(Editor’s note: On March 28th 2022, it was announced that Singaporean policy will shift to allow women between ages 21 to 35 to undergo elective egg freezing regardless of their marital status from early 2023. The change comes about under the Healthcare Services Act and is the culmination of several years of debate.
However, remaining unchanged is that only married couples as recognised by the law will be able to use their frozen eggs for in-vitro fertilisation (IVF) procedures.
On Christmas Eve (2020, obviously), my egg freezing doctor called with bad news.
“Your AMH levels are low,” she said. “Any lower and we might not recommend you proceed with egg freezing at all. We can move forward, but you should check your expectations for how many eggs we’ll get.”
AMH—anti-mullerian hormone—is one marker of fertility. AMH and FSH (follicular stimulating hormone) indicate how well your ovaries are producing eggs. The more eggs you can produce, the higher your chances of retrieving lots of eggs from an egg freezing cycle, and the more eggs you retrieve, the higher your chances are that one of these eggs will result in a baby.
“What can I do?” I asked her.
“Evidence is inconclusive,” she said. “Happy holidays.”
I sat stunned for a few minutes, then swung into distinctly un-festive action. Dozens of friends and friends-of-friends have frozen their eggs, so I reached out to them to ask for advice.
And what I learned surprised me. Most of them had low AMH (aka diminished ovarian reserve) before using holistic interventions to raise their levels. Where my doctor’s best advice was to do multiple $15,000 retrievals—pushing what’s already a luxury “elective” medical procedure not covered by most insurers into the realm of stratospheric unaffordability—I would spend the next three months diving deep into interventions to boost AMH, maximise fertility, and ultimately retrieve double the eggs my doctor suggested we could hope for.
I benefited from a whisper network of women who gave me invaluable advice, but it dismayed me to see how little public information exists for women in my situation. It did not, however, shock me. Western medicine is famously dismissive towards female reproductive health. There are far fewer resources devoted to female reproductive health than for men, researchers often fail to analyze trial data by sex, and serious reproductive conditions like endometriosis take an average of eight years to be diagnosed. We are not yet living in an illuminated age of female fertility, with a medical establishment that takes its complications seriously.
But individual women do, and so do many individual providers of both Western and alternative medicine. I’ve compiled what I learned from them in the hopes it might be useful to any woman looking to boost her AMH, or who has been told for any other reason—like chemotherapy or age—that her shot at a successful cycle may be low. These practical steps are also useful for anyone looking to maximise their egg freezing cycles and fertility, whatever their numbers.
The single most important decision I made was to approach these fertility interventions with an optimistic outlook. I knew the process could quickly veer towards feeling like a slog, or something to be bitter over. But I want my future children to live in a world of optimism, curiosity, and solutions, rather than one of defeatism and fear, and resolved to channel this future mother-self throughout.
Fertility experts say this paradigm shift is key. “It’s essential to keep a hopeful mindset,” Dr. Jaclyn Tolentino of New York City’s Parsley Health told me. “I like to recommend exercises such as visualising a successful outcome, as well as journalling emotions and intentions. There’s so much we can’t control about this process, but we can try to focus on how we feel, while supporting and honouring those feelings in a way that is both optimistic and authentic.”
Jill Blakeway, an acupuncturist, clinical herbalist, and director of the Yinova Center, concurs. Blakeway says many of her patients suffer from guilt or regret if their numbers are low. “But sometimes there is no reason,” she says. “Sometimes it just is. Guilt and regret only adds to suffering.” And stressing out over your numbers is counterproductive, as multiple studies have found stress correlates with diminished ovarian reserve. Monica Yates, a period expert and life coach who works with clients on their subconscious brain and its impact on the body, explained the correlation to me further. “Cortisol from stress lowers progesterone,” she told me. “And progesterone is essential for the healthy development of eggs. So focus on how to do this egg freeze in a way that’s empowering for you in the short and long term. Focus on that, instead of dread.”
A fertility diet
Because I already ate plant-based and organic (with a dash of cheeseburger and martini, for balance), I assumed nothing much about my diet would need to change. This was incorrect. It turns out eating for fertility isn’t just about eating clean. It’s about eating specific foods prepared specific ways.
In her book, Yes, You Can Get Pregnant, acupuncturist and fertility guru Aimee Raupp points to research from Harvard and the American College of Obstetricians and Gynecologists, which found that protein-rich, low-carb diets with full-fat dairy products and minimal trans fats and simple sugars improve fertility. Her three essential food groups for fertility are animal proteins (pasture-fed eggs, grass-fed meat, wild-caught fish, full-fat dairy, pasture-fed butter, and liver); healthy fats (olive oil, coconut oil, almonds, walnuts); and cooked vegetables and low-sugar fruit (berries, avocado, cooked leafy greens, sweet potatoes, and root and cruciferous vegetables). She also recommends bone broth, and Brodo’s excellent creations became something of a 3 p.m. ritual for me, in lieu of coffee. (Sadly, it doesn’t offer quite the same zing.) Perhaps my favorite of Raupp’s suggestions was to eat caviar, which I procured from the fertility/wallet/Instagram-friendly Pearl Street Caviar and spread liberally over everything from omelets to blinis.
Although nothing goes with caviar quite like champagne, I largely abstained from alcohol. Evidence is conclusive that heavy drinking diminishes ovarian reserve, and while the jury is still out on moderate drinking, studies have found that light drinkers seek fertility treatments less than moderate drinkers. In any case, I swapped out negronis for the many excellent non-alcoholic alternatives on the market, and am pleased to report on a few I’ll keep in rotation. Kin Euphorics are made with adaptogens, nootropics, and botanics, and their sparkling spritz tastes like spring and optimism in a can, while also distinctly and incredibly like a cocktail. Seedlip’s Garden varietal makes an excellent pseudo-martini that became something of a ritual for me after every night of injections during my cycle.
I took three supplements every day for three months: CoQ10, DHEA, and Fertility Smart. CoQ10 has been found to improve ovarian reserve and increase AMH-positive follicle count, while DHEA increases antral follicle count, which in turn causes AMH to rise. Fertility Smart was recommended to me by numerous friends with similar low-AMH woes who went on to successful egg freezing cycles, and includes many ingredients which have been shown to improve fertility, including magnesium, B-Vitamins, iron, and Vitamin D. Both Blakeway and Raupp stress the importance of Vitamin D in particular, as deficiency has been linked to fertility issues including low AMH, along with polycystic ovary syndrome and endometriosis. Collagen has also anecdotally been found to boost fertility, and it was easy enough to scoop some Vital Proteins Collagen Peptides into the turmeric latte I drank daily instead of coffee. All of the supplements came with the caveat they should be taken for three months. “An egg takes 85 days to develop,” Blakeway confirmed. “Your health during that time has an effect on the egg and its potential.”
The right type of movement
A six-day-a-week workout routine is typically responsible for a significant portion of my zen, so I was dismayed to find out that level of exercise isn’t conducive to optimizing fertility. Researchers in Norway found a direct link between fertility problems and heavy exercise, while numerous others have found that moderate, low-impact movement for no more than five hours per week leads to the best fertility outcomes. “In some individuals, overexercising can lead to disruption in hormone function due to an impaired HPG axis,” Tolentino said. “The HPG axis is a major signalling pathway that controls the production of our sex hormones in premenopausal women.” Exercise is still recommended, but while you prep for your cycle, keep it to under five hours a week, and don’t pick workouts that push you to the point of collapse. Think Pilates, yoga, and hiking rather than barre, running, or HIIT.
Every single woman I spoke with who had embarked on a fertility crusade before egg freezing or IVF said she believed acupuncture helped her most. Many acupuncturists recommend weekly treatments, but I went biweekly. My guiding acupuncture lights were Raupp, who runs her eponymous practice in Manhattan’s Flatiron District, and the Yinova Center’s expert practitioners.
“Here in the West, doctors have begun to recognise acupuncture as a safe and effective fertility treatment,” Blakeway said. “This is thanks to an increase in research that shows that acupuncture improves IVF outcomes and can help women who have poor ovarian reserve to conceive.” Why does acupuncture help? “One proposed mechanism is increased circulation and blood flow to the uterus and ovaries,” Tolentino said. “Another possibility is acupuncture’s benefit in terms of stress and reduction.” In the three months I saw them, Raupp and the Yinova Center used acupuncture not only to work on fertility points, but to treat insomnia and headaches near-instantly, offering real time proof positive their needles were working.
Liza Roeckl, an EMDR therapist, Reiki master, and energy healer who counts Lena Dunham among her clients, recommends Arvigo massage—also known as Mayan abdominal massage—for clients looking to optimise their fertility. When Roeckl worked her magic on my abdomen out of her Soho studio one rainy March morning, she found that my uterus had moved slightly forward of its optimal placement, and gently, painlessly massaged it ever-so-slightly back into place. She showed me how to massage myself at home—clockwise, around the belly button—not just to keep everything in its proper place, but also to support blood circulation to the reproductive organs. “By repositioning the reproductive organs through gentle massage, blood flow and energy is increased to all organs,” Roeckl tells me. “These vital fluids and energy nourish and repair the organs naturally—including the ovaries—making the quality of the eggs healthier.”
Avoiding endocrine disruptors
As Nicholas Kristof reported recently in the New York Times, endocrine disruptors—found in plastics, makeup, ATM receipts, pesticides, food, detergent, toys; in short, found everywhere—have a negative impact on egg quality, along with sperm count.
But racing to replace every endocrine disruptor you interact with sounds like a recipe for the exact sort of stress expectant egg mums are instructed to avoid. So I decided to focus on reducing toxic exposure rather than eliminating it completely by making a few high-impact swaps.
And as it turns out, shopping in pursuit of reproductive health can spark a fair bit of joy. My (other) quarantine project, finding my culinary groove, necessitated a switch away from toxic cookware, which is most commonly found in ubiquitous non-stick options. Clean swaps abound, but perhaps none is so aesthetically-pleasing as Caraway, whose ceramic-coated dove grey set now plays host to my ragus, roasted veggies, and caviar omelettes—and is also dishwasher-safe and a breeze to clean.
Next up came my beloved candles, which it turns out were perennially/tragically burning carcinogenic soot (from paraffin, a petroleum byproduct) into my apartment. Luckily, Bee Shapiro, one of those chic Williamsburg mums who’s also a reporter for the New York Times, created a line of non-toxic candles because she couldn’t find any while pregnant with her first child, Ellis. The resultant company, Ellis Brooklyn, now includes perfumes, bath products, and candles, which come in heavy moss-green jars and smell like that international vacation you’ve been longing to take.
Further luxurious clean-ups came care of Glacce, whose crystal water bottle replaced my plastic bottles, TenOverTen’s non-toxic nail polish, which has a miraculously-effective quick dry topcoat, and Kate McLeod, a former pastry chef who makes body stones sans synthetics or preservatives traditionally found in lotions out of a chocolate factory in the Hudson Valley.
These swaps were downright pleasurable, which reminded me of some of the most helpful advice Roeckl gave me: to think of maximising fertility as enhancing your own quality of life, rather than adjusting everything around a projected future outcome. Making these three months positive and in some cases downright pleasurable has sustainably changed my lifestyle even though my cycle is over. I drink less, stretch more, and understand the power of an acupuncture needle to work its magic on everything from fertility to sleep to stress. Which means that when I look to conceive naturally, I’ll have already been living a conducive lifestyle. “A baby is the icing on the cake,” Roeckl said. “When you start seeing it like that, the real magic occurs.”
And magic did occur: my retrieval resulted in double the number of eggs my doctor predicted. Studies back up the magic: three months of Whole Systems Traditional Chinese Medicine—acupuncture, massage, supplements, diet—result in much better outcomes for IVF patients than those who do nothing, or acupuncture alone. So don’t let a discouraging early prognosis keep you from freezing your eggs. My Christmas Eve self almost did, and is very glad she found a way forward.
This story originally appeared in Vogue.com.