone is choosing it they are guaranteed to get pregnant, that she has decided to now get pregnant… like you are trying to take matters into your own hands

She is now focusing more on Reproductive and Gynacolgical - having lost babies she has realised she still has work to do in the education she is sharing.

Next, we welcome back a friend of the podcast Dr Christine Ekechi. Christine is a consultant gynaecologist at Imperial College NHS Trust and a spokesperson for Racial Equality at the RCOG. Christine is passionate about tackling the healthcare inequalities of women. We last saw, and interviewed, Christine in a very busy and noisy British Library in London, just before lockdown.

We wanted to chat with Christine about the recent paper, shared by the HFEA, on the ethnic diversity infertility treatment and how using the term BAME is no longer acceptable. Christine is against defining women by... 

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This week to mark Men's Mental Health Week, we are putting the spotlight once again on Male Fertility issues with two conversations to share with you.

We welcome back to the podcast Professor Sheena Lewis to talk about DNA Fragmentation. Sheena is the CEO of Examen and a professor in Reproductive Medicine and has been working on male fertility tests for the last 25 years. You'll also hear from Shaun, who has created an account on Instagram called Knackered Knackers, where he has shared his story of having male factor infertility, having had mumps and ultimately had to use donor sperm.

Male infertility is on the rise but luckily, we’re beginning to make progress in the research surrounding this. Sheena talks about as well as sperm counts declining, sperm quality is also reducing and the DNA of sperm, in particular, is becoming worse, in part due to 20th century living such as environmental factors, having children later in life – the things we can’t do anything about. However, there are factors that we can influence, and we need to do all we can to start focusing more on men, rather than just the woman.

If you go back to basics, the first thing a man needs to do is to get a sperm test. This looks at the count (how many there are), motility (are they swimming), and morphology (the shape of the sperm). What you don’t find out from a sperm test, is what’s inside the sperm – the DNA. Sheena feels that we should be doing more DNA fragmentation tests. However, as fertility clinics are ‘female focused’, this is rarely offered. We need to bring urologists into the picture to also focus on men and have better joined-up working.

Sheena talks about the misnomer of unexplained infertility. 25% of couples are given the frustrating diagnosis of unexplained infertility, but the reality is we’ve not actually searched hard enough for the answer because men are left out of the picture.

Sheena’s research at Queens University in Belfast has shown that 40% of men given a diagnosis of unexplained infertility have DNA fragmentation. A startling figure indeed! It may not be the only answer, but it certainly is one reason for their inability to conceive.

40% of men with fertility problems have varicoceles but as men are not generally examined this is not diagnosed or treated. As a result of male infertility women have to go through ICSI treatment but, as Sheena says, why can we not have equality in reproductive health where men are examined, tested, diagnosed and treated in the same way women are? This would put the man right back in control and be empowered to make the right lifestyle changes to improve sperm.

Sheena also talks about the importance of nutrition. Many men have a calorie-rich and nutrient-poor diet. Sheena recommends getting the right expert advice on nutrition and the right supplements to help improve sperm health. Sheena recommends vitamins A, C and E, with vitamin E being especially beneficial.

Natalie asks Sheena about DNA fragmentation and miscarriage. Research in 2012 and 2020 showed the association between DNA quality and miscarriage. The need for DNA fragmentation testing following miscarriage is now in international guidelines but is sadly rarely done. Sheena recommends that men should be empowered to be proactive and ask for this test to be done.

It was just Natalie chatting with Shaun and the pair didn’t discuss his story in detail as Shaun has set it out brilliantly on his instagram account, talking about how he had mumps which always made him think there might be a problem. He then had to have a number of operations including a varicocele and a microtese and in the end, Shaun and his wife Jenna had successful treatment using donor sperm and Jenna gave birth to their twins Ray and Evelyn in February... 

Unexplained Infertility

In this episode, we’re together, in person and in the same room!! What a novelty. We’re talking unexplained infertility and whilst together we had a quick chat with the lovely Jen who is @jens_endlesshappydays on Instagram

Jen has been diagnosed with unexplained infertility and is struggling with PCOS, however, her doctors don’t feel that PCOS is impacting her cycle and therefore her diagnosis remains unexplained.

Jen tells us how she feels frustrated at the diagnosis of ‘unexplained’ and the rollercoaster of emotions that comes with her thoughts of why she’s not getting pregnant, symptom spotting, the two-week wait, and the crushing disappointment of getting her period every month.

Jen has been really open with her friends and family and feels so lucky that she has a good support network, which includes friends who have experienced a similar journey themselves. Jen decided to be open on social media and as a result as made some amazing Instagram friends. We talk about friendships and how you cope when a friend you make through a shared experience, such as infertility, then becomes pregnant.

We touch on male fertility tests and how men are often the ignored factor when it comes to fertility investigations. Jen and Alex have only been offered a sperm test, but no further testing, and Jen says she is completely unaware that there are any other options for male investigations. Tune in to next week to hear more about this with our guest expert.

Jen is soon to start IVF treatment and has been working hard to reduce her BMI. Due to her PCOS, she has found it hard to lose weight, and has found losing weight to be eligible for IVF has further added to the burden and stress she feels.

Good luck Jen – we’ll be crossing everything for you!

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This week we’re joined by Alice Rose who you may know on Instagram as @thisisalicerose. Alice is a former fertility patient, mum of two, campaigner and a mindset mentor. Alice’s ‘Think not What to Say’ campaign has been a trailblazer within the community, helping to bridge the disconnect between patients and their doctors and help friends and family to communicate better with their loved ones navigating a fertility journey.

On her own fertility journey Alice, who has PCOS, had numerous rounds of treatment, including ovulation induction. Kate explains what happens during ovulation induction. Often it is the first treatment you may be offered, particularly if you’re not ovulating. You may be offered Clomid or letrozole. These medications increase FSH to encourage the ovaries to produce follicles, one of which will mature and be released at ovulation.

In her treatment, Alice responded well to the first round of clomid but was really confused when in the second round she didn’t ovulate at all. Alice talks about not feeling very informed on what to expect during her treatment, including not being aware of the risks associated such as Ovarian Hyperstimulation (OHSS). Following a private consultation, Alice felt more informed and decided to continue with her rounds of clomid but still having varying degrees of response. Alice talks about how she felt as though she had to self-advocate which was hard to do.

We discuss egg quality when it comes to PCOS and long cycles, and how many rounds of ovulation induction you can have – which is generally 6 cycles. Kate discusses taking back control and maintaining a healthy lifestyle to optimise both your fertility and PCOS. Although Alice had been recommended lifestyle changes such as dietary changes, she wasn’t given any guidance on what to do by her doctor until she contact a nutritionist. Alice was also taking back control by working on her mindset and acupuncture which she found so helpful. Sometimes we focus on physical health and our emotional health is the last thing we consider, yet it is vitally important to find good support.

As time went on Alice felt really frustrated about not moving forward in her treatments and after 6 months of clomid, was offered gonadotropins - another type of ovulation induction treatment given by injection. Sadly, this too didn’t result in a pregnancy but happily in the end, Alice conceived her daughter by IVF.

Alice says that going through each round did bring her closer to success in the end. Each part of the experience is not wasted and was very much part of her story. Kate recommends not continuing doing the same thing if you’re not getting results, be your self-advocate and if you’re not responding to treatment go back to your doctor and discuss this.

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This week we are talking about Solo Motherhood with Mel Johnson and Genevieve Roberts, both former guests of the podcast so check out the links to those conversations at the end.

Travelling as a solo mum.

We last spoke to Gen - in Barbados as she’d gone to review a single mum package. Mel travels

with Daisy and has been to Bali, Budapest, done lots around the UK to see friends but she needs it to feel like a holiday, so goes away with people or to see people.

We talked about their decision to become a single Mum. Mel talked about how it took her 3 years to get there, and she spoke about the decision to let go of the fairy tale and how she had to think about the time. She wanted to be in a romcom!

Now she has rewritten her story - she wants loads of people around her and has now bought a house near her family and has people coming and going g and how it doesn’t matter one isn’t a

partner Gen talked about how funny it is looking back on it, now it is your life - she explained how she had her fertility checked, having had a miscarriage about 18 months previously, and assumed it would all be OK. However, her results weren’t good so she quickly made the decision to have treatment and was pregnant within 6 months.

Choosing a sperm donor

Mel had two options from her clinic, so she found the process relatively easy. Mel coaches lots of women who have excel spreadsheets to choose their donors. Mel did speak to her

family about it but she had already chosen. Mel says she tells people all the time how you have to view choosing a sperm donor very differently to how you went about dating online

Gen has more choices and actually enlisted her Italian flatmate to get involved. She said it did feel a bit like a dating website, which made it feel weird. You aren’t looking for a Dad you are looking for

someone to pass on their genetics.

The decision to have 1 or two children

Gen talks about how she was incredibly fortunate to have both and how having a strong sibling relationship with her brother, she felt very open to the idea of siblings from the start.

Mel talks about how her fairytale was two children, yet the practicalities are a challenge as she would love more children. She does has an embryo still left and she can’t come to terms with

the fact that she isn’t going to have another child. She talks about how she doesn’t think she could manage with two and that realistically it would make her life really difficult and she is wary of

getting caught in the loop of ‘if she was in a relationship she would have tried for a second’. Gen explains how having the two kids has meant she hasn’t been able to sort out toys for two

years whereas Mel is a very tidy person and how it impacts her mental health if she doesn’t have a tidy house. But you can’t do everything - like she doesn’t bath Daisy every night

Tips

From the minute you start to consider solo mothers hood - start saving, even if it’s an inkling of an idea as it’s really expensive. The treatment and then you are the only provider so get your finances

in order. A lot of solo mums are strong women and you need to explore being a bit more vulnerable women and you need to feel OK to ask for help. Mel instinctively said no to an offer of help whilst

struggling with a heavy piece of furniture in the Ikea carpark! Previously Gen was a people pleaser and now she says she is more focused.

She talks about being more confident and also the importance of working out your priorities

Have support as back up and have a plan b.

Fears

Mel has coached more than 200 women and the themes she hears are that you will never meet anyone and you are signing up to be single

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This week we welcome Laura Rose Thorogood to the show. Laura is the founder of the LBGT Mummies Tribe, an LBGT+ activist, a lesbian mother of two by IUI, and is currently pregnant again after 5 rounds of fertility treatment.

Laura’s organization supports, celebrates, and reunites the LGBT community on their path to parenthood providing information and guidance on whichever route you choose to create your family.

Laura has had a crazy few weeks of awareness days and months and is balancing this with being 35 weeks pregnant. Laura and her wife started creating their family 10 years ago. They have two children and another on the way, all from the same sperm donor from a US clinic. They’ve both carried children and have navigated failed rounds, PCOS, low ovarian reserve, and, most recently the pandemic, to get to where they are now.

Laura talks about the common pitfalls that the LGBT+ community might face, particularly that they often come to trying to conceive later in life and often don’t consider this and the benefits, for example of preserving their fertility if they’re not ready to start a family until later. Also, the importance of researching the legalities so that all parties in the triangle are covered. Some couples find private fertility treatments inaccessible and may choose to seek a known donor. Laura explains the importance of seeking legal guidance and whilst there are financial implications involved, it is likely to be less costly than should there be any legal challenges in the future.

Laura explains the difference in access to information from sperm back nationally and internationally. In the US and Europe, you have access to more information about the donor whereas in the UK the information is limited to height, hair color, nationality, etc. Sometimes the difficulties in accessing sperm donors in the UK will force couples to use unregulated donors and in some circumstances, this can be dangerous. However, there are organizations such as CoParents and Pride Angle that are regulated and offer a professional service.

The LGBT Mummies Tribe is a central point for information and guidance on starting a family but is also a supportive community to bring other LBGT+ families together. They have a private support group but also get together in person (when the Pandemic allows) for meet-ups.

Laura talks about her interaction with medical services and the microaggression she’s experienced. How, as a lesbian woman, you have to ‘come out’ time and time again. Comments like ‘Who had the baby?’ ‘How did that work then?’ ‘So, you’re the other Mother’.

Natalie asks Laura about the guidance she offers on talking to children to help them understand the make-up of their family. It’s about sitting down as a couple and deciding on how best you address this. It’s very individual and personal, but best done at various age-appropriate sections of their lives.

Laura tells us how the healthcare arena is very heteronormative and the main area where she sees disparity and lack of inclusivity. She hopes that they can one day get to a place where campaigning is not required but is currently working with the NHS and Government to support them in understanding the community better, dispel the stigma and discrimination against them, and ‘usualise’ – making LGBT families visible and the everyday. Laura talks about how she can understand how confusing it is for the heteronormative community and that the LGBT community needs help in the education so that they are better supported. Laura says the NHS and the fertility clinics she’s working with have been proactive in changing for the better.

Laura’s final advice is to take your time, explore all paths to parenthood, join support groups, research, listen to other people's lived-in experiences, and investigated how LGBT inclusive your narrowed down choice of clinics are.

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In this week’s episode we are discussing miscarriage and loss,so before we go any further we are putting a trigger warning firmly in place here.

If you’re not feeling strong today, then maybe wait and listen another day, or make sure you have lots of support around you as our guest does go into detail of her own loss. Please know, you can always reach out to us on our socials if you need a bit of extra support and please do also have a look at our previous miscarriage series on The Fertility Podcast website where we detail more information about the support available.

We start off by chatting about the developments around the world when it comes to miscarriage policy. New Zealand is the second country in the world to provide women and their partners with 3 days of paid leave following a miscarriage or stillbirth, which is amazing! Interestingly, India was the first country to support couples in this way. Let’s hope this is the start of more countries following suit!

You may well have seen that Tommy’s have published the results of their survey with fascinating and shocking stats including the link between depression and miscarriage.

Our episode starts with a snippet from a previous conversation we had previously with Dr. Ingrid Granne – researcher and associate professor in reproductive medicine at Oxford University Hospitals NHS Foundation Trust.

We asked Ingrid why miscarriage happens. She tells us that the most common cause of miscarriage is due to chromosomal problems in the early days and weeks following conception. Chromosome issues are heavily correlated with maternal age. If you’re in your 20’s you have a 1:10 chance of miscarriage but by 45yrs it's 1:2 risk of a miscarriage. Other causes are medical conditions such as uncontrolled diabetes and thyroid issues. Being overweight increases your risk but we don’t really understand why. There also seem to be some genetic factors that may predispose some women to miscarriage. There are also implantation factors, possibly related to hormones and immune factors. 

Natalie asks Ingrid about malefactors. She says that paternal age can impact miscarriage risk but not to the same extent as maternal age. She goes on to explain that the DNA of the sperm can also impact. There is more and more information and research coming out with regards to male factors and DNA fragmentation.

Next up we chat to Jessica Zucker – a psychologist who specializes in reproductive and maternal mental health. She is the founder of ‘I had a miscarriage campaign’ and has just released a book too. Welcome to Jessica! 

Jessica focuses on the mental health impact of suffering from a miscarriage. Jessica shares her experience of miscarrying at 16 weeks. A traumatic experience that occurred whilst alone at home and transformed both her professional and personal life. She talks about her ‘failure to allow herself to fall apart. She miscarried on a Thursday and assumed that she would be right back at work on Monday. Jessica says that the failure to allow yourself to fall apart is, in part, survival instinct. Just to keep going. She says she at that time, she couldn’t allow herself to slow down as this would mean being closer to her pain.

Professionally, having her miscarriage, showed Jessica just how much she didn’t understand about the emotions her patients would be going through and that this was incredibly enlightening.

Next, we talk about sex and miscarriage. Sex can be the last thing you want to think about following a miscarriage. How do you regain that intimacy with your partner? Jessica has interviewed people about returning to... 

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This episode focuses on the impact fertility has on your emotional health and we’re delighted to have Abbie and Karen from Fertility Circle join us on the podcast.

Abbie tells us how she searched for fertility support when she was trying to conceive 7 years ago and how she felt completely lost. Tragically Abbie made some poor decisions on where she looked for support that has impacted her health for the long term. The same was for Karen, in that she didn’t know where to access support and for these reasons, this is why Abbie and Karen felt motivated to start Fertility Circle.

It’s also important to Abbie and Karen to provide women with the right expert advice and information across the whole spectrum which includes both the physical and emotional aspects. As Abbie and Karen are both now trying for their second babies, they both feel so much more empowered and informed to make the right decisions.

Karen talks about the forced break women have had during the pandemic and how it’s been an opportunity to reset and

At the time of recording, the Fertility Circle app has had over 5,000 downloads! Abbie explains that they want women to feel that Fertility Circle is their best friend when trying to conceive but with all the fertility smarts. The app provides a community to connect with peers, a platform to connect with experts, content to inform, inspire and empower and finally offering the very best in emotional wellbeing and support.

The app also includes a section on learning, the ability to watch events and tutorials, live events, ask the expert, offers, and planning to support fertility wellness and IVF.

As many of our guests start a fertility business when trying to conceive, it can be a challenge. Karen talks about the potential triggers she comes across on social media for example but with that comes the immense support from the community. Abbie says that stepping back and taking a break when you need to, is vital in enabling her to carry on supporting their community.

We talk about the amazing friendships that are made within the fertility community, especially when all around you, your friends and family are getting pregnant easily! Abbie and Karen met this way, and even Natalie and Kate met through both working in this space! Natalie is now taking on more clients teaching the Freedom Fertility Formula and if you want to learn more about how Natalie can support you with your mental health click here

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So what is Secondary care and what should you expect to happen?

Well, we want to make sure you understand this, as we don't want you to get to the end of the year and find there is actually a problem because you have been dismissed along the way. 

There are better tests that can’t be done in Secondary Care that can’t be done in Primary Care, which means at the GP and we've discussed them with our resident expert Dr James Nicopollus.

Seeing a gynecologist:

One with a special interest in fertility is key. Women often go to a fertility specialist later, because there is often a delay in referral from GP to Secondary care and then there can be a delay from Secondary Care to IVF. This has been heightened by the Pandemic.

Ideally referrals should happen through the NHS - should come from the GP to a fertility center.

What happens at the referral?

Clinics are trying to do a one-stop-shop. People will have done a semen analysis but will be asked for a report to make sure it is accurate.

GP’s will have tested FSH to check egg reserve and whilst this is OK, it varies between months as well as other variables.

The AMH test is more reliable, as it shows the more follicles you have which is better fertility indicator.

Tubal Patency checks tubes

Important to rule out pelvic issues such as thyroid, polyps, or endometrioma which might impact the outcome.

 If sperm and egg reserve is OK, are you ovulating regularly, with a progesterone check if you haven’t had one?

 Laparoscopy looks inside the tummy with a camera, however, this is done by general anesthetic and this is more likely if there are symptoms of endometriosis

 Most people have a HyCoSy or HSG - inserting dye to screen the fallopian tubes

STI’s such as chlamydia can be silent so these tests are important to exclude them

A complicated appendix procedure could have caused adhesions or any other significant pelvic surgery can cause issues.If there is any suggestion of painful intercourse or painful periods this should be done.

Next, if these tests are clear, in the absence of sub-fertility then an assessment of Sperm DNA fragmentation is needed which looks at the sperm genetic material which can impact natural fertility, IUI, IVF, and ICSI.

Urologists are still not working as much with clinics as they should be

If all these tests are inconclusive and all investigations have been done and you don’t have a diagnosis and you keep trying and it isn’t happening, then the next stage is to go to the fertility clinic for fertility treatment. You should then have your options explained: Continuing naturally, IUI, IVF with the success rates explained 

A lot of people are often well informed, other times incorrectly by Dr. Google, which is why we want to always guide you. The reason people's experiences vary so much in terms of the tests they get access too, is because different clinics and trusts offer different services, and the Doctors in clinics might not map things out correctly. There might also be limitations in funding.

These are all ways in which you might feel you aren’t being guided properly and this is why it is important to become a fertility advocate.

You should always go into a consultation with a list of questions and never feel you shouldn’t ask them.

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In this episode, we’re focusing on Male Infertility which is still not understood well enough and it’s something Natalie has been passionate about giving a voice too. As it was her and her husband’s experience and the pair felt very unsupported when going through treatment. Since its launched The Fertility Podcast has shared numerous episodes about Male Fertility explaining the issues that affect sperm health and also explaining how Men can seek more support and investigation.

Men are often overlooked in conversations with medical professionals and we have had numerous conversations about men feeling ignored at the fertility clinic, the very fact that when it comes to IVF treatment in a heterosexual relationship is it is the woman who has to go through the procedure means men are often left to feel redundant. In the many conversations we’ve had with Men, they have talked about the shame and guilt they have felt if the issue has been a male factor and how many men struggle in silence.

Kate and Natalie discuss the factors that can affect male fertility, such as diet and lifestyle issues. Smoking and drugs are a real no-no for sperm health. It’s really important that alcohol is taken into needs to be taken into consideration and ideally should be limited but not stopped. Factors such as heat and stress can impact. So consider saunas, heated seats, mobile phones in pockets, laptops on laps as important things to think about. Plus wearing tight pants and trousers can also be restrictive for the wrong reasons. When it comes to health and wellbeing, environmental toxins can impact sperm health and there is a real argument against Protein shakes and steroids impact which can you find out more here in this great conversation with Professor Allan Pacey thanks to our friends at Dr. Fertility

Our guest is Kevin Button who talked about his decision to set up The Man Cave to talk about mental health and male Infertility about 3 years ago after losing his cousin to suicide unrelated to fertility. Personally, Kev has had two failed attempts with NHS funding - IVF and ICSI and he couldn’t find anything online and has learned more from being on Instagram than just googling.

Kev’s diagnosis is Non-Obstructive Azoospermia which is defined as no sperm in the ejaculate due to failure of spermatogenesis and is the most severe form of male infertility. He had to undergo a micro-tease ( sperm extraction( which didn’t work and Kev was told his options were sperm donor or adoption.

You can imagine how heartbreaking this was for him and he was told the news without any support which was part of his motivation for setting up what he has done. Kev explained how when he was younger and out dating, he’d end relationships as soon as the conversation moved on to having a family until he met his partner Nicky, who at first he tried to end things, but luckily the pair are still together.

Kev is part of Fertility Network’s Male Fertility as an Ambassador and we spoke about the new HIM campaign and the brilliant Rhod Gilbert documentary’ Stand up to Infertility’

All too often Men won’t talk about this but they are finding their voice within support groups. We also discussed the brilliant Easy Bit documentary which you can find links to more information below;

Kev and Nicky won a competition to have treatment in California with California IVF and are waiting for current

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