By, Amé Damaso
Certified Holistic Health Coach
By, Amé Damaso
Certified Holistic Health Coach
As January rolls on, more and more people ask me what I think about “going on a cleanse.” When I ask why they feel they need it, I get answers along the lines of: “I’m struggling to kick the junk food habit I acquired over the holidays,” or “I feel like a need a reset and drinking juice for 3 days will get me on the right track,” or “my body feels ‘toxic’ and I need to shed my holiday weight gain!”
So what’s a toxic, junk-food-junkie to do? The mega monolith known as the “detox industry” has a million and one solutions for you! Whole Thirty, Master Cleanse, Juice Fasting, Just-Drink-WaterFasting, Intermittent Fasting, soup cleanses, bone broth cleanses, liver detoxes, and kitchari cleanses are what come to mind, just off the cuff!
If you feel like your head is spinning with options and you’re more confused than ever, you’re not alone. Let’s start by breaking down some basic facts about “detoxing,” dispel some common myths, and consider what all of these ‘cleanses’ have in common as you work towards feeling your best!
In short, no. The reality is that our systems have built-in mechanisms that allow for constant, ongoing detoxification. Your liver is a mighty, 24/7/365 detox machine, spending virtually all of its time dedicated to separating substances we need from those we don’t, and sending the junk on its way out (primarily via the kidneys). Speaking of kidneys, those two do a brilliant job of filtering out impurities through our urine, while the lungs send toxins out via respiration; the skin shunts toxins as perspiration, and the trusty large intestine sends out impurities through the... well, you know.
There are a couple of reasons why you [almost] always feel better after a ‘cleanse.’ To understand why, we need look no further than what all of these programs, plans, and systems have in common. For starters, virtually every cleanse out there insists on some common principles: drink more water, avoid inflammatory foods like sugar, alcohol, caffeine, refined carbohydrates, and dairy. Moreover: resume or increase your exercise, sleep, and self-care routines. In all honesty, it’s this “common core” of changes that will make anyone feel lighter, healthier, more rested, and less stressed-- not the maple syrup, lemon juice, and cayenne pepper you might be drinking.
Yes and no. It’s certainly never a bad idea to clean up one's diet from all the junk, and it definitely doesn't hurt to reduce or eliminate caffeine and alcohol! In addition, becoming more mindful of one's water intake, sleep regiment, and exercise routines will only prove to be beneficial. Of course, it’s always a good idea to devote more time and energy to self-care, including: at-home rituals like dry brushing, epsom salt baths, and meditation, in conjunction with treatments like acupuncture, massage, and other types of bodywork and natural healthcare. That said, many of the programs out there impose extreme calorie restrictions (which can harm your metabolism), dramatically limit nutrient variety and can lead to feeling sluggish, hungry, drained, and depleted-- the opposite of what you set out to do! Never fear, there’s a happy medium that we can all benefit from!
First of all, let's all take a moment to repeat the following mantra: THERE IS NO MAGIC BULLET WHEN IT COMES TO MY HEALTH. Feeling your best takes a certain amount of effort and commitment, period. Cleanses, diets, supplements, and programs that promise weight loss, optimal health, and a flawless complexion in 7, 10, 21 or 30 days might offer some short term benefits, but the long-term gains are certain to be disappointing. That said, employing some basic principles to your routine and making those principles the rule rather than the exception will help you to feel your best, look your best, and help you enjoy clarity, focus, good health, and energy for the long haul.
Get yourself a pretty glass water bottle and figure out how many times you need to fill it up to meet your goal. Feel free to throw in a slice of lemon, an orange, a strawberry, or any other fruit to infuse your water, or add an herbal tea of your choice. When 30 days is up, rinse and repeat. After awhile, staying hydrated will be second nature, and you will start to notice that positive glow in your complexion.
That means no cookies, no candy, no ice cream, or any other sugary treats! That means pastas, breads, and refined grains, too! You can do anything for two weeks, I promise. When two weeks is up, see if you have the motivation to keep it up. If not, commit to the 80/20 rule and limit those foods to an occasional treat, rather than making them daily staples.
Take some time this weekend to visit your local farmers market or health food grocery store. Stock up on all the veggies you like, go home, and actually PREP THEM! That’s right... do something radical this weekend-- cut, peel, and chop enough fresh vegetables to get you through the week. Each night, grab a few handfuls of vegetables of different colors and simply steam them, or go nuts and sauté them in a little avocado or coconut oil. Drizzle some organic olive oil on top and add a pinch of sea salt or any other spices you like. Feel free to include things like sweet potatoes and other root veggies. For added protein, serve them alongside a few ounces of organic chicken, turkey, fish, or bison. If you're a vegetarian, have some organic quinoa, aduki/mung beans, or lentils available. Boom! You just ‘cleansed’.
For most of us, it’s tough to keep it up 52 weeks out of the year. Holidays, vacations, times of extreme stress and big transitions can often throw us off track. Rather than forcing your system into a harsh detox regiment, bring it back to the basics of healthy eating, good hydration, adequate sleep, and self-care. If you have specific health concerns, consult with your acupuncturist or other holistic healthcare practitioner to find the right herbs, supplements, and/or nutritional regiments that makes sense for your individual needs.
Finally, my #1 trick for maintaining a healthy diet (at least 80% of the time) boils down to one thing: meal planning. Take the time each weekend to plan dinners (and leftovers for lunch) to ensure that you’re never left staring at a full fridge at 7 PM with no plan other than the persuasion of your Postmates app. My personal favorite meal planning app is brought to you by Emily Bartlett, LAc, my beloved writing partner from Feed Your Fertility. Emily has developed an extraordinary meal planning program called Real Plans. Check it out here, and make 2018 the year of eating and caring for yourself ‘beyond the detox.’
I opened up Yahoo news today and what was the first thing that popped up?
“Chrissy Teigen Back in Sports Illustrated Swimsuit Issue After Baby: Watch Her Photo Shoot.”
Can I first just say…Ugh! And no thank you! Can’t she just model the damn bathing suit? Why must there be the added underlying message of, “Hey, she was pregnant and now her body is back to perfect. And guess what? If you just gave birth and your body doesn’t look like hers, you have failed. You are not good enough. Oh, and P.S. you never will be. Now go back to work or whatever and feel like crap.”
This is the message relayed to women over and over again. Your worth is in your body and beauty. You must police your body at all times.
As a psychotherapist, I have worked with women with eating disorders and body image issues for 12 years. Women are subjected to body scrutiny throughout every phase of life, including the reproductive cycle. I have always thought of eating problems as cultural problems that have become internalized within a person. I don’t know any woman who is not caught by these harmful ideas in one way or another. Of course, not every woman has an eating disorder, but these insidious ideas affect us and the way we think about ourselves all too often.
I also work with women who are having fertility issues. These two “specialties” of mine often intertwine: Eating issues and body issues often complicate the fertility journey. Eating issues or fear of body changes might quietly get in the way of getting pregnant. Perhaps a woman doesn’t want to gain weight even if it might help her get pregnant. Or perhaps she fears eating certain foods that are recommended. Maybe her medical team has suggested less exercise or a different form of exercise and that feels scary. Or as her body changes due to medications, hormones or pregnancy she might be torn between two conflicting cultural ideas: That she should love every moment of pregnancy (and mommy-ing for that matter) and still have some idealized version of a body. Women worry that if they speak of these things, they appear “shallow” or that they don’t really want to get pregnant. This often leaves them to face guilt, shame and sadness alone.
If you feel any of the above, let me tell you loud and clear….you are not alone! This is so common yet rarely spoken of.
It makes sense to have these conflicting feelings considering the culture we live in. A woman can both desperately want to get pregnant and desperately not want her body or eating habits to change.
If you are struggling with any of these issues, I suggest getting support. Find other women who can be honest about these things. Find a team who gets it.
When you do, there will be no need to hide. Honesty with your practitioners will help you get to where you want to go. In my experience, when the invisible ideas that weigh on us become visible…we feel a whole lot better and get moving toward our goal.
Mercier Therapy provides a holistic approach to fertility challenges, pelvic pain, and recovery from pelvic or gynecologic surgery. Mercier Therapy is a safe and gentle, soft-tissue pelvic organ visceral manipulation technique that addresses scar tissue, adhesions, malalignment and/or decreased mobility of the pelvic and reproductive structures. Mobility plays an integral role in proper blood flow and optimal function. Improving the mobility of any structure in the body, whether it’s a shoulder or a uterus, optimizes the function of that region.
Have you ever had surgery or injured your shoulder or knee? In most cases, you will partake in some sort of rehabilitation or recovery program to assist in returning you to pre-injury function. The therapist focuses on reducing scar tissue, improving blood-flow and circulation, and restoring proper mobility so that you are able to do the same activities you did prior to the injury. The pelvis should be thought of similarly in that pelvic organ mobility directly impacts pelvic organ function, i.e. regular menstrual cycles/proper hormone balance, ability to maintain a viable pregnancy. If you are having pelvic pain, cycle irregularities, or are struggling to conceive or remain pregnant, Mercier Therapy can restore proper balance and function, all keys to optimal pelvic health and successful conception.
Mercier Therapy is beneficial for the following:
Our fertility program is 6 weeks in length, custom tailored to each individual, and can be used as a stand-alone regimen or in preparation for a medically assisted cycle such as IUI or IVF.
Mercier Therapy™ completed an on-going four year medical study to show an 83% pregnancy success rate within one year of finishing the Shared Journey Fertility Program. The study concluded in September 2012 and was published in Midwifery Today, Spring 2013.
For questions or to schedule a consultation, please contact Dr. Merkel at email@example.com or (323) 863-5154.
Now that theRoyal Baby is among us, I've been pondering all the frenzy that surrounded the birth of Britain’s future heir to the throne. Like many others, I found myself lured into the “Royal Baby Watch,” otherwise known as a large group of stalker-journalists waiting outside a hospital where the Duchess of Cambridge, Kate Middleton, was likely to give birth at some point. The reporting turned especially dramatic as discussions focused at great length on the fact that Kate Middleton’s due date had passed. HOLD THE PRESS!!
There is so much confusion around how long pregnancy is meant to last, and, even worse, the sense of impending doom that arises as soon as that much anticipated day slips into another. But why? With only 5% of women giving birth on their actual due dates, why are we as a culture so freaked out when babies come “late?”
According to the Mayo Clinic, a woman might go past her due date if:
• The exact date of the start of your last menstrual period isn't known
• This is your first pregnancy
• You've had prior overdue pregnancies
• Overdue pregnancy runs in your family
• Your baby is a boy
• You're obese
So pretty much everyone, unless you’re a skinny second-time mom (who gave birth by 40 weeks the first time), having a girl. Ummmm…..
The Bookends of Pregnancy
A big part of my job is in supporting and mentoring women all the way through their pregnancies. The early days can be pretty intense, as you desperately try to maintain your normal life in the face of nausea, unrelenting fatigue, unrivaled breast soreness and the stress and worry over the health of your tiny growing little bun in the oven (or Bao, if you will). During these first 12-16 weeks, women need a lot of support, both physical and emotional.
Once those weeks pass by, pregnancy usually becomes a time of great joy, excitement and anticipation. Sure, the last few weeks can be a bit cumbersome, but for the most part, it’s a really cool experience… until…
The due date comes.
At that point, pregnancy can become a grueling, stress-filled, agonizing wait for that pot to boil. It brings up a veritable cornucopia of emotions, from fear, to anxiety, to whatifsomethingiswrongwithmeandmyIneverhavethisbaby?!
To name a few.
Let’s break this due date thing down a little, shall we?
First of all, the mere notion of a “due date” is pretty absurd. There is no legitimate research in the entire canon of obstetric medicine that definitively (or accurately) pinpoints exactly how long a pregnancy is meant to last. The most common way to calculate a due date is to add 280 days to your last menstrual period (LMP), which adds up to 40 weeks. This method was published by one Dr. Naegele, in 1806. Dr. Naegle did not arrive at his conclusion via any of the scientific methods we would deem reasonable today. Really, he just published his observations and everyone adopted them as gospel. (source)
Now, that’s not to say that Dr. Naegle was out in left field or anything. I mean, clearly, we all gestate for approximately 40 weeks. Please note that the key word in the previous sentence is approximately, because every legitimate study on the duration of pregnancy gives us a standard deviation of about 9 days (8-10, depending on how the due date was calculated). 9 days! This may not sound like a lot of time, unless you’ve ever been pregnant and watched your due date come and go. In that case, I’m sure you’ll agree that 8 days is nothing short of an eternity. E.T.E.R.N.I.T.Y. (source)
Even the term “due date” is fraught with all kinds of stress-inducing secret code. Starting as early as elementary school, we are indoctrinated into an educational system that gives us assignments, and tells us when they are due. Turning projects in late can get us in some serious trouble, even result in a big fat F on our ever- important report card. When we grow up, failing to finish things on time can result in extra fees, lost opportunities, even the loss of our jobs.
Is it any wonder that passing a “due date” gives women a sense of impending doom?
In addition to the connotations of the term, some (read: NOT ALL) OB/GYN’s play their part in helping women feel like their bodies won’t go into labor on time. Many physicians begin scheduling inductions and even c-sections as soon as a day or two past the “due date.” Women are commonly informed that the risk of fetal death goes up significantly past 41 weeks, even when nothing about the pregnancy indicates any sign of distress or decline. The reality is that things do get a little riskier around 42 weeks, but really not any sooner. Of course, I’m talking about a typical pregnancy here. If you are having serious medical issues, or if your baby is in distress, you should always listen to your doctor. Still, remember that doctors frequently practice defensively, and are happy to have your baby born sooner than later. It’s ok to ask for second opinions or medical position papers that substantiate their recommendations.
According to the CDC report from the center of vital statisics, “[fetal morality rates] declined sharply to a low of .89 for 40 weeks of gestation and then increased to 1.45 [at] 42 weeks of gestation or more. Gestational age data is primarily based on the interval between the first day of the mother’s last normal menstrual period (LMP) and the date of birth, and is subject to error due to imperfect maternal recall or misidentification of the LMP.” (source)
I’m not recommending that anyone avoid non-stress tests, or ignore their doctors advice. What I am suggesting that you ask questions. Lots of them. Ask for data to support any recommendations (like study abstracts). Ask what percentage of patients go into labor spontaneously, how often they induce and for what, what percentage of c-sections do they perform?
In an ideal world, these questions are best asked in the early stages of pregnancy, and choices in care providers made based on the answers given. Unfortunately, the majority of women don’t ask. Many women tell me that they “knew” that their doctor was not an ideal fit for them, but they stayed the course anyway, leaving them with little recourse as their pregnancy days wind down.
What’s the big deal with inducing labor?
While this topic is an entire post in and of itself (coming soon!), I’d like to take a moment to discuss the issue of chemical labor inductions. This type of procedure involves checking into the hospital before you are in labor (or in some cases if you water has broken and you haven’t had contractions for several hours), and having your labor artificially started by a drug called pitocin aka synthetic oxytocin. While labor induction is a reasonable thing to do if you have a medical condition that warrants it, it should be avoided for reasons of convenience, scheduling (yours or your doctors), or being “tired” of pregnancy. Labor induction is not risk free, it increases c-section rates, can cause fetal distress from strong contractions, and increases the risk of infection, bleeding and uterine rupture to the mother. (source)
What you can do
Just because the clock is ticking and your Dr.’s foot is tapping doesn’t mean you can’t work yourself towards a natural start to labor. It’s ideal to start most of these things by 36 weeks at the latest. That will give your hormones and emotions enough time to get balanced so the big day isn’t delayed (too much).
Fudge your due date
We all love the support of family and friends, but post-due-date “support” has driven many a woman around the bend. Endless phone calls, text messages and not- so-well thought out comments (ie. “have you dropped that kid yet? He must weigh 10 pounds by now!”), often contribute to a woman’s sense of impending doom. There’s an easy fix for this problem: lie.
From as early on in your pregnancy as you can, tell everyone you know that your due date is 10 days later than it really is. Tell it so often that you actually come to believe it, too. Doing this will help to keep the crazy questions at bay until your birth is not more than a few days away, possibly allowing you to avoid them all together.
This minor amendment to the truth does more than allow you to dodge the endless queries of loving onlookers- it also contributes to your efforts to maintain inner calm, your ticket to going into labor ASAP, since all those pokes won’t be stressing you out!
Trust me on this one’s, it’s worth its weight in gold!
There is a Yogic expression which states that a “A woman who walks five miles a day has a baby that falls right out.” Wait- 5 miles?! Whaaaaaat?? That’s right. You heard it right. 5 miles. Now, Please, if you haven’t been exercising much (or at all) since becoming pregnant, please don’t go outside and walk five miles right now. Start slowly, adjusted to your fitness level, and work your way up as far as you can comfortably go. You don’t have to do it all at once, either. Lots of ladies break their walk time into two or three shorter sessions per day.
Ever wonder why you hear about women going into labor in the middle of the night? It’s because we can’t stress out as much while we are sleeping! High levels of stress tell your brain that it’s not safe to go into labor, because your body’s first priority is to keep you alive. The part of your brain (the animal instinct part) that is responsible for letting labor happen is also in charge of your survival, and it can’t tell the difference between perceived stress (like needing to go into labor before your mother-in-law’s plane lands) and real stress (like a herd of lions is coming over the mountain to eat you).
A few ways to coax your primal brain into thinking that the coast is clear to let the baby out might include:
• Getting plenty of rest, including at least on daily nap.
• Laughter! Being silly and irreverent increases your serotonin levels, and sends warm and fuzzy signals to your nervous system that all is well in your world. Curl up with a funny book or movie….
• Cuddling and Kissing: Being warm and fuzzy with the one you love releases Ocytocin, the magical hormone thatcauses labor contractions, stimulates milk let down, and makes you bond with your baby
• Sex: It might sound like the worst idea ever right now, but sex can stimulate contractions, and sperm contains prostaglandins that help soften the cervix
• Acupuncture: Acupuncture does a great job at calming the nervous system down, sending signals to the brain that labor is a good idea. Some acupuncture points can also stimulate contractions… be sure to see someone licensed and experienced in acupuncture for pregnancy.
In the End
We can never lose sight of the true means to this end. The birth of a child is one of the most magical moments of a lifetime, and it should be regarded with reverence and consideration of what is best for the baby. I believe, whenever possible, that babies do best when they are able to follow natures course, influenced only by the hormones and signals from their mother without outside intervention. In our current climate of maternal care, this is increasingly difficult to accomplish and requires a great deal of conviction on the part of the birthing mama.
Choosing a care provider that supports these choices, and making sure you have enough support in your corner at the time of your birth is the best way to minimize your risk of unnecessary interventions. However things go in the end, there’s not much that can’t be healed by that baby in your arms.
PS. As of the final writing o
One of the biggest decisions facing couples going through fertility challenges is whether or not to try In Vitro Fertilization (IVF). Every day in my practice, I talk with women (and their partners) about the positives and negatives of this procedure, and whether or not the time has come to give it a try.
A huge misconception about IVF is that it’s a cure for infertility. When couples go into the process with this idea, the disappointment they feel if it doesn’t work can be devastating. In the United States, the cost is almost entirely out of pocket for most people. Topping out around 15 K for one cycle, the added financial strain only compounds anxieties.
Many couples enter the treadmill of Assisted Reproductive Technology (ART) without fully understanding how the various procedures actually work, what they entail, or how likely they are to succeed. I believe firmly that knowledge is power, and that the more you know, the better you’ll be at making decisions about your fertility. So, here’s the scoop!
Why choose IVF?
If you’ve been down the road of diagnosis and you and your RE (Reproductive Endocrinologist) decides that IVF is your best shot at achieving pregnancy, you may quickly find yourself in a two-week whirlwind of injections, ultrasounds, blood tests and procedures. Some reasons for choosing IVF include:
• Increasing the number of follicles available in a given cycle to maximize the chances of achieving pregnancy
• Assisting with the fertilization of mature eggs through procedures such as ICSI (intra-cytoplasmic sperm injection, where a single sperm is injected into an egg) and assisted hatching (helping an egg “hatch” so it can implant more easily).
• Allowing for genetic testing of embryos to eliminate any which are not chromosomally normal (PGD or PGS).
• Circumventing blocked fallopian tubes
• Overcoming poor sperm count (male factor infertility)
Who Performs IVF?
IVF should always be performed by a board certified Reproductive Endocrinologist/Infertility specialist - at a reputable clinic with a highly regarded lab. Take the time to find out which office has the best reputation in your area, and be willing to spend a little extra for the best clinic you can find. The cost of having to undergo multiple cycles due to physician mistakes is not worth the money saved. That’s still not to say it will definitely work the first time you try, but you want to hedge your bets wherever possible.
What are my chances of IVF Success?
It’s important to remember that IVF is merely a strategy for maximizing your fertility wherever it is in that moment.
IVF is not a cure for infertility, especially when it’s due to advanced maternal, age or severely compromised sperm. That’s because the main reason why IVF (or natural conception, for that matter) doesn’t work is chromosomally abnormal embryos.
We all know that the risk of Down’s syndrome increases as we age. This increase happens because the older we get, that harder it is for our eggs to divide properly (once they are fertilized). When mistakes happen in the dividing process, some genes end up with 3 chromosomes on them when they should only have 2 (some end up with only 1, which is just as big a problem).
None of this means that IVF won’t help, or even significantly increase your chances of achieving a healthy pregnancy, but it’s not magic.
When taken at face value, IVF success rates can seem pretty dismal. However, remembering that a totally healthy couple in their prime reproductive years has roughly a 1-in-5, or 20% chance at pregnancy in a given cycle can lend a little bit of perspective to projected IVF outcomes.
Here are the success rates for live birth outcomes for IVF in the United States, according to the American Pregnancy Association:
• 30 to 35% for women under age 35
• 25% for women ages 35 to 37
• 15 to 20% for women ages 38 to 40
• 6 to 10% for women ages over 40
What Happens During IVF?
Day 2 tests
On day 2 of your menstrual period, you’ll go into your fertility office to have your blood drawn to test Estradiol (E2)/FSH levels. You’ll also undergo a trans-vaginal ultrasound to count and measure the number of antral follicles (the eggs that are candidates for responding to the medications).
In an optimal cycle, all of the potential follicles should be about the same size. If one follicle is already bigger than the rest (a lead follicle), then the cycle should be delayed until the next month or synchronized with medications like birth control pills or estrogen. An early lead follicle will absorb a disproportionate amount of medication and result in a less than ideal outcome. The key is not to let impatience get the best of you here! It’s best to wait until the conditions are right!
Once the lab results are in (later the same day) and the follicles are confirmed synchronized, IVF medications are self-administered via injection, usually starting that very evening. It is critical to follow instructions to a T, and to call the office if you have any questions or concerns. Getting off track here could sabotage the cycle.
There are lots of different IVF protocols, and this post is just a general explanation of how IVF works, so don’t be thrown off if your doctor has you doing stuff that’s outside of what I’m describing here.
After a few days of injections, you’ll return to the clinic to check for progress via ultrasound and blood work. It’ is expected that E2 levels continue to rise with each passing day, as the developing follicles are continuing to secrete more and more estrogen as they grow. Cycles that become significantly de-synchronized may be cancelled at any time, though some doctors will push through and allow the larger follicles to become over-mature in an effort to save the smaller majority. The RE’s I work with most often find this practice to be problematic and do not endorse it, as it is often the larger “lead” follicles that are the most likely to be healthy. Once again, patience is a virtue and it’s better to wait it out for an ideal cycle.
The process of self-administering medications typically lasts about 10-12 days, with frequent visits to the doctor for monitoring and blood work. Once the RE determines that the follicles are at the peak of their maturity (measured by a plateauing E2 level and appropriately sized follicles), then an HCG trigger shot is administered to prepare the body for ovulation, roughly 36 hours before retrieval.
HCG is recognized by your body in the same way as LH, the hormone that “surges” around mid-cycle, to tell an egg that it’s time to ovulate. These “trigger” shots allow your doctor to time exactly when your follicles will be ready to go, and your retrieval will be scheduled accordingly. For example, an HCG shot given on Thursday evening will prime your ovaries for egg retrieval on Saturday morning. Be sure to give yourself the HCG shot at the EXACT hour you are instructed to do so.
Follicle aspiration (retrieval) is a minor surgical procedure, which is performed by an RE in order to remove all of the developed follicles from a woman’s ovaries for fertilization in the lab. The procedure is performed in a sterile operating room under heavy sedation (you’ll be asleep!), by inserting a long needle through the wall of the vagina and into the ovaries, one side at a time. The RE skillfully aspirates the follicles and surrounding fluid out of the ovaries via ultrasound guidance, and they are immediately assessed for maturity.
Once the procedure is over, the follicles are taken to the lab where they are stripped of their outer membrane to reveal the single celled ova, and then fertilized with your partner's sperm (a sample would have been given that morning, or a previously frozen sample might be used).
Ova are fertilized one of two ways; naturally or via ICSI.
• Natural fertilization is the process whereby sperm and egg are place together in a petri dish and left to fertilize on their own. This allows for “natural selection” to occur, if you will.
• ICSI is the process whereby a single sperm is corralled into a pipette and skillfully injected into the ova’s cytoplasm. This procedure is typically performed when a man’s sperm parameters are poor in order to increase the odds of having a healthy sperm meet the egg.
The day following retrieval and fertilization (considered “Day 1” in IVF terms), the follicles are assessed. Normally fertilized ova will have 2 nuclei at this point, and are referred to as 2PN’s (2 pro-nuclei). If a “freeze all” cycle was planned, embryos are often frozen at this stage, as this gives them the highest survival rate when thawed. If a fresh cycle is occurring, then the 2 PN’s are left to continue growing for 2-4 more days, and then transferred into the mom-to-be.
Embryo transfer usually occurs on either day 3 (cleavage stage) or day 5 (blastocyst stage). The choice between these two days is related to how many embryos there are to choose from, how old the mother-to-be is, or clinic preference.
Many clinics routinely do day 3 transfers, while others feel that day 5 offers better results. The difference in development between a day 3 embryo and a day 5 blastocyst is considerable. Typically, there is an attrition rate of roughly 50% or more during these two days. What this means is that embryos that are not chromosomally normal (or are otherwise compromised) won’t make it through the complex cell dividing that must take place to go from the 4-8 cell embryo stage to the hundred+ cell blastocyst stage. Hence, it is presumed that embryos that survive to the blastocyst stage have a greater chance of being chromosomally normal than their day three counterparts.
For this reason, significantly fewer blastocysts are transferred on day 5 than embryos on day 3. The decision of how many to transfer is between a couple and her doctor, and should take into account her age, past cycles, and guidelines put forth by the ASRM (American Society of Reproductive Medicine).
Here are the ASRM recommendations by age for number of embryos to transfer, based on a desired outcome of a singleton pregnancy:
• Under 35: 1 embryo for favorable prognosis/blastocyst transfer; 1 to 2 embryos for favorable prognosis/cleavage-stage transfer; 2 embryos for all others
• 35 to 37 years: 2 embryos for all patients (except 3 embryos for women with less favorable prognoses who receive cleavage-stage embryos)
• 38 to 40 years: 2 embryos for favorable prognosis/blastocyst transfer; 4 embryos for less favorable prognosis/cleavage-stage transfer, and 3 embryos for all others
• 41 to 42 years: 3 embryos for those receiving blastocysts and 5 embryos for those receiving cleavage-stage embryos
The procedure for transferring embryos is quite simple, especially when compared to the complexities of the rest of the IVF cycle. Mom-to-be is placed on an exam table, in the same position she would be in for a gynecology exam. A speculum is inserted and her cervix is cleaned off with the same media that are currently housing her embryos. Next, a catheter is inserted into the cervix, and threaded to about 1 cm from the top (fundus) of her uterus. Next, a thin, flexible catheter containing the embryos for transfer is inserted through the already placed catheter and threaded to the top of the uterus as well. At this point, the embryos are pushed gently into the cervix, at the optimal spot for healthy implantation to occur.
In order to guide the catheter to its ideal location, ultrasound is used. Usually, a woman is asked to drink plenty of water prior to transfer so that her bladder will help to flatten out the uterus, making it easier for the doctor to find the ideal location. Most women find that the full bladder sensation is the most uncomfortable aspect of embryo transfer.
Following transfer, a woman is usually left to rest for 15-60 minutes and then released to go home for a day or so of modified bed rest.
One of the greatest fears that couples have following embryo transfer is that their newly placed critters will somehow fall out when she stands up. This definitely isn’t the case! First, the uterus is not on a vertical plane, and secondly, the inside of the uterus is cavernous, with lots of ridges that can catch an embryo where it lands. One of the clinics that I frequently work with actually allows patients get up to relieve themselves immediately following transfer, without any compromise to their pregnancy rates. So, worry not. If it’s a healthy embryo, standing up won’t ruin your chances!
Two-Week Wait & Pregnancy Tests
Finally, the two-week wait begins. During this time, blood work may be done to make sure that the patient's body has enough estrogen and progesterone to ensure pregnancy can be sustained. Around 14 days following retrieval, blood work is done to check for HCG in the blood stream (the HCG from the trigger shot is all worn off now, so you won’t get a false positive!). Detectable HCG confirms pregnancy. A level above 25mIU/ml is considered positive, below 5mIU/ml is considered negative. More important than a high starting number is that the numbers steadily double approximately every other day. Blood work is generally done every few days to ensure a healthy rise in HCG levels until 6-7 weeks gestation, when an ultrasound is performed to check for a fetal heartbeat. (source)
Patients will generally stick with their fertility specialist through about the 8- week mark, at which point they are “graduated” to their OB/GYN of choice. In the case of high-risk factors or multiples, your RE might suggest that you to see a high-risk perinatologist.
What You Can Do to Improve Your Odds…
When pregnancy doesn’t come easy, stress, fear and anxiety can take center stage, this is totally normal! The longer your fertility journey, the greater the stress, as costs rise and your desired outcome begins to feel less than certain.
While there is no magic bullet for overcoming fertility challenges, there are a few things you can do to hedge your bets, and keep your sanity.
My ebook, Feed Your Fertility (co-written by Emily Bartlett, LAc) is dedicated to providing meaningful solutions for maximizing your fertility. Here are a few of the thing we cover:
• Nutrition: A Real food approach is best. Making sure you get enough healthy fats, pasture raised animal products and organic produce will optimize your overall health, a prerequisite for baby making.
• Mind/ Body Practices: Meditation, prayer, mindfulness, yoga…. These are some of the things you can do to help manage your stress load, a vital component of keeping your body primed for pregnancy.
• Acupuncture: Several studies have shown an increase in pregnancy rates when acupuncture is used in the weeks leading up to, before and after embryo transfer. (source) (source). Beyond these studies, acupuncture does great things for your nervous system and is a key component to managing stress and anxiety. Acupuncture is also extremely effective in preparing the body for pregnancy, even if you aren’t pursuing western fertility treatments.
• Chinese Medicine: Beyond acupuncture, Chinese Medicine encompasses herbal medicine, nutrition and a healthy lifestyle. Make sure to always do your homework here and work with a qualified, licensed practitioner to utilize the incredible benefits this approach has to offer!
• Give it some time: When your biological clock is ticking, it’s hard to imagine slowing down the fertility train. Giving your body a few months of healthy eating, mind-body practices and Chinese Medicine can actually improve your chances of a successful IVF outcome, modulate your stress and potentially minimize the amount of treatment you’ll need.
A few more words…
The decision to pursue IVF can be painstaking and scary. Before you proceed, make sure that you understand your odds for success, and maximize it with healthy living, good nutrition and complementary medicine.
I wish you a smooth and blessed road to the family you so desire!
This post was adapted from my upcoming ebook, Feed Your Fertility: Nourishing Your Mind, Body and Spirit with Chinese Medicine and Healthy Living. The
Frequently in my clinic, the phone will ring, and the prospective patient on the other end of the line says something like this: “I’m 3 days past my due date, and my doctor is pressuring me to induce labor in the next few days. I hear you can help.”
As a practitioner, I must admit that this is my least favorite kind of new patient call. As a doula for the last 15 years, and an acupuncturist who is deeply passionate about supporting women throughout the childbearing cycle, the last minute frenzy of trying to beat the clock (so a woman isn’t forced into less-than-desirable medical intervention) really gets under my skin. This is true for me for a few reasons.
First and foremost, I feel for the patient. The unknown abyss that is the onset of labor (and the process of birthing) is often fraught with a multitude of fears. Add to it the stressors of a diminishing maternity leave (for the many whose leave starts even before they give birth), to the schedules of doctors, husbands and in-flying-in-laws. By the time a woman’s due date comes and goes she is often feeling pressure from all directions, except the one that counts the most. To make matters worse, helping a woman understand the absurdity of due dates in the first place (read more about that here) is nearly impossible at this eleventh hour, as she has already succumbed to the fight or flight of being “late” for this very important date.
As a master’s student, I was indoctrinated in the philosophy that Inferior medicine treats the disease, Mediocre medicine treats the body and Superior medicine treats the spirit. Chapter 8 of the Ling Shu tells us that: “Every needling method must be rooted in Shen” and “All treatment must be based on the spirit.” (source)
Yet, for reasons that continue to elude me, we as a profession have veered away from this ideal when it comes to treating reproductive issues, from fertility to childbirth. I am as guilty of this as anyone, as I spent my early years in practice following protocols from every randomized controlled study, following TCM point prescriptions and chasing symptoms.
Over time, I began to feel the disparate quality of this type of acupuncture in contrast to my work as a doula, where every moment with a woman in labor (or preparing for the big day) was about working with her emotions, her body, her spirit and her mind to help her; not only in the journey of childbirth, but parenthood as well. Through this awareness, I began to practice from a place of preparing my patients for labor from as early on in pregnancy as I possibly could.
As practitioners of Chinese Medicine, we have a rare and precious opportunity to infuse our patients with a balanced nervous system, a clear mind and a rooted spirit. When it comes to modern day pregnancy, this takes TIME. Today’s pregnant woman is subject to all of the stressors of modern life, and then some. As her due date approaches, she is faced with an onslaught of unexpected new challenges, from offhanded comments about how ‘big’ her baby is, how ‘low’ her fluid is, how much weight she’s put on. The implications that a woman’s body is somehow inadequate for the task of managing the physiological challenges of childbirth (without the assistance of modern obstetric interventions- gasp!) abound. Women are indoctrinated in the notion that they cannot birth, will not birth, without major help from the medical realm.
In fact, this will be true for many. Not because they want it that way, but because they know no other way. As acupuncturists, we have an incredibly unique opportunity to bring awareness about the birth process to our patients, especially when we bring them into the fold of consciousness surrounding the birth process as early as we can. The reason why I keep harping on this early in pregnancy thing is because it really matters. The earlier they start, the more we can help them to understand the importance of finding the right care provider, for example. Whole-term obstetric treatment also allows us to assist in the maintenance of our patient’s autonomic nervous system- to keep them out of sympathetic up-regulation, and enfolded in the belief system that their bodies carry within all they need to birth.
Please don’t get me wrong- I am by no means a natural-childbirth vigilante. I just happen to believe (and I see it over and over again in practice) that most women want the opportunity to birth on their own terms, whatever those terms may be. For many, with the right education, preparation and intent, being allowed to go into labor naturally, being absolved of the notion that their bodies are somehow defunct and that they can’t do it without help, is enough to make them want to give natural birth a shot. Still, best-laid plans can often go awry, and flexibility remains the order of the day. Nevertheless, when a woman’s labor requires medical intervention for the sake of the baby’s health, or her own, there is no room for regret when the journey was started from a place of conscious intent.
So, when I get those calls, I take them. Of course I do. In those brief few visits I do all I can to bring consciousness to the process, to infuse her with a sense of self-awareness and confidence that she has what she needs. Then, I do what must be done and treat the symptoms, but I root these treatments in a context of whole-ness, and I always address the spirit.
It is with sincere hope that more practitioners will become aware of the value in treating a woman’s spirit throughout her pregnancy, encouraging and supporting her to come to her birth fully prepared for the journey on which she is about to embark, both in birth and in parenthood.
This is part one of three part series examining how to turn a breech baby. Part 2 will look at a Chiropractic Method called the Webster Technique and Part 3 will look at Chinese Medical approaches, including acupuncture and moxibustion.
One spring day in the 1970’s……
“Heidi, it’s a foot!” Those were the first words proclaimed by my father at the sight of my unexpected tootsies as they shuffle-ball-stepped out into the world. You see, I was born a footling breech, back in the day when such things were simply considered a way to be born, rather than the perilous, surgically warranted, lawsuit-waiting-to-happen that they are today.
I’m not implying that breech births are a breeze… by all means they are trickier than the average, low risk vertex (head down) presentation. In addition to being challenging and possibly riskier than head down birth, most doctors these days are not very experienced in breech deliveries. This is because of a decade worth of studies, position papers and retrospectives that went from proclaiming vaginal breech birth universally unsafe, to updated positions concluding that while it might be just fine to deliver a breech baby vaginally, no one is really trained to do it anymore. (source)
In fact, the most recent recommendation from ACOG (American College of Obstetrics and Gynecology) states that the decision to go forward with a breech birth should be based on the experience of the physician and institution. Here in Los Angeles, where I practice, there are only 2 MD’s who deliberately deliver breech babies (some exceptions are made for twins when baby “b” is breech). One of them practices in a home birth setting and the other one is nearing retirement, with no predecessor in sight.
So what’s a pregnant lady with a foot (or a bottom) in her pelvis to do? I took some time to speak with Dr. Jay Goldberg, one of the finest OB/Gyn’s in the LA area, about the practice of External Cephalic Version (ECV). I have had the pleasure of working with Dr. Goldberg on several occasions, both as a doula and as an acupuncturist co-treating patients for various conditions, including breech presentation, and I can attest to both his uber-exceptional bedside manner and way above average clinical expertise. Here is what he had to say:
Me: In your opinion, what causes a baby to stay breech instead of turning head down? Is there something the mom-to-be could have done differently?
Dr. Goldberg: There's nothing [a patient does] to cause this. Sometimes, the baby settles into this position and likes it, so they don't want to move. Sometimes, there is an architecture to the uterus that doesn't allow the baby to turn. Sometimes, there may be a short umbilical cord that is preventing the baby from turning to the down position.
Me: What do you recommend to your patients who have a breech baby and really want a vaginal birth?
Dr. Goldberg: [I say] we still have time to try different things. You can make an effort to help the baby move through chiropractic work or acupuncture, and I have referrals. We can check every 1-2 weeks and maybe the baby will turn on its own. OR, I can try to turn the baby through a procedure called external cephalic version (ECV). This procedure is done in the hospital usually between 36-39 weeks.
I say that there are 4 scenarios that can play out. 1) The baby turns and is not stressed out. We'll send you home until you go into labor. 2) The baby turns and then shows distress and we'll keep you at the hospital and proceed with induction. 3) The baby does not turn but there is no distress. We send you home and schedule a C-section for > 39 weeks. 4) The baby does not turn and shows distress. We proceed with a C-section.
The procedure is performed > 36 weeks because we prefer not to deliver prior to that, and if the ECV results in fetal distress and we have to deliver, we prefer that the patient is farther along. Our group typically does them around 38 weeks.
Me: What does an ECV entail?
Dr. Goldberg: An ECV involves the patient going to the hospital and being monitored for 30-60 minutes. An IV will be inserted and medication is administered to attempt to relax the uterus. Sometimes an ultrasound will be performed to document the fetal position as well as the fluid around the baby. Two physicians with then place the patient in the supine position (completely flat on her back), pour mineral oil onto her abdomen, and then physically press on her abdomen to attempt to turn the baby to the head down position. 2-3 attempts will probably be made. They may try a forward somersault or a back flip of the baby. The ultrasound machine will be used frequently to check the fetal heart tones and the fetal position.
Me: Is ECV painful?
Dr. Goldberg: Attempting to turn the baby is usually described as quite painful because the physicians will need to push hard to get the baby out of the pelvis and flipped to the vertex presentation.
Me: What is the success rate for ECV?
Dr. Goldberg: The success is approximately 50/50, but I usually say 60/40 success with multiparous (women who’ve already had at least one baby) women and 40/60 with primips (first time moms-to-be).
Me: Does your group ever do breech deliveries?
Dr. Goldberg: Our group does not deliver singleton (one baby) vaginal breech. We will deliver a second twin who is breech, but under certain circumstances
Me: Thank you for taking the time to speak with me today. Your answers have been really helpful.
To ECV or Not To ECV… is that still your question?
I must admit that it would still be mine, too, were I to find myself in such a quandary. At the end of the day, it’s a really personal choice, and you won’t get any judgment from this Bao either way. I think it’s important to consider a few things:
1) Acupuncture, chiropractic and other types of body work can go a long way to loosen up the pelvic muscles & ligaments, which may make it easier for the baby to turn. I recommend starting these protocols by 32 weeks. Much of the time, the baby will turn on it’s own and an ECV will never come into play.
2) If you reach the 38 week mark and you’ve tried these other methods to no avail, you might just want to give ECV a try. It’s important to keep in mind that an ECV could result in the birth of your child that day, so plan accordingly.
What if my ECV doesn’t work?
It’s so important to remember that, at the end of the day, we cannot control our childbirth. All we can do is set it up to be the birth me imagine, and then let go. After all who are we, mere mortals, to determine what’s best for anyone? Of course, very few wish for a surgical delivery of their baby, but at the end of the day, we must be present to the medical model we are all a part of, and accept that which we cannot change. While it is my sincere hope that someday, in the near-as-possible future, vaginal breech birth will go back to being just another way to be born, I understand that we are some way from that reality. Talk to your doctor about your wishes, seek out medical care in your community that supports breech birth, and encourage the few who perform it to train others. Be the change, even if your baby won’t make the turn.
About Dr. Goldberg: A Fellow of the American College of Obstetrics and Gynecology, Dr. Jay M. Goldberg earned his medical degree from the Medical University of South Carolina in 1996 after completing his undergraduate education at the University of California-San Diego. He completed his internship and residency training at Kaiser Permanente in Los Angeles. As a founding member of the Cedars-Sinai Center of Excellence in Minimally Invasive Gynecology, he has been at the forefront of laparoscopic and hysteroscopic surgery. Dr. Goldberg has been awarded the Cedars-Sinai Obstetrician of the Year award and was recipient of the Golden Apple Award-given by the resident physicians he teaches. His charity work includes: Autism Speaks, Hirshberg Pancreatic Cancer Foundation, First Ladies Initiative Birthing Center in Namibia, and Hole in the Wall summer camps.
He can be reached through: www.womenscareofbeverlyhillsgroup.com
It is with great pride and excitement that I introduce you to my first published book, Feed Your Fertility,Your Guide to Cultivating a Healthy Pregnancy with Chinese Medicine, Real Food and Holistic Living!
Co-written with fellow acupuncturist and health blogger extraordinaire, Emily Bartlett, Feed Your Fertility is a comprehensive guide to managing the often highly stressful, costly and confusing world of fertility medicine. Within, you’ll find tips for figuring out when in you’re cycle is the ‘right time’ to ‘try’, to knowing when to seek help from a fertility specialist, and everything in between.
Most importantly, Feed Your Fertility brings the importance of self care, stress management and Real Food nutrition to the forefront when it comes to making space for a baby in your body and your life. You’ll discover amazing recipes, real food equivalents for prenatal vitamins, simple meditations, an easy to understand introduction to the benefits of Chinese Medicine and a comprehensive guide to navigating through the medical fertility world. Click here for a glimpse at our table of contents.
Our wonderful publishers, Fair Winds Press, are offering an amazing deal on the electronic download of Feed Your Fertility through March 1, 2015-only 2.99!!
Paperbacks are also available for immediate shipment through Amazon.com!
Once you’ve made you’re purchase, please make your way to feedyourfertility.com, where you’ll find free bonus materials, including a booklet of additional recipes and a downloadable checklist to help you organize your test results and notes.
Some wonderful, notable professionals in the fields of both Eastern and Western Medicine endorsed feed Your Fertility. Here is what some of them had to say:
“Down to earth and practical, Feed your Fertility delivers accessible fertility wisdom that can easily be applied to your daily life. Those who are navigating through the sometimes difficult and confusing labyrinth toward better fertility probably don’t need better reproductive clinics; they need simple, sensible guidance. Feed Your Fertility provides easy to follow solutions for taking charge of your reproductive health.”
Randine Lewis, L.Ac., Ph.D., author of The Infertility Cure and The Way of the Fertile Soul
“Feed Your Fertility is a must read for anyone who wants to optimize their success by integrating eastern and western medicine. It is a comprehensive resource outlining a mind-body evaluation and approach to fertility.”
Kelly J Baek, M.D., California Fertility Partners
“Feed Your Fertility is a must-read for anyone trying to conceive. It draws on traditional Chinese medicine brought right up-to-date, offering couples a simple but effective nutritional plan that works. I recommend it highly.”
Jill Blakeway, M.S,. L.Ac, co-author, Making Babies: A Proven 3-month Program for Maximum Fertility
“Feed your Fertility provides solid information and advice on the most fundamental strategy for increased fertility. We have developed much in the way of high technology, but the foods we eat every day are our most powerful medicine. Laura and Emily provide a path to nourishing yourself not in only body, but in mind and spirit as well.”
Chris Axelrad, L.Ac, FABORM, president of the American Board of Oriental Reproductive Medicine
“Feed Your Fertility is a wonderful and refreshing multifaceted approach towards reproductive care. From diet to stress reduction to conventional fertility treatments and Eastern methodologies, this book is a comprehensive guide for fertility care and successful, healthy pregnancies.”
Eliran Mor, M.D., California Center for Reproductive Health
Thank you in advance for your support of Feed Your Fertility. Writing it was truly a labor of love, and it is our sincerest wish that it may help those in need find a path to the parenthood they so desire.
With warmth and gratitude,