Mind, Body & Lifestyle Management

1. Mind, Body & Lifestyle Management Zita West Midwife, acupuncturist, nutritionist Northern Ireland Fertility Information Day 2014 Saturday 27th September 2014

2. Mind, body and lifestyle management • All body systems are interconnected • Physiological, psychological • Emotion and wellbeing are key • Stress reduction • Nutrition • = a holistic approach Fertility is a whole-body event

3. MIND Ancient philosophy vs modern medicine

4. Mind, body and lifestyle management • The mind-set of a couple trying for a baby • Uncertainty • Negativity • Strong emotions • Fear • Anxiety • Worry • Voices of authority • Lack of belief • Lack of confidence

5. Mind, body and lifestyle management • Relationship Dynamics • What is stopping this couple from conceiving?

6. Mind, body and lifestyle management • The Past, the Present, the Future • Every couple we see: • What is stopping the couple from conceiving? • What is the dynamic of the relationship? • Is there anything else that may be stopping you two from getting pregnant?

7. Mind, body and lifestyle management • Stress • Depression • Natural • IVF C.D. Lynch, R. Sundaram, J.M. Maisog, A.M. Sweeney, G.M. Buck Louis: Preconception stress increases the risk of infertility: results from a couple-based prospective cohort study—the LIFE study Hum. Reprod. deu032 first published online March 23, 2014 doi:10.1093/humrep/deu032

8. Mind, body and lifestyle management • Our clients • Highly anxious • Stressed • Exhausted • Emotional • Physical aspects of stress • Raised cortisol levels • Reduced blood flow • Hormonal imbalances C.D. Lynch, R. Sundaram, J.M. Maisog, A.M. Sweeney, G.M. Buck Louis: Preconception stress increases the risk of infertility: results from a couple-based prospective cohort study—the LIFE study Hum. Reprod. deu032 first published online March 23, 2014 doi:10.1093/humrep/deu032

9. The one question I ask

10. Why do you think you are not getting pregnant?

11. Mind, body and lifestyle management • Hypnotherapy and Visualisation, Stress reduction • 5% conscious mind • 95% subconscious

12. Mind, body and lifestyle management • Writing / drawing • Counselling • Hypnotherapy • Acupuncture • CBT • Breathing • Visualisation • Stress management • Hypnotherapy and Visualisation, Stress reduction

13. Sex

14. Mind, body and lifestyle management • The bedroom is a battleground

15. Pressures sex, work, life

16. Mind, body and lifestyle management • Woman • Computer/stick/app/phone says ovulation • He'd better be home on time • Pacing the floor • Tension rising • MY EGG WILL ONLY LAST 24 HOURS • Then we’ll have to wait another month! • If he’s late and we miss this window, there's no sex for him for the rest of the month • God, I hope it happens this month • I hate being so desperate • I wish sex wasn’t becoming so mechanical • Man • I wish she wouldn’t do temperatures, internet and gadgets: it makes her more obsessive • Such a busy day today: I don’t know how I'm going to leave at 6.00 • I'm going to get such grief if I'm late tonight • The anxiety is starting: I might not be able to perform • I wish I could fix it for her • I feel helpless and don’t know how to support her when it hasn’t happened • I hate seeing her so unhappy • I wish sex wasn’t so mechanical

17. Mind, body and lifestyle management • Time to pregnancy • 84% couples who have regular sex without contraception will conceive in one year. • Of those who fail to conceive in first year, about half will conceive in second year. Cumulative pregnancy rate: 92% at 2 years.1 • For the majority of couples it takes only two things: 1. Time. 2. Opportunities for sex • 1. NICE, Fertility assessment & treatment for people with fertility problems, Clinic Guideline 11, 2004

18. Gismos, gadgets, apps and the internet

19. Mind, body and lifestyle management • Common myths • Myths around ovulation • Timing of sex • How long an egg lasts • How long a sperm lasts • Saving up the sperm • Positions for sex • What happens after sex

20. Body

21. Mind, body and lifestyle management • Nutrition for fertility • Laying the foundations for a healthy pregnancy

22. “The kind and quantity of nutrition you received in the womb; the pollutants, drugs and infections you were exposed to during gestation; your mother's health, stress level and state of mind while she was pregnant with you — all these factors shaped you as a baby and a child and continue to affect you to this day.” – Annie Murphy Paul, Time Magazine Pregnant Woman Heide Benser / Corbis

23. Mind, body and lifestyle management • “the 12 month pregnancy”

24. Mind, body and lifestyle management • What is a good diet ? • The mythical balanced diet doesn’t exist • Women eat according to their hormones, moods and cycles

25. Mind, body and lifestyle management • What depletes our bodies of nutrients needed for fertility? • Alcohol • Stress • Exercise • Medications • Processed foods • Trans-fats • Sugar • Caffeine

26. Mind, body and lifestyle management • “ Nutrition is the most influential non-genetic factor in foetal development ” • Nutritional stores • Diet • Windows of opportunity • Foetal growth • Birth weight • Brain development • Pregnancy complications • All determined by the nutrients available to the foetus

27. Mind, body and lifestyle management • Factors for good fertility • Healthy Eggs • Healthy Sperm • Healthy Implantation • Environmental • Stress • Nutrition • Lifestyle

28. What an egg needs

29. Mind, body and lifestyle management • What an egg needs • Q: Can I do anything to improve the quality of my eggs?’ • Nutrition – most important • Blood flow - acupuncture • Lifestyle factors • Protection from free radicals • Diet rich in antioxidants • Managing blood sugar

30. Mind, body and lifestyle management • Healthy EggsFactors that effect Egg Quality • Age • DNA less stable • Blood flow reduced • Reduced hormonal fuel • Increased free radical damage • Environmental • Toxins • Diet and nutrition • Mental and emotional stress • Immune factors and inflammation

31. Mind, body and lifestyle management • Impact of Age • AMH AFC • Longer time to conceive • Fear about the biological clock • Increases in anxiety • Less sex • Fertile window • Egg quantity and quality decline with age

32. What a sperm needs It takes two

33. Mind, body and lifestyle management • What a sperm needs

34. Mind, body and lifestyle management • Factors affecting egg and sperm health • Reactive Oxygen Species (ROS) • Infections • Age • Weight • Processed foods and trans fats • Occupational hazards • Smoking • Alcohol • Caffeine • Drugs (prescribed and recreational) • Heat

35. Implantation, immune & inflammation Recurrent miscarriage IVF Failure

36. Mind, body and lifestyle management • Mayonnaise miracle babies!

37. Mind, body and lifestyle management • Nutritional testing • Vitamin / mineral deficiencies • Iodine • Essential fatty acids • Inositol • Vitamin D • Antioxidant profiles • Minerals / vitamins involved in hormone regulation and egg quality

38. Lifestyle

39. Tyranny of the “shoulds& shouldn’ts”

40. Mind, body and lifestyle management • Lifestyle factors • Extremes: • All or nothing Lifestyle factors and reproductive health: taking control of your fertility: Rakesh Sharma, Kelly R Biedenharn, Jennifer M Fedor and Ashok Agarwal: Reproductive Biology and Endocrinology 2013 11:66

41. Mind, body and lifestyle management • Common lifestyle questions • How much coffee? • How much alcohol? • Do recreational drugs have an impact? • How much exercise? • Can I have the odd cigarette? • Can stress affect my chances of getting pregnant? Lifestyle factors and reproductive health: taking control of your fertility: Rakesh Sharma, Kelly R Biedenharn, Jennifer M Fedor and Ashok Agarwal: Reproductive Biology and Endocrinology 2013 11:66

42. Mind, body and lifestyle management • How much caffeine is OK? Lifestyle factors and reproductive health: taking control of your fertility: Rakesh Sharma, Kelly R Biedenharn, Jennifer M Fedor and Ashok Agarwal: Reproductive Biology and Endocrinology 2013 11:66

43. Mind, body and lifestyle management • Caffeine • Increased time to get pregnant in females, especially over 500 mg per day • Risk of miscarriage at over 100 mg per day • Caffeine present in caffeinated drinks, coffee, tea, painkillers Lifestyle factors and reproductive health: taking control of your fertility: Rakesh Sharma, Kelly R Biedenharn, Jennifer M Fedor and Ashok Agarwal: Reproductive Biology and Endocrinology 2013 11:66

44. Mind, body and lifestyle management • Is there a safe alcohol limit? Lifestyle factors and reproductive health: taking control of your fertility: Rakesh Sharma, Kelly R Biedenharn, Jennifer M Fedor and Ashok Agarwal: Reproductive Biology and Endocrinology 2013 11:66

45. Mind, body and lifestyle management • Alcohol • Government recommendations are max 14 units a week but no national guidelines for women trying to conceive • Wine now stronger so a 750ml bottle of wine at 14% contains 10 units! • Many women (and men) drinking more than they think • Damage to eggs in women • Damage to sperm DNA in men leading to delayed conception and increased risk of miscarriage Lifestyle factors and reproductive health: taking control of your fertility: Rakesh Sharma, Kelly R Biedenharn, Jennifer M Fedor and Ashok Agarwal: Reproductive Biology and Endocrinology 2013 11:66

46. Mind, body and lifestyle management • Alcohol • A man ‘steeped in wine ... is clumsy[in bed] and bad at sowing seed, and is thus likely to beget unstableand untrusty offspring, crooked in form and character.....’ (Plato circa 400BC) • BINGE DRINKING IN MEN • ↓ Testosterone levels • ↓ Folic acid • ↓ Libido and erectile function • ↑ Oxidative stress → DNA damage Worst is lager, best is red wine, particularly Malbec, and Madiranfrom the Tannat grape (organic if possible)

47. Mind, body and lifestyle management • What about the occasional cigarette? Lifestyle factors and reproductive health: taking control of your fertility: Rakesh Sharma, Kelly R Biedenharn, Jennifer M Fedor and Ashok Agarwal: Reproductive Biology and Endocrinology 2013 11:66

48. Mind, body and lifestyle management • Smoking • Reduces fertility, delays time to conception and reduces IVF success rates • In men: decrease in total sperm count and motility, DNA damage to sperm, depletion of nutrients need for sperm manufacture, implications for future heath of the child • In women: decreased fertility, DNA damage to eggs, disruption of hormone levels, lower pregnancy rates • Pregnancy Lifestyle factors and reproductive health: taking control of your fertility: Rakesh Sharma, Kelly R Biedenharn, Jennifer M Fedor and Ashok Agarwal: Reproductive Biology and Endocrinology 2013 11:66

49. Mind, body and lifestyle management • Body Mass Index & Body Fat %

50. Mind, body and lifestyle management • Impact of body fat on fertility