# Some interesting info on fertility



## XxMichellexX (Oct 15, 2008)

Most of today's fertility treatment focuses on boosting the number of eggs available for fertilization. But in reality, only about 5% of the eggs produced [G1] are even able to become healthy embryos, implant and then result in the birth of a child. I think that it is also important that we explain to women all of the important steps that they may be able to take to optimize the quality of each egg that they are going to produce. Whether you are producing one egg and trying to become pregnant at home or trying to produce as many embryos as possible for an IVF/embryo freezing cycle, this is often the most critical factor which will determine your success.
It takes an egg many months to transform itself from its dormant state to one that is ready to be fertilized. During this maturation process, the egg has to prepare itself for the critical steps of fertilization and implantation. So even though the egg's DNA content was established years ago; the weeks leading up to ovulation or egg retrieval can have a profound impact upon each egg's ability to become a healthy embryo. That is why making wise choices in this critical time before conception is essential to optimizing your outcome. So let's consider what we know about physiology in order to provide you with some practical tips.
Many of the most critical steps that an egg must undergo in preparation for fertilization involve the B-vitamins-specifically B-6, folate (B-9) and B-12. If you're not getting enough of these critical vitamins, you may have an elevated level of the amino acid homocysteine [G2] in your blood. Elevated homocysteine levels are associated with an increased risk of heart disease, blood clots as well as miscarriage and birth defects. In fact, it has long been recommended that pregnant women take supplemental folic acid-the synthetic form of folate-in order to reduce their child's risk of certain birth defects. Recently has it has also been demonstrated [G3] that initiating this strategy prior to egg retrieval could increase the success rates achieved by patients undergoing IVF treatment. This discovery makes sense since the primary role of these vitamins is to enhance how your body processes and replicates DNA.
Having an adequate amount of vitamin D-which is also a hormone made by your skin-has also been shown [G4] to be predictive of IVF success. We now understand that this critical hormone/vitamin has a role in regulating your immune system and reducing insulin resistance as well as improving your bone strength. Since your ovaries and your uterus also have receptors for this hormone; it is uncertain whether the boost in conception associated with appropriate vitamin D levels are from its ability to improve egg quality or to enhance implantation. Either way, the evidence suggests that Vitamin D is another one that women should pay attention to when they're trying to conceive.
To summarize, here are a couple of additional steps to you should consider if you're trying to become pregnant:

Make sure that you're getting enough B-vitamins; especially folate. Since the use of an oral contraceptive is often included in the process of preparing for fertility treatment, consider one of the new ones that contain the most biologically active form of this key vitamin-like Beyaz or Safyrel.

Include a vitamin D supplement in your daily regimen or request a blood test for the active form of this hormone-nutrient called 25-hydroxyvitamin D. Consider your sun exposure well because seasonal variations in production of this hormone do occur. If you're going to take a supplement, make sure that it is Vitamin D3 and not the less effective Vitamin D2.


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## XxMichellexX (Oct 15, 2008)

Recently, I tweeted on study that got some attention in the media by demonstrating that "medical clowning[G1] " can improve the pregnancy rates achieved through IVF treatment. I feel compelled to follow up with a post to be certain that patients going through fertility treatment seriously consider the benefits of laughter.
"Stress" is the hormonal response of your body to unsettling circumstances. These hormone shifts can improve your ability to respond and correct these uncertain situations or they can fester, resulting in chronic changes that have a negative impact upon your health. Your response to any given stress-inducing situation is highly individualized but can result in changes in cortisol, epinephrine, prolactin, growth hormone, insulin, glucagon, thyroid hormones as well as those involved in the recruitment and development of eggs and sperm. So although the "stress response" is present in all of us; our ability to quantify and study it remains very difficult.
Not only can stress impact your chance of a successful pregnancy; it can also effect your choices during treatment. One study [G2] found that patient's experiencing greater personal stress, underestimated their risk of having a multiple pregnancy resulting in a request for higher number of embryos to be transferred. Even worse, the treatment regimens themselves [G3] can trigger stress. This was demonstrated in study involving patients in the USA, UK and France indicating that it was a unique response to one society or environment.
Most patients understand the impact that stress can have upon their success. I experienced this firsthand when my wife and I were going through treatment. That's why I take great joy in sharing practical tips that anyone can take to relieve their own stress response.
v Go see a funny movie-studies [G4] show that just anticipating laughter can lower reduce stress hormones. Better still, a really good belly laugh and normalize stress hormones for nearly two days!
v Simple breathing exercises can reduce stress hormones. These can be performed anywhere. An I-phone app [G5] that I recommend to my patients is called Health for Breath-Pranayama.
v Consider meditation-various forms of meditation have been shown to trigger the relaxation response; thereby inactivating the stress response. Guided meditation CD's can take you through the process including some that are particularly geared towards couples dealing with infertility.


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## XxMichellexX (Oct 15, 2008)

Most fertility treatment focuses pretty intently upon the sperm and the egg. Unmistakably, these are essential factors in initiating a pregnancy. But even the best quality embryos cannot survive more than 7 days outside of the womb. Therefore, a healthy uterus is an essential bridge between conception and delivery. In fact, more recent studies suggest that even impaired implantation can result in a pregnancy but one that may be fated to problems avoidable complications. So taking steps to optimize_uterine receptivity_-the term used to describe how inviting the environment is for the embryo-represent a critical link to take full advantage of your fertility treatment.
Since many fertility treatment centers don't focus on uterine issues, it is uncertain what percentage of patient's have a "uterine factor" as their sole obstacle to conception. However, most centers do use ultrasound to measure the endometrial thickness as an estimate of receptive the woman's uterus is to implantation. In a seminal paper [G1] published in the journal Human Reproduction in 1991, Dr. Geoffrey Sher demonstrated that when this thickness was less than 9 mm, the chance for a successful pregnancy was dramatically reduced-typically to less than 10%. He later went on to demonstrate [G2] that for many women (~70% in our clinic) this failure of endometrial receptivity is due to poor blood flow. This identified a treatable problem that can potentially be reversed with the use of well-known erectile dysfunction drug name Viagra. By implementing the Viagra Protocol, we have been able help many women successfully carry their own pregnancy even when they had previously been told that this was not possible. Even with a thick enough endometrial lining, some additional attention to receptivity may be warranted.
Multiple studies [G3] have demonstrated that the medications used to optimize egg development can cause a hormone imbalance that interferes with endometrial receptiveness. In fact, some studies [G4] suggest that the very high estrogen levels often associated with IVF cycles may have a negative impact upon implantation even while promoting the number of embryos produced. Various strategies have been created to overcome these obstacles and since there is no simple answer, I feel that it is best to inform patients and offer them options when creating a treatment plan. Here's what you should consider when you discuss this with your doctor:

_Ask about your endometrial thickness_. If it is less than 9 mm, discuss the possibility of freezing your embryos and/or consider the Viagra Protocol.

_Talk to your doctor about your highest estrogen level_. If it was above 3500 pg/mL discuss whether or not it may be in your best interest to freeze all of your embryos. Doing so may not only improve implantation but can also reduce your risk of developing Ovarian Hyperstimulation Syndrome (OHSS).

_Consider the use of a steroid_. There have been several studies that demonstrate that various forms of the hormone called cortisol, can off-set the impact the impact estrogen has upon your immune system. The end result may be a greater chance that your immune cells will welcome an embryo and foster its implantation.

_Request "luteal support" through the use of progesterone_. The process of IVF can reduce implantation unless steps are taken to support implantation. Whether it is because of an imbalance between estrogen and progesterone, residual effects of medications used to block ovulation or due to a loss of hormone producing cells at the time of egg retrieval remains a subject of debate. But it is pretty widely accepted [G5] that the use of progesterone helps improve your chances of becoming pregnant. Which form of progesterone to use (injections, pills or suppositories) and how long [G6] to use it for are another topic that can/should be tailored to your unique situation.


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## XxMichellexX (Oct 15, 2008)

One of the greatest challenges involved in infertility treatment is how to improve the pregnancy rate while also keeping the risk of multiple pregnancy (twins, triplets, etc) as low as possible. One strategy for achieving this goal is to let the embryos complete the development in the laboratory-the critical stage of becoming a "blastocyst"-that would normally take place in the fallopian tube. There are many so many studies that support this approach that it has been widely adopted by those centers that can confidently create the environment in the lab for healthy development to occur. Yet this technique still has limitations. One study [G1] recently demonstrated that nearly half of the best looking blastocysts are still genetically abnormal, even for women less than 40 years of age. Embryos selected for transfer before they reach the blastocyst stage only have about a 40% chance of being genetically normal. These studies have driven an interest in making _preimplantation genetic screening_ (PGS) available to more couples going through fertility treatment. To do so can maximize embryo selection as well as provide useful diagnostic information to couples undergoing IVF.
The goal of any fertility program should be one embryo per transfer. But since it is so difficult to predict which embryo is most likely to implant and become a healthy baby, a common strategy is to transfer more in the hope of boosting success. This is often done with the knowledge that if a chromosomally abnormal embryo implants, it has a 99% of miscarrying; compared to a 7% risk of miscarriage for a normal embryo. So PGS can not only boost the pregnancy rate per embryo transferred, it can also reduce the risk of miscarriage as well. Previous studies [G2] questioning the benefits of PGS have been thoroughly analyzed and found that the techniques and the technicians had a big impact upon limiting the successful application of this new tool in those headline-grabbing stories. Emerging research suggests that using PGS to select embryos may result in a pregnancy per transfer rates of 80% or higher; even in high risk patients. The key is to only transfer the embryos that are genetically competent.
Now that the techniques for embryo biopsy and genetic testing have been refined and made more accessible, the challenge is selecting which couples are most likely to benefit from this technology. The goal is to minimize the cost of treatment while also optimizing the outcome. A recently published but exhaustive review [G3] this subject summarized the key selection criteria needed to achieve that goal. Here's what you should consider as you decide whether or not you're interested in PGS:

Couples where the egg comes from a woman that is at least 37 years of age; the time when genetic abnormalities naturally increase in frequency

There are at least 5 healthy embryos (Grade 1 or 2 with at least 6 cells present) available for testing

There are at least 8 chromosomes tested including 13,15,16,18, 21, 22, X and Y (the ones most likely to be abnormal)

Embryo biopsies are only performed by properly trained personnel (>100 biopsies within the last few years with an average of 5 minutes or less per biopsy) to avoid unnecessary damage to the embryo

Established techniques are used for biopsy preparation

All samples are sent to experienced labs with strict quality assurance standards

IVF center has extensive experience in counseling patients and explaining results


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## XxMichellexX (Oct 15, 2008)

what are the top fertility-boosting foods? Although I emphasize the importance of eating an all-around healthy, organic diet, these are what I consider to be the top three fertility-boosting foods:

Beans - Not only are they packed with protein, fiber and nutrients important for fertility and pregnancy, such as calcium, iron and potassium, but they also contain a high percentage of folate (a B vitamin), which boosts fertility in both men and women and helps prevent neural tube defects at birth. Beans are also low in fat, good for digestion and a great source of antioxidants.

Nuts and seeds - They are high in protein and healthy fats, which help stabilize blood sugar levels, ease inflammation and boost fertility. Estrogen is made and stored in fat, so you definitely need fat, you just want to be sure to eat the healthy kind. Nuts and seeds also contain essential minerals and fiber, which is important for the health of the digestive system and lowering cholesterol. Good choices for seeds are pumpkin and sesame, which also contain zinc, and for nuts, almonds and walnuts.

Avocados - This fruit is great for fertility! Not only is it packed with folate, it's also high in monounsaturated fat. That's the good, healthy kind of fat, which helps to lower cholesterol and plays such an important role in our endocrine system, which regulates the hormones involved in reproduction. Finally, avocados contain good enzymes which aid digestion and when you're trying to conceive, anything you do to lessen the impact on digestion helps! Avocados are also high in fiber, which helps regulate blood sugar levels, and are filled with other great nutrients, such as potassium, vitamin B6 and vitamin C.


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## mandimoo (Feb 28, 2011)

Hi Michelle,

Thank you for all the information. I will be digesting this in time for my next appointment as I feel the genetic testing of my embryos could really help and I also feel my uterus health is quite poor. 

One simple question I have though... regarding the beans you mention as a good fertility food... what kind of beans do you mean? And are you referring to female fertility or both when you speak me the dietary aspect?

Just realised that's 2 questions


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