by Beth Heller, M.S.

Nutrition was a big topic at this year’s American Society for Reproductive Medicine conference.  Concepts under discussion included the potential role of inflammation in both male and female fertility and the possible value of antioxidants like resveratrol and omega-3 fatty acids in reversing damage done by environmental toxins.  Another very simple yet compelling idea was presented by Dr. Gil Wilshire from Missouri.  Dr. Wilshire contends that many women, even obese women, are not getting sufficient nutrition for good fertility.  Put simply, the typical low-fat, USDA Food Guide diet that we have all been programmed to eat, is low in essential nutrients like omega-3 fatty acids and fat-soluble vitamins that are essential for our body’s health and reproduction.

Dr. Wilshire was preaching to the choir on this one.  That the poor quality of our modern diet – from the over consumption of fast foods and overly processed meals, to the belief that “low-fat means healthy” – puts all of us at risk for less than optimal nutritional status  is a cornerstone of our fertility nutrition programming at Pulling Down the Moon.  What was especially compelling, though, was Dr. Gil’s use of the concept of “feeding up” in his discussion.  This idea is old as the hills but almost universally accepted in the medical community:  women get pregnant when they are “feeding up” rather than paring down.

The female body is keenly aware of “energy balance,” an evolutionary mechanism that ensures the survival of the human species.  When calories are scarce, bodies begin to shut down non-essential body functions…like reproduction.  Food, however, is much more than calories.  It is also the way our body gets essential nutrients like vitamins, minerals and fats needed for healthy body function.  If a woman is consuming a diet rich in calories but poor in nutrients, she can become malnourished.  Hence an obese woman who lives on processed foods can have plenty of calories but still be “starving.”  And the slender woman who has been told by her fertility doctor to gain some weight in order to conceive may benefit more from shifting to a highly nutritious diet and lowering the intensity of her activity than from simply packing on pounds.

Rather than “feeding up,” we like to say that women get pregnant when they are “nourishing up.”  Importantly, the process of nourishing up can take place without the gain or loss of a single pound.  It begins with a very healthy diet and  good digestion so that essential nutrients are not only present, they are being absorbed and assimilated.  Calorie counting is secondary to this objective, even for the obese woman who needs to lose weight.  In general we believe that certain nutritional supplements  (including a high-quality prenatal vitamin, a probiotic to support digestion and omega-3 fats) can help support the objective of “nourishing up” but the focus should be a diet rich in fruits, vegetables, lean protein, minimally processed grains and healthy fats.

We also know that nourishment can come in many ways – including the nourishment of true relaxation that comes with yoga practice, nourishment through channeling chi throughout the body during an acupuncture session or the healing touch of massage and reiki.  Changing the intensity and intention of our exercise program from “burning and racing” to “energizing and strengthening” can also make a difference.

At a high-tech conference like ASRM it was encouraging to see nutrition on the table, so to speak.  It was clear, however, that nutrition will never get the attention of research dollars.  Many more people attended the class on Pre-Implantation Genetic Diagnosis (PGD) than the class about nutrition.  Doing nutrition research is complicated and funding is scarce because unlike drug research, where there’s potential to patent and produce a pharmaceutical drug that will make billions of dollars, a healthy diet can’t be patented and won’t make anyone rich.  Conflicts of interest are everywhere.   Governmental agencies that are charged with making nutritional recommendations are also charged with protecting the economic interests of food manufacturers.   Our national nutrition association, the American Dietetic Association, is partnering with companies like Coca Cola to get women to drink more Diet Coke in order to prevent heart disease.  Yikes!

So what are we to do?  In the face of misinformation we must begin to live the truth and spread the word.  Have you made changes to your diet that fly in the face of the Dietary Guidelines for America?  Have you switched to full fat dairy and sworn off fat-free yogurt?  Have you switched to a more nourishing lifestyle through yoga, acupuncture or other practice?  If you have, please share your stories and we will feature them in our blog and on via social media.  Send your storied to beth@pullingdownthemoon.com subject line:  Nourishing Up.  You can include your name or let me know that you’d like to remain anonymous.

by Beth Heller, MS RYT

Yoga poses are a mystery in my book.  We go to yoga class, stand on a mat in our bare feet and proceed to bend and twist our bodies until we take on a completely different shape.  What are these shapes?  Why on earth do they make us feel so good?  Why are they such a gift when we are experiencing life and health challenges such as infertility?

There is a lot of information about the physiological benefits of yoga.  Clearly, yoga postures are good for our bodies.  Stretching tight musculature improves our posture, strengthens our digestion and makes our muscles strong and supple.  Hip opening postures feed blood to the uterus and ovaries, backbends stimulate our nervous system and free our respiratory system from chronic tension, and twists “wring out” toxins and stale fluid from body tissues.  But aren’t postures just physical exercise?  The answer is yes, and no.

In his master work Light on Yoga, renowned yogi B.K.S. Iyengar explains that names of yoga poses are significant and symbolize the process of evolution.  There are poses named for plants (tree, lotus), poses named for insects (locust, scorpion), poses named for fish, reptiles and higher mammals like dog and camel.  Some are even named for legendary Hindu heroes and even gods.  The point is, Iyengar says, that while we perform yoga asana we assume many different forms, from the lowliest to the most exalted, and recognize the Universal Spirit that runs through them all.   Mr. Iyengar asserts that it is this unspoken presence of the divine that begins to work on the body of the yogi, causing new discipline and spontaneous healing to occur in diet, cleanliness and character.  What a fascinating thought – and how nice to think that tapping into something greater than ourselves is just a down dog away?

Over tea last week, Joyce, a fellow yoga teacher and friend was discussing her yoga practice when she added another dimension to my musing.

“The postures,” she said, “are the constant and I am the variable.  When I move into a yoga pose that I practice regularly, the pose is the same but depending on my state of mind, what I ate for dinner the night before and my present mood it’s a unique experience every time.  When I am tense, my down dog is rigid.  When I am sad I am reluctant to do backbends.  Because the postures encourage me to breathe and reflect, I see how my life affects my body. “

So, while in some ways these insights make the mystery even deeper, my appreciation of yoga asana is ever expanding.  These insights remind me that while yoga for fertility is trendy and hip openers are indeed great for fertility, the roots of this practice run far deeper than we will ever imagine.  And for this I am truly grateful.

Check out our brand new video companion to our book, Fully Fertile. This easy to use practice is great for any level, designed to support your body’s fertility and, with faithful practice, connect you to this universal healing awareness.

by Beth Heller MS, RYT

No, this isn’t another chirpy post about the power of positive thinking or the law of attraction.  While there are potential fertility benefits to both of those things, the positive I’m talking about here is the little plus on the pee stick or the positive lilt in the nurse’s voice when she gives you the news that your beta hCG has just doubled.  This post is also about the apprehension I’ve seen behind the eyes of my yoga students when they share their good news.  One hurdle cleared – “I’m pregnant!” – but another looms ahead…that tenuous first trimester.   This anxiety is magnified if their journey has been a long one or if a previous “positive” ended in a negative.

Having experienced multiple miscarriages and other assorted disappointments, that odd mix of joy and terror during the first twelve weeks of pregnancy is something I know way too well.  I spent most of the waking hours of my first trimesters taking my basal temperature incessantly to make sure it hadn’t dropped, bracing myself to see blood on the toilet paper every time I went to the bathroom and subjecting every ping I felt in my abdomen to a thorough Google search.  Is there anything we can do to make this time bearable?

Absolutely.  I’m assuming that you’ve been taking pretty good care of yourself on the road to pregnancy, so now is definitely not the time to pull off that road.  Keep on doing what you’ve been doing to stay happy, healthy and balanced.  In case you’re so freaked out that you can’t remember what those things were, here is a checklist for staying positive, figuratively and literally, during the first trimester:

1. Practice your yoga and meditation.   When a woman becomes pregnant during our six week Yoga for Fertility class, which I am happy to report happens quite frequently, we encourage her to stay with the class and the practice during her early weeks of pregnancy.   Researchers hypothesize that stress may contribute to early pregnancy loss, a phenomenon they are calling Pregnancy Stress Syndrome.  The immune/endocrine imbalances that result from stress may be a trigger for pregnancy loss.  The good news is that population studies show that “tender-loving-care” interventions that focus on reducing stress and helping women feel supported are associated with positive pregnancy outcomes in women with history of miscarriage. As long as the yoga is gentle and the teacher is knowledgeable about what’s verboten during very early pregnancy, you’re good to go.  If you don’t feel comfortable doing yoga, find a meditation or other relaxation class to attend to keep the “ritual of relaxation” going during this time
2. Exercise.  Yes, I did say exercise.  Note that I did not say go for a run or start power lifting, but I did say exercise.  Early pregnancy is a time to stroll and smell the flowers or stretch in leisurely manner.  Gentle (stress again gentle) movement will help to relieve anxiety, mediate the fatigue that often comes along with the first trimester and promote a sense of well-being.  Just keep it gentle (did I stress gentle?).
3. Keep eating right.  You may not feel ready for the full-on prenatal nutrition consult, but it is time to contact your nutritionist and make sure that any herbal or nutritional supplements you have been taking are still appropriate during the first trimester.   If you’ve discontinued dairy, wheat or other potential allergens, this is not the time to add them back in without the support of a skilled nutritionist, but it is time to ensure that any eliminations you have made have not created nutritional “holes” in your nutritional status.
4. Keep getting your acupuncture.  Traditional Chinese Medicine is very useful and has specific protocols for miscarriage prevention.  At Pulling Down the Moon we recommend women receive treatment weekly during the first trimester and then continue monthly or on an as-needed basis for the remainder of the pregnancy.
5. Hands on work like massage and reiki can also help you stay calm and centered.  Think about how your dog or cat melts under your touch when they are anxious.  Make sure, though, that your massage therapist knows that you are newly pregnant and is aware of any contraindicated techniques or points on the body that should not be manipulated during pregnancy.
6. Finally, keep breathing.  When the anxiety starts to creep up, take a deep inhale through your nose and let it out slowly through mouth saying silently to yourself “I’m happy, I’m healthy, I’m whole.”  The instinct is to hold the breath and count the days until week twelve but the reality is that staying in the flow of life will help you focus on something other than your fears.   The breath is a reminder of that flow and brings you back to center.

Stay present, stay peaceful, stay positive.  It will be trimester-two before you know it!   Beth

Note:  Before applying any techniques described in this or any other nutrition, exercise or holistic program an individual should always consult and obtain professional medical advice, including from their doctor.

Lisa Espinosa, Reiki Master

By: Lisa Espinosa, M.Ed., Reiki Master

“I took this class to help me find peace and relaxation during my fertility,” commented Martha*, a student in my meditation class. “It helped me find both, but even more importantly, helped me realize how important it was to not lose myself on this journey.”

Martha’s comment reflects one of the main purpose’s of the meditation class I teach: to help women re-connect with themselves, and “not loose themselves on this journey.”  In this class I help you experience an hour of peace and relaxation. And I share tools that you can integrate into your everyday life to help you navigate the stress that is common during the fertility journey.

During the class, I guide women through an hour of relaxing and nurturing meditation, integrated with Reiki healing energy.  The combination of meditation and Reiki really enhances the experience for my students. As one of my students, Jill, shared:

“I got so much from the class. It is wonderful for learning ways to release stress and take care of yourself whether you are going through treatments or taking a break. Lisa’s guidance through the meditations were gentle and helped me get the most of each meditation. The Reiki was a great bonus. I could feel the energy each time. It was fantastic!”

During the class I play soothing music as I guide my students to shift from rushing, stress, and worry to a place of peace, and centeredness. I use different meditation techniques, such as visualization and mantra. I also incorporate a chakra meditation, in which students connect with each chakra (the seven energy centers of our body which can often get clogged and congested) and begin to notice which of their chakras might need some balancing. Throughout the class I gently do Reiki by laying my hands on different areas of my students’ bodies, such as tight shoulders, or achy backs, as well as any chakras students identified that need some balancing. During the last meditation, women lie down as I spend a few moments on each student doing Reiki on an area that is in need of more healing. My clients enjoy having this hour to themselves. As Sharron, wrote:

“I enjoyed the hour to focus on myself without disruptions, to think about the week ahead and focus on what I want to achieve and (sometimes) reflect on the past week. It has been a wonderful prep for a stressful IVF cycle. It calms me during the period and keeps me busy at the same time.”

For the next few weeks this class will be a drop-in class, and will return to a 5-week enrollment class in November.  I invite all of you to take this opportunity to give it a try. There is no experience necessary, and both fertility and pre-natal clients are welcome.  If you have any questions please contact me at lisae@pullingdownthemoon.com.

* all names have been changed

by Breea Johnson, MS RD LDN

When someone is dealing with infertility, they often scour the world for answers. For a lot of women, they never figure out why they have unexplained infertility or experienced a miscarriage. But for some women, the answer may lie in a simple blood test to measure thyroid function as low thyroid function and thyroid autoimmunity are both associated with infertility and miscarriage.

Consider Pulling Down the Moon nutrition client, Ann*, a 32 year old, normal weight woman who had two miscarriages with no explanation. After going to a miscarriage specialist, she was found to have hypothyroidism (low thyroid function) and with thyroid medication was successfully able to get pregnant and carry the baby to full term.

The thyroid gland, one of the largest endocrine glands in the body, is shaped like a butterfly and is located on the front of the neck below the Adam’s apple. While it is very small (only 2 inches across), it affects our entire body, as the hormones it produces and secretes regulate metabolism, growth and development.

A well-functioning thyroid gland is pivotal for a healthy body and to conceive a healthy child. There is a direct interaction between the thyroid gland and the reproductive organs (the testes in men and ovaries in women). Hypothyroidism (low thyroid function) influences ovarian function by decreasing levels of sex-hormone-binding-globulin (SHBG) and increasing the secretion of prolactin. Prolactin, the hormone which stimulates milk production for breastfeeding, also affects ovulation and menstrual cycles. Prolactin inhibits Follicle-Stimulating Hormone (FSH) and gonadotropin releasing hormone (GnRH). With high levels of prolactin, which can be caused by hypothyroidism, ovulation is not triggered and a woman cannot get pregnant. Additionally, in men, low FSH and GnRH caused by elevated levels of prolactin can prevent the maturation of sperm.

Another common disorder affecting fertility is Thyroid Autoimmune (TAI) disease (Graves Disease and Hashimoto’s Disease). It’s the most common autoimmune disorder and affects between 5-20% of women of childbearing age (Poppe, 2008). This group of disorders involves both the endocrine and immune systems. Interestingly, there is double the rate of miscarriages in TAI-positive women and TAI has also been found to be increased in women with endometriosis. In one study, researchers found a 75% reduction in miscarriage among TAI-positive women who received levothyroxine (a drug used to treat low thyroid function) during gestation and pregnancy. Subclinical hypothyroidism also may be an issue, as women with TAI show moderately high TSH (Thyroid-Stimulating Hormone) levels before pregnancy, although often within the normal reference range. There has been discussion among endocrinologists to move the limits of TSH (used to measure TAI) to 2.5mIU/l but that is not in effect yet.

We asked Dr. Christopher Sipe, a Reproductive Endocrinologist and one of our doctor partners at Fertility Centers of Illinois, whether he thinks thyroid disorders go undiagnosed early in the fertility journey when a woman is still with her OB.

“Because thyroid disorders are so common,” says Dr. Sipe “there are many women walking around who are undiagnosed. Thyroid hormone levels fluctuate in our daily lives and can be affected by diet, exercise, supplements, weight changes, medical conditions and seasonal changes. Therefore, a woman can be normal once but 6-12 months later have an abnormal level. Pregnancy also causes a shift in the normal range of thyroid hormones, further making diagnosis of a thyroid disorder more difficult. It is for this reason that diagnosis pre-pregnancy is ideal and screening should be recommended to any woman considering pregnancy.”

Dr. Sipe recommends woman have her TSH checked when she is considering becoming pregnant, when she has an irregular menstrual cycle, if she has a family history of thyroid disorder or if she exhibits symptoms of a thyroid disorder. Symptoms of thyroid disorder include inability to lose weight, dry skin, dry hair, depression, fatigue, constipation or muscle aches and pains.

In the case of a woman who is trying to conceive, testing the thyroid early may save valuable time.

“Treatment can take three to six months before a steady hormone level is achieved, and then pregnancy can be attempted,” concludes Dr. Sipe.

*Name withheld for confidentiality reasons.

by Beth Heller M.S.

You may be surprised to think of your digestive system as part of your immune system, but our gut actually functions as our body’s first line of defense – eliminating bacteria and other bugs before they can infect our internal environment.   When the digestive system is challenged, by such conditions as stress, illness or food sensitivity, inflammation can result.  Frequent bouts of diarrhea, constipation, intestinal bloating/cramping and heartburn can all be symptoms of an inflamed digestive tract.  Chronic inflammation of the digestive tract can impair our body’s ability to break down and absorb the nutrients in the food we eat.  In addition, gut inflammation may affect other organ systems, including the reproductive organs, which are in close proximity.  These factors, taken together, are why we take a very close look at digestion, and symptoms of food sensitivity, as they relate to fertility.

Celiac disease, a condition in which an individual cannot tolerate gluten (a protein found naturally in wheat and used as an additive in many foods), is the classic example of a food sensitivity that is associated with infertility.  Population studies suggest that about 1 person in 100 has celiac disease, but studies also suggest that celiac is also under-diagnosed and may be 2.5-3.5% more prevalent in women with unexplained infertility (http://www.ncbi.nlm.nih.gov/pubmed/17592443?log$=activity)

In people with celiac disease, dietary intake of gluten (a protein found in many grains) causes a two-fold attack in the small intestine. Antibodies first attack the gluten protein and this attack triggers an autoimmune response in which antibodies attack the endomysium, a smooth muscle component in the small intestine, and damage the tiny, fingerlike protrusions on the wall of the small intestine that serve to absorb nutrients from food called villi. This leads to the most likely link between celiac disease and infertility – the malabsorption of nutrients.

New research is emerging that suggests that there is a spectrum of gluten sensitivity and that celiac disease gluten sensitivity can cause symptoms similar to Inflammatory Bowel Disease which may negatively impact nutrition status and quality of life in ways similar to Celiac Disease.  (http://www.ncbi.nlm.nih.gov/pubmed/19455131?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=21 ) Other common food sensitivities besides gluten sensitivity include eggs, soy, peanuts and dairy. Symptoms of food sensitivity are diverse:  diarrhea, constipation, rashes, gas and bloating and headaches – just to name a few.  At the Moon, in cases of repeated miscarriage, multiple failed ART cycles, unexplained infertility and/or Irritable Bowel Syndrome our nutritionists will often recommend our ART Recovery/Preparation Program, an ultra-healing diet that eliminates common allergens from the diet and track any change in digestive function and other symptoms.

Remember, though, that we do not want to throw the baby out with the bath water.  Potentially allergenic foods, like dairy and soy, are also important sources of vitamins, minerals and dietary protein. They should never be removed from the diet without a solid nutrition plan.  Studies have also shown that one side-effect of a gluten free diet can be a reduction of healthy gut flora (http://www.ncbi.nlm.nih.gov/pubmed/19445821?log$=activity) .  As we’ve written before, healthy gut bacteria is critical for optimal digestive function and hormonal regulation, so any plan to eliminate gluten must support the gut.   Don’t forget that any elimination diet should also include a strategy for reintroduction and symptom assessment as the goal of any elimination diet is to determine which foods are causing problems.

If you suspect food sensitivity may be part of your fertility issues, we highly suggest you seek out treatment with a trained fertility nutritionist.  Eliminating foods from the diet can be hard work, and is not necessary for everyone.   However, at the Moon, we’ve seen that for some patients the potential benefits may indeed be worth the inconvenience.

To learn more about our nutrition programming, call 312-321-0004 (Chicago-Area) or 301-610-7755 (DC Metro).

Evans KE et al.  Be vigilant for patients with coeliac disease. Practitioner. 2009 Oct;253(1722):19-22, 2.

Pellicano R et al. Women and celiac disease:  association with unexplained infertility.  Minerva Med 2007 Jun; 98 (3):217-9.

Verdu et al. Between celiac disease and irritable bowel syndrome:  the “no man’s land” of gluten sensitivity.  Am J Gastroenterol. 2009 Jun;104 (6):1587-94.

For optimal health and vitality, traditional medical teachings recommend eating seasonally and locally.  In keeping with the ancient belief that we are healthier and happier when our bodies are in tune with the cycles of nature, it follows we should eat foods that grow in our geographical area while they are in season.  Traditional systems teach that foods and people in the same geographical area have “similar energy.”  This may be true in the sense that plants and the people living as neighbors share the same weather, air, soil and “roots.”  Whether indigenous or adoptive species, plants that thrive in particular areas are there because they are well-suited and have established harmony with their surroundings.  When we eat foods that exist in harmony with our surroundings, it’s believed we allow take some of that harmony into our own bodies.

Yet as we enter deep fall, some of the most touted fertility foods, like berries and melons, are heading out of season.  But that’s no reason to panic.  Instead of spending a fortune this winter on raspberries that have been shipped from half-way across the world, take a deeper look at your flora.  Farmer’s markets are an obvious way to explore what’s locally and seasonally available in your area.  In addition, many larger grocery chains have begun to label produce as locally-grown when applicable.

Here are some tips for reaping the best of Fall’s fertility bounty:

1. Think slow, think stew.  Fall and winter vegetables tend to be tougher and heartier than the delicate sprigs and tender fruits of spring and summer.  Kale, collards and sweet potatoes hold up well to slow-cooking methods like stewing or braising.  The benefit of stews and one-pot-meals is that the veggie cooking liquid is consumed as part of the dish, thus preserving nutrient content.
2. Turn on the oven.  Cruciferous vegetables, including cauliflower, cabbage and Brussels sprouts release a caramel sweetness when slow roasted in a hot oven.  These vegetables are fertility “must eats” and contain compounds that help regulate our body’s hormone levels.
3. Experiment with beans.  Bean soups and chili are nourishing dishes that contain fiber that promotes healthy digestion and elimination.
4. Squashes and sweet potatoes are anti-oxidant powerhouses.  Slow roasted or mashed, they can also quench a sweet tooth.

For more info about a nutrition consultation with a Pulling Down the Moon nutritionist call 312-321-0004 (Chicago) and 301-610-7755 (Rockville).

By Beth Heller, M.S.

“Under such a concept unrecruited oocytes in primordial follicles, however, cannot  age, as current dogma holds. As long as unrecruited, they have to maintain their original quality. Only once recruited and entering maturation do they risk “ losing quality” if their maturation takes place within a poor quality ovarian environment. Since ovarian environments decline in quality as women age, aging women produce increasingly poor oocytes.” (1)

This is the conclusion Dr. Norman Gleicher reaches in a recent reconsideration of the traditional understanding of ovarian reserve published in the journal Reproductive Biology and Endocrinology.  On the surface it may seem like thick scientific speak, but when you sit with it and take the time to digest the article, it is quite radical.  Dr. Gleicher is saying what the holistic world has been saying for years – that the environment in which an egg matures is as important as the egg itself.

The line of reasoning that lead Gleicher and his colleagues to this conclusion is very interesting and is directly related to their work with DHEA supplementation in women with poor ovarian reserve.  In their lab and others, DHEA has been shown to  increase pregnancy rates  in this population of women.  In addition, DHEA treatment has been shown to be associated with lower incidence of miscarriage and aneuploidy.  Gleicher asserts that while the chance of pregnancy in this population is still low, it is more possible than current medical opinion holds it to be.  His lab has documented more than 30 pregnancies in women with severely diminished ovarian reserve.  These reported pregnancies also had a low rate of miscarriage.

Women are born with all the eggs they will ever have.  Current medical opinion holds that these eggs “age” along with the woman so that the quality of the individual eggs declines irreversibly.  As a result pregnancies from these eggs will result in poor quality embryos, lower implantation rates and more spontaneous miscarriage.  In Gleicher’s research, however, pregnancies in women treated with DHEA had a low rate of miscarriage and aneuploidy and relatively high live-birth rates, suggesting that even older women and women with severely depleted ovarian reserve still have “good eggs.”

So, are our eggs getting older with us or are they in a state of “suspended animation” waiting to be recruited?

It will likely take the medical community a while to duke this one out.  From our perspective, while this new argument does not erase the relationship between age and fertility, it does make the relationship more fluid.  Following this line of reasoning opens up new avenues of medical treatment that focus on the four to six months that comprise an oocyte’s full maturation cycle.  Beyond providing a foundation for future medical/pharmacological protocols this understanding gives weight to lifestyle interventions including nutritional therapy, acupuncture and yoga that seek to improve the uterine environment.

What remains unanswered is what, exactly, is causing the decline in the quality of the ovarian environment in aging women.  It has been suggested that inflammation, oxidative stress, circulating stress hormones and environmental toxins may all play a part in egg quality/egg maturation processes.  It is our hope that the medical community does not limit their focus to new pharmacological interventions and fully considers the potential role of low-cost lifestyle interventions as well.

1.  Gleicher et al. Reproductive Biology and Endocrinology 2011, 9:23

by Beth Heller M.S. and Laura Dubrule, R.D., L.D.N.

At Pulling Down the Moon we will often recommend a “cleanse” diet following a miscarriage or failed ART cycle.  While a cleanse can, at times, entail the elimination of one or more common food allergens like dairy, wheat and soy, elimination is not the basis of our program.  More often than not our cleanse consists of limiting processed sugar and other processed foods, artificial additives and colors while focusing on foods that support our body’s anti-inflammatory and detoxification processes.  The cleanse program at Pulling Down the Moon is individualized and takes into consideration a woman (or man’s) past and present digestive function, hormonal and other symptoms, medical history and current lifestyle.

One key element of our program is supporting hormone balance.  After a failed ART cycle or a miscarriage, a woman’s body must re-establish hormonal balance and function.  It may have been months since her last natural menstrual cycle. Weight gain during treatment may also impact hormone balance.  Yet another common symptom reported by our patients post-ART is anxiety and a lasting case of “the blues.”   It’s very easy to attribute these emotional side-effects to disappointment but there may also be a physical component.   The hormone medications used during the stimulation phase of an ART cycle, and the progesterone supplementation post-IUI and ET, can cause emotional side effects and these hormones can be slow to leave the body.  The liver is charged with processing these steroids before they can be excreted.  To do this it requires ample amounts of amino acids (in particular sulphur-containing amino acids), as well as the vitamins and minerals that work as co-factors in detoxification pathways.

Our ART Recovery/Prep Program focuses on limiting sources of external hormones by discouraging foods that contain hormones and hormone-like substances.  Chief offenders in this area include factory-farmed dairy and meat products which contain the hormones and growth factors used in production.  There are also hormone-like chemicals in pesticides and plastics.  By limiting these external sources of hormone-like substances and increasing the intake of foods that support good hormone function (fiber, lignans and lignins, a range of whole grains – not just wheat! – , healthy fats, cruciferous vegetables, antioxidant rich fruits and veg and added-hormone-free protein) we have the potential to bolster our body’s ability to metabolize and excrete excess hormones and restore balance in the reproductive cycle.

Our Rockville nutritionists Laura Dubrule, R.D. recently  shared a case with me that drove this message home.

My patient is 43 and had experienced two failed IVF cycles in quick succession (6 months time).  Her physician had noted several potential factors contributing to failure including egg quality and endometrial lining quality.  In addition, the patient had recently been diagnosed with PCOS.  Since her last IVF the patient was unable to lose the 8 pounds gained during IVF treatment despite eating a healthy diet and working out four times per week.

We discussed the impact of IVF medications on hormone levels as well as the impact of various dietary choices on her body’s ability to break down and clear excess hormones. We focused especially on tweaking her already health-supporting diet to include significant amounts of cruciferous vegetables and berries every day as well as a daily serving  of legumes.  I suggested she add two supplements, RePro Cleanse and FlowPro, to her regimen as well as vitamin D.

I was very surprised when the patient returned for follow-up having lost 8 lbs over the preceding two weeks.  At Pulling Down the Moon we are extremely careful not to encourage rapid weight loss but upon review of my patient’s diet it was clear that a reduction in calories was not a major factor in her weight loss. The patient reported feeling that the weight came off her abdominal area, that she had lost a bloated feeling, and that her clothes fit the way they used to.

The patient also told me about the resolution of another symptom she hadn’t mentioned in our initial consult. She had been experiencing high levels of anxiety while driving, especially on the highway.  This was not her experience historically, but had been a recent development.  Over the course of the two-week cleanse, this driving anxiety completely disappeared.

While we can’t be certain, we suspect that this rapid loss of water weight and alleviation of anxiety may have been due to an increased clearance of excess steroid hormones that had been circulating in her system.   Whatever the reason, the result was excellent.  While there is still work ahead, my patient is very pleased with the results of her cleanse and feels more like herself than she has in months.  We both agreed that anything we could do to reduce the lingering effects of ART would only help her feel more prepared for her next round of treatment.

We believe that a nutritional consultation can make a big difference in the fertility journey.   Our consultations are available in person in Chicago and the DC Metro area and by phone from almost anywhere else.  Call 312-321-0004 (Chicago) or 301-610-7755 (Rockville) for information.

RePro Cleanse includes kudzu, flax, rice protein and other micronutrients that support the liver’s detoxification processes. Because it contains plant estrogens and is designed to help balance and promote clearance of excess reproductive hormones, we do not use RePro Cleanse when a woman is on fertility medications or birth control.  We often recommend supplementation with Re Pro Cleanse when women are recovering from a failed cycle or miscarriage, or in cases of hormone-related conditions like fibroids or endometriosis.  We will also use RePro Cleanse when a woman’s IVF cycle is cancelled/postponed due to high baseline estrogen levels.   Used as directed over a period of 2-4 weeks we feel that this supplement can help jump start a woman’s recovery process in preparation for a subsequent cycle, be it ART or natural.  Of course we recommend that our patients clear any/all supplements with their physicians.

About Laura Dubrule

Laura brings an eclectic mix of passions to her nutrition counseling. Her years studying acting in New York taught her the importance of connecting with our bodies; this deep sense is fundamental to her understanding of diet and nutrition. Laura completed the program in Nutrition and Food Science at Hunter College in New York, and then went on to complete her dietetic internship at Stony Brook University, a program with an integrative and functional approach. She returned to the city and practiced in a worksite wellness program, delivering individualized nutrition counseling to bank employees in Manhattan and Brooklyn. Her vision for her clients could be called “whole foods meet real world.” She believes that food is meant to be enjoyed and works with her clients to find healthful approaches to eating that are satisfying and enjoyable.

Laura is thrilled to be working in concert with acupuncture, yoga and massage professionals because she believes that the nourishment and care of our hearts and souls is integral to the nourishment of our bodies. She considers it a privilege to be a resource to men and women on their fertility journeys and to celebrate every step long that path as an act of love and creation.