Monday, 5 August 2013

Should I take supplements during IVF process? Get some logical answer

Does taking supplements help IVF patients?
Practically all women doing IVF are taking supplements of one sort or another, These are supposed to improve egg yield, egg quality and embryo implantation , thus helping to improve IVF pregnancy rates. I have come across women who take over 10 different supplements daily - and I wonder how they manage to swallow so many different tablets, syrups and capsules in a day, On second thoughts thought, it is not surprising, because the craving for a baby can make a woman move heaven and earth; which means taking umpteen supplements is not such a difficult task to accomplish. I have heard the following questions repeatedly from other women who are undergoing IVF treatment.
·         What supplements are you taking?
·         Can you recommend any supplement which can improve egg quality?
·         Is there any special diet which could help in increasing the chances of IVF success?
·         I wish I knew a magic supplement or diet which will make our much desired wishes come true.
·         Why do women undergoing IVF take so many supplements?
·         And how important is it to take these supplements during an IVF cycle?
·         Do these supplements really help?
·         Why do so may ART centers prescribe supplements for their patients before an IVF cycle?
·         Does this impact their success rates?

There are lots and lots of questions - and this blog is intended to answer some of these in a rational way.

Why did supplements gain importance in the field of IVF?
Women who are struggling to have a baby are desperate to find a solution for their problem and are ready to try anything which may help to make their dream come true. No one can pinpoint why a particular IVF cycle fails - and when there are no simple logical answers for the failure, anecdotal evidence and empirical therapies gain lots of importance in the field of IVF. Patient pressure and competition among IVF clinics have forced clinicians to give nonfactual solutions to these questions. When we are spending lots of money for IVF treatment, we want to give it our best shot. Taking supplements gives us a sense of satisfaction that we are doing our best to maximize the chance of success.

Which supplements are used by woman undergoing IVF?
There are list of supplements which are used by women who undergo IVF  like (Co-enzyme Q10, r-alpha lipoic acid, Pycogenol, Resveratrol, Melatonin, , Vitamin C, Vitamin E, Selenium, Zinc, Myo-inositol, Cinnamon extract, Apple cider vinegar, DHEA, Choline, L-arginine / L-ornithine, Prenatal vitamin, Vitamin D, Vitamin B complex, Folic acid, Biotin, Calcium, Omega 3, Low-dose Aspirin, Vitex , Royal jelly, Wheat grass, Flax-seed oil, Evening primrose oil, Nettle leaf and Red raspberry leaf tea, Probiotics and many many more

For what purposes are these supplements used?
·         For increasing egg quantity
·         For improving egg quality
·         For increasing endometrial thickness
·         For improving endometrial receptivity

How are the above mentioned supplements thought to help?
These supplements fall under the following categories:
1.       Anti-oxidants - (Co-enzyme Q10, r-alpha lipoic acid, Pycogenol, Resveratrol, Melatonin, , Vitamin C, Vitamin E, Selenium, Zinc)
2.       Insulin sensitizers (Myo-inositol, Cinnamon extract, Apple cider vinegar)
3.       PCOD mimetic (DHEA)
4.       Vitamins and minerals (Prenatal vitamin, Vitamin D, Vitamin B complex, Folic acid, Biotin, Calcium)
5.       Amino acids (L-arginine / L-ornithine)
6.       Blood thinner ( Low-dose Aspirin)
7.       Essential fatty acids (Omega 3, Flax-seed oil, Evening primrose oil)
8.       Miscellaneous (Vitex, Royal jelly, Wheat grass, Nettle leaf and Red raspberry leaf tea, Probiotics etc)
9.       Traditional ( home ) remedies

What are the alleged things of some of these supplements on the reproductive system?
Pycogenol is a strong anti-oxidant derived from the bark of pine tree. When did humans consume pine tree bark, It is also present in peanut skin and grape seed. It is thought to help with male fertility and there are several other health claims too. Since it is assumed that free radicals cause damage to eggs; this supplement has gained importance among women who undergo IVF.

Myo-inositol is also called Vitamin B8. It is naturally produced in many of our body tissues. The best sources are fruits, beans, nuts and grains. Humans generally consume about a gram of myo-inositol per day. Our kidneys produce 2 grams per day. There are many functions of it in our body but its positive effect on reproductive system is due to its action as an insulin-sensitizer. PCOD women with insulin-resistance are found to be deficient in myo-inositol (perhaps because they have a defective myo-inositol synthesis pathway). Since myo-inositol plays a vital role in insulin signaling, it is thought to benefit women with PCOD. Cinnamon extract, Apple cider - thought to function as insulin-sensitizers and hence might benefit women with PCOD.

Melatonin is touted as a strong anti-oxidant. The story of melatonin's use in reproductive biology started with its ability to inhibit ovulation. It was even used in phase III clinical trials to test its effectiveness as contraceptive.

Co-enzyme Q(10) is another strong antioxidant which occurs naturally in our body. It is present in abundance in mitochondria. It helps in the production of ATP molecules which acts as the "energy currency" of our cells. Since egg cell contains more mitochondria than any other cell type; and ageing egg cells have defective mitochondrial function .

Vitamin D is the new age wonder vitamin, Since the facility to test vitamin D levels in serum is widely available today, almost everyone is screened for their vitamin D levels, irrespective of their sun exposure status and age. The pity is that there are no proper studies to suggest what vitamin D concentration in serum is normal for a particular group of people. Even worse, a lack of this vitamin has been linked to every disease in the world - and use of this vitamin has been shown to prevent practically all the diseases under the sun. So why should reproductive biology leave this 'miracle' vitamin unused.

Are there any supplements which every woman undergoing IVF should take?
Yes, every woman who is trying to conceive should take folic acid. It is a supplement which is proven to prevent neural tube defects in the developing fetus. Folic acid prevents 70 % of neural tube defects. So make sure you take 400g of folic acid atleast 3 months before starting your IVF treatment. Women who have had a child with NTD and women who themselves have NTDs are also advised to take 5 mg folic acid daily. Myo-inositol was able to prevent folate-resistant NTDs in mice but in humans whether this is true is not known. Women who had child with NTD even after consuming enough folates could try taking a myo-inositol supplement too.

Can lack of a particular nutrient hinder my chances of conception?
There is no need for complicated research findings. Just look at the women around you. I come from a developing country in which there are so many women who live below the poverty line. Many survive on just rice or wheat. They can't afford meat, fresh fruits or vegetables on a daily basis. Do you think that their families are any smaller? Since they are poor and illiterate, they are married at a young age. They are extremely successful in expanding their family - actually most have a bunch of children. due to their lack of knowledge about contraception! If nutrients play such a pivotal role in conception, these women who live below the poverty line would never have any offspring. After seeing them I am tempted to conclude that excess nutrients and lack of physical work might play a role in accelerating reproductive ageing. It is a well-established fact that calorie restriction protects the reproductive system in mice from ageing. 

Supplements don't cause any harm, do they?
It is important to understand that no one are not responsible for ensuring the safety of dietary supplements available in the market and it does not check their efficacy either. This means that there is no certainty that the claims of the manufacturers are true - and their safety is not guaranteed either. Remember that too much of a good thing can be bad. The field of supplements is not entirely black-and-white, and there are many grey areas left. Hence it is wise not to overdo anything when you do not know what effect they have on your reproductive system. When you get a particular nutrient through your diet how could take them in excess helps? Remember, more is not always better.

I am taking only herbal supplements and hence I can't suffer any side-effects.
It is a very Illogical on our part to assume that the so-called 'herbal' supplements are safe. The word 'natural' in supplements doesn't mean they are harmless. Even worse, many herbal supplements contain alkaloids or heavy metal contaminants which can cause serious damage to your vital organs. Some herbal supplements can interact with the medications you are taking and make them ineffective. Are you aware that even grape fruit juice can interfere with medications you are taking and can cause life-threatening complications? So please do not think that everything which is marketed as herbal or everything which occurs naturally is OK to take without a second thought, especially when there is no proof for the tall claims their manufacturers make.

What about supplements for improving sperm count and motility?
The simple answer is - nothing works! However, because this is not an answer which patients want to hear, they consume thousands of dollars worth of cleverly named supplements, to "boost" their sperm count and motility. They usually stop after they fail to see results in a few months - but this wasted therapeutic trial damages their confidence - and their bank balance!

Can supplements make my eggs younger or help my embryo to implant?
Our ovary is like an egg bank where the eggs are stored for years. As women age, their eggs in their ovary age too; ageing affects the genetic quality of the egg; and the quantity of eggs available in the ovary declines too. Unfortunately, we do not know the exact mechanism behind such changes, and hence we do not know how to prevent it. I wish there was a supplement which could make me and my eggs younger too!

Should I take supplements?
When all is said and done if taking supplements helps give you peace of mind that you are doing your best to make the IVF cycle a success, go ahead and take it. But before taking them, analyze critically what you might need, depending on your specific condition. If you have PCOD with insulin resistance, try an insulin sensitizer. But remember, insulin-sensitizers can never replace a sensible diet and a good exercise regimen in controlling PCOD. If you are a women with poor ovarian reserve try using DHEA. Women of advanced maternal age can try taking anti-oxidants. A multivitamin tablet is always a safe option - the extra vitamins will just make you produce expensive colorful urine.

The most important supplements as per my understanding is when patient undergoing IVF are need lots of love and pampering from your dear ones. Never obsess about other 'miraculous' supplements, they are not worth it. 


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