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Staying Healthy During Fertility Workup and Treatment

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A blog by Rashmi Kudesia, MD, RMA of New York, Brooklyn, October 5, 2015

Going through infertility treatment is often an incredibly stressful time. Due to the anxiety experienced in trying to conceive, frequent doctor’s visits or tension that can sometimes arise during treatment, it can feel nearly impossible to have a sense of healthfulness during this time. While there isn’t a lot one can do to influence how their ovaries or endometrial lining might respond to treatment, focusing on staying healthy can help reestablish a sense of control.

First, while going through the diagnostic fertility workup, or even while debating whether it’s yet time to see a fertility specialist, there are a number of things women should keep in mind. Optimizing one’s health prior to pregnancy is the best bet for ensuring a good outcome. This means making sure that you’ve had recent visits with your gynecologist, that your Pap test (and mammogram if applicable) and vaccinations are up-to-date, and that you’ve also recently seen other members of your healthcare team that manage chronic health conditions like diabetes or hypertension. Ensuring that ongoing medical problems are well-controlled prior to pregnancy is absolutely the safest way to conceive.

Reaching a healthy weight is also part of this process, and one that is often overlooked. Being underweight or overweight has important fertility and pregnancy ramifications. Though the body mass index (BMI) is not the perfect measure of a healthy weight, it is a good start and everyone should know where they are. For most women, the goal should be to reach a normal BMI of 18.5-24.9. If losing or gaining weight has been an ongoing struggle, ask your doctor to help, by providing advice or referrals to a nutritionist. For women that have a BMI over 40, or that have weight-related health problems like diabetes, there is new evidence suggesting that bariatric surgery may be an option that will help improve health and pregnancy outcomes. Women that have polycystic ovary syndrome (PCOS) may have particular difficulty in losing weight due to insulin resistance, but lifestyle modifications in women diagnosed with PCOS can be more effective than medication to achieve pregnancy.

There are many other aspects that are also important considerations. Prenatal vitamins are always a great start, and getting at least 400mcg of folic acid daily is essential as you start trying to conceive. Waiting until you are already pregnant will cause you to miss the critical early window of fetal development, and since most of us could stand to improve our diets, the vitamins and nutrients will be beneficial! This is a good time to start learning about and adopting the dietary recommendations for pregnancy. Though views on this vary culturally, working toward elimination of alcohol, tobacco and drug intake is the safest approach, since no safe thresholds have been established for any of these substances. Also consider whether your home or work environment exposes you to significant levels of any potentially harmful chemicals or fumes. Talk to your doctor if you have questions or concerns about these recommendations, or need help cutting back on substance use.

Ideally, many of these concerns are addressed prior to initiating treatment. Once you’re actively in fertility treatment, it can be even more challenging to take care of your mental and physical health. If you are already living a healthy lifestyle, it is much easier to make minor temporary modifications to accommodate your treatment. The main concern during treatment itself is avoiding high-impact exercises that could cause your ovaries to bounce and potentially twist. When this happens, it is called an ovarian torsion, and can result in the ovary losing its blood supply, requiring emergency surgery to restore blood flow. But low-to-moderate-impact exercise is generally safe and is a good habit to maintain through treatment and pregnancy itself.

Finally, try to prioritize your mental health and the needs of your partner, if you have one. Check in with yourself and each other often to ensure that you are on the same page, and to try to mitigate or resolve feelings of depression or being overwhelmed. Keeping track of at least the general goals and milestones of your treatment plan can help prevent surprises later on, if things don’t go according to plan. Be sure to speak with your doctor if you are unsure about what reasonable expectations for success might be.

Though we don’t yet know the full impact of stress on fertility and infertility treatments, it stands to reason that the healthy habits that reduce stress and improve our overall health can only help in establishing a healthy pregnancy. Though many women and couples are eager to get started with treatment right away by the time they seek the help of a fertility specialist, taking the time along the way to get and stay healthy in both mind and body is an important goal that you and your doctors will certainly agree on!

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