Vitamins/Supplements before and during IVF

[GlummyMummy]

Can anyone recommend vitamins to take prior to and during IVF treatment?

I have low AMH, and during my last failed IVF cycle I had a bleed very early on in the two week wait, which I think may suggest progesterone issues. Oh and I also had a fairly thin lining. Hoping I can help address these issues myself before our next go, through diet and a vitamin regime. Any ideas? What worked for others?

[bananafish81]

I can really recommend the book ‘It Starts with the Egg’ - which I found particularly useful. The author is a biochemist who went through IVF with diminished ovarian reserve, and ploughed all the research for evidence about what might help egg quality - it’s very easily digestible for the layperson, I found it made me feel like I was doing something proactive, if nothing else.

I'm a low AMH-er, and also a thin-lining-er

I followed the advice in the book about what supplements to take (I ignored the chapters about plastics and nail polish!) - this is what I take

• DHEA (powerful hormone, not really a supplement)
  
• CoQ10 as ubiquinol
  
• Resveratrol
  
• Melatonin (probably not for TTC naturally, for IVF only)
  
• High dose Vitamin D
  
• High dose Vitamin C
  
• High dose Vitamin E
  
• DHA fish oil
  

plus my prenatal, 5mg folic acid (prescribed because I’m on epilepsy meds) and a probiotic

You should definitely speak to your clinic about taking these, in particular DHEA, because although it’s sold as a dietary supplement, it’s a powerful hormone, and you need to have your levels monitored so that you’re not overdoing it with testosterone through the roof.

DHEA and CoQ10 are both recommended by clinics like Lister for women with DOR, although some clinics like Create and ARGC really aren’t keen on patients taking it.So definitely check

I saw a pretty big difference in the egg and embryo quality between my first and second rounds:

Cycle 1: AFC 5 at baseline: 7 eggs, 6 mature, 4 fertilised and good quality at day 3 but none made it to blastocyst

Cycle 2: AFC 10 at baseline: 17 eggs, all mature, 12 fertilised, 7 made it to blastocyst - of which was transferred (BFP but MMC at 10 weeks) , 4 are on ice, and the remaining two weren’t sufficiently good quality to freeze

I have no idea if there is any correlation or causation but the first round I had only been taking a cocktail of egg quality supplements for about 6 weeks vs the second round, where I had done over 3 months of the supplements (the duration of the egg maturation process).

But women with almost undetectable AMH of 1.5 are not supposed to get 17 eggs and 7 blasts. The embryologists all asked if it could have been a lab error!

[bananafish81]

As regards thin lining, the issue comes down to whether your thin lining is related to non responsive oestrogen receptors (my issue) or uterine blood flow.

Most of the lifestyle stuff can help LOTS with blood flow - I tried it all, and it did absolutely bugger all for me, because the Dr looked at my blood flow with the doppler and it was spectacular.

My issue was sleepy oestrogen receptors in the endometrium, so the only way we were able to thicken up my lining enough to go ahead with a fresh transfer, was with boatloads of oestrogen tablets (HRT). Mine went from 5.5mm to 8.5mm in three days

Minimum for transfer was 7mm, consultant preferred 8mm, anything above that is perfectly adequate.

My lining never got above 5mm in a natural cycle, so the only way we can TTC naturally in between IVF cycles is if we do a monitored cycle with HRT support added in at the right time, so as not to block ovulation.

If, however, your issue is blood flow (has your blood flow been checked?) then there are a number of things that you can try:

• acupuncture
  
• heat packs
  
• vitamin E
  
• l'arginine (but can harm egg quality, according to the book - would use in a FET only)
  
• pomegranate juice
  
• red raspberry leaf tea
  
• baby aspirin (check with your Dr)
  
• vaginal viagra (not available in this country - check Fertility Friends immune FAQ for more info on how to access this)
  

It really does very much depend on your issue, I did ALL of the above in a natural cycle, but because my blood flow was spectacular, they did absolutely nothing for me - there simply wasn't enough oestrogen for my non-responsive lining to grow, and my lining was a horrific 4.6mm and non triple line.

It really really depends on what your issue is. I would get the blood flow checked in the first instance.

[SesameSparkle]

Hi, I’ve also got low AMH and like banana I’ve also read it starts with the egg. I take a pregnancy multivitamin, 600mg CoQ10, Omega 3, high dose Vitamin D (3000IU), Vitamin C and Vitamin E (also meant to be good for lining). I’ve tried DHEA, but it didn’t do anything for me apart from give me horrible skin and greasy hair. I’ve also drastically reduced household chemicals like BPAs, plastics, pvc and parabens. None of this lot has worked at all, but it’s nice to feel like I’m doing something and I don’t think these supplements do any harm. My fc are also fine with my list.

If you’ve been bleeding early on in the 2WW then you should talk to your fc about whether you could top up your progesterone supplementation.

[bananafish81]

sesame you're better than I was - I skipped all the stuff about plastics and chemicals and not using nail polish. I honestly didn't think my falling pregnant or not was going to hinge on whether I wore varnish on my toes, I figured I had to draw the line somewhere

I did experience the greasy hair, oily skin and spots with the DHEA I'm afraid. But it went away once I stopped taking it, and it did seem to have made a big difference - the stims protocols for both cycles were identical, but my follicle count at baseline for my second cycle (after DHEA, before stims) was double what it had been previously. So can only think DHEA had something to do with it.

Vitamin d wise I took a ridiculously high dose (10,000iu) and made sure I got my levels checked as it's fat soluble so too much isn't good. However as I was nowhere near the upper limit I dread to think what my levels were like before I started taking it! Def worth checking your levels to see what dose you may benefit from

Agree entirely with sesame about the progesterone

A friend bled early in her first cycle and was given Gestone injections as well as the pessaries, and she didn't bleed at all and is now 8 weeks pregnant. Would definitely ask about additional progesterone next time xz

[Everhopeful76]

Glummymummy - I followed advice from" it Starts with the Egg"- not quite as stringently as Banana but was certainly on the dhea,COQ10,vitamin D, (had lemon tasting vials things to top up to therapeutic level, plus Pregnacare and extra folic acid.
Also took the no nail varnish and plastics advice with a grain of salt.

Was also told my iron levels were low, but couldn't tolerate any of the iron supplements -gave me horrific constipation. So decided to just try to just improve the levels, rather than optimum level. So I took, and still do take the spatone sachets(either apple infused) or you put them in orange juice (vit c needed for iron absorption) and floradix supplement as well. And tried to eat more leafy greens and other iron dense foods. Other than that I followed a high protein diet and tried to cut out any convenience food, and sugar as much as possible

Of the blood flow suggestions Banana raises, I did do acupuncture and found that really beneficial.I remember when I was originally going to cycle with CREATE, a scan showed good blood flow for me and have only had 1 scan where my lining was a bit suspect. My main issue was endo on ovaries and thyroid issues that could change in quite an alarming way, so that is my concern with pregnancy, going to get these levels checked asap and speaking to GP tomorrow.

Overall I did make quite a few changes with diet, supplements and lifestyle, and think the acupuncture and high protein diet worked best for me. I did take the COQ10 and DHEA for 3 months but because it was my first cycle of IVF and have been successful, I cant be sure if the supplements made a huge difference in terms of numbers of follicles (as mine was piss poor) but the quality of what I ended up with,may well have made a difference.

[SesameSparkle]

I’ve found that the evidence on taking supplements being of any influence is very poor, unless there are specific deficiencies, or medical problems to address (e.g. B12 or iron deficiency). Although it starts with the egg is very well written, much of the evidence that it presents is not particularly high quality. E.g. I’m not really convinced that consuming large quantities of anti-oxidants, means that they are in turn biologically available in greater quantities within individual cells in your body. But at the same time, for £20 a month I don’t mind hedging my bets on the issue, if I feel that the supplements are safe enough to take. It's also a much cheaper placebo than woo like acupuncture.

banana the household chemical issue I actually feel differently about right now. While I would think the direct impact on fertility is probably only marginal at best, I believe that cumulative exposure to common household chemicals could potentially cause DNA damage and increased rates of certain types of cancer. These are the things that matter to me if I ever became pregnant or got to bring home a baby. Small and gradual changes, like replacing Tupperware and drinking bottles with inert materials like glass, silicone and steel were actually super easy to do, and much cheaper than popping any pills. So were changing over cleaning products and skincare (I’d already been switching up products to avoid SLS). These changes might not go far enough and there is still much within my environment I either cannot control, or currently choose not to (eg exclusively buying organic food). But I have at least consciously chosen to make some small lifestyle changes, with potential for the longer term. However, I do still always wear nail polish on my toes…

[GlummyMummy]

thanks all for your suggestions, this is so useful!! Find I get much more info here that I would get from the doctors!

Hi Bananafish, the evidence speaks for itself in your case I think. I definitely want to start now to give these things time to work before we try again. And yeah, I definitely want to get my blood flow checked out. I tried several of these things in our last round (heat packs, pom juice etc) and I think they did help a bit but probably just too late in the day to make a noticeable difference. Doctors did talk about HRT for lining problems but I am pretty reluctant to have to go down this route, but as you say, it might not be necessary depending what the issue is. My lining was perfectly thick 3 years ago, surprised it would have become such an issue now really.

Hi SesameSparkle - wow, well done for going all out and altering all these things in your life. It's definitely worth a go. I am reluctant about DHEA to be honest, as I have suffered with bad spotty skin in the past, only really got my skin under control recently so don't want to go back to that if I can possibly avoid it!

And yip, going to ask about the progesterone thing as I really think that would have helped. Again, it wasn't an issue first time round but I think I have to accept that that was 3 years ago, I am 3 years older and my AMH is 3 years lower!

Everhopeful76 - how did you find the DHEA? any skin problems? I am definitely going to try and eat more healthily and cut out sugar. I've been bad over the last couple of weeks but I think that's because this cycle failed, I've been a bit like "what the heck!" I am really interested in acupuncture too, if I have time I would definitely like to look at that. I am quite a tense person anyway so can only help! My daughter is going through the terrible two's at the moment so been enjoying lots of easter chocolate after she goes to bed as a reward!!

[bananafish81]

Glummy I’m going to be honest about the DHEA - I’ve been back on it 2 weeks and the pimples are coming out in force. My skin was oilier, my hair greasier, my skin spottier….but my testosterone had been almost undetectable prior to my first cycle, but by the time it was up to high normal levels, clearly the DHEA seemed to have done something to my ovaries as well as my hair and skin! I found it tolerable, and my skin pretty much cleared up overnight when I stopped taking it. But your mileage may vary...

BTW HRT for lining was fine for me. Just tablets, no side effects, apart from some lovely plump juicy lining. I was told to stay on it till 10 weeks, and the Cyclogest till 12 (obv I came off both at 10w when we discovered the MMC)

sesame all makes total sense about the household chemicals - I totally admire your lifestyle changes and am sure they will be beneficial in the long term. I also agree that the evidence in the book is patchy - I’m not a scientist so I certainly don’t pretend to understand the ins and outs of mitochondrial function. I do know that clinics like the Lister recommend DHEA and CoQ10 to poor responders, and Serum recommends melatonin, so they seem to feel there is some benefit that they’ve observed with their patient population. For me it’s exactly as you say - it may have made some difference (I don’t know how else to explain the difference in egg quality, quantity maybe because my ovaries were still slightly stimulated from my previous cycle), but for me I think a great deal of the benefit was the placebo effect of feeling like I was actually doing something proactive. My supplements bill is rather more than £20 a month, but compared with my ‘£350 of Gonal-F lasting me 2 days’ it was small beans in comparison

I did read quite a lot about eating a higher protein / lower carb diet, and my consultant recommended eating LOADS of protein whilst stimming. I aimed to get as much as possible through my diet, but also added in some wholefood protein powder from Purition, which when stirred into some greek yogurt with honey, made a lovely high-protein breakfast or dessert, and was really rather tasty!

[Everhopeful76]

Glummy
I found my skin to be great on dhea. Had compliments on my skin glowing, however my hair was a different story -lank, greasy, thinning. Found also I had increased energy
Now am pregnant, my skin is absolutely awful, really deep rooted spots on chin and a new one appearing on a daily basis
Definitely variations. I guess its worth a shot, you will find out early if your skin will be problematic and then can just stop taking it.

[Everhopeful76]

PS if you are a tense person, then acupuncture and maybe reflexology would at least have a relaxing effect whilst your undergoing treatment. I got really into it, really believed it was helping my cycle

[bananafish81]

I was enormously sceptical, but am now a total convert, to hypnotherapy. I saw a lovely woman who specialised in 'hypnofertility'. Which sounds woo but was lots of really positive visualisation and some great mental tools to help with negative thought patterns and endless catastrophising

I felt it made a massive difference to my stress levels. I also bought some fantastic guided meditation / relaxation CDs & Mp3s. The IVF belief CD from Amazon and an aussie website called 'Be Fertile' were great (some others I tried had pretty annoying nasal voices!)

I'd listen to these at bedtime and they were very soothing. Definitely will be booking hypnotherapy sessions for my next cycle.

[GlummyMummy]

I think I might steer away from the dhea just now, but will certainly give some of the other supplements a go. And the high protein/low carbs. As you say, it's a small amount to pay in comparison to cost of IVF!

Does anyone know about evening primrose oil? Always taken it but not sure about it in terms of fertility treatment...

[Sakura03]

Hi, can I ask what brand of CoQ10 you guys buy? I've used h&b's but they are so expensive, I had a look online but was a but worried they might not be proper ones.

[bananafish81]

I use Solgar ubiquinol

It's not cheap - ubiquinol isn't, but you only need to take half the amount of the regular CoQ10. So I take 300mg of ubiquinol vs 600mg of regular CoQ10

Solgar isn't cheap but it's a very reputable brand and v reliable, so I know I'm more likely to be actually getting the stated dose.

If you're going to take the cheaper stuff (if it doesn't say ubiquinol on the label, it's regular CoQ10) then I would think the brand probably matters less.

[SesameSparkle]

I buy CoQ10 from Costco. I take 4X150mg per day.

[Sakura03]

bananafish yeah Solgar are the ones I've been buying. I had my fertility appointment at my local hospital today, hoping they would check my tubes, but was told that as my mc was within the last 12 months, they'd normally send me away for 6 months before considering checking my tubes as there are risks associated to the procedure. I highlighted my age (37, 38 this summer) and asked if my blood tests showed anything in relation to my egg reserves. He said my egg reserve is slightly low so wants me back in 4 months time... I felt really deflated but I realise I could have had far worse news. I'm off to buy some more CoQ10!

[GlummyMummy]

Hi Sakura - I think the CoQ10 is definitely meant to be good, though I do notice it affects my sleep slightly, waken up early and can't get back to sleep!! I know it is used for increasing energy too so must be that!!

I had my review meeting at the hospital today too. They reckon my latest go of IVF failed because the embryo was genetically abnormal so my body rejected it....hence my bleed on day 5 after ET. Said it wasn't likely to have failed due to lining issues, progesterone problems etc as I suspected. They think our issue might be one of embryo quality. Out of 7 eggs on both our IVF attempts, only 1 is ever making it to day 5 blastocyst, so the rest seem to be poor quality. Interestingly, our transferred embryo this time was better quality than on our last go (which resulted in our little girl, whereas this time it failed!!)

Doctor says having tried both protocols, that they would revert back to the long protocol if we decide to try again. Wants to wait 3 months before another go. She reckons we have a one in three chance but that this time we might not have any embryos at all to put back :-( Going to try anything I can to increase my egg quality between now and then!!