'Fertility coaching': can it help women conceive?

Anya Sizer's garden is scattered with toys – just the way she always wanted it. Yet there were moments when this happy scene with Hope, five, and Barney, 22 months, was a distant dream. Soon after marrying at 23, she and her husband Damion started trying for a baby. But when months went by, they decided to investigate.

The result was devastating: tests showed that Damion had azoospermia, where there is no sperm in the ejaculate. The couple were given a one in 125,000 chance of getting pregnant and told that IVF was unlikely to help. "It was like someone had hit me," says Sizer. "You have to suddenly face issues you never thought you'd ever have to think about."

They decided to give IVF a try anyway, and Sizer became pregnant on the first attempt. Having always dreamt of a big family, however, there was another blow when she was diagnosed as pre-menopausal and found to be producing only a limited number of eggs. They underwent another four rounds of IVF and, after two miscarriages, Sizer fell pregnant with Barney.

During her six-year struggle, Sizer explored every avenue possible that might help them conceive. "It becomes like a really sick hobby," she says. "All of our life was either acupuncture, eating healthily or coaching. You become so tunnel-visioned unless you really work at it. From the outside, I think people don't understand what it's like, how focused and one-tracked you can become."

It is an increasingly common experience among British women; with an IVF success rate of only one in four using fresh eggs, couples are looking at alternative ways to aid their fertility. The one thing Sizer felt was really beneficial was talking to a fertility coach, who focuses on the emotions and insecurities evoked by infertility and IVF.

"It helps you to regain a sense of control and restore hope," Sizer explains. "It's great for people who are stuck in a pattern of behaviour. It's solution-focused, not problem-focused, so you are not looking at how awful it is you feel but how you'd like to feel. Many therapies would go to the heart of the issue, whereas coaching will say, 'OK, that happened to you – are there ways we can make that safer, and what do you want your life to look like now?'"

After research into different schools of thought, she found a coaching style based on the principles of cognitive behavioural therapy (CBT). This technique can help to make sense of overwhelming problems by breaking them down into smaller parts. How you think about a problem can affect how you feel physically and emotionally.

Not only can CBT help couples regain a positive attitude, there is even evidence it can help them conceive. A study by researchers from Emory University in Atlanta, Georgia, found that CBT can aid fertility by reducing anxiety, which often inhibits ovulation.

They took 16 women who had not had a period in six months and had all been diagnosed with functional hypothalamic amenorrhoea – a condition in which the hormone that triggers ovulation has been at a very low level. Half were given CBT for 20 weeks and half were merely observed. At the end of this, six out of the eight women given CBT regained full fertility and two of them became pregnant within two months. In the eight women who didn't, only one recovered her fertility.

For many women having fertility treatment, coaching feels like a lifeline in a sea of hopelessness. Marina Nicholas, 39, says that her experience of CBT turned her life around. She was suffering from endometriosis, and was feeling hopeless after four failed attempts at IVF. "After four years of doctors telling me incredibly negative things, I had a serious bout of depression. I was surrounded by negative feedback and these are the professionals, so you believe what they say," she explains.

"Through CBT I was able to change the way I looked at myself. By the eighth or ninth session, I was feeling so confident with all the positive reinforcement. I became pregnant naturally, and although I miscarried, it was the first time I looked on it as a positive turning point, as I knew I could do it."

Nicholas went on to receive one more round of IVF treatment and become the proud mother of Bruno, now four. Since then, she has written a book, Three Steps to Fertility.

Drawing on her own experiences, and her background as a BACP-accredited counsellor, Sizer decided to train as a fertility coach. It is common, she says, for high-achieving women, in particular, to feel a loss of control during IVF treatment, and for these women it can be very difficult to accept that their body is letting them down. "I looked at what I'd most needed and talked to people from clinics and friends who had been through infertility and the same issues came up – self-belief, self-worth, regaining a sense of hope about your life as a whole.

"I help them look at alternative therapies, what family and friends they have for support. Success rates rise with that. People feel more in control, hormones start to balance and the body starts working better."

Fertility coaching is about much more than just improving the chances of conception, however. "The end goal isn't pregnancy, funnily enough; the end result is you retaining a sense of who you are," says Sizer. "Pregnancy would be wonderful, and let's really, really work towards that, but if you have pregnancy and you've lost who you are, there's no point in it."

According to HFEA guidelines, everyone receiving IVF treatment should be offered counselling, but those who do usually receive only one or two sessions. Dr Jo Perkins, a chartered psychologist, did her doctoral research into the psychology of fertility. "Often infertility becomes so medicalised that people don't see it as something you need counselling for. And a lot of the counselling they receive is therapeutic support work rather than dynamic, looking forward."

Although she believes that counselling should be tailored to the individual and people will benefit from different approaches, she thinks cognitive behavioural therapy has a role to play. "In my experience, it is a fantastic model for working with dysfunctional feelings. Women, especially, often find they have a sense of failure, which gives rise to unhelpful assumptions such as, 'I'm not a real woman.' It becomes a negative cycle and downward spiral. But if you can work with that to see they are not truths and challenge their thought process, you can change their behaviour."

The overwhelming response in Dr Perkins's research was that couples isolated themselves and their emotions and wished they had sought support earlier.

Sheena Young, from the Infertility Network, says the psychological and emotional effects of the IVF process can become overwhelming. "It affects every single part of their life. Their whole life revolves around investigations and treatments and it's such a private thing that people tend to isolate themselves and feel they can't turn to family and friends."

She says that you can't underestimate how hard the treatment is to deal with, or how much you need help to cope with it. "There is no greater thing that a couple can go through together. It makes or breaks a relationship. Take all the support you can get, no matter where you get it from – it's a very difficult journey."

Anya Sizer: anyasizer@powerchange.com

http://onfertileground.ning.com

Anya's tips for surviving IVF

Be your own best friend: give yourself the same level of care, understanding and support that you would to your best friend.

Be kind to yourself and your partner: you will deal with the situation in different ways, so it's important to work together, not against each other.

Do everything you can to lead a fulfilling life and don't put your life on hold.

Be proactive about socialising: make a conscious effort to plan fun things and book time with friends.

Gather the biggest possible support group around you: talk to family, friends or even colleagues and tell them what you need from them. Find a support group on the internet or in person, where you can talk to other people going through the same thing.