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When our reproductive hormone levels are affected, it can cause menstrual cycle disruptions that can result in fertility issues. In this article, we’ll take a look at alcohol’s effects on the main female reproductive hormones. Quick facts: How alcohol and hormones interact According to recent data, women and those assigned-female-at-birth are, on average, drinking more alcohol than ever before. Whilst many people are aware of the immediate health consequences of drinking—including the caloric impact and the dreaded hangover, there’s still very limited awareness of the effects that alcohol can have on female hormonal health.  Hormones act as chemical messengers, which control and coordinate various bodily processes. Each of our hormones relies on a complex system of interactions, often with other hormones, to maintain their levels and carry out their intended functions.  Drinking alcohol, as well as other lifestyle factors like smoking, can affect our hormones, both directly and indirectly. Which hormones are affected by alcohol? Hormones affected by alcohol include: Our hormones are sensitive. They rely on a complex set of interactions, both with one another and other bodily processes in order to stay in balance and perform their functions properly.  Alcohol consumption is known to affect our levels of oestrogen, progesterone and testosterone significantly—three very important hormones in the regulation of the menstrual cycle and overall health. It can also affect our levels of Anti-müllerian Hormone (AMH), gonadotropins like Follicle stimulating hormone (FSH) and Lutenising hormone (LH), thyroid hormones and prolactin.  Let’s take a look at each of them in turn. Oestrogen and alcohol Oestrogen is probably the hormone you know best—it plays an important role in many elements of our health, including the regulation of the menstrual cycle, maintaining bone density and skin health. Acute consumption of alcohol has been shown to increase oestrogen levels. Increased oestrogen levels over a prolonged period can be associated with breast cancer development in those assigned-female-at-birth. The United Kingdom Million Women Study revealed that every additional drink per day contributed to 11 breast cancers per 1,000 women up to age 75. Progesterone and alcohol Follicle-stimulating hormone (FSH) and luteinising hormone (LH), are involved in egg maturation and ovulation, two key elements of the menstrual cycle and female fertility. A surge in your levels of LH triggers the egg to be ovulated, however, there is some evidence that alcohol consumption may affect both the levels of LH in general and the ability of the egg to respond to LH. Excessive alcohol consumption may even affect how the cells within the fallopian tubes function. Testosterone and alcohol Testosterone is typically associated with male sexual development and fertility, but it also plays an important role in female sexual development and fertility, including regulating female libido.  There is some evidence that moderate alcohol consumption may increase testosterone levels, causing an imbalance in androgen levels. High testosterone levels can lead to symptoms like acne, excessive facial and body hair growth (hirsutism), irregular periods, mood changes and loss of libido. Anti-Mullerian Hormone (AMH) and alcohol AMH is produced by the granulosa cells within your ovarian follicles and is used as an indicator of ovarian reserve (your egg count). The relationship between alcohol consumption and AMH is slightly contentious. Some studies have found no change in AMH levels in people who consumed alcohol but more recent studies have shown those who engage in “binge drinking” had lower levels of AMH.  Binge drinking is defined by the Centres for disease control (CDC) as “a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 g/dl or above”. Basically, consuming 4 or more drinks in the space of 2 hours.  Because of AMH’s close ties to your ovarian reserve, lowered AMH levels can indicate a low ovarian reserve. Gonadotropins and alcohol There are two types of gonadotropin hormones in the body—Follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Both FSH and LH are involved in egg maturation and ovulation, two key elements of the menstrual cycle and female fertility.  A surge in LH levels at the midpoint of the menstrual cycle is what triggers ovulation—that month’s mature egg being released into the Fallopian tube.  There is some evidence that suggests alcohol consumption may increase LH levels in general and also impair the ability of our eggs to respond to LH. Excessive alcohol consumption may also affect how the cells within the Fallopian tubes function. Thyroid hormones and alcohol Your thyroid is a butterfly-shaped gland that plays an important role in the regulation of many different bodily functions such as your heart rate, body temperature and growth development.  Alcohol consumption has been shown to alter the levels of the thyroid hormones, thyroid-stimulating hormone (TSH), thyroxine (T4) and triiodothyronine (T3) with heavy use showing decreased levels of T3 and T4. Low levels of thyroid hormones are known as hypothyroidism and can cause a huge number of symptoms including fatigue, weight gain, heavy or irregular periods, fertility issues and irregular ovulation, depression and more. Prolactin and alcohol Chronic alcohol consumption is associated with increased prolactin levels. Consistently high levels of prolactin in your body is called hyperprolactinemia and is significantly associated with infertility through interference with other hormones such as oestrogen and progesterone. Alcohol and trying to conceive When trying to conceive, cutting down on your drinking is often one of the first things on your preconception to-do list. The dangerous effects of alcohol on the developing foetus can range from physical to mental and generally disrupt their development in the womb (see foetal alcohol syndrome).  It is also known that alcohol consumption affects the success of IVF treatment, with one study showing people who had at least four drinks per week were 16% less likely to have a live birth than those who had less than four drinks. Additionally, a 21% lower live birth rate was found for couples in which both drank more than four drinks per week. Other effects of alcohol on the body As well as impacting our hormones, alcohol has other broad-reaching effects on the body and the […]

For many, the journey to parenthood can be a challenging process, both physically and emotionally. We’re here to help you understand the different causes of infertility, and the options available for those who need support. Quick facts: What is infertility? Infertility is defined as not being able to conceive after one year (or longer) of trying. This could be despite having regular unprotected sex with a partner, or trying using methods like artificial insemination (IUI).  There are 2 types of infertility: In the UK, as many as 1 in 7 heterosexual couples experience infertility, yet the causes are sometimes preventative, or treatable.  Causes of infertility  There can be many different reasons why you might struggle to conceive. This can include structural fertility issues, ovulation problems, underlying health conditions and hormonal imbalances. Let’s take a look at each. Ovulation issues  Anovulation, also known as the inability to ovulate, is the most common cause of infertility. Ovulation is when a mature egg is released from one of your ovaries, each month, during your menstrual cycle. The egg travels into the Fallopian tube, where it prepares to be fertilised by a sperm, before then travelling down the tube to the uterus.  When trying to conceive, ovulation is a crucial event, with the 5 days before ovulation and ovulation day itself often referred to as your ‘fertile window’.This is the time of the month when you’ll be most likely to get pregnant.  Research suggests that as many as 25% of infertility cases are caused by anovulation. Anovulation can be caused by: Another possible explanation is a problem with the egg maturation process. This means that an “immature” egg may be released from your ovaries when it is not quite ready and unable to fertilise. Underlying health conditions Polycystic ovary syndrome (PCOS) PCOS is the most common underlying condition affecting fertility. PCOS affects as many as 1 in 10 people with ovaries.  People with PCOS produce higher levels of androgen hormones, like testosterone. This can disrupt your menstrual cycle, ovulation, and balance of cycling hormones—like oestrogen, follicle-stimulating hormone and luteinising hormone (LH). As PCOS is still under-researched and misunderstood, many people are left undiagnosed and are unaware they have it until they are actively trying to conceive. This is why it’s a good idea to check in on your hormones before you start your conception journey.  Primary ovarian insufficiency (POI)  POI is when the ovaries stop working properly before the age of 40. POI is far less common than PCOS, affecting only 1 in 100 women younger than 40. Your ovaries produce oestrogen and progesterone—two cycling hormones responsible for the regulation of your menstrual cycle. When their function is disrupted, ovulation can also become disrupted or stop completely.  People with POI also have a lower ovarian reserve, meaning fewer eggs for their age. Without a sufficient amount of eggs and the correct level of hormones needed to regulate your cycle, the possibility of conceiving is reduced considerably. According to the National Infertility Association, POI can be caused by genetics, autoimmune factors, induced by chemo or radiotherapy, or it can have an unknown cause. Uterine fibroids Uterine fibroids are noncancerous tumours that affect as many as 25% of people with a uterus. They can cause symptoms such as heavy periods, intermenstrual bleeding, and pelvic pain. In some cases, depending on the location in which they grow, and whether they affect the shape of the uterus or cervix, fibroids can also cause infertility.  This is because they can block the fallopian tubes, stopping eggs from meeting sperm, or reaching the uterus for implantation. They can also get in the way of implantation if they are near the inner lining of the womb.  Despite being less common than other causes of infertility, around 5-10% of infertile women and those assigned female-at-birth are found to have uterine fibroids, with their instance being much more common in Black women.  Endometriosis Endometriosis is a common reproductive health condition that affects around 1 in 10 women and people assigned female-at-birth. With endometriosis, tissue similar to the tissue that makes up the lining of the womb starts to grow in other places, such as the ovaries and the fallopian tubes, causing lesions and scarring.   This can cause several life-altering symptoms, such as painful and heavy periods, pain during or after intercourse and pelvic pain. It is also another common cause of infertility, with research suggesting it is present in around 20-50% of infertility cases. The exact link between endometriosis and infertility is unknown. However, some theories suggest that lesions and scarring can cause structural problems with the reproductive organs and chemical changes in the lining of the uterus. Structural infertility  Structural infertility is a problem with the anatomical structure of the reproductive organs. This can include blockages, structural damage or abnormal growth in the fallopian tubes, uterus or ovaries.  Structural issues with the ovaries or fallopian tubes can prevent eggs from being released from the ovaries or stop them from moving through the fallopian tubes to reach a sperm for fertilisation.   Additionally, if the structure of your uterus is abnormal or damaged, it may prevent eggs from implanting into the endometrium (uterus lining). This is needed to create a healthy embryo and pregnancy.  Structural infertility problems can also be caused by scarring from surgery, infections, injuries, or endometriosis.  Also, the growth of noncancerous tissues such as uterine polyps on the lining of the uterus, can cause blockages. Polyps occur when additional tissue grows on your uterus. However, sometimes tissue grows elsewhere in your reproductive system potentially blocking your fallopian tubes and preventing pregnancy.  Implantation failure Other possible explanations of implantation failure are: Infections and auto-immune disorders  Untreated sexually transmitted infections (STIs) may have serious consequences for your fertility. STIs like chlamydia or gonorrhoea can cause scarring and blocking of your Fallopian tubes.  Additionally, if syphilis is left to develop, it can cause stillbirth. There are also other forms of infections of the cervix with human papillomavirus (HPV) that could cause infertility. It’s […]

Exercise can greatly improve your overall health, including your reproductive health. In this article, we’ll break down different types of exercise, their impact on fertility and how to find movement that’s right for you.  Quick facts: Finding the right exercise for you We all have different feelings towards exercise. Some of us can’t go a day without it and some of us simply can’t bear it.  Whichever team you’re on, there’s no denying that exercise comes with some serious health benefits—some of which extend to your fertility and reproductive health.  But getting the balance right, with the right amount of exercise, supplemented with good quality nutrition that covers your personal energy and calorie requirements is essential.  We know that finding the right balance for you and your body can be difficult, especially if you’re just getting started with your movement journey. Here we’ll break down some different types of exercise and intensity that you can consider.  Remember, movement will look different for everyone. If your movement is restricted, you may want to speak to a physio or occupational therapist who can help you find the best way to meet your movement goals. Is exercise good for fertility? The health benefits of exercise are too many to mention. It affects every system in your body from your cardiac system to your digestion and even your bone health.  It would be unfair if your reproductive system didn’t get a share of the health kick you get from your chosen exercise regime but thankfully, it does.  There is more and more evidence emerging that physical activity and exercise can improve reproductive health and pregnancy rates (1). Some fertility benefits to exercise might be indirect but they are helpful nonetheless. Insulin regulation People with a high BMI and elevated blood sugars are known to be at greater risk of fertility challenges. Insulin resistance can affect the maturation of your eggs and inhibit ovulation.  Fortunately, regular exercise decreases abdominal fat, blood sugar, and insulin resistance (3).  Hormone balance  Regular exercise also increases sex-hormone binding globulin (SHBG), a protein that regulates the amount of testosterone in your tissues (4). Menstrual cycle benefits Many studies report that exercise improves menstrual cycle abnormalities including premenstrual syndrome (PMS) and dysmenorrhoea, or period pain (5), as well as reducing the risk of anovulation (failure to ovulate) (6).  Stress reduction Exercise is also known to reduce stress, improve self-esteem and greatly improve symptoms of poor mental health and low mood. Reducing chronic stress on the body can do wonders not only for your hormones and reproductive health but your overall health too. What exercise is good for fertility? There are different types of exercise, all of which can have benefits for fertility and your reproductive health for different reasons. Let’s take a look at each. Cardiovascular or aerobic exercise This is generally any exercise that gets your heart beating faster and increases blood flow to your muscles. Cardio is most beneficial for your heart health and blood vessels. It lowers blood pressure, regulates weight, blood sugars, and sleep, boosts mood, and strengthens your immune system.  All of these benefits will have knock-on benefits to your reproductive health. Brisk walking, running, swimming and cycling all fall into the cardiovascular or aerobic exercise category.Cardiovascular exercises are important but try to get at least two strength training sessions in a week too. Strength training  Strength or resistance training will better protect your bone and muscle health. It will make you stronger and help you to develop better body mechanics.  Strength training isn’t all about bulking up, using weights and going to the gym. You can start strength training using just your body weight at home or outside. Things like yoga, pilates and tai chi all count as strength training, as well as swimming which is a combination of strength and cardio. Flexibility and balance Working on your flexibility and mobility will help avoid injury and, if you’re older, lower your risk of falling. Both can be practised with stretching, yoga, pilates or a dedicated mobility routine.  If you plan on getting pregnant, strength and flexibility will help your body to adjust to the changes that come with pregnancy. Types of exercise intensity Exercise is categorised into three different intensity levels: low, moderate, and vigorous. We all do some bit of low-intensity exercise, whether that’s doing the housework, doing the shopping or strolling to the bus. Other examples are beginners yoga, tai chi or a casual walk.  You can make any of these moderate exercises by upping the pace. Moderate exercise can be thought of as anything that raises your heart rate and makes you breathe faster, but not so much that you’re unable to speak without taking a breather.  Any activity that makes your breathing harder and faster would fall into the vigorous exercise category. Examples include running, rowing, high-intensity interval training and spinning. The NHS recommends 150 minutes of moderate activity or 75 minutes of vigorous activity a week. As a general rule, try and aim for 30 minutes of moderate physical activity a day. If you’ve always been active you can continue your usual training regime at the same level to maintain your health. If you’re new to exercise or you’ve taken a long break from fitness, start to build up your level of activity, starting with low to moderate-intensity exercises. If you just don’t feel like doing a high-intensity workout today, then don’t do one. Start with some slow exercises, or try some yoga to help calm your mind. Finding time for exercise Our lives today have hectic schedules and exercise isn’t at the top of everyone’s priority list. If you can’t squeeze in a training session, remember that some exercise is better than none. Ask a colleague to join you for a 10-minute brisk walk at lunchtime, take the stairs instead of the lift or consider getting off a stop early on your work commute. NHS-approved apps for managing and mapping your progress will help you with time management […]

Period poo. What is it and why does it happen? In this article, we take a look at why our bowel movements seem to wreak havoc during our periods and some tips for managing any symptoms. Quick facts: What is period poo? Period poo is basically any changes to your bowel movements during your period. This can be loose stools, diarrhoea, more frequent bowel movements, constipation, or more wind.  Although period poo might not be the most hotly debated dinner party conversation, it’s actually really common—with one study citing that up to 73% of people who menstruate experience period poo.  What causes period poo? Throughout our menstrual cycles, our hormones cause a whole host of changes, some of which can affect our digestion and gastrointestinal tract. Here are some of the changes that occur in the lead-up to our periods specifically, which can lead to changes in bowel movements.  Prostaglandins and muscle contractions Prostaglandins are chemical messengers that your uterus (womb) produces around your period. They act on the uterine smooth muscles to help them contract and shed their lining each month. This means you have prostaglandins to thank for your period cramps.  Sometimes, excess prostaglandins can act on smooth muscles elsewhere in the body, including the bowels. This causes an increase in muscle contractions in the intestines and bowel, leading to loose stools or diarrhoea.  On the flip side, too little prostaglandins can have the opposite effect, causing things to slow down in the gastrointestinal tract. This is one theory of why some people experience constipation at the time of their period (3).  Increased progesterone levels Although the exact relationship is not well understood, your gut – as well as your uterus – also has receptors for sex hormones like progesterone and oestrogen. This means your gut is sensitive to the changes in hormones that come about at the time of your period. Just before your period, progesterone levels are high, which can cause gut sensitivity, including bloating, diarrhoea or constipation, in some people.  For people who already suffer from Irritable Bowel Syndrome, this can be exacerbated at this time of the month. If you’re experiencing flare-ups, stick to your prescribed symptom management plan and if you think you need more relief, speak to your doctor about alternative ways to manage your IBS during your period.  Diet changes and cravings An increase in progesterone levels just before our periods can cause cravings for certain foods. Changing your diet, for example eating more, consuming more carbs and processed foods, consuming less fibre and not drinking enough water can all affect digestion and lead to changes in stools.  Increased stress or anxiety A common symptom of Premenstrual Syndrome (PMS) that is often experienced just before or during our periods is increased levels of anxiety, overwhelm or stress. Each of these symptoms can lead to a change in bowel movements, as our guts are intimately linked to our stress levels (think the nervous poos).  How to manage period poo symptoms There are certain lifestyle changes you can adopt to help alleviate any gastrointestinal symptoms you notice around your menstrual cycle. Try some of the following tips to help make that time of the month a little less crappy. Eat lots of natural fibre  Fibre is like your bowel’s best friend—it helps to move things through and keep your digestion and bowel movements regular. Make sure you’re getting lots of high-fibre foods like fruit, vegetables and whole grains in the run-up to and during your period. Try not to overeat processed foods and carbs as these often have the opposite effect.  Limit caffeine If you’re experiencing loose stools and diarrhoea, try cutting down on your caffeinated drinks and foods (like dark chocolate). This is because caffeine stimulates the gut, resulting in you needing to go more frequently.  Coffee in particular (even decaf) can stimulate the gut, so best to skip the morning coffee at your time of the month and opt for another way to energise yourself, like a morning walk or some yoga. If you do experience diarrhoea, be sure to increase your water intake to prevent dehydration.  Get moving  Movement and exercise are great for the gut and bowels. They help keep things moving through your digestive tract and can reduce the instances of bloating as well as helping to alleviate period cramps. If you’re not feeling up for your usual fitness routine, some yoga or simple stretching and walking are all great options.   Stay hydrated If you’re experiencing either constipation or diarrhoea, then drinking plenty of water is essential. Being adequately hydrated is very important for a healthy functioning gut and if you have diarrhoea you are at risk of becoming dehydrated quickly if you aren’t replacing lost fluids.  Painkillers and stool softeners It’s not unusual to mistake period cramps for bowel urges and vice versa during your period. Pain and cramps associated with either gut problems or your period can be eased with exercise, heat pads, or painkillers. You can also try stool softeners if you’re experiencing bad constipation. Resources:

Is it harder to conceive with your second child? It can be but it’s different for everyone. Unfortunately, infertility affects 1 in 6 people, so if you are struggling, you’re not alone. This article will share everything you need to know about what secondary fertility is, what causes it, and the treatment options available to you. Quick facts: What is secondary infertility? Secondary infertility is when you are having difficulty conceiving after previously conceiving and giving birth. To be defined as secondary infertility, the previous birth must have occurred without help from fertility treatments or medications like IVF (in-vitro fertilisation). The definition of primary infertility, in comparison, is when someone who’s never conceived a child has difficulty conceiving. So, how common is secondary infertility? Struggling to conceive might come as a shock if you’ve already had a baby. Secondary infertility, however, is a challenge faced by lots of individuals and couples who are trying for more children.  A World Health Organization (WHO) report suggests that around 1 in 6 (17.5%) people are affected by infertility (primary and secondary infertility) worldwide. Secondary infertility: definition and signs You can be diagnosed with secondary infertility by a healthcare professional when: The main sign of secondary infertility is being unable to get pregnant when you’re having regular, unprotected sex for up to six months or a year depending on your age. It could also include several failed artificial insemination (IUI) attempts.  If you’re worried about your fertility, discuss it with your GP or a healthcare professional. Common causes of secondary infertility The causes of secondary infertility are the same as the causes of primary infertility. For women and those assigned female-at-birth (AFAB), these include age-related fertility decline, hormonal imbalances, blockages in your reproductive environment (uterus, fallopian tubes or ovaries) and lifestyle choices such as your weight, nutrition, sleep, stress, and smoking and alcohol. For males and those assigned male-at-birth (AMAB), the causes of secondary infertility are similar. These include age-related fertility decline, lifestyle choices, and hormone imbalances. However, specific concerns for males and those AMAB are testicular damage, genital infections, or problems with ejaculation or sperm. Age-related causes of secondary infertility Age-related fertility decline could be a cause of secondary fertility. For women and those AFAB, it’s natural for the quantity (ovarian reserve) and quality of eggs to diminish, leading to a decline in fertility. In your 20s, your fertility peaks. Then, fertility gradually declines in your 30s, particularly after age 35.he chances of getting pregnant each month during your 30s are about 20%. That means that for every 100 fertile 30-year-old women trying to get pregnant in one cycle, 20 will be successful and the other 80 will have to try again.  By age 40, the chance is less than 5% per cycle, so fewer than five out of every 100 women are expected to be successful each month. Advanced maternal age is associated with increased risks of infertility and complications during pregnancy. Factors like decreased ovarian reserve and higher rates of chromosomal abnormalities can contribute to challenges in conception. Hormonal imbalances affecting secondary infertility Hormonal imbalances are a leading cause of primary and secondary infertility. Hormones regulate your menstrual cycle—consider them the orchestrators of your fertility. Hormonal imbalances can indicate conditions like polycystic ovary syndrome (PCOS) or thyroid issues and can affect ovulation, meaning you might not release an egg every month or the release may be delayed. If an egg isn’t released, pregnancy can’t occur. Hormonal changes can also negatively affect male fertility, reducing sperm production, mobility and motility.  Infections and STIs affecting secondary infertility Infections, both viral and bacterial, can affect your fertility. Some infections, particularly Sexually transmitted infections (STIs), can have lasting negative effects on your fertility if left untreated so it’s important to get regular checkups. Other viral and bacterial infections might temporarily affect fertility. For male secondary infertility, the testis are particularly susceptible to viral infection. Evidence is also emerging that Covid-19 might impact the testis. A common cause of secondary infertility in males or those AMAB, is poor semen quality, including a low sperm count, and low motility. This means sperm that isn’t moving properly or abnormally-shaped sperm which makes it harder for them to move and fertilise an egg. There’s a male fertility misconception that the type of underwear someone wears can affect fertility. Although there seems to be a link between increased temperature of the scrotum and reduced semen quality, there’s no evidence to suggest that the type of underwear worn by men and those AMAB can affect infertility. If you’ve had any infections, surgeries or medical diagnoses in the last 12 months, it might be worth mentioning to your GP if you’re having trouble conceiving or with secondary infertility. Medical diagnoses and treatments affecting secondary infertility Unfortunately, cancer treatments like radiation and chemotherapy, surgery, or a medical diagnosis can affect secondary infertility. If you’ve recently undergone cancer treatment or are about to, you might want to check your fertility with a hormone and fertility test and consider fertility preservation treatments like egg freezing, IVF (in-vitro fertilisation), and donor eggs or embryos. Lifestyle considerations for secondary infertility Lifestyle choices can affect secondary infertility. Things like being underweight or overweight, smoking, using drugs and drinking alcohol. These can all increase the risk of secondary infertility by disrupting your hormone balance and impacting your overall health and well-being. Poor nutrition can negatively impact fertility Poor nutrition like eating lots of trans fats and saturated fats found in ultra-processed foods, and having a high-sugar diet have been shown to negatively impact fertility. Regular exercise to support fertility Although regular physical exercise is considered healthy and will support weight management and optimise fertility, excessive exercise can negatively affect ovulation and fertility in women and those AFAB. Getting enough sleep to support fertility Studies suggest that sleep disturbances correlate with adverse reproductive health outcomes like menstrual irregularities, increased time to and reduced rates of conception, and increased miscarriages. Women with diminished ovarian reserve were found to be 30 […]

Egg donation is a procedure where one individual donates their eggs to be used in someone else’s fertility treatment. In this article, we’ll explain who might benefit from egg donation, the process and how you can choose a donor.  Quick facts: What is egg donation? Egg donation is when a woman or person assigned female-at-birth, donate some of their eggs to someone else’s fertility treatment. It’s proven to be a successful option for people unable to get pregnant using their own eggs.  Sometimes eggs are donated to friends or family that are unable to get pregnant. More commonly, eggs are donated anonymously to help couples or individuals trying to conceive. Who might need an egg donor? There are lots of different reasons why someone may need to use an egg donor. Some of the reasons could include:  What is the egg donation process? The egg removal, fertilisation and embryo transfer procedures used in egg donation are the same as standard IVF treatment.  How to choose an egg donor The first step in choosing an egg donor is deciding if you want a known egg donor or not. You might prefer to use a friend or someone you know as an egg donor.  If this is the case, your egg donor will need to go through ovarian stimulation and egg retrieval at the clinic you’ve chosen for your treatment. It is more common for people to choose an unknown donor. Most clinics will have a list of donors you can choose from. Some clinics might have long waiting lists for donor eggs but you can shop around to find a clinic with shorter wait times if you’re keen to get started. Some clinics have special licences that allow them to offer the option of importing eggs from abroad. Your clinic can’t provide you with identifying information about your donor. However, the profile available is extensive and transparent enough to allow you to make an informed judgement on your donor’s character and personality as well as including an accurate physical description. The information available about your donor will include: To get an idea of your donor’s character and personality, most clinics will have a questionnaire and profile completed by your donor. This will include their interests, a brief personal history and why they chose to become a donor. Some donors chose to write a goodwill message at the time of their donation to any potential children. You won’t receive any information that could reveal the identity of your donor and they won’t receive any information about you or your child once they’re born. If you choose a donor through a licenced UK clinic, they will be subject to a strict screening process. This involves background family health checks, screening for inheritable genetic disorders and testing to rule out infectious diseases like HIV, syphilis, gonorrhoea, and hepatitis. If you choose to use a known donor, they are still subject to the same checks at the clinic. What are the laws on donor eggs? The Human Fertilisation and Embryology Authority (HEFA) oversees assisted human reproduction in the UK. There are several laws in place to regulate licensed fertility clinics and donor conception. It’s illegal in the UK to pay a donor for anything other than expenses. The donor’s expenses are usually covered by your overall treatment cost with the clinic but you can double-check this with your clinic if you’re unsure. Donors have no legal rights or responsibilities to any children born with their eggs. That means if you conceive by donor egg, your donor will not appear on your child’s birth certificate, they won’t have any rights over how your child is raised, and they’re not required to contribute financially to the upbringing of your child. In the UK, egg donation is anonymous at the time of donation. This means the egg donor and you, the recipient, won’t know each other’s identity. However, when a donor-conceived person turns 18 they have a legal right to know their donor.  This means that if you have a donor-conceived child, they can choose to learn identifying information about their donor once they turn 18. The donor does not however have legal rights, claims or responsibilities towards your child and will not be able to contact your child or your family.  You can learn more about the rules around releasing donor information and identity from the HFEA. Are there risks involved with donor conception? As with any medical procedure, there are risks with egg donation. There is some evidence that people who conceive with donor eggs are at a higher risk of some pregnancy complications, including higher blood pressure, small gestational size, early delivery, and caesarean section. Are there any support networks for egg donation? There are plenty of support networks for people who have already been through or are just beginning their donor conception journey. DefiningMum.com founder and donor mum, Beaky Kearns, started the Paths to Parenthood support network to help you from the beginning of your donor conception journey through to parenting your donor-conceived child.  Members have access to regular interactive webinars and live chats from other parents and experts. Here, you can share your experience, find support and chat to other members for advice. Including how to choose your donor.  The site is full of resources from webinar recordings, personal stories, tips and other recommended resources. Resources

Premature Ovarian Insufficiency (POI) is when the ovaries stop working normally before the age of 40. Getting a diagnosis can be worrying at first, but there are options available. Let’s take a look at what you need to know about POI including symptoms and treatments.  Quick facts: What is Premature Ovarian Insufficiency? In short, Premature Ovarian Insufficiency (POI) is when the ovaries stop functioning properly before the age of 40. It can significantly reduce your fertility.  This doesn’t always mean that you don’t have any eggs left in your ovaries or that you couldn’t carry a baby. It means your body is failing to mature eggs or to ovulate each month.You may have heard of Premature Ovarian Insufficiency (POI) being referred to as premature ovarian failure. It is also referred to as Primary Ovarian Insufficiency, gonadal dysgenesis, and hypergonadotropic hypogonadism. Premature Menopause Premature Menopause is when someone before the age of 40 experiences menopause. This means they will not have any more periods and are permanently no longer able to become pregnant.  This is different to POI, where although fertility becomes significantly reduced, there is a chance of spontaneous ovulation, and hence a period might still occur. Some people are still able to conceive spontaneously after their diagnosis. However, POI and Premature Menopause do share many of the same symptoms. What are the symptoms of POI ? POI symptoms are similar to menopause and low oestrogen. You’re likely to experience: Other than menopausal symptoms, loss of skin pigmentation caused by vitiligo or hyperpigmentation can accompany POI. As can hair loss caused by alopecia.  Fatigue, anxiety, and depression can also be common symptoms as a result of other symptoms or a diagnosis (3). If you’re missing your period for three or more months, it’s important to get your hormones tested to try and decipher what’s going on.  You can miss your periods for a number of reasons, including increased stress, changes to your diet or exercise routine. Some people might even like the idea of not getting a period every month, but sudden changes should always be investigated to check the cause of the change and rule out POI or something more serious. What causes POI ? Roughly 1 in 100 people will experience POI and it can affect people up to the age of 40, with some affected as early as their teens (4). But despite its prevalence, the causes, like for many female-reproductive health conditions, are still relatively unknown (2).  POI can happen spontaneously. However, there are a few known risk factors that may increase your risk of developing POI. These include: How is POI diagnosed? To receive a POI diagnosis, you’ll need to get a hormone test. High FSH (greater than 25) and low oestrogen levels, also seen at the onset of menopause, are indicators of POI. This is accompanied by absent, unpredictable or irregular periods for at least two consecutive months.  If POI is suspected, you might also be sent for an internal ultrasound to check your antral follicle count (AFC). Antral follicles are small fluid-filled sacs in your ovaries containing immature eggs. An AFC count is an indicator of the number of eggs you have left in your ovaries, also known as your ovarian reserve. What does POI mean for my overall health? POI can increase the risk of other illnesses or health problems if left untreated. People with untreated POI have an increased risk of developing heart disease and stroke.  Also, because oestrogen plays such an important role in bone health, low oestrogen seen in POI is known to lead to lower bone density, increased risk of bone fractures, and osteoporosis.  There is also evidence that lower oestrogen levels earlier in life can increase the risk of developing Alzheimer’s disease or dementia (3,4). If you have received a POI diagnosis, your doctor will likely recommend hormone therapy to you. This could be in the form of HRT or taking some form of hormonal contraception.  Hormone therapy can help to alleviate symptoms and reduce the risk of developing the associated conditions mentioned above. Does POI affect fertility? Often, yes, POI can reduce your fertility significantly. This can mean getting a diagnosis can be stressful and upsetting, particularly if you want to start or grow your family.  Although POI means your ovaries aren’t functioning properly, as many as 25% of people with POI do spontaneously ovulate. Another 10% do conceive and deliver after their diagnosis (5). If you are looking to get pregnant, there are treatment options available if you have POI—including In Vitro Fertilisation (IVF).  Egg donation is also an option for some people. POI is a condition that affects the ovaries, not the uterus. This means egg implantation and your ability to carry a pregnancy are not greatly affected by a POI. Think you might be experiencing POI symptoms? If you suspect POI symptoms, like irregular or absent periods, it’s important to get checked. Our at-home Hormone and Fertility Test can give you a better insight into your hormones and any symptoms you might be experiencing.  Our team of experts will help you understand whether your symptoms are related to POI or other underlying health conditions. We can also support you with follow-up fertility treatments and fast-track you to specialists for tailored care plans. References:

The vegan diet is often hailed as having many health benefits, but what about when it comes to our fertility? In this article, we’ll cover the benefits veganism can have for your conception journey and which nutritional deficiencies to be aware of with a plant-based diet.  Quick facts: What is a vegan diet? A vegan diet omits any produce derived from animals including meats, fish, dairy products, eggs and even honey. Vegans tend to eat lots of vegetables, fruit, beans, pulses, soya products, tempeh and sometimes meat alternatives.  Plant-based diets have become increasingly popular and ubiquitous in recent years. The Vegan Society estimates that the number of UK vegans has quadrupled over the last five years, with lots of people going either fully or partially vegan for health, environmental or animal welfare concerns.  As veganism grows in popularity, the range of vegan food substitutes has rapidly expanded. You’ll now find different varieties of plant-based milk and the fake meat industry has boomed. As such, adopting a vegan diet is now easier than ever, but will switching to a plant-based diet improve your health and fertility? Health benefits of a vegan diet A vegan diet has a multitude of health benefits. Vegans typically have lower BMI and are up to 78% less likely to develop type 2 diabetes. This is because plant-based foods are typically lower in sugars and fat.  Consequently, many people make the switch to a plant-based diet to lose excess weight. Indeed, studies show that individuals following a vegan diet lose more weight on average than those following calorie-restrictive diets. Veganism and fertility benefits Diet and lifestyle factors can greatly impact your fertility. Will veganism boost your fertility? No, not directly. But, that doesn’t mean there aren’t fertility benefits to a vegan diet.  The link between obesity and infertility is well-documented. Being overweight or obese not only makes you less likely to conceive but also increases the risk of miscarriage and pregnancy complications.  In this way, following a vegan diet may be beneficial if you are currently overweight and trying to conceive—helping you to reach a healthy pre-baby body weight.  In addition, following a vegan diet has been shown to decrease your risk of gestational diabetes. However, regardless of the diet you follow, it is important to ensure that you are obtaining all required nutrients when trying to conceive and then throughout pregnancy.  Veganism and fertility risks You can definitely follow a vegan diet and have a healthy pregnancy, but a vegan diet can put you at greater risk of some nutrient deficiencies which may impact your fertility. Whilst a vegan diet may be low-fat, a plant-based diet can increase the risk of certain nutrient deficiencies.  It’s important to remember that with the correct planning, supplementation and nutrition, these deficiencies can be avoided even with a vegan diet.  Iron deficiency Low iron intake can cause anaemia, a condition in which you have a lower-than-normal red blood cell count. As red blood cells are responsible for providing cells with oxygen, anaemia can cause fatigue, breathlessness and headaches, among other symptoms. Iron deficiency is common in pregnancy, even if you eat meat. However, vegans are at a much higher risk of anaemia. Whilst anaemia is detrimental to general health, the direct effects of iron deficiency on conception and fertility remain unclear.  However, anaemia has been shown to increase the risk of preterm birth and can also lead to developmental delays in the foetus. Anaemia can be easily treated by taking iron supplements. Vitamin B12 There is evidence that vitamin B12 deficiency can decrease your infertility and that, in severe cases, vitamin B12 deficiency can cause infertility. This infertility is normally temporary and can be resolved by taking vitamin B12 supplements.  In addition, vitamin B12 deficiency can also cause anaemia. Vitamin B12 is naturally found in animal products such as milk, eggs and meat, and is essential for metabolism. With the exception of fortified cereals, vitamin B12 is not found in plant-based foods and so vegans are often unable to obtain sufficient vitamin B12 from their diet. Therefore, to avoid health risks and maintain good reproductive health, it is really important that vegans take vitamin B12 supplements.   Vitamin D Whilst we obtain vitamin D from sunlight, it is also found in lots of animal products. As such, vegans can be at risk of vitamin D deficiency, particularly throughout the winter months. It’s generally recommended that everyone in the UK take a vitamin D supplement throughout the autumn and winter regardless of their diet or conception plans. The links between vitamin D deficiency and fertility are unclear and require further research. However, observational studies indicate that vitamin D deficiency is a risk marker for subfertility (not being able to conceive after a year of trying). Therefore, if you are following a vegan diet whilst trying to conceive, it is worthwhile taking vitamin D supplements. Deciding if a vegan diet is right for you Switching to a plant-based diet may seem daunting, but if you ensure you’re eating a balanced diet with the correct nutrition and supplements, there is little risk to a vegan diet whilst trying to conceive.  In fact, arguably, with the required vitamins and supplements, the preconception health benefits to a vegan diet are significant. A vegan diet won’t work for everyone, but if you want to get healthy before trying to conceive then it may be worth giving it a go. Even switching to a plant-based diet for a few meals a week has been shown to have health benefits. If you need some help with your diet and nutrition to switch to a plant-based diet, book a consultation with one of our fertility Nutritionists today. Resources:

For trans and non-binary people considering medical transition, it can be difficult to find the right information about how fertility can be impacted and what treatments are available. We sat down with Asher, who shared their story about embryo freezing, pre-medical transition. Quick facts: Fertility concerns for trans+ individuals Thoughts about fertility may seem very far away when you’re experiencing the distress of having a body that doesn’t align with your identity.  But for trans and non-binary people considering a physical transition, whether with hormone therapy or gender-affirming surgery, the decisions made before and throughout can have a lasting impact on fertility.  Trans healthcare can be incredibly hard to access, with waiting lists for NHS Gender Identity Clinics in the UK being an average of 10 years wait or more.  Educational resources and personal stories of transition can also be hard to find. So we sat down with Asher, who was willing to share their journey with egg freezing to preserve their fertility before transitioning.  Before we dive into Asher’s story and the important decisions people may need to make around preserving their fertility, let’s understand some important terminology: Now let’s meet Asher. After many challenging years of living with gender dysphoria, they were able to access gender-affirming care. Yet it wasn’t until diagnosis and the start of a physical transition, that Asher was made aware of the fertility implications they could face.  Did anyone along your journey recommend preserving your fertility before undergoing any treatment? I discovered the importance of this process at the same time I was about to begin physically transitioning — literally the same day I was diagnosed with gender dysphoria and recommended for Testosterone HRT (hormone replacement therapy).  What were your fears and how did you overcome them? At the point of discovering this, I had surpassed the tipping point of how long I could cope with the soul-destroying experience of suppressing who I am in order to live in a world that taught me I shouldn’t exist. Managing gender dysphoria and trying to present yourself as something you’re not is an always-on 24/7 painful mask and bodysuit that you can’t take off. By the time I broke through internal and external barriers and played the arduous waiting game to speak with a doctor, I didn’t want to live another second with that feeling. My whole being was exhausted, terrorised, neglected and desperate for relief. Hearing then that I should freeze my eggs if I ever want children in the future not only felt like an extra obstacle for something so seemingly distant and intangible. The experience itself also sounded like it would be even more painful than what I’d been living with, as it essentially sounded like it would take me in the opposite direction.  On top of that, the information felt impossible to make sense of and the whole process itself seemed daunting, uncertain and expensive. I’ve always known that if life permits I’d love to raise a child someday, but I was totally unable to connect to this purpose. After a few off-putting initial conversations and appointments and my own research, I didn’t think I would be able to cope and was about to walk away.  Luckily, this is when I was introduced to Hertility and thank goodness I was! Finally some humane guidance, clarity and crucially being seen and understood as a trans person. The whole process became a lot clearer and felt more manageable, and honestly, I started to feel inspired by the gift of being able to do this. Was it easier than you expected to freeze your embryos? Yes. Although it wasn’t exactly easy, the actual process wasn’t nearly as bad as I imagined, especially with triggering my dysphoria. I suffered most in the angst-ridden anticipation before speaking with Hertility! It’s all the unknowns and uncertainty that make things feel worse than they are when you just take things day by day. How did you feel once it was over? So happy and so grateful. At the offset, I couldn’t have fathomed how joyous it would feel to get through this and know I’d honoured the future parent in me. This feeling only served to enrich how amazing it felt to start my physical transition after. Do you think we need more awareness in the community about fertility preservation so people know their options prior to gender reassignment surgery?  Absolutely. I wish I had been more informed and sooner but there was no mention of it, and even when it was it was almost a side-note. Transitioning alone is not an easy, self-determined process so we need to be informed about everything to expect as early as possible to start preparing, mentally and practically.  Help with gender dysphoria and transition If like Asher you are living with gender dysphoria and are considering physically transitioning, it is important to understand the implications this may have on your fertility, should you want children in the future.  Loads of great organisations can help you with the medical, practical and emotional aspects of gender journey and transition including: 

After a 9 year battle with pain, Abbie finally got a diagnosis for endometriosis. This is Abbie’s story, detailing the ordeal she went through to finally get treatment for her pain.  Quick facts: Meet Abbie My name is Abbie (@cheerfullylive) and in May 2019 I was finally diagnosed with endometriosis after a 9-year battle with pain.  If you aren’t aware, endometriosis is a chronic and debilitating condition where cells similar to the ones in the lining of the womb are found elsewhere in the body like the ovaries and fallopian tubes.  In response to your hormones, these cells break down and bleed, similar to the lining of your womb. This can cause inflammation and symptoms like painful periods, as well as possible infertility, fatigue, bowel and bladder problems, as well as many other symptoms. This is my story with endometriosis, from pain to diagnosis and treatment. I hope it can help you if you suspect you may have endo symptoms, or just want to learn more about this condition. Living in pain I can remember distinctly the first time I had severe pain. It was about a year before I had my first period. It was absolutely terrifying and things only got worse from there. My periods started when I was 15 and month by month the pain gradually became more debilitating. It got to the point where I could no longer get out of bed or do normal activities.  I would miss school, university and even work, but my pain and symptoms were deemed ‘normal’ period pain. I was told repeatedly that ‘I just had a bad period’, ‘I had a low pain threshold and ‘it was just something I would have to endure as a woman’.  This was even when I was having fainting episodes and vomiting due to the excruciating pain I was getting between periods. Because it was doctors telling me this, I genuinely believed it was just ‘normal’ and put up for it for many years of my life. Years to diagnosis It was only when my pain became chronic in December 2018, that my health was investigated fully. After going back and forth to my GP, A&E, urology and gynaecology, I was sent for an MRI in April 2019.  After so many years of believing this pain was normal, I didn’t expect my MRI to come back with severe endometriosis adhesions all over, but it did.  I was immediately booked in for an appointment with an endometriosis specialist. He told me I had extensive endometriosis on the left side of my pelvis, my left ovary and my bowel (sigmoid colon). I was also told that it was highly likely I had endometriosis growing on my bladder, my kidneys and on the right side of my pelvis. But only this wouldn’t be known until I had surgery. Managing my endometriosis It’s been over a year since I was diagnosed and I’ve tried so many different things to help with managing endometriosis. I’ve gone from being on the combined pill to the mini pill to extra hormones on top of that.  I’ve come off those extra hormones, gone on the waiting list for excision surgery, have taken different painkillers, tried yoga, hot water bottles, a TENS machine and trialled sacral steroid injections!  It’s been a long, hard journey and there are still many difficult days, but I seem to have found a few things that have personally helped me along the road. Deciding to have an expert excision of my endometriosis I’m still waiting for a surgery date, but just being able to make this informed decision with my consultant made me feel empowered. It made me feel like I was able to have some control over my endometriosis and how much it affected my life.  Being on the mini pill This is something that has helped me, as I no longer have periods anymore, which reduces the debilitating monthly pain and anxiety that comes with it. However, I understand that hormones are a very personal choice and you have to do what’s right for YOUR body. Pain management  Investing in a decent hot water bottle and a heat pad, as well as a TENS machine has really helped me manage my everyday chronic pain. Looking ahead Despite the struggles I’ve faced and the pain I’ve had to endure whilst living with endometriosis, I’m very grateful for all the positive experiences that have come out of this journey.  I started up my own blog, enjoyed being creative on Instagram and found an incredible community of #EndoWarriors! A fellow Endo warrior and I wrote a powerful blog post on “What Endo Means To Me”. Thank you to Hertility for having me on their blog to share my journey with endometriosis! If you feel you may have endometriosis or are concerned about your symptoms, please reach out to someone and don’t suffer in silence. Whether that’s your GP, sexual health clinic, hospital or a company like Hertility who can help you get answers on your reproductive or gynaecological health. You can find me over on my blog at www.cheerfullylive.com or on Instagram at @cheerfullylive www.instagram.com/cheerfullylive. I’m always open to having a conversation around women’s/period health, pelvic pain or endometriosis! Let’s break down the stigma and have more of these conversations!