At the Moon we are constantly striving to increase our E.Q.I.Q. (Egg Quality I.Q.) and for years we have believed that nutrition can play a role in eqq quality.  However, until recently there were few studies to support this claim so we needed to temper our recommendations with the phrase “but there isn’t any clinical evidence for this yet.”   Now, several new investigations have shown that, yes, certain nutritional supplements may make a difference in egg quality.  The goal of this blog is to summarize the latest clinical news,  discuss the substances that are now showing potential benefits for women with poor egg quality and help you make choices about which supplements may be right for you.  As with any supplement protocol, you should always consult your physician before starting.

1.  Myo-inositol (MI)

Very recently two clinical trials were published that clarified a lot of the unknowns about myo-inositol, a product we use at PDtM under the name of FlowPro.   Myo-inositol (MI) is a part of the B vitamin complex and is a known insulin-sensitizer.  It has also been shown to improve both physical (hirsutism and acne) and reproductive (anovulation and amenorrhea) manifestations of Polycystic Ovarian Syndrome (PCOS).  In addition, myo-inositol plays a role in cell growth and early studies indicated that higher levels of MI in the follicular fluid was associated with better egg quality.

Several exciting new studies have emerged that have shed new light on MI and its role in fertility, particularly Assisted Reproductive Technology.  The latest study of interest demonstrated that treatment with 4 g per day of MI for three months prior to IVF improved egg quality in women who had failed a previous IVF due to poor egg quality. In this study the treatment also included 3g per day of melatonin, which I will talk about next.

But first, a note about inositol.  For some time there has been a debate as to the efficacy of d-chiro vs. myo-inositol for fertility.  We have chosen to use MI in our products because a) this is the form that has been used in all the clinical research we have seen to date on PCOS, egg and embryo quality and b) it is less expensive than the d- form.  Now, a new study confirms that myo-inositol seems to be more effective than d-chiro for egg and embryo-quality. On another happy note, MI  has also been shown to have a positive therapeutic effect on mood disorders that are responsive to SSRI’s (serotonin selective reuptake inhibitors) including depression, panic and OCD – a potential plus for the anxious, depressed fertility patient!

2.  Melatonin

Melatonin is a hormone that is secreted by the pineal gland.  It regulates our sleep/wake cycle as well as other hormones, in particular the hormones of the female reproductive cycle.  New studies like the one above suggest that melatonin supplementation at a level of 3 mg per day may help to improve egg quality when taken with MI for several months prior to IVF.

There are caveats to the use of melatonin.  Side-effects may include exacerbation of depression symptoms and patients who struggle with depression should make sure to  discuss this side-effect with their physician.  Melatonin should not be used with patients using thyroid medication as it can impact thyroid hormone levels.  It can also suppress ovulation at high doses so in general we only recommend this supplement for women who will be using ART and a trigger shot to stimulate ovulation and/or retrieval.

Finally, melatonin should NOT be taken while pregnant or nursing.  In general we do not recommend melatonin use for longer than 3 months without taking a break.  It can also cause marked drowsiness and is best taken just before bedtime.

3.  DHEA

DHEA (not to be confused with the omega-3 fatty acid DHA) is a hormone that serves as a precursor of steroid hormones testosterone and estrogen.  Research indicates it may also stimulate follicular development.  Several studies have shown supplementation with 75 mg of DHEA daily to improve egg quality and pregnancy outcome in women who were “poor responders” to IVF stimulation medication. Another study suggests that DHEA supplementation may reduce the risk of aneupoloidy.

DHEA should be used with caution as it is a pretty powerful hormone and when used at high levels and over a long term it may damage the liver.  Women who are pregnant or nursing should not take DHEA, nor should women with PCOS as this could exacerbate the condition.  Like melatonin, we recommend a three month treatment period.

4.  CoQ10

CoQ10 is a naturally occurring fat-soluble nutrient that is essential for energy production. CoQ10 has potent antioxidant properties and cell membrane stabilizing effects that make it beneficial for egg and sperm quality, specifically sperm motility. CoQ10 works within the mitochondria (the cellular power stations) in the cells and is essential for energy production. Until recently, CoQ10 was not thought to be a nutrient that required supplementation, as all normal tissue manufactures its own CoQ10; however, this production decreases naturally with age and is also lowered by certain drugs, including statins. When CoQ10 levels in the cells are low, energy production may be reduced and oxidative stress increased as a result.

CoQ10 has been shown to improve sperm quality and is now under investigation for potential use with women of advanced reproductive age undergoing ART to improve egg/embryo quality. The oocyte has among the highest concentrations of mitochondria of all body cells and uses immense amounts of energy in the process of maturation and ovulation. Researchers hypothesize that supporting the oocyte with CoQ10 may improve egg quality (Bentov et al. 2010).

The recommended dosage for overall health is 100-300 mg/day, or as directed by a nutritionist. The dosage under investigation in studies looking at egg quality is higher: 600 mg/day. CoQ10 appears to be a safe supplement: Studies have used supplementation of CoQ10 up to levels of 3,000 mg per day without adverse side effects. At present, the only risk to taking CoQ is the cost, as this supplement can be pricy, and no data currently exists on its usage in high doses during pregnancy.

5.  Omega-3 Fatty Acid (EPA/DHA)

There is still no direct clinical evidence that omega-3 fatty acids improve egg quality but we are convinced they are a good bet and include them in our Egg Quality Protocol.  Eicosapentaenoic acid (EPA) forms the backbone of many of the chemicals that halt inflammation in our body and also serves to support the health of our cell membranes.  Docosahexaenoic acid (DHA) (not to be confused with DHEA above) is important for brain health and adequate stores of DHA are thought to be beneficial for the early cognitive development of the fetus.  DHA may also be helpful for depression.   Look for purity-tested products.

This is exciting news indeed but you should always speak with your physician  before beginning a supplementation regimen of any kind. Of course, we would also be remiss if we didn’t mention that providing your body with the highest quality diet is also important for fertility.  If you are specifically seeking to improve your egg quality you should also consider re-thinking your diet to limit inflammation, achieve good blood sugar control and get ample antioxidant nutrients from food sources. Our nutritionists at Pulling Down the Moon are specialists and will tailor their recommendations to your fertility diagnosis.

For more information about any of the supplements or info in this blog, please feel free to contact me at beth@pullingdownthemoon.com.  These supplements and other fertility-related products are available at our online store.

According to yoga physiology, apana vayu is the downward flow of energy that governs the menses as well as elimination of toxins from the body.  In the yogic view of PCOS, the apana vayu has become stagnant and by stimulating apana we re-invigorate the menstrual cycle.  Poses that stretch and open the hips and lower back facilitate the flow of apana.   Strengthening apana energy flow is just one goal of our therapeutic yoga practice for PCOS.  A well-rounded practice for PCOS also includes twisting and folding poses to stimulate agni, back-bending poses to enliven the nervous system, restorative poses that induce the relaxation response and gentle inversions that stimulate the thyroid, hypothalamus and pituitary glands.

This series of poses to strengthen apana begins with a vinyasa of chair (utkatasana) and standing forward fold (uttanasana) for a simple flow that is both energizing and grounding.  Follow this sequence with warrior 2, to continue to build strength and open groin and hip muscles.  Finish with Supine Cobbler’s Pose, a gentle supported back-bend that stimulates the relaxation response.

Utkatasana

Uttanasana "Forward Fold"

Virabhadrasana 2 "Warrior Pose"

Supta Baddha Konasana - Supported Reclining Cobbler's Pose

Lifestyle treatment including diet, exercise, stress reduction and Traditional Chinese Medicine for PCOS makes sense.  If you have been diagnosed with PCOS, we encourage you to come in for a consultation and work with our expert practitioners.  Our comprehensive and targeted approach to PCOS includes specific dietary recommendations and supplementation, yoga and relaxation for stress reduction  and Traditional Chinese Medicine acupuncture treatment.  You do not need to be struggling to conceive to benefit from our expertise.  In fact, getting a handle on PCOS before you are “trying” is essential. PCOS is often under-diagnosed in teenage girls and the acne, irregular periods and weight gain are chalked up to puberty.

For more information about PDtM’s comprehensive approach to PCOS, call 312-321-0004 to book a complimentary face-to-face or phone session with our Patient Advocate.

A question I frequently get asked in my acupuncture practice is “Can acupuncture help improve egg quality?”  From my own clinical experience the answer is, it can.   Acupuncture and herbal therapy help improve the environment of the ovary enabling it to function optimally and properly, therein allowing it to make good quality eggs.  An example of this is with Polycystic Ovarian Syndrome (PCOS) where the problem is a functional disorder of the entire system that is affecting the ovary.  In other words, the issue is not with that single organ alone.  Since the body systemically is not working properly it is not able to nourish the ovary.  Therefore many immature follicles develop within the ovary impeding the process to fully grow one or two healthy quality eggs, as is the case in a normal cycle.  There are many treatment strategies that traditional Chinese medicine (TCM) offers to help regulate the body’s functioning in PCOS, so that the ovary is being supplied the energy and blood it needs to be able to produce an exceptional egg.

Another instance in which I have seen an improvement in egg quality is with endometriosis.  The explanation is a bit simpler to understand than in PCOS.  Generally speaking, with endometriosis the condition is one of blood stasis, a problem that can hinder fresh, oxygenated, nutrient rich blood from reaching the ovary thereby having a negative effect on its function of making a good quality egg.  Here again there are many options in which TCM can help treat blood stasis so that the ovary is being thoroughly supported to produce a good egg.

Though there is no data via research studies presently to support this claim directly, there is much that I have seen in my clinical experience to believe it to be true.  If you have any questions regarding egg quality and how TCM can help please feel free to contact me or book an appointment!

In a previous blog posting, I recommended that women with PCOS (Polycystic Ovary Syndrome) get screened for autoimmune thyroid disease as research has shown that women with PCOS are three times as likely to also have an autoimmune thyroid disease.  The autoimmune thyroid diseases are Graves Disease and Hashimoto’s Thyroiditis. In both cases, immune system antibodies attack the cells of the thyroid gland which can lead to the gland’s eventual destruction – producing symptoms which can include weight gain or loss, depression, anxiety, rapid heart rate, and in some cases infertility. While most Reproductive Endocrinologists routinely test for Thyroid Stimulating Hormone (TSH) which can determine an over-active thyroid gland (hyperthyroidism) or under-active thyroid gland (hypothyroidism), autoimmune thyroid disease needs to be tested by determining levels of antibodies that the immune system is producing such as anti-thyroid peroxidase antibodies (anti-TPO) or anti-thyroglobulin (anti-TG)antibodies.

In addition to the higher incidence of autoimmune thyroid disease in women with PCOS, a recent study showed that infertile women suffering from PCOS with anti-TPO values that exceeded the upper level of normal were significantly more likely to be resistant to Clomid compared to Clomid responders and Metformin responders. They went on to conclude that elevated anti-TPO levels (an indicator of autoimmune thyroid disease) are associated with poor treatment response in infertile women who suffer from PCOS.

So, why is it so common to see PCOS and Thyroid Disease together?  There is no definitive answer, but there are connections.  Both the thyroid gland and the ovaries are part of the endocrine system.  Insulin resistance, which is very common in women with PCOS, is also associated with thyroid function as studies have found that increased levels of TSH correlate with an increase in insulin resistance (read more about the insulin resistance and PCOS connection in a previous blog). There also may be specific nutritional deficiencies that PCOS and thyroid disease have in common.

While the research is still limited in the area of infertility, thyroid disease and PCOS, there is a link between all of them and getting tested and screened for both PCOS and thyroid disease may be beneficial in your fertility journey. Nutrition also plays a large role in the treatment of PCOS and thyroid disease including helping to lessen insulin resistance. To book a nutrition consultation at Pulling Down the Moon, call (312) 321-0004 or visit www.pullingdownthemoon.com.

Women with PCOS (polycystic ovary syndrome) may endure a lot to get pregnant – from utilizing medications to induce ovulation to undergoing IVF – all while experiencing the typical PCOS symptoms. But, does PCOS also impact miscarriage rates? Pregnancy loss rates amongst women with PCOS have been reported to be as high as 30% to 50%, but some research has shown that information to be conflicting. In a recent study, women with PCOS were found to have a 2-fold increase of miscarriage loss after undergoing ART (IVF or IUI) (Chason et al, 2010).  While not the 30-50%  reported previously, the rate found by Chason et al.  is pretty substantial considering the general reproductive population has about an 11% miscarriage rate.  PCOS has also been found in approximately 40% to 80% of women with recurrent miscarriages (Palomba et al, 2009).

Insulin levels also seem to play a factor in miscarriage, as studies have shown that Metformin has positive effects on reducing miscarriage rates in women with PCOS.  In a study comparing three groups of women with PCOS on Metformin, all rates of miscarriage decreased while on Metformin but the groups that stopped at 8 weeks and 12 weeks had a statistically significant drop in miscarriage rates while the group that stopped immediately after a positive pregnancy diagnosis did not have a statistically significant drop (from roughly 20-40% down to 4-8%). However, a meta-analysis of randomized controlled trials showed that preconception intake of Metformin did not have a beneficial effect on reducing miscarriage rates in women with PCOS (Palomba et al, 2009). The research is still very limited in this area.

Factors in women with PCOS that may be contributing to increased miscarriage rates include higher Lutenizing Hormone (LH) levels which can be increased by elevated insulin. Elevated testosterone levels, obesity, insulin levels and infertility treatments are also factors that may be involved (Palomba et al, 2009). Many of these altered hormone levels seen frequently with PCOS are greatly affected by diet and lifestyle and may be improved through working with a nutritionist.  Acupuncture has also been used to minimize the chance of miscarriage.  Please call Pulling Down the Moon at (312) 321-0004 or visit our website at www.pullingdownthemoon.com for more information.

Chason et al. A Diagnosis of Polycsytic Ovary Syndrome (PCOS) is associated with an increased likelihood of pregnancy loss with Assisted Reproduction.  October 2010.

Palomba et al. Effect of preconceptional metformin on abortion risk in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. Fertility Sterility. 2009.

Margaret Wertheim M.S., R.D., L.D.N.

By Margaret Wertheim M.S., R.D. , L.D.N.

When most people hear the word “inflammation,” they think of a swollen ankle, red and irritated eyes, or the pain of an injury. This is called acute inflammation which occurs over a short period of time and is a helpful process in the body in response to any sort of trauma or injury. This type of inflammation helps to promote healing and prevent infection. On the other hand, prolonged or chronic inflammation in the body is harmful and is associated with many health conditions including PCOS, type II diabetes, and cardiovascular disease.

As Breea discussed in her earlier post entitled The Many Faces of PCOS, women with PCOS have differing characteristics. PCOS is present not only in overweight women, but also in normal weight women. According to a 2009 study in the journal Metabolism, levels of inflammatory markers in the blood are increased not only in overweight or obese women with PCOS but also in normal weight women with PCOS compared to women who do not have PCOS. For certain markers of inflammation, having PCOS and being obese increased inflammatory marker levels even more. This increase in chronic inflammation in PCOS is concerning, because chronic inflammation is associated with increased risk for cardiovascular disease as well as problems with fertility.

Another study from the journal Mediators of Inflammation notes that pathways in the body involved in blood sugar regulation overlap with pathways involved in inflammation which may explain a relationship between blood sugar regulation and inflammation in PCOS. Insulin resistance exists in obese and normal weight women with PCOS, but obesity worsens the insulin resistance much the same as obesity worsens the inflammation in PCOS. These results make a strong case for the beneficial role of weight loss if needed in PCOS. The importance of decreasing this chronic inflammation cannot be overemphasized, because not only may it be helpful for managing PCOS and improving fertility, but also in the prevention of cardiovascular disease.

While the cause and best treatment for PCOS has yet to determined, the research indicates that insulin resistance, blood sugar regulation, inflammation, and hormone levels appear to be linked. The nutritionists here at Pulling Down the Moon can help you to implement changes to your diet and/or recommend supplements which can help you to lose weight if needed, better regulate your blood sugar, and decrease the inflammation associated with PCOS which may help to improve your chances of conception and decrease your risk for cardiovascular disease.

References:

1. González F, Rote NS, Minium J, Kirwan JP. Evidence of Proatherogenic Inflammation in Polycystic Ovarian Syndrome. Metabolism; 2009 July; 58(7):954-962.

2. Sathyapalan T, Atkin SL. Mediators of Inflammation in Polycystic Ovary Syndrome in Relation to Adiposity. Mediators of Inflammation

; 2010.

By Breea Johnson, MS RD

In the world of PCOS, most people are familiar with the common recommended medications such as Metformin and the birth control pill to help regulate the cycle and sensitize the body’s tissues to insulin (helping to lessen insulin resistance). While research shows benefits of these medications there are still many side effects that some women do not want to risk.

At Pulling Down the Moon, we recommend FlowPro (if you visit this page, click on the research tab for a summary of the studies that have been done) for PCOS, as the nutritional supplement contains myo-inositol and magnesium that when taken daily have been shown to restore ovulation and menstruation in some women. Myo-inositol can be synthesized by the body from other nutrients but when deficient can impact the ability of the body to be sensitive to insulin. Supplementation with myo-inositol in women has been clinically shown to lower levels of circulating insulin and testosterone, promote ovulation, improve egg quality, improve hirsutism and acne, and lower the risk of ovarian hyperstimulation during an IVF cycle. Some research has found it to be equally effective as Metformin in restoring ovulation.

Another closely-related and popular supplement for PCOS is D-Chiro Inositol (DCI). There are actually nine different forms of inositol (part of the B-vitamin complex), with DCI and Myo-inositol being the two most heavily researched in conjunction with PCOS and insulin sensitivity. There has been no research comparing the effects of both supplements for PCOS, however, both have been found to be beneficial in helping insulin sensitivity.

Do you have PCOS? Have you tried Myo-inositol or D-Chiro Inositol to help manage symptoms? Please feel free to post your stories here. Thanks!

When most people hear the term “insulin” they immediately think of someone with diabetes- not knowing why or how they use insulin but knowing that something with their levels just isn’t right. Most diabetics in this country have Type II diabetes which is developed later in life and usually attributed to “insulin resistance.” Insulin resistance is also common in PCOS (Polycystic Ovary Syndrome), as a large percentage, but not all, of women with PCOS also have insulin resistance.

To understand insulin resistance it is first important to understand how glucose and insulin work together to provide energy for our body. Glucose is derived from the food we eat. Carbohydrates break down most efficiently into glucose.  Protein and fat eventually can eventually convert to glucose but take a longer time to do so.

Insulin is a hormone that is secreted by the pancreas that enables the liver to utilize and/or store glucose.  Insulin is absolutely necessary to life.  Without it, glucose circulates at high levels in the blood but cannot penetrate into cells and provide energy for our bodies.  Normally, a person would eat a meal containing carbohydrates, their blood sugar (glucose) would rise and insulin would signal cells to allow glucose to enter and be used for energy or stored for later use.  When insulin is present but cells don’t respond to its signals the condition is termed “insulin resistance” because insulin and glucose are both being produced but are unable to communicate.  This communication breakdown causes glucose levels to be very high (outside the cells) but very low (inside the cells) resulting in increased hunger. Because insulin is our “store and save” hormone, higher levels of this hormone in the bloodstream discourage our body from burning the existing stores of energy in our fat reserves.   Taken together these conditions can make it very difficult for a person with insulin resistance to lose weight.

So, what causes insulin resistance? The largest contributor is excess body weight, as an increase in adipose (fat) tissue can interfere with the communication between glucose and insulin. Weight gain in the central stomach area is most detrimental to insulin resistance.  Vitamin D deficiency is also associated with insulin resistance (so be sure to get your Vitamin D levels checked). Chronic inflammation is also a leading cause of insulin resistance and can be improved by a change in diet and lifestyle.  A lifelong diet of highly processed carbohydrates (cakes, cookies, sodas, candy, desserts, etc.) and poor nutritional intake may also be a key cause in the development of insulin resistance. While the causal connection of insulin resistance and PCOS has yet to be established, it is something of concern as the associated conditions of insulin resistance – overweight/obesity, increased risk of developing gestational and Type 2 diabetes, increased cognitive aging, increased risk of some cancers – are very serious conditions.

Luckily, insulin resistance is something that can be modified through diet and exercise.  There are many nutritional strategies to help with insulin resistance and PCOS.  If you are interested in learning more about our nutrition program to help with PCOS, please call (312) 321-0004 or visit www.pullingdownthemoon.com for more info.