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The Role of Nutritional Supplements in Preparing for IVF

by Dr. Geoffrey Sher on November 10, 2015

It is important to nurture and take care of yourself mentally and physically when preparing and going through your IVF journey. This starts with trying to have a positive attitude about what you are about to go through, creating a stress support system for yourself by using tools such as visualization, acupuncture and meditation, eating the right foods taking a few supplements (see below) and balancing exercise with sufficient rest. . Not only will it help your experience but it may also help to increase your chances for IVF success

This article will focus on the role of nutritional supplements in preparing for IVF. You’ve probably wondered whether commercially available fertility supplements could help you achieve your goal. The answer is complex.

Here is my take: Nutrition is indeed a vital prerequisite for optimal reproductive function. However, a well-balanced diet that meets food preferences, coupled with modest vitamin, mineral and antioxidant supplementation (as can be found in many prenatal vitamin preparations) should suffice.

This having been said, conceiving is a delicate process, and eating the right foods is essential to optimize reproductive potential. Indeed, a balanced diet (i.e. a lot of organic and brightly colored foods) will provide most of the nutrients you need. But the truth is that most people do not have a balanced diet and are unwittingly often deficient in important nutrients.

A balanced diet is one that is rich in good quality protein, low in sugar, salt, caffeine and industrially created trans-fats (trans-fatty acids or partially hydrogenated oils) and soy, uncontaminated by heavy metals, free of nicotine, alcohol and recreational drugs. This is why routine supplementation with the following nutrients could enhance preconception readiness:

  • Folic acid (400 micrograms daily)
  • Vitamins D-3 1,000U daily; Viamin A (2565 IU daily); B3 (250-500mg daily); B6 (6mg -10 mg daily); B12 (12-20 mcg per day); C- (2,000 mg a day for both men and women); E (both sexes should get 150-200U daily)
  • Co-enzyme Q10 (400-600mg daily )
  • Amino acids such as L-Carnitine (3 grams daily) and L-arginine (1 gram per day )
  • Omega 3 fatty acids (2,000mg per day)
  • Minerals, mainly zinc (15mg per day); selenium (70-100mcg per day); iron (up to 20mg per day ); magnesium (400mg per day )

There are likely to be significant reproductive health benefits (including enhanced fertility and intrauterine development) associated with the use of nutritional supplements. However there are also certain potential pitfalls associated with their use. Some supplements are not as safe as they would seem. For example, excessive intake of fat-soluble vitamins (A, D, E and K) can even be dangerous to your health and may be associated with fetal malformations.

Additionally, numerous supplements have been found to contain contaminants such as toxic plant materials, heavy metals and even prescription medications that can compromise fetal development. Prior to the passage of the Dietary Supplement Health and Education Act of 1994, supplements (vitamins, minerals, amino acids, and botanicals) were required to demonstrate safety. However, since passage of “the Act”, they are now presumed to be safe until shown otherwise, thus establishing a rather hazardous situation where a typical prenatal vitamin that will provide sufficient vitamins and minerals for a healthy early pregnancy and potentially dangerous supplements can and are being sold in the same store without product liability.

What about the use of dehydroepiandrosterone (DHEA)?  DHEA is a male hormone supplement that is metabolized to androstenedione and testosterone in the ovaries.  While a small amount of ovarian testosterone is needed for optimal follicle and egg development, too much testosterone could be decidedly harmful. DHEA supplements probably won’t do harm if taken by healthy young women who have normal ovarian reserve, but they probably would not derive any benefit either. However, in my opinion, DHEA supplementation could be  potentially harmful when taken by women with diminished ovarian reserve (DOR), women who have polycystic ovarian syndrome (PCOS) and older women in their 40’s as such women often already tend to have increased LH-activity, leading to increased ovarian testosterone. Additional ovarian testosterone in such women, could thus potentially compromise follicle development and egg quality/competency.

In summary: Maximizing reproductive performance and optimizing outcome following fertility treatment requires a combined strategy involving a balanced diet (rich in protein, low in sugars, soy and trans-fats), modest nutritional supplementation, limiting/avoiding foods and contaminants that can compromise reproductive potential, and adopting disciplined lifestyle modification such as not smoking, reducing stress, minimizing alcohol intake, avoiding nicotine and recreational drug consumption, and getting down to a healthy weight through diet and exercise.

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  • Mima K - November 3, 2017 reply

    Dr. Sheer,
    I am 36. Low AMH after a laparoscopy of an endometriotic cyst in February. 0,3 ng/ml. Chromopertubation also done then and shown both tubes pass no contrast. In July I had stimulation with menotrophins and had very low response. Two follicles with no eggs. I was prescribed with Vit.D 800 i.U., CoQ10 300 mg, and DHEA 75 mg. AMH level got even lower… now is 0,14 ng/ml. Now I am preparing for second IVF, but my testosterone level is high and my DHEA-SO4 is too high 22,87 µmol/L. By your opinion is this causing my high-level testosterone, prolongation of my cycle (33 days, average is 27) and is there going to be some consequences of this?
    Thank you! Greetings from Europe

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - November 3, 2017 reply

    You need to be evaluated more thoroughly for your elevated DHEAS. You could have an adrenal component and yes, this could have a deleterious effect on egg/embryo development. Ut would need to be addressed in advance of IVF. This having been said, you do have significantly diminished ovarian reserve and this is the bigger issue.

    In my opinion, the protocol used for ovarian stimulation, against the backdrop of age, and ovarian reserve are the drivers of egg quality and egg quality is the most important factor affecting embryo “competency”.
    Women who (regardless of age) have DOR have a reduced potential for IVF success. Much of this is due to the fact that such women tend to have increased production of LH biological activity which can result in excessive LH-induced ovarian male hormone (predominantly testosterone) production which in turn can have a deleterious effect on egg/embryo “competency”.

    While it is presently not possible by any means, to reverse the effect of DOR, certain ovarian stimulation regimes, by promoting excessive LH production (e.g. short agonist/Lupron- “flare” protocols, clomiphene and Letrozole), can in my opinion, make matters worse. Similarly, the amount/dosage of certain fertility drugs that contain LH/hCG (e.g. Menopur) can have a negative effect on the development of the eggs of older women and those who have DOR and should be limited.I try to avoid using such protocols/regimes (especially) in women with DOR, favoring instead the use of the agonist/antagonist conversion protocol (A/ACP), a modified, long pituitary down-regulation regime, augmented by adding supplementary human growth hormone (HGH). I further recommend that such women be offered access to embryo banking of PGS (next generation gene sequencing/NGS)-selected normal blastocysts, the subsequent selective transfer of which by allowing them to capitalize on whatever residual ovarian reserve and egg quality might still exist and thereby “make hay while the sun still shines” could significantly enhance the opportunity to achieve a viable pregnancy

    Please visit my new Blog on this very site, http://www.DrGeoffreySherIVF.com, find the “search bar” and type in the titles of any/all of the articles listed below, one by one. “Click” and you will immediately be taken to those you select. Please also take the time to post any questions or comments with the full expectation that I will (as always) respond promptly.

    • Controlled Ovarian Stimulation (COS) for IVF: Selecting the ideal protocol
    • IVF: Factors Affecting Egg/Embryo “competency” during Controlled Ovarian Stimulation(COS)
    • The Fundamental Requirements For Achieving Optimal IVF Success
    • Ovarian Stimulation for IVF using GnRH Antagonists: Comparing the Agonist/Antagonist Conversion Protocol.(A/ACP) With the “Conventional” Antagonist Approach
    • Anti Mullerian Hormone (AMH) Measurement to Assess Ovarian Reserve and Design the Optimal Protocol for Controlled Ovarian Stimulation (COS) in IVF.
    • The “Biological Clock” and how it should Influence the Selection and Design of Ovarian Stimulation Protocols for IVF.
    • A Rational Basis for selecting Controlled Ovarian Stimulation (COS) protocols in women with Diminished Ovarian Reserve (DOR)
    • Diagnosing and Treating Infertility due to Diminished Ovarian Reserve (DOR)
    • Controlled Ovarian Stimulation (COS) in Older women and Women who have Diminished Ovarian Reserve (DOR): A Rational Basis for Selecting a Stimulation Protocol
    • Human Growth Hormone Administration in IVF: Does it Enhances Egg/Embryo Quality and Outcome?
    • The BCP: Does Launching a Cycle of Controlled Ovarian Stimulation (COS). Coming off the BCP Compromise Response?
    • Blastocyst Embryo Transfers should be the Standard of Care in IVF
    • Frozen Embryo Transfer (FET) versus “Fresh” ET: How to Make the Decision
    • Frozen Embryo Transfer (FET): A Rational Approach to Hormonal Preparation and How new Methodology is Impacting IVF.
    • Staggered IVF: An Excellent Option When. Advancing Age and Diminished Ovarian Reserve (DOR) Reduces IVF Success Rate
    • Embryo Banking/Stockpiling: Slows the “Biological Clock” and offers a Selective Alternative to IVF-Egg Donation.
    • Preimplantation Genetic Testing (PGS) in IVF: It should be Used Selectively and NOT be Routine.
    • Preimplantation Genetic Sampling (PGS) Using: Next Generation Gene Sequencing (NGS): Method of Choice.
    • PGS in IVF: Are Some Chromosomally Abnormal Embryos Capable of Resulting in Normal Babies and Being Wrongly Discarded?
    • PGS and Assessment of Egg/Embryo “competency”: How Method, Timing and Methodology Could Affect Reliability
    • Treating Out-of-State and Out-of-Country Patients at Sher-IVF in Las Vegas:
    • Traveling for IVF from Out of State/Country–
    • A personalized, stepwise approach to IVF
    • How Many Embryos should be transferred: A Critical Decision in IVF.
    • The Role of Nutritional Supplements in Preparing for IVF
    • Premature Luteinization (“the premature LH surge): Why it happens and how it can be prevented.
    • IVF Egg Donation: A Comprehensive Overview

    If you are interested in seeking my advice or services, I urge you to contact my concierge, Julie Dahan ASAP to set up a Skype or an in-person consultation with me. You can also contact Julie by phone or via email at 702-533-2691/ Julied@sherivf.com You can also apply online at http://www.SherIVF.com .

    *FYI
    The 4th edition of my newest book ,”In Vitro Fertilization, the ART of Making Babies” is available as a down-load through http://www.Amazon.com or from most bookstores and public libraries.

    Geoffrey Sher MD

  • Kristin - July 11, 2017 reply

    What are your thoughts on taking Myo-Inositol for egg quality and/or to prevent OHSS?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - July 11, 2017 reply

    Polycystic ovary syndrome (PCOS) is a common disorder characterized by anovulation, hyperandrogenaemia and insulin resistance. Its prevalence is 5 to 10% in women of reproductive age.

    Insulin resistance has a key role in the pathophysiology of polycystic ovary syndrome PCOS. Jnsulin resistance and hyperinsulinemia, possibly because of a deficiency of a D-chiro-inositol-containing phosphoglycan that mediates the action of insulin may play a key role in the pathogenesis of PCOS. Administration of myoinositol might replenish stores of the mediator and improve insulin sensitivity in patients with the polycystic ovary syndrome (PCOS), thereby improving ovulatory function and decreasing serum male hormone (androgen) concentrations, blood pressure, plasma triglyceride concentrations and thereby help ameliorate some of the metabolic and physical manifestations of this condition.

    More than 18 trials have specifically examined the effects of these drugs on ovulation, and other features of altered metabolism in PCOS. Most of these studies reported have not been randomized but the results appear to be quite promising. It would seem that D-chiro-inositol may improve the potential for ovulatory cycles in patients with PCOS.

    Geoff Sher

  • Jennifer M - May 25, 2017 reply

    So I had a failed cycle in February. I’m 39 with a low AMH but responded well to stims (21 eggs, 19 mature, 11 fertilized). Only two were blasts on day 6. One was frozen day 7. None worked.
    I added coq10 and DHEA but now I’m nervous. I’m on an antagonist-vivelle-no BCP protocol. Start vivelle tomorrow with an expectation to start stims in the next two weeks. Is it too late to stop DHEA?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - May 25, 2017 reply

    I would advise against taking DHEA. I would stop straight away if I were you. Frankly with the egg response you had, I strongly doubt that you have DOR. Something is wrong . Repeat the AMH.

    Geoff Sher

    Jennifer M - May 25, 2017 reply

    Mine was 2.5 3 years ago before I had my daughter after four rounds of IUI. I had two AMHs done in July and September. One was 0.49. One was 0.61.
    I will stop the DHEA. I guess you don’t taper off it? Will add the others. Thank you!

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - May 25, 2017 reply

    Yes! I would just stop the DHEA. But discuss this with your RE.

    Geoff Sher

  • Jessica - May 16, 2017 reply

    Dr Sher: In your opinion, should a mother-to-be continue with this supplemental cocktail post conception?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - May 16, 2017 reply

    Yes, especially while breast feeding.

    Geoff Sher

  • Pile - February 12, 2017 reply

    Hello Dr Sher, can you please recommend good quality brand for Amino Acids , Vitamin Dand Omega 3’s

    Thanks
    Pile

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - February 12, 2017 reply

    I am afraid I cannot! They are all much of a muchness!

    Geoff Sher

  • Amy - October 15, 2016 reply

    Dr. Sher,

    Is it a typo that Vitamin D recommendation is 31,000 IU? I am already deficient in Vit D (13) and taking good prescription dose supplementation. Do all need 31,000 IU? Also, CoQ10 recommendation increased to 400-600 mg from 100 mg (in your prior nutrition blog was 100mg). Is the new recommendation correct?

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - October 15, 2016 reply

    Vitamin D3 might be better at 2,000U per day and 400-600mg COAQ 10.

    Geoff Sher

  • Sarah - March 14, 2016 reply

    Dr. Sher,
    You mention the challenges associated with fat soluble vitamins. I have been deficient in Vit A in the past and have taken Vit A supplementation; however I always stop this supplementation prior to my fertility treatments as recommended by prior doctors (due to concern of fetal abnormalities). I see you do recommend Vitamin A (2565 IU daily). In your opinion is this amount safe to continue with before and during IVF?
    Thank you.

    Dr. Geoffrey Sher

    Dr. Geoffrey Sher - March 14, 2016 reply

    In my opinion…yes!

    Geoff Sher

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