Fertility and Preconception Care Clinic
Often, when we experience fertility problems, there are underlying biological factors that contribute to difficulties conceiving, aside from known medical problems. We also know that, as the body ages, there are various cellular functions that start to work less well. This ageing process can be worsened by damaging lifestyle habits, which, in turn, also affect fertility.
The fertility and preconception care programme at Balance Fertility assesses the overall health and fertility of a couple to look at what might be preventing you from conceiving. We aim to get you in the best possible health before you undergo treatment and provide evidence-based guidance on the dizzying amount of information available online. This gives you peace of mind you are doing the right things for your individual circumstances.
Since maintaining a healthy weight is vital for fertility and the health of the baby, we offer individualised, evidence-based support to either gain or lose weight, whilst ensuring you have sufficient levels of key nutrients for pregnancy, where appropriate.
The Balance Fertility and Preconception Care Clinic is open to male and female fertility patients and those suffering from conditions such as Polycystic Ovary Syndrome (PCOS), which respond well to dietary and lifestyle interventions. Our focus is on diagnostic, personalised medicine to assess the many underlying health factors that can contribute to difficulties conceiving or to worsening of symptoms for conditions such as PCOS, which can vary from person to person.
Conditions such as infertility and PCOS are complex with many components, including inflammatory, metabolic, hormonal and immune function, and these are the issues that our programme aims to address through dietary and lifestyle changes. Subfertility can be seen as a protective mechanism by the body to stop a woman getting pregnant when conditions are difficult, and is therefore an opportunity to optimise health before trying for a baby. Many common health problems such as obesity, cardiovascular disease and depression have origins during development in a mother’s womb as a result of underlying biological dysfunction that can accompany infertility, for example systemic inflammation, impaired metabolism and a depleted microbiome (the “good bacteria” in our bodies). This is why it is important for the future health of the baby to get things right both before and during pregnancy.
One in three cases of subfertility is due to issues affecting the father. And since sperm health and the general health of the father are increasingly known to contribute to the health of the child and to achieving a successful pregnancy, Balance Fertility encourages the male partner to enrol in the programme alongside the woman undergoing treatment, even when semen parameters are normal.
Same sex couples
We have seen many same sex couples who jointly can also benefit from our programme – whilst one may be trying to conceive, her partner will benefit from the lifestyle changes that will improve her long term health and, of course, the lifestyle plan will translate to the care of the baby too, providing the best starting point in life for your child.
When you make an appointment, we will send you a questionnaire in advance of your consultation. This will go through your medical history and include questions about your lifestyle and diet.
The initial consultation is centred around determining what is going on in terms of symptoms, underlying health and factors that may be affecting your condition. We then advise which tests to perform in order to assess your personal situation in more detail. These may be tests to assess your vitamin and mineral status, urine tests that screen for aspects of biological function and environmental contaminants, food allergy tests, and routine blood tests for vitamins, inflammatory markers, metabolic health and so on. We aim to minimise test costs and will let you know where tests are available on the NHS. The initial hour-long consultation includes analysis of your questionnaire and recommendations for testing. Subsequent testing and costs will be determined by what comes up in the questionnaire and consultation, but you decide which tests to proceed with and you are in control of the budget.
Once the test results are available, we offer a tailored dietary and lifestyle programme to help symptoms and address underlying causes of infertility. We look at physical and emotional aspects of your health, including stress, and offer support during your fertility journey.
For couples or individual men and women who either would like to conceive now, prepare for a planned pregnancy within the next two years, or assess their fertility for future conceptions, we offer a full health and fertility assessment. This includes a detailed analysis of your current health, diet and lifestyle, including the “modifiable” factors that can affect your fertility (in other words, the things that are under your control). It also includes a medical assessment of your fertility including ultrasound scans, blood tests for key markers of ovarian function and reserve (which give an indication of how quickly eggs are being lost from the ovaries and the timeline during which you should consider starting a family), semen analysis and any other medical test or procedure that is clinically appropriate for you as an individual. We can also offer genetic testing for certain gene variants that can affect fertility and the associated dietary and lifestyle advice to help mitigate the effects of having particular genes that can otherwise cause problems.
The first part of the Balance Fertility assessment is a detailed review of your current health, diet, lifestyle and any symptoms you may be experiencing. We offer a series of diagnostic tests that assess the many factors that can affect your fertility – factors that you can control. This is important as it gives you an opportunity to optimise your health, physical and emotional wellbeing, and nutrient status before you start trying for a baby, rather than simply offering a medical assessment of your fertility that you can do nothing about. The integration of this approach with the best that medical care can offer – from Adam and Grace who are leading experts in their respective fields – is what makes Balance Fertility different.
It is important that all couples wishing to conceive have a detailed medical assessment. This will include a careful history of any past and current problems, an examination and then tests to assess general health and reproductive health. For women, these will include a measurement of various hormones and other components of the blood that are important for fertility and a healthy pregnancy, an ultrasound scan to look at the uterus (womb) and ovaries and possibly an assessment of the fallopian tubes (by scan, x-ray or an operation to look directly into the pelvis – a laparoscopy). Men require at least one semen analysis and also fertility-related blood tests.
For a detailed assessment of your fertility you can request an appointment to see Professor Adam Balen at one of his private clinics. For details please ring his secretary on 0113 206 3114 – clinics are held either through the NHS at Leeds Fertility or at the Spire (0113 269 3939) or Nuffield Hospitals (0113 388 2000) in Leeds. It is preferable to have a referral from your GP, although not essential for private appointments.
Chronological age is the most important thing for a woman to consider in terms of her fertility and ovarian reserve. Because there is a big variation in how quickly different women experience a decline in their fertility because of ovarian aging (from normal fertility, to subfertility, sterility and then menopause), it’s helpful for a woman to have an accurate picture of her individual fertility and how age may be affecting things.
The response of the ovary to stimulation during fertility treatment is the best test of ovarian function, but we only know this after the event. In order to accurately assess a woman’s fertility before she tries to conceive, we use the combination of ultrasound scan to count the number of visible small antral follicles that contain the maturing eggs (the antral follicle count), together with blood tests to measure the hormones that give us an idea of the “ovarian reserve”
There are two main hormones that we can measure anti-Müllerian hormone (AMH) and follicle stimulating hormone (FSH). Anti-Müllerian hormone (AMH is produced by the follicles inside the ovary and appears to be the best reflection of “ovarian reserve” or the fertility of the ovaries. The more follicles there are, the more AMH is produced. Because of this, since women with polycystic ovaries have more follicles than those with normal ovaries, they also have higher AMH levels.
Follicle stimulating hormone (FSH) has been the traditional test over many years but has more recently been replaced by AMH as the best assessor of ovarian reserve. FSH, hwoever still provides valuable information about ovarian function and is measured in aa blood test taken during the first three days of the menstrual cycle (days one to three of bleeding). Levels of FSH in the blood increase with age and as ovarian function goes down. A high FSH level indicates that fertility treatment should probably proceed without delay and, once elevated, the decline in ovarian fertility is irreversible. FSH is usually measured alongside luteinising hormone (LH) which also gives an idea as to how the ovaries are function and oestradiol (oestrogen) which is the main hormone that comes from the ovaries.
Although there are indications that the AMH test may help determine a woman’s future fertility over the coming years – it’s important to know that this has not been conclusively demonstrated and this must be considered when deciding whether to have the test and in interpreting results. High AMH levels nevertheless are associated with a higher number of mature eggs, embryos and clinical pregnancies during IVF treatment.
All the tests and the scan together, however, do provide a good indication of how quickly fertility may be getting worse with age and, because this decline isn’t the same for all women, it can be a useful tool in family planning. Also, because levels of AMH reduce slowly over time, measuring it once a year over several years may be useful as a long-term predictor of ovarian reserve and reproductive health. This is also a possible indication of likely age at the menopause, although again it is early days in using this test to make such a long term prediction.
Adam Balen is professor of reproductive medicine and surgery and the lead clinician at Leeds Fertility. As well as NHS appointments, Professor Balen also offers private medical consultations at The Nuffield Hospital and The Spire Hospital that feed into the full range of reproductive medicine services at Leeds Fertility.
Leeds Fertility provides a comprehensive service within an NHS Teaching Hospital and provides the full range of investigations and treatments for all aspects of male and female fertility. The team of five subspecialty trained consultants provides world-renowned expertise, and dedicated clinics for the management of Polycystic Ovary Syndrome, endometriosis, male infertility, recurrent miscarriage and fertility preservation (including a rapid access clinic for those recently diagnosed with cancer, social egg freezing and also for transgender patients). Leeds Fertility provides all assisted conception treatments: ovulation induction, IUI, IVF/ICSI, sperm & egg donation, surrogacy, and pre-implantation genetic testing. Furthermore, medical care is available throughout the entire fertility journey, including laparoscopic and hysteroscopic surgery when required, surgical sperm retrieval and full after care during early pregnancy. For those who are required to self-fund, there is a private service within the clinic.