Polycystic Ovarian Syndrome is a common, although often underdiagnosed, condition affecting women in the UK. It is thought to affect more than one in 10 women, and those suffering from PCOS often have concerns about whether they can successfully have a family.

In September, we focus on PCOS, aiming to raise awareness of this often-distressing metabolic disease, which can cause many symptoms, including difficulties conceiving and complications while pregnant.

PCOS and fertility

Symptoms vary from person to person and in severity, but they can include:

• Menstrual problems
• Difficulty conceiving
• Increased body and facial hair caused by high levels of male hormones
• Weight gain
• Thinning hair
• Acne

It affects your ability to get pregnant in several ways. Your ovaries are typically enlarged, with many follicles containing immature eggs that fail to mature and release an egg, meaning many women have irregular periods or no periods.

PCOS can also cause weight gain and a high BMI, making it more difficult to conceive. However, a diagnosis of Polycystic Ovarian Syndrome does not mean you cannot have a baby.

Whether you’re trying to conceive naturally or contemplating fertility treatment, there are steps you can take to improve your chances of success.

PCOS and nutrition

One of the first steps is to try and achieve hormonal balance by addressing diet. Fertility nutritionist Melanie Brown is particularly interested in endometriosis and PCOS and the effect of nutrition on ameliorating their adverse impact on fertility.

“First and foremost, PCOS is a challenging condition for women to live with, and it is also very tough to treat,” Mel explains. “Often the advice when you’re first diagnosed is to go on the pill which masks many symptoms. Many PCOS sufferers come off the pill when they want to start a family and find that their periods might not come back, whereas symptoms such as acne or facial hair return with a vengeance.

“Whether you’re trying to conceive naturally or about to undergo IVF, it’s ideal to prepare your body and improve egg quality. It is also good to reduce abdominal fat, which is often an issue for those suffering from polycystic ovaries, without crash dieting, which is not good for your fertility.”

Melanie explains that her approach to treating PCOS patients is similar to all her fertility patients but emphasises controlling blood sugar. Although the cause of PCOS is not entirely understood, it is believed that abnormal levels of the luteinising hormone (LH) and high levels of male hormones interfere with the normal function of the ovaries.

LH is released at a certain point in your menstrual cycle to stimulate the ovarian follicles to mature and release an egg. PCOS sufferers already have high levels of LH, which means they fail to ovulate normally. We also know that glucose-induced insulin spikes further increase the production of testosterone and LH.

“The basis is always a low glycaemic, low carb diet. As well as its impact on our hormones, a dysregulated blood sugar mechanism means that insulin no longer packages up glucose neatly and delivers it to the liver. Instead, it panics and stores it in your fat cells, particularly around your abdomen.

I always check vitamin D levels as many people, particularly those with a higher BMI, are deficient in it without realising it, and it’s important for fertility. As well as a high dose of vitamin D, I recommend supplements that control blood sugar and inflammation and balance hormones such as Inofolic to my PCOS patients.

“Weight gain is a common symptom of PCOS, and many of my patients have been living with this issue for many years. Often, I have to override the messages we’ve been fed by the diet and food industry for decades and explain that peanut butter on rye toast, avocados and full-fat humus are far better for you than Special K, diet coke and low-fat yoghurt.

“Education is always critical. If patients understand what’s happening in their bodies, brains and biome, they can make positive and informed choices.”

PCOS fertility treatments at Aria Fertility

Consultant gynaecologist Miss Amanda Tozer at Aria Fertility is an expert in general gynaecology and women’s health. She has a comprehensive knowledge of menstrual disorders, including endometriosis, PCOS and fibroids. She will investigate symptoms with a physical exam and complete a medical history check.

She can perform ultrasound imaging to check for cysts in the ovaries. You may also need a blood test to check your hormone and insulin levels.

Miss Tozer can offer advice on potential treatments depending on your symptoms and needs, including lifestyle advice, supplements, hormonal control and possible fertility treatments.

Treatment options include induction of ovulation, where fertility medication is used to gently stimulate your ovaries to produce and release a mature egg. You can then either attempt to conceive naturally or through intrauterine insemination (IUI). In general, IVF success rates are excellent for cases of infertility caused by PCOS. Women with POCS may be at higher risk of developing ovarian hyperstimulation syndrome (OHSS), but our experienced fertility doctors are highly skilled in treating PCOS patients and will take every precaution to prevent and manage OHSS.

For more advice on anything fertility and nutrition-related, see Mel’s website: melaniebrownnutrition.com. Call +44 (0) 203 263 6025 or email us at admin@ariafertility.co.uk for advice on preparing for IVF.

For more information on the individual practitioners and organisations offering support, advice, and information to those undergoing fertility treatment, please visit our Support Hub. To discuss your fertility options with one of our specialists, call xxx.

In vitro fertilisation is a challenging time as it’s both emotionally and physically demanding, and one way to prepare for IVF is to focus on the potential benefits of improving egg quality or ovarian function through lifestyle changes, such as nutrition.

Leading fertility nutritionist Melanie Brown believes nutrition can help improve fertility.

“Women are constantly being told nothing can improve the quality of their eggs. And while we are all born with the eggs we shall ever have in our lifetimes, the environment in which those eggs mature is fundamental to their quality, so this assertion is not strictly true.

“There are many reasons why someone’s egg quality or ovarian function might not be optimal and can be positively influenced.

“We know that smoking damages egg quality, so conversely, I believe that nutrition and other lifestyle changes could also help to improve egg quality. If you can do something that adversely affects egg health, it shows they are not immune to their environment.”

IVF vs a normal menstrual cycle

During a normal menstrual cycle, many follicles containing immature egg cells or oocytes will develop and grow when your body releases a follicle-stimulating hormone called FSH.

Typically, one standout follicle grows faster than all the others, known as the dominant follicle. It sends a signal to decrease the amount of FSH being produced, which causes the other follicles to cease developing, leaving only the one dominant follicle to continue growing and the egg inside to mature.

In an IVF cycle, however, the goal is to grow multiple follicles simultaneously, a process that does not occur in a natural cycle.

“I often say to my patients, if you look at the progress of an IVF cycle as a flow chart, you can see how important it is to ensure you are as well prepared as possible,” Melanie explains. “You might have 18 follicles, which release 14 eggs, 10 of which are mature eggs, from which eight go on to be fertilised, six then go through to day three, and maybe two become day 5 blastocysts.”

Preparing for IVF with nutrition

“I can also advise patients on all the fertility-improving strategies out there on the internet – milk or no milk, soya or no soya, is DHEA right for you, how do I use melatonin?

“There’s an ever-running argument about milk consumption during IVF. Many nutritionists think milk is the devil’s work as it’s very inflammatory and can be a factor in everything from acne to polycystic ovaries. And I certainly think that’s true for those that suffer from certain conditions.

“But, if you don’t suffer from those conditions, I think there’s quite an argument for consuming milk in an IVF cycle. Milk is meant to grow baby animals and full-fat milk is full of growth factors and growth-promoting nutrients.

“Iron takes oxygen to our cells, so if you are even slightly anaemic, then it means you’re not getting enough oxygen to your ovaries. Yet, many people might be entering an IVF cycle with mild anaemia – if you have undiagnosed endometriosis, very heavy periods or have a vegetarian or vegan diet.

“A protein-rich diet is essential to support multiple follicle growth during an IVF cycle. Protein makes up the building blocks for every cell in our bodies, including our sperm and eggs. So ensuring you have the right amount of protein is essential.

“I see maximising ovarian function and potentially improving egg quality before IVF, as a ‘project’ – usually three months will do it.”

For more advice on anything fertility and nutrition-related, see Mel’s website: melaniebrownnutrition.com. Call +44 (0) 203 263 6025 or email us at admin@ariafertility.co.uk for advice on preparing for IVF.

For more information on the individual practitioners and organisations offering support, advice, and information to those undergoing fertility treatment, please visit our Support Hub.

Following on from an international study published at the end of last year that demonstrated declining sperm counts are accelerating, new research has pinpointed that air pollution can significantly damage sperm quality.

A meta-analysis of nearly 27,00 studies identified factors such as air pollution, pesticide exposure, and chemical pollutants as causing increased sperm DNA fragmentation. The research was published in the journal Reproductive Biology and Endocrinology, and the studies they reviewed included data from men exposed to high levels of workplace pollution and those living in areas with high environmental pollution levels.

Standard male fertility tests check the number, motility and shape of the sperm. A further diagnostic assessment we offer at Aria Fertility is the sperm DNA fragmentation test. This provides more in-depth knowledge about sperm quality.

Sperm DNA fragmentation are breaks in the DNA strands that are contained within the sperm, and this can affect the ability to conceive and has been linked to a higher incidence of miscarriage. This is usually caused by oxidative stress and, as well as pollution, the study also identified several lifestyle factors that had a significant impact. Here are 5 common lifestyle factors that could affect male fertility.

Lifestyle factors and male infertility

1. Smoking

Nicotine addiction might be one of the most important lifestyle factors affecting fertility. Numerous studies have found smoking is associated with decreased sperm count, reduced sperm motility, and poor sperm morphology, which is how sperm are shaped, and in this most recent study, researchers demonstrated that smoking could increase DNA fragmentation by an average of 9.19 per cent compared to non-smokers.

2. Alcohol

How much is too much? Many studies have investigated the effect of excessive alcohol consumption and fertility and found that it impacts both male reproductive hormone production and the quality of your semen. One Danish study found that for men who consumed 40 units or more of alcohol per week, their sperm count was approximately 33% lower than those who drank between one and five units per week.

3 & 4. Your weight & diet

These two often go hand in hand. Generally speaking, men and women with a higher BMI are more likely to have lower fertility. Although it is not possible to say that losing weight will definitely improve your chance of conceiving, adopting healthy eating when trying for a baby is a sensible step. A healthy and varied diet, rich in vitamins and antioxidants, is essential for good sperm health.

5. Reduce your exposure to BPAs

Although it might not be possible to avoid the impact of environmental pollutants, particularly if you’re living in a large city, you can take steps to reduce your personal exposure to BPAs.

Bisphenol A (BPA) is one of the most common chemicals we’re exposed to in everyday life, as it’s used in everything from food and drink containers to dental fillings. Try to avoid canned food, use BPA-free plastic storage, eat fresh produce, cook from scratch, and use glass water bottles and reusable coffee mugs.

Call +44 (0) 203 263 6025 or email admin@ariafertility.co.uk to arrange a male fertility health check, including a sperm DNA fragmentation test, at Aria Fertility.

In celebration of International Nurses Day, Maddy, who is egg donation coordinator at Aria, explains what drew her to working in fertility and the satisfaction she gets from being a fertility nurse.

What’s your favourite part about being a fertility nurse?

“The great thing about being a fertility nurse is the diversity of the day-to-day job. You can be down in theatre for the morning doing egg collections or looking after your patients in recovery. In the afternoon, you may be upstairs doing blood tests or scans or doing admin and following up with your patients with phone calls and emails.”

“Our appointments with our patients can cover talking them through their fertility treatment journey and what they can expect, explaining what their scans showed, or teaching them how to take their IVF medication.”

What element of your job do you find most special?

“I am the egg donation coordinator at Aria, which is really, really special. Everything is kept anonymous and takes careful planning to ensure that the donors and recipients are kept separate when they come in for their appointments. But it’s a special moment for both parties, and often the recipients come in with a gift or card for their donors. It’s lovely to see their kind words, and it always reminds me why I am doing this job in the first place.

“We use an external donor organisation that recruits the donors, and then we match them with our patients who may have experienced failed cycle after failed cycle and are unable to use their own eggs.

“I oversee the whole process, so I work with the donor from start to finish, doing their consent forms, blood tests, etc. And then I organise the recipients.”

What makes working in a fertility clinic different to other sectors of nursing?

“The continuity of care and hands-on nature of the role is critical. You see patients throughout an intense journey and are there for their outcomes, whether it’s egg freezing or they are creating embryos. Once they become pregnant, we see them up until 12 weeks before they move to antenatal care with their local hospital or private obstetrician.”

What makes working at Aria Fertility special?

“The team at Aria have all been together since it opened – the doctors, nurses, and the admin team – and we’ve created something unique.

“We are also a small team, so you often look after patients at every stage of their journey. We have a lot of egg-freezing patients at Aria Fertility. The initial step is a consultation with their doctor; then they will have a nursing consultation which I do many of. This will be quite a lengthy appointment as we explain the process thoroughly. You see them for their scans and track their follicle development, and then you often see them on the day of their egg collection.

“Today, we said farewell to one of our egg-freezing patients, who has done a couple of rounds and banked enough eggs. And hopefully, we may see her again in the future!”

What made you specialise in fertility nursing?

“My background is in theatre recovery nursing. I moved here from Australia in 2016 and initially did agency nursing, working at hospitals around London. My recruiter contacted me with a month-long temporary position at a fertility clinic; it’s always lovely to have longer-term positions as an agency nurse, so I immediately said yes. And, from the moment I stepped in the door, it was love at first sight.”

What’s the next stage for you in fertility nursing?

“If any area of nursing needs spotlighting, its fertility nursing. People often think you need lots of experience or training, but you learn on the job, and there’s endless progression.

“I started with zero experience, and five years later, I’m now donation coordinator and furthering my knowledge of scanning. I currently do follicle-tracking scans, and next week I’m doing a scanning training course for two days, so in the future I’ll be able to do pregnancy and diagnostic scans.

“After your initial consultation with our doctors, you’ll have a fertility check, and a diagnostic scan is a cool 3D scan of the uterus to identify any potential issues such as cysts or fibroids. I’m very excited about this next stage!”

The Human Fertilisation and Embryology Authority (HFEA) has opened a patient consultation process regarding proposed changes to UK fertility laws which they say are inflexible and not reflective of modern fertility practice.

The Human Fertilisation & Embryology Act (HFE Act), the law that currently governs fertility treatment and embryo research in the UK is over 30 years old. The HFEA believe that it no longer accurately reflects the medical and scientific innovations and changes in societal expectation that have occurred over the subsequent decades. They recommend sweeping reforms, proposing to put patients at the heart of fertility law.

Julia Chain, Chair of the Human Fertilisation & Embryology Authority (HFEA), explains: “Much of the fertility law has stood the test of time remarkably well but modern fertility practice, emerging possibilities in research that could benefit patients and the changing expectations of donors and of families, are not reflected in the sector’s 30-year-old law.

“With input from an expert advisory group, we have identified where the law needs to be modernised in the interests of patients and their families. This includes providing more up to date powers for inspecting and regulating fertility clinics in the interests of patients and greater choice around donor anonymity. However, it’s important to note that any decision to update the law is for the Government and ultimately Parliament to decide.”

Fertility law changes being considered

• Changes to HFEA’s regulatory powers so they can more rapidly impose conditions, suspend all, or part of a service for a specific period of time, or impose financial penalties where there have been serious non-compliances
• Extending HFEA’s powers to address fertility services outside licensed fertility clinics
• Changing current access to donor information, including providing parental and donor choice where they can opt for anonymity until age 18 (as now) or identifiable information on request after the birth of a child.
• Allowing automatic record-sharing between fertility clinics and GPs to ensure safer patient care.
• Encouraging innovation by allowing the HFEA to authorise trials for low-risk new practices.

HFEA also plan to future proof the law to ensure it is better able to respond to scientific developments and speed up potential new treatment options for patients.

Since the Human Fertilisation and Embryology Act was established in 1990, fertility care in the UK has changed rapidly and currently around 60,000 patients use fertility services every year and approximately 60% of them will pay for their own treatment.

The HFEA consultation opened on 28 February and will run for six weeks on the regulator’s website. It will submit its recommendations for law changes to the Department for Health and Social Care by the end of the year.

For more information and to share your views, Fertility Network UK are holding a webinar on the HFEA’s proposed changes to fertility law with Peter Thompson from the HFEA. The webinar will explain more about this consultation process, what the proposed changes mean to patients and how patients can get involved.

You can register here: Webinar – Why Changes To Fertility Regulations Matter To You | Fertility Network