It started playfully: silly baby names; jokes about sperm donors. Then it became real: a deadline of two years issued by my partner. Outwardly, I hid my doubts, for fear that my partner would doubt me. Secretly, I panicked. I tried to emergency-process all my childhood trauma. I asked friends with kids endless questions about whether they still have hobbies or sex. I even asked my parents. “Don’t overthink it. Having you gave my life meaning,” my dad said, strangely earnest. I stared at him, incredulous, thinking of all the grief and expense I’d caused him. Eventually, partly because of my hesitance about kids, my girlfriend and I split up.
I’m gay and now 32. Although I have no desire to get pregnant myself (it would prompt the uncomfortable feeling I get when somebody calls me “lady”), I am open to having a baby. Yet, when I think about the various complexities of this – choosing a donor or paying up to £25,000 for IVF – I freeze. For my straight friends, the question also feels complex. Some are concerned about their careers or their bank balances. Others haven’t met the right person or are stuck in the spin cycle of dating apps.
In a culture of choice and at a time when we are open to new modes of family-making, procreation is up for review. The term “child-free” has come to replace “childless”, intended to capture the positive and deliberate choice not to have a child. In 2022, the number of live births in England and Wales hit its lowest figure in 20 years. Not only are we having fewer children in the UK, but we are having them later, too: the average age of mothers has risen from 27.7 in 1991 to 30.9 in 2021. Experts attribute this to several factors, including the housing crisis and the cost of childcare. As Joeli Brearley, chief executive of Pregnant Then Screwed, recently said: “Procreation has become a luxury item in the UK.”
And what about the biology of the matter, fertility itself? Today, up to one in seven couples may experience difficulty conceiving, with women taking the brunt of responsibility for family planning and predominantly undergoing fertility treatment. But you may have heard of “spermageddon” – rapidly declining global male fertility. Studies are reporting that average sperm counts have halved in the past 50 years, an issue linked to pollutants and unhealthy lifestyles, yet in 25% of cases of heterosexual couples seeking help with conceiving, the man does not undergo any evaluation.
Against this complex backdrop comes the rise of the fertility coach – a kind of life coach specialising in fertility journeys. However, as Jo Sinclair, a former fertility coach and founder of the charity Fertility First explains, it’s less about telling clients what to do and more about listening and advising. “In your case,” Jo tells me, “a fertility coach might help you consider your options, talk about managing affordability and think about the emotional side of shared parenting.” Why not, I think.
A couple of months ago, I met Karen Deulofeu at Lily Ama Coaching. She has experience of working with LGBTQ+ parents. While there is no formal qualification for a fertility coach, Karen Deulofeu is an accredited Life and Success Coach. Her work involves supporting clients through the symptoms and effects of infertility, including stress, grief, shame, anger, inability to concentrate, low self-esteem and insomnia. Not only to improve their wellbeing but potentially to improve their chances of conception. Karen sent me a 2018 study that tracked 4,769 women who were attempting to conceive, finding higher levels of stress were associated with a lower chance of conception. Although not definitive, the study concluded it “provides evidence that supports the integration of mental health care into counselling for couples who want to conceive”.
There’s been a rise in independent coaches as part of the growing “proactive fertility industry” around today’s shifting fertility landscape. An article I read on the “girlbosses of fertility” – coaches in the US charge $7,000 for a consultation course – raised some initial scepticism. Still, I quickly found coaches in the UK to be more affordable and less formidable. Several trained to become coaches after going through their own complicated fertility journeys, Karen is one such coach.
She is interested in discussing my long list of barriers to having a baby and, suddenly, as though hearing myself for the first time, I say: “I suppose if I actually wanted a baby then I wouldn’t let so many excuses get in the way, would I?” Karen reassures me: “That doesn’t mean you don’t want a child,” she says, “but it would be good to work out what you are really afraid of and where those things come from.”
I tell Karen I’m afraid of my relationships changing and that I’ll be stuck with a decision I cannot reverse. She asks me if, without those fears, I’d feel positive about starting a family. “Probably,” I answer. By the end of our 90-minute session, we have moved past my practical fears to hit at something deeper: a fear of no longer being in control. Karen asks me to compare this to other big life decisions – jobs, moving country, ending relationships. We agree it is not ideal to make decisions purely from a place of fear, but better from a place of excitement or positivity. My homework before our next session is to mull this over.
In the meantime, I speak to Michelle Perkins, 36, from Bedfordshire, who has been with her husband for 16 years. After several years trying to conceive, she spotted a 12-week fertility coaching course on Facebook. Sessions focused on themes such as identifying emotions, reprogramming around negative experiences and tactics for coping. “It helped me realise I am not alone and that these are other things people go through,” she tells me. Throughout her arduous attempts to conceive, her fertility was decreasing – the potential success of IVF generally follows the same trajectory, decreasing for older women. The chances do not only vary with age. People from ethnic minority backgrounds undergoing fertility treatment are also less likely to conceive than their white counterparts, with Black patients having the lowest chances of successful treatment.
A fertility coach and nurse with 20 years’ experience, Yemi Adegbile works mostly with BAME clients, some of whom report encountering biases from medical professionals. With research showing that 65% of Black people in the UK reported discrimination from healthcare professionals based on ethnicity, Yemi attempts to provide accessible advice. “If you’re not armed with the right questions or knowledge, a GP might fob you off. I’m not there to say this is what you should do, just what you need to know. There is no one-size-fits-all solution.”
Yemi finds that her clients experience stigma around infertility, even though the number of women from a BAME background undertaking fertility treatment in the UK has increased over the past five years by 20.6%. “It comes from cultural expectations affiliated with procreation, especially when you are married,” she says. In some instances, Yemi has coached women who have not told their family they are undergoing IVF, because there is religious belief that this mode of conception is not “natural”. Clients often stop by for one or two formal sessions and the relationship may continue more informally. “I can be there if they are struggling.” Sometimes, even when clients get pregnant, emotions that are pent up from the process come out in the wrong way and they return to discuss how they’re feeling. “Coaching just holds your hand,” says Yemi.
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I find myself looking forward to my next session with Karen. I explain that, as I’m gay and it can’t just happen (immaculate conception pending), I feel a lack of autonomy from the outset. My former partner’s desire to have a baby sooner than me compounded this, as does thinking about my mother’s experience of parenthood, separating from my father while pregnant. We discuss what I could hypothetically be in control of: how I choose to have a baby; where I live; my parenting style. It occurs to me that I have dismissed parenting as something straight people do, a process that comes with a blueprint. Yet there might be queer ways of parenting that I have yet to consider.
Just as challenges around fertility are not distributed equally, neither is the ability to access it. The “why not” in fertility coaching might be the price tag. Karen charges £1,299 for 16 sessions over an eight-week programme, or £97 for a 90-minute individual session – a free 30-minute intro call also available. The programme Michelle Perkins signed up for is between £1,200 and £2,400 for eight 90-minute sessions.
There is no easy answer as to whether coaching is worth the price tag, but I speak to Dr Ippokratis Sarris, a consultant in reproductive medicine and director of King’s Fertility in London, for his impartial opinion. Fertility treatments are a fairly unique aspect of medicine in that “part of the journey happens before the clinic and there is a journey that happens after the clinic,” he says. On top of that, fertility is often highly emotional, usually involves multiple parties and there may be various options for a patient facing a problem. With NHS fertility services poorly funded compared to other fields, and long waiting lists, it follows that patients might seek private care. “It’s not that NHS clinicians don’t care hugely,” says Ippokratis, “but that we are overstretched and fertility is complex. To say as clinicians that we can do everything for a patient is patronising, to say the least.” He views the rise of fertility coaching alongside the rise of online fertility forums. “In the past, information was centralised, it came from books or qualified experts. What’s happened now is that people have information at their fingertips and suddenly a lot of the expertise is not from the source, it’s from influencers or advocacy and patient support groups.”
Since fertility coaching has not made it to British Fertility Society guidelines and is not funded through Nice due to a lack of empirical studies into its effectiveness, it exists in a grey area. “If an individual thinks they’d find support from a coach and wants to try it, I would not stop them. The question is validity and value for money, ask yourself: ‘Is this the best way of using my resources?’”
Overall, Michelle found her experience of coaching positive. “Fertility issues can make your mental health suffer,” she says, “especially with the added financial stresses that come with IVF.” She believes her coaching has upped her emotional resilience as she and her partner prepare to seek IVF overseas, where it’s more affordable. Yet, she adds: “before you pay for coaching, make use of free resources on social media.” A useful one was the Peanut app, a forum where Michelle connected with others trying to conceive.
While communities like this can be positive, Ippokratis advises approaching with caution. “Social media communities can be powerful but, in other ways, they can be misleading if they lack context.” Regulatory framework for licensed clinics that offer assisted reproductive technology is tight, he says, but there is a whole world outside that. “I’ve seen it quite a bit, not with fertility coaches, but with alternative therapies, where they overguide from a medical point of view.” He would, therefore, suggest patients “be wary of anyone who starts giving medical recommendations,” describing some cases as “backseat driver style interventions”. As for seeking a coach, he recommends looking at credentials and verifiable reviews. “Importantly, you need to connect with the person; do you trust them?”
In my final coaching session with Karen, we try hypnosis – specifically tailored around not letting fear govern my decisions. I don’t leave with an overwhelming sense of broodiness, but our sessions do subtly shift the dial. I feel like I have more control over a future with a child than I thought. Discussing my own parents’ hang-ups allowed me to distinguish them from my own. It even helped me reassess my relationship with my mother.
“Beyond the medical aspect of fertility, it is an area that touches on the inner sanctum of us as human beings,” concludes Ippokratis. “Family, reproduction, sexuality, relationships and religious beliefs, these are the core things that define us as people.” With this in mind, along with the ever-changing frontiers of family-making as technologies and social attitudes shift, I can see the usefulness in visiting a fertility coach. When a friend in her 30s recently became pregnant and felt unsure as to whether to keep the baby, I suggested she speak to a coach about her decision. From waiting, having a baby alone to becoming a queer parent, many of us are muddling through situations that have less precedent, why not – if we can – ask for help from someone who can guide us?
When my partner and I split up, after the pain of separation subsided, I was left without the background noise of what she wanted to instead contemplate what I wanted. I was grateful to have Karen’s advice. As I started a new relationship, kids began to come up in conversation and I found myself able to talk about my various concerns more openly, understanding that they are valid, quite common, and could be practical to address.
When I am ready to start a family, I would return to fertility coaching, if funds allowed, as a way to navigate the many choices that need to be made as an aspiring LGBTQ+ parent. It offered me great clarity that making big decisions isn’t so much about the decision itself, but how you approach it – and how you let it affect you.
