Fertility Yoga: The Evidence

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Recently, I was asked to put together a handout reviewing the research supporting the benefits of fertility yoga.  I am often recommending these modalities to patients for self-care during preconception, pregnancy and post-partum and even I was surprised by the wealth of evidence out there. Importantly, while most of the focus tends to be on prenatal yoga, the evidence points to starting a yoga practice, like a prenatal vitamin, months prior to conception to improve fertility, including in conjunction with conventional fertility treatments, and though the postpartum period to reap the benefits for both mother & baby.

It is important to note that this article and many of the studies, use the term "yoga" to represent a multifaceted approach to exercise that encourages strength & stretching (asana), mental centering (meditation), and focused breathing (pranayama).

Research suggests that in this way, yoga prior to and during pregnancy is safe and can have many benefits for women and their babies:

  • Improved sleep, quality of life  & self-efficacy 1,2, 5, 6, 13

  • Reduced stress, depression and anxiety. Compared to non-depressed women, depressed pregnant women experience higher rates of pre-eclampsia, miscarriage, pre-birth complications, pre-term delivery, low birth weight and is associated with cognitive and emotional problems in children 1-7, 9-16, 18, 21

  • Improve fertility and increase the success rates of IVF by improving physiological & psychological states, in addition to improved tolerance of IVF treatments. 19, 20

  • Improved immune function as evidenced by increased immunoglobulin A 10 

  • Decreased heart rate variability, indicating increased parasympathetic: sympathetic functioning more than relaxation or exercise alone 2 

  • Increased strength, flexibility and endurance of muscles needed for childbirth 2

  • Decreased lower back pain, nausea, carpal tunnel syndrome, headaches, hypertension, diabetes and shortness of breath 1, 2, 5, 6, 14, 23

  • Significantly decreased duration of first stage of labor and the total duration of labor, frequency of labor induction, perineal tears, episiotomy & C-section; increased rates of comfort during delivery and post delivery through the increased production of endorphins and dopamine 2, 5, 11, 15, 23

  • Improves socialization with other pregnant women and prepares for the stress of being a new parent. 2, 3, 4, 5 as evidenced by decreased levels of cortisol 10, 12, 14, 18

  • Cord blood cortisol level of babies indicates positive health status of the newborns verifies that prenatal meditation can influence fetal health and better temperament at fifth month reflecting the importance of prenatal meditation in relation to child health. 17

  • Infants prenatally exposed to maternal mindfulness have been found to be “less fussy” when compared to those exposed to higher levels of anxiety; an example of “prenatal programming”: Positive/negative traits of mother during pregnancy may ‘program’ infant. 18

  • In the postnatal period, yoga during pregnancy & after delivery was linked with a lower risk of maternal depression & anxiety by up to 67%. 24-26

When to start and what to do

Yoga can be started anytime in the preconception period. New or returning students should focus on yin, slow flow, restorative or prenatal classes; heated classes should be avoided. Research indicates that pregnant women should start at by 18-26 weeks gestation, one to three times per week for 30-60 minutes with the most benefit seen in the integrated yoga interventions (mindfulness + asana). Students should inform the teacher of possibility of pregnancy. 2, 6-9.

References

1. Yoga during Pregnancy: A Review, American Journal of Perinatology; 2012.

2. Systematic Review of Yoga for Pregnant Women: Current Status and Future Directions;Evid Based Complement Alternat Med. 2012.

3. Mindfulness-based childbirth and parenting education: promoting family mindfulness during the perinatal period. Journal of Child and Family Studies. 2010

4.  Effects of a mindfulness-based intervention during pregnancy on prenatal stress and mood: results of a pilot study. Archives of Women’s Mental Health. 2008.

5. [Effects of prenatal yoga: a systematic review of randomized controlled trials]. Nihon Koshu Eisei Zasshi.2015.

6 .Yoga in Pregnancy. Clin Obstet Gynecol. 2016.

7. Potential for prenatal yoga to serve as an intervention to treat depression during pregnancy.Womens Health Issues. 2015 . 

8. Mindfulness yoga during pregnancy for psychiatrically at-risk women: preliminary results from a pilot feasibility study.Complement Ther Clin Pract. 2012.

9. Yoga for prenatal depression: a systematic review and meta-analysis, BMC Psychiatry. 2015.

10.Effects of prenatal yoga on women's stress and immune function across pregnancy: A randomized controlled trial. Complement Ther Med. 2017.

11. Yoga during pregnancy: The effects on labor pain and delivery outcomes (A randomized controlled trial).  Complement Ther Clin Pract. 2017.

12. The effect of prenatal Hatha yoga on affect, cortisol and depressive symptoms. Complement Ther Clin Pract. 2014.

13. The Effects of Prenatal Yoga on Birth Outcomes: A Systematic Review of the Literature. Journal of Prenatal & Perinatal Psychology & Health. 2013.

14. The effects of mindfulness-based yoga during pregnancy on maternal psychological and physical distress. J Obstet Gynecol Neonatal Nurs. 2009.

15. Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison, BMC Pregnancy Childbirth. 2017.

16. CALM Pregnancy: Results of a Pilot Study of Mindfulness-Based Cognitive Therapy for Perinatal Anxiety. Arch Womens Ment Health. 2014.

17.Prenatal meditation influences infant behaviors. Infant Behav Dev. 2014.

18. Maternal mindfulness and anxiety during pregnancy affect infants’ neural responses to sounds. Social Cognitive and Affective Neuroscience,2015. 

19. Yoga can improve ART outcomes in couples with infertility. Altern Ther Health Med 2018.

20. Yoga: an adjunct to infertility treatment. Fertil Steril. 2003.

21. Meditation for preterm birth prevention: A randomized controlled trail in Udonthani, Thailand. International Journal of Public Health. 2016.

22. Effects of a mindfulness-based intervention during pregnancy on prenatal stress and mood. Arch Womens Ment Health. 2008.

23 Brain mechanisms supporting the modulation of pain by mindfulness meditation. J Neurosci. 2011.

24. Impact of prenatal exercise on both prenatal and postnatal anxiety & depressive symptoms. Br J Sports Med. Nov 2018

25. Effects of exercise-based interventions on postpartum depression: A meta-analysis of randomized control trials. Birth. Sept 2017

26. Efficacy of yoga for depressed and postpartum women: A randomized controlled trial. Complement Ther Clin Pract. May 2015

Am I Fertile? 7 Signs to Look For

By Kristen Karchmer

Article Published originally on MindBodyGreen

Being fertile is so much more than just being able to get pregnant.

Whether you're trying to conceive or not, understanding your fertility can give you information about your reproductive health that you have the power to influence.

Fertility isn't black and white, fertile and infertile. Instead, your fertility potential exists on a continuum that is constantly swinging in one direction or the other. That movement is largely dependent on the choices you make.

How do you know if your choices are affecting your fertility? The internet is full of misinformation, and your friends or even your mom won't always be your best guides. Believe it or not, your body and your menstrual cycle are great barometers for your reproductive health — you just need to know how to read them.

Here are a few fertility warning signs to look out for:

1. You're super-skinny.

Being in amazing shape is generally healthy, yes, but six-pack abs may not be your fertility's best friend. A healthy amount of body fat is essential for proper hormone function. If your body mass index (BMI) is too low, your hormone function may not be optimal for reproduction. Research shows that women with a BMI less than 18.5 took longer to conceive than women with a higher BMI (19 to 24.5 BMI). While we often associate thinness with good health, but there isn't necessarily a direct correlation. Listen to your body.

2. You get less than seven to eight hours of sleep per night.

You may feel like you need only six hours of sleep a night, but getting less than seven to eight has been associated with depressed leptin levels throughout the following day. Leptin is in charge of regulating the menstrual cycle. Also, disturbances in leptin concentrations have been linked with poor egg quality. Make sure you get sufficient rest every day to promote fertility in the future.

3. You enjoy more than two alcoholic drinks per day.

A few glasses of wine a week is unlikely to affect your fertility. But daily consumption of alcohol can significantly affect your ability to conceive. Remember, one serving of wine is only 4 ounces — not the 8-ounce pour that the cute guy at the wine bar gives you. Consumption of alcohol can have various effects on fertility including increased time to pregnancy and decreased probability of conception (by more than 50 percent).

A large-scale study in Stockholm, Sweden, found that women who consumed more than two alcoholic drinks per day were on average 60 percent more likely to be infertile than those who did not. That doesn't mean you can't have fun, just that moderation (as always) is the key.

4. You exercise more than five times per week at high intensity.

I love to rock a boot camp as much as the next girl, but high-intensity exercise seems to work against a fertile body. While moderate exercise has been correlated with an increase in fertility, overexercising has also been linked to infertility. Lean women who exercised at high intensity five or more days a week were shown to be 2.3 times more likely to develop fertility difficulties than those who did not. Exercise should always be about becoming a healthier you, not punishing yourself — love yourself with your exercise choices.

5. You have a short or long menstrual cycle (more or less than 28 days).

Most women have no idea how important having a 28- to 32-day cycle is for their fertility. A 28-day cycle allows plenty of time for the egg to mature properly and supports a healthy window for implantation. It also means that a fertilized egg will have plenty of time to implant before your next period starts. Both shorter and longer cycles have been associated with reduced fertility, in some cases decreasing the chance of delivery by up to 50 percent.

6. You have PMS and cramping.

PMS, pain, cramping, and clotting are more than just annoying: They often correlate with more serious issues like polyps, fibroids, endometriosis, or hormonal imbalances. In addition to being a drag, infertile women report these types of symptoms in much higher numbers than their fertile counterparts.

7. You have very light bleeding.

Women are always so happy when they have a short, light period. It may mean you don't have to deal with your cycle for as long, but it is not an indicator of a healthy body. The research shows that five days of bleeding resulted in the fastest time to conception. Why is the volume of blood so important? Healthy menstrual bleeding is the reflection of a healthy uterine lining. When the uterine lining is too thin, not only are bleeding times decreased, but embryo implantation is decreased as well.

What you can do about it:

When the choices we make aren't working for our bodies, it will show up in our menstrual cycles. These changes don't just reduce our fertility but can affect our overall quality of life. The good news is that if you make healthy lifestyle choices, many of these symptoms will improve, and so will your fertility.

Some of the risk factors I identified above are easy to fix. Not getting enough sleep? Commit yourself to getting some more shut-eye! Overdoing it at the gym? Aim for moderation.

But what about those things that are harder to control, something like short periods, for instance? Remember, your menstrual cycle is a reflection of your overall health. One of the best first steps to building a healthy, fertile menstrual cycle is to focus on diet — and a plant-based, whole foods diet is the best way to go. In fact, researchers found that women who substituted plant proteins for animal proteins for as little as 5 percent of their total daily calories had a 50 percent decrease in their risk of ovulatory infertility.

At Conceivable, we’ve researched hundreds of little ways to improve menstrual cycles for women to lead happier, healthier, and more fertile lives. Be sure to check out our blog for more information on how to realize your healthiest, most fertile self. 

ilumina practitioners use Conceivable products as part of a comprehensive treatment plan.

When Hot Tubs Aren’t Such a Hot Idea

Hot tubs can be great…relaxing, soothing, and sometimes romantic. If all a man cares about is sex, then a hot tub can be a perfect aphrodisiac and no harm done. But if he’s interested in having sex and fathering children, he’d be wise to go another route and skip the hot tub. How come? Because it turns out that heat and sperm are a bad mix.Let’s back up a second for some basic anatomy here. Sperm are made in the testicles, which hang from the body in the scrotum. The reason for putting the family jewels in such a relatively precarious position is that the sperm-making Sertoli cells of the testicles don’t work right unless they are cooler than body temperature by a few degrees Fahrenheit. Warm them up for more than a few degrees and for more than a few minutes and sperm production is temporarily shut down.Normally, the testicles maintain a relatively constant temperature by raising or lowering closer to, or farther from, the body. The scrotum is lined with temperature-sensitive muscles. In warm conditions the muscles relax and let the testicles hang far from the body whereas cold temperatures (particularly cold water) make the scrotum contract, pulling the testicles tight against the body for added warmth.But soaking in a hot tub makes it impossible for the testicles to remain cool. As relaxing as it may feel, it’s not a happy experience for the testicles. Sperm formation slows or halts, and sperm that have already been made may be harmed, all of which can lower the chances the man can conceive a child.  The same thing, by the way, happens if a guy has a high fever…sperm production will be temporarily interrupted.This impact on fertility also happens if a man has a high fever, which is why guys going to get a sperm count are told to wait for up to 3 months if they’ve had any kind of cold, flu, or infection.Bottom line? A hot tub every once in awhile isn’t a big deal, but if you’re having a hard time getting pregnant, avoid romantic interludes in hot water.By Harry Fisch, MD