Melanie Brown specialises in helping couples to prepare for pregnancy, be it through natural conception or assisted reproduction. 20 years of experience working with doctors, gynaecologists, urologists, midwives and IVF specialists has given Melanie a unique insight into the process of fertility treatment, and an understanding and empathy of how being unable to conceive affects the whole of your life. For five years, Melanie wrote regularly for the Sunday Telegraph Stella Magazine Q&A health page, and more recently for Harper’s Bazaar Online and has authored the chapter on nutrition for the book – Female Infertility: Basic Science and Clinical Practice.
We sat down to have a chat with Mel about her work including male & female fertility insights, the challenges she sees every day and how nutrition and lifestyle can support one’s fertility journey:
1. With your great wealth of experience in the field of fertility, what are the most common challenges that your clients encounter?
I think the lack of control is a big thing; for so long we control the NOT having babies, then we decide that we’re ready and it doesn’t happen. It is also immensely stressful seeing all your friends getting pregnant immediately. And then you cut out everything, alcohol, caffeine, plastic chemicals, life! And that can impact your relationship with your partner, especially as often, recreational sex has also gone straight out of the window, to be replaced by ‘baby making’ sex, on demand when ovulation occurs. Life can often become ‘before TTC’ and after TTC, and when you are just young in your thirties and early forties, it can be a real shock.
2. Fertility is very personal and can be a daunting and stressful subject - how do you support clients through this?
I am just older and wiser and I have been there myself. It was a struggle having both my children for various unconnected reasons. So, I can truly empathise with how it feels, I really do know. I then went into menopause at 42 anyway so I imagine that had an impact as well on my fertility. I try and encourage my clients to think of my plans a ’project’ – this works especially well for men actually! And surprisingly, we often have quite a laugh in the consultations. I generally would say that I really like my clients very much. Empathy is critical with infertility, as it is such a sensitive and complex subject.
3. What are the main factors that affect fertility, in men and women, outside of diet?
Smoking is lethal for both sperm and eggs. Infection can really affect both male and female fertility too. And I am not talking about sexually transmitted infections here. Just a bit of bacterial vaginosis (BV) or recurrent urinary tract infection usually caused by E. Coli, can have a detrimental impact. Men should always be physically examined by a male fertility expert, a urologist, to check for problems like a varicocele, or a hormonal imbalance, or infection especially for male factor, unexplained infertility or recurrent miscarriage. Women get all the attention and men get very little even though male factor accounts for 50% of infertility.
4. How does nutrition impact fertility?
Nutrition affects fertility in a huge number of ways – how much time have I got?! The food we eat affects all our cells, and sperm and eggs are no different from any other cell, you could say they are the most important as they contain the DNA of our future children. What we eat can be incredibly helpful to us, like the Mediterranean Diet, packed full of fresh, colourful antioxidant-rich vegetables and fruit that protect our cells from damage. But food can also be highly detrimental, like poison really, causing inflammation and blood sugar regulation problems, especially it the diet is high in what are now called Ultra Processed Foods, foods that bear little resemblance to real food and that are so full of chemicals and industrial cooking fats that you could not actually recreate them in your own kitchen. These foods lead to real illness, and sperm and eggs are collateral damage. A good nutrition plan can help you lose weight or put it on if needed, it can help manage conditions like PCOS and endometriosis but you will also feel better, have more energy, better skin and hair, improved concentration and better mood. And there are specific foods that have been shown to help the outcome of IVF too. What is not to like? And you just want a healthy baby that grows up to be a healthy child and a healthy adult so looking after that precious DNA is so important.
5. Do you think there is enough awareness about male infertility and how can men optimise the health of their sperm?
Absolutely not! Men get almost no attention, and for those of us interested in male fertility it is immensely frustrating. And frankly not fair. It takes two to make a baby, and male factor infertility is at 50%. IVF or ICSI does not solve everything, and I would always encourage men to stand up and ask for investigation and help. Nutrition and lifestyle can massively improve sperm health; it’s not rocket science. Vets and farmers know how to optimise the health of their breeding male animals. There’s more research on bull, stallion or boar sperm than on human sperm! And why is that? Financial gain, that’s what! Good sperm is worth a lot of money.
6. Pregnancy & breastfeeding can be very daunting. There are lots of opinions, particularly online, about what you should and shouldn't be putting in your body - what advice can you give to new and expectant mothers?
Well, we know so much more about how maternal nutrition affects the health of a foetus, embryo, baby, child and eventual adult. The study of epigenetics, how our environment affects the expression of genes has showed how those early days can sort of ‘set the scene’. So certainly, pre-conception nutrition and care should be part of your lifestyle if you are having unprotected sex or actively trying to conceive. But you know, babies can come along at the most unexpected times and just because you had half a bottle of chardonnay or a burger and chips or a bad night’s sleep or forgot to do your mindfulness, that does not mean you bare going to have a miscarriage or an unhealthy baby. It’s what you do generally that counts. So, a good healthy diet is important and avoiding the foods that may give you food poisoning is important. Your baby will tend to like what you eat, yes, it’s true! Women who eat broccoli have children who eat broccoli. Women who eat loads of sugar have children that love sugar and will potentially be overweight. In early pregnancy (I remember it well!) you just want to eat carbs, so try and eat the healthiest version of what you crave. And if you are taking your good multivitamin like Inessa, you will be having all the nutrients you need.
7. You mention how the inability to conceive can, understandably, greatly affect all aspects of one’s life. What advice would you give to those who are struggling with their mental health because of this and where can people get support?
This is such a hard question to answer. Infertility is a unique ‘health’ condition, unlike any other, as it affects lives so deeply and in an almost primeval way; procreation is in our DNA, our genes, and when it’s not working it is so profoundly distressing on every level, physical, mental, emotional and social. There are some excellent counsellors who specialise in infertility, and many of my clients find great comfort from acupuncture and reflexology too; the practitioner are incredibly therapeutic too. In terms of what I do, just knowing that you have regained some control, that there are things you can do that may help, can be very comforting. We talk a lot about stress management, sleep and exercise in the consultations. Keeping resilient and finding your own support systems is crucial. Sometimes just going for a walk outside or watching Bake-Off can give you a dose of good endorphins, and this is so important to keep going.
8. What advice would you give to those readers who are inspired by your work and would like to pursue a career in fertility?
Well, there’s a question! As I said before, it helps to have an understanding of the experience of infertility because it is such a unique condition. It cannot be treated like any other ailment, like IBS or migraines. You have to have the empathy but you also feel the pain that your clients go though, so you have to be quite tough. When I first started twenty years ago, I used to cry a lot in and after the consultations (the poor clients!). But even now the odd story gets through and can move me overwhelmingly. But I always feel quite deeply for every person I see. It’s quite different to other nutritional work.
9. Any final words of wisdom?
Do your investigations. Most often there is a reason for the infertility. Be your own detective. Look at the basics, and that is your nutrition and lifestyle. They are the foundation of health. But still enjoy yourself, with your partner, make time for yourselves and each other.
To learn more about Melanie, and her work, visit her website or visit her on Instagram (@melaniebrownnutritionist).
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