One of the most frustrating questions for women trying to conceive is “what can I do to improve my chances?” Given that women are born with every egg that they will ever have, there are a limited number of ways to optimize the health of the remaining eggs. But for those that are motivated, I have described steps like the use of Acai berry extract and CoQ10 as well as improved sleep and Vitamin D. Now for the first time, there is evidence that some women may be able to improve the responsiveness of their ovaries in as little as one month!
The typical diet of people living in the USA has changed dramatically over the last century. One glaring example has been in the type of fats that we consume on a daily basis. Essential dietary fats—those that we must get from foods because our bodies can’t make them—are typically classified as Omega-6 and as Omega-3 and serve many important physiologic functions. The ideal ratio of Omega-6 to Omega-3 is 1-to-1. However, the typical Western diet—popular amongst most Americans—has a ratio as high as 25-to-1. The result of this unhealthy shift is that many people are eating foods that promote inflammation. This unhealthy shift is associated with a higher risk of heart disease, diabetes, cancer and infertility.
Given that it’s not easy to encourage people to make lasting dietary changes, a recent study looked at the effects of starting a high potency omega-3 fatty acid supplement upon ovarian function and hormone balance. For this study, they put 27 women on a 4 gram supplement and measured their FSH levels before and 30 days after starting this program. Even within this short time frame—effectively one menstrual cycle—they found a dramatic improvement in the omega-6 to omega-3 ratio. Their inflammatory markers improved and their FSH levels dropped. Given that FSH level is considered a marker of ovarian sensitivity; this result is interpreted to mean that their ovaries were more sensitive and thus more fertile.
A cautionary note; they did not find an improved ovarian sensitivity in the women in the study that were obese. It is possible that with longer time and with weight loss, obese women might also experience improved fertility. Obesity has been linked to worsening infertility as well as resistance to some of the treatments offered to normal weight women. It is theorized that obesity itself produces inflammatory chemicals in the body which in turn trigger a state of hormone imbalance. In act, it was discovered that all of the women in the study—including the women that were obese—had improved markers of glucose metabolism. That suggests that the omega-3 fatty acids could help reduce the risk of diabetes and maybe make it easier to lose weight as well.
Another important benefit of omega-3 fatty acids is that they can reduce oxidative stress. That means that consuming these healthy dietary fats can reduce the risk of DNA damage to a woman’s eggs—another important fertility promoting benefit. So although this was a small study and needs to be confirmed in a longer time period, you don’t need to wait. Make this health promoting change in your fertility promoting plan now. Here are a few practical suggestions:
- Switch to a low-fat diet plan taking care to avoid animal fats when possible
- Use products at home that include healthy omega-3 fatty acids instead of butter
- Incorporate more olive oil, Flax seeds and tree nuts into your daily diet
- Start taking a daily supplement—preferably a plant based one (rather than fish oil) like those made by Life’s DHA
- IMPORTANT NOTE TO MEN: Emerging evidence suggests that increasing your omega-3 fatty acid consumption can improve sperm shape (teratospermia) as well!!
One of the greatest challenges that we face in treating couples with infertility, is what options to offer beyond the typical treatment protocols. Clearly, most of our patients are well served with the basic ovarian stimulation methods but in some patients that may exacerbate or simply ignore an underlying hormone imbalance that’s compromising success rates. Therefore, one of the greatest challenges is to figure out how and when to tweak the typical combination of meds in order to shift the hormone balance back to a more favorable outcome. This is the reason that we should now reconsider the use of human growth hormone (hGH) for patients that have failed previous IVF treatment.
I trained under Dr. David Meldrum at UCLA-Harbor Medical Center in Los Angeles. Back in the early 1990’s he was advocating the consideration of adding hGH to the protocol of certain patients. His reasoning was good. First of all, we know from previous research [u1] that healthy developing eggs produce a growth hormone analogue known as IGF-2. Better still, other studies [u2] have demonstrated that hGH could possibly increase the ability of eggs to repair damaged DNA. Finally, several studies have found that growth hormone can improve the response of the ovaries to stimulation during an IVF cycle. Given that all of this information has been available for quite some time, it may be surprising to a patient that there hasn’t been wider use of hGH during IVF treatment. Recently, Dr. Meldrum and several other experts [u3] suggested that this was because there remained too much confusion amongst specialists on which patients would benefit from the use of this somewhat expensive but also possibly game-changing hormone.
The good news is that recent studies [u4] have more carefully defined the characteristics of the patients that were receiving hGH. As a result, we have some new data to better guide us as to which women may be most likely to benefit from hGH. Here is a summary of what they found:
- In women >40 years of age, they found a higher implantation rate and better on-going pregnancy rate in women treated with hGH during ovarian stimulation.
- In women that are poor responders to ovarian stimulation—defined as three or fewer eggs produced per IVF cycle—there was a marked improvement in pregnancy rate with growth hormone supplementation. They also found an improved outcome in FET cycles from embryos created during these cycles.
- In women that have poor embryo quality and low pregnancy rate in otherwise encouraging ART cycles, there is not be a clear benefit of using growth hormone. Instead, other causes of poor embryo quality should be explored. Once those have all been addressed, reconsideration of hGH is worthwhile.
Robert Greene, MD, FACOG
Although most fertility treatment focuses on women; at least 1/3 of couples have a male factor contributing to infertility. Newer studies even show that subtle changes in sperm quality—that aren’t detectable by standard testing—can contribute to poor fertilization, abnormal embryo development and even recurrent early pregnancy loss. That’s because the sperm contributes half of the genetic material to the developing embryo as well as factors that contribute to normal fertilization and early development. But they are easily damaged.
Sperm are particularly susceptible to free radical damage—the charged particles that are a normal byproduct of oxygen metabolism. They are so compact, that they contain very low concentrations of the scavengers that neutralize these damaging little sparks of energy. When a free radical encounter DNA—which the mature sperm is loaded with and ready to contribute to the awaiting egg—the genetic material can be damaged; a process called “fragmentation.” Sperm lack the ability to repair this damage when it occurs. As a result, seemingly healthy looking sperm can prevent a pregnancy from getting off to a healthy start.
The good news is that there are steps that men can take to minimize the naturally occurring damage to sperm and markedly improve your chance of having a baby together. Here’s what he can do:
- Avoid exposure to tobacco and other products that promote free radical formation (more about this in future posts).
- Eat foods rich in the following antioxidants:
- β-carotene (i.e., spinach, carrots, tomatoes, cherries, melons, peaches)
- Vitamin C (i.e., citrus fruits, tomatoes, broccoli, cabbage, berries, mangos, pineapples)
- Vitamin E (i.e., peanuts, almonds, soy, olive oil, wheat germ, cereals)
- Zinc (i.e., asparagus, eggs, potatoes, fish)
- Consider a “preconception supplement.”
A recent study confirmed that making these healthy changes can improve pregnancy rate while also reducing the risk of miscarriage. I know when my wife and I were going through fertility treatment; I took the product called Conception XR despite my healthy diet and normal semen analysis. Not only did I feel it was the least I could do but I do believe that it helped us to conceive our daughter.