Back to Back Cycles?
This weekend we caught up for brunch with good friends Nick and Laura who are both Actors. It was interesting to hear about the last 2 roles that Laura has played involved fertility issues and pregnancy loss. In the psychological thriller Undertow, Laura plays a woman who has just lost a child and in the depths of despair stalks another young mother. To get into character Laura immersed herself in the world of fertility. It is refreshing to see that producers and directors are finally giving the issue of fertility and the quest to parenthood a real life showcase. Undertow is due for release in Cinemas next March/April, it had fantastic reviews at the Melbourne Film Festival and is definitely a must see, don’t miss it!
The book I am reading this week is ‘You are the Placebo’ by Dr Joe Dispenza. This is a fascinating read about the brain, how it works and how you can make it work better for your health. Brimming with real life stories and many studies, it gives you the reason behind double blind and even triple blind studies – Because as you believe you are! Definitely one I would recommend that you read.
Let’s jump back into our discussion and talk about Back to Back cycles.
I was speaking with a client recently about back to back cycles and it was clear that this process had not been explained to her properly or most likely somewhere along the lines of communication she had misunderstood the entire process.
So let’s break it down a little. A definition of a cycle in the fertility space starts at Day 1, being your first day of menstruation (period) with the end of your cycle being the day before your next period begins – that is a cycle.
In the stimulated cycles this next period after all the medication to hyperstimulate the ovaries, the trigger injection and other support medications post oocyte collection, is an extremely unknown and varied event in terms of timing.
There are many situations where a specialist will recommend back to back cycles. For example in oncology patients, prior to cancer treatment. Women presenting with low AMH, diminished ovarian reserve in older patients. Also the patients with genetic conditions, it is common to have multiple cycles and screen embryos prior to having any transfers.
In all these cases the definition of the back to back cycle is extremely broad in terms of timing.
Emotionally having back to back cycles is extremely taxing. If you are fortunate enough to feel as though it has not been too bad, I can pretty much guarantee that those around you, partner, family, friend and co-workers would disagree with you on this point! This has certainly been my experience over the years.
One client talked of the 4 cycles that she had undertaken, she was unsuccessful in achieving a pregnancy and the pressure and impact of treatment nearly cost her the marriage to her husband, it was a profoundly difficult time. Knowing when to stop treatment we will discuss in an upcoming podcast, as this conversation is an extremely important discussion to have before you start treatment.
Ovulation in a natural cycle after a stimulated cycle is also an erratic event in terms of timing. When considering doing a Frozen Embryo Transfer cycle directly after a stimulated cycle it will often be with the assistance of HRT medication to assist with regulation. Or you will have the situation of many blood tests to determine the ovulation time and thawing for the embryo.
So is it better to wait and have a cycle break in between having a stimulated cycle and another one directly after?
Physically and physiologically there is no reason to prevent you going straight back into another cycle. The emotional impact though is worth considering, as it is in this space that many women will struggle to cope.
One client had 8 cycles in quick succession and reached the stage where she felt as though she completely going insane. Her thoughts and coping mechanisms were not supporting her during treatment, so she decided to have a break and forget about treatment for a while. This particular client went on a health retreat for 10 days and achieved a natural pregnancy shortly after returning from the retreat.
What is the explanation in such a circumstance? The intense pressure and elevated anxiety levels that this client felt, were suddenly removed, which created space and in that new place of freedom, not bothering with treatment, her body responded accordingly. I have seen this so many times before, it is common place.
If we consider what is happening with your hormones at this time of a stimulated cycle, we would expect to see a significant rise in estrogen levels to upwards of 10 times what you would normally expect to see in a natural cycle.
We know that there are large numbers of receptors in the brain for these hormones, so they absolutely have a major impact on your emotional state and behaviour. And we have to 10X that impact.
Whilst I support the theory of timing with this cycles and the medical urgency for some, I do believe you should consider your support system during this difficult phase of your treatment.
What are some of the things that you can do to assist you during these back to back cycles?
First I would recommend support in the form of friends, family or support groups, to be there for you when everything is in overwhelm.
I would suggest that you plan to do something for yourself every day and indeed once a week plan something a little bigger. For every day events this could be a walk, meditation, listening to music, gardening, journaling … anything really that you love to do. Once a week the bigger things to do for yourself, could be massage, acupuncture, pedicure, hairdresser/barber, coffee with friends – again this is something special just for you, self-love and connection is important at this time.
If you do not having family or friends close by, attending a group event, whether an art class, yoga or other sporting activity will ensure that you have social connection during this often difficult time.
If you listen to my podcast of Diet and Lifestyle Factors you will hear more on why this is so important at this time.
Specialists will talk of the cumulative benefit of having back to back cycles and this can still be of benefit within a 3 month period, having 2 stimulated cycle and 1 off in between.
The reality is that you have to listen to your body, judge the timing of the next cycle around when you feel that you are ready. Unless medical factors mentioned such as oncology treatment, low AMH, PGD and advanced maternal age are present for you – there is time!
If you have 2 cycles in a 3 months, you are still operating within 100 days which some specialists do recommend, your body will have 1 month to regulate prior to the stimulation starting over again.
The emotional benefits of the cycle off in between is huge and one that should be carefully considered on your next cycle.
Reproductive Scientist, Fertility & IVF Coach