Tuesday, May 3, 2016

Diets, and Exercise, and Supplements, Oh My!

On the whole, I would describe myself as someone who likes to be in control. I want to have my own space, make my own decisions, and I’m ready to live with the consequences of those decisions. Studies have shown the probability of successful conception among women suffering fertility problems is higher with a “healthy” BMI and diet(Chavarro, et. al., 2012, Ferti Steril.). Other studies suggest that diet can play a role in fertility, especially caffeine and alcohol.

Thus, I find myself at a decision point: do I make changes that will be unpleasant in my daily life in order to improve the probability of getting the take home baby I want? And for me, the answer is that I have to at least try those changes. I may not succeed 100%, but I’ll feel I’ve let myself down if I don’t give it a shot. So, what am I doing, and why?

Exercise. A minimum of five days a week, 45 minutes a day of exercise. Most studies show a positive relationship between exercise and reduced miscarriage risk (e.g., Zhang, et. al., 2011; Latka, Kline, & Hatch, 1999; Clapp, 1998, AJOG). Further, exercising 3 or more times a week is associated with the most positive outcomes. I’ve seen one study that suggested that intense exercise can have a negative impact on fertility, via miscarriage, even in women with a “normal” BMI (Madsen, et. al., 2007, BJOG). As a result, I’ll drop the HIIT workouts I’d been doing, and focus on a goal to ride 2,000 miles on my bike this summer. That will mean daily exercise of at least 30 minutes, with longer sessions on the weekends, and it should correspond to a reduced probability of miscarriage.

Diet. I’ve been gluten-free for about five years and pescatarian for nearly 20. No reason to change that, but I also eat way too much sugar and processed crap: Udi’s bread, YogurtLab Fro-Yo, protein bars, TJ’s greek coconut yogurt, chocolate – I’m looking at you! Inflammation may play a role in repeat pregnancy loss (Comba, et. al., 2015, Fertil, Stil.), although it’s not well understood. I have a history of juvenile rheumatoid arthritis, thyroid issues, gluten intolerance, and other allergies, all of which suggest my immune system isn’t my best buddy. Based on that I’m going to adopt a hard-core, Mediterranean-focused, anti-inflammatory diet. This is supported by research on luteal phase disorder (Andrews et. al., 2015, Hum. Reprod.), as well as research on inflammation in general.
Sadly for my taste buds, the processed food in my diet is going out. More veggies (kale, broccoli, asparagus, and their friends) and more fruit are coming in. I’ll still stick with my staples of lentils, quinoa, black beans, and chickpeas, but I’ll drop as much dairy as possible. This falls under the category of ‘things that are going to be really hard to do,’ given my love for chocolate, sugar, and processed-carb happy snacks. Still, I keep reminding myself that getting another “I’m sorry” phone call from my doctor won’t be easy, either, and I’d rather feel I’ve tried everything I can if I reach that point. . . see my earlier note on control.

Supplements/Medications. This one is controversial and I’ve spent more time pouring through journal articles than I care to admit. I’m proceeding on the hypothesis that I probably have egg quality issues, since all other likely causes have been ruled out. I also know I have a short luteal phase (10 days) and light periods, so pending further testing, I seem to have lining issues. Thus, I’ve focused on diet and supplements for egg quality and lining. What are some of the options out there, and why might you consider using them?

Melatonin, 3mg, at bedtime. Several studies have shown that melatonin positively impacts pregnancy outcomes. A very small study out of Japan showed improved serum progesterone concentration (>10 ng/mL during the mid-luteal phase) in nine of 14 women (64.3%) receiving melatonin supplementation, whereas only two of 11 women (18.1%) showed normal serum progesterone levels in the control group (Taketni, et. al., 2011). In addition, for IVF patients with PCOS, implantation rates in a melatonin-supplemented group were higher than those of the non-supplemented control group. Pregnancy rates were also higher, although not significantly. The findings suggest that the addition of melatonin to IVM media may improve clinical outcomes. (Kim, et. al., 2013). There is also research correlating melatonin and premature labor, although I haven’t delved into that space. There are few, if any, studies suggesting harm from melatonin.

DHA – A number of studies link Omega-3 consumption to positive outcomes for pregnancy. I think this one is pretty well accepted, so I won’t bore you with citations!

Myo-insolitol 2g dissolved in water, 2x/day. Several studies have shown that myo-inositol can regulate ovulation, improve egg quality, and enhance embryo development (Carlomango, Nordio, Chiu, Unfer, 2011, Eur J Obstet Gynecol Reprod Bio; Kamenovz, et. al., 2015, Gyecol Endicrinol). While it’s probably most effective for women with PCOS, I can find no studies showing harm, and quite a few showing benefit.

Ubiquinol – 100 mg, 3x/day. A relatively small study out of Egypt (N=100) of women with PCOS who took CoQ10 daily showed higher follicle counts, thicker lining (8.82 ± 0.27 mm versus 7.03 ± 0.74 mm), and more regular ovulation (54/82 cycles (65.9%) vs. and 11/71 cycles (15.5%)), and higher clinical pregnancy rates ((19/51, 37.3%) vs. (3/50, 6.0%)) in comparison to women in a control group who did not take CoQ10 (Refaeey, Selem, Badawy, 2014). Ubiquinol is the more bio-available form of CoQ10.

L’agrinine – 1000 mg, 2x/day. This one’s controversial, so do your own research. A small study (N=34) out of Italy looked at poor responding women undergoing IVF. Half received L’arginine in addition to stims, the other half did not. The treatment group saw improved blood flow, improved number of eggs retrieved, higher numbers of embryos transferred, and 3 total pregnancies, compared to none in the control group (Battaglia, et., al., 1999. Hum Repro.).

Pycnogenol – While this supplement has been studied mostly in men, it’s also been shown to have positive impact on reducing endometriosis symptoms (Kohama, Herai, Inoue, 2007, J Reprod Med.). I am somewhat skeptical as the authors of most studies I can find are the same (vested financial interest, perhaps), and the one meta analysis I can locate showed only studies with small sample sizes (Schoonees, et. al., 2012).

Low dose aspirin – 81 mg 1/day. My OB suggested this as a ‘it can’t hurt’ measure. There’s also a bit of research to suggest it can reduce inflammatory processes and thereby help prevent RPL (Radin, et. al., 2015, J. Clin Invest).

There’s an interesting question around how long to sustain changes in diet and supplements to see results. I can’t find good answers in the literature, but for the changes I’m making, I’m going to aim for three months to start and see what happens. That will take me through all the rest of the medical testing I need, and will probably start me down some more invasive and expensive paths, given my age. Here’s to healthy eating and a healthy body!

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