Gut health, nutrition and in vitro fertilization (IVF)
3 areas to consider to improve your IVF cycle outcome from a registered dietician
On EP12 of My Fertility Podcast, we interviewed Brandy Williams, a registered dietitian and the founder of Be Well with Brandy. She specializes in helping women sustainably improve their health and wellness.
Brandy also had a long fertility journey herself, which she very bravely shared with us. Through her Instagram account @bewellwithbrandy, she shares her journey to offer support and raise awareness about recurrent pregnancy loss, IVF, and infertility, ensuring that others in similar situations feel understood and supported in their experience.
Spoiler alert: Brandy had a beautiful and healthy IVF baby with the medical guidance of Dr. Garcia and treatments at Markham Fertility Centre.
We will explore 3 areas to help improve your IVF cycle:
- Female and male lifestyle factors for optimal egg and sperm health
- The importance of gut health
- PCOS, carbohydrate intake & IVF
Female and male lifestyle factors for optimal egg and sperm health
Let’s start with the basics: an egg and sperm meet and create an embryo. It is important to maximize the embryo quality from the start, which means considering what you can do to improve egg quality and sperm health via lifestyle factors.
A few things to consider are:
- Diet and nutrition
- Vitamins and supplements
- Exercise and movement
- Alcohol and smoking
- Environmental toxins
For a deep dive into the above, check out EP05: Egg quality with Dr. Aimee, EP06: Lifestyle factors for women, EP07: Lifestyle factors for men and EP10: Prenatal vitamins: What to take while TTC.
Nutrition and in vitro fertilization (IVF)
When you’re working with patients in the realm of fertility and PCOS, how do you introduce them to this concept and what advice would you give?
Brandy: Normally when I am working with a client, I will do an initial consult to review their history and examine their diet. We’re going to be looking at what their diet quality looks like. I also like to look at the partner if they’re going to be contributing sperm; many of us forget that the sperm plays an important role in creating a healthy embryo.
I think both partners should be working on diet and lifestyle changes. Don’t just focus on what supplements you “should” be taking. That’s a very common focus we see in the fertility space! Supplements are meant to be just that – something that supplements the diet. I see people spending a tremendous amount of money on lots of different supplements that may not even be the right ones for them. People should consider working with a healthcare professional, a Registered Dietitian, or a Registered Naturopath who has the training and knowledge to give individualized supplement advice. But, it’s important not to forget about the basics and the foundations of diet.
Also, stress management, proper sleep, movement, and exercise – all of these things are really important too. I see a lot of people just taking supplements and they may think that’s good enough. But the reality is that you must focus on those other foundational components to overall health because they have the potential to improve egg and sperm quality, which in turn, can make healthier embryos.
So, for me, it’s about finding out: what are your likes? What are your dislikes? What do you normally have to eat? And then we think about what small changes we can make to improve your diet so that the behavior change aspect isn’t quite so overwhelming. I totally understand that clients are already coming to me overwhelmed! We want to make sure your overall diet quality is looking pretty good, but you can certainly enjoy some sugar or some indulgences and some takeout meals; it doesn’t need to be 100% restrictive. But, if you’re doing those things on the regular, it’s probably not going to be the best thing to support your overall health.
I’ll also be looking at the client’s medical history. If they have PCOS, that might inform some evidence-based recommendations for certain supplements like inositol or melatonin potentially.
We have to look at stress management as well – that’s a big one, and I’m not saying, “Just relax and you’re going to get pregnant!”. I know that’s NOT helpful, but we do know that being under significant stress causes your nervous system to be dysregulated; you’re kind of in that ‘fight or flight mode’. When dealing with grief and trauma its helpful to work on some stress management tools and strategies.
I’ll look at their exercise and movement. A lot of people I see might be quite sedentary. Again, I’m going to be looking at both partners. I’ll ask clients, “What do you like to do for exercise? Let’s start there. Do you like walking? Have you done strength training before?”. We will start by setting simple goals to start. We might look at what’s in your geographic area in terms of facilities and resources and consider how we can incorporate them into their goals.
Exercising more consistently can help reduce inflammation, and control blood glucose levels. In patients with PCOS, improving insulin resistance is a key piece in improving symptoms. Exercise can also help with stress management. Often people feel a lot better mentally after doing some physical activity.
At the initial assessment, I will also be looking at sleep and the circadian rhythm. I ask questions like, “What is the bedtime routine like? Are you a night shift worker? What is the quality of sleep like and how many hours of sleep are you getting?”. We will then examine ways to improve all sleep parameters.
I will also look at their fertility journey and we’ll talk about what the fertility clinic looked at and what they are considering doing next and/or if they should consider switching clinics if there is more support potentially elsewhere if the current clinic can’t offer something different.
The importance of gut health
Brandy: I also look at the person’s overall gut health because that can impact nutrient absorption, meaning how well their body is even utilizing the supplements that they’re taking. Its worth noting that your gut can actually create vitamins too. We know that the gut microbiome is involved in the inflammatory process and the immune system.
70% of your immune system is located in the gut. When we’re making changes to the diet, stress levels, sleep, and movement levels all of those things are foundations for improving your gut health.
How healthy is your gut? You may have a lot of bloating, or are dealing with a lot of loose stools or diarrhea, or you might be completely constipated and going to the bathroom only 1 or 2 times a week. I’m also asking about other symptoms, like stomach pains, that may be affecting quality of life.
When you’re going into fertility treatments, I think the goal is to manage any chronic health conditions and the gut is extremely important to your overall health in general.
You mentioned that when you were looking at your diet before heading into your second IVF cycle you actually increased your carbohydrate intake. Especially on social media, there is so much talk about women with PCOS where the “ideal diet” is low carb or extremely low carb. Can you tell us a bit more about that?
PCOS, carbohydrate intake & IVF
Brandy: When you actually look at the research on carbohydrates, we need carbohydrates for our gut microbiome to function.
I should clarify the different types of carbohydrates. If I’m looking at somebody with PCOS, they may have a high carb intake and their carb intake may be a lot of simple carbohydrates: refined sugar like added sugar, a lot of baked goods or sweets, juices, or regular pop. We aren’t talking about increasing these types of carbohydrates.
We’re talking about increasing more of the complex carbohydrates: whole grains like oatmeal, brown rice or quinoa, whole grain breads – which a lot of people are afraid to be eating at all. But we know that whole grains support the gut microbiome and can reduce inflammation as long as somebody doesn’t have an allergy or celiac disease or similar conditions. If you’re dealing with a lot of food intolerances, that’s where the low FODMAP diet can come into play when people struggle to digest carbohydrates.
Let’s say, I have PCOS and I’ve been told I need to change my diet. Some people might drastically change their diet and go on a PCOS-type diet or get a meal plan from somebody recommending that they cut out dairy, gluten, and all carbohydrates; so they go lower carb and then they’re eating a lot more protein. When you minimize carbs, you’re eating a lot more fat as well. Some people have difficulty digesting proteins and higher-fat diets may include larger amounts of unhealthy fats which is not ideal. We don’t know if going low carb means that people are increasing their saturated fat intake as opposed to the polyunsaturated or monounsaturated facts(good, healthy fats) like avocado or olive oil. Also, in lowering carbohydrate intake, we end up reducing fiber intake and we need fiber – it acts as a prebiotic for the good bacteria in our gut. Our bacteria eat the fiber and they’re responsible for doing a lot of the digestion in our large bowel. By digesting and fermenting our carbohydrates for their fuel, they’re creating what’s called short-chain fatty acids; and we know short-chain fatty acids reduce inflammation in the body.
I think we’re just talking about avoiding extremes. Certainly, if someone’s carbohydrate intake is 70% of their calories and it’s not the right type of carbohydrate, that’s not going to be ideal for polycystic ovary syndrome (PCOS) either.
When I’m working with a lot of clients, we may see that there’s a lack of fruit intake and fruits are carbohydrates. So switching the type of carbohydrates you consume is really important for PCOS.
Honestly, the easiest way to look at it is if you have PCOS, try including a little bit of carbohydrates at breakfast. That could be some oatmeal or a slice of whole-grain bread. If you’re scared to have 2 pieces of bread, maybe have 1 slice of bread to start. It could be a gluten-free bread if that’s what you need. At lunchtime, try adding whole grain pasta to a salad, having a pita or a wrap or adding quinoa or couscous. Then at supper time, add carbs to just a quarter of your plate. I’m not recommending a whole plate of pasta. This is exactly what I ended up doing. It is a little bit scary when you have “carb-phobia” but fiber actually stabilizes your blood sugar really well.
A lot of people talk about protein and protein can certainly keep you full and keep your blood sugar stable, but fiber does a really good job at that too. And I think that’s something that we’re forgetting about. If you’re someone who does not digest fiber well, you might need some help to improve that because you can switch the type of fiber too. Again, low FODMAP fibers tend to be digested a little bit better and you’ll still be getting fiber without uncomfortable digestive symptoms. To improve the overall health of your gut, you have to have fiber and we know that with research that’s out there on the gut microbiome and how it functions.
I will give my clients recipe ideas. I have a bank of recipes I can give them and I let them choose. If you already have things that you enjoy eating, or you’re curious about a particular dish you like, we can discuss it, and figure out ways to maybe balance it out a little bit more, add a little more fiber to it, to keep your blood sugar stable and to feed your good bacteria in your gut.
So those are some of the things that I think are really important. And it’s an added stress that people don’t need to be thinking that their diet has to be perfect.
Given your extensive experience as a dietitian and also being a fertility patient yourself, what advice would you give somebody who is going through their fertility journey?
Brandy: If I was talking to anybody dealing with recurrent pregnancy loss, I would suggest if you have had about three miscarriages you should be going to a fertility clinic to help you figure out the reasons why you may be miscarrying. You may not find out the exact reason, but if you’re working with a clinic like Markham Fertility that has worked with a lot of these complicated cases and a clinic that’s willing to look a little bit deeper they can potentially be able to offer you a bit more.
I also think finding a clinic that can do immune testing in case you need it is a good idea. I kind of wish that I would have done that a little bit sooner. This could have saved me from years of the emotional trauma that I experienced. Don’t be afraid to switch things up if your clinic isn’t going to change the plan. I wasn’t comfortable doing the same thing repeatedly and I needed to change things up and do something differently.
Seeking support from others who have experienced recurrent miscarriages or who are dealing with infertility is really important and can be really comforting and helpful in navigating emotional challenges. I found it invaluable to hear other people’s stories. I learned things from them; I found out information that I may have never known because a lot of times you do have to advocate for yourself in this space and ask questions and be a little bit more informed to be able to know what to ask. Finding that support network if you’re feeling alone or feeling isolated, I think is really important because you can learn a lot from people who have gone through similar situations and it might save you from steps that maybe you don’t have to do.
Connect with Brandy
Instagram @bewellwithbrandy
Website: https://www.bewellwithbrandy.com