Environmental factors and things “it doesn’t hurt to try”

It’s indisputable that there are certain lifestyle/environmental factors which can affect fertility. Street drug use is a big one with pot use usually having a negative effect on sperm quality/count at least in the short term.

But what about everything else? And since dose makes the toxin, how much of those things? How much coffee? How much alcohol? How much weight loss is enough and how much vigorous exercise is too much? Do you need to switch to boxers three months ahead of trying or does it even make a difference in effective fertility, i.e., whether or not it might increase count/quality a little, does it actually move pregnancy rates over a year?

Most people don’t worry about these things for the first few months. After all, none of them are silver bullets which doom fertility for everyone. Otherwise people living in terrible conditions for stress and nutrition would never get pregnant; our mantra in my support group was “if stress/diet/a higher power shut things down, no babies would be born in refugee camps / to the food insecure / to unwilling parents”.

But when you hit a milestone where clearly you are subfertile (6 months, 1 year, 2 years… It varies with age and cultural expectations), these things start to feel important. Are you doing enough yoga, or maybe too much hot yoga? Is it true what they say about pineapple post-ovulation? Maybe you can outright jinx it into happening if you book a vacation you won’t be able to take if you get knocked up.

Then you reach the point where you are seeing doctors and they agree that you are subfertile. But unless you get a for-sure-never-going-to-happen reason* (your partner was born without vas deferens or you don’t have working tubes) you start to wonder what other things you can do to help things along.

Where’s the line between the medical and the “alternative treatment”? There are some indications that a diabetes drug shows promise for certain female factors, but since it’s still too early to be sure, it’s considered “alternative” by lots of docs (small pockets seem to say “this is worth study” but women trying now will run out of time before all the double blind studies are peer reviewed and published). Vitamins are chemicals we can measure and control doses of and then measure the possible effects of, but my RE passed on checking my vitamin and mineral bloodwork because it’s not her area. On the flip side acupuncture probably does nothing except help you stay sane if it helps you relax (and while relaxing won’t help get you pregnant, it will help you get through treatment less destroyed).

It’s one thing to take part in self-care activities you enjoy, but on the other end of that spectrum are people waiting to take advantage of you and take your money for pure snake oil. Deciding where a particular “treatment” falls on that spectrum for you personally can be touchy at best.

Essentially we all pick our own comfort level, but in my group, we remind each other to keep things in perspective. Quitting acupuncture the week after you get pregnant will not cause a miscarriage. Yes your partner needs to quit pot, and it’s our group’s consensus that no male partners should be smoking cigarettes either if count is at all affected (otherwise the female partner is going to a lot of pain and effort while working with a possibly easily-improved sample, and also it’s good for everyone in the long run so you can just do it as solidarity too). A cup of coffee should be fine preconception (and definitely for pregnancy) but if your doc said “No ibuprofen in a treatment cycle”, you listen.

(Separate rant: when we compare notes, the docs disagree with each other on the little details — whether you should be on bedrest after an embryo is transferred back in utero, if Aspirin is good for encouraging implantation (yay for increased blood flow to the uterus!) or bad because you just had surgery (boo to risk of bleeding!), what levels and properties of sperm indicate immediate jump to IVF and which are worth meddling in IUIs first.)

Then after a while at this stage, you start to hedge the same bets. I can have a drink until that last week of my cycle (whereas I used to stay away immediately post-ovulation). I’m not avoiding the amount of caffeine found in tea at all and I’m doing coffee on and off at random while I can’t possibly be pregnant yet. Sushi until a positive test.

My dabbling in an unproven but possibly related intervention was a low-ish carb, high-ish protein diet as described in this unpublished paper. Since I had already experienced the exact condition this diet was supposed to help, and the switch gave me a sense of control without completely changing my life (although it was a bit disruptive), I went ahead thinking “well, it can’t hurt”. My outcomes from the following IVF were technically worse than the year before; I returned to the diet afterwards anyway.**

But I never did get the nerve up to ask my doc if I could go on the diabetes drug just for the hell of it.

* There’s a separate rant here about being compared to couples who conceive after being told they never could. I have never heard of a fertility specialist giving this diagnosis except in edge cases (3 sperm per sample (because actually it does not take one, since the ovum has a casing requiring many more for breaking through), missing Fallopian tubes or vas deferens, couples with only one set of gametes between them). Anecdotally it seems these diagnoses are given by GPs and gynecologists to men with low but not tiny sperm counts and/or women who ovulate irregularly at best. Each cycle has a tiny chance of success but statistically, nation-wide, a few will hit the jackpot. Just like most weeks someone wins the lottery doesn’t mean you can tell someone not to bother saving for retirement because “people win the lottery every week, you know”. Or worse after you worked hard and saved up, someone saying “I know someone who won the lottery once! That’s like what you did!”

** The day I started using MyFitnessPal to see how close to the 40/30/30% carb/protein/fat breakdown I could get also happened to be a neighbourhood church’s Strawberry Social and we had cleverly gone at the end to be offered seconds and it worked. Never have the words “The diet starts tomorrow” been truer.

When I started there was also a giant bag of potato and cheddar perogies in my freezer. Carbs stuffed with carbs. Gah. I think I finished that bag the week I quit the diet, 6 months later.

I started as a low-carb skeptic and definitely prefer the idea of people using “net carbs” (not counting fibre). But even at modest <=40% carbs and >=25% protein I lost weight if I didn’t increase my calorie count at the same time. It was much, much less extreme than keto and wow it’s hard to argue with my personal response to it. And at my calorie level for weight maintaining there’s no question I am getting “enough” carbs (a concern for the more- extreme versions).

And every time I said anything to someone who knows me IRL about watching carbs I felt like I needed a giant banner over my head that said “NOT BECAUSE I THINK I NEED TO LOSE WEIGHT”. As a skinny bitch I don’t want to make things weird.

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