Yoga + Fertility

The diagnosis of infertility and the decision to pursue treatment can present significant emotional, financial and physical challenges for individuals and couples that ultimately contribute to increased anxiety and depression.  Behavioral interventions such as meditation and yoga, that focus on increasing mindfulness and self-compassion, have been successfully implemented in couples undergoing fertility treatment and have been shown to improve psychological distress and coping strategies.1,2

The success of assisted reproductive technology therapy relies on numerous factors that are outside the control of any one individual.  Developing a mindfulness practice that facilitates finding peace within the chaos, periods of waiting and unknown is critical to maintaining overall quality of life throughout the process.

As September is National Yoga Awareness month, we want to give a nod to the practice of yoga, as it has been shown to be an incredibly effective tool when implemented prior to and throughout initiating fertility treatment. In addition to the physical benefits such as increased strength and flexibility, the mental benefits from an increasing inner calm, stress reduction and overall relaxation can positively impact many areas of life.3The additional beauty of yoga is that it can be done in the comfort of your own home without any equipment (you don’t even need a mat!) and you can practice anytime you want. So what’s stopping you?

What kind of yoga should I do?
Much of the research that has focused on yoga as an intervention in individuals undergoing fertility treatment has used hatha yoga, which is a type of yoga that combines movement with breath, but you can choose whatever practice suits you best. Other common styles include vinyasa, deep stretch and power yoga. Regardless of the style of your practice. the focus should be on the breath, because that’s where the yoga truly is. Once you learn to breathe and center yourself effectively within the movement, you can translate that practice into everyday life… when you’re stressed about a deadline… while stuck in traffic driving to work or driving to your next appointment… when you find all the ultrasound appointments and injections overwhelming… while waiting in the waiting room… you can find a sense of calm and centeredness within the chaos and keep breathing.

What evidence is there for yoga with fertility treatment?
One study of women undergoing IVF treatment demonstrated that as little as one 55-minute yoga practice once a week for six weeks leading up to IVF treatment resulted in significantly improved overall quality of life, emotional and mind-body scores in addition to a significant reduction in mean anxiety and depression scores.4Another study used a combined approach emphasizing mindfulness of thoughts and feelings through breath, guided body scans and hatha yoga which resulted in improved self-compassion, coping strategies and improved scores in all domains of a quality of life assessment.2

How do I get started?
Make a commitment to dedicate one hour a week to yourself to get started, and see what happens. You could do three 20 minute sessions, two 30 minute sessions, or one hour straight through. Whatever suits your schedule and mind best. Choose a positive mantra to begin your practice with and when you notice your mind wandering, repeat it throughout your practice:
“I am strong… I am capable… I am beautiful… I am resilient… I am a survivor… I am grateful…” Choose a mantra that speaks to you.

There are numerous free yoga videos on YouTube to get you started. Check out our Yoga quick links to view some of our favorites! Once you have the basics down you can simply turn on your favorite music, set a timer for 20 minutes to an hour, go with the flow and breathe. If you prefer a group exercise setting, multiple studios offer very reasonable walk-in rates for anywhere from $5-$10 class.

Commit to taking care of yourself, one breath at a time.

If you have any questions, give us a call! We’re happy to chat!

Ashley Eskew, MD
Wash U Fertility Team

  1. Galhardo A, Cunha M, Pinto-Gouveia J. Mindfulness-Based Program for Infertility: efficacy study. Fertil Steril2013;100:1059-67.
  2. Li J, Long L, Liu Y, He W, Li M. Effects of a mindfulness-based intervention on fertility quality of life and pregnancy rates among women subjected to first in vitro fertilization treatment. Behav Res Ther2016;77:96-104.
  3. Valoriani V, Lotti F, Vanni C, Noci MC, Fontanarosa N, Ferrari G, et al. Hatha-yoga as a psychological adjuvant for women undergoing IVF: a pilot study. Eur J Obstet Gynecol Reprod Biol2014;176:158-62.
  4. Oron G, Allnutt E, Lackman T, Sokal-Arnon T, Holzer H, Takefman J. A prospective study using Hatha Yoga for stress reduction among women waiting for IVF treatment. Reprod Biomed Online2015;30:542-8.


Thoughts on PCOS

September 21, 2018

In honor of PCOS awareness month, let’s open up a conversation…

Polycystic ovary syndrome? What is it? 
The first people to describe PCOS were Stein and Leventhal.  They described it in 1935 in an article published in the American Journal of Obstetrics and Gynecology.  They described a handful of women with irregular menstrual cycles, a sign of irregular and unpredictable ovulation, and excess hair growth.  Ultrasound wasn’t available at the time, but Stein and Leventhal took these women to the operating room, and they did laparotomies (abdominal incisions) and took a look at these women’s ovaries.  They found them to be “polycystic” in appearance. Stein and Leventhal took wedges out of these women’s ovaries and post-operatively most of the women started to ovulate regularly and got pregnant.

The story of Stein and Leventhal’s success in helping these women conceive is terrific.  Especially given the fact that there was so little we could do in 1935 to treat infertility.  BUT, our understanding of this condition has changed dramatically over the years, and our options for treating PCOS medically has also improved.

So, here we are over 80 years later…
How do we diagnose PCOS today?  Well, there are a number of different expert opinions on this.  For this I like to turn to the American College of Obstetricians and Gynecologists.  They just published a new Practice Bulletin for OB-Gyns to look to for guidance in helping patients.  To summarize their advice, here goes:

  • PCOS is characterized by hyperandrogenism (high androgens measured by blood test like testosterone, excess hair growth, and/or acne), irregular menstrual cycles (<8 per year or >35 days between menstrual cycles), and/or polycystic appearing ovaries on ultrasound.
  • PCOS can only be diagnosed once other causes of these symptoms have been excluded. These potential causes include thyroid disease, pituitary adenoma, testosterone secreting tumors, and non-classic congenital adrenal hyperplasia.

Overall, how we diagnose PCOS is a lot more nuanced than it used to be, and how we treat it should really be based on what a woman’s symptoms are and what her treatment goals are.

We have a PCOS clinic at Wash U where we work with women to address their goals.

For women who may want to get pregnant in the future, I recommend checking an antimüllerian hormone (AMH) level.  AMH is made by follicles in the ovary—follicles contain eggs and AMH tells us how many eggs are sitting, resting in the ovaries that could potentially be recruited if someone were to undergo fertility treatments.  Easy, repeatable tests to measure AMH only became clinically available recently.   How we counsel women on improving fertility today is largely based on what their AMH value is.  So we may counsel someone with a low AMH value differently than how we might counsel a woman with a high AMH despite the fact that both women might technically meet diagnostic criteria for PCOS.

PCOS & Insulin Resistance
For women with PCOS who are insulin resistant, we may add medications or counsel on specific dietary plans that may help improve insulin sensitivity.  Insulin is the hormone we make that helps us metabolize carbs.  If we have insulin resistance, our ability to metabolize carbs (or glucose/sugar) is impaired.  Sometimes a low-carb diet may be helpful.  This doesn’t necessarily mean NO-carb…NO-carb can be difficult to sustain (oh, how I love pasta, bread, and ice cream).  It means eating good carbs, and being sensible.  We can eat ice cream once in a while, but if we have insulin resistance we should limit it and keep it in check being aware of all of the other carbs we are eating.

So how do we know if we have insulin resistance?  There are lots of way to screen for it, but the easiest way is probably to measure a hemoglobin A1c.  If your level is 5.7 or higher you may be insulin-resistant.  You may also be pre-disposed to developing diabetes down the road. The good news about this though is if you know you are insulin resistant, you can do something about it! You can modify your lifestyle (diet—food choices, exercise habits, sleep habits), consider medications, and improve your long-term health outcomes.  You can do it!

In regards to pregnancy, the main reason PCOS can impede our chances of conception is that it is associated with infrequent ovulation.  So we can’t predict when we are going to ovulate making it difficult to time intercourse.  There are a number of simple oral medications we can use to help improve ovulation. Letrozole is a common one to start with. Clomid used to be our first choice, but a study published in the New England Journal of Medicine in 2014 showed that letrozole may lead to pregnancy faster.  The side effect profile of letrozole is a lot better than Clomid too. So letrozole is often where we start.

Aside from ovulation, there are other things that can impact our chance of pregnancy including our partner’s sperm counts and the uterus and fallopian tubes.  I often discuss this with my patients.  I ask my patients to consider having imaging of their uterine cavity and fallopian tubes with some non-invasive imaging and that their partners to consider having a semen analysis performed.

Overall if ovulation is the only issue we are dealing with pregnancy comes quickly and somewhat simply with the right treatments!

Education is key in managing PCOS.  There is a lot of good information out there, and we have a lot of experience in helping our patients achieve their goals.  If you have questions we can help you!  Give us a call and let us know! 314-286-2400

Post by: Emily Jungheim, MD, MSCI