Making Everyday Decisions with Confidence During Your IVF Cycle
How are you feeling on the scale of overwhelm? Do you find yourself second guessing seemingly simple decisions such as what to eat and when (or when not) to have sex?
If so, you're not alone. Every day I am asked dozens of questions about how not to mess up an IVF cycle.
In this episode we cover decisions about the following:
Food
Alcohol
Sex
Illness
Travel
My hope is that I can empower you to understand what is in the realm of normal, and what not to stress out about. The bottom line is to listen to your body and live your life, within just a few common sense parameters.
Let me take the burden from you so that you can enjoy your life, and not merely survive it while you're undergoing fertility treatments and navigating your pathway to parenthood.
As always, please keep in mind that this is my perspective and nothing in this podcast is medical advice.
If you found this conversation valuable, book a consult call with me using this link:
https://calendly.com/loveandsciencefertility/discovery-call
Also, be sure to check out our website: loveandsciencefertility.com
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Please don’t let infertility have the final word. We are here to take the burden from you so that you can achieve your goal of building your family with confidence and compassion.
I’m rooting for you always.
In Gratitude,
Dr. Erica Bove
Transcript:
Hello, my love, and welcome back to the Love and Science Podcast.
Today, we're going to be talking about the day to day.
We're going to be talking about how to live our lives while we're undergoing this process, this fertility journey.
And I don't mean like how to go to work, how to, you know, get your groceries, all those things.
I truly mean how do we live our lives in terms of food, in terms of sex, in terms of travel, what happens if we get sick?
What does it mean to be a person undergoing the fertility journey?
And how can we, how can I really give you some guidance today to be able to say, okay, I'm not going to stress out about this, or I'm going to trust my body, or whatever else it is, because I think the question that keeps coming up for me, at least in my own life, is like, am I doing it right?
Like when I do something that is maybe out of my wheelhouse, maybe it's a yoga class, maybe it's, I don't know, like something with my clinical job, like, you know, the question is like, you know, am I doing this right?
Am I navigating this in the right way?
And the hardest part about the fertility journey is that, you know, those of us type A achieving women are like, well, shoot, if I don't do it right, then the other shoe is going to drop, and I'm going to be responsible for this not working.
And so what I'd like to do is give my suggestions on how to live our lives in a way that empowers in a way that reduces stress, and can just, you know, give some guidance so that you don't have to go down the Google rabbit hole, you don't have to stress out, because there's a lot of right ways to do it.
And I think, you know, unless we sort of know, what is the evidence show, like, then we're kind of lost and feeling disempowered.
I've already done episodes on exercise and sleep.
So we'll put those in the show notes if you want to refer back to them, because I mean, really sleep and exercise are part of daily life.
And we do need to know how to approach those things if we're gonna know feel like our best selves and be able to navigate this process with with ease and, you know, empower.
But I can't tell you, you know, both when I wear my clinical hat and my coaching hat, I get so many questions about diet and sex and travel and all those things.
And so let me sort of give my thoughts one by one about those topics to really think about, okay, how can we live our lives in a way that, you know, feels good, doesn't take away our joy, and, you know, does not compromise the success of the IVF cycle?
Where do we start?
Let's talk about food.
People ask me all this time, like, what should I be eating?
What should I be eating?
And, you know, the hard part about this question is it really is, you know, not a one size fits all endeavor.
I think that there are clearly some fertility diagnoses where we do know that there are certain foods that seem to help certain foods that maybe make it harder to maintain weight or even, you know, lose weight, all those things.
But in general, I think diet is a very individual endeavor.
And if you actually look at it, there are there are studies people have looked at this, but there's not really been one conclusive diet, so to speak.
And I hate that word.
I think nutrition plan is a much better, you know, much better phrase to use than a diet.
But there's there's, you know, different things that people have tried, Mediterranean diet options, sort of whole foods, looking at keto, even, you know, inflammatory diets.
I don't even know what that means.
I've researched it.
I don't even know.
But I think that, you know, when things are not working especially, and I'll tell you, the people who find me to work with me as my coach in line, these are generally people for whom traditional treatments, traditional IVF is not working.
And it's like, what am I missing?
You know, is it my diet?
Is it my, you know, sleep?
Is it like whatever it is, people are looking to what they are doing in their own lives and and subtly blaming themselves, actually.
And so is are there any data to suggest that a certain diet is going to have superior outcomes than another?
There really isn't.
And so let's talk about PCOS for a second.
If you have a diagnosis of PCOS, this basically can be associated with insulin resistance, and if you're A1C is normal.
And so people do talk about, you know, thinking about, you know, diet nutrition plans that are higher in protein and lower in simple carbohydrates.
People do have carbohydrates, make it be complex carbohydrates, because the thing about simple carbohydrates is that they're just stored so inefficiently that nutritionally they are, they offer very little.
And you know, especially when there can be foods with high glycemic glycemic indices, that can then promote insulin resistance and kind of promote those cycles.
And so, you know, if you're thinking about, you know, oh, I have PCOS, even if it's clean PCOS, and I'm like really struggling with what I should and shouldn't eat, you know, really like whole foods are great.
You know, avoiding the things that are on the inside of the grocery store aisles, like processed foods, white bread, white rice, you know, a lot of the processed cereals and things, and really thinking about eating more on the perimeter.
Of course, it's more expensive, but most of the people who, you know, are my listeners who really, you know, are on this fertility journey and want to do it, most of my listeners fortunately do have the resources to deal with a funnel them in the direction of healthy foods and, you know, good choices.
So avoid the processed things.
There's so many chemicals in them, especially for PCOS.
They're not very nutritionally helpful, and probably may kind of kick off the positive feedback loops of insulin resistance and inflammation that are not so helpful.
Again, everything in moderation, 80/20.
Don't kill yourself if you, you know, have a piece of pizza on a Friday night.
This is not what this is about.
This is just to say, in general, you know, what are the foods that are going to be most helpful with PCOS, and it's probably going to be avoiding those simple carbohydrates for the most part and focusing on complex carbs and good fats and high protein.
Endometriosis, you know, I am a person, and I know this hasn't yet been completely proven, but I do believe that endometriosis is probably on the spectrum of autoimmune disease.
And you know, there's something about people with endometriosis, understanding that not all endometriosis is the same, but most of us have retrograde menstruation where we menstruate out the fallopian tube because we see this in laparoscopy all the time.
But what is it about endometriosis in some people where there's menstrual blood in the endometriosis?
I think it's if the body just isn't clearing that menstrual blood and then it hangs out in the pelvis, it creates inflammation, the body tries to, you know, run as if we've like cut our arm, right?
It's an injury, it's a foreign body, so to speak.
And then that starts, you know, the cycle of like scarring.
Things getting stuck to each other, etc.
So you know, I do think that endometriosis probably has an autoimmune component, or at least some people with it do.
And so then people are like, okay, well, you know, I know that's not been proven, but like, let's do this severe elimination diet and see what happens.
In my experience, elimination diets just truly make things more complicated and really just stress people out.
So you know, I am much more a believer in intuitive eating.
And it's really hard because I can't give you an RCT.
But I will tell you that we are not taught how to listen to our bodies.
We are not taught to listen to our hunger cues.
We are not taught to listen to our satiety cues.
We many of us, you know, hands up, even though you can't see my face, engage in emotional eating at times, you know, especially if it's not like, I don't do cooking, right?
But like, sometimes I go and get a milkshake, you know, like, so I think that we have to really look at the big picture and say, okay, like, you know, what are we trying to accomplish with the food?
Food is fuel.
We know that whole foods are helpful.
And you know, for each person, the foods that make them feel good and strong and powerful, that might look different for every single person.
So fortunately, in my 30s, I discovered that pizza is not a good food for me.
And if I have a piece of pizza, even though it sounds like a good idea, I will feel like I've swallowed a brick for like three days, which makes no logical sense in terms of digestion.
But it just it does something to me that is not great.
Same with white pasta, same with white rice.
Like, all those foods have no benefit.
And I mean, I think, you know, type two diabetes runs in my family, PCWES runs in my family, you know, at one point, I was diagnosed with that way back when.
And so, you know, I think that, you know, have to think about the nutritional side of things.
Yes, like, perhaps for me, there's something biochemical about my body not liking those foods.
But I can also tell you on the flip side, and I pay attention to the foods that I eat and what makes me feel powerful and energetic and light, you know, a handful of almonds is like the most amazing thing ever.
And so, you know, those of you who who know me personally know that ever since my residency days, I have just like traveled around with a handful of almonds, like, you know, a packet of almonds, even in my back pocket, you know, you never know when a T-section is going to get called like you got to have the almonds.
So, you know, I love the protein in the almonds.
It makes me feel super powerful.
I love fruits.
Again, I'm fortunate that I am able to have those foods, you know, at my disposal.
But for me, intuitive eating involves like listening to my body and realizing that there are some foods that make me feel amazing and some that make me feel terrible.
And in my experience, you know, I think we really have to listen to that as it pertains to the Pachilli journey, especially in the era of we know that not one diet is going to serve everybody.
And what works for one person may not work for another.
And so let's sort of throw out this idea that there is a right way to eat during IVF or fertility treatment and say like, what does my body need?
When do I feel the best?
When do I feel the worst?
And do more of those things.
And, you know, of course, hydration is important.
Of course, rest is important.
But I do think that like even trying to eat a little bit slowly and enjoy the food we put in our mouths and, you know, wonder one of the complaints I hear the most often is, gosh, I've just gained so much weight in these fertility treatments.
And I think part of it is the hormones.
The hormones do influence how our body metabolizes food and our hunger cues and all of that.
So I think the more we can pay attention to our bodies, you know, the better of the fact that we'll have on, you know, not just how we feel on a day-to-day basis, but then how we feel in the overall journey as pertains to our bodies and, you know, our muscle and our fuel and all those things.
So that's my perspective on food.
I think there's many right ways to do it, but just pay attention and listen.
And if you don't know how to do this, please let me know.
Personally, I would love to have a call with you.
It's one of my favorite things to coach on is intuitive eating.
And so there are so many ways through the prison that so many of us have found ourselves in the past.
And I just hope this is an empowering message because there are so many ways to do it right.
And I'd love to help you figure that out.
So that's food in a nutshell.
Let's talk about alcohol.
You know, it's not sort of a major thing, but people do ask me like, when can I drink?
When can I drink?
I think of like, as we are thinking about food and alcohol, etc.
Like if the point of the fertility journey is to be a pregnant person, I try to say like, are my habits today in line with what they would look like if I were like in my first trimester or third trimester or whatever it is.
So you know, if there are certain foods that they have like a heavy mercury content or, you know, like you like to eat a lot of unpasteurized cheeses or things like that.
I'm not saying just look at the alcohol.
I'm saying like, think about what a pre-pregnancy diet looks like and start to think about yourself in that way to prepare your body for hopefully what's to come.
So I think about alcohol in that way.
Like if you're a person who really relies on wine for stress reduction and your typical is two to three glasses of wine every night, maybe look at that and say, huh, if I happen to be pregnant right now or this next transfer works, like would that, you know, how would my evenings look like?
Would I freak out because I missed wine so much?
You know, I know lots of people in my own life who've like lost weight in their first trimester because they didn't really equate for how much wine they were drinking.
So you know, I think about it and just say, okay, what would this look like as a pregnant person?
And you know, not that you have to like abstain from alcohol altogether.
If you have a wedding or you know, you're out to dinner, even the surgeon general just came out and sort of said that alcohol is linked to seven different kinds of cancer.
So we're rethinking a lot of things, but really, you know, alcohol and moderation, if it's a time in your cycle when you wouldn't be pregnant, right?
Like, you know, it's like the follicular phase of, you know, you're not, you know, you know, that you're not pregnant.
I would say in the luteal phase really to avoid alcohol because it's possible that you could be pregnant.
I mean, people say, oh, you don't have a wedding or whatever.
Like again, use your best judgment.
And moderation, you know, I didn't mean there's no safe amount in pregnancy, but you know, I'm not saying that you have to take all the joy away, but just sort of be thoughtful about it because I think that people who at baseline have, you know, a lot of alcohol in their lives, you know, it can be hard to find something to replace that.
If you're thinking about an IVF cycle, like when can you have alcohol when not like the follicular phase is when you're growing the follicles and doing the meds.
And so really the only day in that simulation when you shouldn't have alcohol is the day of the retrieval because you're getting anesthesia.
Those two, as you guys know, most of my listeners are physician women.
You know, those two don't mix very well together.
And then of course, if you're in an embryo transfer cycle and then like from the transfer time on, you know, don't have any alcohol because you might be pregnant.
But those are my thoughts about alcohol conception.
I think, you know, use your common sense, you know, even though it's hard sometimes imagine yourself as a pregnant person and then do your best.
Okay.
Let's talk about sexual activity during the fertility journey.
This is one of my biggest pet peeves in an REI because all the time I'm like, rush, rush, rush, have sex, you're ovulating or wait, wait, wait, you know, your husband needs to provide a sperm sample or, you know, you're having a retrieval.
What if we leave a couple eggs inside?
Like, you don't want multiple situations, like all those things.
I think that having a healthy sex life is very important.
And I also think that this process kills the joy out of so much of what could actually be enjoyed.
And so, you know, really like when you look at the sheets that most REI clinics give you and say like, no sex until you get your period, you're like, wait, I have to go a month without having sex.
Okay.
So, you know, first of all, I would say there's many ways to be intimate and they do not always involve, you know, sort of sperm exposure to possible eggs, peanuts and vagina intervals.
Like there are many other ways to be intimate.
So I just want to start there by saying I think sometimes we can get very tunnel vision in terms of like, what is a healthy sexual life, sexual experience.
And a lot of it is just so much more broad than that.
So the first thing is to broaden your idea about what counts as intimacy and to use your imagination.
You know, if you think about it physiologically, the sperm live in the female reproductive tract for about three to five days, right?
After they are deposited, let's just say in the vagina.
And so, you know, the shelf life of the egg is a lot sooner.
It's like a lot shorter.
It's like 12 to 24 hours.
And so if you think about it, like, you know, if your egg retrieval is on like, you know, day 14 of medications and it's your first week of the IVF cycle and your ovaries are so small, I mean, you know, I don't mean to be a purist in a sense.
Like you could probably live your lives a little bit, you know, especially if, you know, not too much is happening yet, right?
But really that second week of stimulation where if there were sperm inside and they made it in and then you know, miraculously had a conception and then had an embryo transfer, like, you know, I'm all for pregnancies, but I think sometimes if your goal is to really have a successful IVF cycle, just being pure about it in that way, like that second week of stimulation and then from an embryo transfer around the time of the embryo transfer on, like, I mean, I think it's helpful to just try to minimize the chance of multiple gestation in that regard.
So what I tell my patients is like, you know, the second week of stimulation on, like abstain, because I think that that, you know, does increase the chances of one baby at a time.
And then, you know, even if you think about it physiologically, like the ovaries are big at that point, after the retrieval, they are big, they've gone through a lot, they've gotten poked a bunch of times with the needle, and they're getting back to size.
And so, you know, that is that time when I say, okay, you know, you know, at least for the first week after the retrieval, like really just like let your body calm down, there's many ways to be intimate, but like, if you think about penetrative intercourse, at least, the ovaries literally sit right at the top of the vagina, which is how we access them for egg retrieval, like I did this morning in egg retrieval.
You know, and so you really have to think about the potential trauma to a fragile ovary and not wanting to rupture an ovary.
And so it is not to scare anybody, but it's just to say that, like, you know, if you think about if the ovaries are biggest the week leading up until the retrieval and then the week after the retrieval, that's kind of a time to be very gentle in that area, because you really don't want to rupture an ovary with trauma.
That hadn't been said, intimacy is fine.
So please do enjoy your partners.
It's just, you know, really being mindful of what's going on in that space and being gentle to the ovaries.
Do people really have to wait until their period comes to resume, you know, activity again?
This is kind of like the exercise episode where I said that we just don't really listen to our bodies.
And so like, if you start to be with your partner and something doesn't hurt, then stop, right?
I think we got to listen to our bodies more.
That's sort of the tagline of this episode is like, listen to your body because your body will tell us tell you.
And you know, it is really important to me that you are able to maintain joy, spontaneity, pleasure during all of this, and that we don't just reduce sex to, you know, give me some sperm, we're going to put this in with the egg, we're going to make this very mechanical or that you're doing ovulation induction, have sex now, like, I think we really need to remember kind of the bigger picture and the full context of having a healthy sexual life.
And if you have questions about this, feel free to reach out.
But I think there's more options than we realize at the outset.
And if we can use our brains and think with common sense, then and understand why the recommendations are what they are from your REI, then we don't have to live in a prison of just being told when to do things with our bodies when that's just not really spontaneous or natural or fun.
So that's my perspective on sexual activity.
I hope you find that helpful.
I will say, you know, it is March at the time of this recording.
And this winter has been absolutely awful for illnesses, flu, COVID, unspecified viruses, URI, neuro virus, all the things.
I can't tell you how many questions I've gotten about like, you know, I'm sick during this long waited idea cycle, like what should I do?
Does it affect egg quality?
What I can tell you is that it can affect sperm quality, for sure.
Like, you know, it has been documented and studied that men who have high fevers can definitely see a temporary decrease in their sperm.
And any change in sperm stuff is going to take, you know, three months to kind of resolve.
And so, you know, that is really true that there can be effects on sperm in the context of a virus.
But the good news is, I mean, for IVF, especially, like all we really need is one good sperm for egg.
So, if you think about it, most men produce millions and millions of sperm.
And so, you know, I would not halt an IVF cycle for the sake of a male virus.
I just actually talked with our lab director the other day about this.
And yes, you know, there are some viruses that, you know, sort of get beyond all the filters in the lab.
But that presumes that there's virus in the semen in the first place.
And a lot of the filters that they use for concentrating and purifying the sperm, they actually use, like they do use an actual filter that does weed out a lot of the viruses as well, which is, you know, and if we think about other infectious diseases like, you know, HIV and hepatitis and those sorts of things, like we know that those things help reduce the viral load, etc.
So, you know, what I would say is for male viruses, I wouldn't stop the show.
For female illnesses, like it's a little different because the female is the one who's going to be undergoing anesthesia.
And sometimes anesthesia gets a little bit nervous about putting somebody under, especially if it's an outpatient facility.
And so, you know, I don't know.
I mean, it's always so tricky.
Like if you started your stimulation medications, I feel like this is a very nuanced conversation with your REI.
Like, how bad is the illness?
Do you have a fever?
Do you expect to still be ill, very ill at the time of the younger people?
Is it day two of your stimulation?
And the goal is, you know, hope is that you'll be better by like the second week of STEM, in which case, if you're 42 years old and you've long waited the stimulation, maybe it's best to keep going.
And so, you know, I don't know.
I think that this really does require a tailored approach.
I have certainly, you know, done stimulations for people who had mild URIs and they were fine.
You know, and sometimes things happen.
Like, you know, I remember a few weeks ago, I was doing a retrieval on somebody whose partner had norovirus and like, like, how were we to know that was going to happen?
We didn't know until she really showed up and like stayed out because she, you know, had some pains and some, you know, GI symptoms.
But you know, the patient, her wife was fine and we proceeded.
And it was, you know, it really was fine.
But sometimes there are question marks like, is there going to be evolving norovirus, etc.
You just do your best with hand hygiene and, you know, hopefully the eggs are good and hopefully the embryos progress and all those things.
But again, I think we have to use our common sense and take it on a case by case basis.
But I don't think that all illnesses require an immediate halting of the IVF process.
So that's my thought on illness.
I probably will actually record a separate episode on measles, since I know that's been coming up more and more lately.
But lastly, I just wanted to touch on travel.
I think you're hearing from me now that I'm very passionate about people not feeling like they're in a prison of their IVF cycles.
And so, like, so much of the time I hear my family has a trip planned in April, but like, I don't know, is my clinic offered me that date?
And I'm not sure.
And, you know, I don't want to be that much older when I do this thing.
And, you know, I will tell you, like, I tend to see clinically meaningful changes in IVF systems, in reserve parameters, etc., in any less than six months of time.
So, you know, say here we are smart, say somebody has a trip in June, it's a big trip, you know, say they're going to Europe or something, and they really don't want to cancel that trip trip for the sake of IVF.
Like, you know, I think it's very reasonable to wait until July to have an IVF cycle because the parameters are going to be very similar.
And then, you know, you can have your fun, then do your family building stuff.
You know, even if you want to do banking cycles, like, that's fine too.
But I think so much of the time we think, like, we get this message, like, I cannot live my life because I want this cycle to work so well or I have to do it now.
And you know, I would argue, like, if we look back on the spirit of our lives and just think of it as a time that was devoid of joy, devoid of pleasure, you know, devoid of anything to look forward to other than the next retrieval, the next data, that's a very miserable way to live.
And so you deserve the joy, you deserve the pleasure.
I promise you, there is not going to be any meaningful change if you push out an IVF cycle by, you know, a couple of months.
And so plan the trip, plan fun things.
Sure, if you want to buy refundable tickets, do that in case you decide in a very empowered way to, you know, swap out a trip for an IVF cycle, but then make sure you get to go on that trip, right?
So I think we need to plan travel in advance for our own sanity.
And I would also say that, like, if you do have, like, a conference or something else where you know what the dates are, like, clearly during the two weeks of IVF stimulation, you really do kind of need to be within a helicoptering of your clinic so that sometimes you're coming out on treatment day six and they're like, oh, come in tomorrow.
You really do need that flexibility during that time to be able to come in for appointments.
But what I would say is, you know, other than the two weeks of the IVF itself and maybe a couple of days after that to just make sure there's no complications or the time kind of after a number of transfer when you're kind of in that waiting to see if you have good rising betas or, you know, an injury or pregnancy.
I remember one time I had a patient who truly, like, she was newly pregnant and then she had a pregnancy of unknown location and she went to the Arctic tundra.
And I seriously lost sleep over that because I was like, please do not do that.
Do not go to the Arctic tundra and the polar bears where nobody could save your life if you had a next topic.
So, again, I think you have to think, okay, where is the travel to?
You know, if I do travel, am I in a place where I can get good medical care?
You know, please don't go to the third world during this time.
That's not good.
But like I said, like, other than the two weeks of the stimulation a couple of days after that and then, you know, that waiting period from having an embryo transfer to kind of understanding.
And I would say like the six to seven weeks of pregnancy mark is kind of like, that's really if you have to go on a trip the day after your embryo transfer, there's not going to be any badness that happens, like, in that window.
But it's really kind of really trying to establish pregnancy location in the time because even IVF one to two percent of pregnancies on the next topic.
And so you just want to be able to be close to your clinic if you needed to.
And again, the more flexible the travel can be, the better.
And you know, even recently, a client told me, you know what, I always go to this conference.
I'm a big presence.
I'm on the leadership track.
But I did say to them, like, I'm having, you know, a health issue right now and I can't come.
And I also think we have to give ourselves more permission to say those things at times.
Like, sure, if you want to prayer as the conference, go to the conference.
But if you want to prioritize, hunkering down, staying close to your clinic, keeping the stress on the lower side, give yourself permission.
Like I say, if it was an appendicitis, you'd be out.
So I don't know why we think of this process any differently.
And those are my thoughts about travel.
So I hope you found this helpful.
You know, we can certainly do more in this series.
If there's more sort of questions about how do I live my life?
You know, we didn't even get into like plastics and, you know, using glass preferentially and all those sorts of clean living type things.
But I do think that by reviewing, you know, food, alcohol, sex, sickness, travel, hopefully this will give you a guide so that you can live your life in a less stressful way because you're not second guessing yourself.
And you have some guidance from me who has been doing this over a decade and can help you just with some of those choices that might otherwise plague you.
So with that, I love you.
Until the next time, talk to you soon.
Bye!
