How should urologists coordinate IVF bladder symptom care?

Bladder symptoms in patients undergoing in vitro fertilization (IVF) warranted a different evaluation than routine overactive bladder or recurrent urinary tract infection (UTI), according to Aleece Fosnight, MSPAS, PA-C, CSC-S, CSE, IF, MSCP, HAES. The first clinical question was where the patient was in her IVF cycle.

"Someone who is actively undergoing ovarian stimulation has very different physiology than someone 6 months after their treatment," said Fosnight, the founder of the Fosnight Center for Sexual Health and a medical advisor for Aeroflow Urology. Hormonal fluctuations, enlarged ovaries, recent procedures, constipation, emotional stress, and pelvic floor muscle guarding all influenced bladder function.

Fosnight cautioned against anchoring on UTI as the diagnosis. Patients with urgency, frequency, or discomfort were frequently given an antibiotic without further workup, she said, although during IVF those symptoms were often driven by hormonal changes, mechanical pressure from enlarged ovaries, inflammation, and pelvic floor guarding.¹ A thoughtful timeline often provided as much diagnostic insight as laboratory testing.

Pelvic floor therapists were among the most underutilized members of the fertility care team, according to Fosnight. The fertility journey often began long before IVF, after months or years of infertility, pregnancy loss, and repeated disappointments. That chronic stress and anxiety could influence the nervous system and contribute to increased pelvic floor muscle tension, bladder symptoms, bowel dysfunction, and pain, making early referral discussions important.

Beyond muscle treatment, pelvic floor therapists helped patients optimize bowel function, breathing mechanics, pelvic floor coordination, bladder habits, pain management, and nervous system regulation throughout treatment. Fosnight described an optimal collaborative model built on proactive communication: reproductive endocrinologists identified patients who could benefit from early referral, urologists evaluated concerning bladder symptoms within the hormonal and procedural context of IVF, and pelvic floor therapists addressed neuromuscular and behavioral components that neither specialty could fully manage during routine visits. Fertility, bladder function, the pelvic floor, and emotional well-being were interconnected, and patients benefited most when care moved beyond specialty silos.

For bladder irritant counseling, Fosnight avoided giving patients undergoing IVF long lists of prohibited foods and drinks, which added to an already substantial planning burden. Adequate hydration was important, particularly during stimulation, but patients were encouraged to drink consistently throughout the day rather than consuming large volumes at once, which could worsen urgency, frequency, and bladder pressure. Rather than eliminating every potential irritant, patients were encouraged to look for patterns involving caffeine, carbonated beverages, alcohol, acidic or spicy foods, or artificial sweeteners, because triggers varied between individuals; an individualized bladder diary could help.²

Constipation was common during IVF, Fosnight noted, and "that constipation is going to increase bladder pressure, put more tension on the pelvic floor muscles, and then potentially worsen those urinary symptoms." Addressing 1 system could improve the others. Fosnight also encouraged healthy bladder habits without creating fear around normal sensation, helping patients understand what to expect and recognize symptoms that deserved further evaluation.

References

1. Groutz A, Gold R, Gordon D, et al. The effect of a sharp increase in estrogen levels on overactive bladder symptoms in women undergoing ovulation induction. Urology. 2020;140:34-37. https://pubmed.ncbi.nlm.nih.gov/32194090/
2. Handa VL, Ha B, Seo Y, et al. Potential bladder irritants and overactive bladder symptoms: a systematic review. Urogynecology (Phila). 2025;31(4):454-464. https://pubmed.ncbi.nlm.nih.gov/40105788/