Fertility Part 9

I have been following The IVF Diet for 15 days now, today is day 16. I feel my mood is pretty mellow but I am still tired of all the work it takes to make these meals. At least I will be able to look back and say, "I did everything in my power to prepare my body for pregnancy."

April 21-27, 2019, is National Infertility Awareness Week. Infertility is defined as the inability of couples to achieve pregnancy after over one year of trying. As I'm sitting here kind of forcing myself to eat oatmeal with coconut milk, I am thinking of all the other couples out there who have been where I am now.

Infertility sucks. I know cuz I’ve struggled with it for almost a decade. This week is National Infertility Awareness Week, and we need to talk openly about this issue. If you’re going through it, you’re not alone. ❤️ An article I wrote in @cenmag in 2016: https://t.co/klItZt0p7S

— Linda Wang_C&EN (@l_wang_cen) April 23, 2019

Here are some blogs and stories that I found really helpful for myself.

THE DIET
http://www.bubblesandbumps.com/my-30-day-ivf-diet/
RISKS, SIDE-EFFECTS, DELAYS
http://www.whitneyanderick.com/a-real-life-guide-to-mild-and-moderate-ovarian-hyperstimulation-syndrome-ohss/
TO DO GENETIC TESTING (OR NOT)
http://iamrefusingtosink.weebly.com/why-you-must-test-your-embryos-my-story-of-regret.html
https://meetthehopefuls.com/2015/08/20/ivf-2-cycle-update-and-pgs-results/
THE TWO WEEK WAIT
http://withgreatexpectation.com/ivf/sample-meal-plan-two-week-wait/
THE JOURNEY
https://www.theguardian.com/us-news/series/my-ivf-life

We've broken many of these pieces of advice, but I did find many of "The Egg Whisperer" videos to be calming and reassuring. Thank you Dr. Aimee Eyvazzadeh for keeping it real, I love your videos.

Candace Farris is a bright shining light and I am so grateful for her videos. She found very few resources within the minority community, so she decided to start putting herself out there.

We survived Easter (the stress of seeing family, meeting expectations) and every time someone else ate a piece of carrot cake, I ate a roasted chicken breast. Happy Ishtar!

Fertility Part 8

We have been on The IVF Diet for 10 days now, today is day 11. It has been a physical and emotional challenge to keep up with the rigor of meal preparation. I am literally exhausted. I work, rest, cook, eat and repeat.

coconut porridge with raspberry compote and bee pollen sprinkle

Some meals appear twice or three times in the two week cleanse program, others do not. The porridge above is scheduled for Week 1: Day 2 as well as Week 1: Day 6. The first time, I didn't serve it with the raspberries or bee pollen. The compote takes time to make, and for Day 2 we ate in our office at work, so it was too labor intensive to do. The bee pollen I consider an "exotic" ingredient that I didn't find until the end of week 1. We rounded out the ingredients by visiting The Vitamin Shoppe, where we found: bee pollen, spirulina powder, omega 3 oil, and inositol powder.

lentil salad with lemon tahini dressing

roasted root vegetables: sweet potato, parsnip, carrot, beetroot

It was good to make the roasted root vegetables on the weekend (Week 1: Day 6), since they took some time to prepare. Then, those vegetables were used in a frittata the following morning (Week 1: Day 7). If I remember correctly, we finished them for lunch a few days later (Week 2: Day 2). We had some superb heirloom cherry tomatoes, which were used in a variety of dishes.

salmon niçoise salad

I didn't realize it was easy to steam salmon fillets until we made this niçoise salad (Week 1: Day 7). We've gone through so many lemons, making the dressing for all the salads. We had one package of green beans that were in a "steam-in-the-bag" packaging, which made it possible to prepare this salad at work (Week 2: Day 2) where we only have a microwave. On that day we substituted tuna for salmon, which tasted OK but I realized later that salmon is preferred because tuna tends to bioaccumulate mercury.

supergreen flapjack seed bars (8)

After finding the spirulina powder, I made a tray of these date-based bars. They taste actually quite sweet. They have lots of nuts (pumpkin seeds, walnuts, peanut butter) as well as oatmeal and dried cranberries. Added protein powder gives them 3g protein per serving and 20g carbs. I plan to do some calculations based on our grocery bills to determine whether all this effort is saving us money or not. I also made some chocolate protein bars which have 7.5g protein and 19g carbs.

brown rice with red onion and spinach

baked "sea bass" with salsa verde

On some dishes, we are still making compromises. Above was supposed to be a "red rice" with pomegranate (Week 1: Day 7). Unfortunately, pomegranates are a fall/winter crop and are not available in this time of year. It was supposed to have feta cheese, but I forgot to buy it at the store. The toasted pistachios were good though. I saw sea bass at the farmer's market for $34 / lb, and I didn't buy it. The dish above (Week 2: Day 3) used cod instead. Also, I substituted celery leaves for the parsley in the salsa verde.

roast chicken with steamed asparagus 

miso glazed cod with sesame seeds and steamed broccoli

I think you can see that most of these dishes are very colorful. I guess I was too tired to take a photo of one dish that we really enjoyed: fish tagine. The roast chicken (Week 1: Day 6) was pretty easy and tasted really good. We ended up eating the leftover chicken (Week 2: Day 1) for lunch the following week. We couldn't find miso paste, so I bought miso broth and reduced it to make the glazed cod (Week 2: Day 1). We weren't able to make the baked eggs in avocado (Week 2: Day 3) again because of the constraints of being at work.

Today we're having jerk veggie burgers with celeriac slaw and salad for lunch (Week 2: Day 4). As I said, I'm exhausted. Last night I did the meal prep for today's lunch as well as last night's dinner and tomorrow's snack (dreamy salt and vinegar kale crisps). I started writing this post, partly to keep up with what we've been doing, and partly to vent about my feelings. I feel like this diet is something important to do to get my body ready for pregnancy.

During this past month, I've weighed myself nearly every day. This greater than 25% protein, less than 40% carb diet seems to be working to help me shed some pounds. I read that for extremely obese people like myself, it can be beneficial to lose even just 15 pounds before embryo transfer, so that's what I'm aiming for. Dear husband is concerned that this diet isn't sustainable. I kind of agree. It depends on what's motivating a person, and how dedicated they are to that motivating factor. 

It has been great to have dear husband helping out in the kitchen and grocery store to make this two week cleanse come into reality. He has stated that he is giving up on Week 2: Day 6 since we plan to go out to Riverside for Easter weekend to be with family. I'm sad, and I don't know in what capacity we will continue applying the principles of the IVF diet going forward. I'm trying to remain in gratitude for what we've learned thus far. I'm trying to avoid going into fear-mode for what we will face next.

The clue app is predicting maximum PMS for tomorrow, so maybe that's why I'm feeling sensitive today. We'll see how it goes, but it seems for now that my next cycle will start April 26th and the one after that will start May 23rd (which is after I will have grades turned in). The end-of-may cycle is likely when we will start the next phase of our treatment (stimulating the uterine lining with estrogen and progesterone). That's only 5 weeks away, so wish me luck on my goal of losing that 15 lbs.

Fertility Part 7

We've been following "The IVF Diet" by Zita West for the past 4 days. Today is day 5 of the "plan to support IFV treatment and help couples conceive." I heard about the book online. It has all the measurements in grams and the oven temperatures in Celsius because the Zita West clinics are located in the UK, but luckily unit conversions don't bother me. The thing about the diet that is intimidating is the sheer number of ingredients, and to me, exotic ingredients.

We made a master list of all the ingredients from days 1-7. We summed up the quantities of each item that would be needed. We went through the pantry to see what we already had, and then we made a grocery list using a commercially-available template. The original template didn't have many of the items on it, but it was useful for grouping items into the big categories: produce, dairy, baking, meat, etc. There are still a few items I have no idea what they are: inositol, lucuma powder, baobab powder. There were also a few things we couldn't find: juniper berry, spirulina, oatcakes, okra, peaches, arrowroot flour, vegetable starter (for pickling). But we made a good effort.


I hope you don't count all these items to check me on this, but I count 114 separate things, and that's not including the stuff we already had at home. We went over to Whole Foods to buy organic produce and filled up two shopping carts with $350 worth of groceries for 1 week! Dear husband refused to pay $35 for like 4 oz of spirulina granules. If you know an affordable source, please let me know by posting a comment. Mid-week on Wednesday we had to go to Von's to get some other items, which cost another $80.

The meals have been good -- delicious even! I've been checking, and this diet does meet the same requirements of my previous post. The less than 40% carbs and greater than 25% protein is already calculated into the meal plan. I still check it because it's tough to stay within the 1700 calories per day limit and eat all the foods recommended in the diet.

chicken schnitzel (day 1 dinner)

9-bean soup with turmeric bread (lunch day 2)

chermoula-baked salmon (dinner day 2)

kale hemp pesto (day 3 lunch)

turkey san choy bau (day 3 dinner)

sardines with olive tapenade (day 4 dinner)

Of course, I'm not a professional food blogger, so these pictures are just quick and dirty. I don't think I could publish these recipes, or the complete meal plan, due to copyright restrictions. I think you get the idea. What I can say is that it's giving me some peace of mind and freeing me to stop worrying about coming up with recipes. The detail provided in the book is sufficient for a competent cook to follow.

There are a lot of pieces of equipment required to make the recipes. So far we've used:

• blender (every morning there is a protein shake) you could use a NutriBullet 
• juicer (we used this one day, but you could alternately use a NutriBullet)
• food processor (this is used almost every day to pulverize nuts)
• mandolin (I used this to make zoodles, but you could use a spiralizer)
• grater (there is zest in one of the recipes)
• garlic press
• grill (we have a George Foreman)
• oven
• stovetop
• bread machine (you could bake in the oven, but it's easier to do overnight this way)
• baking pans and cooling racks

The recipes come together pretty quickly (for some), and others can be prepared ahead of time so that it takes just a few minutes at the moment when you actually want to eat it. All the recipes are proportioned for two people, with the assumption that both partners will be doing the diet together. This is a big help for us since my husband doesn't really like to eat leftovers and the variety is good.

This weekend we'll spend time planning for week 2, which is ~80% unique from week 1. Dear husband has been helping out with all the cooking. He is a BIG help. I could never do this alone. Having this "food project" is helping me stay busy during the waiting time for the end-of-semester and another "normal" menstrual cycle to pass.

I had a little moment of guilt thinking about how I "should have" been on this diet before egg retrieval. But luckily dear husband corrected that course of thinking. He said that we could go so far with the "what if's" and it's not very useful. Like what if we had been vigilantly saving for retirement, what if we had a large 401k, what if we would have been 100% responsible with our student loan money (or not even taken out loans)... the list could go on ad infinitum. So we're trying to keep a positive mental attitude and be in the present moment.

I've been getting really into classical music lately. It's relaxing, engaging and nostalgic. I've also been carving out more time to be outdoors. My body is craving sunlight and fresh air more than ever. Last week, I went to the Future Currents: Los Angeles River event at the Soraya Performing Arts Center here on CSUN campus. In the background is a sculptural piece made from Arundo donax, giant cane, which is an invasive plant found in the LA river.

Future Currents: Los Angeles River

Future Currents was a music / dance / art event that had a panel discussion on eco-artists who push conversations about sustainability and ecology using their various art forms. I made a pan flute out of the Arundo donax which I had a great time learning how to play. This week, I went to the Earth Fair with some friends from the chemistry department and saw some of my bicycling friends once we got there. Like I said, it was just great to spend a couple of hours mid-day outdoors, which I don't usually do.

I added pain into the topics for today's blog because my fingers are really hurting from all this cooking. I feel like my hands have been through the meat grinder! But the good news is that I seem to be losing weight. I read that I don't have to get down to "normal" body weight for my body to take the pregnancy better. If I lose even 15 pounds, that would be good. So I guess that's a goal too.

Fertility Part 6

So we found out the results of our PGS testing... and I am experiencing THE WORST menstrual cycle of my life.

It's now April, and the symptoms are real. I have had enlarged and swollen breasts since the trigger shot (two weeks ago). I was afraid to go for a massage because I couldn't put any pressure on my chest without severe pain. But I think the swelling is finally going down today because I weighed myself (which I am supposed to do every day now) and I'm the lightest I've been in the past year.

The advice from my case manager is "Rest up for next month" which makes me a little nervous that this is the calm before the storm. I don't remember anyone telling me that the first period after egg retrieval is such an ass-kicker. So if you're reading this and you are like me and want to be prepared for the truth about what can happen... prepare for the worst.

We had our appointment on Friday, March 29th to get the results of our PGS testing. As soon as we walked up to the front desk to sign in for our ultrasound appointment, we were handed the paper below. I know it should have put me over the moon of happiness to know that we had one normal embryo, but for some reason the word Euploid made no sense to me. I had to google it on my phone.

I guess I was hoping for more choice, and more chances, but all we got was one healthy normal embryo, and it's a male. I feel more scared now because I know that with the next stage (implantation) we only have one shot at it and if it goes wrong then we are done. The doctor explained that generally when eggs fertilize normally, about 50% of them are still "normal" by PGS testing, so we were just one embryo shy of that 50/50 ratio. What do they call that, the statistics of small sample sizes?

We went back for the ultrasound, and I got to see all the lovely cysts on my ovaries that are leftover from the egg retrieval procedure. I guess this is normal. And the uterus looked good. We were escorted into another room and seated with this photo on the table.

Those were our embryos, the 11 of them that grew. Our doctor explained to us that bigger is better and some of these just didn't look right. I think that it doesn't take an expert to see how different they all are. But the good news is that embryos are scored with a double letter system. Thankfully, the one "normal" PGS-tested embryo was evaluated as AA grade. Despite all those factors (normal number of chromosomes and AA grade cell quality), we were told that we would have a 60% chance that the embryo will result in a pregnancy.

OK fine. So we went straight to work and just reeled in the news. I ended up going out to the CSUN botanical garden in the afternoon and walked around with the wildflowers.

It wasn't the greatest news in the world, but it could have been worse. We got to ask a bunch of questions that we've been wondering and discuss some possible dates for the next round of hormones. It will be pills of estradiol and shots of estradiol and shots of progesterone and lots of doctor visits (every 2 days) to monitor the growth of the uterine lining. We want a nice soft pillow to deliver that embryo into to give it the best chance of becoming a successful pregnancy.

I think we're going to wait until school is done and grades are submitted to start that process. That day (Friday, March 29th) was our 11th wedding anniversary, so we had a nice steak dinner at home in our underwear and went to bed early.

The following day... I woke up like usual, drank my whey protein shake, ate my 2 egg breakfast with avocados (still keeping up that high protein diet). I got some beans soaking and ended up making a massive batch of 9-bean soup with the bone broth from the steaks from the night before. I was doing my thing in the kitchen, keeping busy when I started to feel a gurgling in my tummy.

Yes, it was watery diarrhea. My body was pushing everything out. I started my period. OK, that's to be expected, but it did seem a little bit violent. Then cramps started kicking down very bad. I tried to eat the 9-bean soup I had just made. I tried to eat some chicken around 11am or noon. Then I started the heavy breathing, the palm sweats and the salivating. I knew I was going to throw up.

Now I have a fairly iron stomach. But there have been times when I get a hormone-related migraine headache that makes me blow chunks. This was unlike anything I can remember. I was in so much pain, I couldn't lay down, I couldn't walk, I couldn't stretch, I just went from the bed to pacing to the toilet and back again, and back and forth for a few hours.

I tried taking some Tylenol, threw it up. I tried taking Alka-Seltzer with acetaminophen, threw that up. It seemed like there wasn't much to be done. It definitely went on until about 5pm. I finally came back downstairs and had something to eat. Dear husband went out for teriyaki chicken and vegetables. I drank some coconut water and ate some beef jerky to catch up on electrolytes.

Sunday, March 31st I begged dear husband to go out for a heating pad. That really did something good to help me through the pain. I took extra strength Tylenol (1000 mg) throughout the day, every 5 hours. It hurt intermittently (in waves). Monday, April 1st luckily was a school holiday, and the campus was closed. I stayed in all weekend with the exception of a short walk on Monday to Rite Aid and back (2 miles) to refill my stash of Lactaid.

I've considered abandoning the high protein diet (less than 40% carbs and more than 25% protein), but I guess I'll stick with it until the transfer. It is a bit hard to stay off carbs, now that my regular metabolism is back (no hormone supplementation). It's hard to stay off coffee too. And dairy. But I did order a book called "The IVF Diet" and it's supposed to arrive sometime this week or next. I'm still keeping up the 3 Liters of water. Don't know exactly why, but it's probably not a bad thing.

With "one shot" I want to try to do anything I can to improve our chances of success. I read that possibly losing as little as 15 pounds can go a long way to making my body healthier for the next stage of the process. I know I should get back to work now, but I'm adding items to my list for an IVF care package. Here's what I have so far:

• maternity leggings
• gel eye mask (for headaches)
• heating pad (for cramps)
• whey protein
• wire whisk (to mix shakes)
• egg timer (for hard-boiled eggs)
• beef jerky
• high protein (Rx) bars
• vitamin D

One thing I have noticed about myself is that I am enjoying spending more time outdoors. I feel like I'm drinking in the sunshine and fresh air when I can. It's more important to me than ever. It cheers me up and helps me shake the blues.