Let’s go through all the do’s and don’ts of fertility treatment. I thought it would be fun to address this topic by taking you through the questions that I get asked the most, every day. Chances are someone out there is wondering the exact same thing.
What do you do with your progesterone?
If you’re new to fertility treatment and you’ve never heard of progesterone, the way I describe progesterone is this: It’s like water to a marathon runner. You don’t want to run a race without water, and if you finish the race, it’s too late to drink water. I ask my patients to start progesterone supplementation 3 days after a positive opk/ovulation/trigger shot (whichever comes first) until the pregnancy test and to continue with a positive test. If your natural progesterone levels are very high, adding more may cause dizziness. Consider stopping it if this side effects happens to you.
What’s so confusing about this label is you can take the capsule and swallow it, or you can place it vaginally. If you swallow the capsule, it can make you feel dizzy, or you might feel a little bit groggy the next morning. If you place it vaginally, you might experience irritating vaginal discharge and that might be a little bit irritating. You can also try taking it orally one night, then switch to vaginally if you experience dizziness. Proov has made a cool test you can take that helps you measure your progesterone from home.
There are different doses of progesterone, so you can start with 200 milligram capsules and go down to 100 milligram capsules if needed. The best way for you to take it is the way in which you experience the fewest side effects.
Can I drink alcohol?
Let’s use IUI as an example. Say you’ve just done your IUI and your best friend’s wedding celebration is the next day. My answer is, no, you shouldn’t drink. Certainly there are people who drink during their pregnancy, but that’s not what I recommend to my patients. When you have done a treatment and you’ve worked so hard to get there, the best thing to do is avoid alcohol and ask for a mocktail.
Before pregnancy, if you really feel like you want to have a drink, enjoy a glass of wine with dinner, but studies have shown that potentially if you’re drinking more than four alcoholic beverages in a given week, that actually might decrease your pregnancy rate.
When we’re talking about a serving, I’m not talking about the entire bottle in a glass of wine. I’ve seen those pictures of those glasses that hold a bottle. But for a woman, a serving is really four ounces, which is half a cup. And if you’re having four of those spread out over the week, it’s okay. But what you’ll hear me say is don’t get your sperm drunk and certainly don’t get your eggs drunk either. And binge drinking is not healthy when trying to conceive, or any other time for that matter.
What can I do for a cold or stuffy nose?
When it comes to a stuffy nose or a cold, what I tell my patients is: saline nasal spray, a humidifier or Vicks vapor rub on your chest, lots of rest, Tylenol, and Robitussin for a cough are all okay. It’s also okay, depending on where you are in your cycle to take Claritin or Zyrtec during the day. Avoid cold medications with dextromethorphan.
If you’re really, really stuffed up, you can take Benadryl at night too. It’s really important that you talk to your personal physician about your medical situation and get advice from them.
Can I do Botox?
Botox doesn’t hurt your fertility. It’s very localized in your skin and doesn’t spread systemically. If you happen to do Botox and didn’t know you’re pregnant, it’s not going to hurt your pregnancy. If you’re doing fertility treatment and you want to do one last Botox treatment before your transfer, that’s okay.
Can I still drink coffee? How much is too much?
I tell my patients, if you want to drink coffee, it’s okay. There’ve been studies looking at women who’ve gone through fertility treatment to look at their IVF pregnancy rates. And there’s no decrease in pregnancy rate when it comes to caffeine consumption (in moderation of course). However: you are what you drink, and you are what you eat. You can actually measure caffeine levels in the follicular fluid around the eggs, which made me think: limit your consumption for sure- one to two caffeinated beverages per day. In the beginning of pregnancy you’re very tired, so you may want a little boost.
The other thing that happens in pregnancy is you feel insomnia at night, so you have to be really, really careful about what you drink because even a little bit of coffee can make you have a really hard time sleeping the rest of the night.
A little bit of coffee every day can help your mood, help your metabolism, especially when you’re not feeling so energetic being on all the hormones that you’re on during fertility treatment. Don’t feel guilty for picking up that cup of coffee in the morning before you head out to work or before you start your day.
What can I take when things slow down?
Another thing that will happen when you’re on fertility drugs is things might slow down, and when I say things, I mean your bowels. When you’re taking the fertility drugs, your ovaries are a little bit swollen, and that pushes down on your bowel and makes it harder to have a bowel movement regularly.
Okay, just a little poop talk. When you’re doing your egg retrieval for your IVF cycle, the anesthesiologist gives you anesthesia medications that can slow things down as well. And if you’re taking pain medication, perhaps something with hydrocodone in it, that can also constipate you.
Medications to take when you’re feeling a little bit constipated that are totally safe, are things like Colace or MiraLax. There are certainly foods that you can too. Eat foods that are higher in fiber like prunes.
Can I visit the dentist, and have dental work done?
Who doesn’t want an excuse to avoid the dentist? I know that a lot of people still dread going to the dentist, but it’s really important to get your teeth cleaned every six months. Studies have shown that taking care of your gums and your dental hygiene can actually decrease risk of preterm labor and preterm delivery. When it comes to going to the dentist, you certainly can and should. Dentists will have a form that they’ll send to me that asks questions such as: is it okay if your patient is having this type of dental work? Can she have Lidocaine? The answer’s yes. You can use local anesthetics for procedures and there are pregnancy safe antibiotics that you can take as well that will not interfere with your growing embryo either before treatment or once you are pregnant.
How much exercise can I do?
It really depends on the person. If you’re someone who has a low BMI (less than 20) you may find that your uterine lining is on the thinner side. Maybe you’re having a hard time ovulating regularly every month. Cutting back on your exercise and doing more low impact activities, avoiding things like running, maybe consider yoga, walking, hiking, swimming, things that might be better for your fertility.
When I make a fertility plan for my patients, I often tell them, okay, so now that I’m seeing you on this day, this is how your ovaries look from here on out. I want you to avoid high impact exercise. Be sure to ask your doctor if it’s still okay to exercise while you’re going through the process.
What should I eat? What can I eat?
First of all, things to look at are:
- Your body size.
- Your medical issues. Do you have problems with hypertension or high blood pressure, high blood glucose?
- Do you have PCOS?
- Metabolic issues
In general, consider eating low carb, high protein, high veggie, and don’t try anything new or exotic or anything that might upset your stomach.
Can I travel?
I included this picture because I really want patients to reconsider flying while pregnant. Airplanes are really, really crowded. If you’re on an airplane with 200 people, and there’s one person on the airplane that has the flu, the next person who’s possibly going to get the flu is now the person who is pregnant. Especially in early pregnancy, when things are so vulnerable, it’s important to rethink travel based on the season and what’s going on.
And I always tell patients to pack a mask so that if there’s someone sitting next to you that’s coughing, then you may want to protect yourself especially if you can’t change your seat.
Can I dye my hair?
My rule about hair dye and salons in general is this:
When you walk into the salon, do you get a headache?
I’ve been in salons before where I walk in and I feel like it’s not well ventilated and I start feeling dizzy. Make sure you’re going into a well ventilated salon.
I recommend to my patients that it’s okay to get your hair treatments done before your embryo transfer, but I like patients to wait through the first trimester and not do any hair dying until they’re past the first trimester.
Do I need any immunizations?
If you’re going to take a big trip, what are you going to do? You’re going to talk to a travel doctor and get a list of all the immunizations you need. Well, same thing in pregnancy. Before a woman gets pregnant, we want to make sure that she’s immune to things like measles, mumps, varicella (chicken pox), and rubella. But the last thing you want to do is get these vaccines while you’re pregnant.
The other things that you want to avoid in pregnancy are the shingles vaccine and the nasal influenza vaccine. So before you get a vaccine, ask yourself, where am I in my cycle? Is it safe for me to do this right now? And certainly make sure you’re immune to the things that you need to be immune to, because if you’re exposed to some of these in pregnancy, it actually could cause harm to the growing fetus.
What can I take to help me with sleep and/or anxiety?
A lot of people have a hard time sleeping, especially when they’re super nervous. If you’re super emotional because you have your embryo transfer the next day, or you have your egg retrieval the next day, I tell my patients it’s okay to take things like Tylenol PM. If you’re feeling super, super anxious, talk to your doctor about prescribing one pill of Valium. I prescribe Valium before the embryo transfer, and if needed, one the night before the egg retrieval to help my patients get a good night’s sleep. I sometimes have them take one 3 hours before the egg retrieval if anxiety levels are extremely high.
Also, try to have a normal circadian rhythm as much as you can. If you’re someone who works the swing shift maybe try working the day shift as you’re getting closer to these really important procedures. When you’re doing all this work to try to conceive, you want to do everything possible to give yourself the very best chance. If you want to plan a treatment, think about all these things, like sleep, and see if you can make some slight adjustments to give yourself the best chance.
Is nail polish safe?
It’s okay to paint your nails. There are some more fertility friendly nail polishes that don’t have formaldehyde that other nail polishes have, but it’s certainly safe to paint your nails.
Can I get a massage?
When you’re trying to get pregnant, it’s totally okay to do a regular massage. Many patients ask me if they need to get a prenatal massage and I tell them it may not be as satisfying of a massage.
However, if your ovaries are really swollen because you’re going through IVF, it may not be a good idea for you to be laying on your stomach. Maybe you should just get a facial. Think about what’s going on in your body, and the position that you’ll be in when you’re getting the massage. Most of the time it’s totally okay, but ask your doctor first.
What can I do about nausea?
When it comes to fertility treatment and IVF, we use medications like birth control pills and fertility shots, and all have a side effect of nausea. Some people are more sensitive to the side effects than others. So one of the things that you can do for nausea is acupuncture. It actually can work, especially in pregnancy: I find that my patients who do acupuncture do really well in the first trimester, and they need less anti nausea medication than patients who don’t do acupuncture.
Some of the medications that you can use during your fertility treatment for nausea are prescribed medications like Zofran, Compazine, or Reglan. Once you’re pregnant, there’s a more pregnancy safe alternative called Diclegis: it’s basically Unisom and high dose vitamin B in a tiny capsule. And the one other way to deal with nausea is rather than swallowing a pill, you can place the pill in the vagina. Talk to your doctor about which ones you could place vaginally.
Should I avoid pain medications?
The next thing I want to talk about is pain. It’s not unusual to have pain, for example, when you have a period. You can take Advil, you can take Tylenol. Why avoid these medications? I think a lot of people are scared of things like hurting their egg quality, or scared it’s going to interfere with the pregnancy and cause a birth defect. But when it comes to pain, there’s no need to suffer through a period at the start of your fertility treatment or when trying to conceive.
There’s a reason why medications like Tylenol have to be taken every six hours, and that’s because they’re only in your system for six hours at a time. Taking them at the start of your cycle when you have pain will not interfere at all with the quality of eggs once they’re removed or the quality of the embryo once it’s transferred.
And remember to take pain medications before the hysterosalpingogram, which is a very painful procedure. There is no need to suffer through that. There are medications you can take to prevent the pain.
Can I go into the sauna/steam room/hot tub?
Just as I said before: Don’t get your sperm drunk. The next thing is: Don’t cook your balls. Your testicles are on the outside of the body. There’s a reason why: they don’t need to be as warm as ovaries. This is for the guys: stay out of the sauna until pregnancy is achieved.
Can I have sex? What kind of sex? How about now? Why can’t I have sex?
When it comes to sex, it’s really an individualized recommendation.
In the scenario of an IUI, what I tell patients is if the sperm count is normal, then every time you ejaculate it will continue to be normal. The volume may not be as high, but that’s okay. There is still enough for insemination.
Some of the reasons not to have sex are: if there are issues with erectile dysfunction, issues with the motility,count and/or the volume of sperm, then perhaps waiting three to five days before the insemination appointment would be the best way to go.
And how about when you’re doing IVF? If you’re someone who potentially has the possibility of ovulating many eggs, then perhaps you shouldn’t be intimate. For example, if you’re going through IVF and there’s a potential of three to five eggs that your doctor could retrieve. I would actually tell the male partner, go ahead and be intimate before the egg retrieval, and take that three to five day abstinence period.
And then you’re getting ready for the embryo transfer and you’re on all these medications. Everyone wants to know can they have sex before the transfer? Well, depending on the protocol, you most likely will not be ovulating before your embryo transfer, unless you’re doing something called a natural cycle transfer.
Sex is not dangerous before a transfer, but if you’re placing medications vaginally, for example, and you’re considering having sex, you can totally have outercourse and not intercourse. The point is that the semen can interfere with the absorption of progesterone, so if you’re going to have sex, it’s okay to have it on the outside, if you know what I mean.
Can I smoke?
No. Cigarettes are basically sperm killers and they are toxic to the DNA in both the eggs and the sperm. Half a pack per day, one pack per day, doing it consistently can certainly be very harmful to your health, especially your fertility health.
Can I have Chinese herbs and teas? Is acupuncture okay?
Try it. Have a consultation and see what they say about you, your body’s chemistry, and what kind of schedule you should be on when it comes to doing acupuncture. I make really detailed calendars for my patients to give their acupuncturist and tell them to work their magic. And I have a very close relationship to the acupuncturists that I work with. I know what herbs they’re giving my patients, and the herbs are basically geared toward the part of the cycle the patient is in.
All of these things are very specific to where a woman is in her cycle. Try it and see if you like it. If it’s not for you, or if you’re someone who’s sensitive to new things, the time to start a new Chinese herb is not on the day of the transfer because a reaction could be detrimental to your future pregnancy.
Is it okay if I do yoga?
Absolutely. The only type of yoga that I sometimes get concerned about is Bikram yoga or hot yoga. I ask patients to really make sure they’re hydrating well, and taking a timeout if they feel like they’re getting overheated. When you’re going through fertility treatment, fluid goes to the ovaries, they swell, and that’s a very vulnerable time when you could be at risk of becoming dehydrated.
Can you go up the stairs? How many times can you go up the stairs?
This question often comes to me after someone’s embryo transfer. Once you’ve done an embryo transfer, you want to do everything possible to give your embryo the very best chance of implanting. A lot of people have stairs, and just taking one flight of stairs to get to your bedroom is not a big deal.
I often do an exercise with my patients’ purses to see how much they weigh. If it makes me flex to lift it, then that is too heavy, and don’t carry it up the stairs! Watch what you’re lifting as you’re going up the stairs, and watch your balance. You don’t want to fall up or down the stairs, but you certainly don’t have to be carried up the stairs.
Is it safe to travel to areas with Zika?
My recommendation is traveling is okay, but I’m always super sensitive about Zika infected areas like Mexico, India, Africa. Before you travel anywhere, look to see if there’s Zika reported in this area.
Always look up the newest or most recent recommendations by the CDC to abstain from trying to get pregnant after visiting an infected region.
