The Fertility Podcast

Frankie Brunker – These Precious Little People

Please be warned that this weeks’ episode is a hard-hitting and emotional one. It is a raw and emotional account of stillbirth and the grief that follows.

Natalie chats with Frankie Brunker, whom Natalie met at a fabulous Yoga day put on by Lucy from The Rainbow Running club.

Route to Parenthood

Frankie’s route to parenthood started really quickly after conceiving in the first month of trying however, devastatingly their daughter was born stillborn at 38 weeks. This came as a complete shock.

Frankie’s husband had to call their family from the hospital to break the news. Frankie felt so concerned about telling family and how they would feel, particularly her nieces and nephews who were excited about a new baby coming into the family. They decided that they needed to be insular and in their own little bubble to get through this difficult time, one day at a time.

The Funeral 

Frankie made the decision for her nieces and nephews not to attend the funeral of their daughter. At the time, this felt like the right decision but now Frankie has some regrets and is now mindful that not being included may make it more difficult for children, in general, to deal with grief.

Experiencing a Stillbirth

Frankie talks about her experience of giving birth at the hospital and how she felt that some of the midwives had limited experience of caring for a mother delivering a stillborn baby, and that she felt there were gaps in the bereavement care she and her husband received.

Frankie’s honest account of the, sometimes insensitive and ignorant, remarks she has received along the way is powerful and arresting

Precious Little People 

As a result of her experience, Frankie is now the author of a beautiful children’s book to help explain baby loss to children but also Frankie says the book helps adults to come to terms with grief too. Her aim for the book is that you can talk about loss of your baby but that you can still think of them and smile. Her book aims to appeals to bereaved parents from diverse communities and cultures.

Blogging as a bereaved parent 

Frankie has recently written a blog giving support to bereaved parents who may be finding it especially difficult going through this experience during lockdown, and urges people to reach out for support.

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Welcome to another ‘Meet the Makers’ episode where we chat to Louise Zeniou from Cradle. When we spoke to Louise, she had been having a busy few days with various media interviews, and in-between her busy schedule she managed to sneak in an interview with us whilst sat on the floor outside the toilets in Pret!

Louise has a personal experience of what it feels like to go through early pregnancy loss when she became ill and diagnosed with an ectopic pregnancy. As she was so ill, she was rushed into hospital and had surgery immediately. She talks about the amazing care she received, but after surgery she missed the most basic of items such as a toothbrush and a hairbrush.

The Comfort Bag

From her own experience Louise started the Comfort Bag Project with the aim to support hospitals, so that in those early moments of pregnancy loss women and men can be provided with toiletries and other products to give them a little comfort and importantly dignity. In the bag Louise also includes a personal message to give immediate words of comfort following a loss and the ways bereaved parents can connect for support once they have been discharged from hospital.

How Cradle Supports the NHS

Cradle provides Comfort Bags to various hospitals across the country and it’s growing! From just starting out as one, Louise now has 73 volunteer ambassadors. Cradle also work with Hospital Trusts as the patient voice to help in the development of services and projects for bereaved parents.

Signposting

The role of Cradle is also to signpost to various support and counselling services to offer parents much needed professional support.

Want to get involved?

Contact Louise for information on how you can become an ambassador for Cradle.

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Meet Katy Leeson, Managing Director of Social Chain who also hosts a podcast called 'I Shouldn't Say This But' and at the time of us chatting had just been nominated for an award for 'Leading the Charge and Pushing the Boundaries' with Campaign Magazine ( a big industry title ) I spoke with Katy in real life at Social Chain's very cool office in central Manchester, in the days where you could do that, which is why Kate isn't in this episode. 

Self Protection

Katy spoke about her struggle with the responsibility of being a young female Managing Director. She had imposter syndrome and took herself into therapy sessions to get support on how best to deal with it. In the context of this chat, Katy explained how she made sure she was mentally prepared to talk about her miscarriage in the public sphere because she had no idea what the reaction would be and she was nervous that people would tell her it wasn't the right place or platform - something so many people fear when talking about infertility. 

Baby Loss Awareness Week

Katy shared her story in October 2019, a year on from her miscarriage which happened in December 2018. She spoke about the challenges of that time of year with everybody being together and how it forced her into telling people that I was pregnant, as she wasn't drinking in the Chrimbo celebrations - this was before the '12 week' point. Her family and friends knew and so she also had to share her that she had miscarried on Christmas Eve because she didn't want to get messages wishing her the best Christmas and New Year because I was going to have a baby in the next year. Katy talked about feeling that she was also ruining other people's Christmas because I'd tell them such sad news.

Miscarrying Naturally Katy spoke about how she miscarried naturally the day before she was due to be put under for the operation. The first the scan she had, she said felt a good connection to someone who really cared and she said 'You look healthy, everything there on the scan looks healthy, you've just started an unfortunate experience, there was just a problem with that egg or that sperm, and you should be fine and I can't wait to see you again' which Katy said gave her such hope as every other interaction she had, felt like she was just being told to get on with things. 

Breakdown in Communication.

Katy explained how she was still getting letters about having scans for her pregnancy after she had miscarried due to being registered with two different hospitals and how they were ringing her partner but wouldn't speak to him so he couldn't even act as her gatekeeper for. This meant in the end, she had to have numerous conversations reliving her experience over and over/

Telling Work

Katy talked about how she had spoken to others about how much of a lift it is, to be told it's not your fault, which is such a straightforward piece of information to give to somebody. We talked about how she had no follow up conversations after going through it and wasn't given any guidance on where to find support. She had stopped her therapy and hadn't told her work as she didn't want to tell them she was going through 'something so horrific' because she was worried they would think she would then be trying again and be off on Maternity. So she didn't tell anyone and struggled with it from Christmas until Easter - which is when she said the broke down. When she did tell them, they were amazing 

Talking it through in Therapy

Katy discussed the grieving process with her therapist and how she had been putting so much pressure on herself with her work and doing the right thing by others. She talked about giving herself permission to grieve once she had accessed support once again. She also talked about how she went to the doctors and was given antidepressants, which she is still on

The Impact of Miscarriage

We talked about how misunderstood... 

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In this bonus episode,Kate and I speak with  Sally Cheshire, who is the chair of the Human Fertilisation and Embryology Authority (HFEA) 

These shownotes are a transcript of part of our conversation with Sally. Please listen to hear the full interview:

What is 'elective treatment' 

It is the word that the NHS use when it's not an outright emergency. So the NHS made that decision. And it's an unfortunate name because no one chooses to go in for surgery, particularly with regard to fertility treatment, but that's the word that's been used. 

So the NHS said that they would suspend all non-emergency treatment during the pandemic, so the only people who were being treated in the first stages of the pandemic after the 23rd of March, that was, were people who were in an emergency situation.

What we said in terms of fertility is that patients who were having cancer surgery, for example, and needed fertility preservation would still be allowed to go ahead and our clinics would stay open for those patients to store gametes and embryos. But also, we would allow as many patients as possible to try and finish their cycles if they had started. And we know that there was a different response from clinics, and you can imagine that they were trying to manage, as well as all other NHS hospitals, some clinics carried on with those cycles, and then collected eggs or frozen eggs or embryos. But some patients we know had their cycles cancelled earlier than the 15th of April. And all I have to say is it was up to the clinic to decide whether they could go ahead. Some of them of course, had already lost staff to the front line. They'd had some of their equipment used for testing for virus testing from the embryology lab, and some of them also had staff who were self isolating or who've been diagnosed.

Counselling:

We do know there's been a massive increase in patients seeking counselling support. But if you actually talk to counsellors, some patients are asking different questions. Some of them are clearly distressed, not being able to have treatment. Some of them are very fearful of the virus and what impact it might have. So counsellors tell us they've seen an increase in patients who were just seeking help to deal with their general anxiety, not necessarily ready to talk about the implications of their particular treatment and what that might mean. So we do know that there is support out there and I'm sorry to patients who didn't quite get what they wanted, perhaps from their clinic.

Professional Guidance:

We've had to rely on professional guidance. So from the UK bodies from the British fertility society and of and the clinical scientists, but also from Europe and America, who advised similarly to stop treatment, until we knew a few more things, and their guidance has been very similar to the UK all along. And the Royal College of Obstetricians and gynaecologists also had to think about whether they considered there was any risk in early pregnancy. And they've also issued a couple of sets of guidance. So I think everybody has issued at least two sets of guidance over the last four weeks from the professional bodies. We've issued a number of letters to clinics explaining our requirements. And we've also tried to communicate with patients as best we can.

The professional bodies have issued their latest guidance, which is cautious optimism.

Tough Decision:

I think this is the most difficult decision the FDA has ever had to make in 30 years really and the board and the staff have tried so hard to get it right. One of one of our criteria, quite rightly, was that there was no, or that there was as much evidence as possible to say there was no increased risk in pregnancy. And when I was thinking about it this morning, as a patient, you know, pregnancy is somewhere over the rainbow, isn't it? It's a long, long time away. And if you are trying to think about having treatment, it's probably not even possible in... 

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Welcome to this bonus episode of The Fertility Podcast in association with Medichecks, the home blood-testing company. 

Medichecks have started working with the wonderful Kate Davies, aka my co-host to develop a range of fertility tests and they invited me to their headquarters in Nottingham to talk more about them. So I headed back to my home town with brand new podcasting kit to chat with Sam Rogers, Medical Director and Natasha Fernando. Head of Clinical Excellence and Kate about what the tests are going to enable you to find out. 

What you will hear in this episode is:  

How the tests were developed looking at which biomarkers people need to understand their fertility and the training for Medichecks doctors in how they process them

How Medichecks will look at people’s medical histories, lifestyle, diet, activity and energy levels and tie in with the info they glean from blood tests.

How repeat customers are getting much more informed about how behaviours affect their lifestyle and how home testing means you don't have to wait until you are over 40 (which is when the NHS do overall health checks ) 

Baseline Fertility Tests 

FSH & LH Levels: these control periods and time of ovulation, levels of Oestradiol - the main female hormone which shows if you are ovulating

Progesterone: 7 days before the first day of a period. This can be called the 21-day test. Kate explains how she sometimes gets two tests during that time

AMH: and how it gives an indicator as it is a useful measurement but is no means a guarantee of a baby. A lower test result shouldn't cause panic, just talk to your doctor, look at your baseline hormone levels. 

PCOS: looks at an initial diagnosis PCOS test as well as looking at the more long term effects

For Men: 

Testosterone: looking at the hormones that control testosterone release as the body it likes to hold on to it. We also discussed the impact on male fertility from using protein shakes and steroids and how you get irreversible, low levels of fertility or infertility as a result. We also discussed tight pants!

Advice for Men 

To limit alcohol and coffee and how smoking is so bad for developing sperm.

Exercise - we discuss how too little or too much can have negative effects on sperm production. We also discussed Jonathan Ramsey - a Urologist and former podcast guest who has talked about how cycling for commuting is OK, but long rides put a lot of pressure on the testicles. Hear a previous chat with Jonathan here 

We discussed the importance of avoiding hot tubs, heated car warmers, and Natasha talked about papers on mobile phone radiation in pockets.

Erectile Disfunction

An early sign that the blood vessels are getting clogged up with cholesterol. Testosterone can also cause it as can the stress and pressures of TTC.

 Diet

Overall benefits of eating a health diet, which can help the balance of your hormones. We discuss what oxidative stress levels are and how you can manage them. 

The benefits of plant based diet and how a Vegan lifestyle - has no impact on testosterone levels. There is a belief amongst Men that a plant-based diet lowers testosterone but there is no evidence available

 Sleep 

The importance of sleep and how many health factors it can impact

How to future proof your fertility

Be proactive in the conversations you have with your family. For example, ask your mother when she had her menopause. With Men, don't be afraid to talk to your doctor if you have any pains in your testicles.  Any concerns you... 

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Meet Janet Murray. Janet is a digital content expert, author, and fellow podcaster. Earlier in the year Janet shared an article about secondary infertility and we wanted to talk to her about this and her experiences of miscarriage and ectopic pregnancy.

Fertility Struggle

Janet struggled with infertility and after routine tests, she was diagnosed with autoimmune hepatitis. Treatment ensued and shortly after her diagnosis, Janet fell pregnant. Sadly this pregnancy ended in a miscarriage, and Janet, who is normally a very pragmatic person, felt completely floored. However, she did fall pregnant again but this pregnancy was thwarted by anxiety and at 29 weeks Janet went into early labor. Luckily after time in neonatal intensive care, Janet was able to bring home her daughter Katie. Very soon after, Janet was surprised to find she was pregnant again. Unfortunately, this pregnancy ended in an ectopic pregnancy and Janet was told that she would be unlikely to conceive again.

The loneliness of the first 12 weeks

Janet shares her thoughts on how difficult it is to reach out for support for after an early miscarriage, as it’s almost taboo to talk about your pregnancy until after the 12-week point.

I have an excuse to talk

Secondary infertility is frequently dismissed by society. Over the last 5 years, Janet has run five London Marathons to raise money for The Miscarriage Association and the Ectopic Pregnancy Trust and she feels this has given her an excuse to talk about miscarriage and ectopic pregnancy in a public space.

"At least you have one

Janet felt that friends didn’t understand her desire to have another child and a sibling for her daughter. Because she was career-focused people always assumed that Janet only wanted to have one child out of choice. In her article (above) Janet talks about the agony of not being able to have a sibling for Katie.

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It was a bleak and dreary day.. .Kate and I connected with Eleanor Stevenson, Professor of Nursing from Duke University, North Carolina USA and Kevin McEleny, Consultant Urologist at Newcastle Upon Tyne Hospitals NHS Trust to discuss a brilliant new initiative to support men struggling with infertility.

Together Kevin and Eleanor have created All about fertility an evidence-based resource providing couples with up to date articles, webinars and videos created by experts from the field of fertility. But they didn’t want to just stop there. From their research Kevin and Eleanor identified that men didn’t want to engage with support from counsellors and so they created a support forum just for men to access support in a way that was accessible to them and on their terms.

Peer Support 

In the future, Kevin and Eleanor hope to roll out other versions of this platform to include support forums for same-sex couples and women. In the US, Eleanor is seeing that professionals are becoming more aware of male fertility but as yet, US men aren’t opening up. Whereas conversely, in the UK men are beginning to talk and there are a number of men that are leading the way, some of who have been recent guests on the podcast.

Educating medical professionals

Kevin talks about the need for greater awareness and sensitivity among professionals. The evidence that has come out of their research shows that what men are told at the very start can have enormous consequences on their emotional wellbeing. Eleanor tells us that while men continue to feel that their problems are not real. It reinforces stigma and men get further silenced.

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https://all-about-fertility.com/

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Kevin on twitter 

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Kevin’s previous episode on The Fertility Podcast 

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In this special episode, we wanted to address some of your questions and concerns with regards to coronavirus and what this means for your fertility treatments.

So over the next few weeks, we’re bringing in the experts!  First up we chat with Julie Morgan, who like Kate, is a Fertility Nurse Consultant. Julie has been keeping the TTC community up to date by sharing really useful information and updates on her instagram @allaboutinfertility

• Not all clinics are routinely cancelling treatments.
• Please check with your clinic to find out what their up to date guidance is.
• Don’t stop any medication until you have spoken with your clinic.
• Clinics are open currently and are here to help and advise you during this difficult time.
• Egg collection does appear to still be going ahead in many cases.
• To help with social distancing, clinics will be operating slightly differently with phone and video consultations, and face-to-face appointments may be staggered.
• If you are undergoing a stimulation cycle it is likely (although not in all circumstances) that you will be able to continue with your cycle.
• If you are newly pregnant it is advised that you self isolate but speak with your clinic for further advice.
• Clinics who offer egg donation have been advised that patients must not donate if they have recently visited a high-risk country, and must wait for a minimum of 28 days if infected with coronavirus or after being in contact with someone with coronavirus before donating.
• If you are having treatment abroad, please contact your clinic for further advice and self isolate if required.
• If you are self-funding your treatment and are required to freeze embryos in what would have been a fresh cycle, it may be that your clinic will not charge you for storage fees. However, there may be costs associated with repeat tests etc on restarting treatment again in a few months.

Please bear in mind that we recorded this interview last Friday, and in this ever-changing and dynamic world, it is likely that there may be more recent updates available. Please do check with your clinic for the most up to date information for your individual circumstance.

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Covid-19 and fertility treatments

We appreciate given the current crisis you may well be worrying about what covid-19 means for your fertility treatments, and therefore at the beginning of this episode, we give you an update on the current advice.

At the moment, there is limited guidance out there, however, this will likely change in the coming days/weeks. Currently, the HFEA recommends that you contact your clinic for advice as each clinic will likely have contingency plans in place. We plan to chat with experts this coming week and will, of course, keep you informed of any developments that relate to fertility treatments.

If you are required to self-isolate over the coming weeks, then you can be reassured that The Fertility Podcast will be keeping you entertained. So, make sure you subscribe so as not to miss an episode!

Parenthood in Mind

Next up, Natalie and Kate talk to Julianne Boutaleb, a peri-natal psychologist, Clinical Director, and Founder of the Parenthood in Mind practice. Julianne works with women and couples who have experienced trauma in relation to birth and miscarriage but also with women who suffer from fertility trauma.

• Typical patients that Julianne works with are couples who have concerns with regard to known genetic issues, couples who are facing assisted conception, couples who have had failed cycles or reproductive injuries, and those contemplating donor conception, surrogacy, or adoption to create or complete their family.
• Many couples who have previously experienced miscarriage come to Julianne as they have a fear – either physically or emotionally of a miscarriage reoccurring.

Tokophobia

• Tokophobia is the fear of being pregnant or giving birth. Tokophobia may occur in women who have never given birth to a child, but it may also affect women who have had prior traumatic pregnancies or birth experiences.

Protecting your relationship

• Couples who don’t conceive are 3 times more likely to separate or divorce than couples who do conceive.
• Clinics are starting to support couples more with regard to the emotional impact
• Often reaching menopause can be a trigger for women who haven’t been successful in conceiving through assisted conception.
• Julianne helps couples rewrite their ‘happy ever after’ story without children.

Fertility Trauma*

• The term Fertility Trauma helps to highlight that struggling to conceive is a real trauma and this also includes ‘perceived’ trauma.
• Fertility trauma is not just depression, anxiety, or stress but is your brain going into ‘fight and flight’ mode.

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Julianne Boutaleb 

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Jessica Hepburn 

Unfortunately, since recording this episode, Jessica’s Pond to Peak Challenge and her ascent of Everest has been canceled due to Covid-19 but she will hopefully be making this journey next year!

Natalie Silverman 

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 Kate Davies 

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*

Fertility Trauma explanation

The term ‘reproductive trauma’ was first coined by perinatal psychiatrist Dr. Janet Jaffe... 

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We all spend A LOT of our time at our place of work of if you freelance, you possibly spend time in and out of workplaces.

However it manifests, if you are working it takes up a lot of your time. So when it comes to trying to conceive and struggling - the one thing you really need in place is a supportive workplace. 

Sadly, this often isn't the case, which is why Natalie has teamed up with two brilliant ladies Becky Kearns and Claire Ingle to create Fertility Matters at work. 

This episode may seem a big self-indulgent as Natalie interviews Becky and Claire, her partners in crime at Fertility Matters At Work, but please do indulge us just this once as we are on a mission. 

One step at a time we are looking to change how fertility issues are addressed in the workplace.

The motivation behind Fertility Matters At Work

Becky has a background in HR but also experienced fertility treatments and a miscarriage whilst holding down a job and strongly felt that so many things could have been done differently. Becky hears from other women just how stressful it is for women going through fertility treatments and how they have felt that they’ve not been able to speak out, feeling misunderstood and unsupported in the workplace. Becky recently featured in the latest video from Ferring Pharmaceuticals talking about one encounter she had with her boss which you can watch here 

Claire also has an HR background and felt that she ‘bumbled’ through her IVF treatment, working around appointments and trying not to inconvenience her place of work. This caused Claire so much anxiety and stress and she felt she couldn’t manage both her job and her fertility treatments. Like Becky, Claire felt this could have been handled so differently. Claire also felt that the policy in her workplace was lacking. Natalie met Claire through a mutual friend as Claire was already running a survey on her instagram called IVF at Work 

Support in the workplace

Natalie shared her experience of not knowing who she could turn to for advice and support within her workplace. Both Becky and Claire noticed that while they were working in HR never once did an employee came to them for support or to understand what they were entitled to. Employees are worried about how they are going to be perceived for openly admitting that they are trying for a baby, and there is the assumption that women who are trying to conceive are not as committed.

Advice to employers and employees

Together they are hoping that they can increase the conversations and narrative surrounding what needs to be thought about from employers and an employees perspective. They have already found that they are getting a huge response on social media and have started gathering examples to use this to inform employers about the issues that women are facing.

Natalie, Becky and Claire want to be able to offer advice and tips to empower women to start conversations and challenge their employers to change current policies and strategy. However, they also hope to be able to support employers to aid retention of the workforce and understanding what their generation of workers need.

Changing policies

All organisations will differ on how easily and quickly they can change policy. Natalie, Becky and Claire hope to be able to offer employers assistance with the development and implementation of these policies.

Socials:

Fertility Matters at Work on Insta

Get in touch via email with your positive or negative experience, we're also looking for you to share a 1-2 minute video of why... 

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