Obese women are less likely to become pregnant through IVF and assisted reproduction as carrying excess weight can affect the function of the ovaries, due to changes in hormones and metabolism rate. They also have less success with assisted fertility treatment because of the poor response to fertility drugs that stimulate ovulation. The same can be said for being underweight, as this can also affect your hormone levels and therefore impact on your fertility.

Maintaining an optimum weight is good for both partners experiencing infertility, and this has been the current focus within NHS proposals. In the South West of England, they propose to refuse NHS funded IVF treatment if the male partner has a BMI of 30 plus, as this is classed as medically obese and could affect fertility chances.
The proposal by the clinical commissioning group is to change NHS funded fertility treatment policy to ensure men get to a healthy weight, before the NHS fund investigations and fertility treatments with their partners.

BMI and Body Fat Percentage

Whilst your BMI is important, your body fat percentage is the vital element when it comes to your reproductive function. The BMI measurement is based on height and weight, but it doesn’t distinguish between fat and muscle meaning that if you are an athletic male you can carry a lot of lean mass, giving you a disproportionately high BMI compared to your actual health and levels of body fat.

The best way to measure body fat percentage is with a skin-fold calliper, with measurements usually taken at your waist, hip and neck, as well as other areas of your body. Once you determine your body fat index, you can then track your weight-loss progress if needed as unlike using standardised scales, it tells you how much of your weight is fat and how much is muscle.

Founder of Colorado Center for Reproductive Medicine in Denver Dr W Schoolcraft, often sends some of his patients to an exercise physiologist to measure their body fat percentage. According to Dr Schoolcraft ovulation is impaired if body fat is less than 12 percent or more than 30 to 35 percent. He states “Women take getting their periods as a sign they are at a healthy BMI and have normal fertility,” “However, you can have regular or somewhat regular periods and not ovulate, though it’s unusual.”
So be sure to measure your basal body temperature and track it on a basal body temperature chart to see if you’re ovulating.

Calories count

If you are underweight aim for between 2,400 to 3,500 calories a day to gain the weight you need for a normal BMI range. If you’re exercising five or more days a week, consider cutting back to three. Dr Alice Domar, of Centre for Mind/Body Health at Boston IVF, states that hatha yoga, such as Fertility Yoga appeals to many women in this category as “It keeps them fit and toned without the potential adverse impact of vigorous exercise.”

If you’re overweight reduce calories gradually in order to reduce your BMI and get fertility fit. A combination of cardio and strength exercises, that builds up tolerance slowly and not too vigorously to the point of exhaustion should form the core of your exercise.

For men don’t over heat the testicular area, as this can temporarily cause low sperm count. The testicles secrete male hormones and also help in sperm production, and for the testes to function properly they need to be cooler than rest of the body. That’s why the testes are anatomically structured to hang outside the body. The ideal temperature for sperm production is around 34.5C, which is slightly below body temperature (around 37C). If the testes are exposed to high temperatures, then the increased heat could kill the sperms and cause low sperm count.

For better sperm production avoid:

• Wearing tight underwear
• Tight trousers around the groin area
• Sitting for long periods of time
• Having laptops or tablets resting on your lap
• Taking hot baths and saunas

Whilst exercise makes you feel good it can affect your fertility, so you need to find a balance between under or over exercising in order to optimise your own body’s functions. So, if you need to lose a few pounds, or gain a few, it’s important to review your lifestyle, diet and exercise levels in order to get healthy and boost your fertility.

If you would like to know more about what types of exercises you can practice in order to get fertility fit, you can read this blog post which will provide you with helpful tips.

Research shows that the quality of health and wellbeing of patients experiencing infertility is greatly reduced. So with the greater understanding of the experience of infertility and related health issues, the fertility treatment plan can be centred on the individual patient’s wellbeing. This will optimise the many factors that could potentially reduce the patient’s success, by dedicating a treatment plan that is in the best interest of the patient’s wellbeing and health.

Associated Factors that affect fertility

• BMI obesity or under weight
• Lifestyle
• Nutrition
• Age
• Female reproductive issues to include PCOS

A survey was undertaken by the Fertility Network UK, published in October 2016, to study the impact of fertility problems had on the psychological and emotional impact of fertility treatment, along with funding and support issues. They found that only 52% of the 865 participants, fully understood the nature of their fertility problems and only 26% felt their GP provided sufficient information.

Over half of the numbered surveyed had to pay for at least part of their fertility investigations or treatment, and on average spent over £11378, with 21% spending around £20k to £100k. Patients mainly self-funded, due to the lack of NHS funding, and the key reasons for being denied NHS treatment included: already having a child or partner having a child, the patient’s body weight and BMI, and for single patients being denied funding due to the absence of a partner.
Infertility patients are increasingly using complementary and alternative medicine (CAM) to supplement or replace conventional fertility treatments plans. Infertility is defined by the absence of conception following one year of unprotected sexual intercourse. With factors affecting fertility to include biological, genetics, infections, environment and lifestyle factors that can associate risks with both female and male fertility. After the primarily investigations by GPs and gynaecologists, assisted reproductive technologies (ART) or IVF may be used to treat infertility. For patients that experience financial, psychological, moral and ethical challenges they might discontinue their medical fertility treatment plan.

Studies show the effects of infertility has on patients include:

• Distress
• Depression
• Anxiety
• Low self-esteem
• Feelings of blame guilt
• Somatic complaints
• Reduce libido
• Relationship issues

Research by the Bio Med Central in 2014, led by E O’Reilly at the University of Ottawa, Canada stated that “CAM practitioners played an active role in both the treatment and support of infertility, using a holistic, interdisciplinary and individualised approach”. CAM practitioners of the study recognised that not just the biological, but also environmental and psychosomatic are determinants of infertility. CAM practitioners used diagnostics investigations, clinical and physical questionnaires and laboratory test results for fertility hormones, along with stress and lifestyle issues to create treatment plans.

As western medicine continues to become more technologically advanced, patients of many illnesses are choosing complementary and alternative medicine (CAM) to treat conditions. CAMs are used either instead of, or alongside, main stream conventional medical treatment. For fertility patients with the advancements in technology, patients perceive a more natural approach with less side effects can help their fertility.

In O’Reilly’s research treatment of infertility patients using CAM, patients participated from many countries around the world, which reflected “the patient’s acceptance and interest in alternative approaches to infertility treatment”. The study showed in Australia up to 75% of infertility patients reported using CAM, in the USA 29% and in the UK 40% used CAM to treat infertility.

CAM patients are predominately female and extremely motivated to have baby, and that more women are open to CAMs and actively seek treatments than men, for infertility and for other healthy issues. Whilst men and women experience infertility differently, in the O’Reilly study “men express strong desires to conceive and subsequent grief with infertility”
In all countries the participants of the study stated, that CAM therapies’ had led to patient trust, and a sense of control and empowerment whether they was trying to conceive naturally or through ART or IVF. Patients of complementary and alternative medicine used the internet, word of mouth and previous personal experiences of using CAM, to help select CAM providers for their fertility treatment. CAM practitioners identify their individualistic approach to each patient’s fertility-related emotional distress. There is often a negative perception of CAM and conventional medicine, so if the patient’s doctor does not support CAM due to lack of scientific evidence, many patients continue to pursue CAM support during their fertility treatment, funded privately.

In the O’Reilly’s study “many aspects of women’s reproductive health, including menopause, infertility and pregnancy have been identified as ideally treated by an integrated CAM-conventional medicine approach”. By accrediting CAM providers, factual research, education and the sensitivity of the cultural philosophies of the types of complementary and alternative medicine, the study concluded that CAMs are strategies to enhance CAM-conventional medicine collaborations. Research continues to increase at academic medical centres and universities worldwide, to understand and study the results of the integration of CAM and conventional medicine in education and clinical care.

Stress of fertility treatment, the 2 week wait and the outcome of pregnancy testing

Research has shown that not all patients respond to the stress of fertility treatment in the same way. Factors affecting this include a person’s physical responses to stress, the treatments themselves, personality types and their relationships, so their individual coping strategies will all be different. With such variation the individual patient should be encouraged to communicate to their fertility specialists, in all aspects of their own specific needs of support along with a CAM treatment plan.
Studies show that many patients need extra emotional support during the 2 week wait, the time to wait to take a pregnancy test after an IVF embryo transfer. CAM therapies can support this difficult time along with pre-treatment, during treatment and with patient recovery, especially if there is a negative result. There are CAM strategies to manage this period of stress to improve the wellbeing of the patient through stress management and psychological support to reduce stress and anxiety on the patient’s fertility journey.

Top Tips for preparing for and coping with fertility treatment

• Do you research to help plan your treatment options
• Ask questions so you understand your treatment procedures
• Prepare yourself physical and mentally before you start treatment, ideally six months ahead
• Stay flexible for appointment time’s changes etc. plan ahead for changes to treatment, to minimise stress
• Prepare for the test result days and build time for recovery, for either a positive or negative result.

What is complementary and alternative medicine?

CAM’s are classified as therapies that work on the physical, emotional and spiritual body. They work on mind and body medicine using a holistic approach and integrate the energetic and biological body, with manipu/lation and body base practices. Energy flows through the body and when this energy is blocked or unbalanced, this can present as sickness in the mind and or body. To re-balance the mind and body CAM’s therapies use and variety of therapies to bring the mind and body into harmony and balance, to include:

• Ancient healing systems form the East, such as yoga and Ayurveda from India and acupuncture and Chinese medicine
• Homeopathy. Using small doses of remedies that cause symptoms to stimulate the body’s self-healing process.
• Naturopathy. Treatments to help the body heal using a variety of practice to include exercise massage, relaxation, herbal medicine, counselling.

Complementary medicine are not usually taught or used in Western medical schools or hospitals. Mainstream western medicine has yet to adopt complementary medicine as part of an integrated health care system due to the variety of cultural, social, economic, or scientific reasons. Whilst doctors can help support you in your choices and may be able to direct you to a certified and licensed practitioner. There are governing bodies or associations for standards of CAM training and providers, so talk to your doctor or fertility specialist about using CAM’s as part of your fertility treatment

Types of Complementary and Alternative Medicine

Complementary medicine is a group of diagnostic and therapeutic disciplines that are used together with conventional medicine. Complementary and alternative medicine (CAM) include the following:

• counselling
• homeopathy
• hypnotherapy
• massage therapy
• yoga
• meditation
• nutritional therapy
• reflexology
• traditional Chinese medicine (TCM)
• acupuncture

CAM providers in the O’Reilly study stated that “An integrated infertility patient care through both collaboration with complementary and alternative medicine practitioners and incorporation of CAM’s holistic, individualised and interdisciplinary approaches would greatly benefit infertility patients.” And that a “greater understanding of CAM approaches to infertility and treatment will enhance cross-professional relationship for integrated infertility patient care”

Many more health professionals and fertility clinics are now working alongside CAM practitioners to help improve the chances to conceive for infertile couples. So if you are experiencing fertility issues for the first time or been on your fertility journey for a while, then perhaps try a CAM treatment that appeals to you and that you are comfortable with. Take your time to build trust and a relationship with your CAM practitioner who specialises in working with infertility patients, to support you and your partner on your fertility journey.