This is the hardest thing that both patients and fertility doctors have to deal with. Women are born with their entire egg supply and never make new ones and about 10 years before the menopause their fertility declines precipitously. The average age at last birth in normally fertile women is 41. As egg supplies dwindle, then chromosomal abnormalities in eggs increase, leading to reduced implantations and increased miscarriages.
There are many women who know that their egg supply is low because of their age, FSH or AMH levels or previous response to treatment and who wish to know how they may improve their egg quality or egg numbers in an IVF cycle.
There is a large amount of research looking at whether the mitochondria in eggs may be refreshed which may mean that eggs do not age in the same way. Currently, there are no products that have been shown to be effective.
There are a variety of medications that have been used to try and increase response ie egg numbers in an IVF cycle, ranging from increasing doses of IVF drugs, DHEA, LH, testosterone and growth hormone. Increasing the dose of drugs only works to a degree as all receptor sites become occupied. There is no good evidence to recommend the use of DHEA or LH. There are 2 small trials suggesting that testosterone may slightly increase response to IVF drugs and pregnancy rates in women who respond poorly. There are 6 small trials suggesting a benefit with the addition of growth hormone. Fertility Associates is recruiting for the LIGHT study, which is a multi-centre Australasian study aiming to recruit 400 women to properly answer the question: Does the addition of growth hormone in women who respond poorly, improve take home baby rates? If you are interested in being part of this study please contact me on mbirdsall@fertilityassociates.co.nz.
Sometimes the only option is the use of donor eggs. There is an increasing demand for donor eggs and along with it an increasing amount of reproductive tourism which has sprung up. Next week's blog will be about travelling to get a baby, what everyone should know.
To find out more about the difference between trying to conceive in your 30s compared with your 40s, take a look at our website here.
Sunday 18 December 2011
Sunday 4 December 2011
Supplements and fertility
Many people ask me what supplements they should be taking to maximise their chances of having a healthy child.
For a man then there is little evidence that a supplement is helpful. Menevit is extensively marketed in New Zealand and Australia for sperm health and contains lycopene, Vitamin C and E along with folic acid, zinc and selenium. There is one published trial on menevit which looked at 60 men with very abnormal sperm, who were randomised to take either menevit or a placebo for 3 months prior to an IVF cycle. The partners of the men taking menevit had 38.5% ongoing pregnancies and those in the placebo arm had 16% ongoing pregnancies and this result was significant. However, there have been no trials looking at men with normal semen analyses and so it is hard to come to the conclusion that all men should take menevit when trying to conceive. We need more trials.
For women, there is very good evidence that folic acid taken for 3 months prior to conceiving and then until 12 weeks of pregnancy is associated with a much reduced chance of a neural tube defect. In NZ the recommended dose of folic acid is 0.8mg. Some women should take an increased dose of folic acid (5mg) such as those with a neural tube defect, or a family history or a previous affected babe and those on some epilepsy medications, as well as possibly women with recurrent miscarriage.
The NZ Ministry of Health has just issued guidelines suggesting that women conceiving should also be on an iodine supplement unless they have hyperthyroidism. We used to get adequate iodine from our milk bottles being washed in an iodine based cleaner and through the use of iodised salt, neither of these things happen now and adequate iodine intake can make as much as 10 IQ points difference to your baby so go iodine.
Adequate vitamin D levels are also associated with better pregnancy outcomes. Dark skinned women are particularly at risk and usually benefit from a vitamin D supplement whereas fairer skinned women can usually get enough Vitamin D by exposing skin for 20 minutes per day to some sunshine.
Omega Fatty acids have received a lot of attention and may improve fetal brain development and in one study in women doing IVF, embryo morphology so reasonable to be on an omega 3 supplement or better still eat oily fish twice per week.
There is some interesting work being done on resveratrol in women with endometriosis suggesting there may be some benefit.
Other supplements? I guess I remain unconvinced and will wait to see some reasonable trials before recommending other supplements.
More information:
When planning to get pregnant, there are no wonder foods to boost fertility, but there are some foods that you should eat more of, and others which should be avoided. Find out what we recommend to our patients here and some lifestyle changes we suggest here.
For a man then there is little evidence that a supplement is helpful. Menevit is extensively marketed in New Zealand and Australia for sperm health and contains lycopene, Vitamin C and E along with folic acid, zinc and selenium. There is one published trial on menevit which looked at 60 men with very abnormal sperm, who were randomised to take either menevit or a placebo for 3 months prior to an IVF cycle. The partners of the men taking menevit had 38.5% ongoing pregnancies and those in the placebo arm had 16% ongoing pregnancies and this result was significant. However, there have been no trials looking at men with normal semen analyses and so it is hard to come to the conclusion that all men should take menevit when trying to conceive. We need more trials.
For women, there is very good evidence that folic acid taken for 3 months prior to conceiving and then until 12 weeks of pregnancy is associated with a much reduced chance of a neural tube defect. In NZ the recommended dose of folic acid is 0.8mg. Some women should take an increased dose of folic acid (5mg) such as those with a neural tube defect, or a family history or a previous affected babe and those on some epilepsy medications, as well as possibly women with recurrent miscarriage.
The NZ Ministry of Health has just issued guidelines suggesting that women conceiving should also be on an iodine supplement unless they have hyperthyroidism. We used to get adequate iodine from our milk bottles being washed in an iodine based cleaner and through the use of iodised salt, neither of these things happen now and adequate iodine intake can make as much as 10 IQ points difference to your baby so go iodine.
Adequate vitamin D levels are also associated with better pregnancy outcomes. Dark skinned women are particularly at risk and usually benefit from a vitamin D supplement whereas fairer skinned women can usually get enough Vitamin D by exposing skin for 20 minutes per day to some sunshine.
Omega Fatty acids have received a lot of attention and may improve fetal brain development and in one study in women doing IVF, embryo morphology so reasonable to be on an omega 3 supplement or better still eat oily fish twice per week.
There is some interesting work being done on resveratrol in women with endometriosis suggesting there may be some benefit.
Other supplements? I guess I remain unconvinced and will wait to see some reasonable trials before recommending other supplements.
More information:
When planning to get pregnant, there are no wonder foods to boost fertility, but there are some foods that you should eat more of, and others which should be avoided. Find out what we recommend to our patients here and some lifestyle changes we suggest here.
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