I recently attended a mind/body programme at one of the fertility clinics relatively near me. I had been to a slightly similar event in late 2011 before I even knew what my fertility issues were and I decided it might be good time to revisit one before I start my second frozen cycle. My husband had never been to one of these events before but agreed to come along to this one. The fee paying event was open to anyone, not necessarily patients of the clinic. The letter of invitation suggested comfortable clothing should be worn so we took them at their word. I dug out my nicest fleece top and best pair of joggers for the day.
There was a mixed group present, mostly couples. The day was subdivided into a number of different topics- cognitive behavioural therapy, acupuncture, restorative yoga, nutrition, mindfulness and relaxation. We were all provided with an information pack consisting of a workbook of articles relating to the course, Dr Marilyn Glenville’s book Getting Pregnant Faster, various information leaflets and 2 CDs, The Relaxation Experience by Alice Domar and Guided Mindfulness Meditation series 1 by Jon Kabat-Zinn.
Stress/Fertility Thinking and Cognitive Behavioural Therapy
The first session on Fertility Thinking and Understanding Stress looked at the pattern of unhelpful negative thoughts that often surround infertility issues. Unhelpful thinking can often lead to unhelpful emotions such as anxiety and we can be very hard on ourselves as a result. With the stress response it is important to consider what/who/where triggers the stress and what is within your control and not within your control. It may be time to start doing things differently in the same situation. For example, learn a relaxation technique, talk to someone, do an enjoyable activity or make yourself a calming compilation of favourite music.
We were shown a Thought Record Sheet and the concept was explained. We were then asked to complete one based on an event we could identify. In the first column you enter the triggering event, then in the next the unhelpful thoughts/images associated with it, then the feelings it inspired, then self-compassionate reformulation of the thought and finally the outcome/understanding gained.
For example this could run thus:
Event: My cycle failed.
Thoughts: I am a failure
Emotions: Anxiety, panic
Reformulation: Yes my cycle has failed. I am not a failure however. There are many reasons why my cycle may have failed which may not be to do with me.
Outcome: The possibility of a failed cycle is a concern for me but I am doing all I can to give myself the best chance and the next cycle may hopefully work.
Dealing with negative emotions was also discussed. It is perfectly ok to feel negative emotions like anger and jealousy but the goal is to keep them healthy rather than unhealthy and to acknowledge that both good and bad people struggle with fertility and that both good and bad people become parents.
We were told of a self-help website for cognitive behavioural therapy http://www.getselfhelp.co.uk where therapy sheets can be downloaded for free and where there are also low cost MP3s on the subject for download.
Acupuncture for Fertility
The next session dealt with medical acupuncture for fertility and was delivered by an acupuncturist working in this area. The ideal time to commence acupuncture before treatment is about 3 months as this is the development time of both sperm and follicles/eggs. However, any treatment at any stage is beneficial. Acupuncture can help with a number of things such as reducing inflammation, increasing blood flow to the uterus, improving the function of the ovaries, decreasing contractions after transfer, stress reduction and regulation of the immune system. It can also help with male fertility by improving the semen. The most important time to have a treatment for women is before and after transfer, ideally both on the same day. No abdominal points are used in the session after transfer, points will be mainly in the legs but these have action on the uterine area. Although you can have acupuncture in the 2ww, it is usually after 7 days or so.
We were advised that it is best to choose an acupuncturist who specialised in fertility rather than one who is a generalist, whenever possible as they will be more familiar with the various treatment protocols.
Yoga for Fertility
The third session dealt with yoga. Gentle forms of yoga were recommended, that would have a restorative and calming effect on the body. With regard to exercise in general, strenuous exercise was not recommended- the question was asked would you do this exercise if you were pregnant and to adjust accordingly. But some exercise is good especially once it was not causing any strain on the back.
Although not discussed at this session there are various yoga poses that seem to be very suitable at this time- these include Cobbler’s pose, Lotus pose, Cat pose, Child pose. Downward facing Dog pose is also ok. Legs up the wall too (yes we have probably all done this one while ttc!!). Avoid head stands and back bends.
We all got practice on the mat then by doing an actual yoga session which focused on breathing exercises and gentle stretching poses both lying/sitting and standing. The people in jeans were a little regretful of their choice of trouser wear!
Nutrition for Fertility
After lunch there followed a detailed talk on nutrition for fertility. Dr Glenville’s book was the basis for a lot of this. We were told that 50% people can have some Vitamin D deficiency, especially in cloudy countries. The 5 portions or 400g of fruit and vegetables a day should be considered a minimum.
The most important fertility nutrients are Zinc, Vitamins E, B (including folic acid), C and D, Selenium, essential fatty acids. L-carnitine and L-arginine are also important for men. Antioxidants are important as they can repair cell damage such as may occur in DNA fragmentation.
Vitamin C and E were deemed especially important for men after a failed ICSI and older women trying to conceive. Vitamin C it was said also helped progesterone levels and encouraged ovulation. Low vitamin C in pregnancy could cause pre-eclampsia. We were advised to avoid vitamin C containing ascorbic acid but to choose instead one made up of magnesium ascorbate. About 500mg should be an adequate dose. Vitamin C is water soluble so you excrete what is not needed. Vitamin C is often lost from foods in cooking and canning, so either cook lightly or eat foods where the juices are also eaten eg soups and casseroles.
Selenium has an impact first on sperm motility. Deficiency is common in men with lower counts. It can be found in foods like nuts (Brazil, Cashew), sunflower seeds, seafood, lentils, brown rice). Eating 2-3 Brazil nuts a day for example would help.
The benefits of co-enzyme Q10 were also mentioned. It is particularly good for men with density/motility/morphology issues. It’s also good for women for egg quality. The recommended dose was 200mg.
B Vitamins can be depleted during times of stress.
Omega 3 benefits were discussed. Low levels were linked to increased rates of abnormal sperm and supplementation can increase sperm count. Many Omega 3 supplements don’t have sufficient EPA/DHA ratio, 750/450 was recommended.Omega 3 can be found in oily fish, seeds, nuts.
Olive oil and avocado were recommended as beneficial although these apparently have Omega 9.
There is no need to supplement with Omega 6 (most people have too much from diet) so no point in getting combined Omega 3/6/9 supplements.
We were advised to get Vitamin D levels checked before taking high dose supplements as it is a fat soluble vitamin. It helps with sperm issues and also promotes immune suppressor cells which may help maintain a pregnancy. About 1000iu dose should suffice. Liquid or capsules are preferable to tablets.
The importance of maintaining a healthy weight was then discussed. Apart from BMI, the waist-hip ratio was mentioned as a good marker. There are calculators online you can use for this. Basically the less weight you gain round your middle the better for your health. (One small advantage of being a pear shape I guess!!).
Sugar was the next hot topic, most particularly the amount of hidden sugars in products we buy like fruit juices, smoothies, yoghurts, fortified breakfast cereals, soft drinks, muesli and granola. It was really quite shocking! 4g of sugar = 1 spoon. Regarding fruit and fruit juice, it was recommended to eat whole fruit where possible but if drinking juice, to dilute it 1 part juice to 3 or 4 parts water.
Another tip was to eat some form of protein with each meal as when eaten with carbohydrates, it makes the meal slow releasing. For example have an apple with a couple of nuts.
Plenty of water (1.5L) to be drunk daily and 30 mins of gentle exercise 5 times a week (like walking or yoga).
We were asked to complete a 2 day food diary and examine it closely, and also to come up with a number of positive changes we could make.
These are mine:
- Buy organic wholegrain porridge unsweetened rather than sweetened instant versions. I will have to sweeten this with honey but at least it is not adding sugar to sugar.
- Buy blueberries so that they can be sprinkled on the porridge along with cinnamon and seeds, and reduce my intake of fruit juices and smoothies.
- When I drink juices/smoothies, dilute them more than I do at present.
- Use wholemeal flour or at least a mix of wholemeal and plain for home baking savoury dishes.
- Make my own lemon and ginger tea using root ginger and juice squeezed from a lemon. According to my acupuncturist a large jug can be made and it can be reused/reheated.
Relaxation and Mindfulness
The last session of the day concerned relaxation techniques and mindfulness. Mindfulness means being in a state of now, being fully focused on whatever you are doing or thinking at that very moment. I guess you could call it observing. The practice ties in very much with your breathing. We were taken though the process of a body scan mindful relaxation practice. It was incredibly relaxing and I wish I could perfect this technique for days of scans, transfers etc.
We were told that You Tube is a good source of information and discussion on mindfulness. There may also be phone apps.We were provided with a CD by Jon Kabat-Zinn of mindful meditation and yoga to try at home.Another recommendation was The Mindfulness Based Stress Reduction Workbook.Some websites recommended were http://www.mindfulness.ie and http://www.actionforhappiness.org
I am sure there are many others too.
So all in all I found the day very beneficial and it was nice to meet others in the same process. Over lunch I spoke to a couple who are in the process of having tests done and may be starting a cycle soon. I felt happy about the fact that I could give them some advice and reassurance. Around a year ago I was starting out on this path too and how much water has passed under the bridge in that length of time. I feel like an old hand!
So if you come across any mind/body programmes in your area I would recommend checking out if they are for you, with an open mind. Both my husband and I enjoyed the day and took information away that we can use. I still have to read all the information in my course workbook and Dr Glenville’s book and listen to the CDs but I will get there. This post only touches on what we covered and you can research the various aspects elsewhere to get fuller information. I wouldn’t presume to give advice!!!
Meanwhile next up for me on Tuesday, treatment wise, is my pre-period scan and endometrial scratch no 2 as preparation for FET 2, probably less than 2 weeks to start! Big deep mindful breath……