Nutrition + Fertility

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Without a doubt nutrition is the cornerstone to laying down a foundations for a healthy body and pregnancy. Nutrients play an essential role in creating and maintaining healthy eggs and sperm. 


Here, I try to bypass the generalizations and provide you with evidence-based information and guidance.  


If you have additional question I have not covered, feel free to contact me via email at laurag@lgnutritionconsulting.com

Polycystic Ovarian Symdrome (PCOS)

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What Is PCOS?

Polycystic ovary syndrome (PCOS) is a hormonal disorder defined by a group of signs and symptoms. These may include:  

  • Irregular or absent menstrual periods
  • Infertility
  • Weight gain (especially at the waist)
  • Acne
  • Excess hair on the face and body
  • Thinning hair on the scalp

PCOS affects 7–10% of women of childbearing age and is the most common  cause of infertility.  In the United States, an estimated 5 to 6 million  women have PCOS, making it the most common hormonal disorder among women of reproductive age.


Women with PCOS often have many small painless cysts in the ovaries  (hence the name “polycystic”).  These cysts are not cancerous. 

PCOS + Nutrition

Eighty percent of women with PCOS are overweight or obese.  The remaining 20% are slim built and sometimes called "thin PCOSer".  The leading treatment for PCOS is weight loss.  A weight loss of only 5% can improve insulin resistance,  leading to lower levels of male hormones, improved menstrual function, and a reduction in cholesterol abnormalities. 


Unfortunately, many women with PCOS have a difficult time losing weight. Additionally, women with PCOS have decreased sensitivity to insulin, the hormone that regulates glucose, aka: sugar, in the blood. This condition, known as insulin resistance, is a major risk factor for type 2 diabetes. Women with PCOS often have type 2 diabetes, low levels of good cholesterol (HDL), and high levels of bad cholesterol (LDL) and other blood fats, including triglycerides. Even if your weight gain is caused by some physiological consequence of PCOS, lifestyle changes offer you the best chance of successful weight loss. 


Research shows that a healthy diet includes lean proteins, heart-healthy fats, and a moderate amount of carbohydrates. Lean proteins options include fish, skinless poultry, egg whites, beans (especially soy and their products), nuts and nut butters. Heart-healthy fats include liquid oils from olives, canola, soybeans, corn, laxseed, sunflower, and peanuts. Choose carbohydrates that have a low glycemic index. The glycemic index is a measure of how quickly and how strongly a food increases blood sugar and insulin levels. 


Choosing foods with a lower glycemic index may help to reduce carbohydrate cravings, especially whole, intact grains that are high in fiber. Eat 100% whole-grain breads, brown rice, and steel-cut oats, or try something new such as barley, couscous, or the grain quinoa.   

PCOS + Functional Nutrition

Function nutrition research into what benefits nutrition supplements can potentially offer to women with PCOS is exploding. Here are a few of my favorite supplements and the link to purchase:


PCOS is a complex and overlooked condition with significant long-term metabolic risk factors that persist throughout a woman’s lifespan. Modifications to diet and nutrition supplements play a crucial role in helping women with PCOS to improve their fertility, optimize their health, and prevent disease.   


* I have personally been effected by this supplement.  During my IVF process, egg retrieval 1 resulted in no viable blastocytes.  Ninety days later, and with the addition of CoQ10, egg retrieval 2 produced 5 healthy blastocytes.*

endometriosis

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Endometriosis is a painful, chronic disease that affects roughly 6.3 million women and girls in the U.S. It occurs when tissue that lines the uterus (this tissue is called the endometrium) is found outside the uterus and in the abdominal region on the ovaries, fallopian tubes, and ligaments that support the uterus, the area between the vagina and rectum, the outer surface of the uterus and the lining of the pelvic cavity. 


Each month, this misplaced tissue respond to the menstrual cycle the same way that the tissue of the uterine lining does: the tissue builds up, breaks down, and attempts to shed. Unfortunately, this misplaced tissue has no way of exiting your body and subsequently becomes trapped in your pelvis. The trapped tissue can become irritated, eventually developing scar tissue and adhesions. This results in internal bleeding, breakdown of the blood and tissue from the lesions, and inflammation potentially causing pain, infertility, scar tissue formation, adhesion's, and even bowel problems. 


Reducing excess estrogen, by avoiding estrogen's in our food and our environment, is a crucial first step for women suffering from endometriosis. Remember, the endometriosis tissue responds to estrogen…the more estrogen in your body…the worse your endometriosis can be. The #1 source of estrogen exposure in our food is from meat and dairy products. Most people should try limiting non-organic animal products, but this is especially important for women with endometriosis. Another large source of estrogen exposure is found in products containing xenoestrogens (aka: fake estrogens). Items such as cosmetics, plastic, canned goods, body care products, and cleaning supplies are typically estrogen-based and add to your bodies estrogen load.   

Possible Causes of Endometriosis

Lymphatic Flow Theory: This theory suggests that the endometrial tissue is spread throughout the body via the lymphatic system. 


Surgical Scar Implantation: After a surgery, endometrial cells may attach to a surgical incision. 


Genetic Predisposition: Women with a family history of mothers or sisters whom have/had endometriosis are at a higher risk for developing endometriosis.  


Retrograde Menstruation: In normal menstruation, the uterine lining sheds following ovulation without fertilization. Blood and endometrial tissue push forward out of the vagina, typically creating steady flow for 3-7 days of menstruation. When retrograde menstruation occurs, some of the menstrual tissue backs up through the fallopian tubes, implants in the abdomen, and grows.  Some experts believe that all women experience some menstrual tissue backup and that an immune system problem or a hormonal problem allows this tissue to grow in the women who develop endometriosis. 


If endometrial tissue clogs the fallopian tubes or reaches the peritoneal cavity, these displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle. If any symptoms of retrograde menstruation exist, they might include: shorter periods, reduced menstrual flow, or a complete absence of bleeding with normal period signs (cramping, irritability, bloating and skin changes, PMS, etc.).  


Dioxin: Research by the Endometriosis Association revealed a startling link between dioxin (TCCD) exposure and the development of endometriosis.  Dioxin is a toxic chemical byproduct of pesticide manufacturing, bleached pulp and paper products, and medical and municipal waste incineration. As mentioned before, organic meat and dairy products are always a safe-guard from possible exposure. For more information visit: World Health Organization 


Low Progesterone / Estrogen Dominance: Low progesterone disrupts hormonal imbalance overall. When progesterone becomes low, estrogen usually becomes too high. Estrogen dominance and progesterone deficiency have been linked to the development of endometriosis.  


Free Radicals and Oxidative Stress: Cell damage from free radicals - electronically unstable atoms or molecules which strip electrons from any other molecules they meet in an effort to achieve stability - create unstable molecules that then attack other molecules in domino-like chain reactions and causing extensive cellular damage. 


Oxidative stress - the total burden placed on the human cell by the constant production of free radicals – caused by the presence of elevated concentrations of free radicals and lowered antioxidant potential, may be one of the links in the chains leading to the development of endometriosis. 1  Immune system disorder. It’s possible that a problem with the immune system may make the body unable to recognize and destroy endometrial tissue that’s growing outside the uterus.  

Signs & Symptoms of Endometriosis

The primary symptom of endometriosis is pelvic pain, typically associated with menstrual periods. A majority of many women experience cramping during their menstrual period, however, women with endometriosis typically describe menstrual pain that is far worse than the averages woman.  


Common signs and symptoms of endometriosis may include: 

  • Dysmenorrhea (Painful periods) 
  • Infertility Pain with bowel movements or urination.  
  • Excessive bleeding 
  • Menometrorrhagia (bleeding between periods) 


Every woman is different and often time women with endometriosis suffer from other illnesses such as pelvic inflammatory disease (PID), ovarian cysts, allergies, chemical sensitivities, and frequent yeast infections. It can also confused with irritable bowel syndrome (IBS).   

Endometriosis + Fertility

The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant. 


Endometriosis in an interesting condition. First, it can obstruct the fallopian tube and keep an egg and sperm from uniting. Second, this condition has shown to affect damage the sperm or egg. Research has shown that a woman’s body may form antibodies against the out-of-place endometrial tissue, and those antibodies may attack the uterine lining causing a miscarriage.      

Endometriosis + Nutrition

When attempting to relieve endometriosis symptoms naturally, one of the most important things to do is reduce excess estrogen exposure as well as reduce inflammation in the body. Begin by eliminating the foods that cause inflammation and increase estrogen in the body: 


  • conventional meat & dairy · non-organic fruits & vegetables (many of the chemicals they spray on our food are estrogen-based) · gluten  · sugar · coffee · soy (soy has a molecular composition similar to estrogen) · refined carbohydrates (bread products, pasta, cereal, granola, baked goods, dessert, etc.) · genetically modified foods (GMO’s) · vegetable oils 


Eliminate these foods from your diet for at 4-6 weeks, paying close attention to your body changing throughout the process. Alcohol and other high-estrogen foods should also be eliminated from your diet because of their estrogenic effects.   It’s important to follow an anti-inflammatory diet when dealing with endometriosis. That means it’s a good idea to add in lots of these super beneficial anti-inflammatory foods:  


  • green leafy vegetables · celery · beets · broccoli · blueberries · wild caught salmon · pineapple · bone broth · walnuts · coconut oil · chia seeds · flaxseeds · turmeric · ginger · bok choy 

Magnesium-rich foods also help soothe the uterus and reduce pain. These include: 


  • pumpkin seeds · sunflower seeds · black beans · avocado · almonds · bananas · chard · spinach

Iron-rich foods are important because they replenish the iron that is lost from monthly excess bleeding:

 

  • grass-fed red meat · organ meat · beans ·  whole eggs · prunes · artichokes · spinach · potatoes 


Additionally, you can regulate hormone production, reduce inflammation and relieve joint and muscle pain with healthy mono-unsaturated and poly-unsaturated fats. Anti-inflammatory fats include: 


  • wild-caught fish & seafood: salmon, mackerel, herring, halibut, shellfish, oysters, cod, tuna, flounder, sardines, hake, skate, trout, red snapper · egg yolks from pastured chickens · fats & oils: grassfed butter or ghee, animal fats from clean animals (lard, tallow, duck fat, bacon grease, etc), raw & unrefined coconut oil, 100% pure olive oil · raw nuts & seeds

Constipation can be a frustrating side effect of endometriosis.  In order to increase gastrointestinal transit time, consider high fiber foods such as: 


  • non-starchy vegetables · chia & flax seeds · steal cut oats · sweet potato · plantain · squash · berries · coconut · figs · prunes · peas · broccoli · cauliflower · brussel sprouts · beans


Kombucha is a probiotic, like yogurt or sauerkraut, and is high in Glucaric acid. (which is beneficial to the liver and aids its natural detoxification) 


Studies on kombucha are limited, but this ancient health superfood has been attributed with several different health benefits. The nutrients it contains are wonderful at supporting the body in various ways.   


One study published in the February 2014 issue of the Journal of Medicinal Food found that kombucha tea has detoxifying properties, protects against free radical damage, has energizing capabilities, and promotes immunity.1 Additional benefits include:  


  • Increased energy
  • Better digestion
  • Improved mood (helps with anxiety/depression)
  • Reducing Candida (yeast)
  • Nutrient absorption
  • May be beneficial for weight loss


So, how much should you have? The Centers for Disease Control and Prevention (CDC) recommends that people limit their consumption of kombucha tea to 4 oz per day. 


I buy my kombuchas locally at Kombucha Tampa.  Thus far, my favorite is their orange carrot ginger!


Supplements

As a Registered Dietitian, my hope is that you consume your vitamin and minerals naturally via food. However, I understand that nutritional deficiencies happen, and I also understand how overwhelming nutritional supplement shopping can be. 


So, I’m going to make it very easy for you. Here are my 5 favorite supplements to help ease the pain and discomfort associated with Endometriosis:  


1. Ubiquinol: Ubiquinol is the most biologically active form of the coenzyme Q10 and can provide a strong first-stage antioxidant effect against cellular oxidative damage. Several conditions associated with reproductive dysfunction are linked to oxidative stress including endometriosis, unexplained infertility, PCOS, recurrent miscarriage and egg and sperm health. 1 


Several studies show that antioxidant supplementation can reduce oxidative stress and positively affects the outcome of each of the above mentioned issues. Additionally, researchers believe that ubiquinol supplementation may help cells function normally and divide properly by restoring energy to the mitochondria (the powerhouse of the cell) in each cell. This is very important because, as all us baby- fever gals know, the first stages of life are dependent on proper cell division. 


2. Omega-3’s: Several studies have found that omega-3 fatty acids reduce inflammation and improve cellular integrity which helps to protect cells in the body from oxidative stress. A study by the University of Western Ontario found that fish oil containing two specific compounds, EPA, and DHA, can relieve pain by decreasing levels of an inflammatory chemical called prostaglandin. Researchers also found that fish oil can slow the growth of endometrial tissue. 


3. Inflammatone: This lovely supplement contains a blend of proteolytic enzymes and is known as one of the most effective natural treatments for endometriosis. Specific enzymes can reduce scar tissue and breakup the excess tissues left from endometriosis. Enzyme therapy also reduces inflammation caused from surrounding scar tissue and may help with endometriosis associated pain by circulating oxygenated blood to the reproductive organs and removing stagnant blood. 2


4. Calcium (Ca) and Magnesium (Mg): Calcium is infamously known for strong bones and healthy teeth…but did you also know it is essential for getting pregnant?! 


Recent research studies are showing two consistent results regarding Ca; 1. Ca is a vital ingredient in the process of triggering growth in embryos. 2. Ca triggers sperm to abruptly convert their slow and steady swimming style, to a whip-cracking snap that thrusts them into the egg! Additionally, the combination of calcium and magnesium help the liver more efficiently metabolize hormones.  


5. Diindolylmethane (DIM): Endometriosis is an estrogen dominant condition and this compound has been shown to help support healthy estrogen metabolism. DIM balances the hormones by breaking down estrogen and removing it from the body. By cleansing the body of excess estrogens, DIM has been shown to prevent endometrial tissue from growing.    


1. Nummer BA. Kombucha brewing under the Food and Drug Administration model Food Code: risk analysis and processing guidance. J Environ Health. 2013;76(4):8-11.  


2. Gupta S, Agarwal A, Krajcir N, Alvarez JG. Role of oxidative stress in endometriosis. Reproductive Biomed Online. 2006 Jul;13(1):126-34.  

Fibroids

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Uterine fibroids will affect as many as 3-4 women at some point in their lives.1 Known as leiomyomas, myomas, or fibromyomas, uterine fibroids are benign tumors that grow within the smooth muscular tissue of the uterus. Women in their 30s and 40s are mostly affected, but fibroids can develop at any age.2 


Did you know that fibroids are responsible for over 200,000 hysterectomies in the US annually?! 


Fibroid symptoms include bleeding in between periods, heavy and prolonged menstrual periods, abdominal and lower back pain, frequent urination, constipation, miscarriages and infertility. They can vary in size, shape, and location within the uterus and can grow inside the uterine cavity, within the uterine musculature, on the outer walls of the uterus, or attach to the uterus in a mushroom-like stalk.  

What causes a fibroid?

It is believed that uterine fibroids develop from a stem cell in the smooth muscular tissue of the uterus. A single cell divides repeatedly, eventually creating a stiff and rubbery mass. 


The growth patterns of uterine fibroids vary – they may grow slowly or rapidly, or they may remain the same size. Some fibroids go through growth spurts, and some may shrink on their own.  


Sadly, the exact cause of uterine fibroids is unknown. 3 Some studies suggest that genetic alterations in the uterine muscle cells may cause fibroids to develop and that fibroids have been shown to contain more receptors for estrogen and progesterone than normal uterine muscle cells, making them more likely to grow.1,5  


Additional theories include internal chemicals (those which maintain normal tissues) may actually stimulate fibroid development 1, eating foods high in unhealthy fats like non-organic animal foods, processed meats, fried foods, and vegetable oils increase inflammation in the body and usually contain multiple chemical additives, being overweight or obese and high blood pressure or hypertension.  

Fibroids + Nutrition

Research does suggest a relationship exists between diet and the growth of uterine fibroids with additional evidence that dietary factors may indeed influence the growth of fibroids. What does this mean? It means that good nutrition can only help women who suffer from fibroids. Continue reading for suggestions on diet elimination choices. 


Dairy:  A study published in the American Journal of Epidemiology in 2010, followed more than 22,000 premenopausal black women from the US Black Women’s Health Study over a 10-year period. Self-administered questionnaires on dietary intake were used to assess whether intake of dairy foods such as low-fat and whole milk, cheese, yogurt, and ice cream—and some dairy components such as calcium, vitamin D, and butyric acid—may reduce risk of uterine fibroids. 


The findings indicated a lower risk of uterine fibroids associated with higher dairy consumption. The perceived protective effect of dairy, according to the researchers, may lie in the ability of calcium to reduce fat-induced cell proliferation and in butyric acid (present in milk fat), which is considered a potent antitumorigenic agent that may inhibit cell proliferation and angiogenesis.5 


Glycemic Index: Eating foods with a high dietary glycemic index (GI) is thought to potentially promote tumor growth by increasing endogenous concentrations of insulinlike growth factor 1 (IGF-1). In vitro studies have shown that uterine fibroid cells proliferate in the presence of IGF-1.      


Caffeine and Alcohol: Excessive alcohol consumption can increases inflammation throughout the body, reduce immune function and encourages hormonal imbalances. By reducing or eliminating alcohol, you can help to get your hormones back on track and hopefully shrink those fibroids fast. 


Excess caffeine stresses your liver making it work less effectively at metabolizing estrogen and ultimately diverts necessary energy away from the reproductive system. Studies also show that drinking 2+ caffeinated beverages per day may boost estrogen levels in women and worsen conditions with a hormonal basis..ie: fibroids. 


Decrease in alcohol and caffeine intake + your liver = fibroid-discouraging behavior  


Lifestyle: Diet modification aimed at reducing the intake of xenoestrogens, or environmental chemicals that possess estrogenic activity which may fuel fibroid growth, such as Atrazine (weed killer), Butylated hydroxyanisole known as BHA (food preservative), Methylbenzylidene camphor known as 4-MBC (sunscreen lotions), Erythrosine, FD&C Red No. 3, (food dye), Bisphenol A known as BPA (found in canned foods and plastics such as water bottles), Ethinylestradiol (combined oral contraceptive pill), Heptachlor and dieldrin, DDT (insecticides), as well as reducing the intake of growth hormones present in foods such as conventionally raised, nonorganic beef.  

1. Uterine fibroids. Mayo Clinic website. http://www.mayoclinic.com/health/uterine-fibroids/DS00078. June 11, 2011. 

2. Frequently asked questions: uterine fibroids. American College of Obstetricians and Gynecologists website. http://www.acog.org/~/media/For Patients/faq074.pdf?dmc=1&ts=20120209T1656069753. Updated May 2011 

3. Martin CL, Huber LR, Thompson ME, Racine EF. Serum micronutrient concentrations and risk of uterine fibroids. J Womens Health (Larchmt). 2011;20(6):915-922 

4. Andersen J, Barbieri RL. Abnormal gene expression in uterine leiomyomas. J Soc Gynecol Investig. 1995;2(5):663-672 

5. Wise LA, Radin RG, Palmer JR, Kumanyika SK, Rosenberg L. A prospective study of dairy intake and risk of uterine leiomyomata. Am J Epidemiol. 2010;171(2):221-232.  

The ivf process

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Will IVF Work?

 IVF is one of the most effective Assisted Reproductive Technologies (ART) in the world.  The truth is though, no one can tell you for sure whether IVF is the answer you are looking for, but there are some important factors which can affect the probable outcome of IVF treatment.  


  • Age: An article in the New England Journal of Medicine (L.  Heffner, Nov. 2004) highlights the impact increasing maternal age has on pregnancy, miscarriage rates and maternal-fetal outcomes.  While age has been statistically tied to success rates for IVF,  your body and your medical history are unique and IVF has been used successfully to help women at every stage of their reproductive life. In consultation with your doctor, the results of comprehensive blood and ultrasound testing are a better indicator of your candidacy for IVF than age alone.


  • Previous pregnancy:  If you have been pregnant before and have carried a baby to term,  either with or without ART, you may have a greater chance of getting pregnant again with IVF.  


  • Type of fertility problem: IVF is an excellent  choice to help patients and couples with a wide range of common  fertility problems. Infertility caused by factors such as endometriosis  or blockages of fallopian tubes, issues with ovulation, or male-factor  infertility such as low sperm count or motility often respond very well  to IVF. Unfortunately, there certain other fertility problems which are  associated with less IVF success, such as:  


  • Uterine abnormalities and fibroid tumors: Sometimes patients have a difficult time carrying a pregnancy to term because of structural problems with their uterus or benign fibroid tumors. Both of these issues can make it difficult or impossible for an embryo  to implant and grow properly. Sometimes, however, problems like these  can be resolved surgically, making pregnancy (with or without the help  of IVF) possible.


  • Ovarian dysfunction: Problems with the ovaries,  such as high follicle-stimulating hormone (FSH) levels indicating low  ovarian reserve, or poor egg quality can mean that IVF with your own  eggs could be less successful.


  • Dual infertility factor: If both you and your partner are struggling with infertility problems, IVF may or may not be able to address both sides of the issue. Careful testing and in-depth  consultation with your fertility experts will be able to give you a  better idea of your individual situation.


  • Length of time that a couple has been infertile: Statistically,  the chances of IVF success go down over time for couples who have been infertile for several years. In practice, only you and your doctor can decide if this is a significant factor in your case.


  • Using donor eggs: For older patients, or patients where concerns about ovarian reserve and egg quality are paramount, opting to use donor eggs may give you a higher chance of  success than attempting IVF with your own eggs.


  • Lifestyle factors: While most factors affecting IVF success are out of your hands, with the help of your healthcare team you may be able to improve your chances by tackling such lifestyle issues like smoking, sedentary behavior and stress. 


  • Laboratory quality: Obviously, a laboratory plays a crucial part in IVF.  Fertilization and the careful culturing of embryos before transfer requires a pristine environment. An excellent IVF lab will go above and beyond the basic requirements to ensure that embryos are given the best  possible start.  


  • Fertility clinic selection: Choosing a fertility  clinic is a deeply personal decision, and one of the most important factors in IVF success. Your facility, like mine, became part of my family as they are involved at every stage of the  process.  


  • Success rate: Your fertility clinic should have a  proven track record, but exactly how they measure success really  matters. Some specific numbers you should ask about include:  
    • Pregnancy ratio per embryo transfer
    • Pregnancy rate for couple’s age group
    • Live birth rate per IVF cycles
    • Rate of patients pregnant with multiples

The IVF Process

Every facility is different, but the general IVF cycle entails multiple steps, and each step takes place at a  specific time during a 6-week period. The IVF procedure is based on the  following steps: (1) preparation for treatment, (2) induction of  ovulation, (3) egg retrieval and (4) embryo transfer. Your IVF cycle could also include Preimplantation Genetic Diagnosis (PGD), a scratch test and much more. The process starts about the time of ovulation in the month prior to the IVF cycle. Everyone typically receives a personalized calendar with your individual schedule, and the ART nurses will carefully review the plan and answer any questions you may have. 

Be Positive. Be Patient. Be Persistent

 

Step 1: Birth Control

Birth control kicks off the IVF party around day 3. There  are 2 main reasons for taking birth control pills prior to your IVF cycle. First, taking birth control pills prior to a stimulation cycle may help the ovaries respond better to the stimulation medication.  Second, taking birth control pills allows flexibility in coordinating  your cycle.  Expect to be on birth control fora minimum of 2 weeks. 

Step 2: Baseline Ultrasound

At the time of your expected period,  you should have a blood test (to check your estradiol level), and an ultrasound to examine the ovaries.


Step 3: Ovarian Stimulation (Deep breath, you'll be fine)

If the baseline ultrasound shows no significant cysts, stimulation medications start after menstrual bleeding begins. Gonal-F and Follistim are the brand names for a group of  medications known as gonadotropins which contain only FSH (follicle  stimulating hormone). Repronex and Menopur are the brand names for  another group of medications known as human menopausal gonadotropins  containing both FSH and LH (luteinizing hormone). Many protocols use a combination of both medications. Typically the injections are given daily for 8-12 days, (Injections don't feel wonderful, but they certainly aren't painful) depending on how your body responds to the medications.  

 

Step 4: Monitoring of Follicle Development and Estradiol Levels

Transvaginal ultrasound examination takes between 5-20 minutes to  perform. It provides valuable feedback for monitoring follicular growth and determining when the follicles are mature and ready for retrieval.  Ultrasound monitoring frequecy is decided by your ATR nurses (in coordination with your doctor). Correlate of the estradiol levels in your blood with the ultrasound results frequently during the IVF cycle to ensure that you are taking the proper dosage of medication. Adjustments can be made. 

Step 5: Final Egg Maturation and HCG Administration

Human chorionic gonadotropin (HCG) is a drug that stimulates the  final maturation of the eggs. The timing of this injection is very important! HCG needs to be given 36 hours prior to the egg retrieval.


Step 6: Egg Retrieval aka: The Big Day!

 The retrieval is done in an outpatient setting. During the retrieval the anesthesiologist administers intravenous anesthesia and the egg retrieval is performed via vaginal ultrasound with a thin needle passing through the top of the vagina.  This allows the tip of the aspirating needle to enter the ovarian follicles and aspirate the follicular fluid from them. The egg retrieval takes 5-10 minutes. 

 

Step 7: Insemination of Egg

During the egg retrieval, your partner has provided a sample. The sperm (donor or partner provided) is prepared and placed with the eggs. In some cases, the embryologist will need to identify normal, motile sperm and inject them individually directly into each egg. This procedure is called  Intracytoplasmic Sperm Injection (ICSI). Once the eggs are inseminated or placed with the sperm, they are placed into an incubator overnight. 


Step 8: Embryo Transfer

You will have 2 options: fresh or frozen. During a fresh embryo transfer, one or more recently developed embryos from the current cycle of IVF are transferred into the uterus as soon as they are  ready – often 3 to 6 days after egg retrieval. The frozen embryo transfer (FET) process involves taking embryos which have  been cryopreserved (frozen) previously and placing them into the  uterus.   


Step 10: Progesterone Supplementation

The start of your progesterone injections depends on whether you did fresh or frozen.  Fresh begin the evening after the egg retrieval and continue daily until your serum pregnancy test. Frozen begins ~5 days prior to the transfer (My husband and I did ours every evening at 6pm) and continues until your serum pregnancy test. If pregnant, progesterone will be administered for a total of 12 weeks. After the seventh or eighth week of pregnancy, the placenta takes over progesterone production   

INFERTILITY IN WOMEN

Infertility is more common than many people realize. It affects, on average, 10% of couples—that’s more than 1 million—in the United States. Both men and women face fertility problems. One-third of the time it is female factor, and about one-third of the time it is a male factor. Sometimes, a combination of female and male factors are the issue. Approximately 20% of the time, the cause of a couple’s infertility is unexplained.


How is infertility diagnosed?

Your doctor will begin with a medical history about your menstrual cycle, past illnesses, sexually transmitted diseases, surgeries, and any  drugs you are taking. The next step is usually a pelvic exam to make sure your reproductive organs are normal and blood tests to measure your hormone levels. Your partner will also have a semen analysis and medical history. Depending on what these tests find, your doctor may do further tests, including one to make sure your fallopian tubes are not blocked.

 

What causes female infertility?

About 25% of women with infertility have infrequent or absent ovulation. These women usually have irregular periods or no periods at  all. Ovulation can be disrupted by changes in the way certain hormones  are released from the pituitary gland (a little gland at the base of the brain). These hormones—luteinizing hormone (LH) and follicle-stimulating  hormone (FSH)—signal an egg to develop and be released from the ovary. Problems that interfere with normal LH and FSH release include: 

 

  • injuries to the hypothalamus (a part of the brain that works with the pituitary gland)
  • pituitary tumors
  • being under or overweight
  • exercising too much
  • extreme stress

Other hormonal conditions that interfere with ovulation or affect fertility are:  


  • polycystic ovary syndrome (PCOS)
  • an overactive or underactive thyroid
  • diabetes
  • early menopause

 


INFERTILITY IN MEN

  

What causes male infertility?

Problems in the male partner affect about 40% of infertile couples. Many different health and physical problems can lead to infertility. In about 30 – 40% of cases, the problem is in the testes, the glands  that produce sperm and testosterone (the main male sex hormone). Damage to the testes can result from infections such as mumps, treatments for  cancer such as radiation or chemotherapy, trauma, or surgery. Heat can affect sperm production. 


Heat damage may occur if one or  both testes fail to descend from near the stomach (where they are  located before birth) into the scrotum (the sac of skin that normally  holds the testes). Many men have enlarged varicocele that may also raise the temperature in the testes. If  they are very large, varicocele may cause low sperm production. 


Certain genetic diseases can cause low or no sperm production or sperm that can’t swim or fertilize a woman’s eggs. In 10 – 20% of cases, the problem is a blockage in the sperm’s path  from the testes, through tubes called the vas deferens to the penis.  This can be caused by scarring from an infection, a vasectomy (surgery  to cut the vas deferens and prevent passage of sperm), or cystic  fibrosis (a genetic disease). Backward movement of sperm into the  bladder, instead of out through the penis, can also cause infertility. 


In 30 – 40% of men with infertility, the cause cannot be found. But,  these men usually have abnormal sperm (for instance, sperm that are slow  moving, deformed, or low in number). Other problems may decrease sperm production and fertility. They include chronic (long-term) illness, poor overall health, obesity, certain prescription drugs, and drug abuse.


So how does nutrition play a role in male fertility?


A number of nutritional therapies have been shown to improve sperm  counts and sperm motility, including carnitine, arginine, zinc,  selenium, and vitamin B-12. Numerous antioxidants have also proven  beneficial in treating male infertility, such as vitamin C, vitamin E,  glutathione, and coenzyme Q10. A multi-faceted therapeutic approach to improving male fertility involves identifying harmful environmental and occupational risk  factors, while correcting underlying nutritional imbalances to encourage  optimal sperm production and function.   


Reference: Sinclair.S, Male infertility: nutritional and environmental considerations.  Altern Med Rev. 2000 Feb;5(1):28-38.