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...)

The Phone Call

David and I had only been trying to conceive for a month when we got our diagnosis. When I told my OB/GYN that we were trying, she suggested that David have a SA done, due to his medical history. The urologist ordered the SA as well as some other tests. One afternoon after coming home from work, I got that phone call from my husband. His doctor had just given him some devastating news after reviewing the lab results. I hung up on him.

I spent the next 3-4 hours making phone call after phone call, calling doctor after doctor. It had been so long since I had felt this way: hopeless, disconsolate, heartbroken. I didn't know what to do, nor where to turn.

I can name at least 6 friends who are currently suffering from infertility, some of it unexplained. Many have been trying for years. My heart goes out to them. Here we were, trying for a mere few weeks, and we already knew it wasn't going to happen. In some ways, that phone call became a blessing. Instead of trying for years to no avail, we know what we are up against and we know what we have to do. This is not at all the path we had planned, and it is going to be a long and scary journey. Almost every day, I feel guilty that we even have this opportunity...but my mom said something so comforting to me: she told me that we were given this opportunity and we should take it...that we shouldn't feel guilty because we were blessed with the chance to give this a try. 

If you haven't seen a doctor yet...
For those of you who have been trying to conceive and are losing hope, I highly recommend that you speak to your OB/GYN or urologist and have some testing done. It may seem expensive up front, but it can save you months of frustration. I would suggest first having a SA done (by a clinic or lab). The reason I suggest a lab (vs. an at-home test) is because the lab is able to look for things like sperm count, motility, velocity, morphology, volume, and liquefaction. While at-home tests measure sperm count, this is only one factor in a man's fertility. A normal sperm count may not necessarily indicate if you are fertile or not. Home tests only determine concentration, and do not measure other import factors, many common causes which are missed with these at-home tests. Having the male partner tested with an SA is going to be less invasive and less expensive than having the woman tested first. 

If the SA results are normal, I suggest moving on to the next step: having the female partner tested. Again, if infertility is not covered by your insurance, this may seem expensive, but in the end, it may save you much frustration. Your doctor may recommend an HSG, which can diagnose fallopian tube blockages and uterus defects. Another test is a transvaginal ultrasound, where the doctor can view images of the ovaries and uterus and determine if there are any follicles in the ovaries. These 2-3 tests may just give you the answers you are looking for, and help determine what further routes (if any) you want to pursue next. And if you don't want to pursue anything further, that's okay too.

I am so glad I spoke to my OB/GYN and she suggested we have the SA done. I am also thankful my husband's urologist ordered further tests. Doing this so early in the game has saved us months (if not years) of frustration, and though we received some heartbreaking news, we are blessed to have the opportunity to move forward.