Eggs, Fertility & Supplements
By: Dr. Ed Coats
Let’s get to the heart of a question frequently asked by women, “Will taking supplements really make a difference to my eggs and my IVF treatment?”. This is a simple question that sadly doesn’t have an easy answer.
So if you feel that supplements are a minefield then you are not alone. There is so much information on the web today driven by powerful marketing campaigns across social media, fertility forums and media platforms that it can become confusing. The supplements market in IVF is complex and not always well understood by clinicians. Unscrambling the evidence for selecting supplements to optimise ‘egg quality’ requires a logical and scientific approach.
Rarely does a ‘one size fits all’ strategy work in fertility or in life, so beware of the response “this is just what we do in our clinic”. It is crucial to take the woman’s age, ovarian reserve, body mass index, medical health and previous IVF performance into account when addressing the question. There are numerous supplements marketed and widely available. More often than not the reality is that supplements provide the icing on the cake rather than transforming the cake mix itself.
It is unusual for supplements alone to transform your chances of IVF success, so it is important that women are not misled with bluff and bluster. Although not totally sceptical of the supplements market there needs to be a logical reason for recommending supplements. Delaying IVF treatment to take supplements for example in older women must be weighed against aging eggs or even a diminishing egg reserve.
In an world of marginal gains optimising egg quality in IVF is much desired. Here are six supplements worthy of consideration:
DHEA
What is it?
DHEA stands for Dihydroepiandosterone, and it is an intermediary hormone in the pathway that leads to oestrogen and testosterone production in the ovaries. Supplementing the diet with DHEA appears to increase egg and embryo numbers as well as improving egg quality.
Who should take it?
Women with a diminished ovarian reserve should consider taking 25mgs ‘micronized’ DHEA three times a day for 2 months prior to egg collection. Avoid taking DHEA if you have PCOS.
Evidence base:
Studies have consistently shown a benefit for women with a diminished ovarian reserve. This evidence comes from a number of reasonably powerful studies.
Side effects:
Oily skin, acne, hair loss.
Coenzyme Q10 (CoQ10)
What is it?
CoQ10 is found directly in the follicular fluid surrounding an egg and is an anti-oxidant. It works directly inside the mitochondria of cells to energise its internal biological processes. Also known as Ubiquinol it is used in IVF to try and increase egg number and quality.
Who should take it?
Anyone looking to improve egg number and quality but particularly those with a diminished ovarian reserve and/or poor embryo development. Consider taking 200mg daily for 10-14 days and then reducing to 100mg daily. Take CoQ10 for at 2 months before egg collection.
Evidence base:
Several studies have shown it to be safe but large scale clinical studies are still to be done.
Side effects:
No safety concerns and with occasional mild gastric upset
Myo-inositol
What is it?
Myo-inositol appears to help normalise cell signalling inside eggs and subsequently aiding egg development. The exact mechanism is not fully understood but inositol is thought to be dysfunctional in PCOS causing insulin resistance. Myo-inositol may help correct this.
Who should take it?
Particularly women with Polycystic Ovaries (PCO) by helping to improve insulin activity, egg development, restoring ovulation, and improving embryo quality. Take around 2g myo-inositol twice a day or perhaps consider inofolic, a combination of folic acid and myo-inositol.
Evidence base:
Studies suggest myo-inositol helps to improve the number of eggs and maturity of eggs harvested in an IVF cycle. It also helps to reduce insulin and stabilise blood sugar control.
Side effects:
A safe supplement in general with possible gastric upset in high doses.
Melatonin
What is it?
Melatonin is an anti-oxidant working inside the body to protect your eggs. It decrease the oxidative stress that may damage eggs, and ultimately improves overall embryo quality.
Who should take it?
Women who have poor egg quality, poor embryo development or a diminished ovarian reserve. Typically take melatonin 3mg once at night for 2-3 weeks prior to egg collection.
Evidence base:
Several studies all seem to indicate that taking melatonin prior to an IVF cycle may improve egg quality and the overall number of top quality blastocysts that result.
Side effects:
Drowsiness, dizziness, irritability and rarely it can worsen depression
Omega 3
What is it?
Omega 3 refers to the ‘Omega 3 fatty acids’, of which there are three types (ALA, EPA and DHA) and they are commonly found in food such as oily fish, nuts and olive oil. They are thought to have an anti-inflammatory effect
Who should take it?
Women who have inflammatory conditions such as endometriosis should consider this supplement. A daily dose of 1000mg per day should have benefit and minimise side effects.
Evidence base:
There has been conflicting study results, but data is emerging that suggest a positive effect of Omega 3 on IVF success.
Side effects:
Belching, bad breath, heartburn, nausea, loose stools, rash, and nosebleeds
Vitamin D
What is it?
Vitamin D is often referred to as the “sunshine” vitamin, is produced in the skin with exposure to sunlight and it can be difficult to get enough from regular foods we eat.
Who should take it?
Studies suggest Caucasian women lacking in Vitamin D or those with reduced sun exposure seem to benefit most from a boost to their Vitamin D levels. A standard daily dose of around 2000 iu each day but this may be dependent on baseline stores. Vitamin D should be taken with food containing fat to aid absorption. You can naturally boost Vitamin D levels with increased sun exposure.
Evidence base:
There have been several studies on Vitamin D but they are not conclusive. Some indicate higher Vitamin D levels support better fertilization, implantation and pregnancy rates.
Side effects:
None of concern
Summary
Supplementing your diet and lifestyle with a few of the above suggestions may improve IVF success but it is not the whole story. This attempt to unscramble the evidence will hopefully guide you on your route to improving your IVF outcome. In depth articles to follow on each supplement mentioned here. Each month we aim to review one area of interest. Next month it is the men who are the focus of our attention.
About 30% of couples have a problem getting pregnant due to male factors and so optimising sperm parameters is essential when approaching an IVF cycle.
Next month we will tackle this in detail and look at what is required to “Make your swimmers prize winners”.
Dr. Ed Coats – Consultant Obstetrics & Gynaecology.