I Was Told To Give Up Yoga During IVF. Was That Necessary?

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Like most longtime yogis, I’ve ugly cried on my mat more times than I can count. But the day after my husband injected me with the final hormonal shot of our in-vitro fertilization (IVF) cycle, I had to take my overwhelming emotional outburst elsewhere because, according to my medical team, I shouldn’t unroll my mat.

Prior to starting IVF back in June, I had a million concerns. What would the daily injections feel like? Would the bloating be unbearable? Would the flood of hormones send my baseline emotional roller coaster flying off the tracks? Would I find a Google search for “annulment” in my new husband’s browser history? All of these questions plagued me in the weeks leading up to the exorbitantly expensive endeavor. But I was blissfully unaware of one particular IVF-specific source of stress until just before the start of my cycle: According to my fertility team, yoga was strictly forbidden.

I was floored.

Before we started the cycle, I had (correctly) assumed that I’d need to put my more intense workouts on pause and that I’d probably need to lay off the HIIT and heavy weights while going through the approximate two-week stimulation phase of daily hormone injections and the egg retrieval procedure that caps the cycle. But I had (incorrectly) expected to use the time off to dive deeper into my yoga practice.

I thought maybe I’d finally have time to understand the physics of Firefly Pose or convince my impinged hips to get over their loathing of Cow Face Pose (admittedly, a lofty goal). But to my surprise—and, frankly, my horror—my fertility clinic’s staff psychologist, of all people, informed me at the end of our pre-cycle consultation that I was welcome to channel my IVF anxiety into meditation sessions and long walks. My most trusted coping skill—coming to my mat to practice yoga—was relegated, along with all kinds of other beloved things, to a list of banned activities.

My mat is my default go-to space for decompression, grounding, and the aforementioned ugly crying. Without it, I tend to struggle with the most basic everyday challenges life throws at me. But being without it during the hormonally-fueled, emotional tornado of IVF, I struggled with much more than the baseline messiness of a bad mood or anxiety attack. I felt foggy, sad, fatigued, and panicky about my impending egg retrieval, which was scheduled to take place 36 hours after that “trigger shot.”

The medical recommendations from my fertility team were enough to scare me away from my mat for an entire month during and after my IVF cycle. But I couldn’t shake the nagging suspicion that this overarching rule was rooted in a misunderstanding about what the practice of yoga actually is—or can be.

The Potential Complications of Practicing Yoga During IVF

Through continued conversations with my treatment team (I asked about it at literally every appointment during my 15-day cycle), I learned the very sound reasoning behind this widespread recommendation: Those undergoing IVF are at an increased risk of a rare but potentially serious complication known as ovarian hyperstimulation syndrome (OHSS). This condition can cause the ovaries to swell and leak fluids into the body, and in severe cases, can lead to issues including severe abdominal swelling, difficulty breathing, and blood clots.

OHSS also increases the risk of another scary scenario that can result in the loss of an ovary. “Ovarian torsion is a very rare complication of IVF that is a surgical emergency,” explains Bay Area-based fertility medicine specialist and reproductive endocrinologist Dr. Aimee Eyvazzadeh, MD, MPH.

A twisted ovary loses its blood supply, resulting in extreme pain. “Women at risk for torsion typically have an ovarian cyst that makes the ovary unbalanced and twist on itself,” Eyvazzadeh says. “Women taking fertility meds are at a slightly higher risk of ovarian torsion because fertility meds cause ovarian cysts to grow.”

Eyvazzadeh happens to disagree with the blanket recommendation to avoid yoga at all costs —and I learned through my research that she’s in good company. But she helped me understand the primary reason many of her colleagues zero in on asana as a particularly risky practice during IVF: twisting the torso—a common move in numerous poses and flows—is exactly the type of motion one wants to avoid when trying not to torque an ovary.

Not All Yoga is Created Equal

“Doctors are saying ‘no yoga’ because their general impression of yoga is based on the kind of yoga classes that are pervasive in the U.S. right now, like ‘yoga-aerobics’ or ‘hot’ yoga, or ‘core-strengthening’ yoga,” says Seattle-based prenatal instructor and founder of Yoga for Fertility, Lynn Jensen.“I would agree that these are not safe for someone undergoing IVF, and not even appropriate for someone who is just trying to conceive naturally,” she says.

After dealing with her own reproductive challenges, Jensen launched her fertility-focused program of classes, retreats, and workshops in 2002. She later co-authored the book Yoga and Fertility: A Journey to Health and Healing and began offering specific Yoga for Fertility teacher trainings to educate instructors on safe practices that are compatible with infertility diagnoses and designed for anyone trying to conceive.

Jensen understands the hesitation many medical professionals have around recommending yoga in any form to fertility patients. “Prenatal yoga teachers are rarely trained to work with fertility patients or anyone trying to conceive,” Jensen says. “I’m a registered prenatal yoga teacher, have been a registered yoga teacher for 20 years, and I’m also a certified yoga therapist—none of those certifications included any training about fertility issues, and certainly no training for working with someone going through assisted reproductive treatments.”

Los Angeles-based yoga and meditation instructor and certified prenatal instructor Kala MacDonald believes the strict no-yoga policy set forth by many fertility experts speaks to a broader disconnect between Western medicine and evidence-based Eastern or holistic practices. “While I understand a Western medical doctor’s all-encompassing ‘no yoga’ policy, what they’re really doing is eliminating a great, accessible, stress-relieving, sleep supporting, whole mind-body practice that could offer so much benefit to a person going through this difficult process.”

MacDonald believes an appropriate, safe yoga practice has the potential to mitigate some of the frustration, stress, and confusion inherent in the process. “A doctor tells their patient ‘no yoga’ but what they really mean is ‘no intensive, acrobatic, overreaching, uncontrolled, too-advanced yoga,” she says. “Those doctors understandably are not co-trained in yoga practices and, with their advice, may be eliminating practices that would not only not be harmful to a patient going through IVF, but could be so beneficial.”

While many  gentle, restorative flows still include some twisting elements, MacDonald says there are still dozens postures that are generally safe, supportive, and worth practicing through IVF.

Research has shown that yoga and movement in general can actually help fend off the psychological side effects of infertility and IVF. Studies have also shown that IVF, as well as infertility itself, can cause a major increase in the risk for mental health conditions such as depression and anxiety—the same ones that yoga and movement may very well help.

The biggest risk of ovarian torsion during the IVF process comes after the egg retrieval procedure, with an incidence of 0.024%–0.2%. The average incidence of ovarian torsion in all women over a one-year period is about 0.0059% (about 5.9 out of every 100,000 women) of all ages. Incidences of OHSS are much higher, affecting between 3.1% and 8% of individuals going through IVF, but rates can be as high as 20% in high-risk women like those who have polycystic ovarian syndrome (PCOS). While the odds of these complications are statistically low, they are very much real and devastating and I’ve known women who’ve experienced the excruciating pain of OHSS. Anyone going through the IVF process should, therefore, be explicitly forewarned by their fertility teams about the early symptoms of these issues and be vigilant for signs of trouble.

But given my emotional reliance on yoga, had I not been explicitly instructed to avoid it, I believe I would’ve been able to navigate things a little less messily by Downward Dogging my way through those days.

What I Know Now

I’ve experienced the calming effects of yoga first-hand over and over again throughout the decades. But I took the advice of my fertility treatment team seriously. My husband and I were investing close to $20,000 in a chance at potential parenthood (the obscene lack of infertility health coverage in this country is a whole other story…). I wasn’t about to screw this up for us just because I missed my Sun Salutations. I dutifully sat out my regular practices, focused on meditation, and avoided any body positions that could in any way, shape, or form, be construed as a “twist.”

Ultimately, even with all that precaution, our IVF cycle wasn’t successful. Out of 14 retrieved eggs and six resulting embryos, only two made it to maturity, and none were deemed genetically healthy. It was heartbreaking but not at all uncommon. In fact, I learned that based on my age, medical history, and various other factors, I only stood about a 30% chance of ultimately having a baby with one IVF cycle.

I knew we’d at least given it our best shot (pun very much intended given the number of injections I endured), but it was an emotional minefield to navigate. I jumped back into my yoga routine as soon as I was given the green light to twist my heart out two weeks post-retrieval, but I had already started to wonder if the no-asana advice was necessary or if I would have mentally benefited from a toned-down version of my typical practice.

After my experience, I reached out to dozens of fertility specialists and was hard-pressed to find a single expert who was adamantly against practicing yoga during IVF. I even reached out to the American Society for Reproductive Medicine (ASRM) and was told they don’t have any members who are “against” yoga during IVF.

Still, the issue is complicated. And so is the practice of yoga, which can take on myriad shapes and forms, with physical twists just one small part of that big picture Although I couldn’t find any specialists who would go on the record against yoga, many—like my treatment team—continue to steer patients away from asana because there are real risks associated with specific postures.

Eyvazzadeh is hopeful more fertility experts will begin to expand their knowledge of the safe, supportive aspects of the practice. “Yoga can help renew your mind,” she says. “It can release both physical and mental tension all while building strength. It can help with better sleep and improve your mindset from stress. My patients are advised to move their bodies throughout treatment and I make sure all of them have built their fertility T.E.A.M.—Therapy, Exercise (especially encouraging yoga), Acupuncture, and Mindfulness—before they start treatment.”

If only I had known.

So Which Yoga Poses Are Considered Safe to Practice During IVF?

Yoga, as practiced in many contemporary Western studios, really isn’t safe during the IVF process. As someone who tends toward the spicy, twisty, inversion-filled vinyasa style, I can say that my fertility team wasn’t wrong in putting me on timeout. But the hope is that more medical professionals will understand that yoga isn’t all arm balances and inversions.

“It’s a long journey ahead, but the answer really is more education so that doctors have a network of professionals, like myself, who specialize in gentle, restorative, subtle body, focus practices, alongside their existing network of chiropractors, physical therapists, and so forth,” MacDonald says.

Eyvazzadeh considers movement an integral part of making it through the IVF process. “I think patients are made to think that they need to stop exercising when they’re going through fertility treatment; that’s a very harmful recommendation,” she says. “Gentle stretching and breathing and poses that don’t involve intense backbends are safe.”

When it comes to which traditional poses are considered safe, Jensen and MacDonald have a list of vetted postures that don’t involve twisting, contorting, or overworking the nervous system—all legitimate IVF no-nos. In addition to gentle breathing practices, Jensen generally endorses resting poses such as Legs up the Wall (Viparina Karani) and Resting Bound Angle (Supported Supta Baddha Konasana). “The key is that even these poses should not be done if they feel uncomfortable,” she says. “And of course, meditation, use of affirmations, chanting, and visualization are always fine to do.”

MacDonald advocates for practicing deep breathing to bring on the calming effects of the parasympathetic nervous system. Included in her list of “safe” poses is Savasana, specifically with support under the knees.

Eyvazzadeh advises all of her patients to read the book Finding Calm for the Expectant Mom: Tools for Reducing Stress, Anxiety, and Mood Swings During Your Pregnancy. And she, in addition to MacDonald and others in the field, advises patients to seek individualized, expert-guided care. No matter which way you lean, it’s essential to consult your physicians and work with your fertility team to come up with an exercise plan you all agree on and feel comfortable with.

While I wasn’t armed with this knowledge when I went through my own IVF journey, my intuitive response to my doctor’s no-yoga policy was to lean into breathwork, meditation, and gentler, more intentional movement. I continued my daily ritual with non-asana-focused practices and even when I was in the clear after my retrieval, I opted for shorter slow flows, yin yoga classes, and even a few pre- and postnatal flows.

And honestly? Re-learning the true tenets of yoga and all that the practice entails inspired me to incorporate a whole lot more of the non-asana facets into my life. And I think my dear, patient husband appreciates how slowing down has kept my typical emotional rollercoaster rides safely on the rails.

About Our Contributor

Michelle Konstantinovsky is a San Francisco-based independent journalist, writer, editor, and UC Berkeley Graduate School of Journalism alum. She’s written extensively on health, body image, entertainment, lifestyle, design, and tech for outlets including Vogue, Vanity Fair, Scientific American, Glamour, Shape, Self, WIRED, Cosmopolitan, Marie Claire, Teen Vogue, and many more. She has also served as the health and wellness editor at Fitbit, senior health writer at One Medical, and contributing editor at California Home + Design. She completed 200 hours of yoga teacher training in 2018 and is still trying to understand the physics of hand balancing. Follow her at @michellekmedia.