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Tuesday, 8 February 2011

Facing IVF and don't want to wean your baby?

I don't often write about my personal 'stuff' because this blog isn't about me - however - sometimes when you learn something important, you want to share it, and this is one of those times.

In life it's rare to learn anything when things are going well - the real lessons generally come out of hardship - and this is no different.  Some of you will have seen that I'm pregnant with our second child.  It probably didn't occur to anyone when I announced it that we'd had a struggle for this baby, but in total we probably tried for 20 months.  Perhaps a bit longer than anyone would like, but no big deal in the grand scheme of things you might be thinking. 

The first six months were pretty relaxed.  Then I started temping and charting.  Everything looked perfect - only a matter of time then...  However another six months later - still nothing.  We decided to have some tests done.  The results weren't good.  Following a lifestyle revamp and more tests, things still weren't any better.  Our doctor referred us to the regional fertility clinic, and we also had a (free) private consultation. 

We were told in August 2010 that we'd need ICSI to have our second child.  For reasons nobody seemed particularly interested in, things seemed to have changed in our fertility as a couple (our first child was conceived naturally and in a normal length of time) and the specialists we saw, both privately and NHS, felt that there was little that could be done to help us improve it.  Again, it happens. 
However, as I know some of you will understand, once you've committed yourself to breastfeeding an existing child to 'full term' and are told you will need IVF it means you have to choose between feeding the child you have, and trying for the child you want to have.  You aren't 'allowed' to breastfeed and go through IVF. 

For me, at that time, I felt like I'd be breaking a promise to my daughter and basically going against everything I believed in about bringing up a little person securely.  I did not want to wean her and I did not want to put myself through the undoubted trauma of IVF.  It was a really hard time.

Some friends of my sister had had two rounds of IVF (for similar reasons to our own) and neither had been successful.  After that they had chosen to go down a different route, and it was at this point in time we decided we should follow suit.  The route they chose (and which gave them both their first child and a subsequent child) was NaPro.  Natural Procreative Technology.  Sounds a bit naff doesn't it?  However, since this other couple had been so successful, the treatment is much cheaper than IVF and because it takes a much more holistic approach to fertility we decided it was definitely worth a shot. 

NaPro believe that male factor sub-fertility (which is what we were suffering from) is treatable and not 'static' in the way the IVF specialists had led us to believe.  We were told by the IVF doctors that even taking into consideration lifestyle changes, we could only expect to see a tiny percentage improvement.  I already know (thanks to NaPro) that this isn't true.  Their understanding of women's health conditions - is also incredible.  Their approach to treating infertility brings together a wide range of disciplines including the herbal/ frontier-pushing medical/ nutritional/ and the psychological - they think 'outside the box'. 

I met with my 'teacher' in late August.  NaPro give you a teacher to show you how to observe yourself and your body to look for clues about what's going on.  You meet with them monthly.  There is no temping, but the observations are detailled and carefully recorded.  You 'baby-dance' (my words - not theirs!) on the days where you see fertile mucus - and their system makes it easy to recognise this.  You don't go by opks, or temping.  (If I had, I would not be pregnant now since my 'peak fertile' day - ovulation - was a full three days after a positive opk).

After a few months of charting their way, it became pretty obvious what was going on with me.  No symptom - emotional or physical was overlooked - and my teacher guided me emotionally and practically through the system.  We learned that taking Co-Enzyme Q10 (200mg) daily can have a dramatic effect on a man's swimmers.  Whilst the IVF clinics look for 'perfect' sperm (those they term 'normal') for IVF, NaPro are more concerned with how well the swimmers SWIM - letting mother nature decide which sperm is perfect since there is no evidence to suggest that 'abnormal-looking' sperm make abnormal babies.  The most important thing is that they get there!  My dh started taking his Ubiquinol Co-Enzyme Q10 and I started charting.

It looked like I was ovulating regularly, but there were some indications from the chart that my progesterone levels were a bit iffy.  How could they tell?  Here's the TMI bit:  I had a little tail-end brown bleeding, an abundance of cervical mucus (you thought that was a good thing I know - but only when it's at the right times!), chronic PMT (we're talking years of misery people..), and my monthly blood tests for oestradiol and progesterone showed that my levels (whilst completely acceptable and normal to the NHS at 28-30) were half (HALF!) what is considered optimal for sustaining a pregnancy (60-100). 
This really shocked me - after all - here we'd been thinking that the 'problem' wasn't me ;) 

I was surprised to learn that 'normal' doesn't mean 'good'.  Normal as far as the NHS is concerned is 2 miscarriages - 3 and then they will start investigating.  NaPro aim to help couples avoid the heartbreak of miscarriage, and this is why their criteria for optimal progesterone are at least double. 
After three months of charting we got a cancellation to see our (frankly utterly incredible) consultant in Dublin.  I am already married, but I tell ya, what a guy.... 

My NaPro chart - showing two cycles, the second of which ended in my pregnancy.

We drove down to Dublin in the middle of the 'big freeze' to meet with our consultant Dr Phil Boyle.  He was so on the ball it was amazing.  He told us that what NaPro wanted to do was 'get us both in good shape' emotionally and physically, and then the baby would come.  Kind of makes sense don't you think?

He explained to me, very kindly, that my years of chronic PMT were in all likelihood down to sub-optimal progesterone levels.  Those same levels may have meant that even had I conceived in the past (nearly two years) there was a reasonable chance it might not have 'stuck'.  I fell in love with him a little when he made a comment about the Irish Dairy Council and the amount of money generated by our over-consumption of dairy products, and he was entirely supportive that I was still breastfeeding.  Nothing more was said about that. 
He talked about how a significant number of doctors are coming to the conclusion that many chronic conditions (including infertility) are linked to low-endorphin levels within the body.  These 'endorphin deficiency states' impact on the body's immune system, creating an imbalance which opens the door to all sorts of conditions.  Early findings show that treating the endorphin deficiency state with a drug called 'Low Dose Naltrexone' (another good link is here), can have a dramatic impact on a wide range of health problems, including some infertility conditions such as endometriosis and PCOD.  You can hear Dr Boyle discussing Low Dose Naltrexone here.

We discussed my husband's situation, and for the first time someone listened to HIM.  He'd been having pains 'down below' for some time, and his tests had shown abnormal cells present.  These were sent for analysis twice but because no culture was grown the doctors had told him he did not have any sort of infection.  This is despite him presenting himself at the emergency room on one occasion because he was in so much pain.  We also paid for a private consultation with a urologist who also told us there was nothing wrong.  Dr Boyle explained that bacterial cultures of this type are notoriously difficult to grow.  Just because you get a clean test result does not mean you don't have a low grade infection.  Low grade infections of the prostate and surrounding area are a cause of male sub-fertility.  It's a cause the IVF docs don't really seem to acknowledge yet - at least not in our experience.  My husband had every symptom in the book, he just didn't have the 'test result' to prove it.

However, since this doctor was listening and making a diagnosis based on symptoms and a belief that his patients weren't idiots, my husband was given a 4 week supply of a simple antibiotic to treat a low grade sub-clinical infection.  His most recent test results were promising too - whilst the abnormal forms were still extremely high, the motility (the number SWIMMING!) had gone from a poor 39% to an average 51%.  This was all down to the Co-Enzyme Q10.  I can say that confidently because the poor man had been off the booze for months with no such improvement...  We were told that if the antibiotics didn't solve the problem there was a lot more they could do to help, but they were simply taking it stage by stage.  As I said, NaPro don't treat sub-fertility as static...  

Dr Boyle told us that between my DH taking the antibiotics and myself getting some support for the progesterone phase of my cycle he 'fancied our chances'.  We left the clinic, went to Eddie Rockets for lunch (my guilty pleasure!) and headed home feeling good.

Two days later I got a positive pregnancy test.

Now, I'm not saying that simply being in the same room as the NaPro doc was enough to get me pregnant (although it's a good story!) - but it seems that by charting their way, basing our baby-making on my natural fertility cues, and by taking a few initial steps to help my dh's boyos get to where they needed to be in greater numbers, we (who were told we'd need ICSI only 4 months before) managed to get pregnant ourselves.
I have absolutely no doubt at all that we managed it with plenty of room for improvement too! 

After this baby is born (all being well) I'll go back to the NaPro doc and I'm pretty sure they will put me on progesterone during the second half of my cycle or perhaps Naltrexone the whole time.  I have no doubt that they will help my PMT.  NaPro supported us as a couple, and they are seeing to it that this baby gets all the help it can in the form of continued progesterone support to my pregnancy.  When they scanned me at just over 7 weeks, and we found that - to the day - my baby's size tallied with the peak day on my chart.  Proof positive that observing your mucus and not just following an opk is the way to go.

Just a word about where NaPro originates.  It's really a 'Catholic' thing.  That's not to say that you need to be a Catholic to be treated - you don't and we aren't.  But you do need to be married if you want to use the system to conceive.  If you just want to monitor and improve your health, then it doesn't matter if you're married or not.  I know some people will find this hard to stomach, but all I can say is no-one else is funding this research, and if the Catholic Church are willing to fund it then I'm willing to use what they are learning! 

There is one other thing I want to say though. Compared to IVF NaPro is relatively new. However, the statistics are showing that the success rate for this type of treatment can be higher than for IVF .  Between 1.5x and 3x higher.  The side-effects are, obviously, considerably reduced as the treatment is much less invasive for the woman.  The cost is also a LOT smaller (we spent in total around £500 and had we continued with monthly treatment the cost would have been about £80 per month).  Compare that with the cost of IVF.  It can be really helpful for couples who have endured repeated miscarriages and also offers an alternative treatment for post-partum depression.  The system can also be used to avoid pregnancy. 

What's all this got to do with breastfeeding though?  Well - for any women out there who are in the same position as we were, I should imagine it's got a lot to do with it.  Some mums do carry on breastfeeding through IVF choosing that the benefits of breastfeeding outweigh the risk to their little ones of the drugs.  Some mums choose to wean in order to try to give their child a sibling.  For the record, I am not making a single judgement on either type of mother.  I support entirely any person who goes through IVF - infertility is SO tough. We never ruled it out entirely for us, we just chose to take another path.  I chose not to wean my daughter and decided against IVF at that point in time.  Not wishing to wean her was a big part of that decision.  I am glad my daughter continues to breastfeed - less now, but still from time to time :) and I feel extremely blessed that we were able to get around our problem without weaning before full-term.

I want to share this information with breastfeeding mums out there (and anyone else experiencing infertility) because it is a real alternative to IVF and therefore to weaning your child.  You might not talk about your fertility problem (and no-one talks about it do they?), but I'm pretty sure you're out there ;)  and I really, really hope this information helps some of you.  Not only can this treatment help you to make another baby, but for sure it will also make you healthier. 

Before anyone asks, no - I'm not on commission.  My bonus is due at the end of the summer.


PS ~ You can read one woman's story of her treatment with NaPro here and if you want to learn more, I can assure you all you have to do is google NaPro. There are clinics in the UK, Ireland, throughout Europe, in the US and in Canada.  NaPro is not suitable for women who have a confirmed menopause or who have completely blocked fallopian tubes, or for men with no living sperm. 


  1. Lovely read! I've heard good things about NaPro. I think their research is great. I chart with Billings, not Creighton, but Creighton (NaPro) is really devoted to treating fertility issues and other reproductive health issues, and their results and way of going about things are fairly amazing.

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  3. Been busy lately, so catching up on posts I've saved for later. LOVE this post - so frank & informative. Definitely sharing. xx

  4. Great blog. I also help couples to conceive via natural methods and support them through IVF. One thing I think really must be pointed out though.

    The reason that IVF clinics don't like you to breastfeed during treatment is that prolactin levels are high whilst a woman is still feeding. As I'm sure you are aware, prolactin has a good contraceptive effect. Since your daughter was already at least 20 months old, she would have been feeding far less than a much younger baby and therefore your prolactin levels would not have been terribly high, potentially not high enough to rule out pregnancy either natural or IVF.

    I think the thrust of your post was to say that there is a way to conceive whilst breastfeeding and this is certainly true. Not every couple however will have the sort of sub-fertility that you had and therefore really will have to go down the IVF route, which is likely to be unsuccessful if the woman is still breastfeeding.

    Having said all of that, I love that you did not ultimately have to do IVF, it is a very hard thing to go through. Congratulations on your pregnancy.


  5. To clarify - the doctors we saw, both privately and NHS, were absolutely unequivocal that I would have to wean my daughter off the breast, despite her only feeding 2 times a day. They were not interested in looking at my prolactin levels, it was simply a requirement for treatment that I not be breastfeeding at all. Perhaps other doctors do it differently and WILL treat breastfeed mums of older children? If so, it would be good to know about them as I haven't heard of any who will?

  6. http://www.babydustdiaries.com/2010/06/breastfeeding-through-fertility-treatments-ivf-and-fet/ I think the above may interest you Helen.

    'Since your daughter was already at least 20 months old, she would have been feeding far less than a much younger baby and therefore your prolactin levels would not have been terribly high, potentially NOT HIGHT ENOUGH TO RULE OUT PREGNANCY EITHER NATURAL OR IVF.'
    ~ Despite my ovulating regularly and us having (largely) male factor problems, the doctors all told me that I could not breastfeed through treatment, which is what I think this may be implying?

    Although I had regular cycles and my daughter a relatively low number of feeds, our male factors (98% abnormal forms and 39% motility) put us straight into the ICSI category.

    The improvement in my DH's swimmers we saw with NAPRO (and which we were told was impossible by an IVF specialist) are - to my mind anyway - the reason I'm pregnant now.
    Yes, it was POSSIBLE it would have happened anyway, but some couples who have undergone IVF in the past find they conceive spontaneously too...

    'The reason that IVF clinics don't like you to breastfeed during treatment is that prolactin levels are high whilst a woman is still feeding.'

    ~ I also believe there are factors associated with some of the IVF medications, reduction in milk-supply, and (potential) safety issues relating for the child also? This will obviously differ from dyad to dyad but the doctors do not seem to make allowances for this in my experience. I would (personally) have been uncomfortable lying to an IVF doctor. Other people may feel differently, it's a very personal decision!

    There are a minority of couples for whom IVF WILL be the only way, but for a large number I am confident that NAPRO is a good alternative. I urge anyone who is undecided to take a look at some of the links in the blog.

  7. I wasn't happy that we had to do ICSI to get pregnant and I was even less happy that I had to stop breastfeeding our first child at 15 months to get a second. I still worry that our kids will 'judge' us for what we did and it is incredibly hard to read that there might have been an alternative particularly when our situation seems so similar to your own.
    However I know that I researched every angle that was open to us at the time (we are now some 10 years on from joining the waiting list for our first IVF), I know we tried everything at we felt able to to have our family and most of all I know I love my kids just the way they are.
    I will not beat myself up over this (and I know you wouldn't want me to) but suddenly I can empathise with those women who fell into a booby trap and were not able to breastfeed for as long as they wanted to. I didn't get something that I tried really hard to succeed at and it's hard reading how someone else did. So I will sit here and have a dam good cry but I wont blame you for it.

    Congratulations on your much longed for pregnancy - well done you!

  8. Hey Anon - I hate to read that this has upset you! For us ICSI was a real option, and not one we discounted at all.. In the end I would have done exactly the same thing as you, except I happened to hear of a possible alternative, and we felt we wanted to give that a try first. I hope you understand why I wanted to share what we learned. It will not be an answer for everyone. I'm so sorry if this post has upset you. NAPRO is still pretty 'new', and some of it is 'experimental'. You can imagine it was even newer and more experimental ten years ago! Hardly anyone has heard of NAPRO even now, and in some forums where this post has been shared (not by me I haste to add!), I know it has been utterly dismissed as 'quackery' in favour of the more trusted method.
    It might interest you to know that even though not all women lose their milk in pregnancy - I have lost mine. My daughter has asked me a number of times to 'fix boo boo'. I can't - there isn't a drop left and she doesn't really comfort nurse... In the end by becoming pregnant I 'weaned' her (just a couple of weeks ago) despite my trying not to. It happened naturally but it still happened. It doesn't happen to everyone, but it happened to me. When other women tell me they nursed all through pregnancy/ tandem fed, I feel a bit of a failure tbh. How come they didn't lose their milk and I did? All any of us can do is try to make the best decision possible using information available to us at any given moment. Then we have to see if our bodies 'play ball'.. I felt I needed to share this information. I'm sorry it seems it may have come too late for you, but I wrote this in the hope that it may be helpful for someone. xo

  9. Oh its so hard isn't it? I finally had a little girl on my 12th IVF cycle, having conceived twins on my 8th but desperately sadly lost them at 20 weeks. I've got an overactive immune system which attacks the developing early pregnancy and have had 5 early miscarriages before.

    I chose to wean (and on advice of my consultant) with huge misgivings at 15m in order to try for a sibling. We have no choice but IVF for a variety of reasons and the extra drugs needed to maintain a pregnancy did not sit well with me if I was still nursing. In addition I needed to tick as many boxes as possible to help the cycle work and if i had an elevated prolactin level that may have hampered implantation - it seems like it can for some but not for others, but at £6K and with everything riding on it with regret it was a decision I was prepared to take, as in the long run I hope that a sibling relationship will be, on balance, more important than an extended nursing one.

    Only time will tell if that was the right decision as though I conceived on my 13th cycle I had a missed miscarriage at 9 weeks.

    In discussion with a local La Leche League leader I concluded that much as I regretted weaning I would regret not trying for a sibling more. You pays your money you takes your choice I guess?

    I also note that for the majority of the stories people are deciding not to wean for FETs or less invasive treatments, not IVF/ICSI.

    Many congratulations on your pregnancy, I'm so glad you were successful with the method you chose.

  10. HI - Thank you for commenting! I completely understand why you chose to wean - it's just an impossible situation. You certainly (more than) went through the mill ((())) Re. your overactive immune system - if you haven't heard low dose naltrexone before it might be something you'd be interested in looking at. There are links to info about this drug in the blog but NAPRO believe (along with many others) that immune factors play a big part in infertility and miscarriage. They're having quite a bit of success with a variety of conditions, using a low dose of the drug at night - and it is safe for breastfeeding. http://www.fertilitycare.net/NewTreatments.htm
    I also know that some IVF clinics are now also starting to medicate for a similar condition although using a different drug called intralipid http://www.telegraph.co.uk/health/healthnews/8229386/IVF-women-given-fresh-hope-by-new-fertility-treatment.html
    Forgive me if you know all this already!
    With all good wishes,

  11. Thanks for the info, will look into the naltrexone and ask at my clinic about it next time.

    The other article made me smile, George is my consultant and I've been having Intralipid infusions, hope they work!

  12. Thank you for writing this! I am looking into LDN for a pregnancy-related auto-immune disease that I have. I'm not pregnant now, but I will take this if I ever become pregnant again. Do you plan to take LDN throughout the entire pregnancy? How much are you on and what is your plan for taking it at deliver time? I've contacted Dr. Boyle earlier but I didn't receive much detail from him at the time. If you would like to contact me, my email is perkbro@yahoo.com

    Congrats to you! BTW, I breastfed and was told by some people I couldn't get pregnant while still breastfeeding. It took me a handful of months, but I was able to conceive while bf. I'm glad you stuck to your guns!

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