Anxious Man

How to deal with performance anxiety



No pressure

I sit with couples every day who are trying for a baby, but the thing that I see more and more is that when you do start trying for a baby it is exciting, but then when you have been trying for a few months it is not uncommon for your sex life to become mechanical. The big thing that I see between couples and where their relationship suffers is the pressure that is put on – particularly to the man around the time of ovulation.

Don’t panic

This additional pressure can cause performance anxiety but rest assured that it is a perfectly normal and natural feeling. The way in which some women constantly track and monitor their fertility can put pressure on their partner, especially around the time of ovulation. The woman focuses on her fertile time, her anxiety goes up, she tells her partner to ‘come home immediately’, his anxiety goes up, and so on. Sound familiar? As I said, this is common and understandable, but can unfortunately cause a lot of upset, frustration and arguments within the couple.

Top tips

Here are my top 5 tips to help if trying to conceive is giving you performance anxiety:

  1. Focus on the sperm not the egg, because the egg lasts for 24 hours and the sperm lasts for 3-5 days.
  2. Don’t feel like you need to tell your man every little detail about your cycle – at the end of the day, it’s a passion killer!
  3. Take the pressure off one another! Try talking to each other properly about how you can get past this hurdle together.
  4. For a man to be able to perform, he needs passion, and scheduling your sex life and giving him specific times when he needs to be home can ruin that. Try to come up with a plan together on how to keep this time fun and romantic.
  5. For many men with performance anxiety, it’s present for a short period of time such as during the time that you are trying for a baby. But for others, it can be a sign of something underlying. Don’t be afraid to go to your GP, just to make sure everything is okay.

It is really important that if trying to conceive is negatively affecting your sex life that you communicate with one another and you work out how you can get some passion and fun back not only into your sex life, but into your life generally as well.

Acupuncture for fertility

The process of trying to conceive can be lengthy, intricate and emotional for many couples.

While media attention often focuses on women delaying conception until their late thirties and forties as the cause of complications with fertility, this is not the only issue at play with sub fertility. Other causes for infertility include; lifestyle factors such as being over or under weight, smoking, heavy drinking and stress. Contributing conditions include blocked fallopian tubes, endometriosis, Polycystic Ovarian Syndrome (PCOS) and compromised sperm quality.  In recent years more complex tests have been developed to assess genetic problems and immunological disorders that may interfere with potential pregnancy by preventing implantation or causing early miscarriage. However, many couples are only offered investigations after years of trying for a baby. Often these investigations are delayed and protracted and can contribute to any pre-existing stress.

The Fertile Ground of Acupuncture

For many, acupuncture offers a positive and beneficial treatment either to enhance the chances of natural conception or to support in the process of assisted conception. There have been several studies in recent years suggesting acupuncture can benefit fertility outcomes by:

  • Lowering stress hormones and regulating FSH
  • Improving blood flow to the pelvic area, ovaries and uterus
  • Reducing contractions of the uterus
  • Regulating the immune system

The research

While the West has tended not to engage with as many clinical trials on acupuncture for natural fertility, there is positive evidence to establish plausible explanations as to how acupuncture may benefit fertility (Gerhard 1992 and Stener-Victorin 2000, 2008, 2010).

Firstly, it has been shown that acupuncture regulates fertility hormones. Stress and other factors can disrupt the function of the Hypothalamic Pituitary-Ovarian Axis (HPOA), causing hormonal imbalances that can negatively impact fertility. Acupuncture has been shown to affect hormone levels by promoting the release of beta-endorphin in the brain, which affects the flow of the gonadotrophin-releasing hormone by the hypothalamus, the follicle stimulating hormone from the pituitary gland, and the oestrogen and progesterone levels from the ovary (Ng 2008, Huang 2008, Lim 2010, Stener-Victorin 2010).

Secondly, acupuncture has been shown to increase blood flow to the reproductive organs. While stress has the negative effect of constricting the ovarian arteries, acupuncture inhibits this sympathetic activity, improving blood flow to the ovaries (Stener-Victorin 2006, Lim 2010), enhancing the environment in which ovarian follicles develop. Furthermore, acupuncture also increases blood flow to the uterus (Stener-Victorin 1996, Huang 2008), improving the thickness of the endometrial lining and increasing the chances of embryo implantation.

Thirdly, evidence illustrates that acupuncture counteracts one of the most common causes of female infertility, Polycystic Ovarian Syndrome (PCOS). By reducing sympathetic nerve activity and balancing hormone levels, acupuncture has been shown to reduce the number of ovarian cysts, stimulate ovulation, enhance blastocyst implantation and regulate the menstrual cycle in women with PCOS (Stener-Victorin 2000, 2008, 2009, Zhang 2009). It may also help to control secondary effects such as obesity and anorexia (Lim 2010).

Acupuncture for IVF

While acupuncture has been shown to enhance natural fertility, it is also used successfully in the preparation for, and during IVF cycles, in order to optimise the uterine environment and enhance egg quality during treatment.

It is suggested that acupuncture treatments should start three months prior to IVF, scheduled weekly throughout the cycle up to the time of egg retrieval. However, a published study has also reported the positive effects of acupuncture on the day of embryo transfer (Acupuncture and assisted conception (Review), The Cochrane Collaboration, 2009). Informal feedback from gynecologists confirms that acupuncture has a hugely calming effect on patients, something which is vital both immediately before and after embryo transfer.

Traditionally trained acupuncturists make a diagnosis according to the principles of Chinese medicine. Those of us who have extensive experience of working with fertility issues offer an integral approach whereby we bring together our knowledge and experience both from an Eastern and Western perspective. This enables us to offer advice and suggestions about lifestyle and diet that complement the treatment and address the imbalances specific to each individual.

The holistic approach of Chinese medicine, which has treated gynecological conditions for centuries, aims to restore the balance of the body back to normal functioning in order to help, where possible, for women to conceive naturally. This move towards homeostasis can be translated in Western terms into better hormonal balance. Using the language of Qi (energy flow) and Blood, acupuncture reestablishes the proper flow of these two substances to enable the organs to function at their optimum. As acupuncturists we are thus particularly interested in the details of your menstrual cycle and other signs and symptoms, which help us to assess where particular imbalances lie; hence the importance of detailed case taking at the initial consultation. Each of the organs and their associated meridians have a physical and emotional influence and, by offering specific and targeted treatment, acupuncture has positive results on both.

We have an expert team of acupuncturists here at the clinic, and if you live outside of London take a look at our affiliated network to find someone near you, personally trained by Zita West.

What to do if IVF fails


It doesn’t matter who you are – if your IVF cycle is unsuccessful, you will undoubtedly feel that you personally have failed and will look for reasons why. Even though some women find it hard to think positively and may not expect their IVF to succeed, the realisation that it hasn’t worked still always comes as a shock.

Each of you will react in your own way and go through an array of emotions, depending on whether this is your first or subsequent attempt at IVF. It will take a while to get over the disappointment and to accept the loss, and then to move on and look ahead. You can’t compare yourself to other people and their reaction when their IVF cycle doesn’t work.

The blame game

Many women blame themselves for their IVF cycle not working and this is a huge psychological setback. They are often unable to look forward at this point or believe that motherhood is still a possibility. So many of the women I speak to say they feel they have done something wrong for it not to have worked, but they have no idea what. Understandably, the question they ask themselves is ‘Why didn’t it happen for me?’ The tyranny of the ‘shoulds’ then come into play: “I should have rested more,” “I shouldn’t have had that extra cup of tea,” “I shouldn’t have argued with my partner.” Trust me (and you know it really) these are not the reasons why an IVF cycle didn’t work.

You are likely to feel hurt, let down and betrayed. You will inevitably look for someone or something to blame. You may feel the need to lash out or punish in some way, or you may experience over-whelming feelings of jealousy that someone else’s IVF worked. Some women shut down emotionally and can’t be reached at this point. They remain silent and contain their feelings of anger, frustration and despair. So many women don’t like who they have become and feel like a shadow of their former selves.

Much of my work and the work of my team involves supporting couples who have had an unsuccessful IVF attempt. I work with them to come up with a plan, making small changes to their lifestyle, helping with their emotional well-being and relationship, or finding them a clinic that is more suitable for their needs. I also help couples to move on to other options. I sit in the consulting room day after day and hear the most tragic stories. However, I am usually able to help couples feel more optimistic because there really are things that can be done to help them achieve their goal. Sometimes it will depend on how far they want to go to achieve it.

Should you try again?

Many couples want to know if they should try again. This depends on their circumstances. Is their relationship solid? Can they afford to pay for another cycle of treatment? Are they emotionally and mentally strong enough? Some couples re-evaluate their situation and decide they simply cannot go through the possibility of another disappointment.

Some couples give themselves a cut-off point in terms of how many cycles they are going to do, but many women want to continue treatment at all costs. Women, more so than men, sometimes feel that if they throw everything at the process then it will eventually work. My inclination is that something has to change – that might be to do with mindset, nutrition or lifestyle. It might be worth seeing if there is anything that can be done to improve the sperm, considering moving to another clinic or even taking a break from the whole process. For some, it will mean moving on to egg donation, surrogacy, adoption, or moving on completely and coming to terms with childlessness.

Making a decision

To help you decide whether or not to try again, work through the following plan, adapting it to your particular needs:

  1. It is important to make an appointment back at your clinic as soon as possible, so that you can discuss the cycle, what happened, what were you happy and positive about, what were the negatives, any further tests that need to be done and what would you do differently next time.
  2. Wait at least two or three weeks before making your decision. This will give you some time to re-evaluate your emotions. Everybody reacts differently: some women want to start again right away while others can’t face another cycle and need a break. How long you leave it between cycles is up to you and the clinic treating you, but being strong emotionally, psychologically and mentally is all key to that decision.
  3. Practise ways of changing your mindset to enable you to feel positive. Daily meditation or relaxation and visualisation will help you to feel more optimistic – this is very important at this point. Get emotional help and support if you need it.
  4. Don’t punish yourself – build treats into your lives. I have said so many times that many of the couples I see put their lives on hold. They focus exclusively on IVF and forget to have fun. I sometimes think you just need a complete break from everything – eating whatever you like, drinking moderately – just to get a bit more fun back into your life.
  5. So many women say to me “I am a failure” and that is just not logical. You are not a failure as a person. Try listing your achievements and positive attributes – get you partner or a good friend to help you – to help get you back in balance.
  6. Look at areas of your lifestyle where you can make improvements.
  7. Don’t give up on sex after IVF. I have seen so many women get pregnant the month after IVF. I don’t know why, but it can and does happen.

Don’t miss out on life

Before you decide on your plan of action, get some normality back into your lives. For weeks now your lives have been a whirlwind of appointments and preparing yourself for IVF. It is easy to lose your sense of self and feel you are no longer the person you were. Many women ask me whether they can exercise again. I say, just go off and do the things you have always enjoyed, including exercise; have a drink if you want; put recent events behind you and let go before you decide what to do next.

Improve sperm health

Improve sperm health

We now know that up to 50% of all cases of fertility issues are associated with a male factor and that the male partner has a crucial role to play at conception in providing the healthiest sperm he can for the future health of the child. Our Vitamen supplement is specially formulated to help support male fertility and to help prepare a man’s body for conception. Combining vitamins and minerals that are most important for sperm health, including antioxidants that help protect DNA inside the sperm from damage:

Folate – vitally important for the normal functioning of the immune system and for normal cell division.
Selenium – important for normal sperm production. Also helps protect DNA, and sperm membranes from oxidative damage, as well as supporting male thyroid function, which is very important for fertility.
Vitamin B12 – helps to maintain the normal production and metabolism of men’s reproductive hormones.
Vitamins C and E – helps to protect sperm DNA from damage. Particularly important if the diet is low in fresh fruit and vegetables.
Zinc – very important for male fertility. Needed to make the outer layer and tail of the sperm. Zinc is lost in the semen, so needs to be replenished regularly.

Did you know…

  • That a single ejaculation will usually contain around 40 million sperm
  • The sperm cell consists of the head (containing genetic material), mid-piece (the energy powerhouse) and the tail (propels the sperm forward)
  • Sperm needs an enormous amount of energy. Passing along a woman’s reproductive tract to get to the egg is like a human swimming the Pacific Ocean
  • Despite the millions of sperm entering a woman’s body, only around 200 will reach the fallopian tube
    Having reached the fallopian tube first, the winning sperm has to drill into the egg to download its most precious genetic material
  • Increasingly, research shows that specific dietary changes can increase the chances of producing healthy sperm

Shop male fertility supplements here.


Zita West Plan Ahead Fertility Assesment

When it comes to fertility and fertility planning, women need to understand their options. The new Plan Ahead programme from Zita West isn’t just a fertility test kit; it takes a comprehensive look at an individual fertility status to help them better understand how to optimise their chances of getting pregnant and how best to prepare. It can also be used by those who are looking ahead to their options when it comes to fertility preservation.

Who is it for?

Preparation has always been the philosophy behind the Zita West approach. Plan Ahead is ideal for:

  • Women who want to prepare for getting pregnant
  • For those who want a better idea of their fertility status
  • Women who have been considering freezing their eggs

“Increasingly, I sit in my clinic and see women who have no fertility awareness at all, and having spent their early 20s trying not to get pregnant, they suddenly have to change their mind-set completely,” said Zita. “Lots of women rely totally on apps, which are not a bad thing if they tune into their bodies, but many have lost the connection to their natural cycles and have little idea of their fertile times and panic around the so-called biological clock. This then leads to stress around ovulation and sometimes performance-anxiety for men when it comes to sex at ovulation time. I also see many women who increasingly want to know about their fertility status and are looking to have fertility assessments. All these tests do have a role but it’s important to take a broad look at your individual circumstances and to understand the implications if a test result comes back and it is not what you are expecting.”

Plan Ahead works by checking a woman’s egg reserves via an Anti-Mullerian Hormone (AMH) blood test in an at-home pin-prick test. AMH is produced by cells within the ovaries and the test helps to assess a woman’s ovarian reserve and provides an indication of their fertility potential.

Combined with the consultation that follows, Plan Ahead has been designed to help the woman get a better understanding of where they are now and the next steps they should take. Based on their answers to a detailed questionnaire the consultation will cover the factors most important to their individual status, as well as helping them to better understand cycles and ovulation and how to think strategically about their fertility. It will also cover any additional tests and investigations which may help.

Next steps will be touched on briefly and a separate in-depth nutrition and lifestyle assessment may be suggested as well. This covers weight, stress, mental and emotional well-being as well as nutrition and diet, and enables women to take a proactive approach to these important, but often overlooked, influences on their fertility.

“Plan Ahead” costs £149.00 including a 30-minute consultation

How to book your “Plan Ahead”

Step 1: Phone 01280 707401 to order and pay for your AMH home-test kit and Plan Ahead consultation or buy online here.

Step 2: Complete the questionnaire you are sent with the kit and return the sample. Instructions are included for taking the sample, returning it and the questionnaire as well as how to book your follow-up consultation.

Consultations will be with Zita West or one of the consultant midwives or fertility nurses at the Zita West Fertility Clinic and will be conducted by phone.

Your seven step IVF preparation plan

The Zita West Clinic in Marylebone, London, specialises in natural fertility and IVF and is the UK’s largest integrated IVF clinic. As part of your preparation for IVF, we develop an individualised four to six-week plan, which includes a variety of different elements designed to help support you not just medically, but physically, nutritionally, emotionally and psychologically.

We understand that everyone’s situation is different, but if you are struggling to get pregnant, have been trying for over 18-months, have had failed IVF cycles or are in you’re in your 30s or 40, it can be important to try something different. Here is what makes us different…

Step 1 – Detailed Questionnaire

This is a questionnaire that is sent out before you come to the clinic and what is different about this is that it covers everything. It not only looks at the medical side – the tests you have had done and the tests you haven’t had done – but it also looks at other key areas, including your nutrition, diet and exercise, emotional health, wellbeing and your lifestyle. There is also a three-page food diary to help give us a better understanding of what you are, or are not, eating.

Step 2 – Initial Consultation

We are very lucky to have some of the leading experts in the field of IVF working at the clinic, including our medical director Dr George Ndukwe, our medical consultant Dr Simone Rofena, midwife fertility specialist Anita O’Neill, lead fertility nurse Terri Morgan-Collins and of course me. Our aim is that you leave a consultation feeling listened to, have had all of your questions answered and you have an appropriate plan of action within a clear timeframe.

Step 3 – Nutrition Consultation

The nutrition and lifestyle consultation forms part of the IVF package and is absolutely key for us at the clinic as we believe it helps to lay down the foundations for healthy eggs and sperm. What happens at the consultation is the nutritionist will go through everything you have included within the questionnaire and food diary and will develop a tailored plan specifically for you.

Step 4 – Nurse Consultation

What’s great about the nurse consultation is that it allows us to explore any fears you might have, answer your questions and touch base on the holistic programme to discuss whether you would benefit from either acupuncture or hypnotherapy.

Step 5 – Acupuncture

A lot of the women who come to the clinic will have acupuncture in the lead up to IVF as part of their preparation, on the day of stimulation and transfer. We believe that it helps release endorphins, which, in turn, reduces stress, as well as improve the blood flow to the pelvic area. Importantly, I believe that women feel very supported by the acupuncturist and it can give them a greater sense of wellbeing during what can be a stressful time.

Step 6 – Hypnotherapy

Mindset is really important to us and we use hypnotherapy a lot here at the clinic. What women find useful is that it helps them understand how they are feeling and provides self-help techniques that can be put into practice while at home.

Step 7 – Second Nurse Consultation

The second nurse consultation usually takes place one or two weeks before treatment begins and is designed to be more of a practical session. We will go through your consent forms, as well as your protocols step-by-step to make sure you are happy with what you will be doing. We also do a full injection teach during the session, to ensure you are comfortable administering all of your medication. It is not unusual to feel nervous in the lead up to IVF, so we find the second nurse consultation is a good opportunity to dispel these nerves and make sure you are feeling as happy and prepared as possible.


The IVF Programme at the Zita West Fertility Clinic is a unique, premium service with exceptionally high pregnancy and birth rates. To book your consultation, please call 0808 196 4060 or email



As well as our team at the clinic we have developed a national network of affiliated though independent acupuncturists who specialise in all aspects of female and male reproductive health.

All our affiliates have received training in Zita’s unique holistic approach to achieving optimum reproductive health as well as the diagnostic processes and treatment protocols followed at our London clinic.

To find an acupuncturist near you, click here