Welcome to another episode of The Egg Whisperer Show. I’m excited to have Dr. Meredith Provost on today’s show. We will be talking about the best health, exercise and weight recommendations for your fertility. Dr. Provost received her undergraduate degree at North Carolina State University in biochemistry and medical school at McMaster University. She has a PhD from University of Cambridge in the history and philosophy of science. She then went on and completed her ObGyn residency at University of Arizona and her reproductive endocrinology and infertility fellowship at Duke University. You can find her at Indiana Fertility Institute.
Dr. Aimee: Why did you go into medicine and more specifically, why fertility medicine?
Dr. Meredith Provost: I had a little bit of an unconventional path. It would seem like I was headed that way cause I was a biochemistry major, kind of a classic premed major in undergrad. After deciding on biochemistry, I thought I was heading directly to medical school. I applied to medical school, had gotten in. I ended up becoming a Rhodes finalist and then Bill Gates started a scholarship at University of Cambridge. I applied for a master’s degree in the history and philosophy of science and medicine, and deferred medical school for a year. I ended up staying and doing my PhD because I was having such an amazing time and learning so much. I realized that I missed working directly with people. A lifetime of research really just wasn’t the career path for me. I eventually went to medical school and went from there.
Dr. Aimee: And what led you to the field of women’s health, OB GYN, and then ultimately being a fertility doctor?
Dr. Meredith Provost: So I’ve always loved working with women. I joked when I was in medical school that it really is often the women that are involved in facilitating medical care for themselves their family and for their spouses. So I’ve always really loved working with women. It was in medical school and as a first year medical student, I did a rotation at a reproductive endocrinology office, and up until that point in my life, I’d always kind of been all over the place on exactly what I wanted to do. I remember coming home and calling my parents and being like, this is it. I just loved the patients. I love being able to emotionally care for them. I love that it brought in the biochemistry and my PhD . I was bringing in all of those things that I’d been teaching about. I studied at University of Cambridge where Louise Brown had been conceived in 1978 (first IVF baby). And, it just brought everything together for me and it was love at first sight. It took 12 years until I could actually practice. From that day on, I knew!
Dr. Aimee: Tell us about your athletic career as well.
Dr. Meredith Provost: I played volleyball at NC state. I was on the volleyball team as team captain for two years and VP my senior year. I also played basketball and ran track in high school as well. I really would have defined myself as an athlete first and a scholar kind of evenly to that. I also played basketball for Cambridge. Actually even boxed for a little while! Which is an unknown fact about me that you’re getting from me here.
Dr. Aimee: You are the perfect expert for this talk today. I want you to talk to our listeners a little bit about the science behind weight and fertility. What do scientists know right now about it?
Dr. Meredith Provost: We know that without a doubt, weight can impact fertility outcomes.
The way that I like to describe it to patients is that our weight affects how our brain talks to our ovaries. Weight impacts the messages that our brains normally send to our ovaries in order to get us to ovulate every month.
That’s the simplest way to think about it. I can go a lot deeper from there, but simply put, it just affects the way that our bodies communicate.
Dr. Aimee: That’s really a great way of describing it. Let’s say you had a higher BMI or lower BMI, can you talk more specifically about those different scenarios?
Dr. Meredith Provost: For patients with a higher BMI I think of it this way as a reproductive endocrinologist: fat isn’t about how your jeans fit or what you’re looking at when you look in the mirror. Fat is a hormonally active tissue and fat cells make estrogen. Estrogen is the same hormone that our ovaries make. So if we have a lot of fat cells in our body, they’re telling our brains that we really don’t need to send a message to our ovaries because we have enough.
And so what having a high BMI does is this: it keeps our brain sometimes from sending messages for ovaries to get ourselves to ovulate each month so it can have an impact on your ability to get pregnant from that way.
For patients that are underweight, it’s kind of the opposite problem. The problem starts at the level of the brain where the brain doesn’t send the messages to the ovaries because it is stressed out and thinks that it’s starved, and so that causes kind of an opposite response.
Other hormones like cortisol can get involved. They keep the brain from sending messages to our ovaries that are involved in our fertility.
Dr. Aimee: And what about for men with the same types of scenarios: overweight and underweight?
Dr. Meredith Provost: Interestingly, it’s actually estrogen in men that sends that same feedback message to the brain. So when men have higher fat cells and more estrogen production, they actually produce less testosterone as well. That can affect their sperm production and their sex drive. Lower sex drive can affect fertility. The other thing that can happen with men who are obese is that the testicles are actually outside of our body for a reason. They’re supposed to be at a slightly lower temperature than the rest of our body, but if we have a lot of adipose tissue in that area, that can raise the temperature of the testes and also affects sperm quality and production in that way as well.
Dr. Aimee: How do you calculate body size?
Dr. Meredith Provost: So when we talk about body size in medicine, especially when we’re doing research studies, we talk about BMI a lot. It’s a function of our height over our weight. So it’s kilograms per meter squared is the way that you calculate it, and there are tons of online calculators that you can use and it’s easy to figure it out. BMI normalizes height and weight across different people and you can kind of look at whether or not you’re obese based on that scale.
Dr. Aimee: Do you think that it’s the best indicator?
Dr. Meredith Provost: There can be certain challenges with it. I still remember as a D1 athlete looking at military scholarships and being told I was obese. As you can see, I’m not overweight, but I had so much muscle mass, and this led to a higher BMI despite being in great shape.
If you’re shorter, you get less wiggle room because of the way it’s calculated. So it’s not the perfect metric. I think it gives us some information, but where we carry our fat can also be important.
Dr. Aimee: I’m sure you get this question all the time: What is the best fertility diet?
Dr. Meredith Provost: I do and I think it’s a challenge.
I think the best diet is something that you can maintain. I always say fertility is a marathon, not a race. So if whatever diet you’re doing, you can only do for a week, that is not going to work. It needs to be something that you can do for a long period of time.
My main rule of thumb is: eat real food. I think if you are eating actual food that’s, you know, fruits, vegetables, meats, that have not been processed, it’s going to be hard to go really wrong with the diet.
I also explore fasting and recommend this book for my PCOS patients. Really restrictive diets just set people up for binge eating though, so you have to be a little bit careful with those.
Dr. Aimee : That’s great advice. If weight is a factor with your fertility, what kind of advice do you give your patients?
Dr. Meredith Provost: I look at their diet and look at how much processed foods they’re eating. I think often even things like diet soda can have an impact on your insulin and can cause weight gain. Seeing a nutritionist can be a great option and having an accountability group is helpful too.
There are many creative ways to have accountability groups with the internet. Whenever you’re trying to make any change, having some sort of accountability really helps.
Dr. Aimee: What exercises can a woman do during her IUI treatment cycle and when should she stop?
Dr. Meredith Provost: I don’t really tell patients to stop. I think if they’re exercising, that’s great. If the woman has a problem with exercise, if she’s over exercising, that’s a different story.
My general rule of thumb is if you can’t take a day off of exercise or you think that taking a couple of days of exercise off is something that you cannot do, then there may be some pathology there. If you’re not a professional athlete and you can’t take a day or two off to rest, then that may be a sign that you’re exercising too much.
But for everybody else that’s out there running a mile or two and lifting some weights on a regular basis, I think that it’s fine to continue exercising. I think it’s a great way to release stress. We take a lot of our other coping mechanisms away and off the table when we’re doing fertility treatment.
Any healthy ways we can have are a good thing to continue.
Dr. Aimee: I think that’s very important point for people to hear: that as soon as you are trying or are pregnant, you think that you have to stop all the things that you enjoy, including exercise, and that can potentially be detrimental.
Dr. Meredith Provost: I tell patients: you’re pregnant, you’re not broken. Your body works. Use it.
Dr. Aimee: What about during an egg freezing or an IVF cycle? What recommendations do you have around exercise at that point?
Dr. Meredith Provost: The only time I recommend restriction of activity is when the ovaries are big and we want to protect them. That’s usually around when we’re actually retrieving eggs and in the second half of the IVF cycle. When the ovaries get swollen, patients need to take it easy because of the risk of ovarian torsion. Walking is fine. But you really have to listen to your body at that time.
Dr. Aimee: What are your exercise recommendations before and after an embryo transfer and in early pregnancy?
Dr. Meredith Provost: I don’t really restrict activity for those patients. I always joke and I say, you know, don’t take up running a marathon and don’t go to the bar and ride the mechanical bull. You know, I just always say that to patients.
Dr. Aimee: I love that. Do you have a goal BMI for your patients?
Dr. Meredith Provost: When we look at IVF outcomes, we definitely see that patients who have a normal BMI do better.
When we look at just straight IVF outcomes and miscarriage rates across the board, as we go up in those BMI categories and get to heavier weights we see a decline in pregnancy rates by about 10%. But even at the highest BMI, our success rates are still higher than we see in some young normal weight patients who have other issues like diminished ovarian reserve.
So we’re really stuck in this hard place with how far we should go in terms of recommendations (that patients lose a lot of weight). I make my recommendations based on the patient’s age, how much room they have to make adjustments to lose weight and how much time we have for that based on their age.
Obviously we would love for everyone to have a normal BMI (under 25 or under 30). I prefer it if patients can get their BMI under 40. What’s best from a reproductive standpoint is also what will be best for carrying a pregnancy.
I would prefer the BMI of my patients to be under 40 if possible. Even a small reduction in BMI can make a difference. Sometimes we’ll talk and see if we can lose 10 pounds. Can we lose 15 pounds? And will that make a difference for you? And if it will, that would be great.
Dr. Aimee: I absolutely love your perspective. So you basically don’t body shame patients and say, you can’t get pregnant right now. I won’t help you because of your size. You’re basically going to work with them to see what they can achieve.
Dr. Meredith Provost: I will work with my patient’s OB GYN and make sure that they are comfortable managing that pregnancy because that’s an important piece of the puzzle. If their OB GYN is in board and I’m on board, you know, we’re just trying to help them get pregnant in the healthiest way possible.
Dr. Aimee: If there is one thing that you can tell our audience about fertility, what would you tell them?
Dr. Meredith Provost: That it’s a marathon, not a race. You take it one step at a time, one day at a time. Just don’t focus and get too locked down on taking everything out of your life. Take it one day at a time. Be you and if you haven’t seen a doctor come see one because it’s not as scary as it seems.
Dr. Aimee: I love it. Don’t be too extreme with all the restrictions. That’s a very good thing for people to know. Thank you again. You can find Dr. Meredith Provost at Indiana Fertility Institute.
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