Dear Dr. Maslow,
We are going through infertility treatment and I’m overwhelmed by all the “advice” I’m receiving. Eat this, don’t eat this, rest and relax, no-go exercise, take these supplements, don’t take those, etc. There are so many instructions just from my doctor’s office! All of these additional pieces make me want to scream, but I feel like if I can’t do “all the things,” it means I don’t want a baby badly enough.
Lost in the journey
I’m so sorry that you’re feeling this way. Many well-meaning advice givers are trying to be helpful in a difficult situation. Each suggestion may seem simple enough…take this extra supplement, go for daily walks, and get weekly acupuncture. I’m sure you’ve heard it all.
I’m sure you’ve heard some version of these too:
“Might as well try it.”
“What’s the harm?”
“Every little bit can help!”
These can easily become a “death by a thousand cuts.” Seemingly little suggestions add up to greater and greater burdens. Additionally, while many come from a good place, it is often not backed by science.
I suggest sticking to the fundamental recommendations with solid data behind them—the ones your doctor probably suggested from the get-go.
1) A prenatal vitamin. And don’t stress about which one. The American College of Obstetricians and Gynecologists (ACOG) recommends any prenatal vitamin that contains at least 400 mcg of folic acid. Everything else is extra. Folic acid helps your baby’s neural tube (the area around the spinal cord and brainstem) form. It is best if the prenatal vitamin is started at least three months before pregnancy, but do not worry if you haven’t. Start the vitamin as soon as you can. And unless you have a history of a neural tube defect, no other forms or doses of folic acid (e.g., folate or methyl folate) are recommended or necessary.
2) Refrain from alcohol only after an IUI or embryo transfer. This means to refrain at times when you could potentially be pregnant. Any other time during your treatment an occasional glass of wine or alcoholic beverage is not harmful! Fertility medications and excessive alcohol are not a good mix, but unnecessary restriction can be a significant source of stress, which is also not beneficial!
3) Limit (not eliminate!) caffeine during times you may be pregnant. Studies have shown that moderate amounts of caffeine (3-4 servings per day) are safe even in early pregnancy. So enjoy your morning Joe minus the guilt!
4) Maintain a healthy but substantial diet. Restrictive diets can make you feel worse, and they may not contain enough calories to support the extra work your body is doing to get pregnant. No need to go overboard but do take in enough nutrition to feel full.
5) Continue an exercise regimen that is moderate for you. There is lots of evidence that exercise is beneficial for pregnancy and fertility. So, while in the past there were recommendations to entirely refrain from exercise (because “why risk it?”), this approach has largely been debunked. Don’t worry about keeping your heart rate in a particular zone, either. There is limited data to support this recommendation as well. Most importantly, listen to your body. This isn’t the time to push past pain or train for a new athletic achievement. Keep your body moving in a way that feels good—no need for less or more.
If you feel up for additional suggestions after the basics, go for it. But be wary of influencers trying to sell you supplements or programs. These are often not based on sound evidence and are meant to profit off the vulnerabilities and insecurities of couples undergoing infertility treatment. Sometimes vitamins and supplements can have unexpected side effects, too. Biotin, for example, can alter the results of hormonal blood work and compromise the way your doctor monitors your treatment. Additionally, “fertility supplements” or cocktails with complex ingredients can sometimes contain hormones that harm your chances of conceiving. Always consult with your doctor before starting something new.
Last but not least, sleep is the original mode of restoration. A recent study showed that restorative sleep was positively associated with IVF pregnancy rates. Granted, the stresses of infertility don’t always create an environment for great sleep. But I’d recommend prioritizing good old-fashioned sleep over any expensive complex supplements.
Most importantly, don’t let anyone convince you that choosing to decline additional supplements or activities is a reflection of your desire for a pregnancy or a measure of your future abilities as a parent. Setting good boundaries and protecting your peace are excellent practices for a fertility or parenthood journey.
Dr. Bat-Sheva L. Maslow, MD, MSCR, is a reproductive endocrinologist and an expert on the intersection of reproductive medicine and Jewish life. To schedule an appointment with her at Reproductive Medical Associates (RMA) of New Jersey’s Englewood or the brand-new Jersey City location, visit www.rmanetwork.com/NJ. If you are interested in inviting Dr. Maslow to speak in your community or to learn more about her educational projects, visit www.batshevamaslow.com and @blmaslowmd on Instagram.