What is Fertility Nutrition?

by Nicole Holovach, RD – Dietitian at Pulling Down the Moon 

Nicole Holovach, RD

Nicole Holovach, RD

Google “fertility nutrition” and you’ll get lots of articles and different perspectives. When I was trying to get pregnant, I dived into the research and have learned a lot about fertility nutrition over the years. Here’s a secret: it’s not that complicated! Among specific, individualized goals and recommendations, I focus on the following things with all my clients:

Attain a Healthy Weight

Many come to me wanting to lose weight per their doctors’ orders for IUI and IVF. This requires a lifestyle change for most and can take time. IUI and IVF shouldn’t be the end goal – having a healthy pregnancy and being a healthy mom should be. Fad diets and quick weight loss can deplete your body of the nutrients it needs for a healthy pregnancy. Nutritionists with a focus on fertility can help design a weight-loss plan that works for you.

 Get Enough Protein

Fresh baked Tilapia fish dinner with asparagus and Hollandaise sProtein is important for estrogen metabolism. Estrogen is mainly metabolized in the liver, where it’s made more water-soluble for excretion via urine and stool. Estrogen receptors in the liver are under the control of dietary protein. I tend to recommend a moderate protein intake of 25% of your daily calories. An easy way to make sure you’re getting enough? Include a concentrated protein source (at least 15g) at all of your meals – don’t skimp out at breakfast and lunch!

Get Enough Healthy Carbs

It’s easy to eat enough carbs, but are you eating the right kinds? Most people aren’t eating nearly enough fruits and vegetables. Adding at least one serving with every meal is a great initial goal. And yes, potatoes count! Then layer on other carbs like grains. Save the processed, packaged carbs like cookies, muffins, chips, bars, and cereals for special treats.

Add Fertility Foods

Common beet and carrots

Vitamin and mineral deficiencies have been associated with significantly high reproductive risks, including infertility. Supplements and synthetic multivitamins will never replace the synergistic nutrition found in real food. I do think there are some foods that history, culture, and research have proven to be beneficial for fertility. I work with clients to see if we can fit some of these foods into their diet.

Ready to get serious about fertility nutrition? Come see a registered dietitian nutritionist at Pulling Down the Moon. We have flexible hours at many Shady Grove Fertility locations and we provide you with documentation for potential health insurance reimbursement. Find more info at www.PullingDowntheMoon.com.

If you would like to schedule an appointment with a fertility specialist, please speak with one of our New Patient Liaisons at 877-971-7755.

 This article was submitted by a guest writer. The opinions expressed in the article do not necessarily represent the opinions of Shady Grove Fertility.

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Top 5 Reasons Why I Decided to Freeze My Eggs

Radell is a 34 year old entrepreneur living in the Washington, D.C. area. She happens to be single, and after a few years of contemplation, decided to freeze her eggs at Shady Grove Fertility. Following her decision to freeze and completing her egg freezing cycle, she had the desire to spread awareness about egg freezing by sharing insight and advice for women who are considering this option. Over the next few months, Radell will be writing blogs describing this experience from her point of view. 

Here are 5 reasons why I felt it was finally time to jump into the world of egg freezing:

#1 – I decided to put myself first in 2014.
As a woman, it is hard. Hard to look life in the eyes and put yourself first. I think we tend to give, give, give. We want to make sure everyone is happy and things are flowing smoothly. Therefore, recognizing that life was passing me by and things were not exactly as I had planned was hard to admit!

Somewhere in 2014 I got real with myself. I realized it was my time to do what I wanted, even if that meant going through non-traditional routes!

#2 – I stopped questioning my moments of clarity.
Not sure if it was the perfect storm or if it just happened overnight, but something happened when I turned 34. As I saw my birthday approaching this year, I felt like I had just turned 30. What happened to the last four years of my life? Are the 30s flying by more quickly than my 20s?

In those moments of self-reflection, it dawned on me that four more years might go by just as quickly. If that was to happen and I didn’t freeze my eggs when I had the chance, I would be devastated. In that moment, when I turned the big 3-4, I knew it was time. It was an internal awareness that I could no longer deny. It was a feeling and a sensation that I started trusting. Hard to explain to some people, but in the end, I couldn’t question it anymore. Sometimes when you know, you just know.

#3 – I wanted to buy time for myself.
There are some things in life we have no control over, sigh. Time happens to be one of them! But egg freezing, although at times seems controversial, might just be one of the powerful options that can freeze the frame.

What other opportunities provide us with the ability to press pause on the aging process?  There is a saying in life, that the only thing we can count on is change. I might add to that and say aging! Egg freezing seems to be able to do something that we are unable to do: stop time! At the end of the day, I want more time. That’s why I said yes.

#4 – I wanted to have the option to do things my way.
When I think about having children and a family, I still want things my way. I want to be able to carry children and have children that are my own. All of this might change in the future, but this is what I want. I understand in life there is no guarantee and the future is unpredictable, but that doesn’t mean we stop going after what we want.

Egg freezing gives me the opportunity to hold onto my own self interests. I am realistic that the journey will not be perfect, but I do believe it will be better than not trying at all.  And this is a better chance to be able to do things my way, as I continue to progress through the natural aging process.

#5 – Important, loving people were in my life, willing to support my decision.
Although this is the last item on my list, it might be one of the most important items.  Embracing the supportive people in your life is one of the best things you can do for yourself. I had two people – I should call them champions – which propelled me to freeze my eggs. A close family member and a highly respected friend both supported my decision, in different ways.

My family member really supported me emotionally through the process. This person guided me through and held my hand. I think without them I would not have been able to complete the process. It is a little bit of a scary, frozen tundra. Receiving that support meant more than I knew at the time.

The other person in my life was a close, business savvy friend. This is someone I respect when it comes to financial decisions, as well as life decisions. Therefore when I shared that I was truly contemplating egg freezing, surprisingly he was incredibly supportive.  He felt my reasons were well-formed and the financial commitment was reasonable.  Hearing this helped release my anxiety around the process. His opinion solidified my confidence around my decision to move forward.

I could go on and on about more reasons why, but that’s it in a nutshell! Overall, I lined up what it was I wanted out of my life. I started getting realistic with myself in terms of my age and relationship status. Next, I found two great friends to talk with about the process. Then I gave myself the green light to go on the egg freezing journey!

To learn more and to follow Radell’s story, fill out this form: Egg Freezing Information Request or call 1-877-411-9292.

What do you want to hear about next? Do you want to ask Radell questions about her process or decision to freeze or hear her speak at a live webcast or seminar? Take this brief survey.

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Extending Your Fertility Treatment: Frozen Embryo Transfers

Medical Contribution by Naveed Khan, M.D.

Dr. Naveed Khan

Dr. Naveed Khan of SGF’s Leesburg, VA office.

In the past decade, one of the greatest advancements in fertility treatment has been vitrification. Vitrification is a flash-freeze technology used for freezing eggs and embryos for the purpose of using them at a later date. While cryopreservation had existed to fulfill the same purpose for many years, the process frequently resulted in the formation of ice crystals in the eggs and embryos, often rendering them unusable. Vitrification’s flash-freeze technology, though, has remarkably advanced the freezing process and corrected earlier flaws. “One of the largest benefits of using vitrification has been increasing the success rates when using frozen embryo transfers (FET), as vitrification has doubled the ongoing pregnancy rate per embryo transfer in the past five years,” says Dr. Naveed Khan of Shady Grove Fertility’s Leesburg, Virginia office.

In order to undergo a frozen embryo transfer though, you must first perform a fresh in vitro fertilization (IVF) cycle. Oftentimes, there may be additional unused embryos from a  fresh cycle. This is where vitrification can be used to preserve the embryos for a later date and a patient can eventually return for a frozen embryo transfer cycle.

Who will utilize a frozen embryo transfer (FET)?

A frozen embryo transfer (FET) can be performed by any patient who has frozen leftover embryos from a fresh autologous IVF or donor egg cycle. The use of frozen embryos may come immediately following an unsuccessful fresh cycle, or, for patients who were successful with their fresh cycle, a FET can be used at a later date to have additional children.

What are the benefits of FET in comparison to performing another fresh (stimulated) cycle?

Cryopreservation

FET is often a good choice over completing another fresh IVF cycle when a patient has frozen embryos to use, as they have a lower cost (see the financial programs section below) and there is no need to have an egg retrieval. “Additionally, the date of the frozen embryo transfer is much more predictable than that of a fresh cycle, as you do not have to wait for the embryos to develop and mature. A FET cycle works much better in terms of planning around the transfer itself,” explains Dr. Khan.

What are the success rates for IVF with FET compared to that of a fresh cycle?

Growth ChartThe success rates for FETs have doubled in the past five years, with an ongoing pregnancy per embryo transfer rate equal to – or sometimes even greater than – that of fresh transfers. In 2013, women under 35 had a 51% ongoing pregnancy rate per frozen embryo transfer. In comparison in 2013, women under 35 had a 48% ongoing pregnancy rate per fresh embryo transfer. FET cycles had a slightly higher success rate than fresh cycles, which can happen due to the presence of more balanced hormones and the fact that only high-quality blastocyst-stage embryos are being used for FETs.

How long does a FET cycle take?

A patient will contact our office with her desire to begin a frozen cycle. Her records will be reviewed to ensure that her prescreening is up-to-date. This can include – but is not limited to – infectious disease bloodwork, pap smear, an updated mock embryo transfer (to accurately measure and map your uterine contours), consents, and an injection review.

Prior to the frozen cycle beginning, most patients will be on a cycle/month of oral contraceptives. Soon after, the patient will come in for their first monitoring appointment, which is a baseline evaluation before the medications are started. Patients will then begin sequential injections of estrogen to build the uterine lining. Mid-cycle, the patient will have to have a ‘lining check,’ to ensure that the uterine lining has thickened. Patients will then be instructed to add in progesterone. A frozen embryo transfer date will be confirmed and then the patient will return for her actual frozen transfer. Approximately two weeks after the transfer, the patient will have a blood pregnancy test (known as the beta hCG).


What types of medications are required for FETs?

“Unlike in a fresh IVF cycle, medications to stimulate the ovaries are not needed for a FET,” says Dr. Khan. “Instead, supplemental estrogen and progesterone are the chief medicinal components of a FET cycle.” Estrogen will be given in the form of an injection every three days to build the uterine lining. Progesterone will be administered in the form of an injection every day as instructed after the mid-cycle ‘lining check,’ to ensure that the uterine lining has thickened, increasing the chances of implantation for the embryo. The estrogen and progesterone supplements will continue to be taken through the point of the patient’s beta hCG, with the progesterone continuing for up to eight weeks after the hCG. Once the pregnancy is confirmed though, the progesterone is taken as a vaginal suppository instead of an injection.

What financial programs are available for FETs?

For patients who have frozen embryos available for transfer, they may be eligible for the Shady Grove Fertility Shared Risk Program for FET. Once a patient is approved for this program, they will pay a flat-fee and then receive unlimited FET cycles while in the program, for as many frozen embryos as that patient may have. They can only use embryos that were vitrified at Shady Grove Fertility though, not embryos from other locations. In terms of program completion, a patient has the following possible outcomes: she will have a successful pregnancy and delivery; she will withdraw from the program at any time and receive a full refund; or she will use all of the embryos that are available without conceiving and then receive a full refund as well.

What are additional benefits of FET cycles?

While FETs have been beneficial in increasing the chances of conception per egg retrieval (when including fresh and frozen embryo transfers), they have also helped to change the treatment process in other areas of reproductive medicine.

On a large scale, FETs have helped to widen the practice of elective single embryo transfer (eSET), resulting in safer singleton pregnancies. In the past, multiple embryos were often transferred because technology was not as strong and IVF was not as successful. “Advances in technology and the embryo culture environment have resulted in the ability for embryos to develop to the blastocyst stage, two days longer than in the past. As a result, embryologists can now more accurately identify which embryos have the highest quality, making possible the selection of a single embryo that is a likely candidate for success, which has significantly decreased the risk of a multiple pregnancy,” Dr. Khan states. “In conjunction with this, vitrification allows additional embryos to be safely preserved. So even in the event that an eSET cycle is unsuccessful, patients may have additional embryos available for future FETs and do not have to feel the need to transfer multiple embryos initially.”

Another lesser known benefit of FETs is the ability to freeze all of the embryos for a later transfer. This is commonly seen when patients are choosing to genetically test the embryos or when an increased progesterone level is found in the patient. SGF’s research team has extensively studied rising progesterone levels and their effect on the chances of a successful pregnancy. Studies have shown that women who have higher progesterone levels at the time of their ‘trigger shot’ before the egg retrieval have a decreased chance of implantation and pregnancy. Dr. Khan says, “As a result, women who are found to have these prematurely rising progesterone levels now have the option to freeze all of their embryos. This allows the progesterone to return to more normal levels, providing the embryo with the best possible environment for implantation.” This two-step process of freezing the embryos following the fresh IVF cycle and then transferring during a FET cycle will allow a patient to have the best chance for a successful pregnancy. While this option only impacts a small percentage of our IVF patients, it depicts yet another way in which this newer technology has helped to improve our patients’ chances of conception.

Frozen Embryo Transfers are Changing the Face of Fertility Treatment

Since the advent of vitrification technology, FET cycles have represented one of the most revolutionary changes in fertility treatment. These cycles provide patients with additional options, whether it’s because they have an unsuccessful cycle or because they want to come back in a few years to further grow their family. FET cycles can also be beneficial because they are easier to plan around and an additional egg retrieval will not be needed. Additionally, FETs have helped to increase the ability for patients to have singleton pregnancies through eSET or to provide the ‘freeze-all’ option for patients. In all of these instances, FETs represent a way to extend fertility treatment. Freezing or suspending these embryos in time preserves them at their current quality, providing patients with an optimal chance for future success.

For more information or to schedule an appointment with one of our physicians, please speak with one of our New Patient Liaisons by calling 888-761-1967.

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