How to fly when pregnant

As a bit of a jet setter with all my work travels, I have written in the past about the effects of flying and jet lag on infertility….but now I am 31 weeks pregnant I wondered what are the effects of flying whilst pregnant?

I don’t have lots of facts for you on this blog post, I know – unlike me!  However, I can tell you that the general advice is not to fly after 37 weeks or 32 weeks if you are carrying multiples.  Every airline has different rules about letting pregnant women fly, so check before you book your ticket!

Just because it is OK to fly before 37 weeks, this doesn’t mean that you won’t suffer side effects of flying when pregnant!!  Overall you are likely to experience leg swelling, bloody nose, ear problems and motion sickness will probably make any pregnancy related nausea worse.  Deep Vein Thrombosis is a higher risk if you fly when pregnant.

Here I offer you the effects that I have personally experienced and some lessons I’ve learned along the way.

So far, I have taken three transatlantic trips in my first trimester, two in my second trimester and two in my third trimester. Two of these trips in the first trimester have required me to make two connections – that’s three legs of flying!!! These trips were quite intense on my body and took a lot of energy out of me.  But overall, I survived them all!  I would like to say that I got used to flying when pregnant, but unfortunately as I get closer to my due date, it becomes more uncomfortable and I discover new challenges!

Picking the right seat in advance.  Choose your airline carefully!  Check out the average legroom by airline here at these two websites: US Airlines overview & All airlines at seatguru.com.  Even before I was pregnant I would choose an aisle seat because of my terribly weak bladder and Irritable Bowels….but this has never been so important when pregnant.  Even when I was 6 weeks pregnant, I went to the toilet over 20 times on a 7 hour flight.  It was ridiculous!  I use the Seat Guru app to check in advance where the seat is in comparison to the toilets.  I like to choose to sit about 4 rows or so from the toilet – not so close you get the smell, noise and annoying people bumping you, but close enough to make a dash for it when it is empty!!

Upgrade if you can afford it.  Sounds obvious!  I have tried to upgrade on the red eye (overnight flight) a few times, but have failed to succeed!  Last time I was 5th on the list, and all 4 people in front of me got upgraded!! I was gutted.  Showing off a big bump doesn’t help unfortunately.  I had even saved up lots of my air miles just for this purpose knowing I’d pregnant at some point in the future!!  I don’t have several thousands of dollars to just buy a business class seat, so I’ve stuck it out in economy for all my flights.

Drinking and Feeding yourself.  Carry an empty plastic water bottle whenever possible to keep hydrated, particularly if you get stuck on the plane before takeoff or taxing after landing, it might be almost two hours by the time you get your next drink!

Fill up your carry-on bag with snacks for both journeys.  I also learned that it’s important to keep snacks for the return journey too just in case you are departing a foreign airport and the shops aren’t open, or certain foods make you nauseous.

I made the mistake of relying on the lunch given out on the plane…they cooked a pasta in a tomato herby sauce and before I even got the food I felt sick from the smell of the herby sauce.  That was the only choice, so I went hungry as I tried to force it down me, it just wasn’t happening!  I also slept straight through an entire meal service because of my tiredness so missed out on food, by the time I got off the plane, got through customs and security again for my next flight, I hadn’t eaten for 7 hours.  I was feeling so, so sick.  I didn’t just have the hun-grumps I was feeling light headed and dizzy.  Fortunately I had water with me at the least.

And another tip – don’t carry nuts, seeds, fruit or dried fruit otherwise it is likely you will have to declare them to customs when you land in another country– and ain’t nobody got time for that!

Getting in the Sleep.  In my first trimester I was suffering a lot from pregnancy tiredness, add on a 5,6 or even 7 hour time zone difference and I am screwed.  For my trip to Turkey I travelled through 4 different time zones.  I strongly suggest not trying to follow a routine, rather listen to your body and sleep when you can.  This is not easy to do.  I had to be at work at certain times and so that meant waking up in the middle of my sleep cycle…I was permanently tired and yawning throughout the day.  Fortunately, most people knew about my pregnancy very early on so they didn’t take it personally as I yawned through their briefs!!!

Remembering your Medication.  This was a nightmare.  I got it wrong big time with my second trip.  My first trip I did the progesterone in oil intra-muscular injections and administered them myself.  It was challenging and I hated it, but in terms of timing this one was easy.  Do the injection just before going to bed.  It didn’t matter about the time zone change because the progesterone lasts several hours longer than 24 hours, so it didn’t matter.  However, this time around after struggling with giving myself the injections, I took the progesterone capsule suppositories, 3 times a day.  This was really hard to do, especially with a 7 hour time zone difference.  I think the first day I travelled I took too much, then on my second day and third day I forgot to take my second suppository in the middle of the day because I was so busy with work.  Then I forgot to change my estrogen patches I was supposed to do on the red eye flight to Turkey.  I remembered the afternoon that I arrived in Turkey when I got into the shower.  So I would suggest putting reminders in a phone with the exact timings so as not to forget.

Don’t forget the sick bags.  Have one of those airline paper bags in your bag just in case you are in a queue and you can’t hold it in!  Fortunately, it didn’t happen to me, but there were times when I panicked I might puke and couldn’t make it to a toilet in time!!!!!

Coping with strange smells.  On one flight I was sat near a man who had a bad Bodily Odour problem.  I was trying not to vomit in my seat, hoping I would just get used to the smell for my 8 hour flight.  Fortunately, he moved two rows forward and my sensitive nose was saved!  But I have experienced smells of things I can’t bear with people sat next to me and then generally in foreign countries the smells are just different.  This is something I don’t know how to resolve or overcome.  It’s just one of those things I guess I’ve got to suck up.  Sorry I don’t have any ideas of how to cope with this, it is more of a warning!  Do you have any ideas??!

The swelling and back aches.  Later into my second and third trimesters I noticed that when I got off the plane the veins in my arms were massively swollen!  At first I was terrified, I looked like a freak and worried they were going to burst or a sign of something bad!  But I discovered later that this is to be expected when flying when pregnant.  There is also no avoiding crappy airline seats – I pack a spare feather pillow, fleecy blanket and neck pillow to make my seat more comfortable.  I have also treated myself to a maternity massage where I had 60 minutes of pure bliss focusing mostly on my lower back.  I have discovered in my third trimester that the lower back has quite a lot of tiny muscles I never knew existed!!

Get yourself Global Entry.  I successfully applied for global entry half way through my pregnancy – this enables you to use the automated passport border control as a ‘trusted traveller’.  The reason I got this was because one time I arrived into Chicago and queued for 2hrs to get through border control…I was feeling very faint by the end.  Nope.  I decided I am not doing that again, particularly for much later on in the pregnancy! I almost punched the woman behind me in the queue because she obviously came from a country where there was no such thing as personal space.  I think the hormones didn’t help me with my patience! So I applied and got a conditional approval after two weeks of applying – then had to wait three months for an available interview slot time that I could get to.  This interview was really quick and easy, it wasn’t so much as an interview for me, more of simply provide my finger prints and have a photo taken.

The other good thing about Global entry is that it also gives you TSA pre-check which is really nice…getting your shoes on and off in the third trimester is a pain in the butt so this has been a nice luxury!!! In my first trimester I travelled to Turkey, and as a result for four trips after I must have been put on a ‘list’ and got ‘extra screening’, known as the dreaded SSSS that gets printed on your boarding pass.  If you ever see this on your boarding pass – it is the ‘not so secret code’ that you will get extra screening.  All this means is that I got a thorough search of my bags, swabbed for explosives and a good pat down.  As long as you don’t fuss about it, the security agents are pretty good about it.

Take it easy and take a taxi.  I learned the hard way that a taxi is a must!  I am usually good and whenever I can get public transport I do.  I personally think it’s a lazy expense that some of my colleagues take.  So for my first trip I took the train and walked to the hotel for 15 mins.  However, this was actually a bad idea.  It was warm and I was dressed for the cold airplane, I almost passed out on my walk to the hotel!  Then lifting and carrying bags up and down stairs when there are no lifts is equally dumb (especially when I had my poor hyper-stimulated ovaries being tender still!).

Know who to call when things aren’t right.  Have a list of phone numbers you can call in case of an emergency, get info on doctors & hospital numbers/names/addresses for where you are going before departing. Fortunately, I’ve not needed this (although I learned this lesson more recently with my experience during the Brussels attacks and the importance of having emergency contacts ready to go and not stored on your phone!).

Not for everyone – telling people you are pregnant.  I know that many people do not like to tell others before the end of the first trimester about their pregnancy, I absolutely get that.  But for me on these work trips it has been really helpful.  I don’t feel guilty for running out of the room to the toilets when I need to, I don’t need to explain the yawning, I don’t need to explain why I am not drinking alcohol when everyone else does, generally I have felt comfortable overall because I have told people I am pregnant.  I don’t need to make excuses or justify my actions or wonder if people are guessing I am pregnant!

So that’s all my thoughts!  There are also some things that Baby Science Project suggested to me from her extensive work travels during her pregnancy…such as flight socks and baby aspirin.  I never used these…mostly because I haven’t been able to find any socks that aren’t horribly itchy.

My OB said I am OK to keep flying up to 34 weeks, assuming I pass all my checkups!  Although it is not top of my list to do when pregnant, it actually hasn’t been quite as bad as I thought.  It is definitely true that the first and third trimesters are the worst for travelling.  In the first trimester it’s the nausea.  In the third trimester, it is just uncomfortable and difficult to move around.  But….I survived to tell the tale.

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Effects of flying and jet lag on fertility pt 2.

In my previous post I described some research that indicates fertility may be effected by the disruption to the body clock as a result of travelling across time zones (or any other job that requires shift work).  There is one hormone that may be taken as a supplement to help overcome and regulate the problems our bodies face as we fly in to different time zones – melatonin.

Melatonin is not new to me.  Some of my US colleagues have told me about the use of Melatonin to help them overcome their jet lag quickly when they are in Europe.

Last year I landed in Germany with a terrible headache that had lasted more than two days, pain killers just didn’t touch it, and I couldn’t sleep – which was probably perpetuating my headache.  So my US colleague suggested I took some melatonin to help me sleep and kick start my body into a natural rhythm.  He warned me that melatonin can have side effects, such as vivid dreams.  I already dream a lot normally, and I had problems in Afghanistan with Anti-Malerial drugs causing vivid dreams and hallucinations; so I was very cautious of taking melatonin.  But I was willing to give it a try as by my third night in Germany I was consistently unable to fall asleep until about 5AM, then working all day with this awful headache.  So I took two of the little melatonin pills, and they helped me to fall asleep before midnight.  Bliss.  I did have some vivid dreams, actually they were more like nightmares, but at least I got some shut eye!  My headache didn’t disappear though, so I decided not to take any more melatonin. I was more afraid of my dreams than my headache.

I didn’t know much about melatonin at that time; I didn’t really look into it.  But since suffering from infertility I have been educated more into melatonin and its purpose.  I came across it in the book “It starts with the Egg” by Rebecca Fett, but I didn’t pay it much attention.

So what is melatonin?  It is a hormone that helps regulate many other hormones in the body and helps to maintain our body clocks (or circadian rhythms).  During light hours of the day, our natural melatonin production drops and when it is dark, the body produces more melatonin.  If we are not exposed to enough light during the day or too bright artificial light in the evening this can disrupt the body’s natural melatonin cycle.

What does melatonin have to do with fertility?  Melatonin is produced by the pineal gland in the brain, but it is also produced by the follicles within an ovary, the mass of cells that surround the follicles, and in the immature follicle itself.  It is here where melatonin acts as an antioxidant which supports cellular health and protection of the immature egg from oxidative stress, especially at the time of ovulation.  Melatonin has beneficial effects not just on eggs but also on embryos.  Mouse embryos grown in a lab with melatonin showed an increased rate of forming bastocyst-stage embryos [1].  As a result of this success, clinical trials were undertaken.   A study of 115 women showed that melatonin may increase egg quality by reducing the level of one oxidising agent called 8-0HdG in the ovum, which is a natural product of DNA oxidation [2].  Women who were given melatonin had a fertilisation rate much higher than their previous cycle and nearly 20% of the melatonin treated women became pregnant.  Whereas only 10% of the non-melatonin group became pregnant.

Melatonin also helps to control body temperature, the timing and release of female reproductive hormones and possibly egg quality.

Finally, melatonin is known to act as an antioxidant during early pregnancy.  In addition, melatonin in the mother’s blood passes through the placenta to aid the creation of the fetal suprachiasmatic nucleus (SCN) where the central circadian regulatory system is located.

Melatonin levels decline with age, and as a result the ovaries lose their natural protector against oxidative stress; hence could be an additional contributor to age-related infertility.

If you are going to consider taking melatonin as a supplement when trying to conceive you need to be careful and should ask your doctor, because the melatonin supplement may disrupt the natural hormone balance and interfere with ovulation.  If you are going through a controlled hormone cycle with IVF this is less of a concern.  In addition, melatonin can cause side effects, such as daytime droziness, dizziness, and irritability and may worsen depression.  Melatonin can also interact with other drugs, so this is why it is important to check with your doctor before taking it.

If you are going to take melatonin as a supplement whilst travelling it is also important to know what time to take it.  You should take the supplement after dark the day you travel and after dark for a few days after arriving at your destination.  In addition, taking melatonin in the evening a few days before you fly if flying eastward.  Again, there is caution to be made here because the long term effects of taking the supplement are unknown.  Therefore this is not overly helpful for airline attendants or shift workers, and only for those who travel infrequently.

For me, personally, I am undecided as to whether or not I will take melatonin as a supplement for either my next IVF cycle or when I am on my next international trip.  But I will certainly be asking my doctor next time we speak.

Have you taken melatonin as a supplement? What are your experiences with it?

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[1] The effect of melatonin on in vitro fertilization and embryo development in mice.  Available here: http://hera.ugr.es/doi/15015646.pdf

[2].  The role of melatonin as an antioxidant in the follicle.  Available here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296634/

Effects of flying and jet lag on fertility pt 1.

I am just returning from yet another trip to Europe, Belgium this time!  This has been my 9th transatlantic trip this year.  Last year I made 10 trips, and the year before that 11.  With an average of a trip every 6-8 weeks I spend a lot of time either sat in a plane or at an airport or, trying not to fall asleep in meetings whilst I try to get over the jet lag!!

Travelling like this is stressful.  I always have a connection to make in the US because I do not live near an international airport, and sometimes I have another connection in Europe as I travel to cities that do not connect directly with the USA so I can often end up with 2 transfers…it can be very stressful making these connections when flights get delayed or security lines hold me up.  For example on this particular trip to Belgium, due to a series of unfortunate and unrelated disruptions it took me 9 hours longer to reach my destination (on top of the planned 14 hours of travel).

I am simply sick and tired of it.  Yes, I get to go visit some cool cities, I am grateful for that opportunity, but it is physically disruptive to my life.  As this is my last trip of the year and I already have 7 trips planned in the first 5 months of next year :-s I am beginning to wonder whether it is such a good idea to do all this travelling.  I am not sure how many of these I will be able to commit to with my next round of IVF coming up.

This got me thinking about how little I know about the effects of flying on my fertility.  Is it even an issue?  Should I be concerned?  So I did a bit of research and here is what I have found so far:

There is currently no overwhelmingly strong evidence that flying has a direct cause of reduced fertility.  However, there are a few studies that indicate that there may be some correlation.

One study I found to be compelling used mice to investigate whether shifting the body clock has an effect on their fertility [1].  The results of this study showed that there may be serious implications for a woman’s reproductive health if her work involves shift work or time zone changes.

To understand the outcome of this study, you need to understand the body clock.  Our body clocks are called circadian rhythms, these are physical, mental and beahvioural changes that follow a roughly 24 hour cycle, responding primarily to light and darkness in the environment.  Your circadian rhythm is produced by your body, but it is also influenced by the environment.  Light is the main thing that influences circadian rhythms – it turns on or off genes that control your internal clock.  Your circadian rhythm can change your sleep-wake cycles hormone release, body temperature and other important bodily functions [2].  (I know travelling certainly screws up my body temperature because I discovered this last year when we were trying to conceive the good old way and I was actually bothering to monitor my temps.)

The researchers of this study found evidence suggesting the severity of circadian disruption may be linked to the severity of pregnancy disruption: mice subjected to advances of the light-dark circle had greater circadian clock disruption and lower reproductive success.  This group’s pregnancy success rate was only 22% compared with the control group of 90%.

WOAH. That’s quite a difference!

So what does this mean?  This means that if this affects mice, there is a good chance it affects humans too – but to what extent remains unknown, more research is needed before conclusions can be made confidently. ….but I couldn’t find anything taking this research further forward.

Now, there have also been a large survey study of flight attendants to examine fertility….there are two interesting conclusions, first that flight crew were found to be more likely to suffer from irregular periods, and also more likely to suffer a miscarriage.  But I find the study designs less compelling, so I’m not even going to write about this in much detail (but you can judge for yourself here).

So is there something that can be done to prevent suffering from the effects of flying and jet lag?  No one knows for sure, but we do know that Melatonin is an important hormone that regulates other hormones…this can be taken as a supplement, but it can also have negative effects on fertility too when taken as a supplement.  And this is what I will talk about in some more detail in Part 2 later this weekend!

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Am I less fertile because I travel trans-Atlantic a lot?

[1]  Summa KC, Vitaterna MH, Turek FW (2012) Environmental Perturbation of the Circadian Clock Disrupts Pregnancy in the Mouse. PLoS ONE 7(5)

[2] Circadian rhythms fact sheet on the National Institute for General Medical Sciences website