The School of Hard Knocked-Up

After a couple of cycles of IVF, I started to notice that that post-retrieval bloated look wasn’t really going away between cycles.   Yep, it was that dreaded cycle weight gain, 5 pounds or so per cycle.  After every cycle, I would start exercising again, get in some minimal amount of shape, lose a bit of the weight, start to feel better in my skin, and then it was time to cycle again.  Cr*p.

After my last cycle with my own eggs, I decided to take advantage of the situation to get really serious about getting fit again.  And can I tell you about the subsequent love affair with lifting really heavy stuff, and the total getting-in-fab-shape-itude that resulted, brought about by this fantastic book?  No?  Dang.

But in any case, what you need to understand is I love to exercise.  It not only makes short shrift of the IVF pudge, it makes me feel great.  As in sane.  As in something that is sadly missing in my IVF cycles, and I would like to have more of.

So that is why I got curious about whether it is OK to exercise during IVF cycles.  There’s surprisingly little information about this out there, so this is my small contribution.

Usual disclaimer: I am not a doctor, just a curious person.  This is what I found out but I may have missed something big.

1. Why do we gain weight when we are doing an IVF cycle?

I used to think that the weight gain was because I was doing comfort eating – lying on the sofa chowing frozen pizza instead of my usual veggie-intensive home-cooked dinners.  But for my most recent cycle, I was tracking my weight daily.  I was slowly (very slowly) losing weight before the cycle, thanks to my awesome weight-lifting routine.  On the day I started on the pill, my weight loss slowed even more.  One might even say I started gaining.  But that was nothing compared to the day I started Decapeptyl (this is basically the same thing as Lupron).   The day after I started taking it my weight started shooting up.  And it continued to skyrocket until I flew to my clinic just before retrieval… at which point I didn’t have my scale any more, so we don’t know what happened.  You should note that my exercise and diet did not change at all during all of this.

So where is this weight coming from?  Obviously, when you do a retrieval you get mighty bloated afterwards, and a lot of that weight is water weight which goes away again after things clear up.  But as far as I can tell the Lupron is playing a different role.   Unfortunately, I don’t remember where I read about this and so there is the chance that I am actually making this up (have I mentioned that I am not a doctor?), but my understanding is that Lupron alters your metabolism so that you are more likely to store carbohydrates as fat.  Once you go off the Lupron, you have high estrogen levels – from your leaky punctured follicles if you had a retrieval, from the estrogen patches or pills if you are on a DE or frozen cycle – and estrogen has the same effect.   Presto, weight gain.

Note: there may be other sources of weight gain that I know nothing about, this is what I did find out about.

2. So if I go on a low-carb diet during my cycle, will I avoid gaining weight?

Maybe.  But in my totally unprofessional opinion, it is probably not a good idea to be on a diet during your cycle.  You want your body to believe that it is not facing a famine – supplies are lush and there is plenty of food around to support little ones, so go ahead, baby, get pregnant!

3. I heard that it’s not good to exercise during your cycle.  Why is that? Because, frankly, I will go insane if I don’t exercise.

I hear ya, sister.  And it is for this reason that I searched in the bowels of Fertility and Sterility to find out more about the relationship between exercise and IVF.   There wasn’t much there. Here is what I did find out.

First, exercising during or after stims is a really bad idea because it can lead to ovarian torsion. “Ovarian torsion” is when your giant, swollen ovaries decide in their sympathy with your movement to do a cartwheel in your belly, thereby twisting off their blood supply.  As you might imagine, if this happens you will be in pain like you would not believe.  And unless you get to a hospital pronto and they untwist your ovary, you will lose it.  And that is something no infertile gal needs in her life.

What’s worse, even exercise the month after your cycle can lead to ovarian torsion, as this case study attests (warning: this is a pretty horrific story).   This is pretty rare, though.  One of my non-RE doctor friends told me that that didn’t need to stop me from exercising, I should just make sure that if I get terrible belly pain the month after stims I should rush to the hospital and make sure they check me for torsion.

Second, there might be a correlation between long-term exercise and problems in IVF cycles.  I only found one very short article about this so you might want to take this with a grain of salt.  And the gist of the article is not really actionable – what they showed was that it didn’t matter if you were exercising regularly now or not, but if you had been exercising regularly for at least 5 years, then you were at a higher risk for bad cycle outcomes (cancelled cycles, BFNs, chemicals).  It’s not clear why, it’s also not clear whether this holds true even if you account for low BMI (which is associated with worse cycle outcomes).

Now there are always a lot of studies that show correlations between various things and better cycle results (whole milk ice cream, anyone?).  Personally, I don’t think you need to live your life around this kind of thing.  But you might want to ask your RE what s/he thinks.

4. I’m not stimming – I’m doing a DE cycle / a frozen cycle.  So can I exercise?  Huh, huh, huh?

I guess you should probably ask your RE.  But if you want some free assvice which is worth what you pay for it, I say sure, go ahead – I did.  And let me tell you what was so great about it.

Like many people, Decapeptyl (i.e., essentially, Lupron) made me feel terrible.   Normally, I am a chipper morning person, but on Decapeptyl I have massive trouble dragging my poor sad body out of bed.  I also get a headache, am exhausted, can’t concentrate, etc.  But by exercising during my cycle I discovered that intense exercise made me feel 100% better, really quickly, and the effect lasted for quite some time after the exercise.  It was hard to believe when I woke up in the morning feeling like I got hit by a truck, but once I had dragged myself to the gym and started working out, I felt better right away.  Intense exercise that required concentration (have I mentioned how much I like lifting heavy weights?) totally dispelled the Decapeptyl fog.  It was like a f*cking miracle.

And this, my dear reader, is also how I found out the following amazing fertile fun fact, which to my knowledge is completely undocumented in the world of infertility blogs – I told my clinic about it and they did not know it either, so chalk one up for me, your amateur infertility sleuth.  I was amazed that even though the Decapeptyl made me feel like a hungover sloth, it did not seem to affect my athletic performance at all.  In fact, if anything, I was performing substantially better than usual… e.g. I improved one of my lifts from 7 kg to 9 kg in 2 weeks – an improvement of 30%, highly unusual).  That was when I remembered something I had read about a while ago… that Lupron is on the International Olympic Committee’s list of doping drugs.  That’s right, gals, for all the horrible side effects that Lupron and Decapeptyl hand us, they hand us one positive side effect as well – they make it really easy to build muscle.  As far as I can tell in my totally unscientific opinion, they do this because they block your estrogen production.  So take advantage of it while you can, until your estrogen patches/pills kick in.

Did I get something wrong?  Do you know something else about exercise and IVF?  Please add in the comments – I’d love to know!