The title of today’s show is Expert Tips to Increase Fertility with Food and Exercise. I’m honored to have Dr. Sasha Hakman with me for today’s interview. She is a board certified OBGYN and sub-speciality trained in reproductive endocrinology and infertility. She’s a former varsity water polo player for the women’s team at the University of Toronto and former marathoner, Chicago and Detroit free press marathons, and made the transition into powerlifting a few years ago.
Dr. Aimee: Hi Sasha! Welcome! Would you tell us about yourself?
Dr. Sasha Hakman: I’m so glad to be here. You did an amazing introduction, thank you for that. Like you said, I am a subspecialist trained in infertility and I am very passionate about lifestyle modification in addition to just simply treating infertility. That entails a lot of exercise and nutrition. It took me quite a long time to get on the right path to finding the most effective way of maximizing my exercise plans and my nutrition to really manage my PCOS in a nonmedical way, so I’m all about sharing that.
Dr. Aimee: You not only are sharing that through your Instagram posts and videos, but you’ve taken it even a step further and now you have a website. Tell us about your website.
Dr. Sasha Hakman: I came to the realization that a lot of women are really intimidated when it comes to lifting weights and strength training. There’s a lot of misconception that it makes you look manly or bulky. Overall, it’s kind of a scary thing to get into, especially when you’re at the gym and you don’t really know what you’re doing.
Over time, I’ve gotten into researching this quite a bit, I even went as far as purchasing the textbooks from the National Association of Sports Medicine that is required to take their exams. Over time I have put together my own workout plans, workout structures, as well as meal plans that are primarily plant-based in order to share that with others who are struggling on their journey trying to figure out how to workout and how to eat during their fertility journey.
Dr. Aimee: What you’re saying is a fertility patient could actually work with you to help themselves get into the best shape, the best version of themselves, both from an eating standpoint and a fitness standpoint. Is that right?
Dr. Sasha Hakman: Yes. I actually offer three things; I offer workout plans, meal plans, and one-on-one coaching for those who really want to cater everything to their personal needs.
Dr. Aimee: You’re basically a quadruple threat, you’re a fertility doctor, a PCOS expert, PCOS warrior, and then everything else. I kind of love you. I have to tell you that I get so inspired with your instagram stories. When I’m having a really bad day and feeling like I’m not going to workout, I think Sasha is doing it, she’s inspiring me, I’m going to go do it. Do you ever have bad days where you’re like, “I just don’t want to go to the gym and lift weights.”
Dr. Sasha Hakman: It actually is incredibly rare now. I used to have those a lot, when I mostly did bootcamps and HIIT training. I’m going to be completely honest, feeling exerted the entire time and out of breath is really not my cup of tea. I know that some people may like that, but I really enjoy my workouts now because I give myself the necessary rest in order to gain strength and muscle mass.
It has also become a really fun thing, because I write down my progress and week to week I can see myself getting stronger, doing things that I wasn’t even able to do the previous week. Now it’s just more exciting. If I’m tired, I feel almost the need to move to get myself wired up again. Then I’m also very curious to see if I am able to do something better this week than I was able to do last week.
Dr. Aimee: I love it. Share your secrets with us, tell us about your workouts.
Dr. Sasha Hakman: My workouts are primarily designed around starting with the more difficult exercises, which are compound movements. Compound movements are specific exercises that involve multiple groups of muscles. For example, if you do squats primarily with a barbell, or deadlifts, military press, pushups, things like that. They work multiple muscle groups, they’re a little bit more exhausting, so I start with those.
Then the second half of my workouts are isolation movements. These are exercises that, as the name implies, work a single muscle group. The easiest example would be bicep curls. It may have some secondary muscle involvement, but these are usually more low impact, lower weights. You’re not really going to progress with your weights the same way that you would with compound exercises.
It’s kind of nice that the first half of the workout is a little bit more intense and then it gets easier rather than the other way around. I always found that kind of annoying when I would go to different workout classes or do HIIT training where it progressively would get more exhausting and I’d have barely any energy left, so I didn’t feel like I was getting the same type of benefit.
Dr. Aimee: What about your meal plans? How do you meal plan day to day? I know you’re super busy, we basically have the same life. How do you prepare your meals? Share your secrets with us.
Dr. Sasha Hakman: For me personally, I find that my greatest success is in eating almost the same thing from day to day. I know that for many people they like the variety. I personally like to stick to two to three different meals for the week. I don’t necessarily meal prep anymore, because I do like the freshness of making it right then and there, so I just have focused on coming up with meals that don’t take a long time to make, so it’s not all that tedious.
With my meal plan that I do offer, there is definitely a lot more variation. I’ve included all of the macro nutrients for those who like to count them. It actually includes a weekly grocery list, so that you don’t have to sit there and plan it out, you just print it out, go to the grocery store, buy all of the items. It does take into account having some leftovers so that you’re not cooking three meals every single day for the week.
Dr. Aimee: I kind of see a new business for you, the Dr. Sasha home delivery fertility meal kits. I’m just thinking out loud for you. I’ll find you an investor. Not that you need one. I’m just thinking out loud here. I do see that. I think there is a huge need for it, so start working on that when you have time.
I want to talk a little bit about exercise, reproduction, and fertility. I have patients that I’m like, “I want you to move. I just want you to have movement every single day,” and they’re like, “Well, I stopped exercising because I’m trying to get pregnant.” Why such a disconnect out there?
Dr. Sasha Hakman: One thing I’ve noticed, even on social media and reading various blogs, is that there are a lot of physicians who say that they recommend to their patients to start low impact exercise, to avoid moderate to vigorous intensity physical activity, to really reduce that especially once they do get pregnant, and to avoid weights, to avoid cardio, and to stick to yoga. This is not based on any science at all, to be quite frank.
I’ve done quite a bit of literature review. If you even look at the American College of OBGYN recommendations, they really stress the importance of continuing to move. Even the U.S. Department of Health and Safety recommends a minimum of 150 minutes of exercise, whether you’re trying to conceive or are even pregnant, and two of those workout sessions should include weightlifting or some sort of resistance training.
It doesn’t always have to include things like dumbbells or barbells, but it can include resistance bands or your own body weight. Either way, there should be some sort of moderate to vigorous stress on the body in order to achieve muscle growth as well as strength. That’s just a minimum recommendation.
There’s actually a significant amount of research out there that shows that women who exercise up to 60 minutes a day — and that’s vigorous physical activity — actually have improved ovulation and reproductive outcomes. Of course, you don’t want to exercise too much, but up to an hour a day seems to be kind of the magic number.
Dr. Aimee: I love it. You’re breaking down the connection between exercise and reproduction. Then obviously with what you’ve shared with us, exercise does not cause infertility. Unless you’re going overboard, and your BMI is under 19.
Let’s talk about strength training and why it’s important. What is it really?
Dr. Sasha Hakman: Strength training involves some sort of resistance training, whether you’re using tools or your body weight, in order to improve your muscular strength and muscle mass as a whole. I know that can obviously be misconstrued or misconceived as increasing muscle mass must mean that I’m going to look masculine.
The reality is that as women we just don’t have the hormonal profile to achieve that sort of masculine look, because our normal testosterone level is substantially lower than the male testosterone levels. The maximum muscular strength we can achieve — and this is with a very rigorous training and nutrition plan, usually with a coach — is up to 50% of what a man can do.
Increasing muscle mass actually helps to reduce your visceral fat and it helps you look more lean. It also has some really improved metabolic profiles, like increasing insulin sensitivity. It can improve your hemoglobin A1C if that’s an issue for you, especially if you have PCOS or are dealing with weight issues and your doctor has told you that you’re prediabetic.
Other major benefits to it, aside from reproduction, is improved bone mass, which long term can help reduce the risk of osteoporosis or osteopenia. It helps with your mental health, it helps with your self-confidence.
Aside from the aesthetic benefit of doing weightlifting, people forget that you actually have improved daily function. If you have kids, being able to lift your kids and multitask while holding groceries and carrying things, moving furniture, etcetera. You are a lot more aware of your mind and muscle connection that you’re able to lift these things much easier without straining your body.
So, there’s just an infinite list of benefits of doing strength training, and more specifically weight training.
Dr. Aimee: How would you define too much exercise when trying to conceive? What is also too much weight?
Dr. Sasha Hakman: Too much exercise, based on the studies I’ve seen, really involves vigorous activity of greater than an hour a day, particularly for women who are underweight. If they have a BMI of 18 or under, then they should really stay clear of too much exercise.
Regarding too much weight, there really isn’t if you’re doing your weight training safely with proper form and it’s gradual. I personally will deadlift up to 230 pounds. Of course, I feel like I’m doing something, but I don’t feel like I’m over-exhausting my body, because I’ve trained myself to be able to do that.
Dr. Aimee: Wow. That’s a lot of weight. That’s impressive. I can only imagine what a great water polo player you were when you were doing water polo, because that’s quite a lot of weight.
What about too much exercise when trying to conceive? Let’s say you’re doing IUI, IVF, and pregnancy. What are your best expert recommendations for patients in those different scenarios?
Dr. Sasha Hakman: There isn’t much of a difference in the different types of treatments you’re getting. The only time is a narrow window of when you’re undergoing ovarian stimulation during your IVF cycle. The main reason for that is we know that the ovaries are incredibly enlarged from all of the exogenous hormones that we’re providing, and they can twist on itself, cause an ovarian torsion, and that turns into a surgical emergency, and of course we want to avoid that. But that’s a very small period of time where you should really avoid exercise.
Aside from that, in preparation for your IVF cycle, doing the daily hour of exercise is incredibly beneficial. Doing it during your pregnancy is also recommended.
Dr. Aimee: That’s what I encourage my patients to do as well, but I feel like they’ve read so much online and maybe other doctors have told them bed rest, you can’t do any exercise. No, I want you to keep moving, there’s absolutely no reason for you after your IUI to stop exercising. Keep exercising and just listen to your ovaries, let them do the talking. If you’re feeling super bloated, take it a little bit easier. Otherwise, there’s no reason medically to stop, it’s not going to interfere with implantation. Thank you for confirming that.
What I want to do is transition to the best exercises for fertility. We talked about strength training. What do you think some of the best exercises are?
Dr. Sasha Hakman: I don’t think there’s a particular exercise. I think that just overall working out pretty all of your muscles are important. They all have their functions for specific reasons. Just integrating various compound movements, I would say, is the most important thing. Isolation movements do help to further strengthen those compound movements and helps to prevent injury as well.
Of course, focusing on proper form. I know that can be sometimes overwhelming, but luckily there are tons of resources for that. I’ve also added videos to my website where I show how to perform all of the different exercises, especially with focus on compound movements.
There isn’t a specific exercise that is a must-have specifically for fertility. I would say generally speaking, the must-do exercises are your squats and your deadlifts, as well as bench press. Those work so many of the muscles in your body that essentially between all three movements, you’re getting a full body workout.
Dr. Aimee: I feel like I need to go do squats now. I feel very motivated and inspired, so thank you.
I want to talk about PCOS. You have your own PCOS story. Can you share a little bit about that with us?
Dr. Sasha Hakman: Yes. Just to kind of give a background on before I even got diagnosed with PCOS. I always had major issues with my periods. They were incredibly irregular, to the point where I would bleed for two months at a time, not bleed for six months. It was absolutely unpredictable.
When I went to go see the physician the first time for this problem, he just put me on birth control pills, no workup, no diagnosis. He just said, “Go on the pill, it will regulate you. It will help treat your acne,” because my acne was a very big problem for me and really affected my self-esteem, especially as a young adult.
Multiple times I tried to slowly wean off of the pill and that never seemed to work. My acne immediately came back, my irregular periods came back. It can be kind of distressing, especially if you’re in a public place and all of a sudden you start bleeding and you had no idea you were going to start bleeding.
Eventually, over time, when I became a resident, the last time I stopped the pill I just didn’t get my period again. I had seen a few OBGYNs, even though I was an OBGYN resident, and no one actually could figure out why I was getting my period. As an inexperienced resident, it was in my second year, I didn’t really put two and two together. It wasn’t until my first year of fellowship that I was really serious with my fiancé about trying to plan for future fertility, and I did the whole workup. My RE who I was seeing confirmed that I did have PCOS.
Dr. Aimee: For people who don’t actually know what it is, what’s the easiest way that you use to define it and explain it to someone who has no medical background?
Dr. Sasha Hakman: I say it’s a combination of lack of ovulation and too much androgens in the body that can cause symptoms like unwanted hair growth, hair loss on your head, and acne.
Dr. Aimee: What do you think is the best lifelong approach to heal and manage PCOS symptoms?
Dr. Sasha Hakman: I am a very strong proponent of lifestyle.
You don’t want to just do a quick diet for quick weight loss. I think focusing on your weight is probably the biggest problem that people have. I think it does originate a lot of times from the doctor’s office where they’re told to lose weight and it will get better, but that’s not necessarily the case.
There’s a number of studies that show that doing things like weight training and eating better even without weight loss improved symptoms, so it’s not always the weight necessarily. Of course, losing weight may be a side effect of living a healthier lifestyle for many, but not necessarily for all, because we know that the genetics of weight loss, especially in women with PCOS, can be pretty complicated.
I think long term just maintaining consistency with your workouts and looking at food as fuel rather than something that you’re trying to either avoid or eating too much of. Just cleaning up your eating habits without focusing too much on the details, I think is the most beneficial thing.
Dr. Aimee: It’s funny that you should say fuel, because I was running through different titles for today and everything had fuel; fuel for your fertility, how to fuel up your fertility, fuel for your PCOS. So, the fact that you said fuel is kind of cracking me up in a good way.
As far as diet, you do one-on-one coaching for people with and without PCOS. Are there any special modifications you make for PCOS patients?
Dr. Sasha Hakman: The biggest modification for women with PCOS is focusing on lower glycemic index carbohydrates. There isn’t any real evidence that low glycemic index carbs are beneficial to women who don’t have PCOS or Type II diabetes, but if you do have insulin resistance, then that’s known to be a lot more helpful. That’s the primary difference.
I also just in general like to focus on a higher protein diet, just because it does really help with body re-composition. Minimizing just a little, just reducing slightly the fat or carbs, or a combination of both. I’ve noticed and a lot of studies have shown that when you do increase your protein intake to 1 to 2 grams per pound of body weight and then slightly reduce your fats or carbs, that actually reduces the abdominal fat, which we know that tends to be the most hormonally active adipose in the body.
Dr. Aimee: What are your favorite sources of protein?
Dr. Sasha Hakman: For me, since I am primarily vegan, I tend to get a lot of my proteins from plant sources. My favorites are things like black beans, lentils, and chickpeas, but I also really do like vegan meats, so I do get vegan sausages, meatless rounds, and things like that. It’s an easy way to get a higher amount of protein. I know it is a little bit more processed, but there is now emerging evidence to show that it is actually less inflammatory than actual animal protein, so I feel a lot less guilty about that and I really enjoy it.
The other source for me is protein powders that are plant-based. My favorite brand is actually Live Body, because it has 25 grams of protein per scoop. I usually just double up the scoops and will get 50 grams of protein right there, which is perfect.
Dr. Aimee: 25 grams is higher than I’ve seen, that’s a good thing for us to know about. What is the one thing you want to tell someone or you’d want someone who is struggling with fertility right now to know? It doesn’t have to be one thing, but what kind of message would you have for them?
Dr. Sasha Hakman: I would say just hang in there. It’s nothing that you did, nothing that you caused. Of course, I do stress lifestyle optimization, but that doesn’t mean that your current lifestyle is what caused your problem, it just means that can help improve it, and if it’s also going to improve your long term health why not give it a try.
Dr. Aimee: I love it. Just share with us your website, your Instagram handle, and where people can find you.
Dr. Sasha Hakman: My Instagram handle is @SashaHakmanMD. You can get a lot more information on specifics about weight training, workout plans, and meal plans on my website at SashaHakman.com.
Dr. Aimee: Awesome. Thank you for coming on and being a guest for us. I hope you’ll come on again. We should have a fertility Q&A with you, I’m sure we’re going to get so many great questions for you to answer. Will you do that with us in the future?
Dr. Sasha Hakman: I would love to.
Dr. Aimee: Okay. Awesome. Thank you. Have a great day. Thanks again.
Dr. Sasha Hakman: Thank you. You too. Thanks for having me.
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