Patients are often hesitant to start an IVF cycle because they are afraid of potential nasty side effects and not being able to cope with all the hormonal changes, injections, and symptoms that come along with it. We are here to tell you that for the most part, our patients are pleasantly surprised that it’s not as bad as they expected! While acupuncture helps manage many of the side effects, we've also got some tips you can use at home to support yourself!
1. Headaches
In the first couple days of IVF stimulation, about 25% of patients report experiencing some mild headaches. People with history of headaches are more likely to experience them. Staying hydrated, gentle movement like walking, and acupressure on the acupuncture point Large Intestine 4 (LI 4) can be helpful. This point can be found between the thumb and index finger in the center of the muscle there. Massage and apply pressure while doing some deep slow breathing for best results. You can also ask your doctor about taking magnesium glycinate and/or Acetaminophen. Acupuncture also helps manage headaches!
2. Bloating
Bloating often happens in the second week of ovarian stimulation as the ovaries become larger from follicle growth (which is a good thing!). The ovaries are typically the size of almonds but become enlarged during IVF and can get as large as tennis balls! This creates some pressure in the abdomen. Patients with a higher follicle count will experience more bloating, but for most patients it is mild. It can intensify as the follicles grow larger and estrogen increases, which affects the electrolyte balance in the blood causing fluid to leak into the abdomen. You can help yourself by wearing loose or very stretchy clothing and drinking electrolytes in the second week of injections and after the retrieval. Coconut water is great, as is clear unflavored Pedialyte. Bone broth is also an excellent addition during this time. We also recommend increasing protein intake (plant and animal sources) at each meal. Patients often report feeling less bloated after acupuncture appointments, but following the above tips can help between sessions.
3. Constipation
It is easy to get dehydrated during an IVF, so make sure you are drinking more water than normal and include electrolytes as we discussed above. Dehydration in addition to increased pressure in the abdomen can lead to constipation. Try adding more fiber in the form of organic berries and vegetables, chia seeds, medjool dates, prunes and figs. You can also add a probiotic, if you aren’t taking one already, or eat foods high in beneficial bacteria like yogurt, kimchi, sauerkraut, and miso. If you have any confirmed or suspected food sensitivities (gluten, dairy, and soy are the most common), avoid those as well. Constipation can be worse after a retrieval due to the side effects of anesthesia. Supplementing with a little magnesium citrate as well as getting regular acupuncture will help.
4. Foggy Thinking
Estrogen levels in an IVF can get much higher than a natural cycle, so many of the side effects we are discussing are from changes in this hormone. Estrogen gets a bad rap, but it’s really the lack of estrogen or low levels that make us feel terrible (think night sweats, headaches, insomnia, emotional sensitivity, dryness). Estrogen is actually quite calming to the brain on its own, so when levels reach their highest just before retrieval, many women report foggy thinking. It becomes easy to forget things and harder to focus. You can help yourself by going for walks to promote good circulation, staying hydrated, eating small frequent meals that are high in fiber, protein and plant fats, low in sugar, and contain moderate amounts of complex carbs. It may also be helpful to plan for this if possible so you aren’t giving an important interview, presentation or something where you have to think on your feet right before your retrieval when this symptom is peak.
5. Mild Fatigue
Doing an IVF involves a lot of monitoring appointments, often at early hours. Many of our patients get sleep deprived from these early wake-ups which, along with hormonal changes and the stress of doing IVF, can lead to mild fatigue. Exercise should also be paused during the IVF stimulation phase, so people who are used to getting energy from exercise don’t get that boost. It’s ok to nap, but keep naps to around 20-30 minutes and before 4pm so you don’t mess with your nighttime sleep. Rest more than usual, but don’t be inert. Brisk walks will also help!
6. Mood Swings, Anxiety, and Insomnia
Irritability and feeling like a hormonal mess is what most women expect to feel, but it’s not actually the most common side effect during the stimulation phase. What can cause moodiness, anxiety and insomnia is low estrogen, so in the beginning of an ivf when estrogen is low, these feelings can be most prominent. As estrogen is rising, however, hormones play less of a role in mood regulation. The process of going through the ivf…all the injections, the appointments, the uncertainty, the lack of control over the outcome, etc., those can definitely create feelings of anxiety, which sometimes leads to insomnia. If you are taking Clomid as part of your protocol, you may be more likely to feel mood swings, as it tricks your brain into thinking you are low in estrogen (it does this so your brain stimulates your ovaries more aggressively). In addition to regular acupuncture sessions, which help the nervous system relax, we recommend talking to someone you trust about your fears, worries and frustrations so you can process those feelings instead of holding them in. Don’t be afraid to cry if you need to. It won’t hurt your cycle! Having a good therapist and/or acupuncturist, especially one that understands the fertility and IVF process, can make a huge difference. You can also try guided meditation programs like Calm or Headspace, especially at night if you can’t sleep.
Side Effects to look out for that need immediate medical attention:
Ovarian Hyperstimulation Syndrome (OHSS) is rare these days thanks to most fertility doctors using “dual trigger” protocols (a trigger shot with the addition of Lupron) or “Lupron only” trigger for women with high follicle count or PCOS. If however, you experience the following symptoms, contact your doctor or go to urgent care immediately: rapid weight gain, reduction in urine output, persistent nausea and vomiting, severe abdominal pain, pain in your legs, shortness of breath, or enlarged abdomen.