IVF

The Nurse we all Need

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I am so excited to share the discussion that I had with Fertility Nurse and Consultant, Leyla Bilali of Fertility Together.  Leyla bridges the gap between doctor visits, the waiting, the results and so much more.

It is no secret that (in)fertility is a lot to navigate both mentally and physically. Leyla’s services combine emotional support with the medicine that's within her scope of practice. It’s also a huge bonus that Leyla helps her patients with the administration of their medicine in the comfort of their own home and is also a constant sounding board. The result is that Leyla’s patients are much more than just that, they are individuals who receive support tailored to their needs during their fertility journey. 

Read on to find out more about the discussion that I had with Leyla, the Fertility Nurse that we all need.  I have come to think of Leyla is a fertility fairy godmother. Everyone going through fertility treatments needs a Leyla!

What is a fertility consultant and what inspired you to become one?

 A fertility consultant holds your hand during your fertility journey. This doesn’t necessarily have to just be for IVF but for all fertility related treatments including egg freezing. I work with some women that aren’t in a secured relationship or ready to have a child yet, but would like the option to potentially have a child in the future. From egg freezing to IVF, I help women navigate the whole process from who to see and what tests to take for baseline testing.

Sometimes an OB will suggest that a patient should see a reproductive endocrinologist, especially if a couple has been trying without success for over a year. I can guide that person on who to see based on their personalized medical history rather than just send them to a clinic where there is a relationship (between the OB and the clinic). A lot of this (fertility) world is not personalized. There is such a high volume at the large clinics which has its pros, but it makes it difficult to personalize care for people. My role is to help guide through all of the results and keep my patients sane.

I believe that a nurturing, knowledgeable partner like me can make all the difference as someone discovers their unique path to fertility. In my 11 years as a registered nurse, six of them in pediatrics, and five of the most recent in fertility, I have learned how to make healthcare more comfortable and human by inserting my compassion, humor and reliability.

 The medical world can feel very stiff and scary and we often need a shoulder to lean on to get through it. This is especially true for fertility patients as they are usually in a vulnerable state to begin with. Whether you are simply curious about your reproductive health, ready to take action via egg freezing or struggling with infertility, it doesn't get much more emotional, raw or intimate than this. And because of this intimacy, it's often hard for people to talk about it. As a society, we are beginning to lift the taboo of fertility but we still have a ways to go!

I have been fortunate enough to recognize my calling as a fertility consultant at the suggestion of some of my most dear patients. I thought I was supporting them medically and emotionally, and instead I was the one that was rewarded ten-fold with a great business idea. It actually occurred to me while I was at the home of one of my patients assisting her with injections. Sometimes the patient or the partner has a hard time administering or doesn’t feel comfortable.

I realized what was missing in fertility care when my patient said “I don’t know how people do this without a Leyla. You should start your own business.” No one else was doing this in the Tri-State area so I officially launched Fertility Together in August of 2017.

You mentioned personalization for each patient. Can you please elaborate?

 After looking at a patient’s medical history and understanding their personality, I make recommendations on who that patient would work well with and provide A – Z assistance from injections to on-call support. Even if it isn’t the full IVF, egg freezing is still the first full part of IVF by way of egg retrieval. I can assist the patient on what to expect from the medications and help administer it, if needed. 

What is your view on the correlation between stress and conceiving?

 Stress wreaks havoc on your body so there is no reason that it wouldn’t wreak havoc on your reproductive system and egg quality. 

 Cortisol (stress) hormones compete with progesterone hormones. Progesterone is crucial to pregnancy, specifically to conceiving and holding a pregnancy. There are a lot of indications that stress plays a role in infertility.

 One method that I like to combat stress is acupuncture. There may not be any direct studies that acupuncture increases egg quality but it does affect your nervous system, which can suppress your stress levels. JAMA recently released a report on an acupuncture study where some patients received traditional acupuncture and others received a placebo of randomly placing needles. The result showed no difference between the traditional and the placebo. However, because the participants felt that they were proactively doing something to alleviate their stress, the positive IVF outcomes were increased. 

What do you most regularly hear your patients “stress” about leading up to and during IVF treatment?

The anxiety from the medication and injections. The partner relationship also plays a huge role (of importance) because that is your support system and any potential lack of it, can also be a source of stress.

What are your top tips for patients to optimize positive outcomes and reduce stress?

  1. Taking care of your body is huge. If you have an eating disorder, are under or overweight, you are damaging your reproductive system. You can improve egg quality and support it with good whole foods, decreasing alcohol consumption, and not smoking.

  2. It is important to work with a doctor that you vibe and feel comfortable with. The doctor and the facility should be available to answer questions. You should not ever feel like a bother for asking.

  3. Communication between you and your partner is crucial. We often forget that our partner is going through this too and that they have (support) needs as well. Maybe you need a third party like me or an IVF therapist to help.

  4. Do what makes you feel sane; that could be acupuncture, exercise, or another healthy activity.

Are there any myths about stress that you would like to debunk?

 Prior to transferring an embryo, I have a lot of a patients who ask if the timing is right and if stressful life events will alter their results. For example they have a stressful work week coming up or life just happened. The answer is no. If the embryo is going to take and it’s going to be a viable pregnancy, it’s going to sustain despite your everyday level of stress and anxiety. 

There is nothing wrong with being stressed and anxious about this process. That is why it is annoying when people say “don’t stress or just relax”. I think that it would be abnormal if someone didn’t stress or have anxiety during the process. Letting yourself feel these emotions is where my services come in. I am a sounding board. You get to tell me that you are stressed out and just talking about it will make you feel better. 

Are there any resources that you think are a must for anyone going through or considering IVF?

  • Acupuncture, Liz Carlson at Common Point. I go to her myself!

  • IVF therapists

  • Resolve.org offers a resource list for consultants, therapists, support groups

I would love to get to the point where people don’t feel ashamed that they had to undergo any fertility treatment to have their baby. Ideally it would be normalized and not a taboo topic.

What moment in your career has inspired you more than you could have imagined?

I was chatting with my husband’s colleague at a holiday party who knew that I am a fertility nurse, and upon meeting me shared that he was an IVF baby. He told me that he was so appreciative of what his mom went through to have him. It brought tears to my eyes.

 

Leyla Bilali, BS, BSN, RN is an experienced fertility nurse and fertility consultant. Leyla received her Bachelor of Science in Biology at Emory University, and her BSN at the Columbia University School of Nursing. 

To learn more about Leyla and Fertility Together, please visit: fertilitytogether.com or @fertilitytogether on IG.

 

 

The Girlfriends' Guide to IVF: Part 1

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I was chatting with a girlfriend going through IVF and realized that it might be helpful to share my experience in hopes that it could help others navigate the process as well. 

During my third round last year, I made the discovery that by changing my attitude towards IVF, it wasn't as mentally and emotionally daunting as it had previously been.  Was piercing myself with needles (or letting my husband do it for me) a party?  Well no, not quite. There are however a lot of uncontrollables during IVF, so feeling emotionally stable and maintaining a positive attitude was an absolute victory.  I learned to accept the process, perhaps even embrace it rather than resent it.  I let go of being attached to the outcome, and THAT helped me make peace with IVF.

I am in no way diminishing the emotional and physical hardships associated with IVF.  I don't wish the experience on anyone.  I just made a decision to look at the process differently than I had been and set other goals (like getting mind/body healthy,) so that I could win no matter the outcome.  Perhaps three (rounds of IVF) was a charm, but I am convinced that my efforts to take care of my overall health paid off.  It still took a lot of effort on my part, and I couldn't have done it without a community and support system.  My doctor, nurse, and husband were the best team that I could have dreamed of, and the support group from CCRM provided ongoing inspiration.  

I learned to not underestimate the importance of the right doctor.  Just because a doctor did wonders for your friend does not mean that he or she is the right fit for you.  If this sounds like the position that you are in, look for a doctor with good credentials, that you vibe with, and who is attached to excellent labs.  Also make sure that you really like your nurse.  Your nurse will be your lifeline.

Only you can control how you feel.  I found my peace through prioritizing my needs.  You will likely need the support of friends, family and possibly a like-minded community during this time, but you will also need to give back to yourself.  This was a rather awkward and difficult new habit for me to embrace but it became yet another silver lining on the journey.

And one more thing... No matter what anyone else tells you, including me, nothing can really mentally prepare you for the IVF process.  It is not for the faint of heart and you are a rockstar to travel this path.  Remember that you are not alone and you do not have to suffer in silence.  

I've put together a cheat sheet of the main points that I believe helped me optimize my outcome and feel decent during the process.  My hope is that these insights will help support your journey and make the ride a little less turbulent.  Read on to Part II to get started.

The Girlfriends' Guide to IVF: Part 2

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Phase One/The Prep for Retrieval:

Similar to a recipe, here is the plan that I followed prior to egg retrieval and leading up to transfer.  This may also be helpful for anyone  just be doing the egg freezing process.

Try to take 90 - 120 days to reset your overall health and mindset to optimize egg quality and ultimately set the stage for a productive IVF cycle.  And go with your gut.  Start on your schedule.  Some doctors will try to rush you by telling you that your eggs will be 2 - 3 months older if you wait.  While true, if that is the case, I find it interesting that my results got better after hitting the pause button for 8 months.

1. Eat clean whenever possible

Focus on a mostly plant-based protein diet with an equal quotient of healthy carbs and fats.  (Translation for carbs/fats: fruits, veggies, nuts, and oils.) 

Pass on dairy, refined sugars, and refined grains (gluten in general whenever possible.)  Also beware of gluten replacement foods and especially any gluten-free foods that come in a box or bag as they might be laden with refined sugars and possibly chemicals.  These items all have an inflammatory effect on the body which doesn't help the optimal egg health cause.

2. Take supplements 

This is in addition to eating whole foods and shouldn't be the replacement for them. Check out my recommendations here. If you already know that you are challenged with egg quality issues, consider adding an organic Acai supplement.  (Avoid any Acai that is not pure or products like Sambazon that have a high sugar content.)

3. Drink water and lots of it

Ideally 8 glasses a day as a benchmark and preferably from glass.  Avoid plastic when possible.  BPA which is found in plastic is a known endocrine disruptor.

4. Try your best to cut caffeine

You'll have to do so anyway to ensure proper labs/monitoring.  Consider replacing your coffee ritual with hot water and lemon which is alkalizing (inflammatory reducing).  Pair it with an awesome refrigerated Probiotic like Natren Healthy Trinity to promote digestion and combat bloat.  

4. Cut alcohol

I'm sorry!  This was extremely difficult for me too.  I promise that you can do anything you set your mind to for 90 - 120 days!

5. Be aware of what you put on & around your body  

Avoid products with sulfates, parabens, and phthalates (fragrance).  All of these items are known endocrine disruptors.  Check out EWG.org to give you a better gauge on how products rank or to demystify ingredients in products.

Go ahead, be a sophisticated hippie with some of these awesome products that I have tested. I am not affiliated with any of these brands, I do however believe in their ingredients.

  • Skin/Hair Products: S.W. Basics, Body Deli, Rika

  • Natural Deodorant (that works): Joyous Organics

  • Cleaning Products: Puracy, Meliora K

  • Glass Water Bottle: BKR

6. avoid receipts

I am aware that this sounds crazy and especially if you live in a city or travel for work.  The thin powder coating found on receipt paper contains an unusually high amount of endocrine disruptor, BPA.  Not sure what to think? Search the terms "bpa receipts" and look for a credible source to learn more.

7. sleep

Try for 8 hours of uninterrupted sleep a night if at all possible.  This time is imperative to repair and restore cells.

8.Get your head on straight

Take ten minutes every morning for yourself to set the tone for the day.

Check out the 5 Minute Journal to remind yourself of what you are grateful for and/or meditate with the Headspace App.

Exercise easily.  Think yoga, barre, micro-toning, hiking/walking. The reason why cardio isn't recommended is because it promotes a fight/flight response during exercise, inducing unnecessary added stress on the body which isn't great for optimal cellular growth and creating the healthy maturation of eggs.  (The IVF process is already stressful enough, no?)

9. Consider Acupuncture

It blissed me out and has known benefits to increase blood flow.  In other words, it's good for egg heath and might also stimulate a thicker lining to promote transplantation when it comes time.

Phase Two/Stimming:

1. Keep on practicing self-care

This includes taking time for you, sleeping enough, staying hydrated and continuing healthy eating habits.

2. Discontinue most supplements

Continue with a daily Probiotic, Pre-Natal and Vitamin D (if you are deficient).

3. Stop any exercise outside of walking

The key is to not get your heart rate up.  If you are out of breath, chances are that you should ease up.

4. join a support group

Check out Pregnantish.  There are also plenty of private support groups on Facebook.  Many clinics also have groups available so make sure to enquire.  It's so nice to know that you can ask a burning question at 3a to a group of people that are going through the same things that you are, right now.  

Phase Three/Retrieval:

1. Try your best NOT to be attached to the outcome

I know that this is easier said than done.  Think of the many ways you have already won with a healthy mind and spirit, no matter what happens.

2. Get a post-retrieval care package ready

A heating pad, Tylenol, coconut water (I love Taste Nirvana and Harmless Harvest), Ultima electrolyte mix, and a bag of salty Kettle Chips will do wonders.  I am aware that the chips sound a little crazy but the high levels of sodium just following retrieval actually help drain the fluid that builds up in the empty egg sacs which can cause uncomfortable bloat.

3. Go native on the day of your retrieval

You and your partner should avoid wearing perfume, deodorant, and anything with fragrance in it.  Why you ask?  Because the fragrance could potentially damage eggs retrieved making them abnormal. 

Phase 4/The In-Between:

Between the time of retrieval and transfer is not the time to go cold turkey on all of the incredible healthy habits that you have been practicing.  Keeping a healthy lifestyle between retrieval and transfer will reward you with a better state of mind, more energy, faster recovery, and possibly better odds of conceiving during transfer.

Phase 5/The Road to Transfer (Egg Implantation):

Congratulations on making it to the transfer stage.  You should feel really good as this is not a given.  Many of the positive habits that you have picked up or already practiced along the way will continue to serve you.

1. Continue to eat, sleep, and hydrate well

2. TAKE supplements

Specifically continue a Probiotic, Pre Natal, and Vitamin D if you need.  Add back in Omega 3s.

3. Keep taking time for yourself

If you like acupuncture, try going once a week to help promote lining growth.  Only go if it doesn't stress you out to manage it into your schedule and get there in the first place.

4. Cut out alcohol and caffeine again

Much to my dismay I was reminded that chocolate has caffeine too.  Just remember that this is not forever.

5. maintain a positive outlook

Be excited but unattached to the outcome. It is a blessing to have gotten this far.  The universe doesn't promise or owe anything; all we can control is our attitude and embrace the silver linings that we encounter along the way.

Phase 6/Time for Transfer:

1. pre/post transfer acupuncture

Many fertility outpatient facilities offer this.  If this interests you, consider it for its calming, blood flow stimulating benefits that helps the eggs get cozy in the uterus.

2. Get yourself in a good headspace 

Consider taking a restorative style yoga or meditation class the night before the transfer.

3. Wear comfortable clothes and "happy" socks

You will be looking at them for a while.

4. go fragrance free

This applies to you and your partner and will minimize any damaging exposure to your hard-earned blastocyst(s).  (A blastocyst is a Day 5 - 7 fertilized embryo.)

Phase 7/Post Transfer:

1. Plan for bedrest for that day and the following

Avoid a heating pad.

2. Eat warm, nourishing foods

This includes organic bone broth to promote a comfortable zone for the embryo to implant.  Wild salmon, dark leafy greens, ginger, and fermented vegetable are also thought to be helpful.

Hydrate, hydrate, hydrate. 

3. Eat fresh pineapple core and raw Brazil nuts

Beginning the day of transfer and continue for a few days... 

Pineapple contains an enzyme bromelain, known for it’s powerful anti-inflammatory properties.  Reducing inflammation in the uterus helps set the stage for implantation by potentially creating a sticky lining where the embryo can settle in comfortably.

Eat 6 - 8 Brazil nuts a day.  Chockfull of selenium, Brazil nuts are thought to help thicken the uterine wall promoting a healthy lining to aid with implantation.

4. Meditate and visualize your embryos getting cozy

What is the downside?

5. Binge on funny movies or shows

In case you are looking for suggestions, I liked Up Schitt's Creek and Master of None on Netflix.

6. Rest and sleep a lot

7. The 10 day wait...

This will feel like the longest week and a half of your life (so far!) to find out what your results are from the blood test.  Try to be stoic.  Unfortunately OTC pregnancy tests can potentially provide a false negative or positive.

8. Be excited but not attached to the outcome

I know that I keep saying this.  This is a friendly reminder that whatever happens doesn't define you one way or the other.  You are also not alone in this journey.

Sending positive vibes your way! xo

 

Baby Makes Three...

I am grateful to my rock of a husband; friends and family for cheering us on; Elaine, an enormously talented healer who helped me understand my path; the designer who fortuitously sat next to me at a brunch last summer and introduced me to "the" doctor;  Claudia for helping me awaken to the concept that all of this was happening for me; Keri who taught me to look at food as fuel and medicine; Daryl for reminding me that (acupuncture) needles can actually be wonderful; and to Dr. Schoolcraft, Melanie and all of the amazing people at CCRM that I have had the great pleasure of meeting along this very long road.

Sound like an awards ceremony?  I sort of feel like I just won the greatest award in the world.  I have won the gift of pregnancy and I couldn't have done this on my own without the expertise, support, and love of so many incredible people.  I now know that every single person that I felt that tinge of energy around was meant to be in my life for a reason, whether for a season, or a lifetime.  For the first time, maybe ever, I feel like I am in alignment and exactly where I am meant to be.  

I have tried so many times to write this entry down over the last couple of months, and every time, I find an excuse to put it off.  First I had to wait until after three months to be sure, then I had to get my energy back, take care of my full time job, wait until the time felt right to share the news, and the list goes on and on...  Despite my very positive outcome, I have felt so many emotions through this process that coming back to center and sharing the news of my pregnancy has actually been more difficult than I could have imagined.

About 6 weeks after starting this blog, I got pregnant.  It’s mildly amusing that I had to expose my “dirty little secret,” and then I conceived so quickly.  The most interesting finding is that by sharing my secret, it was no longer dirty.  In fact, I found out that I was far from alone.  The path to finding fertility can mentally and physically suck the life out of you if you let it.  I am fortunate to have discovered solace and community from several groups consisting of thousands of women who struggle with their fertility.  These women bestowed upon me the invaluable gift of perspective.  And for those still on the journey, I will continue to root for you every single day.

I also thought that getting pregnant would be my end goal.  In hindsight, it is now clear that chapter was a stepping stone to the next leg of this incredible journey.  The lessons that I have learned, and continue to learn, about mental and physical wellness weren’t only the key to helping me conceive, they have become a way of life.

So as I sit here writing this at 6.5 months (26 weeks) pregnant with my little babe kicking inside of me, I am overcome with appreciation for this journey.  Being open to the possibilities, unattached to the outcome and surrounded by an amazing network is why I believe I am able to share this wonderful news with you.

A million thanks.  My cup literally runneth over in gratitude.

 

*A very special thanks to the talented Robert Grima for capturing me and my belly, as well as to Zimmerman for the beautiful dress.*

All About the Egg.

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One of the first things I learned on this path is that for someone who had an absolute obsession with a perfect outcome for every professional marketing campaign that I touched, I wasn’t practicing this behavior personally.  Case in point, nutrition and wellness.

Since I moved to NYC 9 ½ years ago, I have survived as a result of eating out and Seamless food delivery.  Beyond the taste, I had zero idea what was actually making up these meals.  From ingredients to quality control, I was not at all conscious of my daily nutritionally intake.  In fact, I really wasn’t even a fan of vegetables.  True story, I ate everything in a salad except for the greens.  Most meals were focused on an animal protein because the menu items always seemed more exciting. So if I indulged with a cheeseburger, pizza, and more cocktails and glasses of wine than I could remember, I’d solve the program with a Berocca and a spin class the next day. I figured that as long as I wasn’t putting on too many pounds, my lifestyle must be working.

Then my fourth fertility doctor told me to take a pre-natal and focus on eating a Mediterranean diet. (Seriously what does Mediterranean diet actually mean to someone that defines cuisine type based on restaurant reviews and delivery site filters?)  So I did what I was told and incorporated grilled octopus, Greek salad, hummus, and pita chips from the local Greek restaurant as staples into my diet. 

My IVF outcomes were less than stellar for my first two rounds at the beginning of 2016 and I was also plagued with a flu or cold every month for the first four months of the year.  Following my second failed IVF and sick once again, I lapsed into a slight depression fueled by an overwhelming feeling of helplessness.  I had just wanted someone to tell me what to do to get pregnant so that I could focus on the rest of my life, but clearly that wasn't working.

Then something happened…. I decided that I was going to figure out what part I could actively play because I didn't feel like it needed to be the end of this journey.  I called it after three days of a major pity party and dove head first into the sea of the Internet.  After sifting through a lot of junk diguised as schemes and products to get pregnant quickly, I stumbled across an incredible book that I proceeded to download off of Amazon.  “It All Starts with the Egg,” by Rebecca Fett, gave me hope and actual, tangible tools that got me started with my journey.

The book focuses on egg quality as the key to improving IVF odds and reducing miscarriage.  It  also has great research-backed concepts that might actually help natural conception.  I wish I had found it so much earlier and credit it as my learning springboard.  Rebecca’s personal story of trial turned to success inspired me to begin an action plan of my own centered around nutrition and wellness.

If you are interested in checking it out for yourself, you can find it here.