BABY BLOOMERS: SESSION THREE - FERTILITY TREATMENT FOR US
On 29 July 2009 the ‘’Baby Bloomers’’ GP professional development sessions in Reproductive Medicine set out to explore some of the issues experienced by couples undertaking the infertility journey. In this, the last of three evenings, dietitian Holly Frail, and ACA counsellor Narelle Dickinson discussed the impact of nutrition, overall health and correct diagnosis, and the psychological consequences experienced by some individuals undertaking infertility treatment.
Greenslopes specialist Dr Clare Boothroyd also discussed the issues associated with comparing and contrasting IVF units, and how to interpret the results from different fertility centres across the country.
Holly Frail: Fertility and nutrition
Being overweight or underweight can lead to infertility. Dietitian Holly Frail, therefore, focused her discussion on the options available to those women who have a BMI greater than 25 and an infertility problem.
Losing weight for these women is a challenge. To lose 1 Kg of fat in a week is equivalent to cutting out: 3 glasses of wine, a handful of peanuts, a slice of mud cake and one can of soft drink (or 4,620 KJ) every day.
There are also a number of common diets available, so which is the best one?
The Atkins diet is low in carbohydrates, but it is also low in: fibre, vitamin B1, vitamin B2, vitamin C, calcium, magnesium, iron and phytochemicals.
Food combining and single food diets are notoriously restrictive and hard to follow, and are nutritionally inadequate.
Meal replacement diets (e.g. Optifast) will definitely lead to weight loss but are restrictive, hard to follow, can be nutritionally inadequate and are unsuitable for pregnancy.
Low fat/ high carbohydrate diets lead to smaller or slower weight loss and may lead to micronutrient deficiencies (e.g. iron and calcium) if protein sources are not carefully chosen.
Mediterranean diets can be effective for weight loss, although in some individuals the rate may be slow.
Weight loss programs (e.g. Weight Watchers, Jenny Craig) are often effective and include a support group, but may still allow people to make less nutritious choices in the long term.
Low GI diets are difficult for some to understand, but are effective for those with diabetes or insulin resistance.
The CSIRO diet is effective but may be more expensive for those on a budget, and it is not as appropriate for vegetarians.
In summary Holly, favours the combination of low GI, CSIRO and Mediterranean-style diets, that will assist in sustained weight loss and help individuals to establish good eating habits in pregnancy.
To illustrate the type of diet that she would recommend she compared a typical diet eaten by an overweight woman with a diet substitution she had developed, which achieved a reduction in calories from 11,326 KJ to 7,434 KJ. Dietary changes also resulted in an increased intake of fibre, folate, iron and calcium – all important for women trying to achieve a pregnancy and provide for the growing baby.
Alcohol and exercise
Holly also recommends reduced alcohol intake (if any), no more than 1-2 units of alcohol a week for women trying to achieve a pregnancy, with a recommended 5 hours a week of regular physical exercise in a variety of forms.
For more information please visit: www.eatsmartnutrition.com
Narelle Dickinson: Psychological consequences experienced by some individuals undertaking infertility treatment
ACA counsellor Narelle Dickinson has a wealth of experience in the treatment of couples or individuals undergoing infertility treatment. She engaged participants in discussions around the psychological consequences of infertility (such as depression, anxiety, grief, loss of control, and social issues) and positive mechanisms for patients to cope with the stresses and disappointments of the infertility journey.
Recent studies have shown that people in general are at their highest risk of suffering depression in their reproductive years. In the general population females face a 10% risk, infertile women a 31% risk. Those with depression already are twice as likely to suffer depression during infertility treatment.
A number of studies have also suggested that depression is linked to foetal neurological developmental effects.
The best approaches to treatment for those at risk are to identify the risk factors early and to put in place coping strategies and maintain relationships. This relies on good detection by GPs, identification of previous mental health issues by fertility centres and counselling by those experienced in the field. It is reported that currently only 25% of those to which it is offered take advantage of psychosocial counselling, with most people preferring the support of their partner and family. However, 53% of those referred for counselling already have a history of lifelong problems.
Men who suffer male factor infertility, often experience stress in their relationship as sex becomes a means to procreate not recreate, and they experience emotional feelings of failure as a partner, and irrelevance when a donor is involved.
Lesbian and gay individuals are 2.4 times more likely to suffer mood and anxiety disorders, they are often worried about stigma and discrimination and often lack family support. There are also high rates of psychiatric illness in these individuals and the issues for the non-biological parent can be a problem.