By Beth Heller, M.S.

So, you think you eat healthy?  Read on and you might be surprised.  The low-fat dietary pattern that is generally touted as healthy is actually low in nutrients that have been shown to be important for fertility.  To illustrate this point, we charged Pulling Down the Moon nutritionist Margaret Wertheim, R.D. to run a nutritional comparison of two diets 1) a typical low-fat diet taken directly from the practice manual of the American Dietetic Association and 2) a fertility-friendly meal plan based on Pulling Down the Moon’s nutrition program.  The results were  striking.

Here’s the low-fat diet based on recommendations from the American Dietetic Association:

Typical Low Fat Diet - Click to enlarge

And here’s the fertility-friendly eating plan per Margaret’s recommendations:

Fertility-friendly Diet - Click to enlarge

At first glance, both diets look pretty healthy.  The calorie content is the same – just around 1830 calories.  Yet, a nutrient comparison reveals a different story.   Head-to-head the Pulling Down the Moon plan blows the typical low fat diet pattern away in key fertility nutrients.  The low fat diet proved deficient in  iron, vitamin E, vitamin D and very low in the omega-3 fatty acids EPA and DHA – all nutrients that are linked to optimal fertility and healthy ovulation.  The difference?  The fertility-friendly diet derives about 10% more of its calories from healthy fats at the expense of carbohydrates.   Foods in the fertility-friendly diet are also less processed – note the absence of  ”diet” dressings,  as well as”low fat” and “sugar free” foods.

Dietary Comparison LF vs. FF - Click to enlarge

This exercise illustrates a central concept of Pulling Down the Moon fertility-friendly eating that we call “nourishing up.”  In short, nourishing up means that even at your perfect body weight you may still be getting insufficient nutrients for optimal health and fertility (read more about nourishing up in a previous post here).  Remember that current dietary guidelines are based on the idea of preventing deficiency (helping us survive), rather than promoting wellness (helping us thrive).  Even  ”healthy” diets such as the low fat diet above are missing the mark.   Note that this low fat diet doesn’t even include guilty pleasures and convenience foods like McDonalds, Starbucks and Lean Cuisine. Also note that the fertility-friendly diet is rich and satisfying, and doesn’t feel like “diet food.”  Our belief is that many women end up starving themselves of important nutrients in order to lose or even maintain their weight.

For this reason we recommend that women who are trying to conceive seek out a nutritionist who specializes in fertility to learn important steps they can take to optimize their diets for fertility.  In addition we also offer the Pulling Down the Moon Pregnancy Prep Program, a three part program of nutritional supplementation that includes Prenatal Plus, a prenatal vitamin that has been optimized to include nutrients like CoQ10, extra B-vitamins, omega-3′s and choline, Probiotic Powder to support digestion, elimination and the immune system, and our Organic Superfood a 100% certified organic fruit and vegetable drink to provide antioxidants their most effective form – that of whole food.*

Have we convinced you that diet is important?  Click here to book an appointment with a Pulling Down the Moon nutritionist or call 312-321-0004 (Chicago)/301-610-7755 (Rockville) for more information.

*These statements have not been evaluated by the Food and Drug Administration.  These products are not intended to diagnose, treat, cure or prevent any disease.

Karisa Grudi, one of our licensed acupuncturists at Pulling Down the Moon Shady Grove, sat down with us to discuss a little bit about the German Protocol and why it is so important for women who have embryo transfers:

Q. Karisa, can you give us an idea of what the German Protocol is?

A. The German Protocol is a series of two acupuncture treatments that are performed on the day of IVF transfer.  The treatments are scheduled before and after the embryo transfer on the same day.  The German Protocol is based off of a study that was performed in Germany, 2006.  In the study of 160 participants, one group received IVF transfer only while the second group received IVF transfer with two acupuncture treatments (before and after transfer).  The pregnancy results showed 42% in the acupuncture group compared to 26% in the control group.

Q. How does this particular type of acupuncture help increase a couple’s chances of conceiving?

A. In the German study, a select number of acupuncture points were used to help with the efficacy of pregnancy.   Those same points from the study are used in the clinic.  Certain points on the leg have a direct connection to the uterus and ovaries.  Those points help to bring blood flow locally to the uterus to help lessen contractions associated with the actual implantation of the embryo.  Points are also selected to decrease stress and help relax the body and mind.  In addition, points are selected on the ear to further help with relaxation, uterine blood flow and endocrine functioning.

Q. Is it helpful for all types of cycles in which an embryo transfer is taking place?

A. Yes, it is definitely helpful for all IVF cycles, including those with donor egg and/or donor sperm.  Again, the focus is the same on the day of IVF transfer – to bring blood flow locally to the uterus, to help relax the body and mind, and to help with endocrine functioning.

At Pulling Down the Moon Shady Grove, Karisa and our other licensed acupuncturists strive to provide everyone with individualized care, whatever their circumstances may be. The German Protocol is just one of the many ways acupuncture can help you on your journey. We hope you will join us!

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Pregnancy Prep Program

Click here to learn more about our Pregnancy Prep Program, supplements to support optimal nutrition for women who are trying to conceive.

by Beth Heller, M.S.

Nutrition was a big topic at this year’s American Society for Reproductive Medicine conference.  Concepts under discussion included the potential role of inflammation in both male and female fertility and the possible value of antioxidants like resveratrol and omega-3 fatty acids in reversing damage done by environmental toxins.  Another very simple yet compelling idea was presented by Dr. Gil Wilshire from Missouri.  Dr. Wilshire contends that many women, even obese women, are not getting sufficient nutrition for good fertility.  Put simply, the typical low-fat, USDA Food Guide diet that we have all been programmed to eat, is low in essential nutrients like omega-3 fatty acids and fat-soluble vitamins that are essential for our body’s health and reproduction.

Dr. Wilshire was preaching to the choir on this one.  That the poor quality of our modern diet – from the over consumption of fast foods and overly processed meals, to the belief that “low-fat means healthy” – puts all of us at risk for less than optimal nutritional status  is a cornerstone of our fertility nutrition programming at Pulling Down the Moon.  What was especially compelling, though, was Dr. Gil’s use of the concept of “feeding up” in his discussion.  This idea is old as the hills but almost universally accepted in the medical community:  women get pregnant when they are “feeding up” rather than paring down.

The female body is keenly aware of “energy balance,” an evolutionary mechanism that ensures the survival of the human species.  When calories are scarce, bodies begin to shut down non-essential body functions…like reproduction.  Food, however, is much more than calories.  It is also the way our body gets essential nutrients like vitamins, minerals and fats needed for healthy body function.  If a woman is consuming a diet rich in calories but poor in nutrients, she can become malnourished.  Hence an obese woman who lives on processed foods can have plenty of calories but still be “starving.”  And the slender woman who has been told by her fertility doctor to gain some weight in order to conceive may benefit more from shifting to a highly nutritious diet and lowering the intensity of her activity than from simply packing on pounds.

Rather than “feeding up,” we like to say that women get pregnant when they are “nourishing up.”  Importantly, the process of nourishing up can take place without the gain or loss of a single pound.  It begins with a very healthy diet and  good digestion so that essential nutrients are not only present, they are being absorbed and assimilated.  Calorie counting is secondary to this objective, even for the obese woman who needs to lose weight.  In general we believe that certain nutritional supplements  (including a high-quality prenatal vitamin, a probiotic to support digestion and omega-3 fats) can help support the objective of “nourishing up” but the focus should be a diet rich in fruits, vegetables, lean protein, minimally processed grains and healthy fats.

We also know that nourishment can come in many ways – including the nourishment of true relaxation that comes with yoga practice, nourishment through channeling chi throughout the body during an acupuncture session or the healing touch of massage and reiki.  Changing the intensity and intention of our exercise program from “burning and racing” to “energizing and strengthening” can also make a difference.

At a high-tech conference like ASRM it was encouraging to see nutrition on the table, so to speak.  It was clear, however, that nutrition will never get the attention of research dollars.  Many more people attended the class on Pre-Implantation Genetic Diagnosis (PGD) than the class about nutrition.  Doing nutrition research is complicated and funding is scarce because unlike drug research, where there’s potential to patent and produce a pharmaceutical drug that will make billions of dollars, a healthy diet can’t be patented and won’t make anyone rich.  Conflicts of interest are everywhere.   Governmental agencies that are charged with making nutritional recommendations are also charged with protecting the economic interests of food manufacturers.   Our national nutrition association, the American Dietetic Association, is partnering with companies like Coca Cola to get women to drink more Diet Coke in order to prevent heart disease.  Yikes!

So what are we to do?  In the face of misinformation we must begin to live the truth and spread the word.  Have you made changes to your diet that fly in the face of the Dietary Guidelines for America?  Have you switched to full fat dairy and sworn off fat-free yogurt?  Have you switched to a more nourishing lifestyle through yoga, acupuncture or other practice?  If you have, please share your stories and we will feature them in our blog and on via social media.  Send your storied to beth@pullingdownthemoon.com subject line:  Nourishing Up.  You can include your name or let me know that you’d like to remain anonymous.

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

by Margaret Wertheim, MS, RD, LDN

There has been much debate about what the ideal diet is for weight loss, optimum health and of course, fertility. After listening to many qualified speakers at the American Society for Reproductive Medicine conference in Orlando last week, I realized that there are quite a few uncertainties. However, there are some things that we know for sure. As humans we are very adaptable and can survive eating just about anything, but that does not mean we are thriving. When you’re trying to conceive, it’s essential that the body’s most basic needs are being met. In other words, adequately nourishing your body and meeting your vitamin and mineral requirements is a must.

Throughout the 1980s, it was drilled into our heads that we should follow a very low-fat and high carb diet, based on the somewhat misguided notion that eating fat makes you fat. This type of diet has fallen out of favor for the most part. The pendulum swung back the other way to the Atkins diet, full of protein and fat with minimal carbs. I think there is a balance to strike somewhere in between.

In my experience, women tend to follow low-fat diets and eat reduced-calorie foods in order to lose weight or maintain their weight. It’s unfortunate that low-fat and reduced-calorie foods, such as artificially-sweetened non-fat yogurt and diet coke have become almost synonymous with “healthy” in certain circles. While we can survive on these types of foods, we don’t thrive. There are 4 fat-soluble vitamins – vitamins A, D, E and K. These vitamins are only found in foods that contain fat. Eat a very low-fat diet, and you won’t get enough of these vitamins that are crucial to your overall health and can play a role in fertility as well. Vitamin A is essential for embryonic development, and in one study of women going through IVF, the group of women with higher vitamin D levels in their blood had higher pregnancy rates. Furthermore, vitamin E is a potent antioxidant and may have a beneficial effect on sperm quality. (That’s right guys, this is for you too!)

When you eat a very low-fat diet, it’s all but impossible to meet your daily requirements for these important fat-soluble vitamins. Remember that when incorporating more fat into your diet, it’s essential to focus on quality fats and steer clear of unhealthy fats like hydrogenated oils. Eating more healthy fat doesn’t have to mean you eat more calories or gain weight. You’re likely to feel more satisfied after eating, which means you’re less likely to be grabbing for unhealthy snacks later on. Also, when you provide your body with the nutrients it needs to be healthy, often cravings fall away and you feel healthier and more vibrant and energetic.

To learn more about the role of healthy fats in your diet and which fats to stay away from, call 312-321-0004 to schedule an appointment with a Pulling Down the Moon nutritionist.

by Breea Johnson, MS RD LDN

When someone is dealing with infertility, they often scour the world for answers. For a lot of women, they never figure out why they have unexplained infertility or experienced a miscarriage. But for some women, the answer may lie in a simple blood test to measure thyroid function as low thyroid function and thyroid autoimmunity are both associated with infertility and miscarriage.

Consider Pulling Down the Moon nutrition client, Ann*, a 32 year old, normal weight woman who had two miscarriages with no explanation. After going to a miscarriage specialist, she was found to have hypothyroidism (low thyroid function) and with thyroid medication was successfully able to get pregnant and carry the baby to full term.

The thyroid gland, one of the largest endocrine glands in the body, is shaped like a butterfly and is located on the front of the neck below the Adam’s apple. While it is very small (only 2 inches across), it affects our entire body, as the hormones it produces and secretes regulate metabolism, growth and development.

A well-functioning thyroid gland is pivotal for a healthy body and to conceive a healthy child. There is a direct interaction between the thyroid gland and the reproductive organs (the testes in men and ovaries in women). Hypothyroidism (low thyroid function) influences ovarian function by decreasing levels of sex-hormone-binding-globulin (SHBG) and increasing the secretion of prolactin. Prolactin, the hormone which stimulates milk production for breastfeeding, also affects ovulation and menstrual cycles. Prolactin inhibits Follicle-Stimulating Hormone (FSH) and gonadotropin releasing hormone (GnRH). With high levels of prolactin, which can be caused by hypothyroidism, ovulation is not triggered and a woman cannot get pregnant. Additionally, in men, low FSH and GnRH caused by elevated levels of prolactin can prevent the maturation of sperm.

Another common disorder affecting fertility is Thyroid Autoimmune (TAI) disease (Graves Disease and Hashimoto’s Disease). It’s the most common autoimmune disorder and affects between 5-20% of women of childbearing age (Poppe, 2008). This group of disorders involves both the endocrine and immune systems. Interestingly, there is double the rate of miscarriages in TAI-positive women and TAI has also been found to be increased in women with endometriosis. In one study, researchers found a 75% reduction in miscarriage among TAI-positive women who received levothyroxine (a drug used to treat low thyroid function) during gestation and pregnancy. Subclinical hypothyroidism also may be an issue, as women with TAI show moderately high TSH (Thyroid-Stimulating Hormone) levels before pregnancy, although often within the normal reference range. There has been discussion among endocrinologists to move the limits of TSH (used to measure TAI) to 2.5mIU/l but that is not in effect yet.

We asked Dr. Christopher Sipe, a Reproductive Endocrinologist and one of our doctor partners at Fertility Centers of Illinois, whether he thinks thyroid disorders go undiagnosed early in the fertility journey when a woman is still with her OB.

“Because thyroid disorders are so common,” says Dr. Sipe “there are many women walking around who are undiagnosed. Thyroid hormone levels fluctuate in our daily lives and can be affected by diet, exercise, supplements, weight changes, medical conditions and seasonal changes. Therefore, a woman can be normal once but 6-12 months later have an abnormal level. Pregnancy also causes a shift in the normal range of thyroid hormones, further making diagnosis of a thyroid disorder more difficult. It is for this reason that diagnosis pre-pregnancy is ideal and screening should be recommended to any woman considering pregnancy.”

Dr. Sipe recommends woman have her TSH checked when she is considering becoming pregnant, when she has an irregular menstrual cycle, if she has a family history of thyroid disorder or if she exhibits symptoms of a thyroid disorder. Symptoms of thyroid disorder include inability to lose weight, dry skin, dry hair, depression, fatigue, constipation or muscle aches and pains.

In the case of a woman who is trying to conceive, testing the thyroid early may save valuable time.

“Treatment can take three to six months before a steady hormone level is achieved, and then pregnancy can be attempted,” concludes Dr. Sipe.

*Name withheld for confidentiality reasons.

For optimal health and vitality, traditional medical teachings recommend eating seasonally and locally.  In keeping with the ancient belief that we are healthier and happier when our bodies are in tune with the cycles of nature, it follows we should eat foods that grow in our geographical area while they are in season.  Traditional systems teach that foods and people in the same geographical area have “similar energy.”  This may be true in the sense that plants and the people living as neighbors share the same weather, air, soil and “roots.”  Whether indigenous or adoptive species, plants that thrive in particular areas are there because they are well-suited and have established harmony with their surroundings.  When we eat foods that exist in harmony with our surroundings, it’s believed we allow take some of that harmony into our own bodies.

Yet as we enter deep fall, some of the most touted fertility foods, like berries and melons, are heading out of season.  But that’s no reason to panic.  Instead of spending a fortune this winter on raspberries that have been shipped from half-way across the world, take a deeper look at your flora.  Farmer’s markets are an obvious way to explore what’s locally and seasonally available in your area.  In addition, many larger grocery chains have begun to label produce as locally-grown when applicable.

Here are some tips for reaping the best of Fall’s fertility bounty:

1. Think slow, think stew.  Fall and winter vegetables tend to be tougher and heartier than the delicate sprigs and tender fruits of spring and summer.  Kale, collards and sweet potatoes hold up well to slow-cooking methods like stewing or braising.  The benefit of stews and one-pot-meals is that the veggie cooking liquid is consumed as part of the dish, thus preserving nutrient content.
2. Turn on the oven.  Cruciferous vegetables, including cauliflower, cabbage and Brussels sprouts release a caramel sweetness when slow roasted in a hot oven.  These vegetables are fertility “must eats” and contain compounds that help regulate our body’s hormone levels.
3. Experiment with beans.  Bean soups and chili are nourishing dishes that contain fiber that promotes healthy digestion and elimination.
4. Squashes and sweet potatoes are anti-oxidant powerhouses.  Slow roasted or mashed, they can also quench a sweet tooth.

For more info about a nutrition consultation with a Pulling Down the Moon nutritionist call 312-321-0004 (Chicago) and 301-610-7755 (Rockville).

by Beth Heller M.S. and Laura Dubrule, R.D., L.D.N.

At Pulling Down the Moon we will often recommend a “cleanse” diet following a miscarriage or failed ART cycle.  While a cleanse can, at times, entail the elimination of one or more common food allergens like dairy, wheat and soy, elimination is not the basis of our program.  More often than not our cleanse consists of limiting processed sugar and other processed foods, artificial additives and colors while focusing on foods that support our body’s anti-inflammatory and detoxification processes.  The cleanse program at Pulling Down the Moon is individualized and takes into consideration a woman (or man’s) past and present digestive function, hormonal and other symptoms, medical history and current lifestyle.

One key element of our program is supporting hormone balance.  After a failed ART cycle or a miscarriage, a woman’s body must re-establish hormonal balance and function.  It may have been months since her last natural menstrual cycle. Weight gain during treatment may also impact hormone balance.  Yet another common symptom reported by our patients post-ART is anxiety and a lasting case of “the blues.”   It’s very easy to attribute these emotional side-effects to disappointment but there may also be a physical component.   The hormone medications used during the stimulation phase of an ART cycle, and the progesterone supplementation post-IUI and ET, can cause emotional side effects and these hormones can be slow to leave the body.  The liver is charged with processing these steroids before they can be excreted.  To do this it requires ample amounts of amino acids (in particular sulphur-containing amino acids), as well as the vitamins and minerals that work as co-factors in detoxification pathways.

Our ART Recovery/Prep Program focuses on limiting sources of external hormones by discouraging foods that contain hormones and hormone-like substances.  Chief offenders in this area include factory-farmed dairy and meat products which contain the hormones and growth factors used in production.  There are also hormone-like chemicals in pesticides and plastics.  By limiting these external sources of hormone-like substances and increasing the intake of foods that support good hormone function (fiber, lignans and lignins, a range of whole grains – not just wheat! – , healthy fats, cruciferous vegetables, antioxidant rich fruits and veg and added-hormone-free protein) we have the potential to bolster our body’s ability to metabolize and excrete excess hormones and restore balance in the reproductive cycle.

Our Rockville nutritionists Laura Dubrule, R.D. recently  shared a case with me that drove this message home.

My patient is 43 and had experienced two failed IVF cycles in quick succession (6 months time).  Her physician had noted several potential factors contributing to failure including egg quality and endometrial lining quality.  In addition, the patient had recently been diagnosed with PCOS.  Since her last IVF the patient was unable to lose the 8 pounds gained during IVF treatment despite eating a healthy diet and working out four times per week.

We discussed the impact of IVF medications on hormone levels as well as the impact of various dietary choices on her body’s ability to break down and clear excess hormones. We focused especially on tweaking her already health-supporting diet to include significant amounts of cruciferous vegetables and berries every day as well as a daily serving  of legumes.  I suggested she add two supplements, RePro Cleanse and FlowPro, to her regimen as well as vitamin D.

I was very surprised when the patient returned for follow-up having lost 8 lbs over the preceding two weeks.  At Pulling Down the Moon we are extremely careful not to encourage rapid weight loss but upon review of my patient’s diet it was clear that a reduction in calories was not a major factor in her weight loss. The patient reported feeling that the weight came off her abdominal area, that she had lost a bloated feeling, and that her clothes fit the way they used to.

The patient also told me about the resolution of another symptom she hadn’t mentioned in our initial consult. She had been experiencing high levels of anxiety while driving, especially on the highway.  This was not her experience historically, but had been a recent development.  Over the course of the two-week cleanse, this driving anxiety completely disappeared.

While we can’t be certain, we suspect that this rapid loss of water weight and alleviation of anxiety may have been due to an increased clearance of excess steroid hormones that had been circulating in her system.   Whatever the reason, the result was excellent.  While there is still work ahead, my patient is very pleased with the results of her cleanse and feels more like herself than she has in months.  We both agreed that anything we could do to reduce the lingering effects of ART would only help her feel more prepared for her next round of treatment.

We believe that a nutritional consultation can make a big difference in the fertility journey.   Our consultations are available in person in Chicago and the DC Metro area and by phone from almost anywhere else.  Call 312-321-0004 (Chicago) or 301-610-7755 (Rockville) for information.

RePro Cleanse includes kudzu, flax, rice protein and other micronutrients that support the liver’s detoxification processes. Because it contains plant estrogens and is designed to help balance and promote clearance of excess reproductive hormones, we do not use RePro Cleanse when a woman is on fertility medications or birth control.  We often recommend supplementation with Re Pro Cleanse when women are recovering from a failed cycle or miscarriage, or in cases of hormone-related conditions like fibroids or endometriosis.  We will also use RePro Cleanse when a woman’s IVF cycle is cancelled/postponed due to high baseline estrogen levels.   Used as directed over a period of 2-4 weeks we feel that this supplement can help jump start a woman’s recovery process in preparation for a subsequent cycle, be it ART or natural.  Of course we recommend that our patients clear any/all supplements with their physicians.

About Laura Dubrule

Laura brings an eclectic mix of passions to her nutrition counseling. Her years studying acting in New York taught her the importance of connecting with our bodies; this deep sense is fundamental to her understanding of diet and nutrition. Laura completed the program in Nutrition and Food Science at Hunter College in New York, and then went on to complete her dietetic internship at Stony Brook University, a program with an integrative and functional approach. She returned to the city and practiced in a worksite wellness program, delivering individualized nutrition counseling to bank employees in Manhattan and Brooklyn. Her vision for her clients could be called “whole foods meet real world.” She believes that food is meant to be enjoyed and works with her clients to find healthful approaches to eating that are satisfying and enjoyable.

Laura is thrilled to be working in concert with acupuncture, yoga and massage professionals because she believes that the nourishment and care of our hearts and souls is integral to the nourishment of our bodies. She considers it a privilege to be a resource to men and women on their fertility journeys and to celebrate every step long that path as an act of love and creation.

by Beth Heller, M.S.

To fully comprehend the latest research on omega-3 fatty acids and embryo quality it’s important to understand that the goal of medicated fertility cycles is not simply to make a lot of eggs.   In fact mild ovarian stimulation that results in fewer follicles seems to provide the best results.  This approach allows only the healthiest follicles and oocytes to develop.  Since developing follicles produce estrogen, fewer developing follicles also mean lower estrogen levels during the cycle.  This is also potentially beneficial as higher estrogen levels may negatively impact uterine receptivity and deter embryo implantation.

New research suggests that a higher intake of omega-3 fatty acids ALA, DHA and EPA may support this objective (1).  In 225 women undergoing IVF diet data was collected using a food frequency questionnaire.   Intake of  the omega-3 fatty acids ALA,EPA and DHA were calculated, as well as omega-6 (LA) intake and the ratio of omega-6 to omega-3 fats in the diet.

In this study, the women with the highest dietary intake of omega-3′s had lower estrogen response, developed fewer follicles and had better quality embryos, even after controlling for confounders like age and BMI.  A higher omega-6 to omega-3 ratio was associated with higher numbers of follicles.  If the goal of fertility treatment is to help women produce fewer, higher-quality eggs, this research suggests that women undergoing ART  should strive to increase consumption of omega-3 fatty acids and decrease the amount of omega-6 they consume.

As a result of these findings, the research team recommends that twice-weekly fish intake should be encouraged in women during fertility treatment.  While generally useful, this recommendation does not take into consideration the risk of toxicity from fish consumption – especially in the perinatal period.  In fact,  the fish richest in omega-3 fatty acids are the ones most likely to contain mercury and other contaminants.  For this reason, our recommendation at Pulling Down the Moon is that women work to lower their intake of omega-6 fats (found in snack and fast foods, factory/grain-fed red meat and processed oils), increase  their intake of leafy greens, nuts and seeds and supplement their diet with a high quality, purity tested fish oil supplement.

Supplements are only a small part of fertility nutrition, however.  For more information about fish oil, diet and egg/embryo quality, schedule a consultation with one of our nutrition specialists. Learn more about omega-3 fatty acids here.

1.  Hammiche et al. Fertility and Sterility. Vol. 95, No. 5, April 2011 1820-23

Beth Heller, MS, RYT

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.