Embryo Glue: The 5 Secrets Everyone Should Know Post-Embryo Transfer

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There may be no more anxiety-ridden interval than the time between the embryo transfer and the first pregnancy test. Simply stated, it is sort of terrible. Those nine days can feel like nine years. Every symptom you feel (or don’t feel) can take your mind to places you didn’t think it was possible to go. However, while the rollercoaster of emotions is real, the good news is that you are not alone. Nearly every woman who has come before you and every woman who will come after you find the time between the transfer and the pregnancy test to be incredibly stressful. Here are five tips on how to best deal with your emotions during the transfer-to-test interval.

  1. Movement: Standing up after the embryo transfer is finished ranks up there on many women’s top 10 list of scariest activities while going through fertility treatment. The “if I move these embryos are going to fall out sensation” is super common, but it isn’t super credible. In fact, there is absolutely NO medical evidence to show that movement, be it in the form of a trip to the ladies room or a bumpy car ride home, will negatively impact your chances of pregnancy. Don’t sideline yourself just because you had an embryo transfer.  Movement won’t be the factor that makes or brakes the pregnancy.
  2. Diet: Food gets a lot of credit and a lot of flak when it comes to fertility. Pineapples will make your embryo stick, and hot dogs will make your embryos not stick. And although who doesn’t love a sweet pineapple in the middle of July, there is no evidence that food will improve or harm your chances of pregnancy. Bottom line, don’t lose sleep over what you have and have not taken in—your “intake” will not impact if your embryo takes up a permanent spot in your uterus.
  3. Exercise: There may be no more controversial words than exercise and fertility. These two engender A LOT of emotions. And while it may seem like it from what you hear and what you read, in reality exercise and fertility are by no means oil and water. Exercise—be it walking, running, cycling, or swimming—is not a no no post-transfer. While you may have to curtail your specific activity based on if you had a fresh or frozen embryo transfer, breaking a sweat won’t break your chances of pregnancy.  We do usually recommend a 48-hour period of relaxation after the transfer—but after that, most forms of exercise are okay. Just touch base with your doctor.   We will say, for those of you who will look back and blame yourself if the transfer does not work, we recommend you don’t engage in any activity that will make you think twice.  We can tell you there is no sound data to suggest moderate exercise after an embryo transfer will lower implantation rates, but we want you to have zero regrets!
  4. Coffee: Don’t say sayonara to Starbucks just because you had an embryo transfer. Coffee is not the culprit for your infertility and is cool (or hot!) post-transfer. While you should taper the amount of caffeine you ingest (<200mg/day), you can continue to indulge your caffeine kick.
  5. Stress: It’s nearly impossible not to count down the days from the transfer to the pregnancy test. The anxiety, anticipation, and stress mount as the time between these two events is minimized. These emotions are totally normal. Everyone has them. Engaging in activities that can help alleviate your stress is recommended but not mandatory  (although de-stressing will do your mind good, it won’t make a difference on the outcome of the transfer). On the flip side, if you can’t take your stress level below a 10 no matter what you do, don’t freak out. Stress post-transfer has not been demonstrated to decrease the chances of pregnancy.  

It’s important to always remember that whether you DO or DO NOT get pregnant, post-embryo transfer has to do with the quality of the embryo, the genetics of the embryo, and your uterine lining—not what you DID or DID NOT do. Unfortunately, you can live your best you and still not get pregnant. And while we don’t have all the answers for what makes some transfers work and others not, we promise to keep searching for that evasive “embryo glue”—and if we find it, we won’t keep it a secret!

Everything You Wanted to Know about Egg Freezing But Weren’t Sure Who to Ask!

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You’ve been thinking about it. You’ve been talking about it. You’ve been reading about it: egg freezing. Fertility preservation. Oocyte cryopreservation. Putting your eggs on ice. Whatever you call it, you’ve been considering it. And whether it’s been on your mind for weeks, for months, or maybe even for years, you can’t shake the feeling that this procedure is something you want to do—or at the very least, learn more about.

In the age of iPhones, blogs, and Facebook, there’s no shortage of information out there about the egg freezing process. You can get most of your questions answered without even walking out of your apartment! But while we’re big fans of community, particularly one that shares content and empowers women to make educated decisions about their bodies (#trulyMD), not all information sharing is created equal. Some of what’s out there is simply inaccurate. Content can be colored based on an individual’s experience: good or bad.

As fertility MDs, girlfriends, and exercise enthusiasts, we’ve chatted with patients, friends, and ladies we meet on the shower line in the locker room about egg freezing: what they know, what they want to know, and what they wish they knew.

Here are the top five questions we’re most frequently asked:

  1. How do I know if my eggs are any good?
    Hands down, this is the question that we’re asked the most. Will the eggs that I freeze today be good enough to make a baby in X number of years? And unfortunately, despite everything that we can do, answering this question accurately is not one of them. There is no way for any fertility doctor to predict whether the eggs that you make today will have what it takes to make healthy embryos in the future. Although we use factors such as age, follicle count, and hormone levels to guide us in guiding you, there’s nothing out there that can answer your question definitively. However, when all else fails, look at your birth date. Simply stated, age trumps everything. The younger you are when you freeze, the more eggs you’ll get and the better your chances are in the future.
  2. Will I feel crazy on the medications?
    No, you probably won’t. While it’s fairly common to fear the negative side effects the drugs can have on your mind, it’s fairly uncommon to have any such side effects. In fact, most women tolerate the medications without a problem. So, trade the negative energy for the positive vibes! You should feel empowered for going through with the procedure. Giving yourself two to three shots a day for about 10 days makes you a warrior, not a wimp!
  3. Will I gain weight on the medications?                                                                              Here’s the skinny (or the not-so-skinny) on egg freeing and extra lbs. You’re likely going to gain weight during the process. Your pants will probably feel tight, and leggings and loose dresses will be your wardrobe staple for about two weeks. However, for most women this is no more than a few pounds, and the extra weight that is added is shed during the period following the egg retrieval.
  4. Will I ruin my chances of having a baby in the future?
    Unfortunately, with eggs there is no collecting “comp time.” Simply stated, if you don’t use them, you’ll lose them. So, the eggs that we collect during that retrieval are not being taken from you but actually saved for you. There’s no loss, just gain!
  5. Does it matter where I freeze my eggs (a.k.a. should I pick the least expensive option)?                                                                                                                                                  The reality is that not all egg freezing centers/fertility clinics are created equal. Some are way more experienced and way more talented at the freezing process. They not only know how to freeze your eggs but also how to thaw your eggs, fertilize your eggs, and help your eggs become healthy embryos. And while you’ll be spending a lot of time at the fertility clinic for about two weeks, don’t pick a center based on their proximity to your apartment, the color of the waiting room, or the “deals” they’re offering. We’re talking about your eggs and your future fertility. This isn’t a place to play Let’s Make a Deal.

If it’s been on your mind, go and let it out by talking to your GYN or a fertility MD) While you may choose not to do it, you won’t regret not giving yourself that choice. Although you may still play the “should-a, would-a, could-a game,” when you look back on this decision in one, five, or 10 years, you’ll appreciate that you considered all the options and made an educated decision!

The 5 Most Important Questions to Ask When Looking for a Fertility Clinic

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While fertility clinics aren’t as prevalent as Starbucks and Duane Reade in New York City, there are definitely many options to choose from. From uptown to downtown, the east side to the west side, you have a choice. And unless your BFF or your OB/GYN points you in a certain direction, deciding where to direct your care can be difficult. Whom you see and where you go can be the difference between walking away with a baby and walking away with nothing more than a big bill.

Here are the five questions you should ask before deciding where to do your thing!

  1. Success Rates:
    Fertility medicine is moving fast. To quote our friend Ferris Bueller, “Life moves pretty fast…if you don’t stop and look around once in a while you could miss it.” The same goes for fertility treatment! As a result, you need to make sure wherever you go for treatment not only knows this but also practices fertility medicine on their toes. Being up to date with the newest techniques and latest procedures translates into success. Furthermore, you want to check the success rates of the clinic you are visiting and what they are doing to get those success rates—say, are they putting in multiple embryos to get a pregnancy, or can they achieve those success rates with a single embryo transfer? Although your goal may be to have a brood one healthy baby at a time is the safest way to go.
  2. Practice Styles:
    While we all went to medical school followed by a residency and fellowship to become board-certified Reproductive Endocrinologists, the way physicians practice medicine can be very different. Some are talkers, and some are quiet. Some like to chat on the phone, and some prefer to email. Some move fast, and some move slow. Make sure that whom you select as a doctor matches your needs and personality. These partnerships can be lengthy; you want to make sure you find someone who has the “death do us part”-type of feel. While you can certainly get a divorce if things get rocky, starting over puts you back at square one (minus some valuable time).
  3. Take a number; we’ll see you in an hour:
    Unfortunately, many fertility clinics have started to resemble factories. Patients are shuttled in and out like cattle going down an assembly line. Waiting rooms are littered with patients, and you can go an entire IVF cycle without seeing a physician who knows you by name. Before you commit to a specific center, ask around about how the clinic functions and what previous patients who have been treated there have experienced. While it may not change your decision about where you decide to be treated, it will prepare you for what lies ahead.
  4. Availability:
    We all have busy lives and schedules. Trying to squeeze in time to chat with your mom can be a challenge. Therefore, it’s important that you know when both your doctor and fertility clinic will be available not only to speak to you but also to see you. Just like personalities, you want to make sure that your schedule can effectively merge with their schedule.
  5. Honesty is key:
    Sugarcoating the situation when it comes to your ability to have a child can become a “sour” situation. You need to make sure that the physician you are seeing is honest with your prognosis, the chance of the treatment being successful, and the clinic’s ability to help you achieve your goal of having a baby.

     

When You See Red, Don’t Panic: First Trimester Bleeding

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     There is nothing more disconcerting than looking down and seeing red. Whether it’s dark or bright, light or heavy, it can make you hold your breath and start praying. Blood is viewed as the harbinger of very bad things to come. (For all of you Game of Thrones fans, it’s like winter is coming!) But the reality is that blood, be it red or brown, with or without cramping, does not mean this pregnancy is case closed. It could mean absolutely nothing at all.

     And while we get that this is hard to believe and even harder not to panic over, bleeding in early pregnancy is incredibly common. In fact, it is the most common call an OB/GYN gets. It occurs in up to 40% of all pregnancies! It is so common that we can recite the list of dos and don’ts, shoulds and shouldn’ts, whys and why nots in our sleep (which is good, because these calls usually come in the middle of the night!).

     First things first, bleeding in pregnancy is not always pregnancy related. Pregnant women still have intestines, vaginas, and cervices that will bleed irrespective of that baby on board. So while the first finger everyone points is towards your belly, we need to make sure that the uterus is really where things are coming from. Things like cervical polyps, cervical irritation, vaginal tears, and vaginal warts can cause vaginal bleeding. While they are not harmful for you or your pregnancy, identifying them early can ease anxiety and allow us to treat them. In very rare cases, such bleeding can be indicative of a cervical or vaginal cancer, so a good look inside by your OB is important.

     On a slightly different note, the rectum can bleed for a number of reasons during pregnancy. Pregnancy is marked by constipation, pressure, and changes in our bathroom habits. This can exacerbate or lead to things like hemorrhoids, anal fissures, and polyps (not fun). And not only can they cause pain, itching, and discomfort, but they can also bleed. Rectal blood is often mistaken for vaginal blood. While no blood is good blood, rectal bleeding has nothing to do with the health of the pregnancy.

     The big three of early bleeding in pregnancy are the following—miscarriage, ectopic, implantation or physiologic bleeding (a.k.a. nothing to worry about). How we differentiate between the three usually requires both a good chat and a good check. During the chat part, we will ask you questions about timing, quantity, pain, and the events that preceded the bleeding (intercourse, activity, etc.). We will also want to know when your last period was, if you took fertility medications, and if you have recently seen an OB. This will allow us to narrow down the culprit. The “check” part will include both a pelvic exam (who doesn’t love that speculum?) as well as an ultrasound and blood work.

What we are looking for are things like:

  • Is the cervix open?
  • Can we see a pregnancy in the uterus?
  • Is there blood surrounding the pregnancy (subchorionic hematoma) or in the pelvis?
  • Is your pregnancy hormone appropriately elevated?
  • What is your blood type?

These checkpoints, combined with a good chat, will clear the way for a diagnosis (and hopefully a cease fire to this bleeding).

     Sometimes the reason behind bleeding in pregnancy isn’t so clear. And while we certainly don’t want to torture you, it can take a few visits and even a couple of weeks to answer the questions where it is coming from and if this pregnancy is going to be a go. Oftentimes, we need to take a second or third look with the ultrasound and at the pregnancy hormone before we can comfortably call it. During this time, we may ask you to take it easy (no exercise, no intercourse), stay close to home (no major travel), and keep us on speed dial. We want to know what’s going on, as this may get us to make the diagnosis quicker.

     Bleeding in pregnancy not only brings women anxiety but also guilt and blame (almost all of which we point towards ourselves). However, whether bleeding happens for no identifiable reason or because of a miscarriage, in neither case is it a result of something you did, something you ate, or something you didn’t do. Bottom line, it is not your fault. Say that in your head ten times over until you truly believe it. Unfortunately, sh-t happens. And while that may not be eloquent, it is the truth.

     Although you probably found us through a Google search, an Instagram post, or a Tweet, the Internet can be a dangerous place (particularly in the middle of the night when it comes to bleeding and pregnancy). And while we too have our “Google MDs” (in everything non-OB/GYN related) and like to browse and self-diagnose, we caution you from putting a lot of stock into what you read and what you see. It may do nothing more than make you crazy and keep you from getting a good night’s sleep (which every expecting mother needs)!
     To put it bluntly, we have seen women soak their beds with bright-red blood who go on to deliver healthy babies and those who notice one spot of dark-brown blood who go on to miscarry. Nothing is predictive. So doctor’s orders (after you read this): close your computer. Pull out a good book, or put on a funny movie. Getting your mind off of what’s going on below is the best way to pass the time. Laughter certainly won’t make matters worse. Let your doctor focus on the detective work.

Got the All Clear, But Can I Really Re-Consummate This Relationship? Sex after Baby

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The first six weeks after your baby is born are a major blur. Let’s be real: while there are magical moments, most of your days are filled with spit up, dirty diapers, milk stains, and sweats (don’t think we changed out of our workout clothes once!). Your home becomes a welcoming ground for friends, family, and all of those well-wishers who can’t wait to meet your little one.

And while you welcome a break from the routine (feed, burp, diaper, sleep), their presence can be beyond overwhelming. It’s not only the germs you see them bringing into your Purel-ed place or the gift that now requires a thank-you note (you could write a thank-you note for that cute onesie in your sleep!), but your energy level for entertaining is at an all-time low. It is not easy.

And to top it all off, your body still does not feel like your own. You’re still bleeding, your boobs are now enormous, and your belly still looks pregnant. (We have all been there. It is not fun one month after delivering, when that friendly neighbor says, “Any day now: you must be so excited!”). Additionally, you are now on pelvic rest—a.k.a. nothing in the vagina for six weeks post-delivery (whether or not your kid came out from below or through your belly). That includes no tampons and no sex.

So you make it through the first six weeks sleepless and sexless and go to your OB for the famous post-partum visit. She or he chats about life, how you are feeling, and how you are adjusting. They weigh you (ugh, still have 15 pounds to go) and examine your incisions (both abdominally and/or vaginally). Then they begin the discussion about birth control—pills versus patch, condoms versus IUD, or for those at the end of the baby line, tying your tubes versus tying his tubes (a.k.a. a vasectomy).

This subject transitions into “YOU are all good to go”; basically, you have the green light to have sex again. At this moment, you are probably thinking, Am I really ready to turn in my postpartum hospital-grade underwear? (Gotta admit, those are the best!) for my Hanky Pankys? Given your current state, sleepless and shaveless, it’s hard to imagine being intimate again.

Let us give you a quick preview… It’s as dry as the desert in summer down there, and no matter how much lubricant you use, you will still feel like you are being set on fire. We are here to say not to worry; while completely unpleasant, it is totally normal. In a large study of post-partum women, nearly 85% of women reported sexual problems at three months’ postpartum (See, you are not alone).

Your mind and body have gone through some pretty serious changes, and it will take time for things to go back to normal. And the good news is that for most it will go back to normal. Research shows that about 50% of women reported dyspareunia (medical way to say pain with sex) at two months post-partum. By 18 months postpartum, this number decreased to 24% (See, time does heal all wounds!).

Post-delivery, your estrogen levels plummet. This drop is not only caused by the delivery of your baby and placenta, but also by the rise in prolactin (the hormone that produces breast milk). Prolactin levels remain elevated post-partum to allow for the continued production of milk. With this high comes the persistent low of estrogen.

In addition to the mood changes, the hair changes, the skin changes, and the headaches that come with low estrogen, you can also welcome vaginal dryness. And not just the mild “Oh, KY Jelly or Astroglide can fix that” vaginal dryness…it’s a dryness that requires an army of products. Medically, we call it “atrophy” or “friable.” Due to “atrophy,” you can often see bleeding post-sex. Again, we are here to say that this is not uncommon.

In addition to the discomfort experienced with sex post-partum, a significant number of women report decreased libido. Nearly 60% of women reported a decreased libido at three months post-partum. Not surprisingly, they cited fatigue, discomfort, and fear of making a bad situation worse. Women who breastfeed were even more likely to report a decrease in libido than non-breastfeeding women; this is likely because those who don’t breastfeed have a faster return of their hormones to baseline. However, the difference did not persist for the long term (again, nothing lasts forever!).

Ways to combat this problem include lubricants and vaginal estrogen creams. So even without a major makeover, in most cases, things will get better. Now, if you sustained a serious tear or had a complication with your laceration or episiotomy, the situation might be a bit more complex. It may require you to sit out on the bench for a bit longer and apply a more comprehensive armamentarium of medications and products. But don’t worry. Even in the most serious cases, with the help of an OB/GYN, a pelvic surgeon, and in most cases, physical therapists, this team can help restore the situation back to normal (although you may need to consider having a C Section for your next child to avoid a repeat event if the situation was really bad).

Bottom line is that your bottom will heal—it just takes time. If you don’t feel like you, physically and emotionally, it is totally normal. Don’t be afraid to give your body and your brain time to rest; the postpartum period is no joke! But rest assured, with a little rest and assurance, you will be back in the game in no time.

Compounded Bioidentical Hormones…Are They Really the Best Fit?

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Thanks to Samantha on Sex and the City and Oprah, compounded bioidentical hormones have gotten a whole lot of press. They have been billed as the best thing since sliced bread. They have become the good guy, while the prescription drugs (a.k.a. conventional hormone replacement therapy, or HRT) have become the bad guy. Bioidentical hormones have been called “natural,” “organic,” and everything in between.

Unfortunately, most women are being sold snake oil, and what they are getting is far from natural. They are victims of false advertising and in most cases are unaware of what compounded bioidentical hormones actually are and how they differ from standard hormone therapy, if at all.

The public and medical opinion on hormone replacement therapy for post- and perimenopausal women has run quite the gamut. The pendulum has swung further on this issue than almost any other topic in gynecology. Before the results of the Women’s Health Initiative (a large study initiated in 1991 to examine estrogen and progesterone’s impact on postmenopausal women) were released in 2002, HRT was lauded as the fountain of youth.

Estrogen and progesterone in the postmenopausal woman were not only believed to improve the nagging symptoms of menopause (hot flashes, vagina dryness, etc.) but also to improve a woman’s overall health. The results of this large study showed almost exactly the opposite. This led GYNs to turn their HRT-writing prescription pads in ASAP and caused women to quickly trash their stash! However, a closer examination of the study and the study population over the past 10 to 15 years has called into question a lot of the initial findings and negative hype.

It now seems that HRT in the right woman (again, the right woman) is no longer the devil and actually can be pretty helpful. While it is no longer believed to improve overall health and prevent things like heart disease, stroke, and breast cancer, it can be useful for women with beyond-bothersome menopausal symptoms.

So if HRT was good, then bad, and now sort of good, what is all the hype about compounded bioidenticals? Did they, too, follow this trend? What are they, and what makes them so different? Bioidentical hormones are plant-derived hormones similar to those produced by our bodies. They include both products that are and are not approved by the FDA.

Think of the FDA as the FBI; they are there to keep you safe when it comes to anything drug- or medicine-related. They test products, procedures, and techniques and make sure things look kosher before you use them. However, the FDA does not oversee the production of compounded bioidentical hormones. They have not checked these drugs for safety, efficacy, potency, purity, or quality. Basically, the inmates are running the asylum. Overdosing and underdosing are both more than possible, and you can’t be sure that what you took on Monday is going to be the same thing you take on Tuesday.

You might now ask, what is compounding? Is it just a fancy way to say “mixing”? Basically, yes. Compounding is creating an individualized product based on the prescription written by the health care provider. Given that the product is custom made, there is no regulation over what is put into that “cocktail.” While you may think your vodka cranberry drink tastes better with a little more vodka, it might not be good for you. And unfortunately, given that it has deviated from the traditional vodka cranberry, no one will be checking to make sure it’s safe.

Now don’t get us wrong; compounding has its place in medicine. It has traditionally been used when specific products are not available or if different preservatives, routes, or ingredients are needed to deliver a medication. An example is the following…you need to take progesterone but it traditionally comes mixed in peanut oil—but you are allergic to peanut oil. Therefore you can’t take the medication UNLESS it is compounded with something else (aka sesame oil). Changes like this are what compounding was meant for!

But give me a little of this, mixed with some of that, and a splash of something else (a.k.a. blending) is not what compounding is or was intended to do. However, this blending concept is how it is often sold and marketed when used to describe hormone replacement therapy. When we were all down on HRT, compounded bioidenticals gained foot traffic because they appeared, and were billed to be, a safe alternative. They were marketed as the same good but no bad. The story was bought by many hook, line, and sinker and led many women to have a false sense of security about what they were putting into their bodies.

Many practitioners who prescribe bioidentical hormones tout them as personalized or tailored. They sell them as a perfect fit (sort of like those jeans that you are always trying to find!). But in reality, you don’t really know what you are buying, ingesting, or drinking. They are free from warning labels and any information on risks. But while ignorance can certainly be bliss, in many cases, this is not one of them! For example, if you are not taking enough progesterone in comparison to estrogen, you can put yourself at risk for uterine cancer—it’s just not a good situation.

And let’s take it one step further. Those that tout compounded bioidentical hormones will tell you they can check your levels through your saliva and can further tailor your treatment according to what they find. There is no evidence that hormone levels in saliva have any biological meaning; while we can pick up some things from your spit, we cannot pick up the level of your circulating hormones. So chew on this: don’t put yourself in danger because you want something natural. Compounded bioidentical hormones are not necessarily the answer.

The specific medications, the dosage, and the way the medications are delivered (oral, patch, vaginal) should be made to order for you. However, this should be done with FDA-approved medications where your doctor knows exactly what they are writing for you and you know exactly what you are ingesting. So while, yes, medicine should be tailored to you, the tailoring should not come in how the medication is mixed but rather how it is administered.

While we all agree that you need a good designer, some designs are not meant to be worn (think midriff shirts). So while you can look, please don’t buy. If the salesperson tells you it looks good, don’t believe it…just like bioidentical hormones, it’s not necessarily the best fit!