UPDATE ON EGG QUALITY AND FERTILITY; why it matters and what you can do about it

Most of today’s fertility treatment focuses on boosting the number of eggs available for fertilization. But in reality, only about 5% of the eggs produced [G1] are even able to become healthy embryos, implant and then result in the birth of a child. I think that it is also important that we explain to women all of the important steps that they may be able to take to optimize the quality of each egg that they are going to produce. Whether you are producing one egg and trying to become pregnant at home or trying to produce as many embryos as possible for an IVF/embryo freezing cycle, this is often the most critical factor which will determine your success.

It takes an egg many months to transform itself from its dormant state to one that is ready to be fertilized. During this maturation process, the egg has to prepare itself for the critical steps of fertilization and implantation. So even though the egg’s DNA content was established years ago; the weeks leading up to ovulation or egg retrieval can have a profound impact upon each egg’s ability to become a healthy embryo. That is why making wise choices in this critical time before conception is essential to optimizing your outcome. So let’s consider what we know about physiology in order to provide you with some practical tips.

Many of the most critical steps that an egg must undergo in preparation for fertilization involve the B-vitamins—specifically B-6, folate (B-9) and B-12. If you’re not getting enough of these critical vitamins, you may have an elevated level of the amino acid homocysteine [G2] in your blood. Elevated homocysteine levels are associated with an increased risk of heart disease, blood clots as well as miscarriage and birth defects. In fact, it has long been recommended that pregnant women take supplemental folic acid—the synthetic form of folate—in order to reduce their child’s risk of certain birth defects. Recently has it has also been demonstrated [G3] that initiating this strategy prior to egg retrieval could increase the success rates achieved by patients undergoing IVF treatment. This discovery makes sense since the primary role of these vitamins is to enhance how your body processes and replicates DNA.

Having an adequate amount of vitamin D—which is also a hormone made by your skin—has also been shown [G4] to be predictive of IVF success. We now understand that this critical hormone/vitamin has a role in regulating your immune system and reducing insulin resistance as well as improving your bone strength. Since your ovaries and your uterus also have receptors for this hormone; it is uncertain whether the boost in conception associated with appropriate vitamin D levels are from its ability to improve egg quality or to enhance implantation. Either way, the evidence suggests that Vitamin D is another one that women should pay attention to when they’re trying to conceive.

To summarize, here are a couple of additional steps to you should consider if you’re trying to become pregnant:

  • Make sure that you’re getting enough B-vitamins; especially folate. Since the use of an oral contraceptive is often included in the process of preparing for fertility treatment, consider one of the new ones that contain the most biologically active form of this key vitamin—like Beyaz or Safyrel.
  • Include a vitamin D supplement in your daily regimen or request a blood test for the active form of this hormone-nutrient called 25-hydroxyvitamin D. Consider your sun exposure well because seasonal variations in production of this hormone do occur. If you’re going to take a supplement, make sure that it is Vitamin D3 and not the less effective Vitamin D2.

39 thoughts on “UPDATE ON EGG QUALITY AND FERTILITY; why it matters and what you can do about it

  1. so where does coenzyme 10 come into play like mentioned in a previous blog of yours. I have been taking that for six months and starting IVF next month. Thanks

    1. CoQ10 is a supplement which may reduce the damage that can occur to eggs as they mature. There is no reason to believe that everyone needs this supplement but there are clearly some benefits to women that have poor egg quality in previous treatment cycles. Hope this helps clarify the difference.

      Best thoughts,
      ~Robert

  2. Dr Greene, I am currently not on any IVF cycle (only be doing a new one in Oct 2011) as I am currently on traditional Chinese Medicine for several months.

    My previous FS put me on a gonal F dose of 450IU and I had 11 mature eggs retrieved, only 6 fertilsed and 2 went to blastocysts, the remaining 4 discarded.

    My new FS (different clinic) is going to put me on that dose come Oct.

    My recent AMH is 6.7pmol/L (0.85mg/ml) and AFC this month was 15. I am 37 going 38 next Jan.

    Dr Greene, I have seen some IVF buddies who having much lower AMH (3 or lower) and older in age, they are really low ovarian reserve, while I am considered borderline. There FS gave them 300IU or max 350IU and they got about 5 eggs retrieved.

    My concern is why I am going to be put on that high dose when my response wasnt that bad.

    Can you help me with a few questions? I am sorry for such a long comment :

    Will such a high dose of gonal F for me compromise egg quality?
    Will such a high dose make my ovaries build resistance to gonal F in future cycles if my next one fails?
    Also, based on my previous stim response, would you recommend a lower dose to start with, or would you let me be on 450IU as well? I really dont mind fewer eggs as long as the quality is good to make a baby.

    Thank you.

    1. Dear mum2oneds,
      This is one of those situations that I cannot fully address in this forum. There is considerable debate on the impact that a high dose protocol may or may not have upon egg quality. The reason that this debate remains unresolved is because there is conflicting data. When I face such a conundrum with my patients, I prefer to present both sides of the argument. I will guide them toward which side I favor but really want them to weigh the options and decide what makes the most sense to them. Admittedly, this approach takes a bit more time and it depedent upon the ability of the doctor to explain that existing data. Is it possible that your center will offer you this approach if you requested it? If not, it may be worth your effort to consider getting a second opinion elsewhere and then deciding what approach makes the most sense to you and your partner. I can reassure you however that there is no data that suggests such a high dose protocol could possibly build “resistance.” That is the beauty of using hormones that are identical to the ones produced by the body. Hope this helps ease your burden.

      Best thoughts,
      ~Robert

      Robert Greene, MD
      California IVF Fertility Center

      1. Dear Dr Greene,

        Firstly, thank you so much for taking time and thought to reply me.

        For my very first cycle, I was with one facility and started on 225IU then not much response upped to 300IU. I think I stimm for more than 12 days and had 5 eggs retrieved though there were actually 10 or more follicles. I was new, just got swept along, and never asked why the no. of follicles did not produce more eggs. Anyway I concluded that the first cycle is quite experimental too. I changed facility as it was too far to travel to.

        For my 2nd cycle, my new RE put me on 450IU based on my first cycle results as well as my AMH value of 6.1. I did very well but BFN. In your opinion, do you think 6 out of 11 eggs fertilised ending up with 2 blastocysts a good outcome? I felt that probably my egg quality is bad but RE did not elaborate further. He did say it is possible that the 450IU Gonal F compromised egg quality.

        For the next cycle, I have switched RE. 2nd RE is kind and caring but I am sick of the long waiting time between appts. This new RE (practise privately but using the same facility as 2nd RE) wants me to be on 450IU. I did not request for it. However, this time I will be on the antagonist since the last two down reg cycles did not achieve BFPs. When I came home and read up more, I felt that I should not be on 450IU.

        If you were my RE, would you start me on 450IU? I think I have already made up my mind that 450IU is too high for me to start with. I just hope for another opinion from a trusted source. I hope I am not putting you in a spot.

        Thanks Dr Greene!

  3. I am planning my next IVF cycle for September. I would like to try CoQ10 since in my last cycle, I had 3 embryos make it to blastocyst but all three had chromosomal abnormalities. However, I am also in the process of weaning my 12 month old. We are down to two times/day. Is it safe to start taking CoQ10 even though I am still nursing? (For the previous cycle, I gave her stored breast milk so that I would not nurse her while taking the medications, but this time I plan to complete nursing before starting the cycle.)
    Thanks.

    1. Dear Mary,
      First off, congratulations on your pregnancy. Since you are weaning a 12 month old, I assume that you did conceive in the fairly recent past. Was that through IVF or a natural conception? Either way, you can rest assured that there is no data suggesting that CoQ10 can be harmful to you, the child that you are weaning or to your developing eggs. This is a fat soluble compound that is naturally made by your body and it is present in many foods as well. More importantly, it has been studied in various doses and has never demonstrated to be toxic–even at high doses like 1200 mg/day. More importantly, that is way above any sort of dose that has been shown to be useful for improving egg quality. So like with all supplements, keep to a reasonable dose based upon your nutritional status and you will be fine.
      Best thoughts,
      ~Robert

      Robert Greene, MD, FACOG
      California IVF Fertilty Center

  4. Thanks for your response Dr. Greene. I will start taking the CoQ10 that has been waiting in my nightstand for the past 6 weeks.

    I did conceive my daughter through IVF. We did not have any fertility issues. We did IVF in order to have PGD for a genetic condition that has a 50% risk of occuring. We didn’t start the IVF until I was already 38 because the gene mutation had just been discovered at that time. Fortunately, I got pregnant on the first cycle, but of 5 blasts, only two were unaffected, both were transferred and there was nothing to freeze. Now that we would like to have a second child we are dealing with fertility challenges due to my age (I am now 40). As I mentioned, we did just complete a cycle that was our first attempt for child #2 and we had nothing to transfer. We started with 18 fertilized eggs that were all progressing well by day 3, but by day 5, there were only 3 blasts. Before testing for the mutation, chromosomal screening was completed and all three blasts had abnormalities (and so the genetic testing was not done).

    So I am trying to do whatever I can to improve egg quality for the next cycle- vitamins, accupuncture, stress reduction and exercise (for many years I have already been eating a healthy, mostly organic diet and have been using products without chemicals, fragrance, etc.) But I have another question in this regard. I have sometimes read that if you are doing things to try to improve egg quality (like taking CoQ10 for example), you need to be doing it for three full months prior to the cycle. But I have also read that it’s the few weeks prior to ovulation that are most important. Which is it? Of course, I am interested because starting CoQ10 now will only give me about 5-6 weeks before the cycle. I could wait until October but with my age (I only have 5 more months before I turn 41), it feels like it’s best to not delay.

    Thanks again for your help.

    best,
    Mary

    1. Dear Mary,
      The concept of “improving egg quality” is a bit misleading. As we understand it today, the steps that can be taken today are geared to minimizing further compromise of egg quality. Let me explain it this way. As a woman ages, the number of eggs that she has declines. Even more problematic, the proportion of normal eggs becomes smaller in relation to the pool of eggs at large. What we are referring to is the genetic information (DNA) contained within the eggs. The steps that you refer to can’t reverse damage that is present. Instead, what you are suggesting is taking steps to prevent good eggs from being compromised as they mature. That’s why using anti-oxidants can prevent new DNA damage from occurring. In terms of the time frame; it takes an egg ~280 days to go from being completely dormant to mature and ready to ovulate. The last 4-6 weeks are when the egg is most susceptible but it is best to make healthy lifestyle changes are soon as possible. Does this all make sense? I do hope that it helps clarify.
      Best thoughts,
      ~Robert

      Robert Greene, MD, FACOG
      California IVF Fertility Center

  5. I had another question about supplements. I have read about clinics recommending myo-inositol and melatonin in preparation for IVF for women who are older to improve egg quality. Is there research to support this?

    thanks,
    Mary

    1. Hi Mary,
      For the latest information on melatonin; check out my blog post titled “Sleeping well…” It summarizes the latest information on how this hormone which regulates your circadian rhythm can provide some beneficial effect. It also explains the latest science on why it may work and helps identify who may benefit most.

      Regarding myo-inositol–that research was primarily geared toward women with PCOS. It was very inconsistent and difficult to determine if/who/when a patient may actually find this intervention to live up to their expectations.

      Best thoughts,
      ~Robert

      Robert Greene, MD, FACOG
      California IVF Fertility Center

  6. Thanks for your responses Dr. Greene. Your clarifications on what improving egg quality means were helpful. Most of the information I read on that is not very clear. In my case, it seems that the goal is that for the small proportion of eggs that are normal, we are trying to help them to mature well and make it to blastocyst. My supplements might help a little. I hope that it also helps that I don’t have diminished reserve yet (in fact, my recent cycle, which was two years after the first, produced more eggs- 26, while the first one produced 18).

    But I am also guessing that the stimulation protocol and the lab where the eggs/embryos have to mature after retrieval may have even more impact. I go to a large clinic that is supposed to have one of the top labs, but I still wonder with these very large clinics if there isn’t some variation within the lab, like maybe some embryologists are more skilled than others and it’s just luck who gets assigned to your embryos. I can’t do anything about that but I have wondered if I should consider another clinic just to see if they can get more of my embryos to make it to blast.

    Thanks also for the other information. It sounds like the myo-inositol wouldn’t be very useful for me since I don’t have PCOS. I read your blog post on sleep and I sleep fine so the melatonin probably wouldn’t do much for me either.

    This is all very helpful. Thanks again!

    Mary

  7. I am really enjoying reading your comments. I am going to be starting my IVF meds about Mid January 2012. IVF#1 in 2009 led to a healthy baby girl, 2 blastocycts transferred, 6 frozen. FET#1, only 2 embryos survived the thaw, unsuccessful. IVF#2 – March 2011 – only 5 eggs fertilized, had two tranferred on day 3, 3 frozen – unsuccessful. FET#2 – Sept 2011 – 2 embryos transferred – unsuccessful.

    Schedule for IVF#3 in January, and I JUST heard about coQ10. I have sent a question in to my fertility dr to get his opinion, but I want to start taking it tomorrow regardless. I can’t see it harming me in any way. I just hope that it is not too late, as this is our last attempt. We financially cannot try again after this. I have been reading 100mg/day, just want to know your thoughts on that. Also, what about for sperm quality? My husband will be having PESA and will be doing ICSI. I want him to do anything that will help. He is taking Vit C, Vit B12, Folic Acid, Vit E, Zinc and Selenium. I am taking Iron, Vit D, PregVit5, cod liver oil and some chinese herbs from my TCMD.

    1. Dear Ms. Foreman,
      Thank you for your kind words regarding this blog. I am always pleased to hear feedback (positive or negative) as reassurance or opportunity for improvement.

      Regarding your questions, I am not able to provid specific recommendations for you since I am not familiar with your full medical history. Likewise for your husband. What I can do is reassure you that there have been several studies suggesting that CoQ10–at the dose you mentioned–can optimze egg quality. For your husband, check out my blog post titled “What can he do to improve our chance of conception?” Finally, I am glad that you are checking this advice with your local doctor. If they have any questions regarding the research that supports these suggestions, please share the links in posts that are cited.

      Best thoughts and Fertile 2012 for you,
      ~Robert

      Robert Greene, MD, FACOG
      CNY Fertility Centers

  8. Dear Dr. Greene,
    Greetings from Cairo, Egypt! I just turned 39 last October and I have 2 girls conceived naturally (13 and 8) my husband is hoping for a boy so we’ve embarked on the ivf ship after a year of no success at pregnancy. Here is my ivf history so far:
    IVF #1 (sept) luteal downregulation with decapeptyl + cycloprogynova then fostimon 300iu day 5-10 then merional 300 iu for 2 days then trigger; 8 follicles; five matured and 4 fertilized; At blastocyst 2 embryos XX; 1 X0; and 1 no signal (PGD)cycle cancelled as no male embryos.
    IVF #2 (november)flare decapeptyl started first day of menstruation up to trigger and 350 iu of fostimon; only 3 mature eggs so doctor cancels cycle and tells me he is surprised as he was expecting a better response but that the fsh receptors vary from month to month.
    IVF#3 (january) luteal downregulation with decapeptyl; 350 iu of fostimon from day 5-8 then merional from day 9-12; at trigger 4 mature eggs; 3 retrieved and fertilized but only 2 make it to blastcyst; I embryo XX; 1 embryo XO (PGD)decide to freeze the XX embryo.

    My questions are these:
    1. I had a fsh level of 7 last september and all tests were normal; why am I responding low to these protocols? It is my understanding that 350 iu of fostimon is high; do I need even more? Or a change in protocol?
    2. Do I realistically have a chance of conceiving at my age and should I keep trying or am I wasting my time and money?
    3. Does the U. S have anything more advanced or effective to merit trying a cycle there or is it the same everywhere?
    Thank you Dr. Greene and hope to hear your advice soon.

    1. I am so very sorry to learn of all of the difficulty that you have encountered. Unfortunately, this is not the venue for me to be able to provide advice to a specific client for their unique problem. There simply is not enough information here nor is there an ability for us to interact and discuss your situation in a private setting. I would be more than happy to set up a consultation–which can be done through the internet (Facetime or Skype)–if you would like to pursue this further. It may however frustrate you if I suggest a plan and your local provider is not willing to consider my recommendations. That said, please call 1-800-539-9870 if you’d like to discuss this.
      Very best thoughts,
      ~Robert

      Robert Greene, MD, FACOG
      CNY Fertility Center

  9. Hello Dr. Greene.
    Just to tell you a little bit about me. Im turning 30 this year and i have endometriosis. I am preparing for my 8th ivf (5th whole treatment – have hade 3 frozen embrio transfers). I have misscarried onces (frozen embrio) and once i had i cheamical pregnancy (ivf#3)
    After 5 treatments (2 whole once and 3 frozen tranfers) in iceland (there is only one ivf clinik here) we decided to try in another country so i went to embio in athens greece.

    My doctor told me after my last treatment that its likley that there is something wrong with my eggs. (ivf#1 i got 19 eggs but only 7 embrios – 1 up an 4 embrios went in the freezer) ivf# i got 12 eggs but only 8 embrios – 2 up and 2 went in the feezer. Ivf#3 i got 22 eggs – around 10 fully matured and i dont know how many embrios – got 5 up graded 1 to 2, ivf#4 i got 30 eggs – around 12 fully matured and i dont know how many embrios – got 5 up and 4 of them were grade 1).

    I always used gonal f except for the last time when i used menopor.
    Ivf#3 i used klexane and in ivf#4 i used klexane, asperin 75mg, and prednesolone 5mgx2.

    My ASA was 24 – just over normal – should be under 22.

    So my question is…
    1. Now im trying to make my eggs better by changing my diet. I have stoped drinking al alcohol, taking out al soda drinks ( just to drink alot of diet coke), no suger and no aspartme, no white flower, no transfat, no takeaway food…
    Im taking in b vit complex, b6+b12, maca, coq10, spirulina, d vit, omega3, asperin, c vit, iron,….
    Im trying to eat organic and more veg and fruit.
    I also just started to take in melatonin.
    Im doing hot yoga 3 times a week.
    Is there anything else you would recomend?

    2. About steroids… What doses are you giving to your patients? And when do you recomend they start taking them?
    Do you have any experiense with intralipid?

    Thank you so much for your blogg… I really enjoy reading it.
    Kind regards from Iceland
    Berglind

    1. Dear Berglind,
      Wonderful to connect with you. I’ve never been to Iceland but I hear that it is lovely. It sounds like you’re making of the healthy changes that can optimize your chance of success. Given where you live, it might be worthwhile to have your Vitamin D3 level checked to make certain that you’re getting enough. I also feel that it is important to have a good fitness program and to avoid ‘hormone-disrupting’ chemicals. That means making healthy choices in your personal care/cleaning products as well as seeking organic food choices when possible. It is also worthwhile to spend some time journaling (see today’s post) as a way of managing stress as well as advocating for your own success. If you’d like a more detailed and comprehensive list of ideas, you may wish to check out my book PERFECT HORMONE BALANCE FOR FERTILITY. Also, check back on this blog as I will continue to update as new research emerges.

      Regarding steroids–that is getting a bit dated. Although it will not cause any harm, the most current data doesn’t really suggest a benefit. Since it is inexpensive, many centers continue to use it out of habit. By contrast, I am a big advocate of the use of Intradlipids. I have been about 4 years of experience in using this treatment in my patients and I have been quite impressed with the results. I wrote a post about it called “Neither High Fat nor Low Fat but the Right Fat.” Of course this it not something that every patient needs so you should discuss it with your doctor to see if you would be a candidate.
      Best thoughts,
      ~Robert

      Robert Greene, MD, FACOG
      CNY Fertility Center

      1. Thank you so much for your answer.
        They do not use intralipid here in iceland, also they dont have any tests to see if it would help. I did ask a immonologist to check my nk cells (when he took my blood to test for ASA, ANA and more – i printed out a list of tests online and asked him to do those tests on me) but he said that the nk tests that are a valible here are so inaccurate that were was no point doing them.
        I have asked my doctor (dr. Paraschos) in greece for intralipid treatment and he said that they dont use that treatment but he is willing to try it on me…. I do how ever have to start it “my self” before i go to greece.
        In what doses is intralipid given and when should it be given?
        If it turns out that i dont need it, would it be harmfull to use it?
        I do have low egg intolares (did a food intolares hometest). Does that matter?

        Thank you again.
        P.s. Iceland is a cold but beautiful country. The island is about the same size as the uk but we are just over 300.000 people that live here 😉 alot of beautiful nature to see and friendly people.

  10. Dear Dr. Green,
    thank you for providing such up to date and relevant information to all of us who suffer from infertility. I have a child from ICSI who is 4 years old and now I am looking to hopefully add a sibling. I was pleasantly surprised to find out that for the last 4 years some new developments have taken place.

    With regards to Melatonin, do you think it would be a good thing to supplement in my situation- I am 41 yo and my RE is thinking of doing a mini IVF, so we are aiming for quality not quantity (unlike the previous 4 times). I have no other known issues, apart from tubal sterility and age.:)

    Also- melatonin and immune issues. Would you prescribe it to a patient who has immune issues as I read that it actualy can stimulate the immune system whilst all the immune therapy is aiming to calm it down.
    I had raised NK cells at my last ICSI, so I had immune therapy but this time I am only taking fish oil and hope for the best.

    I hope I have been clear in my questions.

    Thank you so much!
    Regards
    Teodora

    1. Dear Teodora,
      I am so pleased to learn that you were successful in having a child through IVF/ICSI. That fact is the most important prognostic test and the reason that you should remain optimistic. Although 4 years have passed–a more important fact in your late 30s/early 40s–it is reassuring to know that you and your husband shared this recent success. That said, your focus on optimizing the quality of each egg that you produce is warranted.

      Regarding whether or not melatonin is appropriate for you I cannot say because I am not familiar with your complete history. As I mention in the previous post on sleep–as well as in my book PERFECT HORMONE BALANCE FOR FERTILITY–the hormone is far more important than was previously believed. It serves to regulate your body’s daily schedule and therefore has impact on many prevoiusly unknown functions including fertility. Your developing eggs have special binding sites for this hormone which also signifies its importance. Finally, it is a potent anti-oxidant as well which means it can help prevent damage from occuring in the developing egg. So it is worthwhile for you to discuss with your doctor whether or not you are a candidate for this treatment.

      Rest assured that melatonin does not “stimulate” the immune system–instead it “modulates” it. That means that rather then making your immune system more active; it guides it toward more appropriate activity. So it can reduce infection yet also help prevent an aggressive action against a developing pregnancy. I do hope that you find this reassuring.
      Best thoughts and good luck in your upcoming cycle,
      ~Robert

      Robert Greene, MD, FACOG
      CNY Fertility Center

      1. Dear Dr. Greene,
        excuse my late reply. I would like to thank you for taking the time to reply to me in such detail! May I just ask you what is your opinion on dexamethasone and IVF?
        Thank you one more time!!
        Regards,
        Teodora

      2. Dear Teodora,
        I do not believe that most patients benefit from the use of dexamethasone. I also acknowledge that it is very low cost and rarely contributes to problems. So though I do not recommend it; I also have many patients that choose to include it–and I respect their decision. Hope this helps.
        Best thoughts,
        ~Robert

        Robert Greene, MD, FACOG

  11. Dear Dr Green

    I am so glad to have found a forum where I can ask questions.

    I am 34 and have had 3 failed IVFs, 4 failed IUI and a failed transfer of a frozen blastocyst. We dont seem to be able to get pregnant whatever we try 😦
    I am starting to lose hope and finding life very difficult at the moment.
    The doctors cant explain why I am not getting pregnant. In our 2ed cycle they said it could be related to the quality of my eggs. But they dont have very strong proofs. I also have a fibroid which they are not too worried about but starting to think that manybe my issue is more a plantation issue rather than a quality of egg?!?!
    I need a direction, some help as to what is going on with me….I am lost and dont know what to do next.

    Any help is appreciated 🙂

    1. Dear Helen,
      I am so sorry to learn that you have encountered such difficulty. Unfortunately, I am very limited in what guidance that I can provide. This is an information forum whereby I can provide explanations of the most recent studies. I do agree that there is a considerable amount of information that can be obtained by reviewing previous treatment attempts. I explain to my patients that an IVF attempt is not only the most effective treatment but in many ways it is also the most diagnostic test available. Maybe you would be well served by getting a second opinion–having someone look at all of the treatment and testing you’ve undergone with a new perspective. You may find that such an effort will reaffirm what you’ve been counseled or you may actually get a new direction to pursue. Typically, whenever I perform a second opinion, I request all of the medical records from previous treatment to review. I would encourage you find a center that willing/able to offer the same sort of quality consultation.
      Best thoughts,
      ~Robert

      Robert Greene, MD, FACOG
      CNY Fertility Center

  12. Hello,

    There is any harm to take CoQ10+ fish oil, Pycnogenol and Inositol during a medicated IUI cycle?
    Thank you

    1. Dear Caroly,
      There is no harm at all in combining these supplements. Depending upon your medical history; they may all be beneficial. That said, you should also discuss this with your healthcare provider as well.
      Best thoughts,
      ~Robert

      Robert Greene, MD, FACOG

  13. Greetings,
    I’ll start my first IVF round on September and my RE adviced me to take Prenatals multivitamins and antioxidants for prepare my body before treatment. This is my supplements cocktail: Prenatals Multi, Co-q10 200mg daily, Inositol 500mg daily, D-chiro-inositol 300mg daily, Calcium 600mg, Vitamin D3 400iu and Pycnogenol 100mg. I want to maximize my chances of become pregnant and I wondering if will be a plus add Resveratrol and L-arginine to my supplement cocktail also if I can keep taking those supplement when my IVF circle started. Thanks

    1. Dear Arana,
      Unfortunately, I am not able to provide you with specific medical advice. This forum is simply an opportunity for me to describe and explain the latest research findings. Then it is best for you to discuss this information with your doctor to determine if the information applies to your specific situation. When it comes to the use of supplements however, it is rarely clear which patient will benefit from which product. Instead, it is important to consider what result each intervention can create and then estimating whether or not that would apply in your specific case. It is also imperative to make sure that any given product will not interfere with any of the other treatment aspects that may be part of your protocol. So these questions are not simple. I do apologize that I cannot provide you with clear guidance.
      Best thoughts,
      ~Robert

      Robert Greene, MD, FACOG
      CNY Fertility Center

  14. Hello Dr. Greene,

    I just received my tests results and I am devastated. My FSH is 19 and my AMH is 0.36. I just turned 40 two weeks ago and never have had children. This is the first time I tested myself and could not believe what I was seeing. I’ve been always very active, working out a lot, eating rather healthy etc…I don’t understand what happened, why my numbers are so horrible? It’s very hard for me to accept the fact that I may never be able to have a baby. Is there anything that can be done in my situation? I hear about egg donors etc. How do I know that I could be succefull trying that?
    Please advise. Thank you. Anna

    1. Dear Anna,
      So sorry to learn of your situation. Please keep in mind that these results indicate a “diminised ovarian reserve.” It does not mean that you cannot conceive with your own eggs; but it does reduce your success rates below the age-adjusted norms. Keep in mind, none of this impacts your chance of a successful pregnancy with an egg donor. My hope is that you would be able to thoroughly discuss both options with you doctor. Have they counseled you about this? If not, please arrange to do so rather than assume the worst. There are options available to you.
      Best thoughts,
      ~Robert

      Robert Greene, MD, FACOG
      CNY Fertility Center

  15. Hello Dr. Greene,

    I am a 32 year old female from India. I have undergone IVF last year in May 2011 and FET in Aug 2011. Both the times 4 A-Grade embryos were transferred on Day 3. In total 8 (3days) embryos were transferred but none resulted in to pregnancy. My RE suggested implantation failure. The embryos looked very good but none of them implanted.

    Could you pl suggest me something to improve the embryo implantation?

    Many Thanks,
    Shruti Bhatia

    1. Dear Ms. Bhatia,
      Thank you for your query and for considering my input. Unfortunately, I cannot assist in your diagnosis with the information provided. That said, if your RE is correct in the diagnosis of “implantation failure” you may wish to consider the benefits of INTRALIPID therapy. If you’d like to learn more about this, check out the blog post titled “Neither high fat, nor low fat but the right fat” as well as the one titled “Is your uterus ready for a pregnancy?” I believe that the information and the links will provide you with some of the insight that you are seeking.
      Best thoughts,
      ~Robert

      Robert Greene, MD, FACOG
      CNY Fertility Center

      1. Dear Dr. Greene,

        Thank you so much for replying!
        I will definitely check out these posts.

        After the failed fresh cycle my RE suggestedme for NK Cells assay & the test results were negative for me. Still she suggested for IL Therapy. Though I never opted for IL therapy but what will be your take on this? should I go for it or not?

        Dr. I have been through all the possible treatments- around 10 Femara/clomid cycles, 3-Injects cycles. Ovulated in each and every cycles but never conceived.
        After all the above mentioned treatments we opted for IVF & then FET.
        My RE herself suggested me to see some other RE as she is clueless what exactly is my problem.

        HSG is all clear. TSH remains below 3. Husband’s SA is Good. All my tests are normal.My BMI is 26.5.

        I have serached a new RE in my city. In your opinion what treatment should I undergo now?

        Let me know what more information you need from my side.
        I have been ttc since Oct 2008. It has really been such a frustrating experience that at times I feel like giving up.

        I am really lookng forward for your valuble input!

        Thanks a lot,
        Shruti Bhatia

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