Tuesday, 6 August 2013

How you mentally, physically and emotionally prepare yourself for IVF?

“We plan to do an IVF cycle this month and I would like to hear about your experiences. We struggled through several failed infertility treatment and through that process I became very emotionally worn down and depressed. I'm concerned about that happening again. I am also concerned about the physical ramifications of the process. My husband is very sweet and tries to calm my fears about the process, but I still have lingering fears. I'm eager to begin the process, but I still have concerns that I'm not sure how to calm. How did you prepare yourself for the process? What did you do to help yourself stay emotionally healthy during the process? What did you do to remain positive? How did you deal with the physical side effects? I know I can never be fully prepared for the process; but any words of wisdom that you can offer are greatly appreciated." This is a thought of Alisha from Goa, not only Alisha but several women who experiencing same kind of thought before experiencing IVF treatment. This post is committed to all IVF patients who are preparing for IVF treatment.

IVF is a big investment, emotionally, physically and financially. Who wouldn’t want to do everything possible to optimize their outcome?  Every day I have patients who ask me what they can do to prepare for an IVF cycle with nutrition, lifestyle and supplements.  There are in fact several health changes you can make on your own which do make a difference. Major factors which you can directly affect (on which IVF success very much depends) are:  egg quality, and the ability of the embryo to successfully implant.

These are dependent on the overall cellular and circulatory health of the couple.  Good quality follicles and a rich, implantable endometrial lining are key factor to having a successful cycle, without either of these factors; your chance of success lowers dramatically.   It is best to work on these issues for several months prior to the IVF cycle if possible, as the eggs which will be retrieved for your IVF cycle spend several months developing in the ovaries. IVF has the potential to be an emotionally, physically, and financially exhausting experience due to the “high stakes” and “end of the line” nature of this treatment.  Thus, patients need to consider thoughtful preparation before beginning the process.  If you are a patient about to begin a cycle, here are some tips to help get ready for IVF:

1.       Gather information and plan ahead:
Good decision-making involves being well educated and informed about your body, the IVF process, and your clinic/treatment program. IVF is an anxiety-producing experience, and one of the best antidotes for anxiety is information and knowledge.  The more you know and understand about the process, the less stress you may feel.  Look for articles and other reading materials about IVF.  If your practice runs educational IVF classes, attend as a couple and talk to others who have been through IVF.

2.       Prepare for decision-making:
It is important to anticipate decisions that may occur during IVF and discuss your options ahead of time.  Sometimes these decisions may have moral and religious implications which you will need to consider and discuss.  You will need to decide how many embryos will be transferred while maximizing your chances for pregnancy and minimizing the possibility of multiple babies.  You will also need to decide what you will do with extra eggs and/or embryos, i.e. freeze, dispose, or donate them.  If there is a possibility that donor gametes (sperm or egg) will be used in the cycle, it is important that you carefully discuss the issues involved in raising a donor-conceived child before starting the cycle.  Counseling can assist you in exploring these issues and is a recommended treatment guideline of the American Society of Reproductive Medicine.

3.       Tend to your psyche and your relationships:
A long struggle with infertility may have taken a toll on how you are feeling about yourself, your marital relationship, and/or your relationship with others, causing distress and isolation.  You will want to be in a good place emotionally and have your relationship on solid ground before starting an IVF cycle.  Facilitate communication with your partner by setting a limited amount of time to talk about IVF, possibly 20 minutes every day, and then putting infertility talk aside.  Discuss ahead of time your hopes and expectations of each—for example, whether you want to be together at appointments, on the day of the pregnancy test, and when you are expecting a call from the doctor.  Counseling can be very helpful when you and/or your partner are feeling depressed, very anxious, emotionally stuck or in a rut.  An ounce of prevention is worth a pound of cure, so get help early before problems get too big.

4.       Gather your supports:
Friends and family can be your best support or they can be your worst.  Decide in advance who you will tell about the procedure by identifying who will give you the support you need.  In hindsight, patients often wish that they had not told so many people at the start as it sometimes adds to the pressure.  It can be helpful to designate a friend/family member as a “spokesperson” who will let others know, when you are ready, what is going on.  In addition, look outside your usual support network to those who truly understand—other infertility patients.  If it is available in your medical practice, consider joining an IVF support group, or check out other infertility self-help organizations, such as Resolve.  The internet is, also, a ready source of infertility support and information, through various websites and “chat rooms”.  A great deal of healing can come from others who understand.

5.       Identify your stresses and your coping mechanisms:
Each person experience stress in different ways; so that it is helpful to identify where yours may come from.  For some, it may be in just getting to the clinic in the morning for monitoring, for others it may be injections.  Anticipating ahead where your stresses may come from will help in developing coping strategies.  Know your own and your partner’s styles for dealing with stress and what has helped in the past.  For example, women may need to talk and receive support, while men may prefer to be involved in an activity or hobby to cope.  Learning to accept differences in the way each of you handles and deals with your feelings can reduce conflict.  In addition, exercise is one of the best ways to alleviate feelings of stress, anxiety, and depression although it may have to be adjusted during the treatment cycle.  Humor is a great coping mechanism and can help you get through difficult times.  No matter how tough things get, you can always find something funny about it and laughing about it is good for your health.  Stress management classes, listening to relaxation tapes and other mind/body techniques used regularly can help in handling these feelings and dealing with treatment Procedures.

6.       Decide what you have control over and what you don’t:
To help eliminate any unnecessary stress, you will want to make you life as simple as possible during the cycle.  This is not a time to make important decisions or changes in your life, such as a move or job change.  If at all possible, avoid major undertakings at work that can add stress to your life.  In addition, you will want to think about how to deal with other daily life challenges on the job, at home, and with family and friends. You do have control over the choices you make in your daily life while how the treatment course progresses is usually out of your hands.

7.       Anticipate problem areas:
Plan for possible changes and difficult times during your cycle, such as the waiting period after transfer and the day you will get the results.  Expect the unexpected, as changes are frequently made in the cycle because of everyone’s unique medical situation.  There are possibilities for failure at every step of the cycle, from a poor response to medication to no fertilization after retrieval.

8.       Planning for waiting time:
 The two-week waiting period between transfer and receiving the pregnancy test results is often described as the most difficult part of the cycle.  Having had daily contact with your medical support staff during monitoring and retrieval, you suddenly are on your own after transfer and just have to wait. You need to think about how to fill your time during these two weeks, and then consider where you will be when you receive the results (probably not at work) and whether you want to be together to hear the news.  To allow some time to deal with what you learn, you may want to consider “fibbing” to family and friends by telling them the results are due a few days later than reality.  This will give you breathing space and time to adjust to the news before dealing with others.

9.       Look past this cycle at the beginning:
 It is important to be looking ahead as you prepare for IVF and to consider your limits as you begin the process.  It is easy to know how you will feel if treatment is successful and you become pregnant.  However, you must also understand that if you are unsuccessful in achieving a pregnancy, you cannot get away from the sadness, loss, and disappointment that are part of the grieving process.  Think about the number of cycles you are willing or able to do, and how much more time and money will be involved in infertility treatment.  Remember that with each cycle new information is learned and that it helps knowing what to do next.  Consider exploring other family building options, such as adoption, which will give you some control and provide information for future decision making.  No matter what the outcome of IVF, you need to recognize you have succeeded in doing all that is within your power to have a child.

Relaxation techniques with Preparation for other option
An IVF cycle is emotionally very stressful.  The most difficult challenge is to relax amidst that emotional stress. But when you relax, you will feel definitely better. You need to use relaxation techniques, and the good news is that there are many available, such as like breathing exercises; meditation; yoga and so on. How can a woman undergoing IVF relax her mind and get relief from the worries and doubts which constantly assail you. While yoga will help you to relax physically, how far will they help you deal with your emotional stress? The major worry for a woman who is going through IVF is - ‘What will happen if my cycle fails?’ This question is the starting point of all stress, so try answering this along with your partner. It can be anything depending on individual circumstances – it can be another IVF cycle. Once you decide what you will do if the IVF cycle fails , then it will be several times easier to relax mentally – and having a healthy conversation with your partner about what is bothering you will help you to relax as well.

Stress Management
         IVF is a stressful business so take time out occasionally to stop thinking and worrying and spend time with your partner doing things you both enjoy. You need to be able to support each other through this and to still have a good relationship at the end of it. You’ll both react differently to the pressures, so try to find ten minutes each evening to talk about what has happened and how you are feeling, so everything is out in the open.
        Do not underestimate the time involved or the space you need to make in order to have IVF.
        If you feel that you need extra support discuss this with your acupuncturist who can refer you to an appropriate Counselor.
        Breathing dynamics and visualization is an excellent way to combat stress during the IVF process. Good breathing technique also helps to circulate oxygen around the body and into the reproductive organs. Ancient Chinese masters taught that the chi is located within the mind and that the mind leads the chi and makes it move. If your mind stays in one spot, your chi becomes stagnant. Once you feel you’ve mastered the breathing technique, you will be able to focus your mind and cope with the stresses of IVF treatments.

IVF Protocols
Tips for the long protocol – down regulation/suppression
        It’s not easy to take a whole month off work, but be aware of what’s happening to your hormonal system and slow down. Take things as easy as you possibly can and RELAX. Get plenty of early nights - sleep is very important for your body at this stage.
        Allow plenty of time in your schedule for appointments - at least seven hours a week, depending on how often your clinic performs scans and blood tests and how long you’re kept waiting at the clinic.
        Close your eyes and breathe deeply. Visualize the hormones in your body shutting down your ovaries and no follicles developing. Tell yourself everything is working as it should be and that you are strong and healthy.

Tips for the short protocol – stimulation
        Stay relaxed and take each day as it comes. Anxiety and stress releases adrenaline into your blood stream. Spend some time each day sitting quietly and breathing deeply. Banish negative thoughts as they arise.
        Repeat positive affirmations out loud: ‘my eggs are growing, ripening and maturing; my eggs are of good quality; my womb lining is growing thick’. Imagine sending oxygen to your womb lining, helping it to grow. Visualize your eggs growing. Focus on how you want your body to respond.

Although each patient has specific needs which are best addressed individually, I have made a list of more important things that women can do to prepare for IVF. I have consistently seen that being on the right combination of supplements can increase IVF success rates and in this article I will mention two of the basic supplements for IVF that all women should be taking.

        Eat high quality, whole grain and low Glycemic index foods.  Avoid processed foods, hydrogenated oils, sugars, and alcohol.  Avoid large amounts of soy products. Quit smoking if you smoke.
        High quality healthy fats should be a big part of your diet– unrefined oils, foods rich in polyunsaturated such as nuts, seeds, and avocado, and uncontaminated fish. 
        Gentle exercise such as walking or fertility yoga 4 times per week.  Exercise reduces stress and improves circulation.  Avoid exercise that is overly strenuous.
        Greatly reduce or eliminate caffeine, especially after transfer. 
        Eat organic to reduce load on the liver and to avoid hormone disruptors.   Many pesticides have estrogenic effects which can lower egg quality.
        Check your thyroid and have full blood work completed including antinuclear antibody, Prolactin, ferritin, INR, FSH, LH, DHEA, testosterone, and Antimullerian hormone.
        Get into a healthy sleep cycle for at least 1 month before your cycle, aiming for 8 hours of sleep.  Sleep in complete darkness to improve natural melatonin production.  Melatonin is required for healthy follicle development.  At this time melatonin supplements are not recommended as they have hormonal effects, however try to focus on improving natural levels of melatonin prior to your cycle.

It is a well-known fact that a healthy body harbors a healthy mind, so take time to prepare you physically, mentally and emotionally.

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