Foods and Supplements for Fertility and IVF/IUI Prep

Pregnancy HCG test and Hope!

You’ve probably read every blog, Instagram or book about fertility and pregnancy diet but felt confused, overwhelmed or exasperated! There is a lot of information out there and granted much of it is anecdotal in the fertility community. The first and most important thing I want to say to you is that no amount of perfect nutrition will make up for giving yourself stress or anxiety about the perfect diet or supplement list! So, please do not allow yourself to feel that way at all.

Especially in the IVF and fertility treatment world there is such a big push for ‘take this supplement’ to cure your XYZ issue but this tends to make patients feel like failures when it doesn’t work or get some false hope if things don’t work out the way they hoped.

Diet, lifestyle, exercise of course are all important – we know the better we feel the better everything downstream goes. But I never want anyone to feel like they are not doing good enough and therefore they won’t get the results they hope for. We ALL can do a bit better in aspects of our lives and frankly we all have days of cheat meals or a glass of wine, but that doesn’t mean you have ruined your fertility!

IVF/IUI Prep

When you are heading into IVF or IUI and you feel the rush and panic to get going ASAP, please consider taking a breather to gather more information, focus on lifestyle and stress management practices, as well as hone your diet/nutrients/fitness! My biggest take away after 7 rounds of IVF across 2 years is that I shouldn’t have stressed myself out to ‘hurry’ to the next round or phase of treatments. I should have listened to my body more and perhaps in doing so I would have yielded even better results.

Below is a list of additional labs you can request from your GP or fertility doctor – knowing some of these can help you tailor your approach or allow you some time to focus on improving your labs to in turn improve your egg and sperm quality. Again, take a breath, pause and assess – taking 1-3 months to do this and focus on your mental and physical wellbeing will likely not make or break your treatment plan and hopefully will actually help you approach it in the best way with the best chances. If you want to read about my IVF journey and the things I did to help my stats, check out my other blog coming soon!

Blood testing

Bloodwork to ask about and why?

·       C reactive protein (CRP) – this is a general inflammation marker. It does not specify where the inflammation may be in your body or why, but it’s a good first level test to take to see where you are at. If it’s elevated then I urge you to discuss with your medical team about things you can dive deeper into (such as metabolic health, autoimmune, BMI, chronic infection, etc).

·       A1C, fasting insulin, random glucose, fasted glucose (all this help assess your metabolic health) à for years all these labs came back ‘normal’ but when I saw a naturopathic doctor she conducted the HOMA-IR test which confirmed I had insulin resistance! Finally, after years of wondering why I couldn’t lose weight despite major diet and exercise I had an answer. Having excess weight and insulin resistance is inflammatory. If this can be managed, it can help improve egg or sperm quality.

·       Full thyroid panel (T3, T4) à unfortunately most GP’s or even fertility doctors are not looking in depth at all of this. If they see your TSH (Thyroid Stimulating Hormone) is in range, they will ignore the other labs. Naturopathic doctors are very helpful for assessing full thyroid health.

·       Along with thyroid hormones, adding the Thyroid Antibodies test is very important. If you have Hashimoto’s or Graves disease, this could potentially impact your pregnancy, ability to get or stay pregnant, and egg or sperm quality.

·       Anti ovarian antibodies are an often-overlooked test but so important when it comes to egg quality! If this comes back elevated, I recommend working with a good naturopathic doctor or even a reproductive immunologist to suppress this antibody attack. Oftentimes this can be managed and allowing for some time to improve and IVF treatments, you could see better results. Unfortunately, many traditional doctors will not order this test until all other avenues are explored. If you have abnormally low AMH for your age, this would be a more critical test to advocate for early on.

·       For more unique/difficult cases, adding immunology testing such as ANA Titre may be useful. This is a general autoimmune marker that will indicate there may be some antibody activity in your body, however it will not tell you what exact autoimmune condition it is. Further testing will be required to diagnose. Sometimes conventional rheumatology will still miss key immune issues that impact fertility. In another blog I will explain in depth the Reproductive Immunology world as it is very complex and unique.

·       Vitamin D level (if you do not have adequate levels … and I am not talking about the basic level to just survive…then you are not feeding your mitochondria as well as can be and giving your egg and sperm the nutrients they need!)

·       Homocysteine testing can help confirm if you have any issues methylating your B vitamins and have inflammation due to this. If this comes up above range, I recommend looking into a naturopathic doctor appointment but also focusing on methylated B vitamin sources and not synthetic B vitamins. If your homocysteine is high your body is struggling to absorb nutrients which in turn will affect your mitochondria and overall quality of egg/sperm.

·       Iron, ferritin, B12 can be important to check as well. It’s great to get these levels to the adequate range before pregnancy and focus on keeping up in pregnancy.

3 Month IVF/IUI Prep?

Now I want to preface that this is only in an ideal scenario where you have enough time to prepare and plan. If you are facing cancer treatments or other urgent situations, defer to your care team and go straight ahead if you wish! You can still follow some of the suggestions below (with review from your medical team). The suggestions mentioned below will be generally good for male and female, but some I will highlight as extra special for either sperm or egg so watch out for what fits you! Reminder that fertility is not just a woman’s duty. Our male partners should also join you in the journey of IVF/IUI in giving their sperm the best chances as well. Any little bit will help and feel like you are in this together.

Another great resource to read is the It Starts With The Egg book. Rebecca Fett did a lot of background research into studies, so I do find her book is quite educational. However, many people in the fertility community talk about how her book can feel stressful because it could make you feel that you aren’t doing enough or even if you did all the recommendations, you still failed. Every body is unique, her anecdotes of success are amazing but also not everyone’s story. This book is simply a tool for knowledge.

	Men	Women
Sauna, Hot Tub	Not ideal to continue, the heat damages sperm in many ways. Good to refrain for 2-3 months prior to treatments or to TTC	Not as bad for women as our ovaries are internal. Sauna is great for relaxation and helping with inflammation. Stop during IVF or IUI stims/once embryo transfer has occurred as heat can affect uterine lining sometimes.
Fitness, Exercise	Continue! Or build up your gains. The only thing to avoid is biking. The constant rubbing and pressure on the scrotum is not ideal for sperm health. Muscle development is very important for mens health as well. Our sex hormones are stored in fat and the body (which is good!) but having good fitness helps these hormones circulate properly.	Zone 2 is great. Really any form of exercise is great for women in these pre IVF/IUI phases. However, once beginning treatment, you will want to avoid anything with twisting to avoid twisting an ovary during stims. If you are already a highly active person, you can certainly continue your regiment. If you are not someone into the gym life yet, start slow and steady. Walking, jogging, biking and lifting weights is a great way to build muscle and the endorphins and muscle growth all help your inflammation/stress levels!
Coffee, Alcohol, sodas, recreational drugs, smoking	All of these should be avoided! Limit caffeine to 400mg per day while TTC and quit smoking/drugs for sure as this causes much DNA damage in sperm quality. Limit alcohol to 2 drinks per week during this phase as well. Limit sodas to 2 per week as well. The sugar load and chemicals often found in sodas is not helping your quality or your hormones!	Switch to decaf coffee if you can! Especially if you LOVE coffee as much as I do. Limit or completely stop all alcohol. Its not serving you and the addiction of ‘needing’ a glass of wine at night is not serving you either. Its truly an addiction our modern world has created for us. Will a glass or two ruin your fertility? No, but during the phase of treatments its best to avoid. Smoking, recreational drugs we all know are bad for mitochondrial health overall and prepping your body for pregnancy it will be better to stop now vs once you are pregnant.
Vitamin D3 + K2	Yes! (see a naturopath for optimal levels for your body). However, unless you are already at the max limit, you can safely take 10,000 - 50,000 IU a week until your levels are replenished. Do not take more than 10mcg K2 per 1000 IU vitamin D as it can accidentally deplete other nutrients if you overdo it. Adding K2 helps the D absorb into your body/bones vs allowing too much calcium being deposited. Vitamin D3 is a powerful antioxidant and also a hormone helper. Higher Vitamin D improves testosterone levels in men.	Yes! (see a naturopath for optimal levels for your body). However, unless you are already at the max limit, you can safely take 10,000 -  50,000 IU a week until your levels are replenished. Do not take more than 10mcg K2 per 1000 IU vitamin D as it can accidentally deplete other nutrients if you overdo it. Adding K2 helps the D absorb into your body/bones vs allowing too much calcium being deposited. Vitamin D3 is a powerful antioxidant and also a hormone helper.
Vitamin E, Liposomal C, resveratrol	Great antioxidants helping mitochondrial function. Great for sperm! (400 IU Vitamin E per day, anywhere from 1000-3000IU vitamin C)	Great antioxidants helping mitochondrial function. Great for eggs! (400 IU Vitamin Eper day, anywhere from 1000-3000IU vitamin C)
NAC (N-acetyl cysteine), NMN (Nicotinamide Mononucleotide), Glycine,	NMN has also been shown to improve mitochondrial function which in turn improves fertilization rates! Glycine is a great partner to NMN and NAC because it enhances the mitochondrial function and both are precursors to glutathione. In modern society we are not consuming nearly as much collagen or gelatinous tissue found in meat products and I believe there is a link to the lack of glycine source in diet to our mitochondrial health.   Men and women can take 200mg Glycine AM/PM per day. Can also take up to 600mg of NAC per day (across 2-3 meals) and up to 100-200mg NMN per day.	NMN is a cheaper day to day supplement you can take which supports NAD+ levels. There is also a lot of discussion about NAD+ for fertility so either option is good. I found taking the NMN in conjunction with the other supplements was sufficient. NAC, NMN all help with insulin resistance symptoms, could help women with PCOS, certainly assists every body with their cellular function / oxidative stress and therefore egg quality. NAC has also been studied for endometriosis help – it seems to be anti inflammatory enough to help the pains and growth of endo.
Resveratrol	Great to take but not as critical as other supplements! No, having wine doesn’t fill this gap :p	In studies its shown to improve dna damage in oocytes, a powerful antioxidant and seems to have properties that aids PCOS, endo by regulating the inflammation and calming down androgenic hormones.
Zinc, selenium, Ashwagandha	Zinc helps testosterone production. Selenium helps sperm quality by preventing oxidative damage. Ashwagandha has been shown to improve sperm count, volume, motility and increase or maintain testosterone levels in men.	Not critical for women. Ashwagandha is a great tool for relaxation and stress but for women and fertility treatments it is counterintuitive as it can accidentally reduce the affects of stimulation medications by reducing the hormonal affect. Best to ignore these supplements for a bit.
Fish oil (Omega 3’s)	See women’s side for info! Yes great to take it for your overall health and sperm quality.	There are so many important benefits to taking fish oil! Improved inflammation levels, when taken in higher doses of 1000-3000mg a day it has shown to reduce CRP and help modulate autoimmune disease. Omega 3’s are fatty powerhouses which gives energy to mitochondria. It appears to assist in uterine lining development and even helps women with PCOS regulate this. Because of its anti inflammatory properties its great for endo and PCOS.
Vitamin B Complex/prenatal	Great for sperm quality! Ensure you are taking methylated not synthetic. Diet is crucial and great to absorb these nutrients.	Great for egg quality and prep for pregnancy! Ensure you are taking methylated not synthetic. Diet is the best way to absorb all these nutrients naturally as well.
Myo and d-chiro inositol	Could be great for men as well. But not as critical.	Great for women with insulin resistance issues, PCOS! The mechanism behind these supplements aids in the way our insulin functions. Along with other PCOS friendly supplements this really aids in regulating the androgenic issues and improves egg quality. If you have Low AMH it is not recommended to take unless you also have insulin resistance issues.
Folic Acid	Good to add, often this can be found part of B vitamin complex	Important for you and future baby’s neural tubes! Finding dietary ways to incorporate folate is very important. All meat and fish products will have this, but your fruits and veggies will as well. Eating whole food sources is the best way to get this. And a methylated folate will be more absorbable to your body.
CoenzymeQ10	Great for oxidative stress and quality! 200-400mg per day	A must for fertility! A proven antioxidant to take for egg quality and overall health in your body. 600mg per day (take 200mg at 3 different intervals for optimal absorption)

 During this IVF/IUI prep time, focus on your mental health. Everyone is different in how they like to approach their self care, but find one thing to do that will help relieve stress along the IVF/IUI journey.

Supplements and nutrition!

Diet, Food, Nutrition

• In general, a core concept to follow is less processed food, more whole foods, low/no sugar, no alcohol or reduce as much as you can

• I find diet is a very nuanced topic - we all have moral or social norms we believe in and generally I believe that we should all eat what lifestyle we believe fits our health (AKA what makes you feel physically good) and if you have any religious/moral reasons to follow a certain diet

• My personal belief and what has worked best for me is following a low carb, high fat, moderate/high protein diet. Generally this falls in the Keto/Carnivore space.

• The reason I believe quite highly in this diet is because it has been shown to drastically reduce metabolic syndromes in most people even those who are not diabetic. It has also been shown to reduce CRP in many people who followed a plant based or standard north american diet.

• High fat (from healthy sources like animals or certain vegetable products) has the core building blocks to support our hormones and the higher fat content can also impact our brain in a positive way! High fat diet has been shown to aid in mental clarity/improve serotonin in our brains.

• protein from animal sources is the most direct way to get a full protein along with essential amino acids - there is no guess work on combining foods to make a complete protein or amino acid profile. Its also a great source of B vitamins and many other nutrients.

• I believe .8-1gram of protein per ideal body weight is a great start point for any woman - we routinely under eat so definitely use a tracker to ensure you are getting enough fatty meat or meat in general! Under eating protein and healthy fats can actually be worse than under eating. I know it is counterintuitive to the whole calorie in and out mantra - but we need to nourish our bodies so it can properly nourish our ovaries, uterus, hormones and eggs!

• Low carb/no carb - removing breads, pastas, grains, starches will help your body focus its energy on the fat/protein. Remember you can get all essential nutrients from the animal based food items so you do not need to worry as much about finding a rainbow of fruits and veggies. If you really like to have some fruit and veg I recommend any fruit that ends in 'berry' as they have a good fiber ratio and lower glucose spike than most fruits. I also like low carb veggies like asparagus asparagus, mushrooms, lettuce - veggies that are low oxolate and carb.

• if you are someone trying to heal immune problems or inflammation, you may want to look into the autoimmune protocol diet (which is essentially an elimination diet). There is a lot of studies to show that brassica veggies (such as broccoli, kale, etc) and nightshades (tomatoes, eggplant, etc.) can cause flares in our immune system. If you ever eat these foods and feel bloated or mild nausea or maybe just tired or less energized, perhaps listen to your body and how its feeling. Food should give us energy!

• Eggs! Its such a great food to include in any diet - 3 eggs has enough choline for your babies brain health. Not only is it a complete protein but it has so many nutrients in the yolk. Don't eat just the whites - eat the whole egg.

• As mentioned above about glycine, NMN, NAC, B vitamins, folate - many of these nutrients are naturally found in animal products. Its some of the most nutrient dense things we can eat. Making stews, roasts, steaks with some beef tallow, butter or just the fat rendering from the meat itself is such a great easy way to get all those vitamins and minerals.

Some ideas:

• find a local tribe! Fertility groups on Facebook are wonderful for this, having some people to speak to in your area are really helpful.

• yoga practice or meditation practice. Even a simple Yin stretch class once a week could be so healing for you. I found Yoga Nidra was also very relaxing - as someone with a very anxious brain it was some of the first meditative practices that actually halted those thoughts. You can get free nidra classes on Youtube or free apps like Insight Timer.

• fitness routine - begin your walking, jogging, running, biking or whatever it may be routine! start with a small goal. Don't make lofty huge plans, sometimes the best thing is to have a short and sweet goal that is attainable vs an 'ideal' scenario that fails.

• date nights/fun nights! Pre plan these! Have something to look forward to and don't let your stress or anxiety talk you out of going. The biggest thing I learned after 3 years with fertility challenges is that I should have kept my life going too. Turning off the IVF/IUI stress brain for a few hours and allowing yourself to have some fun is so important. The endorphins and serotonin will help you and your egg/sperm quality!

• regular RMT or acupuncture - whatever floats your boat

Please reach out to me if you need any advice or a ear to listen to your fertility journey. If you need any ideas or don't know what else you can do to make your fertility treatments successful, let me help check out your protocols and tests to date.

Thank you all so much!

Much love,

Madeleine

Butterfly Beginnings Doula

604-828-4766

Okanagan Valley