Recipe for a baby

The times I experienced a donor egg IVF failure, I went looking for reasons and solutions. I wanted to know what I could do and who I could be in order to increase my chances of a pregnancy the next time I completed a cycle. From all the hearsay, popular press, and message boards, you end up with a list of ingredients, resulting in a serving size of one baby… or, 39.2% of the time, two (Letterie & Klein, 2013).

  • 1 entire fresh pineapple, including the core
  • 9-11 avocados
  • 27 maximum donor age
  • 25 maximum BMI
  • no more than a pinch of stress
  • 8 acupuncture visits
  • 1 exposure to semen near transfer
  • 14 administrations of progesterone in oil
  • 2 drops of embryo glue
  • 24 hours of bed rest
  • 18 oocytes retrieved from donor
  • 5.5 good-quality embryos

Let us unpack this recipe, Snopes-style (and when I say “TRUE” I mean that this is supported by research. Not necessarily “true” in a black and white sense):

  • 1 entire fresh pineapple, including the core
    • UNDETERMINED
    • This suggestions is constantly, constantly trotted out on message boards and popular press articles. You’re supposed to eat the entire pineapple, including the core, over a five-day period starting with the day of embryo transfer. There have been absolutely no studies to determine the veracity of this advice – in fact, there aren’t even any about bromelain supplements. Pineapples are rich in bromelain, especially in the absolutely disgusting core, and this is the reason people give for their efficacy. It is all anecdotal. I saw no reason not to try it in my second cycle, and have concluded that I am never ever slicing a fresh pineapple again, period, no matter what, and I am especially not eating the damn core. SO GROSS.
  • 9-11 avocados
    • MIXTURE
    • There was supposedly a study by Jorge Chavarro, a researcher from Harvard, about a Mediterranean diet and fertility. I couldn’t find this study, and the popular press article that discussed it contained the caveat that we should interpret the results with caution until it was published in a peer-reviewed journal. Chavarro did write a book chapter, though, in which he cited another study about the Mediterranean diet and fertility. This study suggested that the rate of ongoing pregnancy (not the same as rate of pregnancy) is increased among women who adhered to a Mediterranean diet (Twigt et al, 2012). Presumably, this includes a ton of avocados? I tried this, too. It was delicious! It didn’t work. The caveat is that this applies to women using their own eggs for IVF. The efficacy of this diet may have something to do with egg quality or production, which is something the donor egg recipient has no control over. Maybe I’ll tell our IVF nurse to tell our donor that we’ll send her a basket of avocados to eat. And I’ll eat some too. Love me some guac.
  • 27 maximum donor age
    • TRUE
    • Implantation rates are significantly higher when the donor is between the ages of 18-27. Ongoing pregnancy and delivery rates were also higher, though not statistically significant (Son, Demirtaz, Takefman & Holzer, 2013)
  • 25 maximum BMI
    • FALSE
    • A recent and comprehensive meta-analysis showed that BMI of the recipient does not make a significant difference in pregnancy rates when women are using donor eggs (Bellver et al, 2013). I am obese, myself, so…. whew. I’ve tried to lose some weight (lost 10 lbs, even!) but because of these findings, I don’t feel the need to fret too much about it. I believe I’ve read, however, that obesity significantly decreases the efficacy in IVF when women are using their own eggs. This is reflected in donors selection criteria – donors almost always have a BMI from 19-25, or they are rejected. Bottom line for almost all of the research I’ve found – the uterus doesn’t matter as much as the egg.
  • no more than a pinch of stress
    • FALSE
    • The old “stop stressing and you’ll get pregnant!” has officially been debunked in a recent meta-analysis (Boivin, Griffiths, & Venetis, 2011). This is awesome, because I’m pretty sure the “don’t stress out or you’ll ruin your IVF cycle” advice was the source of a lot of worrying about worrying, an entirely unnecessary vicious circle. It’s nice not to be stressed! But it’s not going to make a difference in your chances of pregnancy.
  • 8 acupuncture visits
    • MIXTURE
    • It seems like every single day, a new study comes out with results suggesting that either acupuncture is significantly associated with improved pregnancy outcomes in donor egg IVF, or that acupuncture doesn’t help, but doesn’t hurt. Most reviews don’t offer a conclusion, but acknowledge that overall findings are inconclusive (e.g. Hay & Domar, 2015). I did it at my last transfer, and I’m doing it earlier and more often for the current one. I enjoy it, and it doesn’t seem to reduce the chances of pregnancy. So, why not? And why not eat an avocado while I do it?
  • 1 exposure to semen near transfer
    • TRUE!
    • Women exposed to semen around the time of transfer (…you know. In their vaginas. Not just wherever. Now, that’d be an even more interesting study!) experienced an increase in the rate of continued pregnancy at 6-8 weeks gestation compared to women who abstained around the time of transfer (Tremellen et al, 2000). I will not comment on whether or not I tried this method. But, I see it as equivalent to acupuncture and avocados. Guys…. imagine how awesome it would be to do a study where you had women try doing all three? At the same time?!?!? Ok, maybe I’ve been listening to too much Savage Lovecast.
  • 14 administrations of progesterone in oil
    • TRUE, with caveats
    • Intramuscular injections of progesterone (“progesterone in oil,” or PIO) are associated with higher rates of pregnancy than orally administered progesterone (Licciardi et al, 1999). Vaginally administered progesterone gel is comparable to PIO (Penzias, 2000), but PIO used at the same time as vaginal gel is more effective than the vaginal gel alone (Karande, Meyer, Hazlett & Klipstein, 2014).
  • 2 drops of embryo glue
    • TRUE
    • “Embryo Glue” is a substance containing hyaluronan, a substance that increases in the uterus around the time of embryo implantation. It is included in the liquid that the embryos are swimming in when they’re loaded into the catheter used to place them in your uterus. Embryo glue seems to do its job to stick the embryos to your uterus (Valojerdi et al, 2006; Nakagawa et al, 2012). Elmer’s glue, however, was far less effective (Harhar & Veryfunny, 2016).
  • 24 hours of bed rest
    • FALSE
    • Many, if not most, clinics recommend some level of bed-rest after embryo transfer. My clinic, in fact, recommends 10-20 minutes of bed rest, which is ABSOLUTE TORTURE. You have to have a full bladder for the embryo transfer. Trust me, when you lay on a table for 20 minutes afterward, you want to pee all over anyone who even talks to you. Any level of bed rest – from 10 minutes to the often-recommended 24-hours (!!!) appears to be consistently ineffective, and possibly even detrimental (Küçük 2013). I may refuse to do it this time. Immediate ambulation makes absolutely no difference (Purcell et al, 2007)
  • 18 oocytes retrieved from donor
  • 5.5 good-quality embryos
    • TRUE (both of the above)
    • These are indeed the optimum numbers of oocytes retrieved and quality embryos among cycles resulting in pregnancy (Hadnott, 2015). Some clinics engage in oocyte maturation protocols that result in an extremely large number of eggs (at times, 40+!!!). These are problematic, not only because they put the donor at serious risk of ovarian hyperstimulation syndrome (very dangerous and irresponsible), but this emphasizes quantity often to the detriment of quality. Fewer quality eggs and embryos are better than more that are of low quality. From what I can tell, “shared risk” programs are notorious for high-stimulation protocols. In these programs, a single egg donor produces eggs during one cycle that are split among several recipients. I suspect this practice is likely the case with frozen eggs, as well, which I used during my first two cycles. This time, I’m using a fresh donor – all of her eggs from this cycle will be for me and my husband only, the cost is barely more than a batch of frozen eggs, and we are likely to get 2-3 times as many eggs for the price.

So, there you have it! I’m not going to write a proper bibliography, because it would be incredibly long, I’m not trying to publish this, and I want to go hang out with my husband now. I just want to leave you with one suggestion – seriously, if you’ve never sliced a fresh pineapple, don’t. Just don’t. If stress had any effect on an IVF cycle’s success, cutting up that damn pineapple would make the embryo(s) jump right out of your uterus, because they don’t want to live in a world where they might ever have to chop up an entire pineapple.

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5 thoughts on “Recipe for a baby

  1. I’ve loved fresh pineapple ever since my trip to Hawaii; with rum, cherry and an umbrella it’s even better. I’m sure there must be a pampered chef, Williams and Sonoma, Tupperware ect…gadgets to core/peel a pineapple?

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  2. This post had me laughing out loud at work. Oops. Elmers glue, and an embryo jumping out so they don’t have to ever slice a fresh pineapple? hahah
    I agree cutting a fresh pineapple is pretty obnoxious. But I will give a tip in case you actually like fresh pineapple. Yes, pampered chef does make a tool for it. My mother hates it because she says it wastes a lot of the pineapple, it cuts off too much of the fruit when it cuts off the ‘peel’. However, as someone who hates the tiny pieces of the ‘peel’ on the part of the fruit she’s actually eating, I like that it does that. Pineapple ‘peel’ has these little parts that go in deeper, and I want that cut off too! So the tool is great for that.

    Like

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