Vaginal Microbiome testing is gathering rather a lot of attention in the reproductive medicine field and for all the right reasons! The latest research shows that a healthy microbiota is essential for implantation success and a healthy ongoing pregnancy. Yet it’s unlikely you’ll hear your UK IVF consultant offering you such a test.

Once again I’m afraid we’re behind the times when it comes to relevant diagnostics before embarking on your IVF cycles. But clinics abroad are now running these tests as standard due to the overwhelming evidence supporting their use in aiding a healthy microbiome prior to planning a pregnancy. 

As you know, we always aim to remain ahead of the curve so that we may bridge the gap between the diagnostics patients are offered abroad and those that they are afforded here. So, we’ve been offering vaginal microbiome tests for several months now and we’ve seen some pretty remarkable things. So much so that we are now recommending these tests as standard to all our patients. Let me tell you about it…

A study from October 2023 analysed the evidence to date and what it confirmed is that, basically, vaginas and babies alike love Lactobacillus. It likes all the flavours - gasseri, iners, jensenii - but the one it likes the most when it comes to cooking up a baby is crispatus.

“Non-Lactobacillus-dominated vaginal microbiota has been associated with poor gynecologic health and complications during pregnancy. Lactobacilli and especially Lactobacillus crispatus associate with good reproductive health and dominate the microbiota during healthy pregnancy.” (Väinämö, 2023)

L. crispatus has been shown to be so fundamentally important for a healthy pregnancy that some scientists in the field of reproductive medicine (Koedooder et al) developed an algorithm to predict the success of a woman’s first IVF/Embryo Transfer based on the relative abundance of L. crispatus prior to transfer. (Väinämö, 2023)

“L. crispatus was the most abundant species in the vaginal samples of women who achieved clinical pregnancy and live birth, compared to women with no pregnancy or live births (43.3% vs 23.1%, q = 0.017).” “And of the healthy pregnancies. L. crispatus (76.2%) dominated all early pregnancy samples.” (Väinämö, 2023)

Ok, so I think we get it… L. crispatus is a big frickin deal in the fertility game. But what about the other guys? 

There are various other types of bacteria that have been shown to negatively affect implantation and pregnancy outcome. The key players are those associated with bacterial vaginosis (Prevotella bivia, garnderella vaginalis, atopobium vaginae), Strep B and E. Coli. 

“In the non-pregnancy group, P. bivia and Streptococcus anginosus were more prevalent and abundant” (Väinämö, 2023)

“Ralph et al. indicated when BV is identified before 16 weeks of gestation, the highest rates of preterm labor was detected, and BV was responsible for twofold risk of miscarriage in the first trimester. Similar to these results, Ugwumadu et al. found threefold increase in the risk of miscarriage in the first trimester.” (Işik et al, 2016)

E. Coli in pregnancy can be responsible for preterm rupture of the membranes (waters breaking), preterm delivery, or stillbirth in severe cases. It can also cause a low birth weight (weighing less than 5 pounds, 8 ounces) and sepsis in pregnancy. (NIH, 2023)

Therefore we feel it’s incredibly important that our patients take us up on our recommendation of vaginal microbiome testing and we are now offering this as standard, regardless of whether you may have symptoms of BV or otherwise. We are certainly seeing from the women we have tested that there are a good number of patients showing to have a high prevalence of bacterias associated with BV but who are asymptomatic (not showing symptoms). 

Another important point to mention is that some of these bacterias are considered sexually transmissible and therefore we can assume your partner is also infected and so the bacteria is happily passing between you. This is why it is important that both couples are treated at the same time and barrier method contraception is used prior to and during treatment.
 
And it’s not just female fertility that is affected by certain bacteria. Women with a high prevalence of ureaplasma or mycoplasma will be passing this bacteria to their partners. 

“Ureaplasma spp. has been identified as an etiology of male infertility since 1967. Friberg and Gnarpe demonstrated a higher frequency of Ureaplasma spp. isolated from the semen of men with unexplained infertility (76%) compared with fertile men (19%). Since then the relationship between Ureaplasma spp. infection and male infertility has been studied widely.”

So what is the treatment? A simple course of antibiotics. 

Now, we all know that antibiotics are not to be handed out like sweets. But if we know that treating bacterial infections has such a massive impact on our ability to conceive and carry a pregnancy to full term then it is obviously important we have access to these potentially life giving medications. 

For the main part your GP should be happy to assist you if have evidence of a bacterial infection. We also have our GP/quick prescribe service via The Thyroid Clinic that our patients can access should they feel in a hurry to start their course of antibiotics. 

We then ensure that women are given targeted probiotics that are rich in that all important L. crispatus to repopulate the vaginal microbiota with the types of bacteria they need for a healthy pregnancy…
​
Et Voila! (To honour all those delicious Latin words.)


S Väinämö, 2023, Longitudinal analysis of vaginal microbiota during IVF fresh embryo transfer and in early pregnancy [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10715154/]


G Işık et al, 2016, Bacterial vaginosis in association with spontaneous abortion and recurrent pregnancy losses [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4995870/]


NIH National Library of Medicine, April 2023, Escherichia coli (E. coli) [https://www.ncbi.nlm.nih.gov/books/NBK582525/]


Y Heng Zhou et al, December 2018, Journal of Microbiology, Immunology and Infection [https://www.sciencedirect.com/science/article/pii/S1684118217300713] 

Miscarriages affect 25% of all pregnancies and  1 in 3 pregnancies for women over the age of 40. Though these figures are already quite shocking,  we actually think this figure is much higher since most miscarriages go unreported. For something so common we are wildly uneducated on the subject and so I wanted to give you some examples of the types of conversations I have during a consultation to put some of those myths to bed!


Me: Is your partner not joining us for the consultation? 
Patient: No. I have miscarriages and so it’s obviously just a problem with me. 
Me: At this point in time, knowing nothing more about your case, there’s at least a 50% chance the miscarriages are due to a paternal factor.

The reality is that first trimester miscarriages are now more likely to be due to a paternal factor than maternal since we have seen a steady and dramatic decline in semen parameters in recent years. 

Read this article to understand more about plummeting semen parameters: http://www.verityallenacupuncture.com/blog/the-reason-why-the-handmaids-tale-gave-me-sleepless-nights 

My first port of call, when a patient has had a miscarriage is to test the sperm. This will include a basic semen analysis to give us an idea of count, motility and morphology. If the basic test is below average I will also run a Sperm DNA Fragmentation test to check the genetic robustness of the sperm. 

You can read more about sperm DNA fragmentation here: http://www.verityallenacupuncture.com/blog/could-it-be-sperm-dna-fragmentation 


Patient: It can’t be a problem with my thyroid. I had a blood test and the TSH was normal.
Me: Can you give me your TSH level?
Patient: It’s 2.56 
Me: That’s too high for pregnancy. 
Patient: But the GP and fertility consultant said that’s fine. 
Me: The British Thyroid Foundation advise that a person planning a pregnancy should have a TSH below 2.5. And actually my view, which is shared by thyroid experts in the know, is that the TSH should be below 2. 

I've lost count of the amount of pregnancies that have been lost to unstable thyroids… It is my absolute biggest frustration, not to mention the saddest. Especially as it’s one that can so easily be avoided with the right care and attention. 

America, Australia and most European countries work to get a TSH to below 2. But in this country the NICE guidelines changed their stance several years ago so that they have lumped women of all age groups into one category. Therefore you could be a menopausal woman or a 20 year old and in the eyes of the NHS you should be treated no differently. This is why your “normal” TSH reading of 3.76 might be normal for a 50 year old but certainly isn’t optimal for a woman in her fertile years. 

Therefore your UK NHS fertility consultant might not be willing to help you in creating a stable thyroid but go anywhere else in the world and you would likely be given different attention. 

Cue me… who can’t help but send that nagging email asking that we run thyroid bloods before a planned transfer, or immediately after a positive pregnancy test. I’ve seen too many lost pregnancies that all could have been avoided to throw caution to the wind! 

And, if you needed any further encouragement to check those levels, having an elevated TSH in pregnancy has been shown to have detrimental effects on foetal brain development. “Recent evidence suggests that even more moderate forms of maternal thyroid dysfunction, particularly during early gestation, may have a long-lasting influence on child cognitive development and risk of neurodevelopmental disorders. Moreover, these observed alterations appear to be largely irreversible after birth.” (Moog et al, 2015)


Patient: I know I’m being silly even trying. Clearly my eggs are just too old. 
Me: It’s possible that your eggs are too old but it’s also entirely possible there are other reasons, not linked to your age. 

I see so many women who seek our help in trying to conceive, looking sheepish and embarrassed that they’re even toying with the idea of a pregnancy at 40. 

Yes, for some, age matters. But for others you can have a bigger and better quality egg supply than some 30 year olds. Basic blood tests and a simple ultrasound scan can give us a good understanding of the state of play. 

As Dr Shanna Swan so starkly wrote in her book, Countdown: 
Nowadays, women in their 20s are less fertile than their grandmothers were at 35. 

Therefore, you will find that some women’s fertility has been greatly affected by poor fertile genes, environmental factors, poor diet, being born prematurely, etc. And some women have been blessed with very good fertility longevity. 

Therefore my stance is that age is just a number. Let’s see what’s going on from the inside out before we make a call on your pregnancy options. 

It’s also worth noting that if you have been diagnosed with PCOS you will, on average, enter menopause two years later than your non-PCOS counterparts. 

In contrast, if you were born prematurely, it is more likely you will hit the menopause earlier than had you been born at term. 


Patient: We’ve been struggling with recurrent miscarriage and so we’re just going to pay for a round of IVF and I heard acupuncture can help with that. 
Me: Yes acupuncture does help with that. It can improve the live birth rate by 65%. However, having IVF doesn’t decrease the chance of you having another miscarriage. 

It’s a common misconception, and at present there is not enough evidence to suggest that IVF improves live birth outcomes when there is a background of recurrent miscarriage. (Kirschenbaum & Orvieto, 2019) 

Where IVF can be useful is in pre-genetic screening. This is where the embryos are sent off for testing to check for chromosomal abnormalities before they are transferred to the mother. It’s a fantastic advancement in reproductive science however, one would argue that a simple blood test, before going through the rigmarole of IVF would be a more sensible, not to mention cheaper option! 

Again… go to any clinic abroad and you would be offered karyotyping blood testing as standard before engaging in any talks of IVF. In this Country it’s so often IVF first, ask questions later. 

Top tip: Head over to IVF Matters for a UK clinic who refreshingly present IVF after exploring whether less invasive options might be all that are needed. 

You can read more about balanced translocations, karyotyping and PGS testing here: http://www.verityallenacupuncture.com/blog/balanced-translocation-ever-heard-of-it 



Patient: I keep getting chemical pregnancies. It’s very unclear when I ovulate so we just try all the time. 
Me: It’s possible you ovulate twice in a month. 
Patient: I didn’t think that was possible? 
Me: Yes. Studies suggest that women can ovulate twice or even three times a month, which is why the rhythm method for contraception is fraught with complications! 

Pop into any Google search or speak to most doctors and they will tell you it’s not possible to ovulate twice in a month. But if that’s true, why are we told not to use the rhythm method as a form of contraception? 

Canadian researchers decided to pick this apart… In their study of 50 women, who all had ‘normal’ cycles, 68% of them exhibited two waves of follicle development, and 32% exhibited three waves. 

“Dr Roger Pierson, director of the reproductive biology research unit at the University of Saskatchewan, who led the study, said 40% of the subjects had the clear biological potential to produce more than one egg in a single month. Moreover, they could be fertile at any time of the month.”

“Professor Robert Winston, head of the department of reproductive medicine at the Hammersmith Hospital in London, said the findings were “logical and not altogether surprising.””

My advice to these women is to abstain from unprotected sex until day 14 so that they are not trying to fertilise an immature egg. By day 14 any eggs released should be mature and therefore more viable. 


Discussion
I hope you’ve found these examples useful? 

Of course, there are a myriad of reasons why miscarriages happen. It’s my job to run the right diagnostics to understand why and put the necessary actions in place to avoid it from happening again. This is why our live birth rates for those of our patients with recurrent miscarriage is so high at 78%, according to our 2017/18 clinical audit. (http://www.verityallenacupuncture.com/birth-rates--statistics.html)

We ask questions first, run the necessary diagnostics, spend time optimising your combined fertility before we give you the green light to start trying to conceive again. 

We repeat diagnostics and support you with acupuncture throughout those anxiety-inducing first weeks of pregnancy. It’s a method we’ve been putting into practice for nearly a decade and we have it running like a well-oiled machine so that we know exactly what you need and when you need it. 

Plus, our associates and myself are always on hand to offer emotional support when you need it the most so that you can feel that both body and mind are in safe hands. 


References: 

Moog et al, 2015, Influence of maternal thyroid hormones curing gestation on fatal brain development.   [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4819012/]


Swan, 2020, Countdown: How our modern world is threatening sperm counts, altering male and female reproductive development and imperilling the future of the human race.


Kirschenbaum & Orvieto, 2019, Should we offer in vitro fertilisation to couples with unexplained recurrent pregnancy loss? [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912379/]


Baerwald, Adams & Pierson, 2003, A new model for ovarian follicular development during the human menstrual cycle. [https://pubmed.ncbi.nlm.nih.gov/12849812/]


Dyer, British Medical Journal, 2003, Women may ovulate two or three times a month. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1126506/]

Did you know that every man with erectile dysfunction has insulin resistance? It won’t come as a surprise to you that every woman with PCOS has insulin resistance too. But how about this for surprises - 80% of the U.S. population has insulin resistance and we’re not that far behind. Therefore it is statistically likely that insulin resistance will be affecting your case, whether it’s you, your partner, or both. 

So let’s understand it better…

Insulin is an incredibly important hormone. Every single cell in the body has an insulin receptor and so insulin is one of the big players. Its main function is to promote cell growth. However, insulin is not blessed with the ability to know how to stop growing. Never-ending growth is cancer, (to put it bluntly) and so this is why insulin is a hormone we should understand better. 

There are other hormones of course, and these provide the role of cell breakdown, otherwise known as the metabolism. But with an abundance of insulin the other hormones responsible for cell breakdown have a hard job keeping up and this is what we term as insulin resistance. 

Insulin resistance is a coin with two sides. Imagine, if you will, insulin as an Amazon delivery man at Christmas time. He’s knocking on the door of each cell with a Prime delivery. Now, if you’re a person who isn’t careful about eating mindfully to minimise blood sugar spikes then you are relentlessly hitting the “buy it now” button for yet another insulin package delivery. The knocking is now a constant and it’s not just one delivery per day, it’s multiple knocks throughout the day. Some cells have gotten fed up with the constant interruptions and so they’re not bothering to answer the door. Instead they’ve popped up a sign saying “please leave parcels with the neighbours”. These other cells are still opening to every knock and taking their parcels of insulin and the ones for next door.

And this is how we can understand the other side of the coin - hyperinsulinaemia. In this case the body starts to produce more insulin, which is great for those cells who stopped listening as they’re now occasionally bothering to answer the door and take in an insulin package but not so great for the others who are still answering to every knock. They become completely overwhelmed. And it’s this that really underpins infertility…

The most common cause of infertility in women is PCOS. The most common cause of infertility in older men is erectile dysfunction which affects more than half of men between the ages of 40 and 70. 

In the case of PCOS, insulin is inhibiting a key enzyme called aromatase which is responsible for the conversion of testosterone to oestrogen. The cells of the ovary are so sensitive to insulin that the levels continue to rise and the conversion is inhibited, thusly, oestrogen fails to reach the lofty highs that are necessary to ovulate. 

Erectile dysfunction (ED) is one of the earliest signs of insulin resistance and is a 100% predictor that a man has insulin resistance. You cannot have ED without insulin resistance. Insulin plays a part in the vasodilation that is needed for normal erectile function.

Insulin resistance also affects the body’s ability to produce sperm (spermatogenesis). It is affected both directly and indirectly by fat cells and actually, obesity affects male fertility far more than it does female. When fat cells grow they begin to express aromatase. The testes have aromatase much like the ovaries but in lower levels. In obese men, these excess fat cells are expressing aromatase in higher levels than they should and so now, the testes are acting as ovaries by pulling in testosterone and converting it to oestrogen, which is not what a male body needs to generate sperm. 

Now let’s turn our attentions to man boobs for a moment… The excess belly fat is converting testosterone to oestrogen - the man has too much female hormone. The body becomes confused and grows and stores the fat in typically female places. This is why they might carry weight on the hips or chest. 

It’s not just in the production of oestrogen that insulin plays a role. It also has a direct impact on a hormone called lectin. Lectin is essential to fertility. If you do not have enough lectin in your bloodstream you will not go through puberty and therefore be infertile. On the flip side, too much lectin will stimulate the body to start puberty too soon. As lectin is produced by fat cells, the average overweight person has too much lectin and of course, the average overweight girl will start menses earlier. In the 1850s the age in which women started their menses was 16. It is now age 10. And of course if you start puberty early you start burning through your egg supply earlier and so now we find more and more women starting the menopause in their late 30s. 

Not to mention the wider, social impact of our daughters becoming “sexy” in their early teens with the widening of hips and developing of breasts. Worryingly, they are also giving out pheromones to any man in the vicinity that they are fertile, which is an entirely natural and unavoidable process, designed to allure the opposite sex. 

So how can we combat this? Diet and lifestyle are key. We must retrain ourselves and educate our children that food can be used as poison or medicine. We must also try to help our prepubescent girls in keeping the weight down if we want to preserve their fertility longevity and allow them to be “girls” that little bit longer. The same is true for boys if we want them to be fertile, without the embarrassment of ED and to be able to produce adequate sperm to conceive later in life. 

But how can we be expected to do this when we’re already a country where more of our inhabitants are overweight or obese than those that are not? 

Continuous Blood Glucose Monitors otherwise known as CGMs are becoming more popular, particularly in the States, but we are seeing a move to them being used more and more here in the UK. 

I feel it’s important we utilise whatever technology is at our fingertips to improve the state of the world’s fertility. Not only for our patients but for our children. After all, it is estimated that with the widespread decline in fertility in both men and women, that most couples will need to use IVF by the year 2050. It’s a worrying prediction for our children and for humanity as a whole!

So, in order to get ahead on this new trend I’ve enlisted the help of our fantastic and hugely knowledgeable Nutritionist, Rachel Davies. She has a special interest in fertility but also, as her title suggests, she knows a lot about eating well. 

Rachel has been working with me in the background to help us roll out a new service in providing patients with their own CGMs that can track their insulin levels throughout the day. From there, Rachel can work with you to look at areas in your diet and lifestyle that can be changed. The beauty of CGMs is that you can see for yourselves, first hand, the difference those dietary changes are making to your blood sugar spikes. 

CGM users report that they have transformed their lives, not just in managing weight but also in alleviating afternoon fatigue, headaches, low mood, insomnia - these symptoms can all stand to benefit from tracking blood glucose. 

Of course, personally speaking, I am very excited as to how this might transform the fertility outcomes for our patients. 

If you are interested in our new CGM service please get in touch so that we can provide you with more information.

Reference: 
Dr Benjamin Bikman, 2020, Why We Get Sick? The Hidden Epidemic at the Root of Most Chronic Disease - and How to Fight It
​

We all know that IVF treatment costs a lot. Information collated by Gaia Family Planning who interviewed 250 people last year showed that the average spend on IVF for heterosexual couples in the UK is £13,730. This jumps to £17,290 for those that experience an unsuccessful outcome on their journey. 

70% of people experience financial trauma and 78% of people enter into debt to fund their IVF treatment. 

So I set about on the tedious task of collating our statistics. I was interested to see how our patient spend stacks up to the cost of IVF compared with pregnancy outcomes. The full report can be seen here: https://www.verityallenacupuncture.com/birth-rates--statistics.html 

Our results, based on women receiving 14 treatments and men just 4 treatments, not undergoing IVF, showed a 72% pregnancy success rate for women aged 35 - 42. This is an average spend of £970. The success rate of IVF alone for women in same age category is 21%. Our success rates jump higher to 89% if you combine acupuncture with IVF. 

Therefore, in short, you can spend just shy of £1000 on acupuncture and you have a 72% chance of pregnancy. Spend £15,000 on IVF and you have a 21% chance of pregnancy. And spend £16,000 on IVF and acupuncture combined and you have a 89% chance of pregnancy. 

We’re obviously enormously proud of what we do, but our statistics speak volumes. There are no studies of any real note that show acupuncture to be effective in fertility. There are studies showing the efficacy of acupuncture used alongside IVF. The results of which showed there to be a substantial benefit on pregnancy and live birth outcomes, yet acupuncture is not accepted by UK fertility clinics to be of any benefit to the patient. When has your consultant ever suggested you try acupuncture? 

Why? I wonder? Well perhaps the data just isn’t there to support its use. Who would fund such research? And perhaps there are other reasons…

In our clinics we are unique in that we see a great many more patients than a sole practitioner might, thereby giving us a vantage point to be able to generate data in larger figures than other smaller operations. I wanted to share this with the fertility community and so, last month, I decided to write a lot of letters to IVF clinics across the country. There were three reasons for doing this. Firstly, I wanted to share our great work. Secondly, I wanted to test a hypothesis of mine. And thirdly, I had a bunch of stamps I needed to use up.

In the letter I talked about our statistics. I put it in terms I felt they might like to hear; that using acupuncturists to support their treatments could see their clinics overall statistics improving. I talked about the fact that clinics in America, Australia and Europe have in-house acupuncturists for the purpose of improving outcomes for their patients. 

Enclosed in the letter was a print out of the recent systematic review of research to date showing the benefits of acupuncture used alongside IVF. And, some might say rather cheekily, I included our QR code for our Charitable Trust, set up to help our patients access our services who are facing financial difficulty. After all, 78% of their patients enter into debt. 

So, did I hear back from any of the many clinics I contacted? Did we receive a donation? Of course not! It’s sad really. Especially when you consider that the UK fertility industry is worth about £320 million annually. 

Unfortunately the lack of interest has helped to cement my hypothesis. It’s a belief I’ve held for some years about the state of our UK clinics, which is why I advocate going abroad for treatment. That IVF clinics in the UK are there to sell IVF - not to make babies. So in light of the title of this article - who are the real winners? Well I guess that depends on your objectives. 

Just to end on a less depressing note, I was delighted to see Serum IVF in Athens hold a party for their founder to celebrate all the new families she’s helped to create over the years. It was open to all past patients and free to attend. Well done Serum... Highly regarded as one of the best clinics in the world, has some of the best birth statistics and still has its heart in the right place. A glowing example that you can have it all! Also one of the few clinics to have a female founder… I’m saying nothing! I’ve probably already said too much!!


References:
https://www.gov.uk/government/publications/fertility-treatment-a-guide-for-clinics/a-guide-for-clinics

https://gaiafamily.com/guides/ivf-cost-uk 

https://www.verityallenacupuncture.com/birth-rates--statistics.html

I expect for most of you the answer is no. But we should have. And certainly for any woman over the age of 40 with unexplained infertility, recurrent miscarriage or having had several failed IVF attempts, you absolutely should have heard of it. 

In this article we discuss the affects of chromosomal abnormalities on pregnancy outcomes and whether preimplantation genetic screening or karyotyping is worth it. Spoiler alert: The short answer is, yes! 

So what’s a balanced translocation and where does it come from? 
It’s a genetic condition whereby parts of a chromosome have broken off and attached to other chromosomes in another location. In other words, sections of two chromosomes have switched places. It can be entirely harmless or entirely serious depending on which chromosomes have attached where. 

You might have a chromosomal abnormality affecting the egg or the sperm and it is thought that “50 -75% of spontaneous miscarriages result from numerical chromosomal abnormalities in the embryo or foetus.” (Fritz & Speroff)     

Does age matter? 
Yes. “Data derived from numerous studies reveal that older women and women with a history of recurrent pregnancy loss produce more aneuploid embryos than younger women”. (Fritz & Speroff) 

Is it common? 
Balanced translocations are relatively common, a 2-7% finding among infertile couples. It can affect the man or woman or both - making it a condition we really ought to know more about. (Ching, 2012)

How can we find out if we have it?
Preimplantation genetic screening (PGS) is a relatively new diagnostic and one in which most UK fertility clinics know little about, let alone offer it as a service. 

It is used as an adjunct to IVF whereby the blastocysts are screened for chromosomal abnormalities before being transferred. Generally speaking, half of the blastocysts will be discarded leaving behind the sound ones for implantation. 

If you are unable to garner any blastocysts for PGS you can have karyotyping which involves taking blood samples from both parents which are then examined for chromosome arrangement. 

So why aren’t we told? 
When it comes to fertility, most clinics still like to use the classic ‘get out of jail free’ card - The more attempts at IVF you have, the bigger the chance that one will stick. And it’s true. Even with balanced translocation there’s a chance that one or more blastocysts will still be viable for pregnancy. But the ‘get out of jail free’ card doesn’t take into account the financial and more importantly, emotional toll that multiple failed IVF attempts and/or pregnancy losses have on a person. 

But in order to give a more well-rounded argument the official line is this: “IVF with pre-implantation genetic diagnosis for reasons of advanced maternal age or in couples with unexplained recurrent pregnancy loss can increase implantation rates and decrease miscarriage risk, but have not increased live birth rates. Consequently, the associated costs in couples without other specific indications for IVF cannot be justified.” (Fritz & Speroff) 

Cost aside, wouldn’t knowing that there is a reason for your infertility justify the diagnostic? This is why I strive to explain “unexplained infertility”. It can all be explained with the right diagnostic. And with an explanation, patients are more informed to make decisions over their own fertile future. If the odds are stacked against them and all diagnostics are not pointing in their favour then it might be time to opt for an egg or sperm donor. However for most, the option of donated eggs is presented at a time when they’re at a loss to know what to do next. It then becomes an agonising decision to give up on their own biological children in the quest for a child altogether. It is my belief that, presented with all the facts, a couple can make an informed decision and probably bypass a lot of the emotional anguish. 

So if you’re interested in any of the above, don’t talk to your fertility consultant. As with all my advice - whether it be sperm DNA fragmentation, a varicocele, an underactive thyroid, a balanced translocation. Their answer will invariably be to throw another IVF at it. So instead let’s get informed. Do your own research and don’t just rely on the ‘experts’. 


Extracts taken from: Clinical Gynaecologic Endocrinology and Infertility (Eighth Edition) by Marc A. Fritz and Leon Speroff

Ching, 2012, Presentation and Treatment of Subfertile Men, National Institutes of Health, 
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3783302/ 

Some fab information here about male infertility from Dr. Paul Turek, a leading innovator in male reproductive health.

With declining sperm counts, diminished ovarian reserves, increasing rates of miscarriage, and with the prediction from fertility scientists that all couples will need IVF by the year 2050, protecting our children’s fertility is of paramount importance. Not only so as to shield them from the agony of infertility but also for wider socio-economic reasons. Who will look after the elderly population? 

“Some scientists are now suggesting that the detrimental effects on human reproduction, and the underlying factors contributing to them, could threaten the survival of the human race… an argument could be made that Homo sapiens already fit the standard for an endangered species, based on the US Fish and Wildlife Service’s (FWS) requirements. Of five possible criteria for what makes a species endangered, only one needs to be met; the current state of affairs for humans meets at least three.” (Swan, 2020)

So where does it all begin? The egg of course! But I suppose we’d better not forget the sperm too. Both of which are dictated by the quality of your mother’s and father’s egg and sperm quality, which was dictated by theirs and so on and so forth. 

Next there’s what happens in utero. If babies are subjected to phthalates (plastics) and other chemicals it increases infertility in both girl and boy babies. (Please see my article entitled “Can you predict your fertility?” if you’re interested in this subject.) 

Then there’s what happens at 38 weeks of pregnancy where a huge transfer of antibodies takes place from mother to baby via the placenta. (Cederqvist et al, 1978) Interestingly this is something that happens specifically to humans. 

Then there’s the birth. C-section or vaginal delivery? "Caesarean section use is growing at an “alarming” rate, accounting for 21% of births globally in 2015—up from 12% in 2000—experts have warned.” (Wise, BMJ, 2018) In the UK, one in four babies will be born via c-section according to NHS England. 

To be born is also to enter the world of microbes. “At the very time when the baby is getting out of the mother’s body, its digestive tract and all its mucous membranes are germ-free. Some hours later, there will be billions of germs in its nose, in its mouth and in its gut. The main question is which germs will be the first to colonise the baby’s body?” Will it be those of the mother, or will it be those of the staff in the operating theatre? Will they be friendly and familiar to the baby, or will they be foreign? From a bacteriological point of view there is an inherent and fundamental difference between a vaginal birth and a caesarian birth and the growing number of c-sections has been offered as an explanation for the increasing problem of allergies and food intolerances. (Odent, The Caesarian, 2004) “Children born by cesarean section have been shown to be at higher risk for some immune related disorders.” (Schulfer & Blaser, Risks of Antibiotic Exposures Early in Life on the Developing Microbiome, 2015) 

Then there’s colostrum and breast milk. We of course need not explain how important colostrum and breast milk are at helping to populate the baby’s gut with maternal antibodies known as IgG. And you might feel that provided a baby get to the breast quickly, despite of how they arrived into the world, that they will have adequate IgG. However, the same hormone that is produced in natural labour - oxytocin, which comes in waves during contractions - is also necessary for the contraction of the breast during the milk ejection reflex, when the baby is sucking. Oxytocin must be released through frequent pulsations in order to be effective. A Swedish study “found that two days after birth, when the baby is at the breast, women who gave birth vaginally released oxytocin in a very pulsatile - and therefore effective - way, compared with women who gave birth by emergency caesarian section.” (Odent, 2004) 

Then there’s vaccinations. Some have postulated that the mumps vaccine may be responsible for failing sperm counts. People were vaccinated on mass for mumps virus from the 1970s and so this would correlate with the decline in sperm counts. Of course, this hasn’t been widely researched. No scientist is likely to go near such a controversial hot potato! Not to mention who would fund the research?!

So, taking all these factors into account, it is the immune system that is directly affected. The immune system is in place to protect us from bacterias, viruses, fungus spores and cancer cells but it can make mistakes. It can turn the gun on itself and destroy the very cells it should be protecting. This is what is meant by ‘auto immune disease’. It can also overreact to foreign pathogens who are not really dangerous. This is what is meant by ‘allergy’. 

“Immunologists have to be convinced of the truth that life is a struggle and that struggling is a need, The immune system learns how to fight by fighting. But if the immune system does not get the chance to fight off certain viruses which usually attack in childhood, then it is a much more difficult and exhausting battle as an adult.” (Odent, Primal Health, 2002)  The rush to give a child Calpol to help them sleep at the first sign of a sniffle equates to not giving the immune system a chance to learn how to fight. This is why doctors are nowadays so reluctant to give children antibiotics. We also know that antibiotic exposure within the first 6 months of life significantly increases the child’s body mass for the first 7 years of life. (Tresande, et al, Infant antibiotic exposures and early-life body mass, 2013) With some researchers suggesting that a child’s DNA is significantly changed if given antibiotics in the first year of life. 

The immune system needs to be subjected to the viruses, bacteria and fungi in the early years, so living in a sanitary environment is not conducive to a healthy immune system in adulthood. And there have been many studies showing that children living with dogs or cats have healthier immune systems, simply because of the outdoor bacteria their pet is bringing in. 

So why are our immune systems so important in fertility? Let’s list some auto-immune conditions: 
PCOS, endometriosis, premature ovarian failure, ovarian cancer, breast cancer, cervical cancer, testicular cancer, diabetes, hypothyroidism, lupus, raised natural killer (NK) cells.

So with all this mind I hear you saying, “what can be done?” Well of course some of this is out of your control. You can’t go back in time and knock that drink out of your dad’s hand before he conceived you, or press the stop button when your mum microwaved her TV dinner in plastic at 8 weeks of pregnancy. You can of course try to live healthy lives before you conceive your children. And mums can minimise the risk of exposure to EDCs in utero by eradicating the chemicals that she can from her life; buy organic beauty products and natural cleaning products, get an air purifier, and limit her exposure to plastics, pesticides and fungicides. 

But what about all those emergency c-sections that are out of your control? Vaginal seeding anyone? Sounds delicious doesn’t it. But essentially this is a great workaround to exposing your baby to some of your gut flora. Essentially a swab is inserted in the vagina and then wiped over the baby’s nose and mouth after delivery. Put it on your birth plans people! 

There are many ways we can nurture a strong immune system. Allow your children to bury their heads into as many farmyard animals as possible… that’s an easy one! But also let them get ill. Don’t medicate at the first sign of trouble but allow their immune systems to learn how to fight illness on their own. Let medication be a “fall-back” rather than a “go-to”. 

And lastly, talk to them about infertility. Raise their awareness that fertility is in a dramatic state of decline. And practically, if you have daughters you might want to think about private medical insurance that covers them for gynaecological and fertility problems before they hit puberty so that they may have access to necessary diagnostics and surgery if they need it. Or if you have boys, talk to them about freezing their sperm to be used later in life. You might think this is bonkers but we know that the need for IVF is very much on the rise. You can radically improve the outcome of that IVF by using younger, more potent sperm. (A man is most fertile between the ages of 21 to 25). Wouldn’t it be wonderful if your sons knew they literally had it in the bank! 

References:
Swan, Countdown: How Our Modern World Is Threatening Sperm Counts, Altering Male and Female Reproductive Development, and Imperilling the Future of the Human Race, 2020

Cederqvist LL, Ewool LC, Litwin SD. The effect of foetal age, birth weight, and sex on cord blood immunoglobulin values. Am J Obstet Gynaecol 1978 Jul 1; 131(5): 520-5

Odent, The Caesarian, 2004

Schulfer & Blaser, Risks of Antibiotic Exposures Early in Life on the Developing Microbiome, 2015
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4489621/)

Odent, Primal Health, 2002

Tresande et al, PubMed, Infant antibiotic exposures and early-life body mass, 2012 Aug 21,
(https://pubmed.ncbi.nlm.nih.gov/22907693/)

Like most of you I’ve been trying to forget about Covid. But I came across some research in recent weeks that has really got me thinking about the pandemic and more to the point, the measures in place to control it. 

This little piece of research has implications that are so far reaching that I felt compelled to share it with you all. 

In a mouse study, mice were infected with SARS-CoV2 infection or COVID-19 and were given Oxytocin (love hormone). The mice not only recovered from the infection quickly but found that it offered them protection from the virus. “Oxytocin has now emerged as a strong candidate for treatment and prevention of the COVID-19 pandemic.” 
Let's focus on the wonderfulness of this for a moment, before we jump to feelings of ‘why the hell were we all starved of seeing our loved ones for so long?’. Maybe love really does conquer all? In my musings I wonder “did Covid become so prevalent because there seems to be so little love in the world?” And then, because my brain is hard wired to jump to fertility it got me thinking about all those pregnant women who need to be induced because they don’t have enough oxytocin to get the show on the road, let alone to deliver the afterbirth. “1 in 3 women in the UK now need to be induced, an increase from 1 in 5 ten years ago.” And of those 2 of 3 women that go into labour naturally only a very small fraction will deliver the placenta without the need for an injection of Syntocinon - synthetic oxytocin. This is standard practice and unless it is specifically stated on your birthing plan that you do not wish for it you will have been given Syntocinon as a matter of course. So the amount of women who can legitimately say they gave birth “naturally” are very few indeed! 

Not only is Oxytocin (OXT) a powerful hormone in pregnancy it has so many other health benefits. “OXT can block viral invasion, suppress cytokine storm, reverse lymphocytopenia, and prevent progression to ARDS and multiple organ failures. Importantly, besides prevention of metabolic disorders associated with atherosclerosis and diabetes mellitus, OXT can protect the heart and vasculature through suppressing hypertension and brain-heart syndrome, and promoting regeneration of injured cardiomyocytes. Unlike other therapeutic agents, exogenous OXT can be used safely without the side-effects seen in remdesivir and corticosteroid. Importantly, OXT can be mobilized endogenously to prevent pathogenesis of COVID-19.”

We knew that oxytocin was important in the fight against cold viruses back in 2014. A study group of 404 healthy adults were intentionally infected with flu virus and were asked how often they received hugs from a trusted person during their illness. "Among infected participants, greater perceived social support and more frequent hugs both resulted in less severe illness symptoms”.
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So there you have it… All you need is love. And to never be locked down and socially distanced again! 

Wang & Wang, Cardiovascular protective properties of oxytocin against COVID-19, April 1 2021, (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837104/ )

Rise in women having induced labours, NHS figures show, BBC News, 2018 (https://www.bbc.co.uk/news/health-45978623)
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Hugs Help Protect Against Stress and Infection, Say Carnegie Mellon Researchers, December 2014 (https://www.cmu.edu/news/stories/archives/2014/december/december17_hugsprotect.html)