Surviving the Two Week Wait

The ‘Two Week Wait’ is the term often used for those waiting to see if they are pregnant or not. This is usually after an embryo transfer or a fertility procedure such as IUI, or even timed intercourse. For those who have had an embryo transfer it is an odd state of being in limbo. You technically have an embryo inside you and have to act like you are pregnant, yet there is a chance you are not pregnant. It is no surprise that this Two Week Wait (TWW) drives so many women up the wall. I have created a list of things you could do to try and make the dreaded two week wait more manageable.

Create a morning routine.

Developing and forming a ritual helps calm the mind. This can be helpful during this anxious time. An example of a morning ritual that will help regulate your cortisol and promote general well-being can be something like

Wake up early

Do twenty minutes of stretching or yoga with sunlight exposure which is good for Vitamin D and regulating your body’s natural circadian rhythm

Journal or write down your thoughts and feelings

Make a nutritious protein rich breakfast

Start a new project

 Start a hobby or project to help get your mind off hyper focusing on every single thing you are feeling and googling to see if they could be signs or symptoms that you are pregnant.

Always thought yourself as a creative, take up water painting. Start learning a musical instrument. It will take your mind off anything fertility related for hours.

Perhaps you always wanted to set up a website. Start creating one on platforms such as Squarespace. Try to channel your overthinking into something productive.

Watch stand-up comedy

 Some people may binge watch to distract themselves. There is nothing wrong with that. Watch a lot of stand-up comedy, it is light and laughing is better for you than watching something heavy or emotional when you may already be feeling vulnerable.

Keep your hands busy

 Worry over what will happen may be an over-riding thought. Keeping your hands and mind busy may calm you down. Think old-school activities such as sewing, knitting, embroidery or garden. Listen to a good audiobook or podcast while keeping your hands busy might lull you into a sense of calmness.

Regulate your cortisol 

Try to avoid caffeine first thing in the morning on an empty stomach. Try to sleep early and wake-up early. This helps regulate your cortisol (stress hormone) and is good for fertility and general wellbeing

Reduce screentime

 I would strongly advise reducing screentime by keeping busy as much as you can. It is not uncommon for women during this period to go down rabbit holes or into the depths of Reddit Facebook group forums about testing early, what certain signs and symptoms mean etc. This can be triggering to some and introduce new worries by reading distressing comments and does not benefit anyone. Keep your phone away in a different room so you don’t give in and google every random thought and question you may have. If you are genuinely concerned about something reach out to your fertility clinic as they know your case

Treat yourself

 Get a facial

Get a head massage

Get a manicure/pedicure

Get acupuncture to relieve your anxiety

Buy your favourite moisturiser or body scrub and reconnect with your body.

Many women feel detached emotionally from their bodies after having so many invasive procedures and having so many people invade their personal space during fertility treatments.

Having some ‘me time’ may help you reconnect to your body.

Talk to a therapist/fertility coach

If you feel overwhelmed it is worthwhile talking thru your emotions with your therapist or a fertility coach who knows exactly what you are going thru. If you want a free introductory call with me, don’t hesitate to contact me and we can see if we are a good fit to work together on your fertility journey.

Eating to improve egg quality

Egg Quality

Egg quality is one of the most important factors in determining the success of Assisted Reproduction (ART).

The egg is responsible for most of the vital reactions that occur after fertilisation to form an embryo.

Females are born with all their eggs inside their ovaries. They are formed during the fourth month in utero. Since human eggs have half the number of chromosomes other human cells have, they undergo a special type of cell division called Meiosis. There are many steps to this division and the eggs remain in one stage of this division until after fertilisation.

For this reason, pregnancy can take a longer time to happen as females age, since cell division can be suspended for decades until fertilisation takes place.

Even though human life spans have increased, egg cell integrity remains the same and egg quality starts to decline at quite a young age, around twenty-seven. The quality declines as females grow older yet there seems to be a rapid decline after age 35.

However, increasing anti-oxidants and including a wide variety of fresh fruit and vegetable can help protect egg quality.

Why improving egg quality is important

A healthy egg is necessary to develop into a viable embryo. If egg quality is poor, embryo development may arrest.

In certain conditions like in polycystic ovary syndrome (PCOS) too many eggs may develop each month. The increased number of eggs usually correlates with a decrease in egg quality.

When advanced maternal age is the primary cause for concern, egg quality is the only thing we can try to improve.

How can nutrition help?

A diet focusing on anti-oxidants and plentiful supply of vitamins and minerals have shown to improve egg quality.

Antioxidants

Antioxidants are crucial from protecting mature eggs from damage. When the egg develops it is encased by fluid in a follicle which is known as the Graafian follicle. This fluid is high in antioxidants. Minerals such as zinc and selenium, vitamin C and vitamin E have antioxidant effects.

A diet low in fresh fruits, vegetables, nuts and seeds can adversely affect egg quality.

It is also important to ‘eat the rainbow’ in this aspect to gather an array of different types of vitamins and minerals.

Zinc

Zinc is one of the most abundant antioxidant compounds in the body. Zinc deficiency is common worldwide. Zinc is found in meat, chickpeas, nuts and seeds. People with digestive problems and gastric issues can be especially at risk as proton pump inhibitors (PPI) can prevent it from being absorbed.

In plant-based diets their value can be increased by soaking, sprouting and fermenting.

Selenium

Selenium forms an important family of anti-oxidant proteins. Brazil nuts are a terrific source. Just one Brazil nut has the recommended daily allowance. Selenium is also found in meat, chicken, fish, shellfish and eggs.

Vitamin C and E

These are very very important antioxidants especially in women over the age of 35. They work together to support fertility. Vitamin C is found in fresh fruit and vegetables, especially citrus fruits.

It is recommended to eat 2 pieces of fruit and 5 portions of vegetables per day.

Vitamin E is found in almonds, avocadoes, sunflower seeds, salmon, sweet potatoes, olives and olive oil.

Co-enzyme Q10

Co-enzyme Q10 is an important anti-oxidant in preserving egg quality, especially as women get older. Taking Co-enzyme Q10 for three months has been shown to improve fertility outcomes of ART.

Extra information

It is important to note that being overweight, stressed having an underlying condition or excessive exercise may deplete your body of antioxidants even if you consume the recommended amount.

If you are suffering from PCOS or endometriosis, it may benefit you to have a read through the types of foods recommended for these conditions in my articles.

Tests

If you are undergoing ART, your gyneacologist may order a hormonal profile, require an ultrasound and have you do a blood test for Antimullerian Hormone (AMH). This is a test to get an idea of your ovarian reserve and according to your age and the AMH in your blood test, an estimate about your egg quality can be made.

Where to start?

Start making small and gradual improvements to your diet. You do not have to ditch all your favourite foods and eat nothing but kale leaves and seeds and quinoa bars. My general rule of thumb is; to always try to include something green in all your meals. Just adding greens and fresh fruits to your normal routine is fairly easy and can be very beneficial. It is also worthwhile to get into the habit of snacking on small amounts of nuts and seeds to get a boost of nutrients and help stabilize blood sugar levels.

Fertility Boosting Foods

After studying medicine, I trained to become an embryologist, in 2020 I completed my diploma in nutrition. So naturally I was quite interested how nutrition could impact infertility. During studying epigenetics, I became aware of nutrigenomics and how food and nutrition can affect foetal development and have an multigenerational impact. Multiple studies have shown with consistent proper nutrition, some aspects of infertility can be improved.

How can Nutrition help?

 Following a good fertility diet is beneficial for everyone trying to conceive. A study conducted by the University of Surrey concluded that couples with a history of infertility who made changes in their;

·      Lifestyle

·      Diet

·      Nutritional Supplements

 Had an 80% success rate. If you are going for an IVF or ICSI cycle, positive diet and lifestyle changes can improve your chances of success. A good fertility diet will provide the raw materials needed to support healthy egg and sperm development. It can also alleviate hormonal imbalances and reduce inflammation. It usually takes around three months for eggs and sperm to mature, so it makes sense to start a three-month pre-conceptual plan before trying to conceive. Healthy changes to your diet and lifestyle will positively affect your fertility journey no matter what stage you are on. Based on numerous studies a fertility friendly diet is high in fruits, vegetable, nuts and seeds. Fish intake is also important especially those high in Omega 3 like salmon, mackerel, sardines and anchovies. Including more pulses and plant-based foods are helpful. Reducing red meats, especially processed meats can be extremely beneficial. An overall reduction in high fats and high sugar and overly processed foods is recommended.

 Folic Acid

Folic acid can prevent spina bfida and other neural tube defects in your baby. It is essential you get plenty of folic acid before and during your pregnancy. A supplement of 400ug of folic acid fourteen weeks before pregnancy and twelve weeks into pregnancy is strongly recommended. Folic Acid is part of the very important B complex family of vitamins. These are necessary to produce genetic materials DNA and RNA in growing embryo. Together with Vitamin B12 they help ensure baby’s genetic codes are intact. It is recommended to take a vitamin B supplement (especially vitamin B12 if you are vegan) with folic acid.

Zinc and Selenium

These minerals are often associated with male fertility, but as they are important anti-oxidants, they are essential in protecting egg quality and egg DNA. These minerals are primarily found in nuts and seeds, it is encouraged you include a mix of these in your daily diet. Zinc plays a huge part in balancing hormones, and how reproductive hormones oestrogen and progesterone are utilised. It is also involved in thyroid hormone production. Thyroid hormone is a master regulator of hormones hence it is very important especially in fertility. Zinc deficiencies are very common. Great sources of zinc can be found in meat, chickpeas, nuts and seeds. One thing to note is Zinc cannot be properly digested if you are on Proton Pump Inhibitors (PPI) to help with gastric reflux or ulcers. If you are vegan try soaking, sprouting or fermenting pulses and beans before consumption to increase the zinc content. The best source of selenium is Brazil nuts. Just one Brazil nut has the required daily recommended allowance. Selenium is also found in eggs, shellfish, fish, chicken and meat.

Vitamin C and E

These are crucial antioxidants, especially in women of advanced age.. Egg quality is a major concern as one starts to age. Egg quality is a major factor in the success of both natural and assisted conception. Vitamin E supports a healthy womb lining to develop. One study showed that taking 1000mg Vitamin E daily, helped improve endometrial thickness for women who have thin endometrium. Vitamin C is found in fresh fruits, especially citrus fruit. I recommend aiming for two portions of fruit and five portions of vegetables daily. Vitamin E is found in almonds, avocados, sunflower seeds, salmon, sweet potatoes, olives and olive oil.

Omega 3

These essential fats have an effect on every system in the body, including the reproductive system as they are essential for healthy hormone function. They also play a role in controlling inflammation which may affect obtaining and maintaining a pregnancy. Eating two portions of oily fish a week are recommended, if you do not consume fish, a supplement containing over 500mg of EPS and DHA is beneficial.

Amino Acids

 Amino acids are the building blocks of protein and are found in all foods containing protein. Some amino acids like l-arginine can support blood flow to endometrium. A study where participants took 6g of L-arginine daily was found to significantly improve endometrial blood flow and thickness. A healthy endometrium with high endometrial receptivity is necessary for the successful implantation and maintenance of pregnancy.

Vitamin D

 Conception rates increase during the summer which suggest a role for Vitamin D in fertility. There are Vitamin D receptors in ovaries and uterus. However, be careful with Vitamin D supplementation as they are fat soluble and can accumulate in fat and become toxic.

Coenzyme Q10

 Coenzyme Q10 is an important antioxidant in preserving egg quality, especially as women get older. Taking CoQ10 for three months prior to fertility treatment has shown to improve outcomes.

Reducing Caffeine

There has been evidence showing that caffeine especially in the form of coffee reduces fertility. According to one study, drinking as little as one cup of coffee a day can reduce your chances of conceiving. Drinking two or more cups of coffee increases risk of miscarriage. Limiting and reducing caffeine intake during prenatal period is strongly recommended.

 Alcohol

Alcohol consumption cuts down fertility by half. Reducing or cutting alcohol in prenatal care period is highly recommended. Once pregnancy is achieved stopping alcohol completely is a must. If you are undergoing assisted conception and taking medications it is also recommended to avoid it completely.

Smoking

 Smoking has been linked to infertility in both men and women. It can also bring on early menopause. You will need to completely stop during pregnancy so it is worthwhile to try and to quit during pre-conceptual care period.

Exercise

Moderate exercise is excellent for weight management, stress reduction and maintaining hormonal balance. While pregnant it is recommended to keep up a similar moderate exercise regimen. To reduce stress, try less vigorous forms of exercise such as Pilates and yoga. Walking and swimming are also great forms of exercise. If you cannot go out because of weather or limited time, there are lots of amazing  exercise videos on YouTube.

 Stress

Stress is the number one enemy when it comes to fertility. Meditation and mindfulness can help reduce stress. Stress can alter cortisone levels, which can negatively affect fertility and increase the chance of miscarriage. Vitamin B and Magnesium can help regulating cortisol levels. Small lifestyle changes you can practice to regulate cortisol levels include, regular meals and not going too long between meals to keep blood sugar and cortisol levels stable. Snack on nuts and seeds and switch from refined carbs to wholegrain. Try to get plenty of sleep and you might find guided meditation audiobooks useful.

References

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ii Rafraf M et al, 2012, J Am Coll Nutr, Oct;31(5):361 – 8

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iv Safarinejad MR, 2011, Andrologia, 43, 1, 38 – 47

v Blomberg Jensen M et al, 2011, Hum Reprod, 26, 6, 1307 – 17

vi Hayes, C. E. et al, 2003, Cell Mol Biol. 49(2):277 – 300

vii Showell MG et al, 2011, Cochrane Database Syst Rev, CD007411

viii Safarinajad et al, Int Urol Nephrol. 2012 Jun;44(3):689 – 700

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x Scott R et al, 1998, British Journal of Urology, 82, 1, 76 – 80

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xii Greco E et al, 2005, H um Reprod, 20(9):2590 – 4