Feedback Friday: When you are pregnant and your friend is not

Dear Eggsperts–I am single and have gone through fertility treatment and have come out the other side. I’m super excited, but I’m having a hard time enjoying it sometimes, because my friend has wanted a baby for even longer than me and hasn’t gotten pregnant. What advice can you give to someone who is not willing to do treatments? She’s wanted a child longer than I have and is actually married. She won’t seek fertility treatments, in my opinion, due to religious beliefs. Now that I’m moving forward I feel sad leaving her behind. Any supplements that you believe in more than others?–Caring in Columbus

Dear Caring–First, we want to give you a great big CONGRATULATIONS!!! You really should celebrate your joy. We get that it’s hard, though. I’m guessing that to get to this point, you had a few “ups” and a lot of “downs.” It’s easy, and common, to forget how to be happy and excited because you are waiting for the next shoe to drop. But, breathe, enjoy the next chapter in your life. Survivor guilt is real, but you can avoid it by supporting your friend.

Now, regarding your friend. You are clearly very compassionate and caring. We know that for her, the pregnancy topic may be a sensitive one and she is traveling her own path. Talk to her and let her know that you know what she is going through and that you can be there to help her however she needs it. Just because you are pregnant now, does not mean you don’t have some sense of what she is feeling. She may have a tough time seeing your pregnancy and she may not feel energized to go to a baby party, but let her know that she is welcome. Don’t avoid the topic of your pregnancy and “spare her feelings.” People grieving need to have their grief recognized. Be open about your feelings and openly acknowledge what she may also be feeling. It may be just what she wants or needs. You aren’t leaving her behind, you are just traveling different paths for a bit, but those paths will cross each other along the way.

Advice is a hard. She has her reasons for not pursuing fertility treatments. Absolutely, let her talk with you. Encourage her questions. Let her know you care. But I generally don’t recommend offering advice unless she asks for it. And, if you recently went through treatment, she may ask you a lot of questions.

I will try to address the questions you asked in case she asks you for advice?

What advice can you give to someone who is not willing to do treatments?

Infertility is a medical condition. It does NOT define who we are as people. I would recommend that she see a doctor (it can be her gynecologist if is nervous about seeing a fertility specialist) to see if there is something that is making it harder to get pregnant. Her gynecologist can order the basic tests for ovarian reserve, semen analysis, and hysterosalpingogram. But, the doctor can also get a detailed history to see if there is some other medical condition contributing to fertility troubles.
- If something is identified that makes the chances of pregnancy very, very low, at least she will know and can grieve without always wondering, and without the anxiety and agony of loss with every period.
- If another medical issue is identified, maybe this can be treated to improve her potential fertility without treatments like insemination or in vitro fertilization.

For all patients seeking pregnancy, I do recommend healthy lifestyle.
- Healthy lifestyle applies to both men and women as these things can also affect sperm.
- Each of these aspects of healthy lifestyle and impact on fertility can be a long discussion in itself.
- We are learing a lot about fertility and the impact of:
  - healthy diet
  - body weight
  - moderate exercise
  - anti-oxidants
  - not smoking
  - limiting caffeine
  - appropriate vitamin intake
  - avoiding toxin exposure

We know it’s a “buzz word” these days, but we do recommend compassionate self-care. I encourage your friend, and you can help her, to take good care of herself. It is important not to lose herself in her struggle to conceive. If it is getting harder and harder for her, I recommend seeking professional help from a counselor who specializes in the stress of infertility. There is good evidence that focused cognitive behavioral approaches have improved fertility outcomes.

Any supplements that you believe in more than others?

Without knowing her full history, it’s hard to recommend particular supplements, and we don’t recommend any particular brand. I do have some general advice, though.There are many, many potential supplements out there and many, many potential ingredients. I sometimes hesitate to list the supplements that may be useful, because data is mixed, or limited, regarding benefit. In general, if it won’t hurt, and might help, I can support it. This is a small list of common supplements that may be considered. In my clinic, I have a much bigger list, but with the caveat that data is not great. Also, taking fistfulls of pills every day is not for everyone. But, here are some general thoughts:

I recommend a Prenatal Vitamin for all women who may become pregnant. This will provide the proper balance of vitamins and minerals to support a pregnancy when it happens.
Most prenatal Vitamins will have 600-800 mcg Folic Acid. There is some thought that methylated folate has better bioavailability. I also recommend supplementing to 1,000 mcg daily. There is one study that suggested higher pregnancy rates in women undergoing In Vitro Fertilization (IVF) who took the higher dose.
We know Vitamin D has significant impact on all aspects of our health and many of us are low. We have sun protection in our skincare products and even infused in the fabric of our clothing. This limits our sun exposure and production of Vitamin D. Again, there is one recent study that suggests that for women who had Vitamin D deficiency and were supplemented, pregnancy rates after IVF were higher than women with low Vitamin D levels who did not have supplementation.I recommend 2,000 units/daily.
Docosahexaenoic acid (DHA) is an Omega-3 Fatty Acid, commonly found in fish oils. It is a potent anti-inflammatory agent. The essential fatty acids are also important for formation of healthy cell membranes, proper function of thyroid and adrenal glands, as well as hormone production. All of this is important for conception. And for developing babies, DHA is necessary for proper development and function of the brain. I recommend 500-1000 mg daily.
MyoInositol is a B vitamin and recent research has been promising. It can help balance hormones, improve ovarian function, and enhance egg quality. I recommend 2000 mg twice a day.
Ubiquinone/Co-Q10 is a strong anti-oxidant. In many areas of health, it has been found to be beneficial. The impact of oxidative stress and free radicals is a big topic associated with aging. This oxidative stress also impacts ovaries. There is mixed data that 600 mg daily of CoQ10 may improve egg quality.

As a final note, we want to remind you that it’s ok for you to be happy, while also feeling compassion and sympathy for your friend. She will appreciate your support, your advice if she asks for it, your encouragement, and your sensitivity to how she may, or may not, enjoy the celebrations of your pregnancy. Let’s hope she can join you there in time.

We hope we met your Eggspectations—An Eggspert

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Disclaimer: All of the comments on this page are for basic information only. They are based on the opinions and expertise of the authors and are not meant to provide a substitute for medical care or specific treatment recommendations. Each person is unique and requires individualized diagnosis and treatment plans. Any specific questions should be directed to your personal healthcare provider.

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