If Your Friend Jumped off a Bridge, Would You Do It, Too? Altering your lifestyle for fertility.

How many times do you remember telling your parents, “I did it because Susie did it”? And how many times do you remember your parents saying, “If Susie jumped off of a bridge, would you do it, too”? This usually was met with a muffled “no” and a trip to your room. Bottom line, the “because my friend did it” response never got you anything more than a grounding. And while our moms may no longer discipline us, our doctors do. And telling us that you have picked up bad habits because Susie has them is not going to go over well.

Saying that habits are hard to break might be the understatement of the century. They become a part of us, our routines, our cultures, and the essence of who we are. Whether it be smoking, drinking, drugging, or doing lots and lots of exercise, they become a part of who we are and how we see ourselves. Because of the latter, it makes them really hard to taper or totally take out. Even the best of habits (exercise, eating healthfully, or engaging in some sort of activity) can become excessive, and while they may not need to be eliminated, they may need to be reduced.

Substituting is a great concept and often works well. For cardio junkies who can’t turn up the torque during IVF stimulation, we recommend a long stroll in the park or an inclined walk on the treadmill. You don’t have to lie on the couch and eat bon bons (although it is nice to give yourself a break!); you can still do something that will build a sweat.

While some habits can be halved or quartered, smoking and drug use need to be out out completely. There is no healthy amount of smoking or toking; it’s got to go. It’s not good for your ovaries or any of your vital organs, so take this as an opportunity to go cold turkey.

When it comes to alcohol, we are definitely more lenient. I think someone said a glass a day will keep the doctor away. Although this is probably more wishful thinking than reality, a glass of wine from time to time (it even rhymes!) is nothing to stress about. You don’t have to cork the bottle when you’re trying to get pregnant.

Food is a fairly big issue when it comes to fertility. Although nothing has been proven definitively, there is a lot out there on the internet and blogs, as well as in friendly conversations, about what is best to eat. Should I can the carbs, should I forget about fat, should I say goodbye to gluten? We say no, no, and no, not unless you have been diagnosed with celiac disease (true gluten intolerance) or have been directed to follow an anti-inflammatory diet.

Dietary variety is a good thing. We need proteins, fats, and those carbs (we have such a love-hate relationship with the lattermost). While everything in moderation is the right way to go and no one ever overdosed on fruits and veggies, eliminating foods to boost your fertility probably isn’t the best idea.

What works best for you and your body may be very different than what worked best for your BFF or your pseudo BFF. As much as we may think our bodies are the same, they are not. Yes, we all have bones, brains, and muscles, but after the basics, there is a lot of variety. So while Sally had to cut out sugar and Georgia had to remove gluten, you don’t necessarily need to follow their menu plan.

Despite what you hear, fertility treatments do NOT mean you have just seen the finale of your favorite things; telephone is a dangerous game! Exercise, caffeine, and alcohol plus are okay when trying to conceive. While we may ask you to tone it down, we will infrequently ever ask you to turn it off completely. Although your friends and those who have made the fertility journey before you are a good source of information, they do not have the final word. Just because they were told to do something or had to change something doesn’t mean the same applies to you.

Leader of the Pack, Take It on Back!

For all of you runners, cyclists, and swimmers out there, you know how good it feels to exercise in the pack. There’s definitely comfort in numbers—the energy and the spirit can pull you through even the steepest of hills or the roughest of currents. Drafting off the guy or girl in front of you is also pretty nice! Follicles (a.k.a. eggs) also like the group mentality. Growing in concert or an evenly sized cohort is ideal. It increases the chances that many, if not most, will achieve maturity simultaneously. Mature eggs are the ones that get fertilized, and fertilized eggs = usable embryos!

When a follicle takes the lead, we’re not standing on the sidelines applauding and screaming, “Go, follicle, go!” We’re actually pretty bummed and do everything we can to hold it back and let the others catch up. No, we’re not believers in the “Everyone gets a trophy no matter what place you come in” phenomenon, but lead follicles can negatively affect the outcome of an IVF cycle. They can force you into scheduling the retrieval a bit early to avoid compromising the bigger ones. This can result in a bunch of eggs that are uneven in development and therefore uneven in maturity.

Additionally, if one follicle is putting the pedal to the metal while the others are strolling in the pack, there is dis-synchrony in the hormones secreted. The leader has enough juice to get him or her across the finish line. However, the fumes the leader is releasing can be toxic to the smaller follicles. Hence, it can impair their growth, development, and quality.

When an egg retrieval is performed, there will always be something of a Goldilocks story. Some eggs will be post-mature (too hot), some will be immature (too cold), and some will be mature (just right)! It’s very hard to complete 100% maturity (and probably not normal). When a lead follicle pops up, it can throw the balance off even more. To avoid the leader of the pack, we have many tricks up our sleeve, a.k.a. the birth control pill, estrogen patches, and luteal antagonists, to name a few. The purpose of pre-stimulation medications is to level the playing field and make sure everyone starts the race when the gun goes off (and not a minute before).

If a dominant should arise, we can either chose to cancel the cycle or ignore it. By ignoring it, you can recruit what’s called the secondary cohort. While this can work, it can also compromise the quality of the follicles on the B team. In this case, it becomes a pluses and minuses and pros and cons-type of situation that you and your physician need to have.

Synchrony’s a big deal in ovarian stimulation. It’s what we strive for, what we train for, and what we aim for. We know when it isn’t happening and know how to try and make it happen. When we can’t get it to happen, no matter what we pull out of our hats, it’s a sign of poor egg quality.

Follicles, just like females, like to travel in groups. We can chat, we can bond, and we can share experiences. Going out on your own can throw off the balance of everything else, and it can be lonely! If your follicles appear to be growing unevenly, have a sidebar with your doctor and talk about calling a time out. Even if you do it again and have a lower number that’s more even, that’s probably a better race to run. Think about how much you and your friends can cover if you do it together!

Does Everything That Itches Equal Yeast? Vaginal Infections

When anything feels off down there, our mind usually goes to one place: yeast infection. No matter what the actual symptoms are, any discomfort seems to signal yeast. For whatever reason, for most of us vaginal discomfort reflexively equals yeast. And while some of us will call our GYN to get their take on what’s going on down there, most of us simply head over to the local Duane Reade or CVS for some sort of topical relief.

Whether you pick the one-day, the three-day, or the extended seven-day course, you leave with something to stop the itch, the burn, and the overall discomfort. It isn’t until your symptoms outlast the one-, three-, or seven-day regimen that you pick up the phone and call your doctor. It is usually here that you find out that not all burning, discharge, or itching is yeast—a.k.a. Monistat works, just not on a bacterial or urinary tract infection.

Here are some tips on how to know if yeast is really the culprit…

  1. Discharge: While most of us associate vaginal discharge with some sort of problem or infection, news flash: a healthy vagina also secretes vaginal discharge. However, the latter is usually odorless, fairly clear, and doesn’t make you think or wipe twice! An infection, be it yeast, bacteria, or something else, will cause the discharge to change color, content, and quantity. While yeast is routinely associated with white, clumped (cottage cheese-like) discharge, discharge that is green or yellow is more commonly seen in bacterial infections (e.g., bacterial vaginosis or Trichomoniasis). And taking it one step further, urinary tract infections (which are often misdiagnosed as a yeast infection) will likely cause no change in the quantity or quality of the vaginal discharge. Bottom line, what the discharge looks like may “color” our diagnosis of what is causing your vaginal discomfort.
  2. Odor: Nobody wants to smell bad…especially down there! So, when something smells off, it should signal you that something is not right. However, that “not right” does not mean a yeast infection. Here’s the deal. A normal vaginal pH is about 3.8 to 4.5. Infections can alter the pH and change the vaginal odor. Select bacteria (think bacterial vaginosis, a.k.a. BV) can result in foul-smelling vaginal discharge. And although yeast can alter the pH, it doesn’t usually have a significant impact on vaginal odor. Therefore, when the odor seems way off you are likely dealing with something else.
  3. Itching: Vaginal itching and yeast infections sort of go hand in hand. In fact, this is the symptom that sends most of us straight to the drugstore. But while yeast is the infection that is most likely to cause an itching sensation, the vaginal mucosa, just like your skin, is sensitive to changes in body washes, soaps, and detergents. The same sort of itching that can occur on your arms, legs, stomach, and face when you change detergent or add a new skin care product can happen to your vagina. Before prescribing yourself Monistat, think about what has changed in your hygiene routine, and make sure that it is not what’s making you itch!
  4. Abdominal Pain: Most vaginal infections are limited to the vulva and the vagina. They rarely make their way to the cervix, the uterus, the tubes, and into the pelvis/abdomen. However, some sexually transmitted diseases (think chlamydia and gonorrhea) can move. They are frequent trespassers in the pelvis and pelvic organs. Therefore, when abdominal pain is accompanying your vaginal discharge the culprit is more likely to be a bug that can do damage on the inside as well as the outside rather than your garden-variety yeast. However, the pathogens that can move can do some major damage (e.g., infertility) if they are not treated.
  5. Fever: While most vaginal infections are super annoying, that won’t make you super sick. Therefore, when a woman reports a fever as well as vaginal discharge we start to think of things like gonorrhea, chlamydia, and even an infection in the kidneys. If your temperature goes up, you should get up and go right to your doctor!
  6. Pain with Urination: Although vaginal discomfort can make urinating super uncomfortable, pain with urination is usually the tell-tale sign of a urinary tract infection. Add to that urinary frequency and urgency (a.k.a. I have to go right now!), and urinary discomfort is more likely to be from a urinary tract infection rather than a vaginal infection.

So, while we all love to play Dr. Google not everything can be solved without a visit to a doctor. Not everything that itches, burns, or makes you feel uncomfortable is a yeast infection. Make sure you take note of everything that you are feeling. If your discharge comes with any one of the above, Monistat is not going to make it go away. Go and see your GYN!

 

“Judgey” Eyes: What Are Embryologists Really Looking At?

How do I look in this dress? What do you think of these shoes? Is red a good color for me? Let’s face it: even the most down-to-earth among us has an inner diva. Who doesn’t want to look good and turn some heads? Furthermore, how we look on the outside can impact the way we feel on the inside. While we’re certainly not saying that looks matter, we are saying that how you think you look often impacts the way you feel. The same can be said for your embryos. How they look to the embryologist in the lab can tell us a lot about their health, their genetics, and their ability to make a baby.

While different labs use different grading systems, most that perform day 5 or 6 embryo transfers use the Gardner and Schoolcraft embryo scoring system. This dynamic duo introduced their scoring system in 1999 to determine blastocyst (day 5 or 6 embryo) quality.

And while it’s certainly not the Miss USA competition, embryologists are grading the embryos in three ways: development and morphology (don’t worry; we can count). Morphology is assessed for both inner cell mass and the trophectoderm, bringing the total to three!

Embryologists are looking for things like embryo expansion, cell compaction/tightness, and cohesiveness. Years of experience and tons of training have trained their eyes to be really judge-y and label these areas with letters and numbers. We don’t give an overall number; it’s more of a general impression! The cumulative score determines which embryos have the potential to wear the crown. The scoring system not only helps embryologists and fertility doctors decide which embryos to transfer but also how many embryos to transfer. Those with straight As should have a limited number of embryos transferred to avoid an octo-mom situation.

Remember, just like undergrad universities, some grade inflation may go on. An A at Harvard may be a B at Yale—grading is subjective. (Just sayin’. And no, neither of us went to Harvard or Yale). Therefore, while a patient may make all A+ embryos in lab #1, when they come to lab #2, the report card can be totally different. Usually, this is not because your eggs or your partner’s sperm went over the cliff, but because the scoring was skewed. Skewed scoring doesn’t decrease one’s chances; it just messes with one’s expectations. If you have an A+ embryo, you’ll think this is a slam dunk. If it’s really a C, you won’t expect to win the science prize.

Unfortunately, even those with the “judgiest” of eyes can’t discern a trisomy 21 from a 46XY. Visually, they look pretty much the same. Aneuploid (genetically abnormal embryos) clean up well; they can look just as handsome when it’s time for their big date. Cue modern day PGS (pre-genetic screening). PGS has allowed us to distinguish between those who have natural beauty and those who are caking on the makeup. By subjecting the embryo to genetic screening, we can take embryo selection and success rates to the next level. We know a lot more about their abilities to make a healthy baby and the reasons why IVF cycles work or don’t work.

For the type As among us (we’re both raising our hands, so you’re not alone!) we lived and died by our grades. We burned the midnight oil to get the coveted A in Chemistry and logged many sleepless nights for the Honors on our English paper. However, grades don’t mean everything. In the same regard, there are several modest-quality embryos that make the most beautiful, smartest, and kick-butt kids.

So, while we totally get your hangup with the grade, don’t obsess. It won’t change the outcome and will only increase your anxiety. You’ve studied as hard as you can; the rest is in our hands!

Ten Tips for First-Time Moms: What to Do in That Last Month!

Take everything we say in this post with a grain of salt. Most of it has minimal medical basis and maximal learn on the job-type tips. Pregnancy can be amazing and awful all at the same time—yes, we just said awful and pregnancy out loud together!

When you head into the home stretch, the physical pain usually gets worse, as does the anticipation and anxiety, especially if it’s your first time at the rodeo. First, all the emotions you are feeling are totally NORMAL. We totally give it up to Brooke Shields, who broke barriers by sharing her postpartum experiences. It’s important to know that joy is not the only emotion you’ll be feeling at the end of pregnancy and the beginning of mommyhood…

Here are our top 10 pre-delivery tips.

  1. Get groomed.
    While we are not telling you to run from the nail place to the waxing place and back to the hair salon, we are telling you to treat yourself! Make time for you before the baby arrives. A spa visit and some good R&R is the best way to do it. Besides, who doesn’t like to be pampered?
  2. Make a delivery playlist.
    Labor is not called labor because it comes and goes in the blink of an eye! Much to the chagrin of the family members camped out in the waiting room, it can be a LONG process—especially for your first! We recommend bringing along some good music, downloading some good movies, and maybe even packing a good book. Nothing takes your mind off things like laughter and light tunes.
  3. Plan a dress rehearsal.
    It’s never a bad idea to map out the best route to the hospital. Know where you are going and how to get to the labor and delivery floor. While it may seem silly to make a dry run, it will likely ease anxiety when game time comes. On that note, it’s also not a bad idea to have your “costume” (a.k.a. overnight bag) ready to go. The last thing you need when those contractions start is to be searching for your favorite sweatpants!
  4. Breast milk vs. formula.
    We are NOT here to pass judgment or tell you which is better for you or the baby. In our opinion, what works best for you will work best for your baby. But if you do think that you want to give this breastfeeding thing a whirl, make friends with a good breast pump, and a find a good lactation consultant (or someone in the know). This will help you prepare for what’s to come and increase your chances of getting the milk flowing.
  5. Bag the birth plan?
    We get it…you know exactly what music you want to be playing, exactly where you want your partner to be sitting, and where the baby should be placed right after delivery. And while having a birth plan is important, be FLEXIBLE with your bullet points. For sure know if you want an epidural, if you want a doula, and if you want a vaginal delivery or a C-Section—but unfortunately, labor and delivery don’t follow a plan. Be prepared for things to deviate from the script…the show will still go on!
  6. Know who you want to be there at the final push!
    Who you want to hold your legs and wipe your forehead is a very personal decision. Don’t be bullied by parents, your in-laws, or your friends—only people you want in the room should be there. It’s okay to want privacy during your special moment.
  7. Eat your heart out!
    While we want you to be careful about how many pounds you add during your pregnancy the night before you go into the hospital (if being induced, having a C-Section or as labor is starting), we recommend going all out in the food department. Treat yourself to a decadent dinner with your significant other. You will not only need the energy to push, but you will also want to enjoy the last moments of being kid free.
  8. Be mindful of unsolicited advice.
    Everyone is an expert when it comes to all things pregnant, and they are not afraid to share it. While most mean well, the advice can become moderately annoying. Listen to what you want to, and shut out what you don’t want to hear. Your doctor and medical team have probably done this several hundred times; they have got you covered and know what’s best.
  9. Accept the unacceptable.
    So many times, we hear women saying through tears and sobs, “This is not how I planned it. I feel like such a failure.” Unfortunately, no matter how hard you try to control what happens on D-day, you can’t. Nature doesn’t care if you dreamed of delivering in a bathtub in the dark with classical music in the background—if your baby’s heart rate drops, you’re having an emergency C-Section under the bright lights, no questions asked. The number-one priority is your and your baby’s safety; trust us, when you hold that baby in your arms, the plan will be nothing more than a moment in the past.
  10. It’s ok to want to quit—at least several times a day.
    Motherhood is the only job you don’t get to call in sick to, you don’t get to resign from, and you don’t get fired from. You can’t clock out, and you don’t get a paycheck. But even with all the exhaustion, the frustration, and the anxiety, it is the most amazing experience you will ever have. Labor is TIRING. Pushing is HARD. But quitting is not an option—you are stronger than you know.

Wine = Whine

We’ve all been there. The incessant instances of “No,” “I don’t wanna go,” and “Mama…,” whether it’s at the 5 o’clock witching hour or the 1 o’clock I don’t want to take a nap, these sounds are less than pleasant. Like nails on a chalkboard, the longer it goes on, the more it drives you insane. It drives your blood pressure up and takes you to a place that can only be made better by some time alone and a sizeable glass of rosé! Let’s face it: they whine, you want wine.

Motherhood isn’t easy. It’s non-stop, 24-hours-a-day, seven-days-a-week work. And unlike any other job, you can’t clock out, you don’t get paid, and there’s no such thing as overtime. And no matter how badly you wanted this “job” or how long you took to perfect your “resume” (a.k.a. did whatever it took to have a baby), there are many times when you want to quit. We know…we feel it too.

Although we can’t offer you a break room, we can offer you a few words of advice. When you’re all whined out, take a moment and step away. Whether it’s for some deep breaths, a quick workout, or a glass of wine, do something that will help you reset. Stepping out of the moment rather than stepping into the drama will let you come back to the scene in a whole different headspace.  

But when all else fails and your self-inflicted time out doesn’t do the trick, pick up the phone. Call your BFF, and let it all out. The more you share, the less isolated you’ll feel. Community and camaraderie can be more powerful than any cocktail you concoct. Verbalizing your feelings to a peer can prevent you from loudly vocalizing (a.k.a. yelling) your frustration to your kids. So, while a phone call may seem second best to a glass of wine, “pouring” out your emotions can be pretty powerful.

Cheers!