Pre- and Post-Egg Retrieval - What Worked for Us

I've been thinking about writing about the lifestyle/diet changes we made pre- and post-egg retrieval as well as pre- and post-transfer. There are some things I wish I had known about before we got started (like cutting out alcohol and caffeine several months beforehand), so I thought it might be helpful to share these with anybody who is getting ready for an egg retrieval!

Now that I have 2 egg retrievals under my belt, I thought I'd share what worked for us. I will preface this by saying that I am not a doctor, and that not everything I am sharing was specifically recommended by my doctor. A lot of what I ended up doing came recommended by other people going through IVF, research studies/articles, other fertility clinics, etc. I will try to link to resources where I can. Please don't feel like you have to do any of these things, or that you messed things up by not doing these things. My thought process is this: Since we are investing so much into this--financially, emotionally, physically--I want to do whatever I can (reasonably) do to improve things, whether that is egg/sperm quality, number of eggs retrieved, quality of embryos, implantation rate, etc. I figure, even if there isn't scientific proof behind things, if it's not going to hurt, why not give it a shot so that I don't regret things later? I'd rather know I tried my best than live with the "what if?" later on. 

Scroll down to the bottom for Conclusions, or a recap of what I discuss in this post.

Exercise: 3 Months and Prior
This is absolutely something you should talk to your doctor about. They will let you know if you're at a healthy BMI, and what you can do to help achieve one. Doctors generally recommend achieving a normal BMI, as "obesity has been found to alter mitochondrial function and increase oxidative stress, leading to reduced fertility and egg quality. It can also alter hormonal balance, disrupting ovulation." If you have some time before starting Stims--maybe you're saving up money, or waiting for a good time--this is a great time to start exercising and improving your overall health.

Exercise: During/After Stims
You should definitely consult your doctor about exercise during/after Stims, and during/after the 2WW. My nurse said I could continue my normal cardio/strength training during the early stages of injections (days 1-5), but by day 6, I would want to decrease intensity and focus on non-impact exercises (yoga, light elliptical, swimming, etc.). The main concern with strenuous exercise during Stims is that the medications will cause your ovaries to enlarge as the follicles start growing. According to the Southern California Reproductive Center, "You need to protect your ovaries during this sensitive time and avoid strenuous training. Your IVF cycle is not a time to push any limitations...Your body is already working extremely hard during your IVF cycle, so take the time to acknowledge yourself for that." One thing to think about after egg retrieval is the risks of ovarian torsion or ovarian hyperstimulation syndrome (OHSS), so following your doctor's orders and avoiding strenuous exercise are very important here.

Diet: 3 Months and Prior
Alcohol/Caffeine
I read an article that said that "given that egg and sperm maturation takes up to 3 months, it is ideal to stop/reduce alcohol consumption for at least three months before attempting pregnancy." I didn't know this prior to my first egg retrieval, so I had a minor freak out and wrote all about it here. I came to the conclusion that it wouldn't hurt to reduce/eliminate alcohol/caffeine in the 3 months prior to IVF (for both you and your partner), but that ultimately, it is not going to drastically compromise your chances. Knowing this information, we eliminated caffeine/alcohol from our diets 3 months before our 2nd egg retrieval, and I think it did make some improvements for us!

Vitamins/Supplements
My nurse did encourage me to take a prenatal vitamin before we started Stims. Memphis fertility specialist, Dr. Amelia Bailey, recommends that "a woman planning pregnancy should start taking a prenatal vitamin with DHA 6 months before conceiving." She (and other other specialists) also recommend Coenzyme Q10 (CoQ10), DHEA, DHA, folic acid (as needed), and Vitamin D (as needed). CoQ10 is helpful for overall sperm and egg health. Vitamin D insufficiency and deficiency in women attempting to get pregnant has also become an increasing concern. (This article is really helpful if you're thinking of taking any of these mentioned vitamins/supplements.) I personally just took a prenatal vitamin, fish oil, and Vitamin D supplements before and during Stims.

According to Dalene Barton-Schuster, Certified Herbalist and Birth Doula, "The life cycle of sperm, from production to maturation for ejaculation, ranges from 42 to 76 days...to make a plan for increasing fertility and boosting sperm health, you should start at least 2-3 months prior to giving sperm for IVF." CoQ10 is said to improve men's sperm motility and count. There are also many articles claiming that selenium, Vitamin C, zinc, and other vitamins/supplements can help improve male reproductive health. Three months prior to our 2nd egg retrieval, David cut out caffeine/alcohol. He also took a multivitamin, 200mg of Ubiquinol (CoQ10), and the Daily Wellness Company's Fertility Blend for Men daily. The Fertility Blend for Men is something I stumbled upon a few weeks prior to our first egg retrieval. It has great reviews online, and contains many of the recommended supplements to boost male fertility, such as L-carnitine, Vitamins B/C/E, zinc, and selenium.

Here's a helpful article on pre-conception vitamins written by Sarah Yang for the Bump. Here is an article on nutritional guidelines for your fertility treatment published on the Southern California Reproductive Center's blog.

Diet: During/After Stims
My nurse told me that during Stims, "the recommendation for caffeine intake is less than 600 mg" per day and that restricting "all caffeine intake is preferred." She also said that "no alcohol intake is preferred/recommended." I checked and she said that it would be okay to drink caffeine-free Diet Coke and decaf coffee. I had eliminated diet sodas and artificial sugar from my diet once I became pregnant, so it was easy for me to continue avoiding it during my 2nd egg retrieval, though I've added in the occasional Diet Coke or Splenda now that I'm done breastfeeding. (We don't plan to do our next embryo transfer for awhile.)

I think that eating healthy is something that is great to do now for yourself and for your future baby! There are a lot of diet changes you need to make when you become pregnant, so it doesn't hurt to start getting used to those changes now.

Acupuncture
I had never given much thought to holistic medicine (except for chiropractic) prior to IVF, but my fertility clinic actually has an acupuncture facility right in their building, so it was something I looked into. Some studies have shown that "when used in conduction with Western fertility treatments, acupuncture increases conception rates by 26%." Others say that "acupuncture is not harmful and most of those so treated swear by it. For the nay-sayers, what can be said with certainty is that at the very least acupuncture has a 'feel good' aspect to it and in most, evokes a psychological benefit that should not be discounted." My thoughts are that it's not going to hurt anything, so why not give it a shot? I didn't do acupuncture prior to my first egg retrieval, but I did do it for about a month prior to my 2nd one, and I think it did make some improvements for us the second time around.

Conclusions
My main suggestions for Before Stims (preferably 3 months or prior):

• Exercise and get to a healthy BMI
• Eat healthy--limit/eliminate caffeine/alcohol, fake sugars, trans fats, processed foods, etc.
• Take prenatal/multivitamins, CoQ10, and other recommended vitamins/supplements
• Acupuncture (talk to your acupuncturist, but you can start 3 months prior, or even 3-4 weeks prior to Stims)

My main suggestions for During/After Stims:

• Limited non-strenuous exercise (as discussed with your doctor!)
• Continue to eat healthy--eliminate caffeine/alcohol, fake sugars, trans fats, processed foods, etc.
• Continue taking prenatal/multivitamins, and other recommended vitamins/supplements as needed (and recommended by your doctor)
• Acupuncture (talk to your acupuncturist about what they recommend for during Stims and leading up to the embryo transfer...)

FET Schedule

I just got a voicemail from my nurse. My FET is scheduled for 2:00pm, but I need to check in at 1:30pm. 75 minutes prior to the FET, I need to empty my bladder and then drink 20 oz. of water (from 12:45pm-1:00pm). I am not looking forward to the full bladder part--that was absolutely awful last time!

My pre-FET acupuncture appointment is scheduled for 12:00pm (45-minute appt.). Then I will drink my water and check in for my FET appt. After the procedure, I will go back and do my post-FET acupuncture appointment, then go home and rest.

I will take it easy for 2-3 days (no lifting anything over 25 lb.), and continue my oral/vaginal Estrace and Progesterone injections until my first blood pregnancy test (scheduled for Wednesday, 11/23/16).

I am a little less nervous/anxious this time around, but of course I'm sure that will change as I enter the 2WW! 

FET Schedule for Thursday, 11/10/16:

• 12:00pm – 1^st Acupuncture Appt.
• 12:45pm – Empty bladder, then drink 20 oz. of water before 1:00pm
• 1:30pm – Check in (4^th floor) for FET Appt. (Bring photo ID)
• 2:00pm – FET procedure
• ~2:450pm – 2^nd Acupuncture Appt. (exact time TBD)

After Transfer:

• Take it easy for 2-3 days; no heavy lifting
• Continue medications  until first blood pregnancy test

The Transfer

I had my transfer yesterday! My mom and I left the house at around 9:30am, and got to the clinic a little early. I went in for my pre-FET acupuncture appointment at 10:45am. The acupuncture points were a little different than last time. They were on different parts of my limbs and included my inner wrists. After my appointment, my mom and I went to lunch at Panera before I had to empty my bladder and start drinking 20 oz. of water. By this time, I had not gotten a call in the morning saying anything went wrong with the embryo thaw, so I breathed a sigh of relief, assuming that the embryo thawed without complications.

Drinking the 20 oz. of water was no problem, but right before I was called back for my appointment (around 1:45pm) I started feeling the fullness in my bladder. Then my mom and I sat in the room waiting for awhile and it kept getting worse and worse. I should explain that I already have a teeny tiny bladder to begin with...20 oz. of water is a ridiculously large amount of liquid for my little bladder to hold! Before the doctor game in, I absolutely couldn't hold it any longer so I scrambled to put my shorts back on and ran out the door into the nurses about to come into the room! They told me I could relieve myself for a (very fast) count to 10. I counted to 5 and (surprisingly) was able to stop mid-stream. 

Our little embryo! The embryologist gave us the cutest little
card framing a photo of the little nugget!

I went back into the room and they came in to start the transfer. I'll be completely honest. The fullness in my bladder was so incredibly uncomfortable that I don't remember much of the procedure, except that the catheter going into the cervix felt like nothing compared to the U/S tech pressing the wand on my abdomen. The doctor tried to distract me by asking me about my students, and I tried to answer him as best as I can. He showed me my embryo on the screen before the procedure, and then I got to watch as the catheter was threaded through my cervix into the uterus, and then as the embryo was released! There was a clip on the monitor that they replayed several times so I was able to record it on my phone.

After the procedure (which probably didn't take more than 15 minutes total), the doctor told me to stay lying down for 5 minutes, during which a nurse would come in with discharge instructions. I was just about to get up to go to the bathroom (because I couldn't hold it any longer) when the nurse came in...so I (begrudgingly) listened to her as she gave me the instructions. (I told my mom to listen closely since I wouldn't be able to pay much attention!)

After I was finished, I went to my post-FET acupuncture appointment. The points were similar to the first time, except the acupuncturist did not put them in my abdomen and concentrated the heat lamp on my feet (instead of abdomen). After my appointment, I was headed toward the bathroom and almost tripped on my feet. I didn't trip/fall, but just kind of stumbled a little and landed on my left foot harder than I would have liked. Of course I started freaking out because I was worried I dislodged the embryo or moved it or something. In the car on the drive home, I frantically called the office in a panic until a nurse finally got back to me and said the doctor said I would be fine. After we got home, I spent the rest of the afternoon/evening in bed and lounging on the couch. 

Today I took it pretty easy too. I started getting some abdominal cramps during the late afternoon that started on the left side. I took a nap to sleep it off, and when I woke up the cramps had radiated toward the right side as well. I called the on-call nurse who said cramping is normal. She did say I could take Tylenol (not Advil) although it may not help much with cramping. It did seem to help a little though. Then after I ate dinner, I got heartburn. I spoke to another nurse (the one who did my first at-home IM injection for me) and she said I could take TUMS, Pepcid of Zantac as needed and that sometimes cramps and heartburn could be early signs of pregnancy! I don't want to get my hopes up, but that makes me feel a little better.

FET Schedule

I just got off the phone with my nurse. My FET is scheduled for 1:45pm, but I need to check in at 1:15pm. 75 minutes prior to the FET, I need to empty my bladder and then drink 20 oz. of water (12:30pm-12:45pm). They prefer you have a full bladder during the transfer so that they have better visualization during the abdominal ultrasound to help the doctor know where best to implant the embryo.

I am planning on going in for my pre-FET acupuncture appointment at 10:45am (45-minute appt.), then go to lunch with my mom, drink my water, then check in for my FET appt. After the procedure, I will go back and do my post-FET acupuncture appointment, then go home and rest.

The nurse recommends I take it easy for the 2-3 days after the transfer, with no heavy lifting, and light aerobics only (walking, yoga, swimming). I am to continue my del Estrogen and Progesterone injections until the first blood pregnancy test (2 weeks later).

I am getting super nervous/anxious, especially since we are still waiting on the embryology lab to re-biopsy the non-concurrent embryo (they are taking their sweet time!)...in the mean time, I am doing a whole lot of meditating and praying to get me through today and tomorrow!

FET Schedule for Thursday, 7/14/16:

• 10:45am – 1^st Acupuncture Appt.
• 12:30pm – Empty bladder, then drink 20 oz. of water before 12:45pm
• 1:15pm – Check in (4^th floor) for FET Appt. (Bring photo ID)
• 1:45pm – FET procedure
• ~2:30pm – 2^nd Acupuncture Appt. (exact time TBD)

After Transfer:

• Take it easy for 2-3 days; no heavy lifting, light aerobics only (walking, yoga, swimming)
• Continue injections until first blood pregnancy test

Acupuncture

Figuring out flights and travel plans has been so stressful. When we originally started planning everything, we thought I'd be done with the transfer by now. Here we are, and my (original) flight home is scheduled for tomorrow, and my transfer is not until 7.14.16! I have decided I will go home for a week, and then come back for my next lining check (on 7.9.16). Unfortunately, this means I will be missing a good friend's wedding. :(

I will come back, do the lining check, and then the transfer 5 days later. After that, I begin the two week wait (2ww) for my first pregnancy test (7.26.16). Last night while lying in bed (not sleeping), I started thinking about things I could do to help with the transfer. I read different things about eating pineapple core, walnuts, Brazil nuts, and doing acupuncture. I had completely forgotten about acupuncture, but there seem to be a lot of people who have done it during their cycles. I reached out to a couple local clinics and got a call back from the clinic that happens to be in the same building as my IVF clinic. They offered a package with a consultation/treatment, plus treatments pre- and post-transfer. I was able to schedule the consult for today (right after a much-needed massage). 

The massage I had (although shorter than expected) was just what I needed--I fell asleep on the table as soon as I flipped onto my stomach! After that, I drove to the acupuncture clinic and met with the acupuncturist. She spent some time going over my intake paperwork, asking me questions about my health and our fertility procedures, and then she brought me to the room where we got started. I don't know exactly how many needles she used, but I know she put some in my scalp, forehead, hands, abdomen, and feet. After that, she covered my eyes with a mask, and told me to rest for 30 minutes. Again, I fell asleep! I didn't even realize that the needles were still in my extremities until I moved my hand. 

While I don't typically practice holistic medicine (except for chiropractic), and I don't know how that acupuncture will really help with the FET, I do know that after the procedure, I felt extremely relaxed. That in itself, I feel, could help improve the chances of implantation since it's so important for you to be rested and relaxed. Some studies have shown that "when used in conduction with Western fertility treatments, acupuncture increases conception rates by 26%" (Pacific College of Oriental Medicine, 2015). While I don't know how true that is, "in fairness...acupuncture is not harmful and most of those so treated swear by it. For the nay-sayers, what can be said with certainty is that at the very least acupuncture has a 'feel good' aspect to it and in most, evokes a psychological benefit that should not be discounted" (Sher Fertility, 2016). My thoughts are that although there may not be much scientific proof of acupuncture increasing implantation rates, it's not going to hurt anything, so if you can afford it, why not give it a shot? I plan to go in for (same day) procedures before and after the transfer.

Right now, I'm all packed and ready to head back home for a week. The only thing I have to worry about while there is giving myself two IM injections. Other than that, I plan to RELAX!