Why male fertility matters. A conversation with Lauren Manaker.

Lauren Manaker grabbing her favorite snack.

I am so excited to share my recent chat with Lauren Manaker. Lauren is passionate about her family, nutrition, and the fertility space. Lauren is also filling the vast void in the (in)fertility space by tackling the subject and providing evidence-based nutritional counsel for male fertility.

To kick off the discussion, I asked Lauren to tell me two lies a truth and reveal the truth at the end. Read on to find out if you can figure out which of the three statements are true before Lauren shares it with us later on.

Two lies and a truth!

LM: I cried for two days when George Michael died.

I have a twin sister.

I have a rubber Duckie collection.

When did you know that you wanted to become a Registered Dietician?

LM: I knew I wanted to do something in the health sciences, and dietetics was a match for me. Unlike a lot of other dietitians, I am not a "foodie". I am a math and science geek, and nutrition is the perfect marriage of the two. I get to interpret data and do nerdy math equations every day!

What is your (in)fertility story and what made you want to share it?

LM: My story is not different from many others, but it was still a painful experience. My husband and I got married and wanted to start a family right away. Things did not go according to our timeline, and after spending a lot of time and even more money in the process, we are now parents to a four-year-old girl named Hannah. The process taught me a lot about patience and trust.

What inspired you to write Fueling Male Fertility?

LM: Once I started my business and was meeting so many women practically killing themselves trying to get pregnant, I realized that many assume that fertility is a women's responsibility alone.

“So many women carry all of the pressure on their shoulders and many men don’t make many changes to their life because they simply don’t know that they play such a role in fertility.”

A quick search will show that there are tons of resources about fertility and women, but only a handful are focused on men. I needed to fill the gap by writing an evidence-based guide for the man who wants to enhance his fertility through diet and lifestyle choices.

Why does male fertility matter?

LM: Male fertility matters because many experts say that 1/3 to 1/2 of infertility cases are due to male-factor causes. Ensuring both partners are doing what they can do to support their fertility is one of the best things a couple can do. 

What is something about you that we could never find on Google?

LM: I have one three hula-hoop contents in my life.

Speaking of Dr. Google... what is one thing that you wish people struggling with infertility would never search on Google and why?

LM: I wish people would not depend on the Internet for supplement recommendations.

“Over-supplementing can be dangerous, and every body has different needs.”

Two pieces of nutritional fertility advice that you would give to someone dealing with infertility?

LM: Make a point to eat at least five servings of fruits and vegetables a DAY for both men and women. Ideally, it would be two fruits and three veggies a day. Antioxidants, vitamins, and minerals are so important for fertility, and getting these from food is ideal. And Exercise. Moving your body is so good for your body and your mind during the process.

Favorite self-care practice?

LM: Barre class. It forces me to step away from my phone for an hour, sweat, and not think.

…And a good foot massage if my husband is up for it!

Favorite fertility food and why?

LM: Walnuts! They are an easy food to sneak in throughout the day and are super-portable. They have tons of features that are fertility-friendly: plant-based proteins, ALA omega-3 fatty acids, antioxidants, vitamins, minerals, the list goes on and on!

Guilty pleasure?

LM: Jamming out to George Michael in my kitchen with my daughter.

Hidden talent?

LM: Tap dancing and napping on-demand!

What gets you out of bed in the morning?

LM: My four year old daughter who refuses to get up without letting me know that it's morning time.

What are you most excited about right now?

LM: How times are changing and sharing personal (infertility) stories is more of the norm. There is comfort in knowing that you are not alone in difficult situations.

So which is the truth to my very first question?

LM: I cried over George Michael for two days!

A quick PSA from Nathalie and Lauren!

We liked chatting so much that we have joined forces to co-admin a private “fertility warriors” group to support the (in)fertility community on the Ellie App. We invite you to download the app today and continue the conversation with us when we launch on June 12th!

Lauren Manaker is a Registered Dietitian-Nutritionist (RDN), MS, LD, CLEC who focuses on reproductive health. Lauren authored the book “Fueling Male Fertility”, and is a counselor and consultant through her company, Nutrition Now. She is also a contributor on pregnantish.

Lauren’s pride and joy is her four year-old daughter who was conceived after many IVF cycles. Lauren's mission is to help busy people get evidence-based nutrition information that isn't based on fads or "Dr. Google".

NIAW Feature: Options are Valuable

Anthea King-Pascual captured by Alexis Mera. Shirt designed by Kayla Kleinman.

I had the opportunity to sit down with fertility warrior, Anthea King-Pascual to discuss her journey of secondary (in)fertility, IVF and the relief she found in the egg donor option. Read on to find out how Anthea is redefining the conversation around (in)fertility through her story of loss, heartache and love.

Anthea’s story:

I got pregnant with my daughter when I was 35 after three months of trying. When I was 37 and my daughter was one, we tried again for a second. We got pregnant after trying for a while and discovered at five months that the fetus had trisomy which meant it wouldn’t be a viable pregnancy. We then turned to IVF and after four times, had an ectopic pregnancy that resulted in a miscarriage, DNC, and chemotherapy to flush out my fallopian tubes. After the ectopic, we took the mandatory break from treatment for six months.

We decided to try (IVF) again by bundling embryos over three more rounds (of retrievals) and banked a total of 11. Our embryos were sent for genetic testing and every single one came back abnormal.

I was now 42 years old. Our insurance had been covering up to 80% up until that point and we were about to go entirely out of pocket. We consulted with our Reproductive Endocrinologist (RE) and he shared that the chances of a viable pregnancy was about 1% based on my age and our history. As a result, our RE recommended that we consider the egg donor route which I hadn’t really thought about up until that point.

We decided to move forward and initially had two failed attempts with possible egg donor candidates. As a result, we decided to go the frozen rather than fresh egg donation route and purchased multiple eggs from one donor. The first egg that we transferred resulted in my son, Simon!

The media gives a false sense of expectation and hope by covering celebrities who get pregnant at 45 or 50. It is very likely that these pregnancies could be the result of donor eggs. It’s so important to voice the option about leveraging donor eggs. In fact, our clinic, RMA NJ does approximately 2,000 egg donor transfers a year!

What was your high?

My high was making the decision and the plan to go the egg donor route. It was the hope in knowing that there was an option (to have a baby), and that it wasn’t the end of the road for us. It wasn’t the original way we thought that we were going to (have a baby), but it was the way that it happened for us.

What was your low?

The low over my entire journey was after banking multiple eggs over three cycles. After all the emotions, medications and money, and then finding out that none of them were viable. My husband and I felt completely defeated.

Do have a silver lining?

My husband. He was so supportive of everything that I was doing, wanted to do, and the decisions that I made. I felt like I really wanted to have another child and give my daughter a sibling.

I knew that I married the right man because we hit rock bottom and were able to get through it together by supporting each other. I know my husband very well but we had never been in this situation before. There is no way of knowing how a partner may be or react during an extremely trying experience, and he was beyond supportive.

Do you have any words of wisdom?

I think that it is important to remember that there are options. I remember someone sharing with me that “only you are going to know when/if you need to change your path”. Be honest with yourself and don’t give up hope. Consider going about the process a different way such as donor egg or adoption. It could save you a lot of heartache, time and money.

People also question whether they could love their (donor egg) child as much as their biological child. Speaking from experience, the answer is YES, you most definitely love that child just as much!

Anthea, her husband and her two children live in New Jersey. Anthea’s love for her children’s care and safety inspired her to launch Homepaired, the first online marketplace connecting families with motivated and talented American students, with the goal of making live-in childcare affordable, accessible and ethical.

Trailblazing with Andrea Syrtash

Photo of Andrea Syrtash by Alexis Mera.

During National Infertility Week, Alexis Mera and I had the opportunity to meet with six fertility warriors who have been bold enough to share their stories publicly. Please meet Andrea Syrtash a fertility force and trailblazer. Although I have known Andrea for years, our first in person meeting was only very recently when our group of fertility warriors got together for this NAIW project.

Andrea has been a trailblazer in the fertility space and has been actively supporting fertility warriors since she founded pregnantish, the first online lifestyle magazine dedicated to helping singles, couples and LGBT navigate (in)fertility treatments. Andrea’s background as a relationship expert and coach regularly featured on national TV shows including Good Morning America and The Today Show, and as the author of He's Just Not Your Type (And That's A Good Thing) and Cheat On Your Husband (With Your Husband), combined with her compassion for the fertility journey, has made her an unwavering authority in the world of fertility.

I had the privilege to connect with Andrea on some of the aspects of her personal journey that I am so pleased to share in our recent interview here:

Andrea, what is your story?

How much time do you have?! Approximately 18 fertility treatments, one open-stomach surgery to remove a large fibroid, eight years of trying to get and stay pregnant, and eight reproductive doctors. I always knew it might take a while to get pregnant because I was diagnosed with endometriosis as a teenager, but I never imagined that it would take as long as it did to meet our baby (in December 2018)! 

After IVF transfer after transfer, and after learning we miscarried a 'heatlhy' baby in 2013 after a D&C, a doctor told me not to do anymore embryo transfers until we genetically tested our embryos. In 2016, I did many more retrievals to try to create enough Day 5 embryos to send away for PGS (now called PGT-A) genetic testing. Once we had healthy embryos, we knew we should try to find a gestational carrier (a surrogate who would use my embryo) to carry our baby to term.

This was another big chapter! Two surrogates dropped out on us and I had no idea how we were going to afford to keep going through this. In January 2018, my first cousin Elana stepped up and offered to carry our embryo. I was so emotional I couldn't respond! We transferred one into her in April 2018, during National Infertility Awareness Week. I remember telling my audience at pregnantish that I had no idea if I'd meet our baby this way, but I was hopeful. In December of 2018 of my cousin delivered our baby girl Arielle (into the world). I'm so grateful and in shock that I'm her mom!

Your High?

I created and launched pregnantish.com to help others navigate this incredibly stressful process right in the middle of my own treatment/IVF. At the time, I was not sure if or how I'd have a baby. Finding a deeper purpose during an experience I was really struggling with was a high for me.I was not only able to use my voice to help others, but I learned so much from others in the community. So often when you're dealing with infertility, you feel alone.

Your Low? 

I had many lows over almost a decade of trying to make a baby! One happened in public at a department store after an appointment where the doctor told me my embryos were growing unevenly. (I later learned it's because I needed estrogen priming, but that's another story!)  A tourist came up to me and asked if she could pray for me. I felt awkward about it, right there in the middle of the shoe racks; we held hands and she prayed while I cried. Another low was learning that I would miscarry again in 2014. By this point, I had been trying for about 4 years and I was so depleted. December 2015 was another low because my doctor told me that I had a 'beautiful perfect looking embryo', that didn’t take. I had done everything (diet, vitamins, taking care of myself) to let it implant. When it didn't work, I felt hopeless. I called the doctor and he told me to stop treatment and suggested more testing.

What was a low then turned out to be a high because more possibilities opened for us once we got more information (as a result of the testing).

Do you have a silver lining?

I got 2 babies out of this! One is my baby Arielle, who I'm so grateful for and who is a joy. The other is pregnantish which is fulfilling because I often hear it helps others who are struggling.

Do you have any words of wisdom?

I used to tell myself and often tell our readers that so much is out of our control when it comes to goals like parenthood, and if you want to be a parent, there will be a path. You don't need to know the how, the when, the where, you just need to know the what which is that you will be a parent. There are so many paths...

Learn more about Andrea, her story and the wealth of fertility resources available through her site pregnatish.

The Girlfriends' Guide to IVF: Part 1

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.

Learning how to lead a Nutritious Life with Keri Glassman

I realized after some initial setbacks with my fertility that nutrition held the keys to the kingdom that I was looking for.  I became convinced that what I put in my body would ultimately help me achieve conception.  I got to reading books on foods for fertility and met with a couple of nutritionists, but ultimately knew that I just wanted to be more educated on the subject.  (Maybe the Type A in me?)  Cue Keri Glassman and The Nutrition School (TNS).  The courses not only solidified my understanding of nutrition, but also gave me a “wholistic” view on health, wellness, and nutrition.  Thanks to Keri and TNS, I am now Nutritious Life Certified and accredited by the American Association of Drugless Practitioners.

You may have heard about Keri… she is a nationally recognized celebrity nutritionist, registered dietician, healthy cooking expert, published author, and the founder of Nutritious Life and The Nutrition School.  Or you may have seen Keri on TV; she has been tapped as an expert to speak on The Today Show, Good Morning America, The View, The Talk, The Chew, Dr. Oz, and much more. 

I was recently fortunate enough to snag some time with Keri to discuss how her life was destined to be a nutritious one.  Read on to find out how you too can glean some important tips on leading your most nutritious life!

How do you spend most of your time?

Good question.  Every day varies but there are a few things that I do to keep my schedule consistent despite travel and projects.  I always take a look at my week and assess what I am doing with my kids, when I am having my family time, and what are the fun and exciting things that we are doing together based on their schedule.  I also always try to be home for breakfast unless I have early morning TV (interviews), as well as dinners to spend time with them.  Breakfast and dinner together is a huge part of our day. 

When you are your own boss and someone is not telling you where to be all day, it can lead to lack of structure and productivity.  I am an early riser and am my best in the morning so try to tackle one big project on my list between 5:30am and 7am.  That gives me a little bit of time for myself, plus a bit of time to organize and map out the day.  I pause, have breakfast with the kids, and when they go to school, I get my workout in.  Then I try to block out time to get in computer time (writing my own content, doing research) until around 1pm to harness my most productive hours.  I take the time after that to power through media interviews, calls, and meetings.  I find that I am better in those situations because I have crossed off things from my list earlier in the day, am clear-headed and focused.

What inspired you to launch Nutritious Life and TNS?  

Since I was a little girl, I was interested in nutrition without even realizing it.  I played sports and had a natural interest in how the body works and fuels itself.  In seventh grade science class, I told my friend that I was craving almonds so my body must need Vitamin E.  I probably had no had idea what Vitamin E actually did but I had read it somewhere, and was interested enough to remember that fact. 

Fast forward to college, I continued to play sports and eat well.  A lot of my friends did not.  They drank Diet Coke, didn't eat healthfully, yet I was the one who gained the “Freshmen Fifteen”.  As a result, I became interested in how to fuel the body for performance but also how to be lean and fit.  After I graduated, I worked with Sports Illustrated and because it was owned by Time Inc., I could get my hands on all the magazines.  I remember sitting at my desk and going over every last word in Health Magazine.  In fact, I was so interested that I went back to school part-time and took nutrition courses at NYU.

To some extent the rest is history, but when I graduated I started working for an online health and wellness company and was counseling people; first at Equinox, and then privately.  At the same time, I was getting my business experience at a small start-up.  The start-up pulled me away from hard-core nutrition because it took so much of my time so I decided to take the business skills that I had gained and couple it with my passion for nutrition. Then I went for it.

I quit my job (at the start-up) and opened up my own practice called Body Fuel about fifteen years ago, which has since evolved into Nutritious Life.  My practice from day one encompassed the mantra of a nutritious life, and it being more than just food.  In fact, my first logo was an icon for stress (a brain) with an arrow going to a drop of water (hydration) to an arrow going to a bed (sleep)!

I created TNS to scale my practice throughout the country.  It started with a binder to keep myself accountable and to eventually train others.  Then I hired my first dietician, trained her, and then the binder evolved into the program that it is today.

How old were you when you started playing with food?

I talk about this with my mother all the time… My mom still has a recipe box and found all of these cards with recipes that I had written, even though some were make-believe like Lizard Stew!

In the second grade, I made a “cookie dough machine” for a school project.  My dad brought cardboard and paper towel rolls for me to make it.  I always think of that as my first recipe and foray into entrepreneurship.

What’s the first thing that you remember cooking?

Growing up I cooked with my mother who made so many great recipes!  I remember the ritual and experience more so than what we actually made; sitting on the counter in the kitchen and being with mom, and cooking dinner every night.   We started every meal with half a grapefruit, and a salad with Ken’s Italian dressing.  Every night we had a vegetable, starch, and a protein, followed by dessert.  It may not always have been focused on health per se but it was always balanced.  We also always sat down as a family.

An ingredient that you can’t live without?

Nuts and nut butter.

One ingredient that you avoid at all costs?

There is almost nothing that I do not like but I can’t stand cilantro. 

What do you listen to when you cook?

Everything from what I listened to when I was growing up to what the kids listen to now.  From Coldplay, Eminem, U2 to the Bee Gees to Taylor Swift.  I was rocking out to Katy Perry the other night and loved it.  My daughter took the opportunity to share… “Mom, that song is not good”.

Favorite vegetable?

That is hard…  I have to pick one?!  Mmm…. Let’s go with spinach.

Favorite fruit?

Blueberries

Last cookbook that you used?  What did you cook?

I recently made a great recipe from “It’s All Good” by Gwyneth Paltrow.  I made Two-Pan Chicken with Harissa, Preserved Lemons and Green Olives. I love olives.  In fact, it inspired me to make poached olives and they were so good.

Do you have any secret talents?

Hand-eye coordination.  If you throw something at me, I will catch it.  I can also pogo stick for hours.  I think I beat a neighborhood record when I was a kid.

If you could have dinner with anyone, who would it be and why?

Oprah.  Who wouldn’t want to sit with Oprah all night and pick her brain?

What is the number one piece of advice you would share with those looking to lead a Nutritious Life?

The combination of eating real, whole foods in conjunction with listening to your body, eating when you are slightly hungry, and to stop eating when you are slightly satisfied.  You’ll never have to count calories or worry about anything food related if you can master that powerful combo.

Remember it’s not just about the food.  It’s also important to pay attention to the other areas like focusing on stress reduction, sleep, and to not forget that they are just as important as exercise and food.

Ready to get started?  I put together a sample meal plan below with balanced and healthy recipes designed by Keri.  Just click on the recipe links below to get started with leading a Nutritious Life!

Breakfast: Morning Glory Muffins

Snack: Avocado Banana Smoothie 

Lunch: Chopped Salad with Tofu & Soy Nuts

Snack: Carrots & (10) Almonds

Dinner: Noodle Free Turkey Lasagna

*Note: Look out for GMO-free soy products.  Also, all recipes shared were created by Keri Glassman, Nutritious Life.

pregnantish: An interview with Andrea Syrtash

Andrea Syrtash, a real life superhero bridging the gap between her work and personal life, talks about fertility, relationships, and embracing the“ish”of things.

If ever there was the definition of Superwoman, Andrea Syrtash is it.  Andrea is a dating and relationship writer, online broadcaster and author.  She has been featured as an on-air personality on ABC’s The View, Good Morning America, NBC’s Today Show, and Oprah to name a few.  Andrea has also spoken at TEDxNavesink Makers on “How to Make Love (Outside the Bedroom)”, and is a regular contributor to Glamour.com.  To add to her growing list of credits, Andrea also recently founded pregnantish, the first-ever digital lifestyle magazine dedicated to providing resources for the fertility-challenged, inspired by her own and others' experiences associated with the trials and tribulations on the road to getting pregnant.

I had the opportunity to catch up with Andrea in between the filming of a TV pilot that she is hosting. Before kicking off our discussion, Andrea thoughtfully shared that both aspects of her career, being a relationship expert and the Editor-in-Chief of her new fertility-focused site pregnatish, go hand in hand. “Infertility is not just a medical issue, it's a relationship one. That's part of my goal with the site - to help singles/couples/LGBT navigate the personal and practical parts of the process.”

What made you decide to launch pregnantish?

As I've navigated my own infertility and fertility treatments for a number of years, I've searched far and wide on the Internet for a smart resource that wasn't clinical and it's been tough to find.  Information on this primarily has lived on parenting sites; and while these can be helpful, I felt it was time that we had our own lifestyle destination.  There are amazing medical and advocacy sites and we're not competing with them. We're trying to fill a different need. Instead of waiting for it, I decided to create it.

pregnantish is a great name, what is the inspiration behind it?

Over the last six years, I've undergone many fertility treatments, have been very hormonal, and told by my doctor to take it easy: not to drink alcohol or exercise too much, in the case I might be pregnant.  I've also had a positive beta test and have literally been pregnant for a time, and have lost the pregnancy.  Essentially, the inspiration behind the name is that it's a misconception, and you can in fact be a little bit pregnant!

Three adjectives you would use to describe pregnantish?

Supportive.  Smart.  Relatable.  Our tagline is ‘Real Talk About Fertility.’

What is your mantra?

When in doubt, choose love.

The moment(s) when you knew you were “ready” (to be a mom)?

Some women have always known they wanted to become a mom.  In my case, it happened a couple of years into my marriage.  I realized my partner (who is a teacher) would be a great dad, and that I was ready to expand our family. Once my niece was born, almost 4 years ago, it was even more solidified to me that I would love to raise a child.

You’ve written dozens of books on relationships; fertility can be taxing on a relationship. What is your number one piece of advice to couples on navigating the potential fertility minefield?

Good question!  Firstly, couples should give themselves a break.  This is such a tough thing to navigate, as infertility challenges relationships in the deepest way: the relationship you have with each other, with yourself, with your bodies, with your work, with your community, with your bank account and more.  I'd suggest that couples leave the lines of communication open, so they don't feel as alone.  I'd also suggest that they don't just look to each other for support.  Each person in a partnership has a right to feel feelings of frustration, despair, hopelessness, confusion and more.  Sometimes, though, it's too intense to rely on your partner to help you through this.  I'd suggest finding a trusted source - a friend, clergy member, or therapist, to help each or both of you so that you have the support you need.

You recently posted a meme that “Facebook is constantly reminding me that everyone is pregnant but me.” How do you recommend handling the news of a friend’s pregnancy announcement?

I have learned that you can hold two emotions: you can be happy for a friend and sad for yourself.  You can celebrate your friend's pregnancy news, but you aren't a bad friend if your heart sinks and you feel sad for yourself at the same time.  That's normal.  It's helpful to remember that we can hold both emotions.

Has there been a silver lining to your experience? 

Some people have said to me, 'All this was worth it so you could create pregnantish.'  I have mixed feelings about this.  I'm an eternal optimist, who sees the good in most situations; and yet, I wouldn't wish these 6 years of pregnancy losses, intense fertility treatments, invasive surgery, emptying the bank account, etc. on anyone!  It's been a very tough road.  The silver lining is that hopefully I can help others feel less alone as they navigate this, too.

Your go-to for managing stress?

I'm a glutton for massages!  I don't get them often, but every time I go, I feel better after and well taken care of.  The body goes through so much during treatment that it's important to practice self-care!  I also swim regularly.  This helps me alleviate stress.

Cook or order-in?

In my head I cook a lot.  In reality, I go out or take out more (part of NY living, it seems!).

Favorite feel-good food?

I enjoy foods with a surprise inside (dumplings, empanadas, ravioli, etc).

Last book you read?

I re-read Emotional Intelligence.  So good!

Who inspires you?

So many people inspire me (including my parents!); but in terms of a public figure, I'm inspired by Oprah.  A few years ago I hosted a great show for her network and it was a great honor.  I grew up watching her show religiously.  What I appreciate about her is her authenticity, her commitment to helping people live well and her drive.  She's created so many amazing opportunities and platforms, and has made the world a better place.  I hope to do (at least a fraction of!) the same with the media platform I have and the writing I do...

Best piece of advice that you have ever received?

The most important thing you can offer in a relationship is your presence.

Number one piece of fertility advice that you would like to share?

As much as possible, embrace the 'ish' of things.  Life isn't black and white, and some of the best life paths aren't expected or linear.  I've realized that it's important to know the what (that you want to be a parent) and it's okay to not yet know the who (biological or not), how or where of it."

To find out more about Andrea Syrtash visit pregnantish and sign up for the newsletter.  You can also follow along @pregnantish on Facebook and Instagram, and @pregnantishmag on twitter.

 

Supplements to Optimize Fertility

I am so excited to share that after a third round of IVF and a year later (and older), I recently DOUBLED my number of eggs from both our first and second cycles to 16!  15 were mature, most fertilized and some even went on to blastocyst.  I am convinced that editing my lifestyle, eating habits and taking supplements played a large part in making me feel better and putting me in a better headspace, which ultimately produced overall better results. 

For those that may be considering IUI, IVF or are even trying naturally, you may be wondering what supplements you can take to optimize your outcome.  I've put together a cheat sheet for you.  Please just remember that supplements are meant to be just that: “supplement” your diet.  Eating clean and healthfully is the first best step.

Using the CCRM (Colorado Center for Reproductive Medicine) “Female Fertility Cocktail” that I was thrilled to get my hands on, coupled with my own research, and discussing with my doctor and a certified nutritionist, here is where I landed to safely “supplement” my own diet.

The supplemental basics:

1.     Probiotic - once a day first thing in the morning

2.     Pre-Natal Multi-Vitamin - as directed each day 

3.     DHA (Omega 3 Fatty Acids) – 1,000mg once a day

4.     Co-enzyme Q10 Ubiquinol (Kaneka QH) – 400mg twice a day in both AM and PM  

5.     Vitamin C – 500mg once a day

6.     Vitamin D – Once a day and levels dependent on any deficiency (Mild: 1,000 – 2,000mg)

7.     Vitamin E – 200iu once a day

The items in italics (Probiotic, Pre-Natal and Vitamin D) were not on the CCRM list that I received but are important supplements that my doctor and most recommend. I was so adamant about getting this right that I lugged a bag full of the physical bottles to show both my doctor and fertility nutritionist for their review and blessing.

The recommended amount of time to take supplements is 90 – 120 days prior to trying naturally during ovulation, or attempting an IUI or IVF cycle.  This is based on recent studies that show that egg quality might be positively improved during this critical time frame when they could be most impacted by diet, supplements and environmental factors.

The full CCRM "Female Fertility Cocktail":

The Colorado Center of Reproductive Medicine known as the nation's leading fertility clinic recommends the below supplements to increase fertility.  Many believe this list that updates as more research becomes available the holy grail of fertility supplements.  I've included it here.

1.     DHA (Omega 3 Fatty Acids) – 1,000mg once a day

2.     Co-enzyme Q10 Ubiquinol – 400mg twice a day (Kaneka QH)

3.     Vitamin C – 500mg once a day

4.     Vitamin E – 200iu once a day

5.     L’Arginine – 1,000 mg twice a day. (Might be detrimental to most but helpful to some poor IVF responders)

6.     Pycnogenol – 100mg once a day. (Might be best for those with endometriosis)

7.     Myo Inositol - 2 grams OR (3) 750mg tablets AM, and (2) 750mg tablets PM. (Based on research this may be best for those with PCOS)

8.     Melatonin – 3mg only at bedtime at the beginning of an IVF cycle only and as necessary       *Contra-indications: If you are taking thyroid medicine, avoid melatonin as it has been shown to increase T3 – T4 levels

** This is the CCRM list as of 11/2016, is meant to be coupled with a Prenatal, and is not a one-size fits all approach.  Please consult with your physician or health care provider based on YOUR individual needs and especially with the supplements above numbered 5 - 8.**

So what’s the WIFM (what’s in it for me)?!

If you are interested in knowing details on each supplement, read on…

1.     Probiotic - New research is looking at the possibility that a GI tract brimming with microbes helps to maintain a healthy weight.  Plus probiotic bacteria helps fight bad bacteria found in your intestines, promotes good digestion, may also help with infections of the digestive tract, enhance immune function, and control IBD (inflammatory bowel disease.)*  If you’re going through any sort of IVF journey, it can also help with the discomfort including cramping caused by the medicine and procedures.  A daily probiotic may also be a great tool for anyone who does not eat enough probiotic-rich foods. Common sources are yogurt, kefir, sauerkraut, sour pickles, tempeh, and miso soup. If you are going down the “I just need a supplement version,” my pick is Natren Healthy Trinity Probiotic.  Make sure that they arrive cold if you buy them online and keep them refrigerated once at home to keep the cultures alive!

2.     Prenatal Multi-Vitamin – There is very little difference between the brands available by prescription and non-prescription.  There are high quality prenatal vitamins available without prescriptions. I take New Chapter Perfect Prenatal, made with organic veggies and herbs, and without any preservatives, additives or fillers which was very important to me.  However, the Folate is a little on the low side at 600mg so if you don’t get the additional 200mg or so from your diet, you may want to consider a Folate supplement.  Pure Encapsulations (400mg) is awesome. Note that  prenatals that cause nausea or digestive issues might be resolved with a version containing chelated iron.

3.     DHA (Omega 3 Fatty Acids) –Omega-3s are important for immune functioning, brain health and inflammatory response.   EFA (Essential Fatty Acids) may reduce inflammation throughout the body (a possible cause of PCOS and other types of infertility) and promotes overall health.  The best source is whole fish oil.  My pick is Nordic Naturals or New Chapter Whole Mega.

4.     Co-enzyme Q10 Ubiquinol - Ubiquinol not only works as an antioxidant but is crucial in the body’s production of energy. It is the very fuel that makes your heart beat. With age, our bodies progressively produce less CoQ10 and struggle to convert it into Ubiquinol, which is the usable form of CoQ10.*  Fertility speaking, Ubiquinol may also improve egg quality and improve chromosomal division during fertilization. Ubiquinol is the concentrated version of Ubiquone, and there are no known safety risks for either.  There are plenty to choose from but I like Doctor’s Best Ubiquinol with Kaneka QH.

5.     Vitamin C – Highly effective antioxidant that plays a role in egg health by helping to combat free radicals.  I am a fan of Garden of Life, Vitamin Code, Raw Vitamin C.

6.     Vitamin D - Assists in maintaining a healthy immune system.  Vitamin D2 is the form from eating foods rich in it, and vitamin D3 is synthesized in the skin from sun exposure. (Fun fact, since the body makes D3, it’s actually considered a hormone and not a vitamin.)*  A simple blood test can determine any deficiency.   I take Pure encapsulations Vitamin D.

7.     Vitamin E – Antioxidant that fights against free-radicals and cell membrane damage.  (May be especially helpful in reducing free radical damage in ovarian follicles.)  My pick is Blue Bonnet Vitamin E 200iu.

9.     L’Arginine – Please consult with your doctor before taking to make sure it’s right for you.  Recent research indicates that for most this could potentially reduce egg quality as opposed to improve it.  CCRM promotes this to a specific group of people that fit within a specific framework that could actually benefit from this amino acid which helps with cell division, immune function and release of hormone.

10.  Pycnogenol - Please consult with your doctor before taking to make sure it’s right for you.  A patented extract from pine bark, which is not naturally occurring in the body, and may help stimulate the immune system and increase blood flow.  Since it’s not naturally found in the body and good-quality clinical studies have not been able to confirm that it improves egg quality or even that it is safe made this one not worth the risk in my book.  However, there are studies that show that Pycnogenol might be helpful for patients with endometriosis.

8.     Myo Inositol – Please consult with your doctor before taking to make sure it’s right for you. Might be best for women with PCOS.  Vitamin B component of cell membrane helpful in restoring ovulation and improving egg quality in women with PCOS or insulin resistance.  It may also reduce the miscarriage risk associated with insulin resistance.  Note that studies have shown that Myo Inositol may be unfavorable to non-PCOS patients by possibly reducing the number of mature eggs and embryos.

9.     Melatonin – This helps calm the head chatter and promotes shut-eye.  During IVF, it’s clearly a better alternative to an Ambien.  Melatonin is a powerful antioxidant that helps to regulate circadian rhythm.  Again, based on your needs, this one is best to discuss with your doctor.  Pure encapsulations makes a nice version.

And for those of you wondering about DHEA… It’s a steroidal hormone that turns into testosterone and estrogen which seems to be quite controversial and fertility doctors either are or aren’t a fan.  DHEA is produced naturally, peaks at age 20 and diminishes thereafter; it is thought to help with ovarian function.  The synthetic version may have side effects though.  Side effects may include acne, hair loss, stomach upset, and high blood pressure. Some women can have changes in menstrual cycle, facial hair growth, and a deeper voice after taking DHEA.  So that was enough for me to say no thanks.  My doctor also shared that he’s not really a fan based on more recent studies.  Even if your doctor recommends it, always remember that you have a choice.

Speaking of doctors, please know that I am not one.  I have taken a genuine interest in nutrition and wellness and use my recent education/certification by The Nutrition School by Keri Glassman, my own research (not from Internet chat forums), and validation from doctors and nutritionists that I have worked with.  My hope is that you will use this as a guide to help you see the options available and determine your own course of action with your own doctor or certified health professional.

The last word.

Remember to stop taking all supplements outside of your Prenatal (with extra Folate if necessary,) Probiotic and Vitamin D once you start stimming (stimulating with medicine).  I didn’t get that memo until my third IVF and AMAZING doctor #5.  I guess that three really is a charm…

*Credit: The Nutrition School by Keri Glassman.  I found this program to be so beneficial that I became an affiliate, which means that if you sign up for TNS after clicking on that link, Fertilust may get some funds.  Thanks.  

All About the Egg.

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.

Amazing Almond Milk

When I first started my journey of eating clean, my friend Shannon sent me a kit to make my own almond milk.  I was a serial breakfast skipper and I think that this broke her heart a little.  Shannon wanted to ensure that I was covered from a non-dairy alternative in my coffee to easy pre-made breakfasts.  (Almond milk is a key ingredient to my now go-to breakfast, Overnight Oats.)  I am pretty sure that this was one of the first times that I began using my kitchen since we had moved in to our new home two years ago.  I have since played around  enough to make a recipe that I love and hope that you will too.

Homemade almond milk is a fantastic substitution for dairy milk; from coffee to baking.  Most importantly it tastes great plus is so ridiculously easy to make.  It seriously only takes around 10 minutes or so to achieve an awesome dairy-free milk alternative without all of the gross additives like Carrageenan* that might be found in the store bought versions.

Here's what you’ll need

• 1 cup Raw Almonds (ideally sprouted)
• 3 ½ cups Filtered Water
• ½ tsp salt (I recommend Himalayan Pink Sea Salt because of its added benefit of trace minerals)
• Zimtal Nut Bag

And because I was always a sucker for the sweet drinks at Starbucks, I sometimes sweeten the pot with the following:

• ½ tsp Vanilla
• ½ tsp Cinnamon
• 1 tsp raw Honey

The Prep

• Soak almonds in salted water, in a covered container, in the fridge overnight (or at least 8 hours).

The Process

1. Rinse almonds thoroughly, throw into a blender and blend away.
2. Grab a small bowl, line the bowl with your nut bag and pour the liquid through.  Remove the bag from the bowl and squeeze the liquid through the bag. (I always imagine this is what it must feel like to milk a cow.)  
3. Once all liquid contents are in the bowl and you are just left with the almond bits in the bag, pour the liquid back into the blender.  (Don’t forget to give your blender a quick rinse in between to lose any almond bits.)
4. Add in the natural sweeteners as recommended or to taste, blend and viola, you are done!
5. Your almond milk should last 3-4 days in the fridge.

*Carrageenan is a food additive that keeps products and beverages from separating.  It can be labeled as organic and natural since it is made from algae.  The seaweed is cleaned, extracted, filtered, concentrated, combined with chemicals, pressed, dried, blended, and refined.  Still sound organic to you?  Research studies link carrageenan as a trigger to inflammation that could be a factor in severe health conditions including cancer, diabetes, colitis, and other GI tract damage.