Journal Tag: IVF

5 Steps to Take Before IVF

Steps to IVF

Written by Gina Fox, FGHG Naturopath (This article was originally published on www.conceivebaby.com.au)

Trying to conceive takes time and once you’ve made the decision to have a baby frustration, impatience and sadness are just three of the emotions that can grow with each menstrual cycle that passes.  It’s worth reminding ourselves that we have a 20% chance of conceiving in any one cycle and that 80% of couples will be pregnant within 12 months.  Having that longer term view and doing things to improve your chances of conceiving can be a good focus while you wait.

This impatience for results and lack of understanding about timing is one of the reasons why many couples embark on IVF treatment before they really need to.  We find that many couples benefit from focusing on some key basics they do have control of.  Addressing these things increases the chance of conception within a reasonable time frame and allows women to exert some control over their ability to fall pregnant.

Here are 5 steps to take before IVF:

Have sex at the right time of the month

Know when your fertile window is so that you have sex on a day when you increase your chances of conception.  You only have at the very outside 6 days in your cycle that you may be able to become pregnant and that’s if the sperm lives for 5 days and the egg for 1 day.  The most likely days you will conceive are 2 days prior to ovulation and the day of ovulation.  If you have sex on one of these days then your chances of becoming pregnant in that cycle dramatically increases to 27-33%.

The funny thing is that although 70% of women in a recent Australian study thought they knew when they were ovulating, only 13% accurately estimated their day of ovulation.

If you are relying on an app for this they can be grossly inaccurate. It’s much more accurate is to keep track of your vaginal mucus changes and recognise when your mucus is wetter and more stretchy.  Ovulation predictor kits can also help to more accurately pinpoint your fertile window.  For more information on this go to Your fertility website and watch the video by Kerry Hampton on pinpointing your ovulation (http://yourfertility.org.au/for-women/timing-and-conception/).

Check that your weight is in a healthy range

If you are overweight then you can improve your chances of conceiving by committing to healthy eating and exercising and reducing weight even by a little.  A common measure of whether you are over or under weight is the BMI calculator which you will easily find on line and by putting your height and weight into the calculator it will work out if you fall in the 18.5-25 healthy BMI range.

For women who are overweight and have PCOS reducing weight by as little as 5 % can significantly improve regular ovulation and your chance of conception.

Being underweight can also affect hormones and reduce fertility. Underweight women may be twice as likely to take over a year to conceive compared with healthy weight women.  A man’s weight is also a factor, so father’s-to-be also need to trim down to improve fertility.

Three tips to start off a healthy weight plan:

–  swap soft drinks and alcohol for water;

– make half you plate vegetables or salad at lunch and dinner with a palm size of lean protein such as meat, fish, eggs or pulses;

– get moving more by standing every 40 minutes from your desk, walking rather than taking the car to the shops and taking the stairs.

Have you stopped smoking and drinking?

Smoking affects egg and sperm development and can damage the DNA in both eggs and sperm.  Smoking not only reduces your chances of getting pregnant but also puts you and your baby at risk of pregnancy and birth complications and birth defects.

Even if a woman has never smoked, her partners smoking makes her up to 30% more likely to miscarry.

It’s much easier to quit smoking with your partner so make a plan to do it together and seek help from a counsellor or acupuncturist to give you extra support.

It’s known that drinking alcohol in large quantities reduces your chance of conceiving but low and moderate drinking may also have an impact.  For men alcohol can cause impotence, reduce libido and also reduces sperm quality and so reduces fertility.  Because of the known toxic effects on a baby’s development the National Health and Medical Research Council recommend that not drinking is the safest option for women who are planning to conceive or who are pregnant.

Clean up your environment

Reducing the levels of environmental toxins that have been shown to affect DNA cellular health can affect your Simple steps to take include:

  • increase your intake of organic food;
  • buy non chemical cleaners including laundry powder;
  • start to use natural face and body creams such as coconut or almond oil;
  • men keep your mobile phone away from the reproductive area by not carrying it in your trouser pocket and at night keep on flight mode if you have it by your bedside.
Optimum nutrition

Research shows that optimum nutrition in the pre-conception period three months prior to conception is associated with a lower rate of birth defects.  If you eat well your eggs and sperm will benefit from all the nutrients required for healthy DNA.  Eating for a healthy weight and to support the growth and development of sperm, eggs and healthy hormones we suggest referring to the Fertility Boosting Diet Summary on our Fertile Ground Health Group website (www.fertileground.com.au) and for more information and recipes read The Fertility Diet by Tasha Jennings and The Fertility Food Map by Petra Joly. Or if you feel like you could benefit from some more specific nutritional testing and advice, you could make an appointment with a Fertile Ground Health Group Naturopath.

By taking some control of your own health, most women and couples find they feel happier and healthier and regain a sense of control over their own fertility.

Of course expert help is not far away if you need further support to achieve your aims and make changes, or if you feel you have more complex issues to manage. For more information on support available for your fertility, explore our Trying to Conceive information and other related FGHG blog articles:

Fertility Charting Instructions

Marijuana and your fertility: Are my eggs / sperm stoned too?

Acupuncture to help you quit smoking

 

References

Hampton K, Mazza D; Fertility-awareness knowledge, attitudes and practices of women attending general practice. Aust Fam Physician. 2015;44(11):840-5.

Your Fertility Website

 

 

 

 

 

Gina Fox

Gina Fox is a naturopath with over 15 years’ experience. She trained under Francesca Naish (author of Better Babies) and has a Masters in Reproductive Medicine. As well as being an experienced clinician she is a speaker, naturopathic lecturer and student clinic supervisor.

Gina is highly skilled in providing naturopathic care for women’s health issues, pre-conception health, infertility, IVF support, pregnancy care and through menopause. She treats a wide range of issues including recurrent miscarriage, thyroid, auto-immune antibodies and she has seen good results working with men to improve sperm quality.

Acupuncture for improving sperm quality

Acupuncture for Improving Sperm Quality

Do you really need to improve your sperm health and can acupuncture help? If your semen analysis results came back less-than-ideal you are not alone. Male fertility is a common reason people go to IVF with research showing that 40% of infertility cases are due to poor sperm quality. The good news is that research also shows there is a lot you can do about it. Even if your results came back in the okay range you can still improve your sperm-health even further, giving you the best chance of conceiving.

Do I need to improve my sperm?

The answer is that we all probably could! Since 1989, there has been a 30% decrease in sperm count in the general male population and about one in twenty men has a fertility issue, even if they live a seemingly healthy lifestyle. This may be due to the plethora of environmental toxins we are all exposed to that are known or suspected to impact sperm quality.

Like women, men’s fertility also declines with age:

  • A man’s sperm volume drops by 20% between ages of 30 and 50.
  • The sperm motility (i.e. “swimming power”) drops 3.1% for each advancing year, whereas the percentage of sperm who swim in a purposeful manner decrease by 5%.
  • The older the man, the longer the length of time for his female partner to conceive as well as an increased incidence of miscarriage, regardless of her age.

Many men present with borderline sperm counts that have been deemed ‘fine’. There are a number of considerations we would take into account when assessing the values attributed to sperm counts. Firstly, it is important to know that reference ranges account for normal values in a given population. If the whole population has low values, then normal will be somewhere within a range of overall low values. This is shown clearly when looking at research comparing changes in normal values in a population over time. We also see that overall sperm counts have declined rapidly in the years 1935 to the present.

Secondly, during IVF in particular, low sperm counts are not considered to be a problem due to technological advancements that allow doctors to ‘choose the best’ sperm and inject it directly into the egg (Intercytoplasmic Sperm Injection, or ICSI).  From a natural medicine point of view, we would consider it important to improve the condition of the sperm overall to increase the likelihood of obtaining a healthy embryo when a healthy egg and sperm meet.

As an example of how sperm health affects embryo viability, consider that a non-smoking woman has been shown to have a 30% higher chance of miscarriage when her partner is a smoker than a couple who are both non-smokers. Studies have also shown that miscarriage and birth defect rates increase when fathers have lower sperm counts.

How is sperm evaluated for quality?

Sperm is evaluated according to four main parameters:

  • Volume (i.e. how much semen per ejaculation)
  • Density/concentration/count (i.e. how many million/ml)
  • Morphology (i.e. % of normal v. abnormal in shape)
  • Motility (i.e. % of moving/swimming sperm)

If any of these parameters are abnormal, fertility may be compromised.

Can Acupuncture improve sperm quality?

Acupuncture has been found to improve the motility of sperm by improving its zinc:cadmium ratio. Zinc improves sperm motility whereas cadmium causes thicker semen, thereby slowing the sperm. SOD, an antioxidant which increases both sperm count and motility is also positively influenced by acupuncture.  Furthermore, acupuncture can increase levels of metenkephalin (an opioid which allows sperm to remain mobile for longer) in sperm. Therefore, acupuncture around the female’s ovulation may increase the chance of conception.

Acupuncture has been shown to increase the percentage of sperm with normal morphology. Sperm takes between 70 – 90 days to fully mature, with some studies showing positive results after only 5 weeks (bi-weekly treatments). Improving morphology with acupuncture has also been shown to improve the fertilisation rate using Intercytoplasmic sperm injection (ICSI, an IVF procedure).

Where do the needles go?

Acupuncture points for improving sperm quality are not located on the genitals! Rather, points on the lower back, lower leg &/or abdomen are used. These points are generally painless and are used to increase a person’s strength and vitality, improve digestion, promote good-quality sleep and relieve stress. Any other health problems are simultaneously addressed during an acupuncture treatment, since we believe that your whole wellbeing is important to the health of your sperm. At Fertile Ground, we consider 10 weekly treatments to be optimal owing to sperm maturation time, although a minimum of 4-5 weekly treatments can still achieve positive results.

What else can help?

Diet and nutrition, lifestyle, weight, exercise, environmental toxins and smoking (including marijuana) also play a huge role in sperm health. We believe the most powerful approach is to make changes in these areas together with having acupuncture to really sky-rocket your fertility. This is were we see the best results. In fact, acupuncture can help with lifestyle changes such as quitting smoking and treatment can be tailored to address this along with improving sperm quality.

 

 

Research and references
Jensen, TK, Carlsen, E, Jørgensen, N, Berthelsen, JG, Keiding, N, Christensen, K, Petersen, JH, Knudsen, LB and Skakkebæk, NE. 2002. Poor semen quality may contribute to recent decline in fertility rates. Human Reproduction 17(6): 1437-1440.

Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. 2002. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy.

Siterman S, Eltes F, Wolfson V, Zabludovsky N, Bartoov B. 1997. Effect of acupuncture on sperm parameters of males suffering from sub-fertility related to low sperm quality.

Gurfinkel E, Cedenho AP, Yamamura Y, Srougi M. 2003. Effects of acupuncture and moxa treatment in patients with semen abnormalities.

Pei J, Strehler E, Noss U, Abt M, Piomboni P, Baccetti B, Sterzik K. 2005. Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility.

Dong C, Chen SR, Jiang J, Xiao YH, Cai MX, Zhang YJ, Xu H, Deng LH, Li S. 2006.

Clinical observation and study of mechanisms of needle-picking therapy for primary infertility of abnormal sperm.

Fujisawa M, Kanzaki M, Okada H, Arakawas S & Kamidono S. 1996. Metenkephalin in seminal plasma of infertile men.  International Journal of Urology 3(4): 297-300

Bensoussan A. 1990. The Vital Meridian. Churchill Livingstone: 112

Guzick DS, Overstreet JW, Factor-Litvak P. 2001. Sperm morphology, motility and concentration in fertile & infertile men. New England Journal of Medicine 345(19): 1388-1393.

Ford W, North K, Taylor H, Farrow A, Hull M, Golding J. 2000. Increasing paternal age is associated with delayed conception in large population of fertile couples: evidence for declining fecundity in older men. Human Reproduction 15(8): 1703-1708.

Marijuana and your fertility: are my eggs/sperm “stoned” too?

by Charmaine Dennis FGHG Director and Naturopath

The most commonly used illicit drug amongst people of reproductive age, this one is worth discussing as it is linked to decreased fertility in both men and women, dramatically affecting the quality of sperm and impacting negatively on the health of developing babies during pregnancy.

In men, marijuana disrupts the complex THC (the active ingredient in marijuana) weakens sexual drive and reduces sperm production by interfering with the production of testosterone. Sperm party hard too – research has shown that they become hyperactive, swimming too hard too early and burning out before they reach the egg.1 Yes every cell in your body becomes “stoned” and if sperm don’t have the energy left by the time they reach the egg, they don’t have a chance of breaking through the outer casing of the egg for fertilisation to occur.

Women who smoke marijuana also secrete small amounts of THC in vaginal fluid and reproductive organs, and when the sperm come into contact with it, they go into party mode, becoming hyperactive and burn out too quickly. Marijuana can also harm a developing baby, especially in the first weeks when you may not even know you are pregnant.

Consequences of smoking marijuana on fertility

In Men: 1,2

  • reduces libido and sexual function
  • decreases fertility
  • reduces the number of sperm produced
  • reduces capacity of sperm to fertilise the egg

In Women:3

  • reduces chances of conception
  • reduces the number of eggs retrieved in IVF4
  • reduces chances of healthy pregnancy, associated with implantation failure, spontaneous miscarriage, foetal growth restriction, low birth weight babies and premature birth5

Of course some men who smoke marijuana do get women pregnant, but every man has a different fertile potential and it changes throughout his life. If your fertility is already compromised, smoking marijuana will make you infertile. Women who smoke can also conceive, but as for men, if your fertility is already compromised by any factor, or your man’s fertility is poor, smoking marijuana will make it very difficult to conceive, reducing your chance of having a healthy baby.

If you are trying to conceive we recommend that you don’t use marijuana in any form
Aside from the above risks, marijuana may also be contaminated with problematic heavy metals (such as lead to increase its weight and sale value per gram) or more addictive illicit drugs, such as cocaine. It’s just not worth it.

Research is tricky to conduct on the singular impacts of marijuana on fertility specifically, as people who do smoke or consume it tend to higher rates of cigarette smoking, alcohol, caffeine and other illicit drug use before and during pregnancy, confounding results of any research as they are known to cause issues for fertility and pregnancy.  Of course marijuana is often smoked in combination with tobacco and this has it’s own inherent fertility disasters too.

What about other drugs?
Party drugs, street drugs, illicit drugs such as cocaine, speed, ecstasy, heroin and ice all have dramatic affects on fertility and of course your overall health. Men may suffer reduced libido, abnormally shaped sperm and low sperm count and women often suffer abnormal ovulation and irregular menstrual cycles as well as a reduction in ovarian reserve.1 Long-term use can lead to permanent problems for your fertility and your baby, but in many cases, any damage caused may start to reverse as soon as you quit your habit.

Results from research can be confusing, however, the growing body of evidence that suggests that to produce optimal outcomes for healthy pregnancy and baby, women and men should be encouraged to avoid all forms of substance use behaviour while trying to conceive and during pregnancy.

My future baby
With the regular use of any addictive substance during pregnancy, your baby must suffer the withdrawal symptoms after birth that you are avoiding yourself. After getting your baby used to regular doses of these substances, even though some will cross to the breast milk, compared to being more directly attached to your blood supply there is a dramatic reduction in exposure. This means your baby suffers severe headaches, pains, shakiness, emotional turmoil – all of this while getting to know the feeling of life on the outside – what a difficult start to life (for all of you!). There is no better reason to give up now! Giving up now is not more stressful than the potential poor health outcomes you are creating for yourself and your baby.

But what if I am addicted? How can I give up?
Stay motivated. Get support. Join a group. Be kind to yourself but stay on track. Remind yourself why you are doing it. Reward yourself regularly. Save up the money you don’t spend on these things and treat yourself to a massage – or even a holiday! Do the maths – most people don’t realise how much these habits are costing them!  Literally put the money aside and use it to reward yourselves every week or month that you stay on track.

Support for detoxification with naturopathic work can help by improving elimination and reducing suffering experienced during withdrawal and reduce cravings. Acupuncture and hypnotherapy have both been shown to significantly reduce cravings.

With our patients we often find that emotional reasons underlie substance use. We try to duck and weave away from our feelings and fears by masking them or pushing them down with a cigarette/a drink/a shopping spree/a food binge … (or insert your special avoidance tactic here).

Counselling of some kind can be very useful to identify the ways in which we hide, what in fact we are hiding from and how we can show up to and resolve these issues without the need to dampen it down. You may have tried this in the past and didn’t find it worked for you – don’t give up! Try someone else, something else to give you the support you need to make the change.

You know the ways these things are harmful for you, your fertility and your baby. Now is the time to work on this and it will actually make the inevitable stresses of early parenting easier too. Let us know if you need a referral to a good practitioner.

Research cited:

  1. Fronczak CM, Kim ED, Barqawi AB. The insults of illicit drug use on male fertility. J Androl. 2012;33(4):515-528. doi:10.2164/jandrol.110.011874
  2. du Plessis SS, Agarwal A, Syriac A. Marijuana, phytocannabinoids, the endocannabinoid system, and male fertility. J Assist Reprod Genet. 2015;32(11):1575-1588. doi:10.1007/s10815-015-0553-8
  3. Brents LK. Marijuana, the Endocannabinoid System and the Female Reproductive System. Yale J Biol Med. 2016;89(2):175-191. http://www.ncbi.nlm.nih.gov/pubmed/27354844. Accessed April 18, 2018.
  4. Klonoff-Cohen HS, Natarajan L, Victoria Chen R. A prospective study of the effects of female and male marijuana use on in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT) outcomes. Am J Obstet Gynecol. 2006;194(2):369-376. doi:10.1016/j.ajog.2005.08.020
  5. Fergusson DM, Horwood LJ, Northstone K. Maternal use of cannabis and pregnancy outcome. BJOG An Int J Obstet Gynaecol. 2002;109(1):21-27. doi:10.1111/j.1471-0528.2002.01020.x

Charmaine Dennis NaturopathCharmaine Dennis is a naturopath, fertility and health expert, mentor, writer, mother, and businesswoman. She is the founding director of Fertile Ground Health Group, co-creator of the Be Fertile relaxation CD series and co-author of The Breakfast Project, among other health inspired projects. Her greatest gift and inspiration is making health, wellbeing, and passionate living accessible, inspiring and achievable for everyone. Charmaine’s naturopathic career has followed a special interest in working with couples with infertility requiring IVF support since 1999.  She has assisted many in realising their dreams to conceive healthy, beautiful babies in collaboration with GPs and fertility specialists, acupuncturists and other health modalities.

 

Acupuncture to help you quit

Acupuncture for Improving Sperm Quality

by Ashley Gordon, FGHG acupuncturist

Do you hate smoking and can’t stop? Found a reason to quit, but you just can’t find the will-power to make it happen? Keep reading and see if Acupuncture could be the helping hand you need…

Like many addictions, what can start off as innocent frolic with fun, can often end up being an extremely difficult habit to kick. Smoking, being the most common of addictions, means that if you are wanting to quit, then you are not alone. Exhausted all of the popular means of trying to end your relationship with cigarettes but to still no success? Then if you haven’t tried Acupuncture, then you are not yet out of options!

In this scenario, we will utilise specific acupuncture points, some relating to your bodily organ functions which may assist you in stopping smoking, but many linked with very important detoxification points in your ear. This is a very popular method among us acupuncturists in addressing the withdrawal/detoxification process in efforts of doing everything in our power to bring you closer to your goal of a cigarette-free life.

Note that this is not a miracle cure and no acupuncturist will claim to help you stop smoking if you don’t want to do it. A “can-do” attitude is THE most important part of this process. Getting over the everyday mental struggle is where the initial steps of this process lie. It’s a team effort, so if you aren’t willing to be a team player, then this may not be for you. Alternatively, if you are on board and want to end your toxic relationship with cigarettes, then the sky is the limit! In my time working at Windana Drug and Alcohol Recovery centre, I have seen the difference it makes when you have the support to take positive action, set clear intentions and be held accountable.

This study suggests that acupuncture may help motivated smokers to reduce their smoking or even quit smoking completely.*1 While systematic reviews of data remain inconclusive, I have seen so much benefit for acupuncture to help people stay motivated, on track and supported in their attempt to quit for good. Along with reducing taste and desire, acupuncture supports the body back to good health and vitality in a myriad of other ways, helping you to feel good while your body detoxifies from each cigarette you have smoked in the past

Apart from potentially saying “adios” to these unwanted friends, here are some added benefits of the process:

#1 – Ever heard of Acupressure? Simple to do and you can do it anywhere!! A great technique to help manage cravings – just by massaging your ears… if you are massaging your ears, you can’t possibly be having a cigarette in your hand!

#2 – Acupuncture has been shown to reduce taste for tabacco and the desire to smoke *2

#3 – Not only can acupuncture support your body through the quit smoking process, it may also be helping your organs detoxify simultaneously – it is one thing to treat the symptoms, but why not call in the cavalry to increase your chance of success…

#4 – As there are no medicines, sprays, gums, patches, tablets or pills as part of this process (unless, of course, you chose natural herbal medicine as an additional support), this is an ALL NATURAL approach to ridding yourself of cigarettes.

So if this article speaks to you and you feel as if now is the time to initiate the change you have been wanting to see in your life, then you have nothing to lose by integrating Acupuncture into your quit-smoking campaign… we are waiting for you!

What can you expect?

Overcoming the obstacle of quitting smoking, not only requires determination, but also a high frequency of treatments. Once the cravings start to back off, so does the need for treatment. Of course, every scenario is different and the plan is tailored to each individual’s needs, however, the general plan will look something like this:

Stage One: 3 x treatments in the first 3 days – generally consecutive

Stage Two: 2-3 x treatments per week for 3 weeks, progress depending

Stage Three: 1-2 x treatments per week or fortnight for 3 months, progress depending

As previously mentioned, every plan is different and tailored to the progress and individual needs of the patient. The initial goal of Stage One is to decrease and manage the cravings and potentially the taste of the cigarettes. Following that, in Stage Two, we aim to address decreasing the habit of smoking in everyday-life, and maintaining a ‘no cigarette life’ is the aim of Stage Three. Ensuring that you are supported throughout every stage of your journey is our highest priority, so if you know that now is the right time to give smoking the heave-ho, don’t go it alone. Take the first step by booking in for your initial acupuncture session today.

 

References

*1. “Effects of acupuncture on smoking cessation or reduction for motivated smokers”, Preventitive Medicine, Vol. 26, Issue 2, March 1997, p208-214, https://www.ncbi.nlm.nih.gov/pubmed/9085389

*2. “Effect of Acupuncture on Smoking Cessation or Reduction: An 8-Month and 5-Year Follow-up Study”, Preventative Medicine, Vol.33, Issue 5, Nov 2001, p364-372, https://www.ncbi.nlm.nih.gov/pubmed/11676576

 

 

Ash-Gordon-colourAshley Gordon is a compassionate, caring and nurturing practitioner with an ear for listening to help people move through their healing. He has a passion for assisting others with the power of Chinese medicine and is dedicated to continued personal learning and education of others. Ashley uses acupuncture and Chinese medicine to treat a wide of range of conditions, but has a special interest in treating pregnancy, fertility issues in both men and women, conditions relating to women’s health and digestive problems.

Congratulations Tina & Gina!

Both Tina Jenkins and Gina Fox recently received their Masters of Reproductive Medicine (with Excellence). Here’s a picture of Tina at the graduation ceremony in NSW. Well done ladies!

Here’s what Tina had to say about getting her Masters degree…

“Obtaining a Masters degree has been a long process for me; 4 years of hard work and study alongside my usual consulting work at Fertile Ground and my weekly student clinic supervision for final year naturopathic students. I have always been more academically minded and furthering my knowledge in the very specialized area of fertility was my main inspiration for embarking on the journey towards my Masters. A Masters in Reproductive Medicine requires a Health Sciences degree as a prerequisite along with clinical experience and the course itself is primarily done by GP’s, obstetricians/gynaecologists, nurses and embryologists. All the subjects are medical subjects (Clinical Reproductive Endocrinology, Laboratory Techniques in the IVF lab etc). There were very few naturopaths studying with me, however I was really fortunate to have my Fertile Ground colleague Gina Fox completing it at the same time. Not only did completing my Masters allow me to continually keep up to date with the latest research in the field of fertility, it also allowed me the privilege of learning from some of the great IVF specialists currently working in Australia. All the subjects were taught by renowned IVF and fertility specialists who were all in clinical practice and who were all continually taking part in cutting edge research  in the area of infertility.

I have no doubt that my patients have benefited significantly as a result of this additional training. Not only do I have a much greater depth of knowledge in regards to the medical approach to fertility issues, but I also have a greater knowledge of the latest medical advances in this area. This has not only helped me to work more collaboratively with patient’s medical professionals and specialists but has also allowed a greater level of understanding of  my patients medical issues and their fertility medications.

On another level, it has also enhanced my teaching knowledge so that the students I supervise in student clinic benefit in turn.

Personally it has also been a significant achievement for me. Balancing looking after a young family alongside work commitments (and still trying to have some downtime!) has been an achievement in itself and one of which I am extremely proud.”