TICK… Tick… Can you hear that? It's Scotland's collective infertility timebomb telling us to get a move on and procreate. Because as the nation postpones starting a family until we are into our late 30s and even 40s, an estimated one is six of us experiences infertility at some point.
In an attempt to defuse the situation, a health expert recently suggested all women aged 30 take an 'MOT', to ensure any problems are spotted early enough to deal with them. But for those not currently in a breeding frame of mind, it's almost impossible to understand how hard discovering you are unable to have a child can hit.
Fiona MacNeill already had a six-year-old son, Louis, from her previous marriage, so assumed she would have no trouble getting pregnant again. "I just thought it would be a simple case of coming off the pill and Bob's your uncle. But every month came and went and I got more tearful and more stressed out."
A wedding photographer, she found it didn't help that her job was stressful, her diet "rubbish" and, since she had several bookings for two years down the line, she had only a small window of opportunity in which to conceive. Also, at 35, her ovaries weren't getting any younger. In fact, despite the fact she was still having irregular periods, a blood test showed she wasn't even ovulating any more.
"It was terrible," she says. "I wanted to be pregnant so badly that it became an obsession. My husband Jason got to the stage where he was saying, 'I think we should just be happy with Louis. I can't watch you destroy yourself like this every month.' I was miserable, snappy, and the tablets to promote ovulation were hellish – they made me feel unwell – it was a combination of feeling physically grim and mentally grim."
Still, every day she had to turn up for work, smiling as if nothing was wrong. "I almost resented the career I'd given myself. I kept thinking if my job had been easier and less demanding things would be happening by now. There I was, taking pictures of some poor girl's happiest day of her life, and I just wanted to be at home looking at the internet, finding out about not being able to get pregnant and getting myself into an even bigger state. I bought every magazine, I looked at every website, I was on forums – it was hideous."
The internet turned out to have its virtues, however, as it led her to the Edinburgh Natural Fertility Clinic, based at Napier's apothecary. Her first appointment was in September 2007, nearly a year after she had started trying to conceive. "I had acupuncture that day and I slept well for the first time in about a year. After that, I came through from Glasgow every week and saw the nutritionist and had acupuncture. I just felt more positive and more focused on life rather than letting it take over. I was being proactive rather than pumping my body with chemicals every month."
Just two months on, she discovered to her amazement that she was pregnant. "I think I did about seven pregnancy tests – I must have been Boots' favourite customer! And I was buying them in odd places like Waverley station in Edinburgh and going into the toilets there.
"I couldn't believe it. It was so early; it was about eight days before my period would have been due and I thought, there's no way, but I had to do it anyway, I was compelled; I had the overwhelming urge to keep peeing on a stick."
Nina was born in July 2008 by elective Caesarean section. "I couldn't believe she was here," says MacNeill. "It took a couple of days to sink in. After all that time and all the waiting and all the obsessing."
When she was told she was no longer ovulating, MacNeill had assumed that IVF would be her only route to having another child. It's a common misconception. Renowned New York gynaecologist Dr Sami David estimates as many as 50 per cent of American women are put on courses of IVF unnecessarily, when all they really need is a more thorough diagnosis to assess the exact cause of infertility, so it can then be treated appropriately.
It is this holistic approach that has resulted in a 47 per cent success rate at Edinburgh Natural Fertility Clinic, which has seen 350 patients since it opened its doors two years ago. The figure is even higher – 57 per cent – for those who, like MacNeill, have secondary infertility.
Headed by Deirdre Armstrong, a fertility awareness practitioner, the team is made up of acupuncturist Rachael Forrest, who specialises in fertility issues, nutritionist and herbal medicine practitioner Helen Gestwicki, counsellor and hypnotherapist Gabriella Moericke, and Fiona Wolfenden, an authority on massage therapy, acupuncture and Chinese herbal medicine.
If breezy breakfast talk about sperm-counts, sexual positions and bodily functions makes you uncomfortable, look away now. This is just another typical day at the clinic.
The first patient through the door is Rebecca, a 33-year-old occupational therapist who is recently married and wants to start a family, but who fears her MS might cause problems. She has stopped taking the drug that regulates her symptoms so it won't affect her chances of pregnancy, but her health has worsened as a result.
The talk goes over general health and diet, whether she has had any abdominal operations or STDs, and if her family history includes any occurrence of rheumatoid arthritis (which could mean she might have trouble conceiving) or early menopause. Then we're on to more intimate topics. She has never been on the pill, so gets Brownie points straight away for that. She is also advised to take a test for chlamydia, but because her only sexual partner has been her husband, that will be unnecessary.
However, her periods are long and painful and she gets bad PMS, for which she takes ibuprofen – a big no no, as the drug can interfere with ovulation. She is also advised to avoid tampons while trying to get pregnant.
But Armstrong sees no reason why she should not conceive. The important thing to remember, she says, is not simply working out when she is ovulating, because by then it will be too late; she needs to have sex before the egg is released, so the sperm are in position, ready to pounce. For this to happen, Rebecca must get to know her body a bit better – better than she'd probably like, truth be told – to understand when she is most fertile. To this end, she is shown some photographs of what her discharge should look like at various stages of her cycle.
Then, armed with some nutritional advice ("eat more protein"), bedroom tips (no lubricant, including saliva – "it's full of digestive enzymes that eat the sperm"; which sexual positions work best (missionary and rear-entry, since you ask), plus a prescription for some herbs to help increase her energy, she leaves reassured and raring to go.
Diane, the next patient, is a 29-year-old nurse who has been married for a few months and plans to start a family in the new year. She had been on the pill for ten years but came off in May, and since then she and her husband have been using the rhythm method of contraception. He is fully operational, she says, because he managed to get a former partner pregnant, but she is concerned that her irregular and painful periods might be a sign of more serious gynaecological problems.
Her hormones are definitely all over the place, says Armstrong, so she recommends a course of acupuncture to bring them under control. "Your periods should last five days, should be pain-free and there should be no clots," she says. "Painful periods are not something you should be putting up with, even if you're not trying to get pregnant."
Diane is also very slim, so under no circumstances should she lose any more weight – all that blubber women hate so much around the thighs, bottoms and upper arms is what helps keep our hormones in check.
Her husband comes under the spotlight too. He likes going to the gym but is ordered to avoid the steam room – "one session can obliterate the sperm-count for three months," says Armstrong. He must also avoid cycling shorts (in fact, cycling in general is bad for the little swimmers – all that heat in the nether regions, apparently), working with a laptop on his knee and tight boxer shorts (electric blankets and hot water bottles come under fire for the same reason). Still on the underwear front, thongs are bad news for girls trying to conceive, as is fabric conditioner. Finally, the vices of beer, fags and coffee must be cut to a minimum to ensure optimum fertility.
Not all the clinic's patients are young, newly marrieds with no known fertility problems. In fact, a large number are in the 30-40 age group and have been trying unsuccessfully to get pregnant for some time.
Isla and Bryce, both in their 40s, had their first baby when Isla was 38 and have been unable to achieve a successful pregnancy since. Now on the IVF waiting list, they are reluctant to go ahead with the treatment because the success rates are so low in their age group. Bryce's stressful job means that he is always run down and catching colds; perhaps for that reason his sperm-count is also low. Isla, meanwhile, is so busy running around after her young child that she makes no time for herself, and her diet is poor.
Both have been prescribed a session with Helen Gestwicki, the clinic's nutritionist, and Isla has had a course of acupuncture that, over four months, has helped lengthen her cycle. Now, just over a year after their first appointment, Isla is pregnant and their baby is due in a few weeks' time.
One of the last patients of the day is 37-year-old Kate, who had originally come to the clinic on her own. She and her husband had been trying to conceive for almost two years, and her husband was at the end of his tether. He had refused to consider either IVF or adoption, and Kate admitted that this was her last resort before giving up altogether and accepting childlessness.
The couple both seemed fit and healthy, but Kate's test results from her GP indicated "unexplained infertility". Over the course of an hour and a half, however, she admitted that she had a termination nearly 20 years ago. She had never told her husband and was plagued by guilt, believing that she was being punished. To add to her woes, she said she was a "stress cadet" and worked too-long hours.
A course of counselling and hypnotherapy was prescribed, where she was able to talk about her decision not to have the first child and to accept that she 'deserved' to be pregnant again. She was encouraged to take a small reduction in hours at work and was, as with the other patients, instructed how to identify when she was about to ovulate (those photographs again).
A year on from her first appointment at the clinic, Kate found out she was pregnant and now has a healthy baby girl, Miranda.
All this success could go to a health practitioner's head, and the team admit that they can get personally involved in each patient's journey – the rows of thank you and birth announcement cards are testament to that.
And while patients have to pay for the clinic's services, the average total cost of 300 is significantly lower than the amount many couples pay for IVF treatment. Some, meanwhile, choose to work with the clinic in conjunction with their in-vitro treatment.
Jenny, 32, and Ryan, 34, were both healthy, and tests from their GP had come back clear, yet they had been trying to conceive for two years without success. Armstrong suspected that Jenny was suffering from endometriosis, though this had never been diagnosed; she was also producing very little fertile cervical fluid, which is essential for keeping sperm alive.
While she was undergoing a course of acupuncture and hypnotherapy, the couple came to the top of the IVF waiting list and decided to go ahead. However, they continued to receive acupuncture at the clinic and the IVF was successful first time. Then, when baby Thomas was 18 months old, the couple wanted to try for number two, so Jenny called Armstrong for some tips. They talked over the phone, Armstrong reminded her of the key advice from her sessions two years before, and they made an appointment for a couple of months' time.
Three weeks later, Jenny called back with the news that she was pregnant.
The Edinburgh Natural Fertility Clinic (0131- 315 2130, www.edinburghfertilityclinic.co.uk) is hosting an informal drop-in evening, Making Babies Made Easy, at the Apex Hotel, Waterloo Place, Edinburgh, on 28 October, 6.30pm to 8.30pm
This article was first published in Scotland on Sunday on 18 Octoer 2009