When thinking of having a child, it’s important you keep your body healthy and working well so your baby can develop with minimal risks of complications.

Over the past thirty years, fertility science has helped millions of couples overcome their difficulties and have a family of their own. There are a range of treatments and options available to help you achieve your family in a variety of circumstances. There can often be a lot of information to take in of what may be expected of you and what you can expect along the way.

Understanding your fertility

It’s normal to undergo a series of initial fertility tests when planning on starting a family and it’s also normal to feel a little anxious. The tests are simply to check the quality of your eggs or sperm and check for any potential infections that might be harmful to your partner or surrogate and child.

The first step is to visit your doctor and explain your concerns. It can be daunting at first, but your doctor will be very understanding of any concerns you voice. They will give you a series of simple tests to begin to determine what your fertility issues are, if any. Once you receive your test results, your doctor may refer you to a specialist if they decide there is a need for further testing.

Your doctor will ask you and your partner to recount your medical history and sex life in detail. It’s very important you are honest and open with your doctor. Remember, what you tell them stays between you and them, so there is no need to feel embarrassed. If you don’t feel comfortable going into this level of detail in front of your partner, you can arrange a private discussion with your doctor.

Over the past thirty years, fertility science has helped millions of couples overcome their difficulties and have a family of their own.

Common tests for men

Your doctor will conduct a routine physical examination of your penis, testicles and prostate gland to check for anything unusual. They will be looking for varicose veins around your scrotum and check your sperm ducts are present and undamaged.

Your doctor will ask for blood and urine samples from you for testing, it will give a clearer indication of further tests they may need to perform. They may request a semen sample too; this can be done at home or in clinic, and they will check semen for quality and volume.

Common tests for women

You might receive a pelvic examination; this is to check the size and shape of uterus. You may also have your breasts examined and your weight and body mass index (BMI) measured. You will be required to have some routine investigational blood and urine tests. Your doctor will run through what these are used for and why.

You may also be required to have routine monitoring such as hormone, blood and urine tests taken on specific days of your menstrual cycle to measure different hormone levels. These will help determine if you are ovulating, as well as the quality and quantity of eggs products. Your temperature may be required to be taken throughout your cycle to indicate when you are ovulating.

Depending on the results of the fertility tests, you may be referred to a specialist for further tests or treatment.

Visit www.merckbloom.com/en_GB/clinic-finder to find a clinic near you to help you better understand your fertility assessment.

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Tracey Bambrough

Co-founder, IVF Babble

Right now, you might feel like you’re the only person in the world who understands the pain, loneliness and heartache of infertility. But you’re not alone.

IVF is tough. Infertility can make you feel like no one understands what you are going through. When people keep telling you to “relax and it will happen,” you probably feel hopeless and panicked. It’s not uncommon to pull away from friends and family as you try to deal with the disappointment of negative pregnancy tests, month after month. 

Sharing personal experience

We have both been through it. We’ve experienced both the emotional pain of failing to conceive and the physical pain of fertility treatments. We truly understand the feelings that go hand in hand with infertility: the isolation, the frustration and the sadness. As the founders of IVFbabble, we can relate to the hours spent trawling through medical sites searching for clear information, only to be left feeling totally overwhelmed and confused.

That said, we also know the incredible feeling when we could at last say, with insurmountable joy, that the journey was worth it. 

Looking back, there are a few things we both would have done differently when we went through the IVF process. We would have reached out to others going through IVF. We would have asked our doctors more questions and we would tried to better understand why we were failing to conceive. 

Creating a platform of support

However, there just wasn’t anywhere to turn for help, other than confusing forum-based information. That’s why we founded IVFbabble – we wanted to give people both a support centre and a repository of reliable information. 

Every person’s journey through fertility treatments is different. The right treatment path for you will depend on the cause of your infertility, your age, your overall health and whether you are using donor sperm/eggs/embryos. Shockingly, your eligibility depends on where in the country you live, with some counties offering three fully funded cycles of IVF and others offering nothing. 

The World Health Organization defines infertility as a “disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.” We know that people are struggling with infertility at record numbers all over the globe – the number is thought to be one in eight couples. That’s why we’re committed to breaking down the taboos, sharing our stories, and providing a reliable resource for anyone dealing with the pain and frustration of this most heart-breaking condition. 

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Pre-eclampsia is being identified in pregnant women via a rapid, quantitative fluorescence immunoassay, being rolled out across the NHS in England.

A highly specific blood test, is helping pick up the potentially dangerous condition of pre-eclampsia among pregnant women.

PlGF (placental growth factor) testing is available across the NHS in England to identify the condition, which is thought to relate to the placenta.

High blood pressure, protein in the urine and liver function issues are among the tell-tale signs for a condition that can be confirmed by the routine test.

Consultant Obstetrician Louise Webster says pre-eclampsia can range from being mild to very severe and occur late in pregnancy or in the early stages from gestation week 20.

If not picked up, it can, affect development of the unborn child, lead to stillbirth, or develop into full-blown eclampsia, which can result in seizures.

Dr Webster explains: “Placental growth factor is a molecule produced by the placenta. In healthy placentas, we see it rise across gestation to a peak of around 32 weeks and then it slowly starts to fall after that.”

Early detection

If PlGF is not at the levels doctors expect, they can increase monitoring of the mother and baby, though there is no established way of treating pre-eclampsia other than delivering.

Conversely, a normal PlGF level can reassure doctors and pregnant women that they don’t have pre-eclampsia, reducing the number of times they need to attend the hospital.

If identified around the 37-week mark, doctors can take the decision for the baby to be born ahead of full term.

PlGF testing for pre-eclampsia is becoming a routine part of antenatal care when blood pressure is high or protein is found in the urine. Midwives will also ensure women are aware of symptoms of the condition, which include headaches, visual disturbance, swelling of the hands or face and concerns about baby’s movements.

Studies have shown that PlGF is better than other currently used tests at predicting which women have pre-eclampsia. A further trial demonstrated that the PlGF test halved the time it took to diagnose pre-eclampsia in women and also led to reduced adverse outcomes.

Rapid results

Dr Webster’s department at a hospital in London use the Quidel platform for the test, which returns results within 15 minutes and shows if a woman has pre-eclampsia, or not, or if a higher level of surveillance needs to be instigated.

The test reassures women that are at less risk, leaving doctors to focus of those at higher risk of developing pre-eclampsia.

The PlGF-based test, which has NICE endorsement, is available in hospitals across England and the hope is that it will soon be adopted in Wales, Scotland and Northern Ireland.

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The use of lasers to treat pelvic floor problems has become increasingly popular in recent years, thanks to new minimally invasive treatment protocols.

Many women experience urine leakage and other bothersome symptoms of pelvic floor dysfunction during their lifetime; still, these are rarely talked about.

The pelvic floor is a hammock of muscles and connective tissue extending from the pubic bone to the tailbone. It consists of many structures that work in harmony to provide support to the womb, bladder, colon and their connected structures. With ageing and deliveries, the pelvic floor support weakens, causing symptoms of vaginal laxity, unwanted urine leakage or pelvic organ prolapse. Menopause can bring about additional problems, such as vaginal dryness, pain and irritation.

Treatment for pelvic floor problems starts with physiotherapy and exercise to strengthen the pelvic floor muscles. If these conservative treatments don’t help, surgery is usually recommended.

The power of light and heat

Recently, a new treatment has become available – non-invasive vaginal laser therapy. Erbium laser with Fotona SMOOTH® technology is an especially gentle, yet effective treatment option. It does not injure the gentle vaginal tissue, but works through a patented thermal pulsing method, utilising the body’s own potential to build new collagen and improve the condition of the vaginal mucosa. The end result is functional strengthening and regeneration of pelvic floor support, which is achieved naturally, without surgery or implants. 

Patients prefer laser treatments as a non-invasive option that can delay or even diminish the need for surgery.

The technology has been shown to improve urine leakage, vaginal dryness and improve sexual function in more than 60 clinical studies, with high effectiveness and minimal side-effects. One study in particular, titled “Safety of Vaginal Erbium laser: A Review of 113,000 Patients Treated in the Past 8 Years” showed that the procedures are safe and carry a very low risk profile.

Key benefits of laser treatments

Patients prefer laser treatments as a non-invasive option that can delay or even diminish the need for surgery. Laser treatments can perfectly complement and improve the results of physical therapy.

Of course, although laser therapy can help many patients, it is not appropriate for everyone – correct diagnosis and expert and holistic patient management are the key.

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Endometriosis affects 176 million people worldwide and costs the UK economy £8.2 billion annually. Yet many of us have never heard of it, the main reason being that we feel too embarrassed to discuss it. 

This most archaic of taboos and woeful of social stigmas is leading young girls to inherit a generational legacy of shame and biases. Shame around discussing periods, sex and pain and gender biases mean, even now with the best that modern hospitals have to offer, a woman ends up waiting an average of 15 minutes longer than a man to receive pain relief in A&E. 

However progressive we want to consider ourselves being, we have a basic problem around prioritising women’s health, validating their suffering and believing their needs. Driving many to suffer a lifetime of physical pain that 40% don’t dare to discuss with their nearest and dearest, as well as the harrowing and isolating sorrow of infertility that ends up affecting 50% and the mental scars of depression reported by 88%. 

77% of women wouldn’t tell their employer about their condition for fear of judgement and the consequences of that.

Endometriosis does not discriminate  

Struggling with symptoms that, more often than not, feature pain that even affects normal bodily functions, such as urination and defecation. Women with endometriosis find it particularly hard to cope with the gender bias at work, with 77% who wouldn’t tell their employer about their condition for fear of judgement and the consequences of that.  

Advocating greater education

At present, we don’t insist on educating about endometriosis at school, as we’d rather use 500 other words to describe menstruation. Our medical systems are falling woefully short of being able to treat this condition and we don’t invest in the necessary research, as we find it too embarrassing to talk about women’s intimate anatomy. This results in millions of girls and women paying the price of societal shame, with 62% reluctant to see a doctor about their symptoms.   

Being one in 10 does not make it acceptable to wait 10 years for a diagnosis and endure a decade of being gaslighted by everyone from medical professionals to friends. We need change and we need it now more than ever.  

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Vaginal atrophy is one of the more common of the 34 symptoms of the menopause, however it is unsurprisingly one of the least talked about. 

We know that there is an awareness problem with the menopause in general and that women just don’t realise it is coming. Layered into that, their intrinsic way of putting other people first and you get the perfect storm. Then consider symptoms that are very undesirable to have to go through, no wonder they don’t want to discuss it openly. 

Vaginal atrophy is also defined as postmenopausal atrophic vaginitis, it usually begins with the thinning of the walls of the vagina, caused by decreased oestrogen levels. In fact, without oestrogen, vaginal tissue thins, dries out and the tissue becomes less elastic, more fragile, and as a consequence, it can be injured more easily. The vagina can tighten and shrink causing the shortening of the vagina canal. 

Impact on relationships

Women suffering with vaginal atrophy can experience painful sexual intercourse and spotting after sex. This can negatively affect their relationship and enjoyment of intimacy. This in turn can lead to vaginismus, which is where the vagina muscle closes due to stress and makes intercourse impossible. This could be caused by psychological pain from experiencing vaginal atrophy symptoms. They also have a greater chance of chronic vaginal infections and urinary function problems.  

It’s all about being aware of the menopause, understanding the symptoms and then combating that with treatments that work for you. 

Variety of treatments available 

Importantly, there are a variety of treatments available to help combat these symptoms, you don’t have to live with it. One option is HRT (hormone replacement therapy) which will partially restore your (low) hormones, there are also topical oestrogen creams which work in a similar way. Alongside these, vaginal moisturisers which help with dryness and lubricants which help remove friction and pain from intercourse are a great solution. 

There are also new treatments such as laser procedures, that gently stimulate collagen production of the tissue within the vaginal wall.  

It’s all about being aware of the menopause, understanding the symptoms and then combating that with treatments that work for you. 

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Gynaecological health affects every single woman we know, so why do we find it so hard to have the conversation? 

When working in clinic, I take pride in ensuring all patients leave feeling they’ve been heard and that I’ve answered their questions and concerns. Having over 135,000 followers on my social media account, now means I can educate thousands more about symptoms and conditions, empowering them with the knowledge and language to make their problems heard by medical professionals. 

I think it’s important that our patients are aware that we are normal people who can be relatable and approachable.

Sharing my honest, human side 

I also like to share what I get up to during my shifts, which many people have commented has made them feel more relaxed about going into hospital, especially during the pandemic. I’m not afraid to show my human side online. I think it’s important that our patients are aware that we are normal people who can be relatable and approachable.  

I recently spoke about having terrible period pain during a caesarean section on a night shift. I received an outpouring of messages from other women thanking me for making this ‘ok’ to talk about. Why is it that we find it so hard to say the word period or vagina to each other and out loud?  

Most notable was the message I received from a male colleague; “Lots of respect here, this is the right conversation to have.” Unfortunately, many people don’t experience such support from those around them. 

Dialogue with healthcare professionals

So, what’s missing from the conversations we are having and are we really currently meeting the needs of all women?  

Sometimes just asking the question, using the correct language and saying something isn’t right is the first step. As doctors it is our job to listen and help patients make positive change for permanent gain. And that’s my social media mission – that all women are heard. 

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The fight for women’s healthcare continues, as both GPs and women themselves clamour for information.

With a declining take up of HRT after the flawed WHI study, hormone related products were left to gather dust. Research stalled, companies even discontinued products. Theramex rescued crucial HRT products and fixed supply issues to once again provide GPs with a variety of menopause products.

But this isn’t enough for CEO Robert Stewart, he wants women to know that they have choices as they age, and that their GP will support them. He says, “I’m so proud of our team not just for getting our HRT products relaunched, but also to keep in focus the huge need for education on women’s health issues.

We know that with patients who are better informed, we can expect better outcomes.

Ensuring the best outcomes

“We know that with patients who are better informed, we can expect better outcomes. This is why we’re working with initiatives to help both GPs and patients better learn about the myriad of conditions a woman can face.”

For Stewart, the challenge is not just getting the message out, but tackling the chronic underfunding challenges which has left menopause care a postcode lottery. Still, he is optimistic. “There’s much more awareness now than a few years ago, but it’s clear there’s more to be done. And we want to help.”

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While women may feel that they are taking up precious resources, women’s health is still a top concern for clinicians such as GPs.

Dr Jane Davis is a GP and British Menopause Society Specialist. She also fronts Rock My Menopause, a campaign of the Primary Care Women’s Health Forum (PCWHF), a group of 10,000 healthcare professionals with a specialist interest in women’s health.

In her evenings, she currently runs Zoom classes for GPs on understanding menopausal symptoms which have been very well attended during the pandemic. She says, “I’ve watched menopause care for many years and I’m really enjoying seeing people waking up to see how important it is. Not only are women demanding better care but clinicians are becoming more interested as a result and requesting more training. Even giving up their evenings during this busy time to learn more.”

Tackling the perfect storm

Yet Dr Davis admits that GPs continue to struggle against a backdrop of underfunded care, which has tested the system. She thinks that combined with the pressure on women right now – who are often primary care givers to multiple generations – this could create a perfect storm thanks to both socio-economic concerns and rising health problems.

But there has been one benefit of the pandemic. Dr Davis says, “With the roll out of telephone and video consultations, we’re finding that women are opening up now, more than ever. Whether that’s because they’re in a home environment or they haven’t battled with the traffic to get to a surgery, actually menopause care can be delivered remotely very easily.”

The Rock My Menopause campaign has made it incredibly simple to highlight key concerns thanks to a downloadable template a patient can fill in before speaking to their GP. She adds, “It’s the job of a GP to figure out what’s going on. Whether it’s those embarrassing hot flushes or you can’t sleep at night – our message is talk to us. And don’t apologise!”

Addressing women’s health care needs – specialists on the phone

Dr Karen Morton

Consultant Gynaecologist and Medical Director of Tonsmor Doctors from Dr Morton’s

With gaps in the NHS, many practices find themselves short-staffed, but thanks to specialist funding, trials of a GP and gynaecologist-led service are helping to address women’s health issues over the phone.

Dr Karen Morton is a Consultant Obstetrician and Gynaecologist who set up Dr Morton’s medical helpline in 2013. Since December, she has worked with several groups of primary care settings to allow patients to use the helpline as part of Tonsmor Doctors, which allows NHS patients to instantly speak with a specialist in women’s health, for free.

She says, “Over 600 practices don’t have women’s health GP specialists, we want to improve the model and show that the resource is both valued by the patient – and the practice.”

As a model, telephone care is both cost-effective for the business, and incredibly valuable for the woman.

Dr Morton is currently working with Theramex to help validate this model, who is funding the initial access for each practice. It will allow patients to speak to women’s health GPs and gynaecologists through a dial-in phone number that allows patients as much time as they need to talk through their concerns.

Offering a more efficient quality service

Dr Morton explains, “We work with the GP practice so that as soon as a patient comes through on the telephone, I have access to their medical history and that initial discussion takes much less time than a private telephone appointment, but offers more quality time than an appointment in the surgery.” Dr Morton and her team are able to add their notes to the patient’s records and any prescriptions are sent through as normal.

“It’s a new way of working” she adds. “Women find it amazing to talk to a gynaecologist on a Saturday morning, and the GP practice is happy because they’re offering expert care to their patients without having to take on additional staff internally.

“As a model, telephone care is both cost-effective for the business, and incredibly valuable for the woman.”

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Dr Paula Briggs

Consultant in Sexual & Reproductive Health, Liverpool Womens NHS Foundation Trust

The impact of the media debate around the Women’s Health Initiative (WHI) study in 2002 is still being felt today as women and GPs lack confidence in HRT, despite newer studies confirming its effectiveness.

For Dr Paula Briggs, previously a GP and now a Consultant in Sexual and Reproductive Health in Liverpool, many issues with prescribing menopause care can still be attributed to the WHI study. These attitudes impact on what gets ordered and prescribed in each region.

Challenges in accessing treatment

She says, “In our area we’re lucky to have a very forward-thinking Deputy Chief Pharmacist who cares about menopausal options, but I have patients visit from a neighbouring trust who are desperate for information and products that aren’t available just a few miles down the road.”

“This is in part due to the sheer size of the multi-disciplinary teams that prioritise hospital care, if there are no menopause advocates on board then it’s hard to fix the restrictive behaviour in area prescribing committees.”

Dr Sarah Gray, a GP in Cornwall for 30-years with a specialism in women’s health, believes that it was the negative messages stemming from both the WHI and the MWS which were so damaging. They contributed to funding for her specialist menopasue clinic being cut.

The council will pay for a coil fitting for contraception reasons, but not menopause. And if the Clinical Commissioning Group (CCG) says no – then who pays?

Dr Sarah Gray

While attitudes are now beginning to change, Dr Gray already feels that valuable time has been lost and that there have been little updates through the NHS on HRT. She says, “For a long time it seemed as though the profession was hesitant around HRT as when the messaging surrounding the study came out, it created a negative discussion in the media. Luckily over the last few years that has started to change. However, there are still significant gaps in some GP’s knowledge. Many recognise this and because of the problems experienced by their patients are thinking ‘I need to know this’ which is why education for both GPs and patients is so important.”

Tackling funding issues

But both women believe that the innovation between collaborating colleagues is what will drive the conversation forward on the benefits of menopausal care, such as a reduced risk of osteoporosis.

The problem at the heart of these issues is funding. Dr Gray adds, “The council will pay for a coil fitting for contraception reasons, but not menopause. And if the Clinical Commissioning Group (CCG) says no – then who pays?”

For Dr Briggs, she believes the issue is bigger than a North/South divide, she adds, “There would not necessarily be a menopause expert on the Area Prescribing Committee when a decision is made whether to add a drug to the formulary. Local experience of a drug is required to inform the Committee prior to consideration to add a particular product to the local formulary, making it available for GP’s in the area to prescribe on the NHS.”

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