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Thursday, January 24, 2013

Does taking supplements help IVF patients ?

Practically all women doing IVF are taking supplements of one sort or another ! These are supposed to improve egg yield, egg quality and embryo implantation , thus helping to improve IVF pregnancy rates. I have come across women who take over 10 different supplements daily – and I wonder how they manage to swallow so many different tablets, syrups and capsules in a day ! On second thoughts,  it is not surprising , because the craving for a baby can make a woman move heaven and earth; which means taking umpteen supplements is not such a difficult task to accomplish. I have heard the following questions repeatedly from other women who are undergoing IVF treatment – What supplements are you taking ? Or can you recommend any supplement which can improve egg quality ? Is there any special diet which could help in increasing the chances of IVF success ? I wish I knew a magic supplement or diet which will make our much desired wishes come true ! 

Why do women undergoing IVF take so many supplements ? And how important is it to take these supplements during an IVF cycle ? Do these supplements really help ? Why do so may ART centers prescribe supplements for their patients before an IVF cycle ? Does this impact their success rates ? There are lots and lots of questions - and this article is intended to answer some of these in a rational way.

Why did supplements gain importance in the field of IVF ?

  • Women who are struggling to have a baby are desperate to find a solution for their problem and are ready to try anything which may help to make their dream come true. 
  • No one can pinpoint why a particular IVF cycle fails – and when there are no simple logical answers for the failure , anecdotal evidence and empirical therapies gain lots of importance in the field of IVF ! Patient pressure and competition among IVF clinics have forced clinicians to give nonfactual solutions to these questions. 
  • There is always a huge market for snake oil – the human mind is irresistibly attracted towards claims of miracles – especially when you are desperate for a baby! 
  • When we are spending lots of money for IVF treatment , we want to give it our best shot ! Taking supplements gives us a sense of satisfaction that we are doing our best to maximize the chance of success. 
  • We all crave simple solutions for our complex problems ! 
  • It is a very interesting topic to discuss with others amidst the IVF struggle. 
  • We easily fall prey to marketing gimmicks !
  • They are easily available over the counter – and people love to self-medicate

What are dietary supplements?

The Food and Drug Administration (FDA) defines a dietary supplement to be a product (other than tobacco) that is intended to supplement the diet that bears or contains one or more of the following dietary ingredients: a vitamin, a mineral, an herb or other botanical, an amino acid, a dietary substance for use by man to supplement the diet by increasing the total daily intake, or a concentrate, metabolite, constituent, extract, or combination of these ingredients.

Which supplements are used by woman undergoing IVF ?

Following is an incomplete list of supplements which are used by women who undergo IVF (thanks to Dr.Google !) : Co-enzyme Q10, r-alpha lipoic acid, Pycogenol, Resveratrol, Melatonin, , Vitamin C, Vitamin E,  Selenium, Zinc, Myo-inositol, Cinnamon extract, Apple cider vinegar, DHEA, Choline, L-arginine / L-ornithine, Prenatal vitamin, Vitamin D, Vitamin B complex, Folic acid, Biotin, Calcium, Omega 3, Low-dose Aspirin, Vitex , Royal jelly, Wheat grass, Flax-seed oil, Evening primrose oil, Nettle leaf and Red raspberry leaf tea, Probiotics,..........the list goes on and on !

For what purposes are  these supplements used ?

  •  For increasing egg quantity 
  •  For improving egg quality 
  •  For increasing endometrial thickness 
  •  For improving endometrial receptivity

How are the above mentioned supplements thought to help ?

These supplements fall under the following categories :

  • Anti-oxidants (Co-enzyme Q10, r-alpha lipoic acid, Pycogenol, Resveratrol, Melatonin, , Vitamin C, Vitamin E,  Selenium, Zinc) 
  • Insulin sensitizers (Myo-inositol, Cinnamon extract, Apple cider vinegar) 
  • PCOD mimetic (DHEA) 
  • Vitamins and minerals (Prenatal vitamin, Vitamin D, Vitamin B complex, Folic acid, Biotin, Calcium) 
  • Amino acids (L-arginine / L-ornithine) 
  • Blood thinner ( Low-dose Aspirin) 
  • Essential fatty acids (Omega 3, Flax-seed oil, Evening primrose oil) 
  • Miscellaneous (Vitex, Royal jelly, Wheat grass, Nettle leaf and Red raspberry leaf tea, Probiotics etc) 
  • Traditional ( home ) remedies


Anti-oxidants are believed to help us stay young. Just like iron rusts ( forms iron oxide ) and eventually deteriorates when exposed to oxygen and water, it is believed that free radicals produced in our body ( naturally and in response to environmental insults) makes our body “rust” , leading to degenerative diseases. If anti-oxidants are believed to prevent general ageing, will it not prevent reproductive ageing too ? This thought might be the reason behind the use of anti-oxidants in the field of IVF. It is a deeply held belief that free radicals induce ageing; and by using anti-oxidants which scavenge free radicals, the ageing process can be reversed. Sadly, even though this is very tempting and seductive, there is no valid proof to support it. Our body contains many natural anti-oxidant enzymes which prevent free radical damage. Taking large amounts of anti-oxidants doesn’t seem to help prevent ageing - and recent studies have shown that taking certain anti-oxidants could actually increase the risk of death.   Free radicals are not villains – they also function as key signaling molecules during oocyte maturation, uterine function and embryo implantation !Using anti-oxidants may actually impair their role in these vital processes.

Insulin- sensitizers

Women with PCOD have insulin resistance. Their cells lack the ability to utilize insulin efficiently. Excess insulin in the body can disrupt hormonal balance , leading to anovulation. Insulin sensitizers like metformin are proven to be effective in inducing ovulation and hence helping women with PCOD to get pregnant. So insulin sensitizers have gained importance in the field of reproductive biology. Since they induce ovulation and help attain pregnancy in PCOD women , they are also thought to improve egg quality in normal women as well. This is why insulin sensitizers have become important as IVF supplements too.

PCOD mimetic

DHEA come under this category. PCOD women have lots of antral follicles in their ovaries. DHEA is supposed to increase the number of antral follicles in the ovary, through an androgen dependant mechanism which is not yet understood clearly. Taking the PCOD mimetic DHEA is thought to help women to produce more eggs.

Vitamins, minerals and amino acids are necessary for the optimal functioning of the body and hence necessary for the reproductive system too.

It is believed that an anti-coagulant like baby aspirin will help to improve blood circulation to the uterus and thus can help in the development of a good endometrial lining. By thinning the blood , they are thought to help embryo implantation too

Essential fatty acids are thought to be necessary for normal hormone production

Other miscellaneous substances (whose mode of action is not known) are thought to reduce stress, improve mental health, act as a “tonic”, “ flush out “ toxins, “boost immunity”, and improve general well-being of the body and our reproductive system as well ! These are just tall fancy sounding claims, which can never be proven – or disproved ! 

What are the purported effects of some of these supplements on the reproductive system?

Pycogenol is a strong anti-oxidant derived from the bark of pine tree ! (When did humans consume pine tree bark ?) It is also present in peanut skin and grape seed. It is thought to help with male fertility and there are several other health claims too. Since it is assumed that free radicals cause damage to eggs (?) this supplement has gained importance among women who undergo IVF. 

Myo-inositol is also called Vitamin B8. It is naturally produced in many of our body tissues. The best sources are fruits, beans, nuts and grains. Humans generally consume about a gram of myo-inositol per day. Our kidneys produce 2 grams per day. There are many functions of it in our body but its positive effect on reproductive system is due to its action as an insulin-sensitizer. PCOD women with insulin-resistance are found to be deficient in myo-inositol (perhaps because they have a defective myo-inositol synthesis pathway). Since myo-inositol plays a vital role in insulin signaling, it is thought to benefit women with PCOD. There are studies which claim that it helps women with PCOD by improving their metabolic parameters and thus by inducing ovulation. So it was also tested as an IVF supplement and as usual there are some studies which show a positive effect on IVF outcome - and some which do not. Why should women without PCOD and/or insulin resistance take myo-inositol as a supplement, when it is produced naturally in our body and can be obtained easily through our diet ? I do not think it can help women of old age in improving their egg quality. Women with poor ovarian reserve and advanced maternal age should be very careful in taking insulin-sensitizers (including metformin) because use of such substances can actually reduce their yield of eggs drastically. 

DHEA is a PCOD mimetic which is used in laboratory mice to induce PCOD I took it for 9 months and I did have a high egg yield during IVF. But still I will be very cautious about the claim that DHEA can do wonders for women who are running out of eggs. When there are no eggs in their egg bank (ovary) how could DHEA recruit more eggs ? Some women say that it helped them to produce more eggs , but for many it does not work. 

L-arginine / L-ornithine are non-essential amino acids, which mean that they are synthesized in our body and we do not need to depend on our diet for procuring them. They are naturally made in the body and our daily consumption of these amino acids reaches upto 5.5g (even though it is not necessary to take this !). I have no idea how supplementing this amino acid could help with egg quality or improving blood circulation to the uterus !

Cinnamon extract, Apple cider – thought to function as insulin-sensitizers and hence might benefit women with PCOD !

Melatonin is touted as a strong anti-oxidant. The story of melatonin’s use in reproductive biology started with its ability to inhibit ovulation. It was even used in phase III clinical trials to test its effectiveness as contraceptive ! Suddenly now they are talking about its efficacy in improving egg quality when supplemented during IVF cycles because of its anti-oxidant function ! The suggested dosage for women who are undergoing IVF is 3 mg / day. Do you know that this dose is 10 times higher than what our body  naturally produces ? Is it wise to take such an overdose of a vital hormone ? 

Co-enzyme Q(10) is another strong antioxidant which occurs naturally in our body. It is present in abundance in mitochondria. It helps in the production of ATP molecules which acts as the “energy currency” of our cells. Since egg cell contains more mitochondria than any other cell type; and ageing egg cells have defective mitochondrial function (energy production), supplementing with CoQ10 is thought to be beneficial for women of advanced maternal age . There are many unproven claims , like aneuploidy prevention, increased egg yield , better egg quality and so on. CoQ10 is synthesized in our body and can also be also obtained through our diet. Fish, meat and vegetable oils are all rich sources of CoQ10. Should we supplement it when undergoing IVF ? It is a very costly supplement – and it seems to be a shame to waste money on something which has not been proven to help.

The story of how wheat grass gained importance as a supplement in order to increase egg yield is amusing. In 1930s, a farmer observed that hens fed with wheat grass yielded 150% more eggs and the egg quality was much better too !  I wonder whether the quality was determined by the ability of the egg to give rise to a chicken or by its ability to improve the health of the consumer !  Might be spinach would have done a better job – don’t you think so ? Spinach contains more nutrients than wheat grass has ! I bet if the hen is fed with a proteinaceous meal it would have fared much better ! I am sure the modern poultry industry is successful in coaxing the hens’ reproductive system to produce better and more eggs than in 1930 -  and I wish we women could get that recipe too! It is a scientifically proven fact that FSH decreases when you are in love, especially during the first three months of the relationship. How about a romantic trip with your partner, where you fall in love all over again and enjoy a secnd honeymoon ? Instead of spending your valuable money on unproven therapies and supplements , this is a much better option - even if your FSH level does not go down , you will have made the best use of your hard-earned money !

The Royal jelly tale is even more enlightening – if queen bees fed with royal jelly can produce a large amount of eggs, then why shouldn’t humans consume it if they want to produce more eggs too ? I wish honey bees never start thinking - ‘If we eat what humans eat , we will become wise like they are !’. Poor bees – their hard-work is exploited for our sheer greediness ! Royal jelly contains royalactin, a protein which is found to give the queen bee its phenomenal reproductive capacity. I am sure royalactin will be manufactured in tons in the future - the company which sells it is sure to reap a huge profit !  

Vitamin D is the new age wonder vitamin ! Since the facility to test vitamin D levels in serum is widely available today,  almost everyone is screened for their vitamin D levels, irrespective of their sun exposure status and age. The pity is that there are no proper studies to suggest what vitamin D concentration in serum is normal for a particular group of people. Even worse, a lack of this vitamin has been linked to every disease in the world - and use of this vitamin has been shown to prevent practically all the diseases under the sun. So why should reproductive biology leave this ‘miracle’ vitamin unused ? Vitamin D was shown to increase AMH level, the hormone which is a marker for ovarian reserve . Hence it is widely believed that taking Vitamin D will improve ovarian reserve – a claim which can never be true (you will realize this if you understand the relationship between AMH and antral follicle count ( AFC) )! If you have a high AFC , your AMH levels will be high but a substance which increases AMH level will not increase your AFC (actually it can do the opposite) ! A study in Fertility and Sterility journal in 2012 concluded that “A novel relationship is reported between circulating 25OH-D and AMH in women aged ≥40 years, suggesting that 25OH-D deficiency might be associated with lower ovarian reserve in late-reproductive-aged women” – I wonder how a reputed journal in reproductive biology has allowed the publication of such a speculative conclusion which is totally misleading ! There are contradictory publications which state that repleting vitamin D levels increases IVF success rates; and another which states that a high vitamin D concentration in follicular fluid can decrease IVF success (crazy experiments and crazy findings !). A recent study also suggests that people with less vitamin D levels live longer (PMID: 23128285) !

Fifteen minutes of exposure to sun for three days every week is enough to satisfy your body’s vitamin D requirement. Vitamin D was found to regulate 3000 different genes (not only AMH!) in our body – which means it is wise not to take an overdose of this vitamin when there are controversial research findings. If you are healthy and have good sun exposure I do not think supplementing this vitamin will help you in anyway - if you do not believe me think about your ancestors who never supplemented their diet with vitamin D and had a healthy reproductive life . I live in a country where the chance of exposure to sun is very low in winter (we have short summers too) and many people living here never take vitamin D supplements nor do they test their serum levels - and they are very healthy and fertile ! 

Are there any supplements which every woman undergoing IVF should take ?

Yes ! Every woman who is trying to conceive should take folic acid. It is a supplement which is proven to prevent neural tube defects in the developing fetus. Folic acid prevents 70 % of neural tube defects. So make sure you take 400 µg of folic acid atleast 3 months before starting your IVF treatment. Women with a mutation in their MTFHR gene need 5 mg folic acid in order to protect their fetus against neural tube defects. Women who have had a child with NTD and women who themselves have NTDs are also advised to take 5 mg folic acid daily. Myo-inositol was able to prevent folate-resistant NTDs in mice but in humans whether this is true is not known. Women who had child with NTD even after consuming enough folates could try taking a myo-inositol supplement too.

Can lack of a particular nutrient hinder my chances of conception ?

For answering this question , there is no need for complicated research findings. Just look at the women around you ! I come from a developing country in which there are so many women who live below the poverty line. Many survive on just rice or wheat. They can't afford meat, fresh fruits or vegetables on a daily basis.  Do you think that their families are any smaller ? Since they are poor and illiterate, they are married at a young age (this is the most important reason for their high fertility potential !) They are extremely successful in expanding their family - actually most have a bunch of children (some even have 10-12 children and many are successful in producing babies late into their reproductive age !) due to their lack of knowledge about contraception!  If nutrients play such a pivotal role in conception , these women who live below the poverty line would never have any offspring ! After seeing them I am tempted to conclude that excess nutrients and lack of physical work might play a role in accelerating reproductive ageing ! It is a well-established fact that calorie restriction protects the reproductive system in mice from ageing !

Supplements don't cause any harm, do they ?

It is important to understand that the FDA is not responsible for ensuring the safety of dietary supplements available in the market – and it does not check their efficacy too .  This means that there is no certainty that the claims of the manufacturers are true - and their safety is not guaranteed either . Remember that too much of a good thing can be bad.  Certain vitamins when taken in excess are toxic (especially fat-soluble vitamins like vitamin A and D).  Studies have shown that taking some vitamins in excess actually increases the risk of death ! Do you know that excess Vitamin B6 can cause permanent nerve damage ? Even the CoQ10 story is very confusing. There are studies which show that CoQ10 can function as a pro-oxidant (a substance which can increase free radical levels) too. A study in the Journal of Science showed that C. elegans (a worm which is used to study many of the evolutionarily conserved signaling pathways which are similar in humans too !) fed with coenzyme Q deficient diet lived 60 % longer - and the worms looked younger too (PMID: 11778046) ! A calorie restricted diet ( which is shown to preserve reproductive function in mice well into their old age ) also decreases their CoQ10 levels ! (Should older women really take CoQ10 ?) Do you know that a Finnish study conducted for 8 years in smokers showed that smokers who supplemented their diet with anti-oxidants vitamin E and beta-carotene paradoxically had increased mortality (PMID:8127329) ? The field of supplements is not entirely black-and-white, and there are many grey areas left. Hence it is wise not to overdo anything when you do not know what effect they have on your reproductive system. When you get a particular nutrient through your diet how could taking them in excess helps ? Remember, more is not always better !

Patients end up wasting a lot of time and money consuming ineffective supplements such as Fertilaid, just because they are marketed very slickly ! They spend a lot of money on marketing and posting patient testimonials on bulletin boards and forums , and because patients are so desperate, it's easy to take them for a ride.

I am taking only herbal supplements and hence I can’t suffer any side-effects !

It is a very illogical on our part to assume that the so-called ‘herbal’ supplements are safe. The word ‘natural’ in supplements doesn't mean they are harmless ! .  Even worse , many herbal supplements contain alkaloids or heavy metal contaminants which can cause serious damage to your vital organs. Some herbal supplements can interact with the medications you are taking and make them ineffective . Are you aware that even grape fruit juice can interfere with medications you are taking and can cause life-threatening complications ? So please do not think that everything which is marketed as herbal or everything which occurs naturally is OK to take without a second thought, especially when there is no proof for the tall claims their manufacturers make ! 

What about the IVF preparation kits which are available in the market ?

Many online websites are cropping-up which are trying to exploit our desperation to have a baby . I received a mail from one of my friends who enquired about the IVF preparation kit which the following website sells -  I looked at their website and was very impressed as to how cleverly they have designed it to sell their products !  They gave very good scientific explanations for all the problems infertile women face - and they then also gave pseudoscientific solutions for the same ! 

Can supplements make my eggs younger or help my embryo to implant ?

Our ovary is like an egg bank where the eggs are stored for years. As women age , their eggs in their ovary age too ! Ageing affects the genetic quality of the egg; and the quantity of eggs available in the ovary declines too. Unfortunately, we do not know the exact mechanism behind such changes , and hence we do not know how to prevent it ! I wish there was a supplement which could make me and my eggs younger too !

What about supplements for improving sperm count and motility ?
The simple answer is - nothing works ! However, because this is not an answer which patients want to hear, they consume thousands of dollars worth of cleverly named supplements,to "boost" their sperm count and motility. They usually stop after they fail to see results in a few months - but this wasted therapeutic trial damages their confidence - and their bank balance !

If supplements don’t help, then why do doctors prescribe them ? 

Most take the approach – if supplements do not cause harm, then why not let patients take them ? Most doctors are happy to humor their patients – and will prescribe supplements to keep their patients happy – and not because they think they are useful. Most doctors are quite clueless about the role of supplements, because these have never been scientifically studied properly . They are quite happy to get on to the supplement bandwagon , primarily because of the pressure on them to “do something” ! The danger is that taking these supplements creates false hopes – and this is an unkind thing to do . Not only are they expensive, when they do not work, patients lose confidence in themselves – and in their doctor. In reality, most patients do not even bother to ask their doctor for advice on supplements. For one thing, they are scared their doctor may disapprove , because these are not “mainstream medicine”. For another, since these supplements  are easily available online, they are quite happy to buy them on their own, without having to bother their doctor. Patients get easily swayed by the anecdotal success story of a patient who took a supplement and then promptly had a baby in 4 weeks ! They have no way of checking the failure rate of these supplements . 

Should I take supplements ?

When all is said and done, if taking supplements helps in giving you peace of mind that you are doing your best to make the IVF cycle a success, go ahead and take it. But before taking them , analyze critically what you might need , depending on your specific condition. If you have PCOD with insulin resistance , try an insulin sensitizer. (But remember, insulin-sensitizers can never replace a sensible diet and a good exercise regimen in controlling PCOD). If you are a women with poor ovarian reserve try using DHEA. Women of advanced maternal age can try taking anti-oxidants. A multivitamin tablet is always a safe option – the extra vitamins will just make you produce expensive colorful urine ! But it is definitely not advisable to take a cocktail of supplements ( a mixture of powerful anti-oxidants, insulin sensitizers and so on )  at a time. Respect your body and have faith in its ability to handle things. Having a fertility problem doesn’t mean that your body has lost all its ability to produce, absorb or utilize nutrients. Reproductive ageing doesn’t mean your body is sick. If a particular supplement can be synthesized by your body or you can obtain it through proper diet, please do not take them – you never know how your body will react to too much of good thing ! To bolster their claims, many supplement manufacturers provide “scientific evidence” that when we get old , a particular nutrient declines in our body -  and they trick us into believing that it  is this decline which is the reason for ageing. Hence they suggest that we buy their supplement, to increase our levels of that nutrient, the hope being that this will reverse the ageing.  We need to learn to be critical and not get fooled  – perhaps the level of the nutrient in our body declines as we age because our requirement for that particular nutrient decreases ! The wisdom of our body senses this , and decreases its level in order to protect us from unknown insults which could happen as a result of nutrient excess ! Using supplements is like dying your hair - you get the satisfaction that you look younger , but the truth is you cannot reverse ageing - you can’t fool your cells. If you are suffering from a particular disorder (PCOD, diabetes etc) or do not have a proper diet , please talk to your doctor to determine which supplement might help when undergoing IVF. Never underestimate the power of healthy eating habits and proper exercise regimen ; it will definitely help your reproductive system to fare much better than any other supplement could !

The most important supplements as per my understanding when undergoing IVF are vitamin L (lots of love and pampering from your dear ones !), Vitamin H (Hope!), Vitamin P (Patience and Persistence !) and Vitamin K (Knowledge about the IVF process!). Nothing can beat these supplements in providing proper mental balance and support (and this will increase your physical well-being too). Never obsess about other ‘miraculous’ supplements (when there are no trials with sufficient power to substantiate the claims) – they are not worth it !

Monday, January 21, 2013

Dr.Malpani's Blog: The HELP Video Guide to Ovarian Cysts

Dear Friends,

I have a request. Below is the link for a patient education video prepared by HELP. They need to hear your feed back on it - whether it is OK in the present format, what can be done to make it more interesting, is it understandable, is it helpful for you, etc. I would appreciate a lot if you could leave your opinions and suggestions about this video. Every suggestion is valuable and will help the makers of this video to design it even more better  !


Dr.Malpani's Blog: The HELP Video Guide to Ovarian Cysts: The HELP Video Guide to Ovarian Cysts Please provide feedback !

Thursday, January 17, 2013

When bad things happen to good people - how infertile couples can find the inner strength to cope !

Why do bad things happen to good people ? Why do good people suffer ?  This question arises in our mind many a time , but most frequently when we are suffering ourselves. Most infertile couples ask themselves - ‘Why is this happening to me?’ I am a good person. I haven’t done any harm to anyone. I am fond of children. When everyone around me has children so easily, why am I doomed to suffer physically, financially , socially and emotionally ? Did I do something wrong ? Is it a punishment from God ? Why is the natural happiness of having children denied to me ?”  Most of the time , there are no answers to why , but the pain becomes much easier to handle when we start thinking how to deal with it ! After all, what happens to us doesn’t matter , but how we look at it and deal with it matters a lot ! 

Infertile couples are as anxious and depressed as patients with other chronic illnesses such as cancer or heart disease. Why is infertility so hard to handle? Most infertility treatments demand lots of blood tests; frequent vaginal ultrasounds where our most private parts are poked and prodded by strangers ; and the use of hormones , which are pumped into our body in the form of injections, tablets and pessaries. As a result of all this , we feel we no longer have any control over our body !Infertility treatments are costly and can empty our bank balance in no time , leaving us panicking about the future. In many societies, infertile women are treated as unfortunate, pitiable creatures who are considered to be second-class citizens. This damages our self-esteem and our confidence vanishes. Many women leave their much sought-after job,  fearing that their ‘job stress’ makes them incapable of conceiving , only to realize later that this decision causes even more havoc financially and emotionally (no career, no money, no baby and lots of spare time in which to obsess fruitlessly !) Infertility can disrupt friendships as well. An infertile woman recount, ‘ I had a friend with whom I used to share my pain and suffering , but when she got pregnant , she didn’t even inform me until very late into her pregnancy. I felt betrayed and was totally crushed .This physical and emotional ordeal , coupled with the social stigma of being infertile and being subjected to a barrage of ‘advice’ from ‘well-meaning’ people can make the infertility journey more hazardous than walking through a minefield ! How can you endure such suffering and yet remain sane ? Can we find a purpose and meaning in life during this crazy struggle ?

Is suffering bad ? Before answering this question let me ask another  - Is  physical pain bad ?  What will happen if we lose the ability to feel pain ? It appears on first thought that if we do not feel physical pain , everything will be well and good – no need for painkillers, no need for a doctor, and because the body always feels good , there is no fear of physical suffering. But, if you start to think clearly , you will understand that if you stop feeling pain , our body is in danger all the time.  For example, what happens when you step on a sharp object ? The pain you feel immediately alerts you; you remove your leg from that sharp object and you take care not to step on it again. In this way, your body is protected from the danger of being wounded deeply. Pain also alerts you to seek medical help at the proper time , so that further damage to your body is alleviated. In short, pain teaches you to avoid dangerous situations and to seek help when necessary, by acting as a protective shield. A person who is unable to feel physical pain is physically handicapped – and a living example of this is patients with leprosy, who are at risk of progressively losing their fingers and toes because they cannot sense pain anymore . Just like physical pain is good for our body , emotional suffering is definitely good for our soul ! Emotional hardship makes us sensitive to other’s pain; it teaches us to respect life; it helps us to appreciate the goodness in our own life; and makes us stronger and humble at the same time . Suffering teaches us a lot of life lessons – and most of us learn much more by experiencing hard times .  Suffering helps us to grow spiritually; and shapes us into mature human-beings.  A human without suffering is emotionally handicapped , because he cannot relate to what others are going through , nor can he know what real happiness feels like !

It is true that suffering teaches us many valuable lessons in life which happiness cannot, but if we are not resilient  , this suffering can tear us apart emotionally, rob us of our natural goodness and can leave us bitter and full of fear and cynicism. But there are humans who blossom gracefully amidst the pain they endure – like a dazzling flower in a desert ! How can some people manage to become better human beings inspite of all the suffering they have had to experience ?Why do others become bitter, resentful and downhearted ?How can we use this experience of infertility to become better human beings ? How can we find the strength to cope ?  I have listed some strategies which help me to stay strong , and I hope they help you too !

Compare yourself with the less fortunate !

When you compare yourself with someone who is worse off than you, it will help you to accept your suffering gracefully. Gratitude for the blessings you do have in your life ( as compared to those who do not have these)  helps you look at the glass as being half full, rather than half empty. Being empathetic and experiencing another’s pain makes managing your pain a lot easier .‘Look at people who are less fortunate than you are and be contented with what you have ’- this is the lesson which my parents taught me at a very young age - and it has helped me to tackle one of the worst crises in my life very effectively. As the saying goes – I felt sorry because I had no shoes – until I saw a man with no feet . 

I agree infertility is very hard , but if you decide to live a life filled with anger, resentment and hopelessness , won’t this just make it much worse ?  I have a friend who was full of happiness and energy. Her favorite pastime was to read books. She completed her PhD with flying colors. She stood first throughout her studies; got married to the love of her life and gave birth to a beautiful daughter within a year of her marriage. A year later, she fainted and slipped into coma. The doctors , after a lot of struggle , diagnosed her as having TB of the brain. In the course of her treatment , she lost her eye sight. She turned from a beautiful woman to a person who is just skin and bones. Her daughter was separated from her for three years. She spent this time all alone , sorely missing her daughter. Now she is getting better after years of struggle. She is someone whom I respect and worship wholeheartedly. I believe the suffering she has endured has raised her above all of us.  When I talk to her I learn a lot about life. Even if she is depressed sometimes , she fills me with positive energy. I have never seen her cry for herself but she broke into tears when she heard about my IVF attempts and the failures I went through. She has given me many gifts, but the best one is a book (I hope you understand the importance of getting a book from her – she gave me something which she cannot enjoy anymore - her unfairly denied pleasure !); and a cute pink frock for my prospective daughter. She is the most beautiful human being I have ever met and her suffering has transmuted her into a woman full of strength and compassion. When she was in hospital , she wrote the following verses from the Bhagavad Gita and stuck it in her room (in her present childish scribbling). It read :

“Whatever happened, happened well. Whatever is happening, is happening well. Whatever will happen, will also happen well. For what are you crying? What did you bring with you, for you to lose? What did you create, for it to be wasted or destroyed? Whatever you took, it was taken from here. Whatever you gave, it was given from here. Whatever is yours today, will belong to someone else tomorrow. On another day, it will belong to yet another”.

I understood the profound wisdom in those words; and if I hadn’t been infertile , I don’t think I would have been able to do so !Is infertility a greater suffering than what many other people endure ? I have come across people who get very angry when I say - Look at the suffering which others go through in order to console yourself. Their argument is, isn’t every suffering unique ? Is my pain worthless ? Don’t I have the right to feel my pain ? Like happiness, suffering is relative. Comparing yourself with persons who are less fortunate than you, will turn you into a compassionate and grateful human. When you feel their pain,  your pain will automatically appear a lot lesser , and this protects you from many negative emotions and depression. It stops you from complaining , and helps you to appreciate life. If you spend most of your life feeling sorry for yourself because you are infertile, learning to shed tears for others will help your own life to appear worthy and precious !

Be happy !

Isn’t the purpose of life to be happy? What will you achieve by being sorry for yourself, carrying a ton of guilt, being resentful and angry and by becoming bitter everyday , just because you are infertile ? Aren’t your hurting your spouse too by being sorry for yourself all the time?How can you be happy when you are struggling with infertility? The truth is our circumstances don’t have anything to do with our happiness – it is the way you look at your circumstances that either robs you of your bliss or helps you to stay strong. Look at infertility as an interesting challenge rather than a mere struggle. You have something to hope for, to wish for, something to be excited about (a baby!) most of the time – is there anything else needed to keep someone happy ? Of course there are very hurtful and sad times during infertility struggle, but doesn’t that sadness make the happiness in our life taste better ? The best way to be happy is to make someone else happy– try it and you will understand! Give happiness priority in your life. It will make all the suffering appear a lot less and you will gain enormous strength to cope with infertility ! Below is the serenity prayer by Reinhold Niebuhr which helps me to remain serene amidst my infertility journey :
God, grant me the serenity
To accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference.
Hope it helps you too ! Stop worrying about things which are beyond your control and appreciate the blessing which you do you have. 

Do not equate happiness with a baby

The mistake many infertile couples do is equate happiness with a baby. They wait and wait for a baby -  and for happiness too. All through their journey to have a baby , they remain sad and bitter. When you are sad and bitter , you turn the people around you off . Happy souls tend to make others happy and hence attract happiness ! During your infertility journey, you need support from your friends and dear ones; leading a lonely life only adds to emotional suffering. Many infertile couples live an isolated life. People do not move away from you just because you are infertile – rather, you move away from them because you are sad and depressed. I have heard many women say – “ If only I had a baby , how happy I would be!” Do you think having a baby will solve all your problems and bring you everlasting joy ?  Of course having a baby is one of the sources of happiness , but a baby is not the only source of happiness. The time to be happy is now; you never know what the future has in store for you ! Only when you are contended with what you have do you get the ability to enjoy happiness ! If you make your happiness conditional to getting something you don’t have , life becomes miserable. If you learn to be happy , you learn to tackle life’s ups and downs with equanimity ! 

Helping others is the best way of helping yourself !

We all need help sometimes ! When going through infertility we definitely need help; I am not talking about monetary help, I am talking about emotional help. We need kind words to keep us strong ; we need a shoulder to lean on when we are tired; we need an understanding heart who empathizes with us ; and we need to know that we are not alone ! But how do you get this much needed help ? I have learned a very important lesson in my life by going through this infertility struggle – “ helping others is the best way of helping yourself”. My blog helps me to help others by sharing the knowledge I have acquired. When I do this , I gain more knowledge too , because I have to keep myself updated !After all, teaching others is the best way to learn something. So by gathering knowledge , I am helping myself first so that I can help others ! Nothing gives me more satisfaction than when I can help other infertile couples. By supporting them , I am supporting myself; by helping them I am helping myself ! I get a feeling of self-worth and I am proud to be a patient ! My self-esteem grows daily because I  get so many comforting words and emotional support from my virtual friends. So if you think you need help, learn to help others first. Infertile couples often feel that they are alone – that no one understands them , and they crave for comfort. In such a situation , the best way to get support is to support others who are in a similar situation as you are. Online infertility communities and forums are the best way to reach out to someone who is going through what you have gone through. Helping them and supporting them can bring a sense of goodness in your life. Having an online journal can help you emotionally and help others too !There are always people around you who need help , and you can help them in many different ways - providing monetary help; sharing your knowledge; supporting them with your kind words and deeds -  anything which you do is fine, when it’s done without any vested interest ! Spending your precious time and resources for others will help you to have a positive attitude.When you taste the happiness which is inherent in the help you extend to others, you will never feel tired or sorry for yourself. It is not only about the appreciation you receive, it is about the genuine intrinsic spiritual happiness inherent in such activities which keeps you strong and resilient. Helping others provides enormous emotional gratification and protection and I will always be thankful to Dr. Malpani for teaching me this valuable lesson – thank you very much Dr !

Out of suffering have emerged the strongest souls !

Kahlil Gibran said Out of suffering have emerged the strongest souls; the most massive characters are seared with scars.”The more suffering you face the stronger you become. When I had my last IVF failure and was struggling with depression Dr.Malpani quoted  Nietzsche  What doesn't kill you makes you stronger ! Grappling with infertility can help to make you more empathetic and emotionally much more resilient, so you can deal with all the hard knocks life can (and will) deliver in the future as well !” So, never look at your suffering as punishment – it is a blessing in disguise. It helps you appreciate how strong you really are !It will prepare you to face other difficult situations in your life with a strong heart and a clear mind. Once you have successfully weathered the storm of infertility, anything else life chooses to throw at you will be child’s play to deal with. Infertile couples suffer for what they deeply crave for – a baby – can there be a sweeter pleasure than such suffering ? The way you react to struggles determines who you are. A person who is in his comfort zone may be good – but only one who is pushed by challenges can grow to his true potential.  If you grow better every day without becoming bitter amidst your struggles , that is the greatest achievement you can aim for in your life. Accept your sufferings gracefully and allow it to shape you into a beautiful human being. Suffering is a brutal teacher , yet it teaches you the best lessons in life ! Make sure you learn the lessons without yielding to self-pity and depression !

Life is a succession of lessons – learn from them!

Life is a continuous learning process - when you stop learning, you stop growing too ! Many infertile couples avoid social gatherings because they are afraid of facing awkward situations and unkind thoughtless comments. They try hard to isolate themselves , and as a result they stop learning the valuable lessons life was designed to teach them ! There are many unreasonable people around , and they might hurt you with their words or  deeds. But remember that no one can hurt you without your permission – and their unkindness reflects on them , rather than on you. By meeting them , you can learn how not to behave ! Tackling hurtful situations and comments helps you to grow spiritually and emotionally. We all build resilience by tackling difficulties in life. Remember, life is a learning experience and it’s the experiences you need to struggle with will teach you the most precious lessons. If you refuse to tackle your pain, you will never grow emotionally. Stunted emotional growth makes you vulnerable to pain and depression. If you want to be emotionally hardy , treat life as a continuous learning experience and be willing to learn from it !

“Life is a series of experiences, each one of which makes us bigger, even though sometimes it is hard to realize this. For the world was built to develop character, and we must learn that the setbacks and grieves which we endure help us in our marching onward.”
                           -        Henry Ford

Be occupied !

The best antidote for depression is being occupied with something you like doing. Anything you are good at will bring you happiness. An idle brain is the devil’s workshop and being idle exposes you to all sorts of unreasonable thoughts and fears. So always engage yourself in some work which keeps you busy. If that work becomes your passion you will naturally excel in it.  If you are a working woman who is trying hard to have a baby, please do not quit your job for the sake of a baby. The stress you experience in your job will not prevent you from conceiving – this is just an old wife’s tale ! In fact, being busy will help your emotional well-being ! If you are mentally unoccupied you will find lots of time to obsess, and the more you obsess, the more likely you will sink into depression. The best way to cope with infertility is to engage yourself in activities you like– be it a hobby, your job, some charity work and so on. If the work you do gives you a sense of satisfaction and self-worth , you will be able to cope better with the times when you feel sorry for yourself, and you’ll be able to snap out of the infertility blues more quickly.

Turn a deaf ear to hurtful opinions and comments

 Many women say “I try hard to be strong and happy amidst my infertility struggle , but the people around me hurt me with their words and deeds. This turns me into a coward , and I am unable to face them . How do I cope with this? “ One of my friends told me “I got a call from one of my relatives who recently had a baby, and she went on and on about how good it feels to be a mother  ! To add insult to injury, she also gave me her opinion on how infertility treatments can actually prevent one from conceiving  ! “   One of my friend’s in-laws made the cruel comment  - “What use is a fertilizer if the soil itself is inherently bad ? “ How is possible to remain strong when such unreasonable people are around ?

I agree it hurts to have to deal with these emotional assaults all the time. It can make us weak and fearful. But if you observe people who get happiness by poking their nose into other’s misfortunes,  you will find that they are unhappy themselves.  Rather than to get angry, you should feel sorry for them. If someone hurts me unreasonably, my first thought is “ What has this person gone through which has made him this bitter “. Remember, a happy human will not hurt others. Only people who lead a miserable life filled with anger, hatred, guilt and suspicion will have the time and energy to find happiness in other’s troubles. So the best thing you can do to safeguard your peace of mind is to pity  these nosey-parkers - being compassionate will give you a sense of superiority, and will allow you to forgive them more easily ! You cannot control someone else’s actions – but you can control your response to them ! Just turn a deaf ear to their hurtful opinions and comments , and ignore them. When you give undue importance to such comments and worry about them, you unconsciously give them power over you. Your brain starts believing that what they said is right - and this can actually make you more emotionally susceptible. Remember that what they say and how they behave shows who they are - and not what we are . Anyone who deliberately chooses to hurt you deserves your pity !

Seek therapy !

Last , but not the least, please seek psychotherapy if you find it hard to deal with infertility. Infertility can play havoc with your emotional-wellbeing. If you are someone who is constantly tearful and fearful; if you are overwhelmed with negative thoughts all the time; if you cannot take your mind off the thought of infertility;  if you cannot sleep well; and if your work and personal life are affected because of the crisis of infertility, please seek medical attention. Not everyone is blessed with the ability to be strong and resilient during all major life crises. We all can benefit from professional help during a crisis in our life – and a good therapist will teach you tools to tackle stressful situations in a more constructive fashion. Seeking medical help doesn’t mean you are weak. Actually, reaching out for help shows that you are wise enough to understand something is wrong and can take bold steps to overcome it. There are many different forms of psychotherapy available , which will help you to bounce back !
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