“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.

Fertility Treatment: why “the numbers” don’t add up

Most of us have learned to rely upon numbers. Their dependability, their consistency, their ability to communicate an unemotional truth is something that most of us have come to value. However, as a fertility specialist that counsels patients on a daily basis, I’ve come to realize how subjective numbers can be misinterpreted by people wanting to have a child. The same numbers that may discourage some; serve as a source of hope for others.

The most glaring example from recent history is the case of the “octomom.” None of us was present when she was counseled so we can only guess what was or was not discussed between her and her doctor. However, based upon the low success rate of the center that she was treated at, the odds of her accepting 6 frozen-thawed embryos and them resulting in 8 babies was calculated at 1 in 3.4 trillion. Yet we all know how that worked out.

Let’s consider a less dramatic example. The estimated chance of achieving a pregnancy for a very fertile couple on a given month is roughly about 15%. A common strategy to improve upon this for couples that experience infertility is to promote ovulation induction. Despite its popularity, studies show that this treatment either doesn’t result in pregnancy for most couples or it results in an adverse outcome.  What makes ovulation induction an appealing option to couples is the perception that it is less costly. In reality, studies are consistently demonstrating that it delays the initiation of pregnancy and results in higher treatment costs due to repetitive cycles. Furthermore, the Centers for Disease Control and Prevention along with the March of Dimes just published a report that about one out of every four multiple pregnancies are due to the use of approach. Advanced treatment options such as In virtro fertilization provide us with the ability to dramatically improve pregnancy success rates and outcomes.

The process of IVF allows for more effective management and also makes it easier to prevent twins and higher order pregnancy by performing single embryo transfers and freezing extra embryos for future pregnancy attempts. Better still, the information that is gained from a single IVF attempt can be diagnostic. Therefore even when a cycle fails it can provide closure or offer new information that can be used to redirect treatment. So what seems like the most costly treatment can actually save you both time AND money.

Here are some steps that you can take to protect yourself from making decisions that don’t add up right:

  • Create a “family building plan” rather than focusing on just getting pregnant—In my book, Perfect Hormone Balance for Fertility I provide a series of questions that you and your partner should consider. Some treatments are more effective than others in reducing the risks of multiple pregnancies while others are more likely to be effective quicker—a key to success for couples wanting to have more than one child or those in their later reproductive years.
  • Ask your doctor what your prognosis is in words like “excellent, good, fair or poor” rather than as enticing numbers—Since statistics are calculated based upon groups of people, they don’t apply to an individual cycle. Instead, they can often be misleading. By using words to express your chance of success, you’ll get a much more accurate estimate of your chance for becoming pregnant.
  • Encourage your employer, insurance coverage and legislators to make fertility treatment part of their covered benefits package—As insurance options are being evaluated, consider switching coverage to meet your needs. A recent study demonstrated that plans that paid for IVF coverage can cost less than an extra $1 per month. If you’re not currently offered a plan with fertility coverage, request it of your employer.

Dietary Supplements; are yours making you sick?

A recent survey estimated that nearly half of the US adult population (~114 million people) regularly takes dietary supplements. In fact, last year Consumer Reports estimated that our passion for these products costs us over $15 billion; more than $150 per person and that didn’t even include the amount that we spend on vitamins. Unfortunately, emerging information shows that we’re often not getting what we’ve paid for, or worse, we can be taking in products that can actually impair our health.

In this consumer driven market, products tend to target the most popular problems or conditions including infertility and pregnancy. Unfortunately the US Food and Drug Administration (FDA) have identified a growing trend of tainted products. Many have been found to be contaminated with toxic plant material, poisonous heavy metals and bacteria that can create various illnesses. Worse still, the supplements that have been confirmed to be problematic are believed to be a small fraction of the growing problem. How did we get to this point? It dates back to the 1994 Dietary Supplement Health and Education Act (DSHEA) under which vitamins, minerals, botanical products, amino acids and tissue extracts were all classified as “dietary supplements.” According to this regulation these products are presumed to be safe and can be marketed to consumers with no pre-release testing and very little oversight. The end result has been a growing list of consumer complaints, possible health complications, and uninvestigated claims of efficacy.

In reality, anything that promotes health can also have adverse effects. This is as true for supplements as it is for medications. That’s why as more of these products target men/women wanting to conceive or women that are already pregnant it is important to be your own advocate; both as a consumer and as a patient. Especially since a growing number of supplements are tainted with impurities and unlisted ingredients.

In 2007 the US FDA published a report titled “Survey Data on Lead in Women’s and Children’s Vitamins.” I find it disturbing that the investigators concluded that of the 324 products tested they contained levels of impurities that were considered “safe/tolerable exposures.” Yet, they all tested positive for lead! As a healthcare provider and patient advocate I’m outraged People shouldn’t unknowingly purchase and consume products that introduce toxins into their body. Fortunately there are steps that you can take to protect yourself and your family:

• Go organic—A growing number of studies show that organically produced products are higher in health promoting vitamins, minerals and antioxidants. By choosing organic products when you can, you’ll decrease your need to supplement your healthy diet.

• Be an informed consumer—Since most supplement manufacturers don’t voluntarily hire agencies to monitor the quality of their product, investigate the quality of the ones you are using. Independent agencies like Consumer Lab test and report on the quality of many supplements.

• Notify your healthcare provider of everything that you’re taking—A growing number of products have been found to be deliberately tainted with active ingredients including prescription medications not approved for use in the United States. Therefore it is important that your doctor know about everything that you’re taking in case you develop a reaction to your supplement or experience an adverse response due to how it interacts with your other medications.

• Periodically re-evaluate your needs—Most dietary supplements have not been well tested despite the claims to the contrary. I recommend that my patients reconsider each product that they’re using at least once a year by asking themselves two questions. First, why did I start this? Second, is it meeting or exceeding my expectations? If you’re not satisfied with these answers discontinue anything that isn’t specifically recommended by your healthcare provider.

Getting out of a tough position; yoga to boost your fertility and improve your health throughout pregnancy

by Lindsay Brin

“For years, yoga has played an important role in my life. It not only helps me manage the stressful life of a fertility specialist but also assisted my wife and me in having our daughter. Since it’s much more difficult to design research studies to prove the benefits of yoga; I thought I’d share another compelling story with you by introducing you to a friend of mine, Lindsay Brin.

Lindsay is a fitness and nutrition expert as well as a former NFL cheerleader. For over 15 years, she’s been helping women achieve the balance of both healthy mind and body. For the last few years however, she has focused more specifically on helping women with infertility as well as during their pregnancy. She has done this through her books, videos, DVD’s and her website. But even more convincing has been her willingness to share her own experience as a successful fertility patient as well. ” Robert Greene, MD, FACOG

In August 2007 I went through my 3rd IVF.  I knew I had the best doctor and it looked like the odds were on my side.  But still I could not get over the emotional & physical turmoil of infertility.  Why does my sister-in-law hold hands with her husband and get pregnant?  Why did we increase my Gonal?  Why did I fill my bladder too much before ET?  How does my husband put up with me right now?  Why?  Why? Why?

Then I realized I was only in control of one thing, my body.  I couldn’t control the situation I was put in but it was time to take control of my attitude, emotional well-being, stress and physical body.

Having been a pre/post-natal fitness expert for several years I knew the incredible benefits of exercise and yoga.  So why didn’t I apply them through my 1st IVF?  Well, I’m not really sure.  All I know is I was an emotional wreck, 10 pounds heavier and cranky!

But if you’re like me, by the 2nd IVF I was willing to do anything and everything to improve my chances!  I added acupuncture, read Dr. Greene’s book, Perfect Hormone Balance for Fertility and got back to my daily exercise regime which included yoga.  And we did better this time around…but miscarried at 6.5 weeks.

This brings us back to August 2007 when I got the best news ever!  Betas 32 @ 11dpo and 130 @ 13 dpo!   I believe that was always the plan but again I could only control 1 aspect of the situation: my body.

Yoga is known for stress relief of infertility and increased blood flow to the uterus.  So of course it’s beneficial!  But if increasing your chances isn’t enough motivation please listen to me when I say that feeling better about yourself is the reason you should try it!

Yoga is a series of postures and exercises that promote control of your body, spiritual well-being and a connection with your body.  You can use safe yoga postures to build strength and flexibility along with relaxation to develop or enhance calmness and confidence.

Here are some known fertility yoga poses.

  1. Start in butterfly, sitting with bottoms of feet touching and knees bent;
  2. Twisting butterfly, first place your right hand on the outside of your left knee and look over you left shoulder as you twist, switch sides;
  3. Goddess pose, lie on the ground with bottom of feet still touching;
  4. Butterfly rest, from goddess pose pull your feet towards your center, knees still bent in butterfly, look to the right for 5 breathes, look to the left for 5 breathes;
  5. Bridge pose-place feet on the ground about 12-18 inches form buttocks, place hands on the ground at your sides, lift your hips and do a series of pelvic circles;
  6. Savasana- corpse pose, lie with feet falling open and hands to your sides, breathe so deeply the back of your rib cage expands into the floor, relax until the point your feel your limbs getting heavy.

Now I am blessed to be pregnant with baby #2 after IVF #4.  And the only thing that keeps the swelling away and the energy high is exercise and yoga!  I do my prenatal DVDs which have both exercise and yoga on them (although I have to mute myself).  So once you do get pregnant continue your yoga program to benefit your body and your baby!

If you’d like to know more about my fertility journey please visit my blog www.lindsaybrin.com.  You’ll also get to see the good, the bad and the ugly of getting rid of the fertility lbs. and pregnancy weight gain!

Do your hormones feel out of balance?

Hormones represent an integral communication system. They are chemical messages that are made in one part of your body and sent through your blood stream to coordinate everything from digestion to ovulation. They even make it possible for you to sleep. They are essential to your health and wellness. Yet most people don’t realize that they also impact how you feel. Your energy level, your hunger even your physical attractions are profoundly impacted by what is happening in your body hormonally. Although we may not think of this delicate balance when we’re at our peak of fitness; people often have a strong sense of “imbalance” they’re not doing well. Yet these symptoms are often overlooked when they can actually provide tremendous insights into what’s going wrong as well as provide strategies to improved health and quality-of-life. By paying attention to your symptoms, you can feel better while boosting your chances of conceiving as well as improve the health of your baby. Here’s how it works.

There are over 200 hormones that can be circulating through your blood stream at any given time and new ones are being discovered every month. I like to think of these hormones in groups according to their function. Most people have heard of the fight-or-flight hormones associated with the stress response. The other groups to consider are tend-and-befriend, rest-and-digest, mate-and-relate. Think of them as if they are different elements on a mobile in a dynamic state of equilibrium; an imbalance in one group can cause an imbalance in another.  If you have too much stress hormone for instance, it can cause digestive problems, difficulty with sleep and infertility problems.

Some of the most exciting research in this field is shedding light on the dual role some hormones can play. For instance, one study recently demonstrated that the same hormone—called oxytocin—which is responsible for promoting feelings of love and affection can also contribute to jealousy and envy. Some imbalances can be ominous. For instance, another recent study demonstrated that women with even slightly reduced levels of thyroid hormone during pregnancy are associated with blood pressure problems during pregnancy.  That’s why I feel it is so important to consider how hormones interact with one another.

I’ve spent a decade and a half now studying symptoms and how they relate to hormone balance. In my books, I’ve tried to use questionnaires in order to help people gain insight into their own hormone milieu as well as provide practical tips on how they can restore harmony when problems occur. I encourage you to check out PERFECT HORMONE BALANCE FOR FERTILITY and PERFECT HORMONE BALANCE FOR PREGNANCY in order to learn more about how you can optimize how you feel as well as maximize your chance of success. And please check back here as I update this blog with the latest research in this exciting field.

Why didn’t my IVF cycle work?

The most common and unanswerable question posed is that which follows one failed IVF cycle.  Although our success rates continue to improve, on average about 1 in 3 couples is successful after one IVF attempt. However there are a growing number of studies that show that that success rate at least doubles when couples undergo at least 3 cycles. This is according to a just released report out of Sweden. A larger study published in the New England Journal of Medicine earlier this year was even more optimistic. In a study which followed more than 6,000 women through nearly 15,000 IVF cycles, they found that the live birth rate on the third attempt was between 65% and 86% in younger women and between 23% and 42% for women beyond age 40. Yet despite these advances in success rates, many couples drop out after only one attempt.

I regularly counsel my patients that a single IVF cycle can provide valuable information that can be used to plan future treatment; yet rarely does a single cycle serve to definitively identify those that will not conceive with one or more additional attempts. As a former IVF patient I personally understand the frustration at receiving a negative pregnancy test. That’s why I feel it is essential that good communication occurs throughout the treatment process.

Current estimates from the National Center for Health Statistics indicate that over 6 million women between the ages of 15 and 44 are affected by infertility. Yet many either never seek treatment or don’t complete enough therapy to be certain of their potential benefit. As our treatment attempts become increasingly more successful, I think it’s important to realize that a single cycle of IVF might only be the beginning of treatment and should only rarely be considered the end of the line.