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

The Neti Pot nasal wash

The Neti Pot This teapot-looking device is certainly not what it looks like.  It’s a Neti Pot used for nasal washing, a practice that has been around more than 5,000 years as a means to ultimate health and better breathing.

What is it? The Neti Pot is a device used to clean out the nasal passageway to counteract pollution, allergies, colds and sinus problem.

Why does it work? The nose is the barrier between the atmosphere and our bodies. The mucus in our nose filters the air from dust, dirt and other particles.  Without cleaning the mucus out often, the particles can end up in the stomach. The Neti Pot cleans the mucus out of the nose allowing it to regenerate fresh mucus and keep the body healthy.

How does it work? You fill the Neti Pot with a saline mixture of pure non-iodized salt with two cups warm water. Then lean over a sink with your nose slightly higher than your lips and leaning toward one side. Breathe through your mouth, insert the spout of the pot in your upper nostril until it forms a comfortable seal. Raise the Neti Pot to allow the solution to flow through the upper nostril and out the lower nostril.  After you are done, be sure to exhale vigorously through both nostrils, simultaneously, to clear the nasal passages. Repeat with the other nostril.

Can I buy it at ilumina? Of course! It’s $20.50 for the Neti Pot and $3.50 for a bag of Neti salt with over 160 scoops of salt.

 

Yoga for Fertility and Conception

Which type of yoga class has the best possible benefits to aid fertility and conception? By Jaki Nett

—Kelly, Long Beach, California

Jaki Nett's reply: The type of yoga class that I recommend to aid fertility and conception is a restorative class—a class where the body, mind, and spirit learn the art of relaxation. A woman's desire to conceive can be overpowering and can drive her to the point of obsession. If this happens, sometimes logic is overlooked and stress becomes the foundation for coitus.

Since it is the woman's body and mind that has to be healthy and free of stress, it is her responsibility--with the unwavering support of her partner--to create the most favorable conditions for conception. To start the process both partners should have a comprehensive physical and psychological examination to determine that they are both without physical and mental conditions that could block conception.

To further alleviate stress about trying to conceive, start mapping your cycle of fertility. When entering a fertile time, start practicing restorative poses. As you practice, soften the abdominal area and begin to consciously remove tension from around the uterus, fallopian tubes, and ovaries.

My teacher, Geeta S. Iyengar, author of Yoga a Gem for Women (Allied, Publishers Limited, 1983), writes extensively on women's issues. She stresses the importance of practicing several asanas to aid in conception. Salamba Sirsasana (Supported Headstand), Salamba Sarvangasana (Supported Shoulderstand) , and Setu Bandha Sarvangasana (Supported Bridge Pose) are recommended because of their hypothesized effects on hormonal balance.

She also recommends the following poses:

Forward bends—To make the poses more restorative, place a chair in front of you and rest your head and arms on the seat for support, or use a bolster for support.

Reclining Poses—These poses are helpful because they open and elongate the abdominal area.

I also recommend Viparita Karani (Legs-Up-the-Wall Pose) after coitus (which will theoretically keep the sperm inside the body and close to the opening of the uterus) to encourage the opportunity for sperm penetration. Before coitus set up for Viparita Karani (Legs-Up-the-Wall Pose). As you move into and out of the pose, keep the abdominal area soft-your partner can assist you to make this possible. The amount of time you spend in Viparita Karani is up to you.

To set up for Viparita Karani: Fold a sticky mat into quarters and place it two inches from the wall. Place a round bolster or a firm folded blanket on top of the sticky mat with the back edge of the bolster or blanket in line with the back edge of the mat. Place the buttocks on top of the bolster with the sitting bones as close to the wall as possible and the legs up the wall. The tailbone should tilt toward the ceiling so that the vaginal area is pointing upward. The shoulders, arms, and head rest on the floor. Once in the correct pelvic position, allow the legs to soften and bend the knees to allow the abdominal and pelvic floor to relax.

Jaki Nett is a certified Iyengar Yoga instructor in St. Helena, California, and a faculty member of the Iyengar Yoga Institute of San Francisco. She teaches public classes in the San Francisco Bay Area and leads workshops in the United States and Europe, including specialty workshops on female issues. Written by: Jaki Nett

www.yogajournal.com

Labor of Love

Tune in to your body, connect with community, and embrace the birth you're given with prenatal yoga.By Catherine Guthrie (as appeared in Yoga Journal)After the birth of her first child, Colleen Millen, 35, knew that she would approach childbirth differently if given another chance. Then a Forrest Yoga teacher in Chicago, Millen stuck to her typical yoga routine throughout her pregnancy. She modified her practice as her belly blossomed, but she shrugged off the prenatal classes at her studio, assuming her years of practicing yoga had bestowed on her the tools for a trouble-free childbirth.But when the initial pangs of labor brought unrelenting nausea, Millen and her husband raced to the hospital, where her confidence unraveled. Nurses rushed to start intravenous fluids and hook up equipment to monitor the baby's heart rate. Millen was soon on her back, and as the contractions intensified, so did her feelings of helplessness. "I'd practiced yoga for years, but none of that was a comfort when the pain came," she says. After a long, difficult labor, she gave birth to a healthy baby boy, Jacob, but she still feels haunted by the lack of presence she felt during the experience.Three years later, while planning for baby number two, Millen dived into prenatal yoga. "I cultivated a strong prenatal practice so that when the time came, the movements and breath would kick in instinctually." And that's what happened. When her labor began, Millen focused her attention on a gazing point, relaxed her jaw (to encourage the pelvis to release), and harnessed the power of her breath to make the most of every contraction. "My preparation helped me surrender to the energy and move with it instead of fighting and struggling against it."After just 15 minutes of pushing, she and her husband welcomed their daughter, Samantha, into the world. But even if she'd had to face an arduous labor again, Millen believes that her prenatal practice would've helped. Not only did she feel more physically prepared the second time around, but she felt as though her mind and energy were more united throughout the entire birth experience.Prenatal yoga, the deliberate weaving together of yoga and childbirth preparation, opens the door for women to reclaim their physical, mental, and emotional power and receptivity during the birth process. "Somehow, as women, we think we will automatically know how to give birth," says Gurmukh Kaur Khalsa, co--founder and director of Golden Bridge Yoga in Los Angeles, who has taught prenatal yoga for nearly 30 years. "But we are so detached from our instinctual selves that sometimes we need to be reminded of what we already know."For a growing number of women, that reminder is prenatal yoga. Expectant mothers in urban centers are flocking to yoga studios that have whimsical names such as Mamaste and Baby Om, while moms-to-be in smaller locales are finding a proliferation of prenatal classes at yoga studios, gyms, and birthing centers. What's the universal appeal? Prenatal yoga classes offer a place of refuge where women learn to connect with their chang-ing bodies, their babies, and each other. Asana prepares them physically for giving birth, but most women find that the awareness of body, mind, and breath that it teaches is what truly helps them when it's time to deliver. As Rachel Yellin, a prenatal yoga teacher in San Francisco, says, "Doing prenatal yoga doesn't mean you'll have the 'perfect' birth; it means you'll be able to accept the perfection of the birth you're given, regardless of whether it goes according to your plan."

Creating Connection

The community-oriented approach of prenatal yoga took Stephanie Snyder, 35, by surprise. A Vinyasa Yoga teacher in San Francisco, she was accustomed to using her practice as a means to feel connected to others. But the true meaning of oneness didn't fully resonate until she joined her first prenatal class. "When I practice yoga in the company of pregnant women, not only do I feel connected to them, but I feel connected to every woman who has ever been pregnant and any woman who will ever give birth," she says. "That primal connection is empowering, and I know it will help me through the labor and delivery."Cultivating that bond is a big part of most prenatal classes. Like many of her counterparts, Deb Flashenberg, founder and director of the Prenatal Yoga Center in New York City, encourages the women in her classes to get to know one another. She starts each class by asking students to introduce themselves, give their due date, and share any pregnancy-related aches and pains. The check-in is both an icebreaker and a means of lessening isolation. "I can see the relief register on women's faces when they realize they aren't the only ones with a particular complaint," Flashenberg says. "The sharing of information among new mothers is a wonderful perk of prenatal yoga."Snyder, pregnant at press time with her first child, often found that her jitters were best soothed by those women in her class who were pregnant for the second or third time. Judith Hanson Lasater, president of the California Yoga Teachers' Association and author of Yoga for Pregnancy: What Every Mom-to-Be Needs to Know, says that prenatal classes provide the space for women to pass down the legacy and wisdom of childbirth. "The way we live now, pregnant women aren't around their family and friends as much." The result? As Lasater explains, "There is very little tribal support anymore for pregnant women." Prenatal yoga can be the answer. Flashenberg notes that many of her students form bonds that last long after they leave the classroom. Connections blossom into friendships, moms' groups form, and their children often become friends. What manifests is a network of support that grows richer as their children grow.

Not Just for Newbies

The community-based atmosphere makes prenatal yoga a magnet for newbies, but even experienced students may find themselves stretching in new directions. Snyder, for instance, has practiced two to three hours of Vinyasa Yoga daily for the past 12 years. Needless to say, she knows her way around a mat, yet she's discovered the value of bringing a beginner's mind to her prenatal yoga class. For the first time, she's actively mellowing out her practice and shifting her focus away from rigorous vinyasa and toward the union of being one with her baby. "It's a great way to literally start making space in your life and in your practice for your baby," she says. "And I get to practice asana that is geared toward the special sensations and vibrations that come with pregnancy." She especially enjoys Savasana (Corpse Pose) at the end of class, when the teacher offers guided visualizations, prompting the women to envision their babies surrounded by love and warmth. "Prenatal yoga is a special bonding time for me and my child in a way that's different from my regular asana practice," Snyder says.For others, the switch from practicing solo to having a baby on board can be a little bumpier. Releasing the ego can be a challenge for intermediate and advanced practitioners, Flashenberg says. Students may find it hard to accept how pregnancy changes their bodies and how their practice must shift. Some women can continue to practice fairly vigorously. But certain poses should be dialed back or phased out during pregnancy, particularly unsupported inversions, deep twists, prone backbends like Bhujangasana (Cobra Pose) and Salabhasana (Locust Pose), and strenuous backbends. That means forgoing Sun Salutations with Cobra or Urdhva Mukha Svanasana (Upward Facing Dog) and instead stepping back to simple lunges. Also, certain pranayama techniques should be avoided, such as Kapalabhati Pranayama (Skull Shining Breath) and anything in which you hold the breath, which is called Kumbhaka Pranayama (breath retention).Attending classes can help you reconsider the temptation to overdo. "Prenatal yoga reminds you it's not just your body," Flashenberg says. "You're sharing it now, which means it's not the time to push yourself." She also notes that during pregnancy, the ligaments in your pelvic area and lower back loosen due to an increase in the hormone relaxin, which is thought to help widen the pelvis and facilitate labor. So it's especially important to avoid overstretching, or you could wind up injured for lack of the usual painful warning signs telling you to stop.That's not to say prenatal yoga is for wimps. You won't master any new Handstand variations and you should avoid jump-throughs, but the level of intensity might surprise you. Classes focus on uncovering hidden sources of stamina, nurturing new ones, and maximizing hip flexibility. To that end, the most strenuous portion of the class is typically the standing segment, during which you can expect to work your edge by holding poses for a minute or longer—the length of an average contraction.Prenatal teachers knowingly seed their classes with opportunities for students to safely explore and expand their threshold for discomfort. When Amy Zurowski, 32, a prenatal yoga teacher who lives in McMinnville, Oregon, takes her students into Warrior II, for example, she guides them through an imaginary labor. As they hold steady in the pose, thighs working overtime, they imagine themselves breathing through a contraction. Zurowski encourages them to stay present and accept the discomfort by gently reminding them that women have been birthing babies for hundreds of thousands of years. "As you ease out of your pose, perhaps with tired quads, you are more confident of your innate abilities as a woman and as a mother-to-be," she says.Otherwise, classes typically start with gentle warm-ups, graduate to standing and some basic balancing poses, then move to the floor for seated poses. Savasana may be as long as 15 to 20 minutes, giving students time to set up props and sink into deep relaxation. After the first trimester, lying on the back for long periods of time is not recommended since it can slow blood flow to the baby, so blankets and bolsters are used to support students as they lie on their left side to rest.

Don't Forget to Breathe

Prenatal yoga conditions the mind even more than the body. "The primary benefit of prenatal yoga is breath awareness," Yellin says. "If you can use the breath as an anchor, it will draw your attention inward and downward, exactly the direction you want your baby to go."Yellin gently reminds her students that the breath should always be their primary focus; the physical sensations arising from the asana are secondary. In this way, she explains, they learn to train their focus on the breath during labor and not on the contraction: "Using the breath as an anchor keeps a woman grounded, no matter how overwhelming the sensations might be."Monica Paredes, a Kripalu Yoga teacher in Austin, Texas, relied on her breath during the birth of her son, Gabriel. On the taxi ride to the hospital, she took comfort in the vibration of chanting Om. Later, as her labor progressed, she relied on the Ujjayi Pranayama (Victorious Breath) to steady her resolve. Looking back, she says, "My breath and intention were focused on trust and surrender. I dropped into my breath and let everything else go."As a Kundalini teacher, Gurmukh Kaur Khalsa encourages her prenatal students to return to the breath as a touchstone during the intensity of labor and childbirth. She uses the mantra Sat nam with the breath. Loosely translated, it means "Truth is my identity." Say "sat" on the inhalation and "nam" on the exhalation. The mantra can quell anxiety during pregnancy and childbirth. Gurmukh says, "Added to the breath during pregnancy, it can help you realize that where there is truth, there is no fear, and where there is no fear, there is only love."

Own Your Birth

The benefits of prenatal yoga can extend well beyond the big moment. Yoga's time-honored teachings of acceptance and surrender can gently nudge practitioners past a birth that doesn't go according to plan. Flashenberg likes to remind her prenatal students that birth is like everything else in life: You don't always get to choose your circumstances, but you can choose how you react to them.The acceptance she honed in her prenatal yoga class helped Jennifer Coffin, 36, a yoga teacher in Knoxville, Tennessee, come to terms with the birth of her son, Max. She'd set her sights on having a natural birth, but Max had other ideas. Toward the end of her last trimester, an ultrasound revealed the baby was about to enter the world feet first, a breech position often considered too dangerous for vaginal delivery. First, Coffin threw herself into a "fix it" mode, trying to goad him into flipping. She tried therapies from traditional Chinese medicine and practiced gentle inversions. But when he refused to budge, she acquiesced to a cesarean section. "I had to accept the fact that it was the safest option for me and my baby," she says. She credits her prenatal yoga training with helping her let go of the disappointment. "I would have fallen apart if it weren't for the mental and emotional strength I had gained from my yoga practice," she says.In the end, childbirth, like parenting, comes down to trusting your intuition, feeling what's right, and not relying on what others think, Lasater says. "That's what the practice of yoga is all about...being fully, deeply, richly, and radically present with your own self."

Catherine Guthrie is a freelance writer who lives and teaches yoga in Bloomington, Indiana.

Welcome Suzanne Gaynor

Suzanne Gaynorilumina healing Sanctuary would like to welcome Suzanne Gaynor to our practice. Suzanne is an Acupuncturist/ Chinese Medicine practitioner specializing in women's health. Suzanne graduated from the Phoenix Institute of Herbal Medicine and Acupuncture and is nationally board certified in Acupuncture and Chinese Herbology by the NCCAOM. She will be working at the clinic on Wednesdays and Saturdays providing acupuncture as well as attending IVFs at our affiliated sites.Suzanne is also a registered yoga teacher and will soon be offering yoga for fertility, pregnancy and women's health through ilumina.In Health,Dana Price L.Ac.ilumina Healing Sanctuary7520 E Camelback RoadScottsdale, AZ 85251(602)957-2602