Self-care coaching for fertility patients

Yes, everybody asked me this. The short answer is if you’re at either extreme of weight, incredibly underweight or in one of the class 2-3 obesity categories, it can be detrimental to both achieving a pregnancy, carrying a pregnancy to term and the size of your baby. If you are in an extreme category, then it would help to move a little bit more towards the middle in terms of the normal, overweight or the lower of the obesity classes. There have been a couple of studies now actually done in Europe and their longitudinal studies where they look at people over time, people who had been told they had obesity and in order to go through a treatment they needed to lose weight quickly. When those people lost weight really quickly (they did it in an unhealthy way), changing their outside wasn’t enough to change their inside. As a result, their pregnancy rates and their babies’ weight were not that much better than those who didn’t end up losing the weight. Use some of the habits we talked about to get more towards the middle. Of course, you want to get to the lowest sustainable weight that you can do but not if it means rash dieting because then what that does is it changes the metabolic picture in your body. It makes your body think it’s under stress. It’s starved, it’s deprived and that’s not the state you want your body to be and when you’re attempting pregnancy.

I would say the regular movement. I see a question there on thoughts about running, an exercise during pregnancy. I’m a runner. I have kids and it was very difficult for me too and I struggled with infertility. I was a runner before, that was my form of stress release. Then I was told by my doctor once I get pregnant to not run because it’s shunting the blood away from the body. I do know people who are marathon runners, very dedicated nurses who do run those distances during pregnancy but they do it against medical advice. It doesn’t mean that issues with running are mostly theoretical; you’re shunting the blood away from the uterus but there still should be some sort of movement. It doesn’t matter what type. The movement should precede the pregnancy. Whatever you were doing before, you should be able to maintain but maybe just at a different level of intensity. You do not want to be starting the hardcore exercise program once you’re pregnant. I give people a couple of large muscle exercises to do: planks because you’re using the core in the back and then squats, like wall-sits, because you’re using the big muscles and legs just to get those muscles fired up and increase the metabolism. Those you can do. You shouldn’t be doing anything to lay on your back. In terms of sleep, get your sleep now. The poor quality sleep skews your hormones a lot, not just the hunger and satiety hormones but your reproductive hormones theoretically. Getting great quality sleep really can help with insulin sensitivity or reducing your insulin resistance which can be detrimental. Then working on some of those stress-free strategies that we’ll probably talk a little bit more about. If you’re a bike rider, it’s okay to ride a bike. The issue with riding the bike is, once you are pregnant and are a little bit bigger, your center of gravity can change, you can become a little bit wobbly on the bike and then it becomes a safety issue. Here I mean a real bike not stationary bike. There is the potential of falling off even when you’ve never fallen off before. It is just a little bit more difficult to keep that weight balanced. If you rode a bike before, you can continue to ride a bike once you get a little bit bigger. Your doctor or clinician might recommend a stationary bike. Also, you don’t want to let your temperature get too hot. The temperature often changes in terms of what your OB allows. Some of the OBS have a lower threshold but you don’t want to get too much heat. Often when people go through infertility treatment, you’ve had a long road right by the time that you’re able to achieve a pregnancy. Hopefully, it’s short for many people, it’s longer than they wanted it to be. What we don’t want as nurses and as the people taking care of you is if there’s any kind of issue challenge the pregnancy, worst-case scenario, a pregnancy loss, even if we didn’t attribute it to the running or to whatever it is that the person is asking to do (people ask for all different kinds of things) we just don’t want you to look back. You shouldn’t be saying “I shouldn’t have done XYZ.” Some of it is for peace of mind. If you were not going through the fertility journey your OB might say “great” because you wouldn’t then go back and blame yourself and say “why did I have to do that one thing”. If you feel comfortable doing it and your OB is comfortable with it together and it becomes an educated decision, very intentional and you feel that the benefits of running outweigh the possible risk and the possible mental risk, then I think that would be a personal decision but it would be the right one for you.

This is the part that I love and I can probably adjust the acupuncture question a little bit. I love acupuncture as long as the acupuncture provider is somebody that is well versed in women’s health and reproductive health. There are certain acupuncture points that can cause uterine stimulation. Obviously we do not want these, we don’t want uterine contraction or stimulation. Acupuncture, acupressure, reflexology, a lot of them work on the idea that our emotions are energy, they’re vibrations in our body. Ideally, we want these vibrations to be able to flow easily and not have any blockages. A lot of times something causes a blockage and this is more of an Eastern medicine principle but there are meridians, channels, through which the vibration flows. By unblocking these channels which can be done in a couple of different ways, you might have the energy flow, increase your vibration, experience good feelings of well-being and expansiveness, the opposite of contracting. By doing that it makes you much more resilient, both mentally and physically, to deal with infertility treatments and to be able to achieve a pregnancy. I think acupuncture is great. I’ve seen with reflexology they need to be having knowledge of reproductive health so they’re not hitting those other points. The other thing is tapping, EFT. EFT is a way of just getting the acupressure, the meridian points at their beginning and end. There are eight acupressure points, karate chop points. As you tap these points, you’re saying “even though I am worried about my infertility treatment I choose to love and accept myself.” Then you would do these points in these three places. EFT is another great way if you have acupuncture to keep those acupressure points up, expanded and open. I also love journaling. It is great. I gets the crazy out of your head and onto a piece of paper. I also tell people when they go with fertility treatments because of that feeling of lack to keep something called an achievement journal or achievement diary. I know a lot of people who know about gratitude diaries and I think gratitude is amazing. But I want people who have this sense of “nothing’s working for me, I can’t do anything right” to feel a sense of achievement. You can use a calendar that has a couple of lines. Make a couple of bullet points and write down what you did that day, as little or as big as it was. It could be “I got stopped at every red light and I didn’t lose my mind”, “I wanted to react this way and I didn’t”, “I was able to turn my phone off or notifications off and I was able to work on this project fully through for an hour and a half or really do some deep work”. The achievement journal does two things: one is that you can go look back on all the things you did throughout the day; the other thing is it prepares your mind to write in the journal as you go about the day. It allows you to see these little things that maybe you didn’t see as a big deal before as being an achievement. In terms of the tips and techniques to getting good quality sleep, sleeping in a room between 68-72°F (20-22°C) would be really helpful. Cold room, dark if you want is best. If you’re too cold, you can put a warm blanket at your feet and it will keep your core cooler. Doing the achievement journal at night or having a piece of paper and a pencil at night where you can write everything down (so called brain dump), helps to get it all out of your system. When you wake up in the middle of the night, you don’t have other things to think about because you already wrote them down. Also, you should not be doing stuff in bed other than sleeping. If you need to read to go to sleep, then read and go to sleep. I have people that wake up at 3 or 4 in the morning and they cannot go back to sleep. They stay in bed and start to panic. If you can’t sleep and it’s been a couple of minutes to get out of bed to go to the other room, get a book, a cup of tea or do something that makes you sleepy. Then as soon as you start to get sleepy, go back to bed because you’re strengthening that muscle in your mind that makes you realize that your bed is for sleep. That way when you wake up your body will recognize the bed is for sleep, this is what I’m supposed to be doing. I’m not supposed to be checking my computer. In terms of electronics, this is something that I tell a lot of people and nobody likes me. You should not have electronics on about an hour before you sleep. It’s not only the stimulation. It’s the blue light that stimulates substances like adrenaline, epinephrine, etc. they can keep you up. If you want to read, you should read an actual book, newspaper, magazine if that helps you get sleepy. Any electronics start to shut you down if you use them. If you watch TV, I’d love for the TV to be not in your room. When you’re watching TV and as you start to get sleepy, turn the TV off and go to your room to bed. Watching TV in bed or falling asleep with it the background is conditioning your body to not see your bed as your respite, oasis, as a place where you sleep. It’s just like you don’t sit at the dinner table waiting to be hungry. You get at the dinner table once you are already hungry or once dinner’s prepared. I hope that helps.

The breathing I had mentioned before, the breathing techniques. I do love the tapping as well. There are some apps that I recommend. There are lots of free ones for Coronavirus and then if you want specific ones, they actually have one on attempting to conceive which is great. As for tapping, if you do an affirmation “I am great, I am strong, I am healthy” but they don’t feel real to you, the tapping tells the part of your brain that this is the alarm to calm down. There are affirmations, mantras, things that you’re saying to yourself to really mean something. The other app that I like is Insight Timer that has a ton of free meditations. It is the largest free library of meditations and I love that they have these mini-meditations so if you only have five minutes, you go for the one that’s five minutes. If you want a certain teacher, go to that certain teacher. If you want a certain topic, you go to that certain topic. There’s also an app called Fertile Calm. It was actually made by a friend of mine who is a psychologist who specializes in infertility. There are other apps like Calm that are good. I think you’d be surprised about the tapping. I’m just getting certified with that. The results are impressive with weight control and cravings because it’s one of those things that you don’t need to know how it works for it to work. One of the questions is how to deal with feelings of frustration. One of the ways that people feel frustrated is that the boundaries are being crossed. If the person that is crossing the boundary doesn’t know you have that boundary, then you need to tell them. If they know you have the boundary and they repeatedly cross it, that’s a different conversation. You give them a couple of chances and remind them that you talked about this. That feeling of helplessness is what often causes a feeling of frustration. I showed you a slide of the continuum. It’s okay to say “I’m feeling incredibly frustrated” but I choose to love and honour myself, I choose to see myself as this, etc. I also tell people to do something that makes them feel that they can accomplish it quickly. This could be decluttering your cabinet or home, or changing around your refrigerator or pantry, putting things into sections. I always tell people to make a little space in your pantry/refrigerator that’s just for you, that has all of your healthy stuff in it. That little act gives you a sense of accomplishment and has a positive connotation. Also, connecting with people who are also going through this can make a big difference. Giving yourself sitting with that feeling of frustration and not feeling like you’re not supposed to have it. It’s very difficult to sit with the feeling. Usually, we want to repress it, ruminate on it. Sometimes it’s okay just to sit there and think “I’m frustrated right now” and if you just allow it, it will go through. It may take a little bit longer than 90 seconds because it’s been sitting in there. It may be associated with some other story but if you let go of the story and just allow yourself to have that feeling, then you can look at your accomplishment journal and look at all the things that you actually do well. If you say to yourself “I can’t do anything right. Nothing ever works for me.” it becomes this all-or-nothing mentality. We can’t help it. We’re frustrated. Then you need to find evidence to the contrary and that would be in your success or achievement journal. There are a couple of other interventions that take time and practice. I work with people a lot about their inner voice but it takes practice. It’s not something that you can do quickly but it is something that you can do over time.

I have covered that in my slides. I do think that the most comforting thing and the easiest thing is to assume positive intent, assume no one’s being malicious, assume that person thinks they’re being helpful. That really helps because as soon as you see your mother-in-law coming, you might feel anxiety or stress, but if you think to yourself she’s doing the best that she can, she feels helpless and powerless – this is how she thinks she’s helping. First of all, this doesn’t mean that you should not set boundaries with her and it doesn’t mean she’s not going to like the boundaries. But I still think that’s incredibly important. Don’t assume. It’s what we make stuff mean. If you feel that somebody ignoring your text is disrespectful, you’re making it mean. But in actuality, that person might have been busy. Then you are getting upset about something that was not that person’s intention. Assuming positive intent can really make a difference. Try to stop and acknowledge what you are thinking right now, what you are feeling, what is the story you’re telling yourself. A lot of them are programmed for us from childhood. The other thing is that we have been told that if you work really hard at a goal, you get it. So you practice the sport, you get good at the sport, you eat really well and you exercise, you can be a little bit more fit, you study hard at school, you get a good grade. You can study all you want about fertility treatments and it may happen or not. You can do all that you can to do it and you still might not achieve pregnancy as early as you like. But that doesn’t mean the fault is with you. It doesn’t mean that you are lacking so don’t make it mean that. Realize, when it comes to others, that they mean well but you may have to unfollow some people on social media. Maybe their stuff is annoying, maybe somebody’s always posting stuff about baby showers. You are at that age where you’re going to people’s baby showers but you don’t want to see it all the time. You don’t want to see everybody’s back-to-school pictures. There was a gentleman that I was talking to when I did male factor infertility talk. He said that having infertility feels like not having a date on Valentine’s Day 365 days of the year. No one understands that unless somebody’s gone through it. They’re trying to do their best but you still need to protect yourself and your energy. Don’t let somebody else take away that energy from you. You don’t give them that power. However, it takes a lot of time and practice.

My perspective is always to eat food as opposed to taking supplements whenever possible. There’s something about the way that the food is packaged, whether it’s in a cell membrane that makes your body digest it and use it better than taking a supplement. If you don’t like fatty fish (tuna or sardines), then you might need Omega-3 oils. I think Omega-3 fatty acids are really important. I prefer that people eat them as opposed to taking them as a supplement but if you are not somebody that likes fatty fish, take Omega-3. I think you should get your vitamin D tested. Vitamin D is actually a hormone, not a vitamin. It’s produced in one part of the body and used in all the other parts: in the ovaries, the uterus, the testes. Many people’s vitamin D levels are low and vitamin D is an easy supplement to take. There is some literature on CoQ10. It can help make the energy generator of the cell, which is important for cell division which is basically what reproduction is, act more efficiently. For some people, if they’re deficient in CoQ10, taking it can help. However, it really only helps if you’re deficient in it. You cannot be tested for CoQ10. Some infertility centers are putting everybody on it and some infertility centers are only putting certain people on it. I would ask them what the level is that they want you to be on. For some people, it’s like 300 a day, for some people it is 300 twice a day. Ask your clinic if it’s applicable to you and if they would like you to do it. It has mostly been shown in animal studies to be helpful but it hasn’t been shown to be harmful in any way to humans. I would just double-check that that’s what your clinician would want for you.

It is hard and a lot of people feel that way. It’s very difficult to make a big change in a vacuum. You can’t live with somebody when you’re the one that makes the change. As a nurse, a lot of male partners will say to me “what can I do? I feel so helpless and powerless. She’s doing everything and I control the finances but otherwise, there’s nothing else to do.” You can say to them “I want to talk to you because I am getting ready to go through this journey. I’ve been told that making a couple of these changes can really give us a better and quicker outcome, make me have a healthier pregnancy, a healthier baby of good weight, less of a chance of C-section, etc. It’s going to be very difficult for me to do this on my own. Is this something that you would do with me?” Make it very clear that it’s for both of you and if you have a partner who says that they feel powerless, this is something that they can do. They can be all in on this with you so that you’re not making this one change by yourself.

Sometimes I can get this to happen in a couple of situations, sometimes I can only get it to happen with just a male group. When I have just a male group, I often have a male facilitator with me. In the first session, I don’t even try to get into this because no one’s willing to talk about it. Sometimes by the second or third sessions, one person in the group will bring up how they feel. For a lot of men they feel like they are not the patient as well. The clinic staff barely sees them, they don’t really contact them, they get a semen analysis done and then their wife gets the results for a lot of places. Men feel like they are persona non grata. If there’s any percent of chance that there is a male factor (which is almost 40%), there’s guilt, there’s shame, then there’s the powerlessness. They want to have a family but they also see their partner being upset and they feel powerless. Men have to be willing to do it. They have to understand it. It is best when they have a male counterpart or somebody that’s going through this to talk to them. It’s almost better with a group with couples. But a lot of times when men are just with other men, they open up quicker. They say “do you believe my wife wants me to do this? She shows her stick and says ‘I’m ready, it’s time’ and I can’t produce like that.” This will bring out the deeper feelings that are underlying these behaviors. Try to find a good support group that is for men. A lot of mental health professionals starting to have the men groups that are facilitated or led by men. In my opinion and with my experience these are the ones that really get to that.

You have reasons to be stressed. One psychologist says that when people come to her for therapy the one thing that she wants to make sure is whether the person really needs therapy or is just in a difficult situation and surrounded by negative people. You are in a stressful situation. Your story is “it’s not going to work, it never works.” I’d be the same way so I completely understand. There’s your story, your perspective, your bias is “this isn’t going to work” because it hasn’t been for so many cycles for you. Statistically and theoretically speaking, without knowing your medical condition or your chance of conceiving with a donor cycle and a carrier the chance should be pretty high, especially if you end up using pre genetic screening which is an additional expense. When it feels like too much, and it can, you can use the stress techniques. What you need to do is think of “what do I need to do at this moment, at this particular time?” So at 3:00 in the morning there’s nothing to do, but that doesn’t work at 3:00 in the morning. This is going to take practice so that at 3:00 in the morning you get to that point. It looks like you did your research, then the next decision is when you’re looking for a surrogate is to ask yourself if you trust her, to look through her records, to talk to her on video communicator, do the genetic screening. Theoretically, the success rate of surrogacy with genetic screening is high but it’s not 100%. It might be 70-something percent in a good clinic but it’s not 100%. So it’s very good but it’s not a sure thing and that’s the hard part. The only thing that you can do is to take small steps, one at a time. Don’t attribute this to you, having something wrong with you. The problem is because of all this lack of control in this particular infertility setting, you are experiencing a lack of control in other ways. Then you might try to control all these things but some things you can’t control and you have to let go. Ask yourself: what is the next thing I need to do? I need to get up from this chair if I feel powerless. The next thing I can do, I need to walk into the kitchen and I’m going to go to this app. Create a nourishment menu. 5-10 things that make you happy. Some of them are going to be quick, they could be like a beautiful sunset. Some of them are going to be something that takes practice e.g. tapping. You do need to acknowledge “I feel stressed and out of control, I feel helpless, powerless, I feel these things but I don’t want it to be like this. This is never going to work for me. I am deficient. I am anything black & white.” If you start to get into this thought, sometimes calling it something helps. If you feel anxious, call this feeling a silly name e.g. googly goop. Then you can say “I’m having this thing that’s googly goop happen to me.” This helps take the level of intensity off of it. The thing with anxiety is, you can’t just fix anxiety. But you can name it, for example, Carol, and say: “Carol is telling me this isn’t going to happen again.” Making it into the third person separates it all away from you. Understand that the stuff that you have control over, you’re doing and you’re going to do it in small steps. The other stuff you have to leave up to fate to work. Some of this is a roll of dice. I’ve seen beautiful embryos that don’t result in pregnancy in the first cycle and not so beautiful embryos that end up in pregnancy in the second cycle. I can’t tell them why it happens. By doing this, you are going to really strengthen your inner part of you, your strengths that you already have. You are becoming aware of them and realizing how resilient you were to get up to 12 cycles to be able to do that and keep going with this. You are going to be your own safe place to land. You are going to be your own best advocate, your own best friend, therefore, if something else happens, it’s good that’s just icing on the cake. You have everything that you need inside you right now. Anybody else saying that something is going perfectly is just extra, it’s just topping. Because everything that you need, you have inside of you and this is going to be something that although you desire it, it doesn’t mean that you’re lacking because you haven’t had it yet and that’s a big difference. I hope that makes sense.