Blog - Fertility Fact Checker

How environmental toxins can impact your IVF cycle

It seems we can’t avoid environmental toxins. Being aware of this and where possible reducing your exposure is one step you can take to improve the chances of creating your little family.

You’ve modified your diet, significantly cut down on alcohol and well, smoking was never your thing anyway. The next thing you might be wondering is about toxins and the potential impact that has on egg and sperm quality and the little embryo about to implant. If you believe the news environmental toxins are EVERYWHERE but do they really matter or is it yet another, hippie fad?

Call them toxins, environmental contaminants, chemical contaminants or environmental toxicants, the synthetic chemicals that we come across in our daily living seem to be linked more and more to declining fertility in ‘normal’ populations and poorer outcomes in the IVF world. These chemicals have been linked to all sorts of conditions including cancers, neurological conditions and even mental health conditions. For the purposes of your upcoming IVF cycle we are most concerned with link to a decline in fertility and poorer IVF outcomes.

Endocrine Disruptors Explained

Environmental contaminants are often referred to as being ‘endocrine disruptors’ as they can interfere with the bodies endocrine, or hormone, system and more specifically in this instance with estrogen. The chemicals do this by either mimicking how estrogen works, blocking its use or simply just interfering with the way it is made or controlled (National Institute of Environmental Health Sciences). Regardless of the exact mechanism, they are preventing the normal functioning of our endocrine system from happening and this has the potential to adversely impact on our fertility and IVF success.

Endocrine disrupting contaminants are in many different substances (both natural and man-made) with some of the main ones being certain pharmaceuticals, dioxin and dioxin-like compounds, DDT and other pesticides, and plasticizers such as bisphenol A and phthalates.

Endocrine disruptors have been given a bit of attention recently and are thought to be so important as they can travel vast distances both through air and up the food chain (1) meaning that their impact can be wide reaching. The two ‘plasticizers’ have particularly been topical recently and are further discussed here (though pesticides and other contaminants are also of importance and should be reduced where possible).

Ive heard of it… but what is BPA?

Bisphenol A, or BPA, is a substance that was primarily used in the manufacturing of plastics (which is why it is called a ‘plasticizer’. It is still often used in the lining of tin cans and in some plastic drink bottles and is even used on the coating of til receipts that is then absorbed through our skin when handling the receipt (2).

There have been small studies that have been conducted analyzing the levels of BPA in the blood of women undergoing IVF and it has been found that the higher the levels of BPA the lower the fertilization rates (3). Other studies have also shown that for women doing IVF, those with higher levels of BPA in their blood had lower numbers of eggs, less mature eggs and lower rates of fertilization (2).

Now there are two things to be mindful of when getting your morning coffee – too much caffeine AND BPA from the cash register receipt!

BPA is found in many plastic containers and coatings and although the studies are small, at times contradictory and inconclusive, where possible it does seem like it is beneficial to limit the amount of BPA that you come into contact with (despite studies from the United States Food and Drug Administration saying that the level of BPA that is absorbed in day to day activities is within safe limits). This would include looking out for BPA free plastic containers (preferably glass containers because who knows what they are replacing the BPA with in other plastics), being mindful of which brands of tinned food that you eat (as BPA is often in the coating) and avoiding drinking water from plastic bottles. Oh and if you work in retail try and reduce the amount of receipt handling you do – just to be safe.

…and phthalates?

Phthalates are a group of chemicals that are used to make plastics more flexible and harder to break (Center for Disease Control; CDC). They are also used to in anything that is fragranced which is why they are found in many personal care products including perfumes, soaps, deodorants, hair sprays and even nail polishes! This is together with the hundreds of products including flooring, adhesives, detergents, lubricating oils, automotive plastics, plastic clothes such as raincoats and sometimes children’s toys, plastic packaging and medical tubing. It seems, phthalates are everywhere!

Similarly to BPA we can ingest phthalates by, for example, eating food that has been in contact with the plastic containers it has been heated in or particularly in the case of cosmetics and personal items, absorbing them through our skin. You can even breathe in phthalates. Once the phthalates are in our body, they are metabolised into metabolites are are then excreted in urine.

Reduce your exposure to phthalates by only using phthalate free makeup and toiletries.

It is by analyzing the metabolites in our urine that researchers are able to quantify how much phthalates a person has been exposed to and make comparisons to various outcomes, such as, the success of an IVF cycle. Before we look at IVF specifically, there is a significant body of research that has been done in animals implicating phthalates with poorer reproductive outcomes and also linking phthalates to an increase in oxidative stress in our body (particularly researched in men and pregnant women).

From what I have seen though, whilst it seems increasingly undeniable that the influence of phthalates negatively impacts our IVF cycles the hard human evidence demonstrating its impact in women is still coming. However, a study in 2016 (4) reported that when analyzing the metabolites found in the urine of women undergoing IVF the higher the amounts of metabolite DEHP and DiDP found, the lower the number of eggs produced and number of mature eggs produced. Additionally, an increased presence of the metabolites DiNP and DiDP were associated with lower fertilization rates. This ultimately led the researchers to conclude that higher levels of DEHP ultimately led to lower clinical pregnancy and live birth rates.

Whilst having high amounts of phthalates in your blood (and urine) isn’t going to be the only factor to make or break your cycle, or even be the major factor, it may be at the very least a significant risk factor and is certainly worth reducing your exposure where possible.

It should be noted though that not all studies support this. For example in 2017 a paper was published (5) that indicated that male, but not female, urinary concentrations of phthalates influenced blastocyst quality and another study reported that even though metabolite MEHP and MBP where found in follicular fluid and urine of females doing IVF these were not associated with the usual IVF outcomes (which may include things like egg quality, number, fertilization rates etc).

As we have already stated though, regardless of the evidence being somewhat inconclusive, there does seem to be enough evidence to suggest that it is worthwhile reducing your exposure to endocrine disruptors as much as possible.

So, how do we do this?

Throw out the plastic storage containers in your house and investing in either glass or stainless steel. Watch out for plastic recycling codes 3, 6 and 7 as these may contain endocrine disruptors. Particularly avoid reheating your food in plastics as when the plastic is heated the integrity of the plastic is changed making it easier for the transfer of phthalates to your food.
Try not to use cling film and other products to wrap your food in. Paper bags for sandwiches may seem like a throwback to the fifties but its at least worth a try. So is aluminum foil.
Use ‘natural’ cosmetics products available such as those from Nourished Life (this is an Australian website but there are others in the US). Or if this proves to be cost prohibitive looking for products that are ‘phthalate free’ (and their derivatives). This can be tricky and they can hide so it pays to do your research as sometimes the name can be somewhat ‘hidden’. Remember products that have added fragrances nearly always contain phthalates so looking for ‘fragrance free’ is worth a try also.
Beware of the scented candle! They may also be a source of phthalates.
Reducing chemical cleaners in your home. I have recently started using ‘Enjo’ and although expensive and at times does take a little more work the benefits of not having harsh chemical cleaners make it worthwhile.
Try eating organic. Non organic vegetables can often contain residue pesticides which although not directly discussed here can also be endocrine disruptors. Additionally, non organic meat can contain remnants of hormones and antibiotics given to the animals which then passes up the food chain to us.
Limit handling til receipts!
Stick as much as possible to unprocessed foods and avoid canned foods (unless you know that the lining of tins are BPA free).
Being aware of the environment you are in. For example, trying to avoid places where you know lots of air freshener or scented candles are used or if you have laid new carpet, for example, ensure it has been aired out as much as possible before you move back in.

For more practical ways to reduce your exposure to chemicals to increase your chances of IVF success, have a look at Eat Think Grow.

The bottom line

Although the evidence to say that phthalates negatively influences IVF outcomes is not yet conclusive, there does seem to be a growing body of evidence to say that they are very likely to have at least some impact. Although it will be near impossible to ever completely eliminate your exposure to phthalates, BPA and other environmental toxins, given that your IVF cycle is potentially the most important thing to ever happen to you and you want to do all you can to support its success it wouldn’t hurt to eliminate reduce your exposure as much as possible whilst still living life. This includes eating organic, reducing use of nail polish hair spray and especially fragranced cosmetics and minimising food that has been inside plastic (especially plastic that has been heated such as in a microwave) containers. You know, while living in the 21^st century, juggling work and ultrasound appointments.

References

Younglai, E, Holloway, A, Foster, W. (2005). Environmental and occupational factors affecting fertility and IVF success. Human Reproduction Update, 11 (1) 43–57, doi:10.1093/humupd/dmh055
Ehrlich, S., Williams, P., Missmer, S., Flaws, J., Ye, X., Calafat, A., Petrozza, J., Wright, D. and Hauser, R. (2012). Urinary bisphenol A concentrations and early reproductive health outcomes among women undergoing IVF. Human Reproduction 27 (12) 3583–3592.
Fujimoto, V., Kim, D., vom Saal, F., Lamb, J., Taylor, J. & Bloom, M. (2011) Serum unconjugated bisphenol A concentrations in women may adversely influence oocyte quality during in vitro fertilization. Fertility and Sterility 95 (5) 1816 – 1819
Hauser, R., Gaskins, A,, Souter, I., Smith, K., Dodge, L., Ehrlich, S., Meeker, J., Calafat, A. and Williams, P. for the EARTH Study Team (2016). Urinary Phthalate Metabolite Concentrations and Reproductive Outcomes among Women Undergoing in Vitro Fertilization: Results from the EARTH Study. Environmental Health Perspectives 124 (6) 831- 839.
Wu, H., Ashcraft, L., Whitcomb B., Rahil, T., Tougias, E., Sites, C. and Pilsner, J. (2017). Parental contributions to early embryo development: influences of urinary phthalate and phthalate alternatives among couples undergoing IVF treatment. Human Reproduction 32 (1) 65- 73.

3 things YOU can do to improve your chances of IVF success

If you have downloaded the FREE IVF Guide you may already know about these methods... and even if you have, they each have so much potential to impact your next cycle that a quick reminder can't hurt!

I've been reading a lot of fertility books lately and a lot of the information in the books crosses over with the IVF guide... except the IVF guide is 100% free!

Anyway, check out the video and let me know what you think!

Protein – Carbs = Increased IVF success rates

Eating an ‘IVF Diet’ is a minefield. Eat organic, don’t eat sugar, eat brasil nuts, don’t eat soy – no wait, DO eat soy, eat pineapple – but don’t eat it before transfer, drink raspberry tea, avoid peppermint tea.

It does NOT STOP!

And here is one more. But this one is really promising and has some good elementary science to back it up.

Looking at the amount of carbohydrates and protein in the diets of women doing IVF, researchers where able to provide some suggested guidelines on the ratios of how much of these foods you should be eating to best increase your chances of IVF success. As always though, make sure you check with your fertility specialist before making any major changes to your diet to ensure it is right for you and your unique situation.

>>If you are looking for easy, simple ways to increase your chances of IVF success, make sure you check out Eat Think Grow. It’s got over 340 pages of reliable, easy to read scientific information as well as thorough meal plans, daily mindset tips and loads of other essential evidence based information to help your IVF cycle<<

Peas. Obviously. And a decent source of plant based protein too.

THE IVF CONNECTION

In 2013 in a fertility clinic in the U.S, fertility doctors were noticing that young women (aged 36 and 37) of normal weight and no obvious reason for it where getting eggs of poor quality.

Although these women were eating what some would consider a healthy diet – oatmeal for breakfast, bagel for lunch and pasta for dinner it was observed that there was no protein in their diet. It was believed that the lack of protein was contributing to the poor results.

A low protein, high carbohydrate diet potentially has negatives on two fronts. One, carbohydrates essentially convert to sugars which can fuel the insulin resistance cycle and hormonal disturbances (not only in women with PCOS, 1) but proteins are the building blocks of the body – and hence our eggs. If we are missing out on them, it makes it harder for the supercharged process our ovaries are going through to make high quality eggs.

120 of these women were split into two groups, one group who ate over 25% of their diet as protein and the other that ate under 25%. They had three outcome measures: 1. Blastocyst formation (that is the embryo could make it to day 5) 2. Clinical pregnancy rates and 3. Take home baby rates

Here are the results

Protein vs Carbohydrate success rates — Blastocyst formation, clinical pregnancy rate and live birth rate for women who ate under and over 25% protein in their diet respectively

My excel spreadsheet skills aside, you can see that those women that had over 25% protein had higher rates of blastocyst formation, higher rates of clinical pregnancy and higher rates of a take home baby. Much higher rates. And with the statistical p values ranging from .002 to .0005 there is only quite a small chance that these results were due to coincidence.

BEFORE YOU START THE ATKINS DIET

Have you heard of the Atkins diet? It’s that one that says to eat ONLY meat effectively letting your body go into ketosis to burn lots of fat.

We don’t want that. Eating before going into IVF shouldn’t be about a going on a particular fad diet and if you are just about to start a cycle the goal isn’t to lose weight. You don’t want to shock your body or do anything like that. Eating sensibly is the goal. Additionally, it takes 3 months for an egg to form so any dietary changes that you are doing to increase egg quality should be done this far out from your planned IVF cycle.

THE ISSUE OF PLANT PROTEIN

If you have read The Fertility Diet you would know that not all proteins are considered equal and they recommend eating plant protein over animal protein.

They go as far as to say if you add animal protein instead of carbohydrates this causes even more disruption to normal ovulation.

Salmon. It's a protein so the picture is kind of relevant. Did you know farmed salmon has higher content than wild? I'd still stick with wild though. — Salmon. Not only is it a good source of protein but also of omega 3, win, win.

But combining these two pieces of research and eating 25% of your diet in plant proteins is HARD. I’ve been trying to do it for awhile now and it seems to be impossible. Unless it seems you eat a ton of eggs (one serving a day of fish and eggs didn’t influence ovulatory functioning apparently) and effectively cut out grains and potatoes, but then that seems like too much of a fad diet to me. There must be a happy medium.

And for me, that is sticking as close as possible to the 25% protein intake and eating as much plant proteins as possibly but inevitably there is a bit of animal protein in there as well. Also, we have to remember that The Fertility Diet is for women who wish to conceive naturally . For women doing IVF that dream has long sailed. So in my opinion, The Fertility Diet is not always going to be relevant to women doing IVF and I think it is more important to make sure you get proteins in, while following those rules of not eating too much red meat and avoiding the transfats that meat contains as much as possible.

Dairy products also contains a healthy amount of proteins. Some women would have heard that dairy is one of those inflammatory foods that should be avoided during IVF. Personally, I have not seen enough research to validate this claim and believe that dairy foods should be one of those things consumed in moderation. Or maybe its just that I love cheese too much. If you have ovulatory dysfunction as your reason for all this mess, when I say ‘mess’, I mean infertility and everything that comes after, The Fertility Diet recommends full fat varieties citing that the process of producing the skim milk and making it look creamier adds substances that disrupts hormonal and ovulatory functioning.

High Protein. Low carbohydrate. Plant based. Tick, tick, tick!

Oh, and just lastly, if you have access to Lupin Flakes, these bad boys are a whopping 40% protein. That’s pretty high for a plant based protein that is also gluten and soy free. You can use them as a breakfast cereal, make it up to be like a cous cous, a substitute for breadcrumbs, the list goes on. Check out their facebook page for details.

THE MAIN POINTS

Try and eat 25% of your diet as protein – there are free apps around that you can download onto your phone to help you monitor this. They are way easier and quicker to use than what you think. At the moment I’m using ‘My Fitness Pal’.

When increasing protein, try and make it a plant based protein (or at least not traditional meat type protein all the time). This includes fish (but remember to eat the right type of fish to avoid mercury), eggs, lentils, beans and peas.

Cheese and dairy is also high in protein (make sure the added sugar, such as in yoghurts is kept low).

Don’t make it a faddy diet and don’t lose too much weight with it (unless of course your doctor has advised you to).

Most importantly, if you are looking to make major changes to your diet make sure you consult a qualified dietitian before doing so. We all have different medical needs and histories and what is going to benefit one woman may not benefit another.

Well, I hope that is all just a little bit clearer than mud. Good Luck!

P.S If you have liked this article don’t forget to download your free guide to find 19 different ways that are easy to action that will hopefully improve your egg quality, implantation and ultimately IVF success.

References:

Chavarro, J. & Willett, W. 2009. The Fertility Diet. McGraw Hill
Johnson, Kate (2013). Low Carb Diet Improves In Vitro Fertilisation. www.medscape.com

Is this the elusive IVF alternative?

Get your free guide with 19 evidence based ways to improve your chances of IVF success

Whether it is because of religious reasons, ethical reasons or the cost, for some women doing round after round of IVF is not really an option. And even if that is an option, if there is an IVF alternative that doesn’t involve shelling out thousands of dollars, an egg collection and the minefield that is growing embryos, you’re in, right?

That’s why when I came across NaProTECHNOLOGY I had to have a second look. I mean, all of the above PLUS apparently it has comparable rates to IVF… winning!

What is NaProTECHNOLOGY?

NaProTECHNOLOGY stands for Natural Procreative Technology and from now on I am just going to refer to it as ‘NaPro’. It was developed with support from the Catholic Church as a method of treating infertility and one of its key features is its very detailed diagnostic process in order to identify abnormalities in the reproductive system. Knowing it has been advocated for by the Catholic Church can give you some idea regarding the foundations and practices of this technology. And if you are adverse to Catholicism, don’t let this put you off just yet.

NaPro considers infertility as a symptom of an underlying condition or disease and not the actual disease itself. Through a prolonged period of tracking and monitoring it aims to identify exactly what is wrong in the ovulatory and reproductive cycle. Once these abnormalities are identified, where possible they are corrected, either by surgery or medication. Abnormalities commonly identiﬁed include decreased production of estrogenic cervical mucus, irregular bleeding or spotting, short or variable luteal phases, and low levels of estrogen and progesterone (1). Common treatments include clomiphene (also known as Clomid), support of luteal hormonal production with HCG or progesterone, and medications to enhance cervical mucus production. By ‘fixing’ these abnormalities and causes of infertility either through hormone support or surgery, it is believed that conception can then ‘naturally’ occur.

NaPro goes hand in hand with the Creighton Model FertilityCare System (CrMS) which essentially uses methods of observing and documenting cervical mucous to identify when ovulation occurs as well as identify abnormalities with ovulatory functioning. But before you start thinking it, CrMS is SO much more standardised and complex than just determining ‘egg white’ or not and extensive training is given to women who have been recommended to use this method.

From what I have learned from women who have used NaPro, the diagnostic process is much more thorough than that of the traditional IVF journey. Although it uses much of the same technology as IVF, such as regular blood tests, laparoscopy and ultrasounds, the monitoring of your cycle is done on a much more frequent process in order to accurately identify when ovulation is going to occur and make sure that the hormonal environment is ideal. For example, in a tracking cycle instead of having bloods on day 7 and then again on day 14 when ovulation is meant to occur, you might actually have blood tests and/ or ultrasounds every couple of days throughout your cycle.

The above is just a very short explanation of what I understand NaPro to be. If you would like more detailed information you might find it useful to check out the founder of NaPro, Dr Hilgers, book on NaPro.

Success Rates

Like IVF, the success rates of NaPro will alter with diagnosis. For a woman who has low estrogen and a cervical mucous problem, she will have a much higher chance of success than the couple with a very low sperm count (though the NaPro website does state that even couples with significant male factor infertility can have success with NaPro).

From the research I have done, I have seen only one large study done investigating NaPro (1). This 2008 study followed 1072 women over a period of 3 years after they commenced NaPro.

What they found was that after 12 months on the NaPro system 26% of women had successfully conceived and after 24 months 33% of women had conceived. For an extra year, only 1% extra of women had conceived, with a cumulative rate of 34%.

But as any woman who has experienced the pain of a miscarriage will tell you, the real thing that matters is that ‘take home baby’ rate. After 24 months of NaPro fertility treatment 26% of women were able to have a live birth.

It should be noted that the above data is ‘crude’ proportions and numbers. That is, the numbers I have reported is what actually happened in the study. Because of things like dropout rates and other factors, the authors believe that ‘adjusted’ proportions can be calculated, but again, certain assumptions are made to calculate these rates and caution should be maintained when reading these inflated success rates.

Interestingly another, much smaller study was done in a Canadian Clinic (2). Only 108 women took part however, after 24 months the live birth rate was higher (38% vs 26%) as well as the number of conceptions (47% vs 33%). While the average female age was similar in both studies, the average length of time that couples tried to conceive before starting NaPro was much longer in the larger study (5.6 years vs 3.2 years) and many more women (33% vs 8%) had been trying to conceive using traditional fertility treatments in the larger study.

So who is NaPro for?

From the above data it seems that women who have not previously trialed traditional fertility treatments were more likely to succeed using NaPro. It’s not necessarily the fact that these women have tried IVF (or similar) that makes the success rates lower but if the reason for fertility was going to be ‘easy’ to resolve it would likely to have been resolved at the fertility clinic and she wouldn’t have even looked at NaPro.

The average age of the women who were able to conceive was 35 years, though like IVF, these ages varied and well, we do know that the younger the eggs the better.

I have also read that you should be prepared for the NaPro journey to take around two years, which does seem like a long time, though for a lot of women IVF can take just as long and a lot longer. So if patience isn’t your strong suit this is worth considering.

Although NaPro does not involve egg collection or creation of embryos in the lab it still utilises medications and science and is not altogether ‘natural’. For example, if you are diagnosed as having an estrogen deficiency you will likely take the same injectable medications that you would take during a normal IVF cycle to increase this. So if this is why you would like to use NaPro than it probably doesn’t have much advantage over IVF. Though to be fair, presumably you would use less of the medication as you are aiming to produce one egg every month, not the ten or so you would be aiming for (maybe) on a standard IVF cycle.

Regardless though, of how long you have been on your ‘journey’ or how old you are, if you are looking for an alternative to IVF it might be worth further investigation. After all, what can another appointment matter!?

What I like about NaPro

There are two main things I like about NaPro:

As the NaPro literature states IVF ‘bypasses’ what is abnormal with the reproductive system and instead of treating that abnormality uses the egg collection and embryo creation process to provide a ‘fix’ to that abnormality. Some say IVF is like putting a bandaid over the problem (though I still think that if that bandaid is going to get you your take home baby that is a good thing right?)
As the diagnostic process is SO detailed according to the 2008 study, the ‘diagnosis’ of ‘unexplained’ infertility is pretty much eliminated. In my mind, if you are experiencing infertility there must be a reason for it. ‘Unexplained’ just means that they haven’t found that reason, not that it doesn’t exist. NaPro through its thorough diagnostic process takes the time to work out exactly what this problem is.

Questions I still have with NaPro

The research still seems to be limited on NaPro, and from what I have seen a fair proportion of the information provided is from Dr Hilgers in his book (who created NaPro and therefore, in my opinion, has an invested interest) or by groups of the same people. Like all fertility treatments it would be beneficial for it to be studied by a wider community from a variety of geographical locations and ethical approaches.

The success rates on NaPro websites seem higher than the success rates in the articles I have read. I know, there are always different ways to interpret research and well, we shouldn’t judge on this alone, as fertility clinics can be some of the worst culprits at producing misleading success rates.

Ok, this is a really soft reason and totally judgemental but the NaPro website looks a little outdated (I know right, pot, kettle, black!). But if I’m going to spend two of my dwindling fertile years investing into a system, I would want to know that that system is a professional team, that reinvests back into its self and cares enough to present it’s best self. If they can’t update their website, does that mean they can’t stay on top of fertility technological advancements as well?!

In summary

If you have religious or ethical beliefs and IVF does not sit well with you NaPro might very well be worth considering. Be cautious though and read up on it as depending on your medical diagnosis the success rates may vary and IVF be more likely to lead to that take home baby.

Additionally, if you have been down the IVF route too many times than you care to remember and still have been diagnosed as ‘unexplained’. NaPro may also be worth a try. After NaPro intervention only .5% of women have the ‘unexplained’ diagnosis (1) which does seem a lot lower than many of the women undergoing normal IVF.

I am not sure if I would use NaPro, maybe I would have if I came across it at the beginning of my ‘journey’. Or maybe I still would have been too impatient and had more faith in the IVF crew. Who knows. Although it does seem promising for a certain group of people, like all fertility treatments, there is no ‘one size fits all’ and careful consideration is needed to determine if this will be the right one for you.

Reference:

Stanford, J., Parnell, T. and Boyle, C. (2008) Outcomes From Treatment of Infertility With Natural Procreative Technology in an Irish General Practice. The Journal of the American Board of Family Medicine. 21(5) 375 – 384.

Tham, E., Schliep, K. & Standford, J. (2012). Natural procreative technology for infertility and recurrent miscarriage: Outcomes in a Canadian family practice. Canadian Family Physician 58:e267-74

Decrease stress during IVF with this quick, easy strategy (and early research also links it to increased success rates!)

It seems that everyone has an opinion about IVF, stress and the impact stress has on success rates.

I’ve both led guided relaxation sessions in my professional life as an allied health professional and tried to find the time to fit them in during my personal life. Whilst I believe that the evidence is still mixed on the direct impact it has on IVF success rates (see the IVF guide for details) I think it remains unanimous that the lower our stress levels the better.

Regardless of whether or not stress has a direct impact on IVF success rates (because lets be honest, that is what we really care about), over time it can have serious health consequences such as raised blood pressure, adrenal dysfunction and ulcers.

So what is the answer

Women undergoing IVF have both psychological and physical reasons to feel stressed. Granted, not everyone has PCOS, but I once read an article that reported women with PCOS are more likely to have anxiety and depression IRRESPECTIVE of whether or not they were trying to conceive. What this means is that regardless of whether or not you have the added worry associated with IVF and infertility just the very fact that you have PCOS means that there is a biochemical function happening that means you are more susceptible to anxiety and depression.

That is where mindfulness comes into it. Mindfulness seems to be a bit of a buzz word at the moment and with good reason.

There are many articles documenting mindfulness and its ability to reduce stress in a variety of patient groups. One study has even researched the direct link between mindfulness and IVF success rates:

This study, only just published in 2016 (1), looked at the outcomes of 108 women in China undergoing their first IVF cycle. Dividing these women into two groups, one group (50 women) became the ‘experimental group’ and voluntarily attended mindfulness classes every Saturday or Sunday for 2 hours for six weeks. The other group became the control group and they did not attend any classes but instead just continued on with their IVF as normal. What they found was that as well as reporting improvements in measures of self compassion, coping strategies and a whole other host of areas women who practiced mindfulness also had an increase in clinical pregnancy rates . What they found was that women who participated in the mindfulness activities, 44% became pregnant in that cycle and the women who did practice mindfulness 26% became pregnant (p = .04).

Granted there are a few factors to consider here :

are the women who would volunteer to do mindfulness more likely to be those that have the predisposition and health attitudes that might favor pregnancy regardless?
is it that mindfulness improves sleep patterns and that is what improved the pregnancy rates
it is quite a small sample size
what if the control group participated in another form of intervention such as guided relaxation or counseling – would there still be the marked differences in pregnancy rates?

Although these questions exist, ultimately there is minimal expense to you, no side effects and a lot to gain. It is still promising stuff.

But not all of us can take part in mindfulness programs run through their fertility center (can anybody?!?)

That’s why we need to take control of our own risk factors and implement the practices of mindfulness where we can.

Not only can you practice mindfulness ‘on the go’, sitting waiting for an appointment or even when brushing your teeth it can be practiced in all different sorts of ways and there is generally something for everyone.

So what is it?

There is loads of information on mindfulness out there so I will keep it quick. Mindfulness at its most raw form is simply being present in the moment. It is not worrying about what those results you will get at 2pm are going to bring, nor is it worrying about getting time off work next week for egg pickup. It is not feeling guilty that you had that extra glass of wine last night or anxious about your best friends baby shower coming up. Whilst it is undeniable that these thoughts are going to enter your mind, the trick is to let them enter your mind, acknowledge that you have had them and then without judgement or guilt simply bring your mind back to the present. And best of all it can take as little or as long as you like!

Yes. It sounds pretty simple. And yes, obviously there is much more to mindfulness activities then what will fit into a blog post short enough for you to read.

But just try this.

Things are always better when you try it for yourself. Assuming you are not driving a car or something equally dangerous that requires your attention, just stay sitting where you are now.

You can spend as little or as much time doing the above exercise. The idea is just to get used to slowing your mind down. The breathing exercise that follows can be done whenever you are feeling stressed or anxious or need to just take a minute. I do this exercise every night as I am trying to fall asleep.

Breathing is an important foundation skill you need to have to practice mindfulness and requires practice and shouldn’t be rushed.

See? It works doesn’t it? Do you feel a sense of calmness that you didn’t have before? Refreshed even? It’s not the magical cure but it certainly helps to break tension that you are feeling and break the cycle of those ruminating, often negative, thoughts that just keep going over and over in your mind.

The whole goal of mindfulness is to give yourself a bit of a break. Just pay attention to the moment and live only in that one moment.

Mindfulness is a skill that gets easier the more you do it. Try to spend just a few minutes at first every day practicing it. So tonight when you are in bed, mind racing as you try to calculate ‘if I get pregnant at my next cycle, when does that mean I can go on maternity leave?’ try just breathing. Just lay there. Be in the moment and enjoy the relief.