October is Breast Cancer Awareness Month, a time dedicated to raising awareness about breast cancer, promoting early detection, and supporting those affected by this disease. In the United States, over 11,000 women under the age of 40 are diagnosed with breast cancer every year (1). While most conversations about breast cancer focus on diagnosis, treatment, and survivorship, it is crucial to address the impact breast cancer can have on a person's fertility and reproductive future. Unfortunately, Oncologists (cancer specialists) do not always discuss the options for pregnancy after breast cancer treatment, leaving patients fearful that they will not able able to one day have a family of their own. We are here to chance that and educate you on how you or a loved one may have a beautiful fertile future despite the disappointment of a devastating diagnosis. In this blog post we will explore the intersection between breast cancer treatment and fertility, highlighting the vital role fertility clinics and resources play in supporting patients through their journey. Understanding the Impact of Breast Cancer Treatment on Fertility Standard breast cancer treatments can have a detrimental impact on reproductive health and may reduce a woman's ability to conceive in the future. Many women hesitate to undergo treatment due to concerns that the time required for treatment may further delay conception, potentially lowering fertility. Cancer treatment options include: Chemotherapy: Many chemotherapy drugs used to treat breast cancer have a direct impact on fertility. One of the major consequences of using chemotherapy agents in what is know as "Chemotherapy Induced Amenorrhea" (2). This essentially means the absence of a menstrual period. It is important for you to speak with your doctor about the side effects of the medications they hope to incorporate into your treatment plan and if it will negatively impact your fertility. Radiation Therapy: The chances of the ovaries being exposed to radiation to the breast/axillary region during treatment is relatively low. However, the ovaries are still at risk of exposure and it is recommended that the pelvic region is carefully protected to minimize damaging effects. Hormonal Therapy: Hormonal treatments for breast cancer such as the medication, tamoxifen, may require patients to avoid pregnancy during the course of therapy. This delay can reduce fertility, particularly for those diagnosed at a later age. Surgery: Certain surgical procedures, particularly those involving the ovaries or uterus, carry the risk of organ damage, which can directly impact a woman's ability to conceive. Understanding those potential impacts is crucial for patients diagnosed with breast cancer, especially those who have not started or completed their family building journey. This is where fertility clinics can play a pivotal role. The Role of Fertility Clinics in Breast Cancer Care Fertility clinics provide essential services and support to breast cancer patients who are concerned about their fertility. Here's how they can help: Fertility Preservation Counseling: Upon a breast cancer diagnosis, one of the first steps for patients should be consulting with a fertility specialist. These specialists provide detailed information on how various cancer treatments might impact fertility and will discuss options women have to preserve their fertility before beginning cancer treatment. Egg and Embryo Freezing: One of the most common fertility preservation methods for breast cancer patients is freezing eggs and/or embryos. This process involves stimulating the ovaries with hormones to produce multiple eggs before they are retrieved and frozen for future use. If the patient has a partner or chooses to use donor sperm, embryos can also be created and frozen to be used in the future. Ovarian Tissue Freezing: This is a newer technique where ovarian tissue is surgically removed and frozen before cancer treatment begins. After treatment, the tissue can be re-implanted in the hope that it will restore hormonal function and fertility. This option is often considered for younger patients or those unable to delay cancer treatment for egg retrieval. However this treatment is not commonly done at most clinics at this time. Collaboration with Oncologists: Fertility specialists work closely with oncologists to ensure a coordinated approach to treatment. This collaboration is vital to timing fertility preservation procedures around cancer treatment schedules to minimize any delay in cancer care. Emotional Support: A breast cancer diagnosis is overwhelming and the added stress of fertility concerns can be significant. Many fertility clinics offer counseling and support services to help patients navigate the emotional aspects of fertility preservation and future family planning. Support for Male Partners: While breast cancer predominantly affects women, men with partners undergoing treatment may also have fertility concerns. Fertility clinics can offer sperm banking for male partners who wish to preserve their fertility before their partners starts chemotherapy or radiation. It is also important to note, while very rare, breast cancer can also impact men. Less than 1% of all breast cancer cases impact men. Resources to Help Here at Grain Fertility, our goal is to empower you on your fertility journey and help connect you to organizations that working to educate breast cancer patients and survivors. Here are a few groups that help provide everything from grants, education, counseling, and other resources: The Chick Mission Founded by a cancer survivor whose fertility preservation was denied by her insurance company, their mission is to ensure every young woman newly diagnosed with cancer has the option to preserve fertility through direct financial support, education programs, and advocacy efforts. RESOLVE: The National Infertility Association RESOLVE works to ensure that all people challenged in their family building journey reach resolution through being empowered by knowledge, supported by community, united by advocacy, and inspired to act. The Alliance for Fertility Preservation AFP works to increase information, resources and access to fertility preservation for cancer patients and the healthcare professionals who treat them. Livestrong The Livestrong Foundation helps thousands of fertility cancer patients gain access to life-changing services by alleviating the burden of costly fertility preservation. The Livestrong Fertility Discount Program works with over 150 clinics across the country that have committed to at least a 25% service discount for qualifying patients. How Grain Fertility Can Help One of the goals of Grain Fertility is to help fertility patients navigate the complexities that come with their journey and cancer patients often have more complex journeys that require additional coordination. Our team at Grain Fertility strongly advocates for a holistic approach to breast cancer treatment that includes fertility preservation as a standard part of care, ensuring all patients have access to the information and services they need. The Grain Fertility application is specifically designed to help onco-fertility patients organize all of the information they collect during their cancer and fertility treatments so they and their care team have all of the information they need to make informed decisions. Our Patient Empowerment Coaches are here to support you, helping you navigate this frightening time. If you or a loved one is fighting a battle against breast cancer, our Patient Empowerment Coaches are here to discuss your options with you. Fertility is a deeply personal and important aspect of life that shouldn't be overlooked, especially in the face of a breast cancer diagnosis. Fertility clinics play a crucial role in providing information, options, and support to those navigating this challenging path. (1) Shah NM, Scott DM, Kandagatla P, et al. Young Women With Breast Cancer: Fertility Preservation Options and Management of Pregnancy-Associated Breast Cancer. Ann Surg Oncol. 2019;26(5):1214-1224. doi:10.1245/s10434-019-07156-7 (2) Ruddy KJ, Guo H, Barry W, et al. Chemotherapy-related amenorrhea after adjuvant paclitaxel-trastuzumab (APT trial). Breast Cancer Res Treat. June 2015;151(3):589-596.

When undergoing in-vitro fertilization (IVF), couples often encounter a wide range of terms and concepts that can seem complex and daunting. One such term is "mosaic embryos." If you are on a fertility journey, it is essential to understand what mosaic embryos are, how they differ from normal embryos, and what their presence means for your chances at a successful pregnancy. In this blog post, we will explore the topic of mosaic embryos In detail to help you become a more informed patient and advocate for your care. What is a Mosaic Embryo? A mosaic embryo is am embryo that contains a mix of normal and abnormal cells in terms of their genetic make up. In a mosaic embryo, some cells have the correct number of chromosomes (46 total, 23 from each parent cell), while others have an abnormal number (less or more than 46). This is known as "mosaicism." There are a few terms you may hear associated with this such as "euploid" or "aneuploid." An euploid embryo is an embryo with the correct number of chromosomes, 46, while an aneuploid embryo has an abnormal number (more or less than 46). Mosaicism can occur during early embryonic development when an error happens in cell division. For example, a cell may begin as euploid, but as it continues to develop and divide, some of the cells may undergo abnormal chromosomal divisions, leading to a mix of normal and abnormal cells. How are Mosaic Embryos Identified? Mosaic embryos are typically identified through a process called Preimplantation Genetic Testing for Aneuploidy (PGT-A). During this test, a few cells are removed from the embryo at the blastocyst stage, usually around day 5 or 6 after fertilization. These cells are analyzed to determine their chromosomal makeup. The results of the test lead to the categories of: euploid- cells with the correct number of chromosomes aneuploid- cells with an abnormal number of chromosomes which usually leads to a failed implantation, miscarriage, or a genetic disorder mosaic embryos- a mix of euploid and aneuploid cells What Does it Mean to have a Mosaic Embryo? The presence of mosaic embryos can be confusion and emotionally challenging for couples. The implications of transferring a mosaic embryo depend on several factors, including the percentage of abnormal cells and which chromosomes are affected. Chances of a Successful Pregnancy Research shows that mosaic embryos have a lower implantation rate compared to fully euploid embryos (1). However, they do have the potential for a successful pregnancy, particularly when the percentage of abnormal cells is low or when certain less critical chromosomes are affected. Today, fertility specialists may suggest additional genetic screenings for birth defects throughout your pregnancy if you transfer a mosaic embryo, although at this time evidence-based guidance is lacking. An amniocentesis, a procedure used to take a small sample of amniotic fluid from the uterus to test cells directly from the fetus is the gold standard for prenatal follow up tests (2). This fluid surrounds the fetus during pregnancy and can provide powerful information about the baby's health. Remember, it is important to discuss with your doctors the risks associated with amniocentesis. Risk of Miscarriage or Genetic Disorders The main cause of failed pregnancy or a miscarriage in both natural conception and assisted reproductive technology is an aneuploid embryo (3). This occurs at the first stage of fertilization, known as meiosis. Even if an embryo starts off as genetically euploid, as it continues to multiply, divide, and grow, there is a risk for abnormalities that rise to a mosaic embryo. "Compared to euploid embryos, mosaic embryo transfer (MET) has also been shown to be associated with increased risk of miscarriage in multiple studies" (4). Should You Consider Transferring a Mosaic Embryo? Deciding whether to transfer a mosaic embryo is a deeply personal decision and should be made in consultation with your fertility specialists and genetic counselor. To help you with this decision, here are a few things you could consider when making a decision: How many available embryos are there? If you only have mosaic embryos available or if you have a few euploid embryos, you might consider transferring a mosaic embryo, especially if the mosaicism involves a low percentage of abnormal cells. Type of Chromosomal Abnormality Some chromosomal abnormalities are less likely to result in severe outcomes than others. Your fertility clinic and genetic counselor can provide more detailed information on the specific abnormalities detected. Personal and Ethical Considerations Some individuals and couples may feel more comfortable only transferring embryos with a higher chance of being chromosomally normal. Others may be willing to take the risk if mosaic embryos are the best option of achieving a pregnancy. Take the time to talk through this important component. Cost and Availability of PGT-A The cost of PGT-A and the potential need for additional IVF cycles if mosaic embryos are not transferred can also play a role in the decision-making process. Make sure to talk to your fertility care team and try to determine what you can afford, what may be covered, and your chances of needing to do additional cycles. What Does the Future Hold for Mosaic Embryos? The field of reproductive medicine is quickly evolving and research into mosaic embryos is ongoing. New studies are helping us understand more about the potential outcomes of transferring mosaic embryos and this knowledge may lead us to more refined guidelines and better predictions of success. Currently, many clinics are cautiously optimistic about the potential of mosaic embryos. As testing methods improve and more data becomes available, the ability to counsel patients on the risk and benefits of transferring mosaic embryos will become even more precise. We Are Here to Help The discovery of a mosaic embryo can be both hopeful and a challenging moment in your fertility journey. It is important to stay informed, ask questions, and work closely with your medical team to make the best decision for you. Every single fertility journey is unique and with the right support and information, you can make choices that align with your values, needs, and goals. If you want someone to help you better understand your options, assist in creating questions or resources so you feel more confident in your understanding of your embryos, or simply want someone to talk to you, Grain Fertility Patient Empowerment Coaches are here to answer your questions. If you are a new member, simply go to www.grainfertility.com/signup to create your account and schedule an initial consultation appointment with one of our Empowerment Coaches. If you are using the free version of our app and want to take advantage of our Premium Member benefits including custom guides and one on one coaching, you can go to your Account to upgrade your service today and begin meeting with our coaches regularly. Citations Greco E., Greco PF, Listorti I, et al. The Mosaic Embryo: what it means for the doctor and the patient. Besser, Andria G et. al. Evidence-based management of preimplantation chromosomal mosaicism: lessons from the clinic Hassold T., Hunt P. To err (meotically) is human: the genesis of human aneuploidy Munne S., Spinella F., Grifo J., Zhang J., Beltran M.P., Fagouli E. Fiorentino F. Clinical outcomes after the transfer of blastocysts characterized as mosaic by high resolution Next Generation Screening- further insights.

Whether it's your first time or you are a seasoned pro, the progesterone in oil (PIO) shot is often one of the most dreaded parts of the IVF process. But don't worry- you've got this! And if you are feeling a bit anxious, our Patient Empowerment Coaches (PECs) are here to help. Why does the PIO shot get such a bad reputation? Big Needle: The PIO shot uses the largest needle among all IVF injections Thick Medication: The oil-based medication is thick, so it takes longer to inject Intramuscular Injection: PIO shots are injected into the muscle of your buttocks, rather than the fatty tissue, making it more painful. Quick Tips to Make the Process Earlier: Warm Up the Vial Pro-Tip: You can rub the vial between your hands. The friction creates the right amount of heat to thin the medication, making it a little easier to inject. Warning: Don't use a microwave or submerge the vial in warm water as this could affect the medication's effectiveness. Have an Injection Buddy Having a partner or friend to administer the shot can be a huge help. It's challenging enough to give yourself an injection, especially from behind. An injection buddy can ensure you hit the right spot. You can also look to see if there are local services or nurses that will help you administer shots. If you need help finding someone qualified and can trust, our Patient Empowerment Coaches can help you find someone local! Confirm the Spot Injecting into the wrong area is far from ideal- PIO must be injected into the muscle of the buttocks for maximum absorption. To find the right spot, place your hands on your buttocks and feel where the back pocket of your jeans would be. The ideal injection location is where the upper outer corner of the pocket would be. Still need help? Talk to your nurse in person or schedule a call with a Patient Empowerment Coach who can help show you exactly where to inject. Relax- Don't Flex Your Buns Laying down on your stomach helps ensure your glutes aren't flexing. Staying relaxed will make the shot less painful. Remember to breathe in and breathe out. Apply Warmth at the Injection Site After injecting, use a warm compress can help the oil absorb better. Simply soak a washcloth in warm water and place it on the injection site. Massage the Injection Site Massaging the injection site for a few minutes afterward will help break up the oil and increase absorption into the muscle. Alternate Sides Switching which glute you inject each time helps reduce the risk of swelling and soreness. Additional Resources to Help! Registered nurse, fertility patient, and founder of 412 Fertility , Megan Kukic, wrote another blog post with tips, tricks, and techniques to help make shot administration a little easier. You can read the post here . We also know shot administration can be overwhelming and are proud to partner with MyVitro, a medication organizer for IVF and other fertility treatments. You can go to their site and get $10 off your order with the promo code Grain to help organize your shots and make them a little less overwhelming. Finally, our Patient Empowerment Coaches are here to help with any questions you may have. New Premium Members get a 30 minute call with our Head of Patient Empowerment, Kimberly Schamroth, RN, to better understand your journey. You can sign up for an account today at https://app.grainfertility.com/signup .

Many people rely on coffee to start their day, but if you are trying to conceive or are pregnant, you may wonder whether it is safe to consume caffeine. This resource discusses the relationship between coffee, fertility, and pregnancy outcomes. It contains excerpts from our Caffeine and Fertility guide available to our Premium Members. What is caffeine? First, it is important to know what caffeine is. It is a natural stimulant found in coffee, tea, soft drinks, energy drinks, chocolate, and some medications. Potential benefits of caffeine include: Stimulating the nervous system: increasing alertness and energy Enhancing cognitive functions: improving memory, mood, and general cognitive functions Physical performance: boosts endurance and performance in athletes Antioxidant properties: it contains antioxidants that combat oxidative stress and inflammation. Potential risks of caffeine include: Sleep disruption: it can lead to insomnia or disrupted sleep patterns if consumed late in the day Dependence and withdrawal: regular use can lead to dependance and stopping suddenly can cause withdrawal symptoms such as headaches, irritability, and fatigue Health health: high consumption may Increase heart rate and blood pressure, which can be problematic for Individuals with cardiovascular conditions Digestive issues: it can cause gastrointestinal discomfort such as acid reflux or upset stomach Dehydration: caffeine acts as a diuretic, which can contribute to or cause dehydration Caffeine and Fertility Most research does not conclude that caffeine is unsafe for pregnancy, but it is recommended to limit intake to 200mg per day. There are some historical concerns, including a 1998 study that suggested women who drank coffee had lower conception rates, but subsequent studies have not confirmed this finding. No conclusive evidence indicates caffeine affects the ability to become pregnant or the time to conception. However, excessive intake (300 mg or more) has been linked to higher miscarriage rates. Caffeine and Pregnancy When you are pregnant, your body metabolizes caffeine slower than non-pregnant women. Caffeine may also increase nausea and dizziness during a pregnancy. Caffeine can also contribute to hypertension (high blood pressure) and tachycardia (a sped up heart rate). This occurs when caffeine crosses the placenta and can increase catecholamines (a neurohormone important in stress responses), potentially raising your blood pressure and heart rate. Recommendations People always want to know what they can or should do to limit the impact caffeine can have as they try to conceive or are pregnant without having to give up their morning cup of coffee to get the day started. It is recommended that you do not exceed 200mg of caffeine per day to mitigate the chance of complications. Below are a few common drinks caffeine content to help you decide what you should or should not have: Drip Coffee: 95 mg per 8 oz Starbucks Pike's Place: 235 mg for a tall coffee (12 oz) Espresso: 63-75 mg per shot Latte/ Cappuccino/ Americano: 75 mg for a tall or 12 oz coffee Cold Brew: 200mg for a tall or 12 oz coffee Decaf Coffee: 2-5 mg per 8 oz Starbucks Earl Grey Tea: 40 mg Green Tea: 55 mg per 12 oz Conclusion Balancing your caffeine intake is important while trying to conceive and during pregnancy. You can enjoy your coffee in moderation, adhere to the recommended limits, and always consult with your healthcare team if you have any concerns. If you are interested in learning more about the impact coffee and caffeine can have or want to become a Grain Fertility member to get a more comprehensive version of this resource, you can sign up here or, if you are a member using our free version, go to Your Account to upgrade your service today!

PCOS, short for Polycystic Ovarian Syndrome, stands as one of the most prevalent hormonal disorders affecting females of reproductive age on a global scale (1). It is a metabolic dysfunction of the ovaries that impacts approximately 5% to 15% of women worldwide. In this blog post we will dive into what PCOS is, its potential causes, common symptoms, diagnosis, and available treatment options to help individuals navigate this often complex and misunderstood condition. What is PCOS? According to the World Health Organization, PCOS is a hormonal condition that can cause hormonal disturbances, irregular periods and multiple cysts in the ovaries. The Science Behind PCOS Let us back track a bit. Women are born with all of the eggs they will ever have. The greatest number of eggs one would have is before they are born, at 20 weeks gestation (approximately 6 to 7 million). This number drops significantly at birth to 1 to 2 million and continues to decline from infancy all the way through menopause. Eggs within the ovary undergo growth and development in response to a cascade of hormonal fluctuations across the body. The brian communicate with the ovaries, prompting growth and maturation of a follicle- a fluid-filled sac housing an egg. Upon reaching optimal size, the brain triggers the ovary to release the egg, a process known as ovulation. In PCOS, hormonal communication is disrupted, resulting in irregular or absent periods. Follicle Stimulating Hormone (FSH) is dispersed among multiple follicles, impeding the proper growth and development of individual follicles. Consequently, the failure of one egg to mature and release occurs, which is crucial for conception. These accumulating follicles in the ovaries manifest a distinctive appearance on ultrasound imaging, this leading to the term "polycystic" ovary syndrome. What Causes PCOS? The exact cause of PCOS remains unknown, but several factors may contribute to its development, including: Hormonal Imbalances Fluctuations in insulin and androgen levels can disrupt the normal function of the ovaries and lead to the symptoms associated with PCOS. Genetics PCOS tends to run in families, suggesting a potential genetic predisposition to the disorder Insulin Resistance Many women with PCOS also have insulin resistance, a condition where they body's cells do not respond effectively to insulin, leading to elevated insulin levels PCOS Symptoms PCOS symptoms can often be overlooked due to their nature, but it is important to watch for and document these symptoms if you suspect you have PCOS. Symptoms include (2): Missed periods, irregular periods, or very light periods Ovaries that are large or have many cysts Extra body hair, including the chest, stomach or back Weight gain, especially around the belly Acme or oily skin Male-pattern baldness or thinning hair Infertility Small pieces of extra skin on the neck or armpits, also known as skin tags Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts Diagnosing PCOS If you suspect you may have PCOS, it is important to speak with your OBGYN or Fertility specialist. Your doctor will be able to order the appropriate tests to evaluate if you have PCOS and then would be able to curate a treatment plan to help restore hormonal equilibrium. Because PCOS is a cluster of symptoms and it is not a one-size-fits all, it may look different to you than to someone else. PCOS is diagnosed based on the presence of two out of the three following: Irregular/Absent Menstrual Cycle Cycles exceeding 35 days or no menstrual cycle at all Elevated Androgen Levels Blood tests revealing increased levels of testosterone Typically women with elevated testosterone present with increased facial hair, male pattern baldness, acne, and increased abdominal fat Polycystic Ovaries on an ultrasound scan An OBGYN would be able to evaluate these signs/ symptoms through a set of blood tests and an ovarian ultrasound. It is possible for your OBGYN to conduct further diagnostic tests to rule out other potential conditions that may mimic PCOS, such as hypothyroidism, hyperprolactinemia, and nonclassical adrenal hyperplasia. Other abnormal hormonal lab values that could be tested include: Estrogen Luteinizing Hormone (LH) Insulin Anti-Mullerian Hormone (AMH) Treatment Options for PCOS While there is no cure for PCOS, various treatment options are available to help manage symptoms, improve reproductive health, and reduce the risk of long-term complications. These include: Lifestyle Modifications to reduce stress and inflammation throughout your body Diet: the Mediterranean Diet has gained popularity as a means to manage PCOS due to its anti-inflammatory properties and reduction of chronic inflammation (3). This includes foods such as health fats like olive pils, walnuts, and full fat cheeses. You can also increase protein intake with salmon and reduce red meat consumption. Sleep: aim for 7 to 8 hours a sleep Exercise: moderate cardio and strength training is ideal to build and strengthen your muscles. However, it is not necessary to stress out your body with high intensity interval training workouts. Acupuncture Therapy/Mindfulness Medications can help regulate your hormones and reduce symptoms and restore your menstrual cycle Hormonal birth control may be used if you are not trying to conceive. If you are trying to conceive, your doctor may try to trigger ovulation induction. Women with PCOS have a hormonal imbalance. The brain is releasing too little FSH for the amount of follicles that are available inside the ovary. This prevents an egg from growing and developing. The goal is to increase FSH production for an egg to grow and eventually ovulate. Medications include Clomid, which tells the brain there is not enough estrogen and increases FSH production and Letrozole, which eats up estrogen throughout the body, signaling the brain to release more FSH. Fertility Treatments and PCOS For individuals struggling with infertility due to PCOS, there are a number of options available. In addition to the ovulation induction medications listed above, a fertility specialist may advise assisted reproductive technologies such as intrauterine insemination or in-vitro fertilization (IVF). If you suspect you may have PCOS and you are experiencing symptoms associated with PCOS, it is crucial to meet with a medical professional for a thorough evaluation, timely diagnosis, and personalized treatment recommendations tailored to meet your individual needs and concerns. Take the time to track and document your symptoms as these are important factors your doctors will consider when deciding next steps including testing and diagnosis. There is a wealth of information to explore regarding PCOS and its influence on reproductive health. If you're seeking personalized guidance, our Patient Empowerment Coaches can help. Through our Grain Fertility Premium Member Program, you can benefit from one on one support to address all of your questions and concerns. We can help you track your symptoms, prepare for appointments, and answer questions you may have. Do not hesitate to reach out and take proactive steps towards managing your PCOS and optimizing your reproductive well-being. Your journey matters to us and we are committed to empowering you every step of the way. Citations: https://www.ncbi.nlm.nih.gov/books/NBK459251/ https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos Barrea L, Arnone A, Annunziata G, Muscogiuri G, Laudisio D, Salzano C, Pugliese G, Colao A, Savastano S. Adherence to the Mediterranean Diet, Dietary Patterns and Body Composition in Women with Polycystic Ovary Syndrome (PCOS). Nutrients. 2019 Sep 23;11(10):2278. doi: 10.3390/nu11102278. PMID: 31547562; PMCID: PMC6836220.

Every year, thousands of intended parents use donated sperm or eggs to help them achieve their dream of having a child. The decision to use donated sperm or eggs often does not come easily and can have implications that are important for consideration. To help intended parents think through these implications, we are proud to feature a guest blog by Dylan Stone-Miller. Dylan is an advocate for the donor-conceived community after becoming a known donor to a sibling pod of now 46 children and their families and is founding executive director and CTO of DCPData. You can learn more about DCPData at https://www.dcpdata.org/ IVF is a journey filled with hope, anticipation, and crucial decisions, especially when using a sperm bank or egg donor. While the focus often remains on the procedure and the joyous outcome of having a child, it is equally important to understand what comes after IVF. Here are five critical aspects to consider: 1. Your Child May Have Siblings Worldwide One of the lesser-known realities of using a sperm or egg donor is the potential for your child to have numerous siblings around the globe. In the United States and Canada there are no legal limits on the number of families that can select the same donor, and major cryobanks distribute their donor's gamete internationally, so even those in countries with legal limits may not actually remain within those legal limits globally. This can result in your child having many half-siblings, a phenomenon that can have both positive and challenging implications. Implications: Emotional and Psychological Impact: There is a correlations between connecting with siblings and feeling positive about being donor-conceived . A sense of curiosity and excitement about meeting their siblings can turn to a sense of loss if they are not introduced to them. Risk of Consanguinity: When the children grow up and join the dating pool, having a large and likely unknown number of siblings means there is a risk they might accidentally couple , particularly with ineffective tracking of births in some countries. 2. Limited Access to Updated Medical History When you choose a sperm or egg donor, you typically receive a medical history that pertains to the donor and their immediate family at the time of the donation. Unfortunately, this information can be outdated, incomplete, or inaccurate. The absence of updated medical histories can compromise the health of your child, making it difficult for doctors to diagnose or anticipate medical conditions. Implications Diagnostic Difficulties: Without accurate genetic information , doctors might struggle to diagnose hereditary conditions. Potential Health Risks: Unforeseen medical issues could arise if critical genetic information is unknown . 3. Navigating the Conversation About Conception A pivotal moment for parents of donor-conceived children is explaining how they were conceived. Children naturally have questions about their origins and how you handle these questions can significantly impact their sense of identity and well-being. Using an anonymous donor or even an Open ID Donor can complicate these conversations, leaving children with unanswered questions and more. Considerations: Openness and Honesty: Being transparent with your child from an early age helps build trust and has a positive impact on their mental health . Support Resources: Utilize resources and counseling services to navigate these conversations effectively. 4. Connecting with Other Families Deciding whether to connect with other families who used the same donor is another important consideration. These connections can be beneficial for your child, providing them with a broader sense of family and support network. There are various platforms available, such as DCPData , the Donor Sibling Registry , and Facebook groups, which facilitate these connections. Considerations: How to Facilitate Connections: Connecting with other families can provide shared experiences and mutual support. Which online platform allows for the most secure and robust connections ? How might you broach the topic of connection with the other families? Structure of the Connections: Will the relationship take the form of an online interactions, in-person, or a hybrid of the two? The earlier the introductions the better, but be sure to manage your child's expectations and budget for travel if you choose to have in-person relationships between the children, which adult donor-conceived people have unequivocally said is important to them . 5. Managing Extra Embryos or Gametes Post-IVF, you may have extra leftover embryos or gametes. Deciding what to do with these can be emotionally taxing. Options include donating them to other families , participating in a cyrobank's buyback program , or destroying them. Each option comes with its own set of emotional and ethical considerations. Options: Donation or buyback: This increases the number of donor siblings, which may have implications for your child. Destroying Extra Embryos: Deciding to destroy unused embryos or gametes can be difficult. Storage Costs: Long-term storage of genetic material can be expensive. Preventing and Mitigating Issues While the post IVF journey with a sperm bank or egg donor comes with unique challenges, there are steps you can take to prevent or mitigate issues. Key Preventative Measures: Ask the Right Questions: Inquire about how the sperm bank or egg bank ensure adherence to advertised family limits. Even if they have limits that they or an outside entity enforces, consider how the lack of an international regulatory body means the true limit is the combined limits of each country that imported the donor's genetic material Understand how they verify and update donor's medical histories over time if they are not legally required to do so. Leverage Resources: USCDD , DC UK , and DC Aotearoa are organizations that offer resources and support for donor conceived families Join DCPData to access up-to-date medical histories from participating donors and donor-conceived families and connect with other families who used the same donor. Educate and Prepare: Stay informed about the implications of using donor gametes and the potential challenges that may arise. Consider professional counseling to help navigate the emotional and psychological aspects of donor conception. By taking proactive steps and utilizing available resources, you can navigate the complexities of IVF using a sperm bank or egg donor with confidence and ensure the best possible outcomes for your family. Remember, while the journey may be complex, it is also filled with opportunities for growth, connection and profound love.

Ovulation Predictor Kits (OPKs) are at-home fertility tests designed to detect a surge in luteinizing hormone (LH) levels in urine, which typically occurs 36 hours before ovulation. By identifying the LH surge, OPKs help individuals predict and pinpoint the most fertile days within their menstrual cycle, optimizing the timing for conception. This post helps you understand how OPKs work and how to use them. How Ovulation Predictor Kits Work OPKs operate by detecting the presence of luteinizing hormone (LH) in urine. LH, a hormone produced by the anterior pituitary gland, plays a crucial role in ovulation. The LH surge facilitates the release of the egg from its follicle by enhancing enzyme activity, which breaks down the follicle's wall to allow the egg's passage. Subsequently, the mature egg is released from the ovary into the fallopian tube, where it awaits fertilization. Additionally, LH prepares the uterus for potential implantation of a fertilized eg by stimulating the release of progesterone post-ovulation, creating an optimal environment for embryo attachment (1). How to Use OPKs OPKs are pretty straightforward and user-friendly. They can be found over the counter at your local pharmacy or purchased online. They normally come as test strips or sticks. To test for an LH surge, it is best to test your urine first thing in the morning on the days leading up to the days you may ovulate. For the average person who has a 28 day cycle, ovulation will often fall out between day 12-16. It is best to begin to test for an LH surge starting on day 10. NOTE: It is important to keep in mind not everyone has a 28 day cycle and a "regular" cycle may vary from 24 to 35 days. Step by Step Instructions It is important to always follow the instructions of the specific OPK you are using, but here are some general tips and instructions for using OPKs. Early morning is the optimal time to test for urine LH. This is when it will be more highly concentrated. It is essential to test at the same time each day and avoid excessive fluid intake a few hours before testing to ensure more accurate results. You can either hold the strip or stick under a stream of urine or place it in a sample cup However, it is important to make sure the container is sterile. After waiting the designated period of time (usually a few minutes), read the test results by comparing the color or lines on the test strip or stick to the control line(s) and test line(s) indicated on the package. The results will inform you if there is LH presence in the urine. Ovulation typically occurs within 24 hours of an LH surge, which is the green light to be sexually active to optimize your chances of conceiving. However, it is important to remember a positive OPK result does not guarantee ovulation and a negative test does not mean always mean you will not ovulate. If you are trying to avoid conception, make sure to use any form of contraception during your fertile window. Hormonal fluctuations, irregular cycles, and other factors can affect OPK results and ovulation. Benefits of Using OPKs OPKs offer a convenient and affordable way to monitor and track ovulation at home without the need for invasive tests or procedures. By detecting the LH surge and predicting ovulation, OPKs help individuals identify their fertile days and optimize the timing for conception, increasing the chances of achieving pregnancy. Considerations When Using OPKs OPKs are most effective for women with regular menstrual cycles. Women with irregular cycles, hormonal imbalances, or underlying fertility issues may experience unreliable results with OPKs. It is essential to use OPKs in conjunction with other fertility tracking methods and consult with a healthcare provider for personalized guidance, evaluation, and support when trying to conceive. Working with a Patient Empowerment Coach at Grain Fertility can offer invaluable support and guidance, especially when tracking ovulation. They can help you find the best OPKs to use to help you become familiarized with your cycle. They are here to ensure you receive timely, appropriate, and individualized support and guidance throughout your ovulation tracking and fertility journey. If you have any further questions or need assistance, don't hesitate to reach out to your Patient Empowerment Coach. We can help you track your cycles, develop questions for your care team, and help explain the confusing parts of your journey. If you are not a Grain Fertility Premium Member, you can sign up here  or if you are a member using our free version, go to your Account to upgrade your service.

Both fibroids and polyps are growths that can develop within the uterus, but differ in terms of their composition, location, symptoms, and potential health risks. Understanding the difference between polyps and fibroids can help you make more informed decisions about your health and treatment options. In this blog post, we'll explore the key distinctions between these two types of uterine growths and how they may impact your fertility. What Are Polyps? Uterine Polyps are small, benign (non-cancerous) growths that develop within the inner lining of the uterus, also known as the endometrium. These growths are typically composed of endometrial tissue and can vary in size, ranging from a few millimeters to several centimeters. While polyps tend to be non-cancerous, they have the potential to become cancerous, specifically in post-menopausal women (1). What are Fibroids? Uterine fibroids, also known as leiomyomas or myomas, are non-cancerous growths that develop from the muscle tissue of the uterus. These growths can very in size, ranging from small, seed-like growths to large masses within the uterine wall (intramural), protrude outward from the uterus (subserosal), or attach to the inner lining of the uterus (submucosal). Key Differences Between Polyps and Fibroids Composition Polyps are made of endometrial tissue Fibroids are made of muscular tissue Location Polyps are located in the Endometrium Fibroids can be located throughout the uterus Size Polyps are small in size Fibroids are large in size Symptoms Polyp symptoms can include bleeding, irregular cycles, and infertility Fibroids symptoms can include bleeding, prolonged periods, pelvic pain, frequent urination, and constipation Risk of Cancer Polyps are often benign, however there is a small risk of malignancy (presence of cancer) Fibroids are benign in nature Diagnosis and Treatment Both polyps and fibroids can be diagnoses through imaging tests such as ultrasound, MRI, or hysterectomy. Treatment options may vary depending on the size, location, symptoms, and individuals overall health. Options include watchful waiting, medications, minimally invasive procedures, or surgical removal. Surgical Methods of Treatment Polyps can be removed with a polypectomy Uterine fibroids can be removed surgically with a myomectomy, also known as a "fibroidectomy." Both procedures may be performed either by a gynecological surgeon or a reproductive endocrinologist. Impact on Fertility While many women with polyps and fibroids may conceive and have successful pregnancies, these uterine growths can sometimes interfere with fertility and reproductive health. How Polyps Impact Fertility Disruption of Implantation The mechanism by which polyps interfere with implantation is unclear (2), however studies suggest polyps may cause inflammation similar to an Intrauterine Device creating a suboptimal environment for implantation and fetal development. Biochemical Effects The presence of uterine polyps may increase the presence of inflammatory markers causing an imbalance in the environment of the endometrium (3). Mechanical Obstruction In rare cases, large polyps may obstruct the fallopian tubes or cervix, preventing the sperm from reaching the egg and fertilization from occurring (3). How Fibroids Impact Fertility Fibroids are present in 5-10% of women struggling with infertility (4). Fibroids impact fertility by: Distorting the Uterine Cavity Fibroids can alter the shape and size of the uterus, potentially affecting the sperm's ability to reach the egg, the implantation of a fertilized egg, or the growth and development of the fetus during pregnancy. It is important to note that where a fibroid is situated impacts embryo transfer outcomes (5). Limited Blood Supply Large fibroids may interfere with the blood supply to the uterine lining, affecting its thickness and receptivity, which can impact implantation and increase the risk of miscarriage. Compression of Fallopian Tubes Subserosal or intramural fibroids may compress or distort the fallopian tubes, preventing the egg from traveling to the uterus and decreasing the chance of fertilization. Discussing With Your Doctor If you suspect that polyps or fibroids may be contributing to your struggle to conceive, it is important to discuss your concerns with you OBGYN and/or fertility specialist. It may be overwhelming and you may feel unsure where to begin. This is where we can help. Here are a few tips to help. Track Your Symptoms It is important to log any symptoms you are experiencing in detail, such as: Detailed description of symptoms How long the symptoms last Write down when they began and keep track of how long they last How intense your symptoms are Questions to Ask Your Doctor Ask your doctor to differentiate what is normal and what is not. It is important to be forceful In explaining if something doesn't feel right. Remember, severe pain or other symptoms that impacts your daily life is not normal and should be communicated to your doctor rather than just dismissed What will happen if you do not seek treatment? What are the least Invasive to most Invasive treatment options available? How long will take me to recover from each treatment and proceed to accomplish my fertility goals? The good thing is you can use the Grain Fertility application to keep all of this in one place. Capturing Your Medical History The Grain Fertility application lets you upload and track any testing, results, or diagnosis from any of your doctors so you always have accurate, timely information available to help you and your doctor accurately discuss your history. Using Ongoing Tracking Features The ongoing tracking feature in the application lets you write down your signs and symptoms, capturing in real time what you are feeling so you can accurately convey them to your doctor. You can also use this as a way to write down questions you have before any appointments. Patient Empowerment Coaching If you have any further questions or need assistance, don't hesitate to reach out to your Patient Empowerment Coach. We can help you create a customized set of questions, track your symptoms, and help explain the confusing parts of your journey. If you are not a Grain Fertility Premium Member, you can sign up here or if you are a member using our free version, go to your Account to upgrade your service. Our coaching can offer personalized advice and support tailored to your specific needs and circumstances. Trust in their expertise and lean on them for assistance whenever needed. With proper preparation and support, you can navigate the fertility treatment process with confidence and peace of mind. Early detection and intervention can help optimize your fertility outcomes, enhance your reproductive health, and increase the chances of achieving a successful pregnancy. Managing polyps and fibroids alongside the daily challenges of your fertility journey can indeed be daunting. Rest assured, our Patient Empowerment Coaches and staff at Grain Fertility are dedicated to guiding and supporting you through every phase of your journey. References: Wong M, Thanatsis N, Nardelli F, Amin T, Jurkovic D. Risk of Pre-Malignancy or Malignancy in Postmenopausal Endometrial Polyps: A CHAID Decision Tree Analysis. Diagnostics (Basel). 2021 Jun 15;11(6):1094. doi: 10.3390/diagnostics11061094. PMID: 34203810; PMCID: PMC8232598. Jee BC, Jeong HG. Management of endometrial polyps in infertile women: A mini-review. Clin Exp Reprod Med. 2021 Sep;48(3):198-202. doi: 10.5653/cerm.2020.04119. Epub 2021 Jul 30. PMID: 34352167; PMCID: PMC8421660. Nijkang NP, Anderson L, Markham R, Manconi F. Endometrial polyps: Pathogenesis, sequelae and treatment. SAGE Open Med. 2019 May 2;7:2050312119848247. doi: 10.1177/2050312119848247. PMID: 31105939; PMCID: PMC6501471. Guo XC, Segars JH. The impact and management of fibroids for fertility: an evidence-based approach. Obstet Gynecol Clin North Am. 2012 Dec;39(4):521-33. doi: 10.1016/j.ogc.2012.09.005. PMID: 23182558; PMCID: PMC3608270. Ezzati M, Norian J, Segars J. Management of uterine fibroids in the patient pursuing assisted reproductive technologies. Women's Health (Lond Engl) 2009;5:413–21

Insights from a Fertility Nurse & Patient Empowerment Coach If you're reading this, chances are you're exploring the wonderful world of family planning within the LGBTQ+ community. As a fertility nurse, I've had the privilege of working with individuals and couples from all walks of life, including those who identify as LGBTQ+. At Grain Fertility, we strongly believe everyone is entitled to grow the family of their dreams and families are not one-size-fits-all. The path to parenthood in this community is nothing short of remarkable and while often people do not know where to begin, we are here to guide you through the process. First things first, let's debunk a common myth that family planning and fertility treatments are just for heterosexual couples. That could not be more than false! LGBTQ+ individuals and couples have every right to pursue their dreams of parenthood. Here at Grain Fertility, we want to help you make those dreams a reality. No matter your race, religion, sexual orientation, or identification, Grain Fertility can provide you with the organizational tools and fertility navigation services you need to help you through your own journey. Assisted Reproductive Technology for the LGBTQ+ Community The path to parenthood in the LGBTQ+ community is commonly achieved via assisted reproductive technology (ART). Whether it's through intrauterine insemination (IUI), in vitro fertilization (IVF), or surrogacy, there are a myriad of options available to help LGBTQ+ individuals and couples conceive. Let's not sugarcoat it; the road to parenthood for LGBTQ+ individuals and couples can come with its fair share of challenges. From navigating legal hurdles and escalating expenses to facing societal stigma, there are obstacles that must be overcome. As a fertility nurse and a Grain Fertility Patient Empowerment Coach, part of my role is to provide not only medical education but also emotional support every step of the way. One of the things I love most about my job is the opportunity to educate and advocate for my patients. Whether it's explaining the ins and outs of ART procedures or connecting patients with resources within the LGBTQ community, I'm here to empower individuals and couples to make informed decisions about their family-building journey. A growing number of same-sex couples are turning to Assisted Reproductive Technology to have children. However, there are a number of factors to consider, including: Same-Sex Females For women who are considering ART for their family building, it is important to consider several questions when exploring fertility options, including: How will you find a sperm donor (either known or anonymous); and Is either partner is interested in carrying the pregnancy or will you use a surrogate? Same-sex femals have several options for assisted reproduction, including: Intrauterine Insemination (IUI) An IUI is a fertility procedure in which donor sperm would be inserted into the patient’s reproductive tract by the means of a catheter. This is done at your fertility doctor’s office while you are awake and can be slightly uncomfortable. Before the IUI, you may need to visit the fertility clinic multiple times to monitor the development of the follicles, each containing an egg, in order to time the IUI with ovulation. Reciprocal-IVF Simply put, this option is when one partner’s eggs are used to create an embryo and the other partner carries the pregnancy. Reciprocal-IVF is unique in that it enables both partners to be directly involved in the pregnancy journey. One partner can donate their eggs by undergoing ovarian stimulation and a surgical procedure to extract the eggs from the ovaries. The eggs are then fertilized in the laboratory through the process of IVF create embryos. At this time, the second partner may undergo preparations for the embryo to be transferred into her own uterus. Both procedures will require sperm from either a known donor or an anonymous donor. Both of these procedures will require sperm from either a known or anonymous donor. Same Sex Male Couples For men considering ART for their family building, there are several options, including: The sperm that is used; Either one or both partners are able to provide a sperm sample to fertilize eggs from an egg donor. This enables the offspring to be genetically related if you choose to grow your family with more than one child. By using donor eggs, embryos can be created via the process of in-vitro fertilization and stored for later use. The use of donor eggs to be fertilized with partner’s sperm; and How will you find a surrogate to carry the child? Our friends at Expecting.AI have drafted an amazing resource for intended parents navigating the complexities of third-party reproduction. This can be read here. Single Parents by Choice While Hollywood has sold us on the story that we are all meant to meet Mr. or Mrs. Right, fall in love and have children, that is not always the case. Your relationship status should not be a barrier to parenthood. Thankfully with modern day fertility treatment, there are a number of options for single men and women to become parents. Women: Most common path to parenthood is IUI involving donor sperm The IUI procedure may be done at home, as there are at-home kits to support this, however the majority of the time IUI is performed at a fertility clinic. Unfortunately women exploring this option may be at a later age and therefore may have diminished fertility. Do not despair, the beauty behind fertility is the opportunity to explore egg donation or embryo donation Men: Men who are interested in pursuing the path to parenthood may do so by the means of egg donation and a surrogate. If a man does not want to be genetically connected to his child there is the option for embryo donation or adoption as well. Transgender Men/Transgender Women: Prior to gender affirming hormone replacement therapy and/or surgical intervention, there are options to help set yourself up to be able to have a biological child. Transgender Men: Those born with a uterus and ovaries may consider preserving their eggs prior to gender affirming treatment. Therefore, when they want to grow their family biologically, their eggs may be fertilized with donor sperm and transferred into a gestational carrier’s uterus. Transgender Women: For a man who is transitioning, they have the ability to freeze their sperm before undergoing gender affirming treatment. The sperm may be inserted directly into a uterus via Intrauterine Insemination or sperm may be fertilized to use the embryos in the future via a female partner or gestational carrier. It is important to discuss with your Reproductive Endocrinologist where you are in your journey and provide detailed documentation and records with all of your doctors to ensure you are medically cleared to begin fertility treatments. This is something Grain Fertility can help with, as our organizational tools and timeline feature allow you to record and save your most important health information in one easy to use location. Every Journey is Unique It is important to recognize that every LGBTQ family's journey is unique. What works for one couple may not work for another, and that's okay. As a fertility nurse, I'm here to listen, support, and tailor treatment plans to meet the individual needs of each patient. At the end of the day, LGBTQ family planning isn't just about biology—it's about love, resilience, and the unwavering desire to create a family. Here at Grain Fertility, I,  along with our team of Patient Empowerment Coaches,  feel incredibly privileged to be a part of that journey. The application is user-friendly and can support anyone embarking on the path to parenthood through fertility treatments. Premium users at Grain Fertility are able to access 1 on 1 coaching sessions, receive discounts with our fertility partners and gain access to exclusive webinars. We are committed to providing compassionate care to all individuals and couples, regardless of sexual orientation or gender identity. So, to all my LGBTQ friends out there who are dreaming of starting or expanding their families, know that you are not alone. With the right support and resources, your dreams of parenthood can become a beautiful reality. We are here each step of the way, cheering you on. If you have any further questions or need assistance, don't hesitate to reach out to us. If you are not a Grain Fertility Premium Member, you can sign up here or if you are a member using our free version, go to your Account to upgrade your service.

Note: The following post is courtesy of our friends at Hera Fertility. Grain Fertility is proud to feature resources and information from trusted sources of information on the different aspects of the fertility treatment process, including male factor infertility. Visit them to get more information about the amazing services they offer to help you on your fertility journey. Infertility isn't just a challenge couples face; it's a deeply personal journey many of us go through. Often, there's a misconception that infertility issues are mostly on the woman's side, but that's far from the truth. In fact, men are just as likely to contribute to infertility issues. Let’s break down what male infertility is, why it happens, how it's diagnosed, and what can be done to treat it. What Exactly Is Male Infertility? Male infertility is when a guy has trouble getting a partner pregnant, usually because of issues with his sperm. It might be there’s not enough sperm, they don’t move the right way, or they're not the right shape. If a couple is trying to conceive and having issues, it’s time evaluate all of the potential causes, including potential male factors. It is amazing how many fertility patients begin treatment without a full evaluation of both partners (if applicable). Why Does Male Infertility Happen? Here are a few of the usual suspects: Varicocele: This is a fancy word for swollen veins in the scrotum. It’s actually the top fixable reason for male infertility. Infections: Some infections can mess with sperm production or health, or even block their travel route. Trouble with Ejaculation: Conditions like retrograde ejaculation send sperm into the bladder instead of out the penis during an orgasm. Immune Problems: Sometimes the body gets confused and attacks sperm as if they were a threat. Hormone Imbalances: Issues with the hormones that manage sperm production can throw things off. Lifestyle Choices: Being overweight, smoking, using drugs, taking testosterone and even exposure to environmental toxins like pesticides can impact sperm. How Do We Figure Out What’s Going On? Diagnosing male infertility usually involves a few steps: Check-Up: Your medical history and even a physical exam can reveal your risk for any issues. Sperm testing and Semen analysis: An important test where a sample of semen is analyzed. Some tests like Hera Fertility’s sperm test, can be done entirely at home to give you information on the count and motility (the movement of the sperm). A full semen analysis requires the sperm sample to be analyzed in a lab to check the count, motility, and shape of the sperm. Hormone Tests: These can check hormone levels to see if something’s off. Genetic Tests: These can show if there are any genetic reasons behind the infertility. Imaging: Sometimes, doctors use ultrasounds to look for blockages or other physical issues. What Can Be Done About It? Treatment depends on the cause, and includes surgery, medications, and assisted reproductive technologies (ART) like IVF. There are lifestyle modifications you can make to increase your fertility. Tips for Boosting Fertility A few lifestyle tweaks can make a big difference. A few things you can do to help boost your fertility include: Stay Healthy: Keeping a healthy weight is crucial. Eat Smart: Support optimal body function by reducing the intake of synthetic ingredients, refined sugar and processed foods. Kick Bad Habits: Smoking and heavy drinking are out. They can really hurt sperm quality. Check Your Meds: Some meds can affect fertility. Always talk to your doctor before stopping or switching any medication. Keep Cool: Overheating the testicles can reduce sperm production. Avoid hot tubs and opt for looser clothing. Wrapping Up Male infertility is complex, but understanding the causes and treatments can empower you to take control and make informed choices. If you're trying to have a baby, contact Hera Fertility to get your sperm test. You never have to leave your house or speak to anyone unless you want to. The convenience and privacy of their male fertility program is designed to ensure you are comfortable and supported in your journey to parenthood. If you have questions about your own journey, our Patient Empowerment Coaches are available to assist you. Book a 30-minute consultation with a Fertility Registered Nurse to explore how to optimize your fertility safely and effectively, with customized modifications as necessary. At Grain Fertility, Premium Users have the opportunity to work 1:1 with our dedicated Patient Empowerment Coaches. They will help you prepare for your upcoming consultations with your provider and they will provide resources tailored to your individual needs. Our PEC's are committed to supporting you throughout your fertility journey. You can become a Premium member and take advantage of a risk free two-week trial by signing up today at https://app.grainfertility.com/signup.

We all know that staying fit is good for our health, right? Well, it turns out fitness can also play a positive role when you're trying to conceive. But not all workouts are created equal, especially when it comes to reproductive health. This blog dives into how high-intensity exercise can affect fertility and suggests some fitness alternatives to consider on your fertility journey. The Benefits of Fitness: Regular exercise comes with a host of health perks. Think longer life, better heart health, improved mental well-being, and a reduced risk of conditions like Type 2 Diabetes, Hypertension, and Congestive Heart Failure (1). Cardio workouts are key for overall health, but here's the catch: too much intense exercise can be tough on women of reproductive age. How Exercise Affects Female Reproduction: Let's get a bit technical. The female reproductive system relies on something called the Hypothalamic-Pituitary-Ovarian Axis (HPO Axis). In simple terms, your brain talks to your ovaries and uterus throughout your menstrual cycle. Each month, follicles go through a growth process, preparing to release a mature egg thanks to the intricate communication of reproductive hormones (2). Hormones are chemical messengers that coordinate different functions in the body. Too much exercise can mess with these hormonal levels, leading to irregular periods and exercise-induced amenorrhea (absence of menstruation). Which Hormones Take a Hit? Intense workouts can disrupt how Gonadotropin Releasing Hormone (Gn-RH) is released from the brain. Gn-RH is essential for follicular development, without it the HPO Axis is thrown off.  As a result, estrogen and progesterone levels alter as well, two hormones essential for ovulation and embryo implantation. And let's not forget cortisol, the stress hormone, which can spike with excessive exercise. When we exercise too hard, we get that “adrenaline rush” and our body goes into a “fight or flight” response. Think as if you are getting chased by a bear. Constant stress will lead to a hormonal imbalance, including fertility. Elevated cortisol levels reduce the release of Gn-RH ultimately impacting the release of FSH (Follicle Stimulating Hormone) and LH (Luteinizing Hormone) (3). FSH is essential for follicular growth, while LH is essential for ovulation. As these hormones get off balance, the menstrual cycle is unable to operate properly and therefore fertility is impaired. Consider Your Exercise Routine: While the American Society for Reproductive Medicine provides guidelines on smoking, alcohol consumption, and diet for those trying to conceive, exercise guidance remains somewhat of a gray area. The type of exercise suitable for you depends on your overall health. PCOS or Overweight/Obese: Women with Polycystic Ovarian Syndrome (PCOS) or who are Overweight/Obese, may benefit from maintaining a healthy weight through regular, moderate & high intensity workouts. Studies show that moderate exercise can regulate hormones, improve ovulation, reduce insulin resistance, and restore fertility in women with PCOS and overweight women (4). Assisted Reproductive Technology (ART) & Fitness: For women undergoing ART, exercise has minimal impact on fertility outcomes. However, your provider will advise limited high intensity exercise while undergoing these treatments to avoid ovarian torsion. Ovarian torsion is a complication in which one or both of the ovaries twist, including the fallopian tube(s) (5). Twisting of these ligaments may lead to loss of blood supply to the ovary and ultimately loss of the ovary itself. Ovarian torsion is a medical emergency, therefore, it is advised to minimize high impact workouts to mitigate the risk of ovarian loss and potential infertility. Healthy Women & Fitness: For healthy women trying to conceive, studies indicate that vigorous high-intensity workouts may negatively impact fertility, and therefore, caution is advised. Although high-impact workouts may be satisfying, they can induce stress on the body, which is not ideal for reproductive health. A specific study highlights the correlation between vigorous aerobic activity and time to pregnancy for women with a healthy Body Mass Index (BMI). "Women engaging in 2 weekly hours of vigorous exercise were 16% less likely to conceive than sedentary women over the same time frame. Among women exercising 3–4 hours per week, this number increased to 27% less likely, whereas ≥ 5 hours were associated with a 32% reduction in the chances of conception" (6). Furthermore, the high caloric burn during HIIT workouts can disrupt your menstrual cycle . While maintaining a low calorie intake may seem appealing, malnourishment can disrupt the hormonal balance, hindering the ability to conceive. However, active women need not halt their workouts altogether; rather, they should be mindful to increase their caloric intake on days of strenuous exercise. Fitness Options to Consider: Low Impact Choices: Brisk walking Light jogging Yoga, Pilates, Barre Swimming If minimizing your stress levels is your goal, yoga is the way to go. Relaxation techniques that are often a by-product in yoga and meditation practice have been shown to reduce anxiety levels in women undergoing fertility treatments (7). Workouts to Limit: Running High-Intensity Interval Training (HIIT) Intense cycling or spinning Abdominal twists and turns (can lead to ovarian torsion) That is not to say to stay away from high intensity fitness all together. Rather than engaging in 4 days a week of HIIT, try to alternate one day of high intensity followed by one day of low impact fitness. Try to be mindful of your nutrition on days you engage in vigorous activity to avoid a state of caloric deficit. The right level of high-intensity exercise is different for everyone. If you are a gym-rat, do not feel that you have to give up fitness completely. It's always a good idea to chat with your OB-GYN or Reproductive Endocrinologist about a fitness routine that's best for you. Uncertain about whether your exercise regimen is fertility-friendly or suitable during fertility treatments? Our Patient Empowerment Coaches are available to assist you. Book a 30-minute consultation with a Fertility Registered Nurse to explore how to optimize your fertility safely and effectively, with customized modifications as necessary. At Grain Fertility, Premium Users have the opportunity to work 1:1 with our dedicated Patient Empowerment Coaches. They will help you prepare for your upcoming consultations with your provider and they will provide resources tailored to your individual needs. Our PEC's are committed to supporting you throughout your fertility journey. You can become a Premium member and take advantage of a risk free two-week trial by signing up today at https://app.grainfertility.com/signup. Sources: Ruegsegger GN, Booth FW. Health Benefits of Exercise. Cold Spring Harb Perspect Med. 2018 Jul 2;8(7):a029694. doi: 10.1101/cshperspect.a029694. PMID: 28507196; PMCID: PMC6027933. Warren MP, Perlroth NE. The effects of intense exercise on the female reproductive system. J Endocrinol. 2001 Jul;170(1):3-11. doi: 10.1677/joe.0.1700003. PMID: 11431132 Oakley AE, Breen KM, Clarke IJ, Karsch FJ, Wagenmaker ER, Tilbrook AJ. Cortisol reduces gonadotropin-releasing hormone pulse frequency in follicular phase ewes: influence of ovarian steroids. Endocrinology. 2009 Jan;150(1):341-9. doi: 10.1210/en.2008-0587. Epub 2008 Sep 18. PMID: 18801903; PMCID: PMC2630911. Lundgren KM, Romundstad LB, von Düring V, Mørkved S, Kjøtrød S, Moholdt T. Exercise prior to assisted fertilization in overweight and obese women (FertilEX): study protocol for a randomized controlled trial. Trials. 2016 Jun 1;17(1):268. doi: 10.1186/s13063-016-1398-x. PMID: 27250851; PMCID: PMC4888643. Guile SL, Mathai JK. Ovarian Torsion. 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32809510. Mussawar M, Balsom AA, Totosy de Zepetnek JO, Gordon JL. The effect of physical activity on fertility: a mini-review. F S Rep. 2023 Apr 14;4(2):150-158. doi: 10.1016/j.xfre.2023.04.005. PMID: 37398617; PMCID: PMC10310950. Domar AD, Clapp D, Slawsby E, Kessel B, Orav J, Freizinger M. The impact of group psychological interventions on distress in infertile women. Health Psychol. 2000 Nov;19(6):568-75. doi: 10.1037//0278-6133.19.6.568. PMID: 11129360.

It is impossible to tell the story of Grain Fertility without mentioning RESOLVE Federal Advocacy Day and the impact it has had on founder Joe Cody. When Joe and his wife were in the middle of their nearly 4 year IVF journey, Advocacy Day became a way for Joe to try to take back some semblance of control during a process that was very much out of his control. It was actually the therapist that Joe and his wife were seeing that recommended Advocacy Day as a way for Joe to use his background in government relations, policy development, and communications to help others who were struggling with family building. What is Federal Advocacy Day? RESOLVE is greatly involved in advocating for the family building community on both the federal and state level, helping lawmakers understand the practice of fertility treatment, the barriers to care that exist, and promoting policies that help ensure access to these important family building technologies is available to all. One of the main drivers of this support is through Federal Advocacy Day, where hundreds of patients, professionals, and allies all come together to meet with their legislators to ask for their support. This year, over 1000 people signed up for Advocacy Day, representing all 50 states, making it the largest virtual gathering of fertility patients in RESOLVE's history. Over the course of the day, these advocates met with all 100 Senators and hundreds of Representatives and told their stories. The goal of Advocacy Day is to thank those Members of Congress who have supported legislation that impacts family building and ask those who have yet to support the legislation to join the others who have made their support for IVF known and ensure they are working to protect IVF. What Issues Are Your Advocating For? This year, in light of the Alabama Supreme Court's recent ruling that threatened IVF access, RESOLVE has actively worked with Senator Tammy Duckworth to get a vote on her legislation, The Access to Family Building Act of 2024, S. 3612/ H.R. 7056. This bill would establish a statutory right to access IVF and other Assisted Reproductive Technology services and ensure they remain legal and available everywhere in the US. In addition to this important legislation, RESOLVE supports a number of other bills designed to help improve access to care for service members, veterans, and federal workers. Bills also hope to improve access to family building services for those who pursue adoption through tax credits and prohibiting discrimination by adoption services. These bills include: Access to Infertility treatments H.R. 4731, S. 2386 Adoption Tax Credit Refundability Act of 2023 Comprehensive Cancer Survivorship Act, H.R. 4363/S. 2213 Equal Access to Reproductive Care Act, H.R. 4391 Family Building FEHB Fairness Act of 2023 Infertility Resolution, H. Res 345 Stephanie Tubbs Jones Uterine Fibroid Research and Education Act of 2023, S. 2303, H.R. 4572 Support Through Loss Act, S. 3137 Veteran Families Health Services Act, S. 2801 and H.R. 5492 Veterans Infertility Treatment Act of 2023, HR 544 All of these bills have a central theme that echoes with Grain Fertility's mission: anyone struggling to build a family deserves access to all family building options. What Is Advocacy Day Like? Our day kicked off at 8 am with an inspiring speech from RESOLVE staff, including the CEO and Chair of the Board of Directors. The highlight though was a conversation with Senator Tammy Duckworth, lead sponsor of legislation RESOLVE supports and an IVF mom herself. She talked about her own journey, how she thought she was too old to have children after serving in the military and suffering a service related injury in Iraq, and how inspiring members of the community are. From there, advocates work with their state delegations to prepare for and attend their meetings. Below is the schedule Joe had. In these meetings, advocate tell their stories and help to inform Members of Congress and their staff about the importance of protecting IVF and ensuring access to care. Sometimes you even get to meet with the member, which is always a surprise and something first time Advocates love experiencing. Although it seems overwhelming and nerve wracking, it is quite the opposite. You are surrounded by others who know what you are going through and the support is inspiring. How Can You Get Involved? We understand taking time out of your day to meet with your Members of Congress is not for everyone and that is ok. Luckily, there are multiple other ways you can get involved. You can send a letter to your Member of Congress through RESOLVE's easy to use system. Simply enter your name and address, and they will send a letter on your behalf, expressing your support! You can sign up for RESOLVE's Advocacy Network (RAN) to get alerts with other ways to stay involved. Tell your doctors about RESOLVE and ask their clinic and staff to support RESOLVE and get involved in Advocacy Day in the future. You can simply tell your story on social media and voice support for others who are struggling with infertility. You would be surprised how many people are silently struggling and knowing someone else out there is going through the same thing and willing to share their story is a source of strength for so many.