Ask Our Doctors – Archive
Our Medical Directors are outstanding physicians that you will find to be very personable and compassionate, who take care to ensure that you have the most cutting-edge fertility treatments at your disposal. This is your outlet to ask your questions to the doctors.
In your opinion, can supplements help with egg quality and what are the main ones you recommend apart from Ubiquinol?
Possibly so…
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); 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.
Geoff sher
Hi Dr Sher, a friend of mine told me that you do egg competency testing to select the best embryos for transfer to the uterus. Unlike PGD which targets 9 of 23 pairs of chromosomes, SIRM has a new genetic technique allows to accurately assess all chromosomes in the egg and in one or more cells of the embryo cells (blastomeres). Can you tell me more about this? My friend wasn’t able to explain it in a way I could understand it!
We currently do PGS to assess embryo “competency”.
About 10 years ago, Levent Keskintepe PhD and I introduced Comparative Genomic Hybridization (CGH) into the clinical IVF arena, as a preimplantation genetic sampling (PGS) method that enables full karyotyping (numerically chromosomal analysis) of all 23 pairs of an embryo’s chromosomes so mas to determine its subsequent ability to propagate a viable pregnancy (i.e. its “competence”). Since then we have, over a period of a decade, authored many articles on the clinical utility and advantages associated with the selective performance of embryo PGS and with it have witnessed embryo karyotyping emerge as a valuable efficiency tool in the IVF arena. Several alternatives to CGH have since emerged and while none are perfect, they have all enhanced our ability to better select the most “competent embryos for transfer to the uterus, thereby improving the efficiency of IVF, and reducing the risk of chromosomal miscarriages and birth defects. One recently introduced method known as “Next Generation Gene Sequencing (NGS)” bears special mention since its improved accuracy and reliability over previously used methodologies, has established it as a method of choice when it comes to embryo karyotyping..
Gene Sequencing is a method that determines the precise order of nucleotides within a DNA molecule. The method/ technology determines the order of the four bases—adenine, guanine, cytosine, and thymine—in a strand of DNA. A new generation of sequencing technologies known as NGS now provides unprecedented opportunities for high-throughput functional genomic research. NGS is currently being applied to identify the karyotype of the human embryo and in my opinion is more reliable than other available PGS methodologies.
NGS can be conducted reliably on single blastomeres (derived from day 2-3, cleaved embryos) as well as on pooled cell samples biopsied from a blastocyst. When performed individually on several cells derived from a blastocyst NGS can help differentiate between meiotic and mitotic (mosaic) aneuploidy. Done selectively, this could have potential advantages because unlike meiotic aneuploidy which is permanent and often lethal to the embryo, mitotic aneuploidy (mosaicism) is often self-correcting with further embryo development.
Optimal timing of embryo PGS biopsy is very important. You often hear told that embryo biopsy is more reliable if conducted on a blastocyst, rather than on an early (day 3) cleaved embryo. I disagree for 2 reasons. The first is that the earlier in embryo development that the biopsy is done for PGS, the more likely it is that a numerical chromosomal irregularity (aneuploidy) originated during egg (and rarely sperm) meiosis and accordingly is irreversible. In contrast, the later in embryonic development that the biopsy is done, the more likely it becomes that the aneuploidy occurred post-fertilization, affecting only some of the embryo’s cells during mitosis and is thus potentially autocorrectable over time. Thus, it is in my opinion preferable to perform embryo biopsies for PGS on day 3 rather than on day 5-6. The second reason that I prefer doing day 3 biopsies is to give the embryo time (over the ensuing 2-3 days that it develops into a blastocyst) to recover before being vitrified (ultrarapidly frozen). In my experience embryos that are biopsied earlier tend to survive the subsequent freeze/thaw in a much better condition than when they are biopsied as blastocysts whereupon thy are immediately frozen.
Based upon available data, it is my opinion that the time has arrived to recommend that NGS be used as the preferred method for PGS in IVF.
Geoff Sher
800-780-7437
Dr Sher, what do you mean when you say “agonist competitively binds with ovarian FSH receptors”?
For the granulosa cells that line follicles to multiply, causing the follicle to grow, estrogen to be produced and the egg to develop requires that these cells allow FSH to attach to receptors on the surface of the cells. The agonist can parially block this attachment process.
Geoff Sher
Me and my husband undergoing Gestational Surrogacy with Egg Donation Program. His sperm investigation had shown Positive for Candida Glabrata (DNA). The sperm at the moment awaiting frozen, as doctors said that it is Ok to be used for creating an embryo (with donor’s egg). But myself I’d found the info on Oxford Academic website: ‘… “…Chorioamnionitis due to C. glabrata usually becomes clinically apparent in the second trimester. It has high lethality with only 31% of the published affected pregnancies having any neonatal survival..-Pprognosis mostly grim, entailing a high incidence of stillbirth or rapid neonatal death.
C. glabrata contamination of IVF tissue for implantation, via infected semen, is also reported.” Since we are worry a lot, as response from our Clinic was: “Discussed this issue with the reproductologist and embryologist, and found out that:
– fungi live in the liquid, and not in the spermatozoa themselves, and as the sperm undergoes the process of “washing” in a high-density gradient, then embryologists for fertilization take only sperm cells further
Embryos are cultivated under sterile conditions and undergo morphological selection, which already minimizes the risks and likelihood of the incidence of stillbirth .” Should we go ahead and trust the procedures to be continued with infected sperm? Or must take the treatment for my husband first? Seeking for your advice. I hope that you can help us on this difficult forced decision make. With high respect . Victoria.
I would go ahead! I agree with your RE’s opinion.
Geoff Sher
Hi Dr Sher,
I can’t find much information regarding day 6 blasts. I have one day 6 blast frozen from a donor egg cycle but relatively poorly graded. I know you cant be exactly sure…but what percent chance might you give a day 6 expanded blast (graded BC) from a 24 year old donor that it would actually result in a pregnancy in your experience?
Needless to say, the most important determination , i.e. the chromosomal integrity of the blastocyst, being unknown, only leaves you with its morphologic grade and the fact that it is a day 6 blastocyst to go by. Indeed, day 6 expanded blastocysts do make babies, albeit a little less likely to do so than an equivalent day 5 blastocyst. The young age of the egg donor is also in your favor.
Good luck!
Geoff Sher