Functional Fertility Foods: eating soy foods associated with higher IVF success rates

There are few topics as emotionally driven as food choices. For most of us, our dietary choices are guided mostly by our taste preferences, familiarity (think comfort foods) and convenience. In fact, much of what passes as nutritional science in the popular media is incorrect or overstated. As a result there are often widely held misconceptions and untruths about what is a “healthy food.” A classic example is soy based food products. About 4 years ago, I wrote a column  to debunk the popular (and inaccurate) belief that some of the hormone-like chemicals—called phytoestrogens—in these healthy beans could interfere with fertility. The latest research goes one step further suggesting that these foods actually boost the pregnancy rates in women undergoing advanced reproductive techniques (ART).

It’s been well established that adding soy based foods can lead to small changes in the hormone balance  of people that eat them. But for too long, people that wanted to promote unhealthy dietary choices successfully created concerns among fertility patients. Then two clinical studies came along that demonstrated women taking soy supplements during either ovulation induction  treatment or IVF cycles  had higher pregnancy rates. The problem with these studies however was that the supplements that were used boosted the level of phytoestrogens to levels that are over 10 times higher than people eating a traditional Asian diet. New research has provided more practical insights into the health benefits achieved by simply switching to easily obtained soy based foods.

This latest study  was very practical because they looked at the dietary choices in a group of 315 women that ultimately completed 520 ART cycles in 2013. Better still, they followed them prospectively to minimize the risk of obtaining biased results. They then looked at various results from their IVF cycles. They found that the eggs from women that were eating foods that contained soy had a higher fertilization rate. More specifically, they found that the clinical pregnancy rate was 11% and live birth rate was 13% when they compared women that were eating soy to age-matched women that were not. In fact, women that were consuming the most amount of soy had a nearly 80% higher chance of success. Bottom line was that soy containing foods seem to be very beneficial to women undergoing fertility treatment without making huge dietary changes.

An important step towards validating any finding is to then try to establish a theory of how the intervention may have resulted in the finding. The previous studies on soy supplements and IVF outcome suggested that the isoflavones—these are the estrogen-like chemicals in soybeans—resulted in a healthier uterine lining and thereby improved the ability of embryos to implant. They based this assumption on the fact that the ultrasound imaging of the lining appeared different. This recent study did not find any such changes. Instead, they hypothesized that the benefit are demonstrated by the fertilization rate of the eggs from the women eating soy vs. those that weren’t The fact that it was higher in the soy group suggests that eating soy may improve egg quality. Regardless of the mechanism, all of the research agrees that dietary soy is associated with higher pregnancy rate and greater chance at a live birth.

Maybe the most important aspect of clinical research is guiding and motivating patients on how and when to implement changes. Given the large number of products that now contain soy as well as the various “meat substitutes” (ie, veggie patties, soy milk, soy yogurt, soy butter) it makes sense to encourage women going through IVF to try to make some conscious changes to select these products or to eat soybeans. Another potential advantage of reducing meat, chicken and fish consumption is that plant based proteins contain far less of the unhealthy aspects of our modern diet like; hormone disrupting chemicals, pesticides and antibiotics. The end result is not only a higher chance of conceiving but also having a healthier pregnancy and giving your child the very best start possible.

[r1]Link to https://thegreeneguide.wordpress.com/?s=soy

[r2]Link to http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=906924&fulltextType=RA&fileId=S0007114500001872

[r3]Link to http://www.rbmojournal.com/article/S1472-6483(10)60465-8/abstract

[r4]Link to http://www.fertstert.org/article/S0015-0282(04)02356-8/abstract

[r5]Link to http://www.fertstert.org/article/S0015-0282(14)02529-1/abstract

“What else can I do to improve the quality of my eggs?” the new frontier in fertility treatment

Unlike men, it is very difficult to assess a woman’s fertility at any given time. A man simply needs a quick trip to the video closet to collect a sperm specimen for viewing under the microscope; whereas it is only through the process of IVF that it is possible to truly assess the quality of a woman’s eggs. This entails several weeks of medication to prepare for an egg retrieval at which time her eggs are collected, fertilized and then monitored for normal embryo development prior to placing them back in her body to implant and become a pregnancy. There is no comparable test. As a result, recommendations of treatment to improve egg quality have been based upon unproven and often misguided observations.  

One of the more popular myths has been to encourage women to consume wheat grass. Although the suggestion is harmless enough, the only basis for its link to “improved fertility” can be traced back to a Kansas farmer from the 1930’s named Charles Schnabel. He claimed that when he fed wheat grass to his ailing chickens that they not only recovered but increased their egg laying potential. Not the best model to making assumptions about human egg quality.

Another folk remedy is the use of royal jelly. This is a special secretion made by honey bees and fed to future generations in order to cultivate the conversion of a drone to a fertile queen bee. Unfortunately, it doesn’t work as well in humans and has been linked to severe allergic reactions, asthma and even in rare situations death. Analysis of this chemical product reveals that it is little more than vitamins and other healthy nutrients. I think the lesson here is that good nutrition is important which is why it is a good idea to start a prenatal vitamin at least 3 months prior to trying to conceive.

A more recent recommendation has been for women with low ovarian reserve to take the pre-hormone supplement DHEA. While there is limited data that it may cause a slight increase in the number of eggs produced— in this clinical trial the average participant went from producing three eggs to four—there was not any demonstration of an improved pregnancy rate. From a practical standpoint, since it required 90 days of the supplement prior to undergoing IVF these patients may have produced even more eggs by going through 2 or 3 cycles of IVF instead. Most importantly, without a measureable improvement in pregnancy rate, it is premature to suggest that this may improve egg quality. There are ongoing studies which may provide insight as to whether there are some women that can benefit from this treatment but at this point the question remains unresolved. In fact, the available research is given a “C” grade indicating “there is unclear scientific evidence for its use.”

A well researched suggestion has been to optimize the energy storage/ utilization of the egg through supplementation with CoEnzyme Q10. This has not been considered a necessary supplement since your body can manufacture this on its own. However, the human egg has the greatest energy demand of any cell in the body; and its needs go up considerably during the process of follicle growth. It was therefore theorized that supplementing with CoQ10 could improve egg quality. Early studies have confirmed this theory.

Finally, it’s worth mentioning that avoiding harmful chemicals is also likely to improve egg quality as well. There is a growing list of toxins referred to as endocrine disrupting chemicals (EDC’s) that have been linked to diminished fertility and reduced egg quality in animals. Many of these same products have been tied to a reduction in male fertility which is easier to track through diminished sperm counts and decreased motility. Until it’s confirmed that EDC’s don’t compromise egg quality as well, I recommend that you take steps to reduce your exposure to chemicals like Bisphenol A (BPA) and phthalates.

In summary, here are some steps you can take and have confidence that you’re doing all that you can to optimize your chance becoming pregnant:

  • Avoid well intended but not well researched recommendations
  • Begin a prenatal vitamin several months before you want to become pregnant
  • Take CoEnzyme Q10 to optimize the quality of your eggs—typical dose is 100 mg taken two or three times each day

Consider modifying your food choices, cooking preparation, personal care products and lifestyle to reduce your exposure to endocrine disrupting chemicals. If you need some specific advice, check out my book PERFECT HORMONE BALANCE FOR FERTILITY which is loaded with useful charts, tables and tips.

Egg Quality: here is the reason that your medications matter

A reader of this blog recently requested that I explain why I utilize certain medications for my IVF/fertility patients and caution against the use of others. It all comes down to their effect upon egg quality. Although there is still much to be learned, most fertility specialists agree that what is going on hormonally in a woman’s body will impact the success of her cycle. That’s why I feel that it’s so important to optimize their hormone balance and individualize the protocol to suit each woman’s unique situation. Here’s what we know.

Prior to the month that an egg is going to have its opportunity to ovulate, the DNA within it remains inactive. It has been in this state of rest since birth. Whether or not egg develops in an environment that is balanced more toward estrogen or testosterone is the key factor which will determine whether it will mature normally. Eggs that are “estrogenized” are more likely to mature earlier, fertilize normally and develop into healthy embryos. “Androgenized” eggs are more likely to become atrophic, fertilize abnormally or become a first trimester miscarriage.

Typically, a woman’s fertility begins to drop dramatically about 13 years before she’s going to enter menopause; typically their mid to late thirties. This drop is associated with a shift toward a higher level of testosterone within the ovary and not surprisingly a drop in egg quality. What triggers this hormone shift within the ovary is that as women age they produce a more potent form of the hormone LH as well as develop a tendency to have greater sensitivity to this hormone. Therefore, when designing a protocol for a fertility treatment cycle, I feel it is important that we shift the balance toward a higher level of FSH relative to LH in order create a more favorable setting for egg maturation. Creating such protocols has been among the great accomplishments of my friends and colleagues Drs. Geoffrey Sher and Jeff Fisch when they demonstrated in their landmark paper that pregnancy rates can be substantially improved in women with a history of previous fertility treatment failure. The trick is to stimulate the ovaries with an FSH dominant signal early in their development and then add in a low level of LH late in maturation to optimize the quality of as many eggs as possible. From a practical standpoint, that means being able to control FSH and LH levels independently.

Many centers use simplified preparations of FSH and LH for their ease or lower cost. But I describe this as being similar to mixing your salt and pepper together in the same shaker. It may work in some situations but most patients need varying degrees of adjustment get “more salt” or “less pepper.” What makes this approach even more problematic is that these mixed preparations—called urinary derived gonadotropins—are made from the urine of the least fertile population, women in menopause. In effect, that “makes the pepper even spicier” as these women produce a far more potent form of LH. All too often, this results in a disappointing outcome. It is true that the lower cost, pre-combined products work well enough when given to the most fertile patients. I believe that’s what keeps the market for them alive. In addition to their impact upon egg quality however, I am also concerned about the impurities that they contain.

A recent analysis of both the standard and more highly purified urinary preparations found them to be 95 to 99% free of contamination. These contaminating proteins can not only impact the how a woman’s ovaries respond to them, they can also initiate an allergic reaction. Even more problematic, they carry a very low but real risk of transmitting infection which recently resulted in their use being banned in England and the rest of the United Kingdom.

In summary, the use of the latest technology has made it possible for companies to manufacture untainted FSH and LH in separate preparations so that their dosing can be uniquely adjusted to each patient’s individual needs. Better still, these are BioIdentical products that are exact replicas of the hormones produced by fertile women. Additionally, they are 100% pure and therefore free from the risk of allergic reaction or infection. For all of these reasons, I believe that these products are most suited toward meeting the needs of the patients that I see in my practice.