Supplements to Improve Egg Quality

There is so little in this delicate game of TTC that we actually have control of, so when there is something that can improve our outcomes, it makes sense to act on it.

There isn’t a whole lot of information on supplements that can improve egg quality, but of what is known, I have summarized here. Obviously, I am posting this in my role as a blogger dealing with fertility challenges, and not as a physician.

Since follicles are recruited from “storage” as early as 90 days from when they are ovulated, supplementation is best started three months prior to when your IVF/IUI/BD is happening. In fact, most studies testing the efficacy of supplements on egg quality have subjects taking them for 3 months before their procedures.

Now, obviously, this isn’t always possible, but I don’t think it is an all-or-nothing kind of thing. For example, last cycle, I was doing an FET, so for several weeks, I was not taking these supplements. But I figure that giving my eggs 45 days of quality-improving support will be better than nothing. So don’t sweat it. Do what you can. After your eggs have been retrieved/ovulated, you stop these supplements.

So here’s what I am taking for this round of IVF:

Ubiquinol– this is the more active form of the antioxidant CoQ10. Doses that I have seen suggested range from 200mg to 600mg, going higher if your base egg quality is worse. I am taking 400mg daily, split up 200mg in the AM and 200mg in the PM. Warning: ubiquinol is very expensive.

Myoinositol aka Inositol – this supplement used to belong to the family of B vitamins but because it can be made by the body, they nixed its status. There have been positive studies on the use of Myoinositol for improving egg quality. The dose that was studied was 4 grams or 4000mg per day. Myoinositol at much greater doses has also been shown to be as effective as SSRIs in the treatment of mood disorders. I have taken mine in capsule form, 2 grams in the AM, 2 grams in the PM. The store I buy it from ran out of the capsules, so I am currently taking the same dose in powder form. I just have to measure it myself now.

Melatonin – follicle/egg samples taken from people with good egg quality have eggs that are bathed in naturally greater melatonin concentrations than those from people with lower quality eggs. 3mg is the recommended dose, taken at bedtime, as it can help with sleep. Be careful taking this if you are hypothyroid. Melatonin down-regulates (slows down) thyroid function, and thyroid function is super important in TTC. For example, my TSH level before tak
ing melatonin was 0.84, and after taking melatonin daily for a month, my TSH went up to 1.15! So it really does make a significant difference. Since 1.15 is still under the TSH limit for TTC of 2, I’m not worrying about it too much. Especially since I will be stopping it after egg retrieval.

Omega 3 Fish Oils – help to decrease inflammation, which is important in egg development. Inflammatory cytokines can compromise egg quality, and inflammation in general is bad. I have not found any solid suggestions for dosing, but I take a total combined dose of 1800mg daily. 900 mg in the AM, 900 mg in the PM. I took the same dose even before TTC. It is important to buy good quality brands. Ascenta is a good brand.

DHEA – I don’t take it, but there is research that shows that it can help with egg quality if you are found to have low levels of it. If you do not have low levels of it, it can do more harm than good. Generally, people who tend to produce lots of follicles (PCOS types) should not take this. I am not sure of dosages recommended.

Now there are some other supplements that I have seen recommended by trustworthy sources, but without the randomized controlled trials to back them up, I wasn’t going to spend the money.

I also think that food can be both healing and harming. I have major digestive issues, and when I eat something that triggers my immune system, I get major inflammation. It is noticeable the next day- my tattoos become puffy like braille, the fluid in my joints accumulates and becomes so sore that I feel pressure when I close my hand into a fist. As a result, I am doing my best to stay away from my food sensitives- gluten, dairy, fructans, and polyols. It is so hard, as I love the flavour of garlic and onions, and veggies like broccoli and brusselsprouts. But everyone is different, so just be aware of your food sensitivities and stay away from things that harm your gut.

Too much exercise can also cause problems, as increasing your metabolism causes free radicals and oxidative stress to happen. This can damage DNA in the long term, and I think is part of the reason why female athletes who had an exercise history of greater than 4 years prior to TTC had poorer IVF success. But of course, this is pure speculation, and really, the damage is done. Most women who have a BMI over 30 can benefit from regular exercise. What I’m talking about here is over-exercising to the point of stressing out your body. Like what I have been doing since the 1990’s, and still did until a few days ago.

Anyways, that’s all I’ve got. I hope you find this helpful. Stay tuned to see if 45 days on these supplements made a difference on my egg quality for the upcoming IVF#2 (predicted for end of January, early February).

F$%K Presents! We’re Buying Ourselves IVF for Christmas!

A little over a year ago, DW and I embarked on our very first IVF. It was a special IVF, as it was a reciprocal IVF, and we were amazed by how science could allow my wife to carry embryos with my biological genes in a pregnancy. If you’ve followed our journey since last year, you know that for unexplained reasons, she miscarried twice. She had all of the immune testing that I had, with the exception of the natural killer Th1/Th2 cytokine ratio. All of her results were normal. Later, in September, I miscarried a blighted ovum. It has been heartbreaking for both of us, but hers seems to be a silent one, as we have moved our primary reproductive efforts to me. I try to honour her role and contribution to our journey, but realize that it is nearly impossible to fully do this because she is in essence “being benched” for the time being. She deserves so much more than that, but due to her age, our financials, and the unexplained nature of her infertility, this is the best that we can do for now. I know however, that my wife will be an amazing mother to our babies, and I am so lucky to have her as my partner. All you non-gestational parents out there, share your awesomeness with us.

For days now, I’ve been waiting to hear from our fertility clinic about our next steps, and finally, we have a plan!

We will be doing another round of IVF.

I bombarded our RE with some questions, relayed by email through his nurses. Of course, his answers were super vague and generally unhelpful, but provided some reassurance.

I have copied and pasted them below:

1. Why do you think that none of the seven day-five blastocysts were
successful?

It can be either embryo— genetics vs
random bad collection—– or it could be recipient issues.

2. What is your opinion on how my body responded to the stimulation cycle?

The response was good

3. Any changes he would make to the stimulation cycle this upcoming round,
and why?

Nothing different.

4. Would he recommend that we do PGD/S testing for chromosomal issues or
aneuploidy?

He wouldn’t recommend either.

5. Does the clinic do PGS on day 3 or day 5?

We do pgs on both day 3 and
day 5 embryos. We can do PGS testing on either day 3 or day 5 embryos.

6. If we do PGS, does that mean that we cannot do a fresh transfer (and all
have to be frozen for FET)?

If bx is done on day 5 embryos then those embryos are frozen. This is what is preferred. We are able to do a day 3 bx and then proceed with a fresh cycle and transfer would happen on day 5.

So what I gather from this is that he does not think that there is an issue with our embryo quality (pathology testing of embryo in September 2014 miscarriage was of a chromosomally normal female), and even though we are willing to shell out the dough for PGD/PGS, he doesn’t think that we need it. In fact, because he doesn’t recommend it, the clinic’s plan for me is not to to PGS. I have mixed feelings about it, as embryo quality is one of the major factors that affect IVF success.

Now, some of you may be surprised that we are sticking with the same clinic, but after a lot of thought and consideration, we decided that it was in our best interest to continue with them for several reasons:

– continuity of care- they know what worked/didn’t work for us last time.
– familiar with their system- I know who to call when I need whatever, and have realized that if I need to talk to the nurse asap, I just need to flood the nurses voicemail line with messages.
– the RE is open-minded enough to treat me aggressively for the immune issues, which if we started at a new clinic, would want to put me through the ringer before being satisfied that I need all of the intralipids/steroids/blood thinners.
– proximity- the clinic has 5 locations, 2 which are within 15-20 minutes of our home and work places.
– we got a good lot of quality blastocysts the last IVF. Carrying was the issue.

There is one uncertainty that I feel we just need to live with, and that is the quality of the clinic’s embryology lab. On one hand- we got 7 good day-five blastocysts in the end, but on the other hand, none of them worked out for us. The fact that we got 7 blasts makes me think that their lab is good enough to support their development to day 5, but with none of them working, it leaves me to wonder if it’s them (lab), or us (uteri). Anyway, it’s something we kind of have to roll with, and I will never get an answer to that question, so I should just move on with my life.

I am currently on day 8 day 9 of my current cycle, on no meds, and on day 21 I start taking Lupron again. As you know from above, the plan is to do the long Lupron protocol again. Last time, they started me on a 200IU dose of Gonal-F, went up to 250IU for a few days, and then back down. In total, I stimmed for 14 days, which is on the long end of normal, but I think the Lupron over suppressed me a bit, and 200IU is quite low of a dose of stims.

Last year, the pain of the egg retrieval had me swearing that I would never do IVF again… And here we are, a year later, seemingly in the same place we were last year. We aren’t- we are more desperate, more jaded, but hopefully also little wiser (immune issues). While we are doing the same protocol again (the results were good), I won’t be on BCP’s at the beginning of this one (unlike last IVF- anyone with experience doing IVF without BCP? Please share your experience in the comments below), and we will be fully armed with the intralipids/prednisone/fragmin/aspirin that we weren’t last year.

So yeah, F$&K presents! We are buying ourselves IVF for Christmas!

Happy holidays to you and yours!

Finally- Some Answers

I need to take a breath before I post this. I am an intense ball of “need to google everything” right now, but I also wanted to put this out there for all you super smart fertility people.

So, I got a phone call today from our RE’s head nurse. We got my natural killer Th1/Th2 results, and they are abnormally high. I am very TH1 dominant. In a normal person, TH1 and TH2 should be balanced, as each is responsible for protecting the body against different pathogens. I will write a more informative post about this another day. Right now, I’m just trying to process this new important piece of information.

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They want me to start intralipids next week on cycle day 13. I’m supposed to bring a pillow and a blanket because it involves having me hooked up to an IV for 2 hours. It will cost us $750, but I am willing to do just about anything for this to work.

I am worried about my prognosis for a successful live birth, even with the intralipids. Since I know so little about this, I’m going to spend the evening researching the fuck out of it. My plans were to set up the Christmas tree, but that can wait.

I know a couple of you are also on intralipids. Can you tell me what it feels like, what success you’ve been told will happen with it, and also anything else you think can help me wrap my head around it.

So far, all I know is that being TH1 dominant is related to a slew of autoimmune issues, and explains the Celiac Disease that I have. I also know that stress shifts the dominance even more so in favour of TH1. While stress as a cause of miscarriage is kind of a weak claim, I think that my extreme stress at work during the beginning of the school year certainly could have worsened my TH1 dominance. Next week, I will meet with my family doctor, and get an extension on my medical leave. There is no way that I’m going back to work when I’ve got an embryo transfer happening in two weeks.

Anyways, I’m gonna go google like it’s going out of style, and will post again sometime tomorrow.

Happy Humpday!