Tag Archives: Infertility


imageAs a GP I regularly see young women who are anxious about not getting pregnant and if they have been trying for 12-18 months or sooner if over the age of 36yrs, despite having regular unprotected sex we consider that they may be infertile and need further investigation.
Around one in seven couples may have difficulty conceiving. This is approximately 3.5 million people in the UK.
About 84% of couples will conceive naturally within one year if they have regular unprotected sex.
For every 100 couples trying to conceive naturally:
84 will conceive within one year
92 will conceive within two years
93 will conceive within three years
For couples who have been trying to conceive for more than three years without success, the likelihood of pregnancy occurring within the next year is 25% or less.

There may be physical problems or often they are not conceiving due to a stressful, unhealthy lifestyle or for no apparent reason, which infact amounts to 15% of women. Hence, my first bit of advice is to advise a couple to have some quality time together and forget about babies and not infrequently within a couple of months they report back with a positive pregnancy test! One couple having been trying to conceive for several years and were due to go to India I suggested they forgot babies but to make sure they visited the Taj Mahal and looked into each other’s eyes. Needless to say 9 months later they were blessed with a beautiful son. I have watched some of these babies grow up and I couldn’t help but smile to myself when several of these, now grown up babies have approached me to do a work experience or help with their application to university or even medical school!  (recruiting preconception- has Jeremy Hunt heard about that!)

Moreover, over the decades, the availability of treatment and the type of women receiving it has changed dramatically. Dr Robert Forman worked with the British doctors who “created” Louise Brown, and is now medical director of the CRM Care London clinic, part of the country’s biggest fertility company, with seven “branches” in the UK and Ireland. Care now performs more than 7,000 cycles of treatment a year and boasts success rates of up to 50 per cent. When IVF started, it was purely for women with blocked fallopian tubes,” says Dr Forman. “One of the biggest changes over the years is that we are now increasingly treating people who are not technically infertile. It is single women who are opting for egg freezing or donor insemination, gay couples coming for treatment, as well as those who can conceive but have genetic testing of embryos, for instance, to screen out cystic fibrosis if they know they are carriers of that gene.” Recently we were delighted to facilitate a referral of a gay couple for successful IVF and for this family to be part of our practice and there are others in different situations who now feel confident to ask for support in preparing to conceive and then have their antenatal care within the practice.


However, infertility has become an industry and very costly to couples who take the route of IVF when in some cases a simple alternative could solve the problem. The NHS alone doesn’t carry all this demand: it only funds 41% of the IVF cycles in England and Wales, with more than half of people paying to sort out the problem for themselves – or at least trying to sort it out. We as GPs try to do as much before referral to avoid unnecessary IVF. As I read in one article about infertility,  “If you’re having sex three times a week, you have a much greater chance of success, rather than just waiting for that ovulation window. We need to talk about these things as well as IVF.” It would be useful to read the article on infertility in NHS choices website prior to consulting your GP before rushing off to ask for IVF independently.

Age-based infertility (rather than infertility that would exist regardless of age) is on the increase because it’s more socially acceptable, and indeed more possible, to delay motherhood than it was 30 years ago. This isn’t scaremongering, it is fact. Now they have recourse to a solution; but IVF is expensive and requires an average of four cycles to work – at roughly £5,000 a cycle, if it’s on the NHS – and the more that women “delay” their childbearing years (whether by design, accident or life circumstance), the heavier the demand for IVF. It was recently written in the press that schools are advising girls not to leave it ‘too late’ to have a baby.

Having conceived pregnancy is not always straight forward and employers are not always sympathetic  and women are expected to continue and cope with all that comes their way. There are many questions to be asked as women prepare to enter this new world of motherhood.

Eventually, the precious baby arrives but more and more mothers are isolated with no grandmother or extended family nearby to advise them how to deal with the numerous problems of caring for a baby ensue. We frequently see mothers in surgery coming to ask us for advice, which we are happy to help but attending a surgery or urgent care centre alongside ill patients is not ideal for a new mother and baby let alone being inconvenient for both. Hence, when Diana Hill an award-winning BBC science documentary film-maker.attended one of our Multi-Disciplinary Group meetings to talk about her company, “The Essential Parent Company” which she created with  Dr Rebecca Chicot a Cambridge PhD in Child Development and Parenting I felt it was an excellent resource to share with patients especially new mothers.

For a limited period of time there will be free access and if those viewing the videos give favourable comments there is a chance this may continue.


Professor Robert Winston, a pioneer of fertility and reproductive health pioneer has been a key advisor and provides expert information in maximising the chances of getting pregnant

With expert team of obstetricians, midwives, antenatal dietitiants and antenatal health experts The Essential Parent Company brings the most trusted advice to help you have a healthy and happy pregnancy, labour and birth.


With expert partners The Royal College of Paediatrics and Child Health, UNICEF UK Baby Friendly as well as midwives, paediatricians, sleep experts, paediatric dietitians, development psychologists and The Essential Parent Company present trusted video demos and advice to help have a safe, happy and healthy baby. With advice on feeding, sleeping, crying and everyday care and health they aspire to give a one stop hub for warm, expert advice.




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Posted by on October 18, 2015 in Training and Advice


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One of the things I most enjoy in life is chatting with young people especially my children and their friends and relatives. I love to listen to their zest for life, their enthusiasm to explore the world around them, their hopes and thoughts of the future and most of all their wit and humour, albeit honest and direct. It is good to laugh out loud one minute and then be in serous conversation about where our world is going and what they think ought to be done. I cope with being teased, infact I  secretly enjoy it but at the same time they usually show respect for my views. It makes me feel refreshed and inspired to look out for opportunities in my life.


Hence, when I went with my youngest daughter to see The second Marigold hotel,  starring actresses such as Judi Dench and Maggie Smith, who I have followed since my late teens, the poignant words at the end said by Maggie Smith ” There is no present like the time” stayed with me and made me write this blog which I published whilst still writing!  It was an amusing film, not necessarily outstanding in anyway but not a bad way to spend a late dreary Sunday afternoon. For those that haven’t seen it, it is the story of a group of retired, typically English people (almost cringeworthy) who decide to go to an Indian retirement home rather than face the alternative in England. Before long amidst the chaos they find themselves finding employment of varying sorts and subsequently feeling rejuvenated and stirred into embarking on new intimate liaisons or just simply falling in love’  and generally rekindling a youthful lifestyle. Hence, Maggie Smith’s reflection at the end.


  One of the things that prevent us making the most out of time is fear. fear of commitment, fear of the unknown, fear of being hurt or simply fear of being left alone. It doesn’t matter what age we are these feelings loom large. Many people find themselves in a rut, unfulfilled, or suffering a job which they don’t enjoy, being underpaid, putting  up with working with a bully or someone who is not pulling their weight. I hear this again and again in surgery and I know the impact it has on their lives and those close to them. Inevitably,  if they don’t move on it effects their mental or physical health or both and that’s when they appear in the surgery for help. It is interesting in Chinese medicine that ‘fear’ is the emotion related to the kidney and by weakening the kidneys this impacts on the other major organs. Also, they hold the view that the kidneys are related to fertility and because of this it is important to maintain a balance by avoiding fear and preserving kidney function to become fertile. An interesting idea and over the years I have been aware of several infertile couples becoming pregnant very quickly when they have cast cares and fears aside!

At our CQC inspection the staff were asked if they were happy and whether there was much sick leave and if they were able to talk openly and whistle blow if appropriate. Fortunately, it was remarked by the inspectors that they felt there was a positive atmosphere in the surgery and we fulfilled these criteria. I think on a day to day basis I believe for the most part we do. I also hope that if we don’t that patients and staff alike will be able to complain so that it can be redressed.

I feel very sad when I talk with young people who are trapped and can’t move on, they are lost and without direction. They fear getting a job that doesn’t sound good enough or is not paid well enough, but often taking up the most unlikely job can lead to job of your dreams. General Practice was always furthest from my thoughts, I only went the interview for the training scheme because the scheme was new and they wanted as many applicants as possible to attend in order to promote the new scheme. I was doing nothing on that afternoon and many of my friends were going so I thought I would go along . When I was offered a place I thought the jobs would be useful for my paediatric career. But at this time General Practice was under great change and before long I became drawn to it and I certainly have no regrets.

As we get older the fear can increase so that often people fear leaving the comfort of their homes. However, with the advent of easier travel and better health care I never fail to be astounded at the corners of the Earth our elderly patients venture –  from jungles to Antartica. I have often thought it would save the country a lot of money if retired people could have subsidised consecutive cruises to combat loneliness and they would receive excellent day care. I have learnt how oxygen can be arranged from country to country overcoming who is responsible from the aeroplane to the other side of passport control. This was to arrange various ambitious holidays for a patient dependent on constant oxygen, but it was a rewarding challenge! This demonstrated how determination and drive can overcome a disability. Travel is not everyone’s ‘cup of tea’ but  it is important to make the best of life while we can and with modern technology there are ways in which the World can be brought to the home. I remember a  90 year old came into the surgery with neck pain. I asked her if she had been polishing or gardening but the she said” I have a confession to make, I bought myself a laptop for my 90th birthday and I think I have been spending too long on it!” She is by no means the only nonagenarian ‘techy’.

My message to young and old seize those opportunities whilst you can as time is precious and  not only will you enjoy life and be more fulfilled but it will preserve both your mental and physical health.


                                       There is no present like the time


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Posted by on March 31, 2015 in Training and Advice


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Yes you did read correctly…..


Could two handfuls of walnuts a day improve the sperm shape, movement and vitality of your sperm?
It seemed appropriate to write about this as September 29th in France is the day people harvest their walnuts and that is what I shall be doing during the next week.

he tao ren | 核桃仁 | Juglandis Semen:walnut

This Chinese herb has been used for many hundreds of years in traditional Chinese medicine (TCM) to reinforce and Tonify the Kidney and Lung Yang. In Western terms this means that if you are ageing, a cold person, tendency to being overweight, backache, knee pain, breathlessness, constipation and infertility. These type of herbs particularly walnuts can gradually ( over a minimum period of 3 months) improve these problems along with other other lifestyle measures.
The Walnut tree is a common sight in the Dordogne,France and it is interesting that it always grows alone or with other walnut trees and has been has been harvested for many years for the nuts or taken to mills to make walnut oil,which is used for salad dressing and is very high in Omega-3 fats with all the health benefits.
imageThe mills are at intervals along the Dronne and are often in the shape of a boat(bateau) and the wiers associated with these mills make exciting canoeing! Most are not in use but there a few which still produce walnut oil. It is possible to take the harvested nuts,after drying them over the winter, to the mill and collect the oil at a later date.Sitting by an open fire cracking nuts in the winter months,watching a good film can be pleasant winter pastime. Old dordogne kitchen tables have large dents in the table surface after years of family nut cracking with a mallet. The new nutcracker is much easier…
imageBut since I read about a small study carried out in Californis and written up in the journal Biology of Reproduction suggesting that eating around two handfuls of walnuts a day improves sperm health in young men harvesting walnuts has a new meaning.
This study involved 117 men between the ages of 21 and 35, who were divided into two groups. One group added 2.6 ounces (75 grams) of whole-shelled walnuts to their daily diet.
The other group continued their usual diet but avoided eating tree nuts. Both groups ate a typical Western-style diet.
Lead author, Prof Wendie Robbins from UCLA’s Fielding School of Public Health said: “We found a significant improvement in sperm shape, movement and vitality in men who added walnuts to their diet over 12 weeks.”
“The men who ate no tree nuts saw no change.”
The fatty acids Omega-3 found in these nuts are thought to have helped sperm development. It is not known if this would help improve male fertility.
About one in six couples are infertile, with 40% of these due to a male factor.
The researchers say the next step is to work with couples who are attending infertility clinics to determine if placing sub-fertile men, with poor semen quality, on a walnut diet results in better success conceiving.
When I resd this I wondered whether it was a signifant result but Dr Allan Pacey, senior lecturer in andrology at the University of Sheffield said: “It would be relatively easy to poke fun at studies like this, but there is increasing evidence to show that aspects of a man’s diet can affect the number and quality of sperm produced by his testicles.”

Moreover,all those young men that need to improve the health of their sperm and potentially their fertility

*Avoid cigarettes and illicit drugs, especially anabolic steroids
*Avoid exposure to toxins such as pesticides and heavy metals
*Limit alcohol intake
*Eat a healthy diet and maintaining a healthy weight
*Take care to keep your scrotum cool, because heat slows sperm production. Avoid hot baths and hot tubs, wear boxers instead of briefs, and avoid pants that are tight or restrictive.

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Posted by on September 28, 2013 in Training and Advice


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