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  • Hands On Women’s Wisdom: Thankful

    Hands On Women’s Wisdom: Thankful

    By Meredith Nathan

    November is a month that draws our focus towards thankfulness. It is
    a time to reflect on what we are grateful for, and to pause and
    appreciate things we may have taken for granted. This month I’m
    thankful for many things, but especially for two visionary women who
    created an integrated center for fertility over 13 years ago. I have
    always appreciated Pulling Down the Moon as a place to work, a place
    to innovate fertility enhancing techniques, a place to meet incredible
    women, and hopefully play a role in their journey to becoming mothers.
    But this past year I got to experience Pulling Down the Moon not just
    as an employee, but as a patient.

    Fertility challenges run in my family. My mother had severe
    endometriosis, and suffered through several miscarriages and surgeries
    before having my brother and I. So it wasn’t a big shock when I
    discovered at 27 that I had large endometriomas, blood-filled cysts on
    my ovaries, that created daily bouts of pain. The birth control pill
    kept these cysts in check, but didn’t cure them – in fact, 6 years
    later as my husband and I were trying to start a family, the cysts
    still had not budged (other than occasionally rupturing and growing
    back again). Add to this very inconsistent cycles, and I knew I
    likely had my own fertility journey ahead…

    After a few months of trying, my husband and I decided I should start
    acupuncture to help my body get into balance. Through acupuncture and
    herbal blends, my cycles normalized over the course of several months.
    I now had 25-27 day cycles (previously my cycles could be as short as
    11 days). Meanwhile, I received a nutrition consult and started a
    detox. After this, I incorporated some general dietary shifts, a
    vitamin protocol, and a pituitary supplement.

    A year after we’d started trying, I had an ultrasound and bloodwork
    done. I was elated with the results! The cysts, which had stubbornly
    plagued me for what was now 7 years, were completely gone! My
    bloodwork came back perfect, and I was told I had a ‘model uterus’! I
    was thrilled with my progress, and thought that certainly now we would
    get pregnant without a hitch! I incorporated timing-specific
    Fertility Enhancing Massage month after month. And yet several months
    later, I was still having tearful mornings and negative pregnancy

    Finally we sent my husband in to be checked out. It may sound silly
    that we waited this long to see what was happening on his side of the
    equation, especially since I work in fertility. But he is such a
    robust, healthy person, and since I knew I had a host of fertility
    issues, we both somehow assumed the problem was only on my end. But
    sure enough, his results came back with room for improvement: though
    he got an A+ for quantity, his motility and normality were more like a
    C-. Without delay, we got him in with our acupuncturists and
    nutritionists, shifted his diet, changed a few lifestyle factors, and
    incorporated supplements and herbs into his diet.

    Meanwhile, I abandoned my high intensity workout regime in favor of
    PDtM’s yoga programs during my two week wait (and eventually during my
    whole cycle), after experiencing what may have been a chemical
    pregnancy…I felt safer doing these restorative, gentle poses, versus
    workouts that may have been overly-stimulating for my body and uterus.
    After giving my husband’s body a month to balance, we started
    re-incorporating timing-specific Fertility Enhancing Massage for both
    me and him.

    19 months from the time we started trying for a baby, I was several
    days late. At this point, I was hesitant to even take a pregnancy
    test…I’d seen so many “Not Pregnant”s at this point, and didn’t want
    to get my hopes up. Lying in bed, I debated whether I would take one
    or not, and finally decided I would. As the minutes ticked by, I
    found myself getting more and more hopeful, even though I tried not to
    be. Finally it was time to check the results. I looked dumbfounded
    at the test that said something I’d never seen it say before:

    This November I am thankful for many things. Unlike when my mother
    was attempting pregnancy, we have so many tools now to help us achieve
    our goals of starting families. There are so many advances in
    Assisted Reproductive Technology, and Reproductive Endocrinologists
    can achieve results that decades ago could only be imagined. My
    husband and I prayerfully considered these options after our first
    year of trying, but never felt like we were being moved in those
    directions. With a little (and then a lot of) patience, and with
    access to so many incredible tools, we immersed ourselves in every
    service Pulling Down the Moon and the world of holistic medicine had
    to offer for both husband and wife. Fourteen years ago the concept of
    a center for integrative care for fertility (to my knowledge) didn’t
    exist. But two visionary women, Beth Heller and Tami Quinn, took
    their own experiences, their pain and loss, and their successes, and
    created a space that offered something they never had during their
    fertility struggles: a multi-disciplinary center for fertility,
    incorporating the best of what holistic therapies could provide for
    couples trying to conceive naturally or through ART.

    Because of their vision, women like me have so many tools and
    resources to accomplish our most urgent, important, and emotional
    goal. And the results of their vision never cease to amaze me…the
    results take my breath away.

  • This Fertility Warrior’s Best Weapon: Breath

    This Fertility Warrior’s Best Weapon: Breath

    By Mollie Ewing

    An important mentor during my fertility journey once used the phrase “Fertility Rambo,” referring to the women who after suffering loss put themselves right back out there on the battlefield; raw, but willing to keep fighting. This idea of being a warrior on the battlefield of infertility has really stuck with me. I have found that if I can breathe, I can keep going.

    I’ve been practicing yoga for almost 10 years and I have always struggled with my breath. I attended many momentum-driven vinyasa flow classes that are meant to “link breath with movement,” but I could not inhale into Warrior II (or UpDog or any other pose) for the life of me. I would move into a pose and then pause for the breath, before holding my breath again in order to move into the next pose. This is the opposite of relaxing for the nervous system and this breathholding left me feeling off balance. One of the most valuable lessons that I have learned over this past year, by far the most challenging year of my fertility journey and possibly my life thus far, is how to breathe through these moments of struggle.

    It sounds too simple when life is so complex, right? But it works- I promise. The best way I can describe the results are a calming and untangling of my mind. It gives me a moment to recoup before reacting to whatever triggered my need to take a breath. Breathing through tough yoga poses is such a compelling lesson on and off the mat- you can breathe through anything. It started on my mat, but works just as well in the real world, especially out on the battlefield of infertility. I am now aware of my natural tendency to hold my breath and how depleted, agitated, and off balance that makes me feel. As soon as I feel this coming on, whether triggered by a challenging yoga pose or an unexpected or unwanted fertility event, I tell myself to take a deep breath. And every time I am reminded of how powerful a deep breath can be. It’s becoming more natural, but I still have to remind myself occasionally to stop and breathe and that is okay because life is about growth. Some days it is easier to say than others, but I truly believe that navigating the wild rollercoaster of the fertility journey is making us stronger with each twist and turn. So, I encourage all of my fellow fertility warriors to pause and take a breath when you feel the struggle coming on. This crisp autumn air will serve as a beautiful reminder of the power of your breath.

  • L-arginine: A supplement for thin lining and low sperm count

    L-arginine: A supplement for thin lining and low sperm count

    by Margaret Eich, MS, RDN

    L-arginine is a supplement that may be helpful for a few specific situations in female and male fertility. First, let’s go over some basic information about L-arginine. L-arginine is an amino acid that our body makes and is naturally found in foods containing protein. Amino acids are the building blocks of proteins that make up structural components of our body like muscle and organs, act as enzymes to catalyze vital reactions in the body, and allow cells to communicate with each other to perform vital body functions.

    Role in Female Fertility

    For women with a thin uterine lining, L-arginine may help improve the thickness of the lining. Adequate thickness of the endometrium, or uterine lining, is important for supporting a pregnancy. Women with a thin lining tend to have low pregnancy rates. A thin lining is defined as a lining of less than 8 millimeters (mm). A thin lining may be due to reduced blood flow through the uterine arteries. L-arginine is a precursor to nitric oxide, which increases blood flow by increasing the dilation of the arteries. L-arginine treatment has been shown to increase the thickness of the endometrial lining. In 6 of 9 patients with a thin lining who took L-arginine, the endometrial lining increased to greater than 8 mm. 1

    Research also suggests that L-arginine may be helpful for patients who are poor responders in an IVF cycle. Poor responders are women who respond poorly to ovarian stimulation medication in that they tend to have few eggs to retrieve or IVF cycles are cancelled. In a study of 34 patients who were poor responders going through IVF, treatment with L-arginine resulted in a lower frequency of cancelled cycles and an increase in the number of eggs retrieved. 2 Later research in patients with tubal infertility showed that L-arginine treatment resulted in fewer good quality embryos and lower pregnancy rates, suggesting that L-arginine may be detrimental for women who are normal responders. 3

    Role in Male Fertility

    L-arginine has been studied in combination with other supplements like pycnogenol and found to be helpful in increasing sperm concentration (count). In one study, sperm concentration increased after 1-2 months of daily treatment with L-arginine. 4-5 It’s thought to work through increased nitric oxide production improving circulation.


    L-arginine is contraindicated if you struggle with low blood pressure. Arginine can also trigger a herpes outbreak, so L-arginine may not be the right choice if you have herpes. As mentioned above, L-arginine may also be detrimental in women who are not poor responders. Remember to discuss all supplement regimens with your physician.

    Bottom Line

    The bottom line is that L-arginine may be helpful for women with a thin lining or who have a poor response to ovarian stimulation medications and for men with low sperm count/concentration.


    1. Takasaki A, Tamura H, Miwa E, et al. Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in patients with a thin endometrium. Fertil Steril. 2010;93(6):1851-1858.

    2. Battaglia C, Salvatori M, Maxia N, et al. Adjuvant L-arginine treatment for in-vitro fertilization in poor responder patients. Hum Reprod. 1999;14(7):1690-1697.

    3. Battaglia C, Regnani G, Marsella T, et al. Adjuvant L-arginine treatment in controlled ovarian hyperstimulation: a double-blind, randomized study. Hum Reprod. 2002;17(3):659-665.

    4. Stanislavov R, Nikolova V, Rohdewald. Improvement of seminal parameters with Prelox: a randomized, double-blind, placebo-controlled, cross-over trial. Photother Res. 2009;23(3):297-302.

    5. Stansilavov R, Rohdewald P. Sperm quality in men is improved by supplement with a combination of L-arginine, L-citrullin, roburins, and Pycnogenol®. Minerva Urol Nefrol. 2014;66(4):217-223.

  • You never know how strong you are until strong is the only choice you have

    By Michelle Johann

    Navigating the world of infertility, I never felt like more of a failure. It was such a frustrating time where you don’t know if you will find your way out successfully. I started going to the fertility clinic before work. Our first procedure failed and that call was devastating. We were already a couple years into the process and wanted some good news. We soon realized this was a marathon and not a sprint! We tried again to get the approval, wait for the following month, and plan for the next medication regime. After our second attempt, we got a positive and were surprised with twins!

    My pregnancy was uneventful. We did the required testing due to ‘advanced maternal age’ with all results clear and we learned we would be having boy/girl fraternal twins. We let everyone know past the 12 week ‘safe period’ on Mother’s Day.

    We were counting the days. We had ultrasound visits with excited family members. We had brunches after appointments. Our twins were growing and we were wrapping up our 20 week appointment when the look on the tech’s face changed. We knew something was wrong. We were notified there was “funneling” of my cervix. We were in shock and the words flowed over us. Diagrams and explanations did not help. We wanted to know what this meant for our babies. We were told that I would have to go on bed rest to get to viability.

    We researched what to do while on bed rest and let everyone know. Hubby made healthy meals and did everything around the house. We had a plan, we were a team, and we would do anything for our babies. I could feel the babies moving and I talked to them. I told hubby that we had to finalize our babies’ names: Payton Marie & Anderson Chris .

    We made it through our follow-up doctor’s appointment and were almost 22 weeks. We were making it through for us and for our little family. On July 21st, I wasn’t feeling well. I seemed to be having Braxton and Hicks contractions. I wanted to be in denial until nothing resolved it. I told my husband that we had to go to the hospital. The car ride was a fog and my husband drove so fast. Nothing worked to stop my labor. Looking back, I can see the movements like a bystander watching a movie. It all went so fast and painfully slow at the same time.

    We were moved to a delivery room. Payton’s bag broke. Anderson’s bag broke. We waited and waited. Again, it was a marathon and not a sprint. I was at risk for infection. We finally met our beautiful babies on July 22, 2012. Despite all odds due to their level of prematurity, they were alive. I saw and felt my children take their first, then last breaths.

    Leaving the hospital without your baby (or babies) is an indescribable feeling of emptiness. During those early days, there doesn’t feel like a way out. My body literally failed me and my babies. We baptized our babies and we buried them. We were thankful for our village that helped us get through those days. My friend that walked in the garden with me, when walking into the church for the funeral took my breath away. My sister-in-law that gave me breast pads for the leaking as my body wanted to nurse my babies that were no longer with us. My dear friend who lost her son and was now pregnant with her rainbow, who hugged me and understood. Her husband that hugged my husband as he also understood. I will never forget the blood curdling cry that escaped my husband’s throat when the tiny casket carrying our twins together came out. It all hurt so much. His cry was what we all felt in that moment.

    I had another diagnosis: Incompetent Cervix. Cervical insufficiency can happen the first pregnancy or subsequent pregnancies. It can be due to trauma from delivery, cancer, biopsies, and unknown reasons.

    We slowly picked up the pieces. You don’t want to hear that time heals, as it doesn’t make it go away, but it does help. Some days you just put one foot in front of the other. We did not want to try again, then one day….we did. We researched, fought doctors, appealed insurance, and then scheduled a pre-pregnancy transabdominal cerclage surgery (TAC) with Dr. Haney. It was the best choice we ever made.

    As the anniversary of their birth approached, I wanted to do something. I did a vision board. I consulted a nutritionist. I did yoga for fertility. I am forever grateful for the women at Pulling Down the Moon. They helped me heal. They helped me be at peace. PDtM, along with all the wonderful women who joined “a club that no one wants to join”, helped me not only survive, but gave me the strength to try again.

    We had two subsequent failures. We were not sure if we wanted to continue to try. Five months after my surgery, I was surprised to find out we were five weeks pregnant. Naturally, for the first time in our lives–after loss, after failures, after surgeries, after everything–we had a chance for a rainbow.

    It was like walking a tightrope for nine months, but I knew with the TAC that I had a 90% chance of a full-term pregnancy despite PCOS, IF, and IC. I am a different person now. I would not wish the experience on anyone, but everyone has their own journey and I am able to share mine to help others. Our five year journey for a family was completed on May 6, 2014 when Gavin arrived at 37.5 weeks. When you see me at the office and I listen to your journey, please know that I do understand.