Improve your chances of IVF success using evidence based research
If you have downloaded the FREE IVF Guide you may already know about these methods... and even if you have, they each have so much potential to impact your next cycle that a quick reminder can't hurt!
I've been reading a lot of fertility books lately and a lot of the information in the books crosses over with the IVF guide... except the IVF guide is 100% free!
Anyway, check out the video and let me know what you think!
We have heard many, many times about the disastrous effects of sugar on our natural fertility. ‘Disastrous’ sounds quite dramatic, but it is the current bad thing in nutrition circles right? Sarah Wilson, ‘I Quit Sugar’ author, Pete Evans, general paleo champion and a whole host of trainer-slash-tv-show-celebrities will be back me up here.
And it seems rightfully so.
For natural fertility, sugar is frequently cited as being responsible for increasing inflammation (especially in women with endometriosis), altering hormone levels such as progesterone, estrogen and androgens and increasing insulin resistance which has its own collection of negative consequences.
Want 19 evidence based ways to improve YOUR IVF cycle? Click Here.
But what about the impact of sugar on IVF success? Unsurprisingly there is only an incredibly limited number of randomized control trials looking at the impact of sugar on IVF success rates. Is that because it’s generally understood that of course sugar negatively impacts IVF? If so, why isn’t that information fed to us (pardon the pun) in the fertility clinics in a very clear way? Or is it because there are no funding bodies willing to pay for such a trial? Or perhaps it’s thought to play very little of a role at all. Regardless of the reason the outcome is still the same. More evidence is needed.
For those of you who have read my free ebook (and those of you who haven’t, why not? Did I mention it was free?) you will know that I am a big believer that despite all the medications, medical procedures and laboratory techniques that IVF utilizes as ‘patients’ we are still active in that process. That is despite the fact that your body is about to be highjacked by all sorts of medications you still have control over what you eat, drink and the way you live your life.
That is NOT to say that if we have a bad cycle with skyrocketing estrogen, 50 antral follicles developing and only one lead follicle that eating the right food is going to save the day, but in a more moderate situation modifying diet and lifestyle factors have been shown to have a significant impact on IVF success rates (1). As we know Lady Luck also has her hand to play in the IVF cycle – so perhaps modifying those lifestyle factors can be considered a bit like buying extra lines in the lottery rather than just the standard ticket.
Its not just monkey business
So back to sugar and IVF.
Like I said, there is insufficient information examining the exact impact of sugar on IVF success. Interestingly though in 2014 a study conducted on rhesus monkeys was completed (2). I know, a human study would have been preferable but don’t we share over 90% of the same DNA with primates?
What the scientists did was get a group of monkeys and divide them into two separate groups. Over a period of six months one group was given extra sugar in their diet and the other group was not. I know, try and suspend that part of your brain that is telling you this is a step back for animal rights.
They then did a stimulated cycle, very similar to that of an IVF cycle and compared the outcomes of the monkeys that were given sugar against those that were not. What they found was that when they did an egg collection, after six months of eating extra sugar, although overall the number of eggs collected was similar between the two groups, significantly less mature eggs were able to be collected in monkeys that had been given extra dietary sugar versus those that were not (18.5% of eggs were mature in the sugar group versus 86% mature in the non-sugar group). It is believed the sugar interfered with how the eggs were able to mature. This is obviously concerning as fertilisation and production of a viable embryo is not possible without eggs first developing to maturation. And because I know you are thinking it, the extra sugar that these primates were taking wasn’t even that high with researchers reporting that it was in fact the equivalent of less than half of what most women in the U.S. would consume.
Although this is only a small, elementary study completed in monkeys it is one of the first to particularly look at the direct relationship between sugar and IVF cycle outcomes. It is therefore absolutely worth noting and women undergoing IVF could do worse than to simply reduce the amount of sugar they intake.
A human study this time
Another study was also done (3), this time in humans, looking at the relationship between carbohydrate intake (and as we know, sugar is a simple form of a carbohydrate), protein intake and IVF outcomes. Although this was only a small study – only twelve women participated, so yes, there is plenty of room for these results to be skewed – they found huge differences when women aged 35 or younger and with a BMI of 26.5 or less modified these two food groups.
After being unsuccessful for one of their IVF cycles, these women waited at least two months before commencing another cycle. In between these IVF cycles the women focused on reducing their carbohydrate intake and increasing their protein intake (these women had dietary support and were guided on how to do this) and found that blastocyst formation increased significantly as did clinical pregnancy rates – from 16% to a whopping 83%.
All in all, this led the authors to summarise that
Seemingly young healthy patients with poor embryo development can possibly increase the percentage of blastocyst formation by increasing their daily intake of protein and lowering their daily carbohydrate intake 2 months prior to their IVF cycle. – Russell et al 2012
And for ladies over 35…
Dr Russell repeated this kind of study on 120 ladies who were aged 36 and 37. As reported by Kate Johnson for Medscape, these ladies were categorised depending on whether their diet consisted of high amounts of protein (over 25% of their food intake) or low amounts of protein (under 25%). It was found that ladies who were in the ‘high protein’ group had better rates of blastocyst formation (64% vs 34%), clinical pregnancy rates (66% vs 32%) and the holy grail of IVF treatments, live birth rates (58% vs 11%) .
Additionally, when protein was greater than 25% coupled with carbohydrate being less then 40% the clinical pregnancy rate skyrocketed to 80%. I think that is AMAZING.
Dr Russell concedes that although from the data presented here it seems as if a high protein, low carbohydrate (and that includes sugars) diet is the way to go, the underlying mechanisms is unknown. Is it the actual grains that causes this change or is it another factor such as a possible inflammatory effect of gluten (have a look at my post on gluten if you haven’t already)?
Before you start throwing out all the pastas, breads and cookies from your pantry remember that changing your diet when imminently about to commence an IVF cycle is not necessarily about weightloss (you don’t want to drastically alter your weight without your fertility doctor being aware of it as it may change your medication regime) but is about making sure you are eating the optimal foods to assist in the production of healthy eggs and ensuring that there is a healthy environment to welcome any little embryos. The women in these studies also had help from nutritionists to help them get their balance just right. Likewise, before you make any drastic changes to your diet it would be prudent for you also to get this type of advice – or even just speak about it with your doctor or fertility nurse. In the meantime though, it is safe to say that I would definitely rethink that afternoon Mars Bar.
References
Tin hat thinking is when you do something which you can see might be worth a try even though the hard scientific backing isn’t necessarily there. Things that can’t hurt to try and there seems to be loads of qualitative evidence on the internet though the quantitative evidence seems a bit lacking. You know the general sort of things – eating organic, not wearing perfume or cosmetics and perhaps eliminating dairy. They might be things that your naturopath prescribes, but what your fertility specialist doctor might say makes no difference. I realize this sounds quite dismissive to naturopaths and it is really not meant to. The more and more I research into fertility treatments the more and more I can see that sometimes some of the answers are in the way we live our lives rather than being solely dependent on how many units of Gonal F we are injecting into our stomach.
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For me, eating a gluten free diet was one of those tin hat thinking moments. After several failed cycles I felt the need to attempt to take some control back and try something different. So amongst a couple of other things I tried eating gluten free diet starting from cycle day one. I did happen to get a BFP on the cycle I went gluten free, though I was also on some additional medication which also would have made an impact. Saying that though, I also know of others who have also experienced a BFP when eating gluten free (and there is that qualitative evidence again). But was it just coincidence and would it have been ‘our time’ regardless? Who knows. For a significant number of people though, particularly those with unexplained infertility, eating a gluten free diet may be much more than tin hat thinking and might just well be the real underlying cause of their infertility.
Celiac Disease
Celiac disease occurs in up to 1% of the population, but only 20- 50% of those may experience symptoms. As you are probably aware, traditionally people who have celiac disease are required to eat a gluten free diet. This is because celiac disease is an autoimmune condition which is triggered by gluten which is the protein fraction of wheat, barley and rye. There is a bit of a complex biochemistry reaction but essentially the gluten causes a number of chain reactions which results in an inflammatory response in the body and the production of some specific antibodies. It is perhaps the presence of these antibodies that may contribute to difficulty conceiving, recurrent miscarriages and once you are finally pregnant with one that sticks, intrauterine growth restriction, which can result in your baby being born with a significantly lower birth weight and other difficulties.
The evidence for associating gluten with infertility
There has been a bit of research around celiac disease and just last year a meta-analyisis was completed investigating the association between celiac disease and issues of the reproductive system in women (Tersigni, 2014). The meta-analysis included 24 studies that had been completed on this area and here are what I consider the five essential things to know:
1. Women with unexplained infertility or recurrent miscarriage have a 5 or 6 fold, respectively, increased risk of being affected from celiac disease compared with the general population.
2. Classic celiac symptoms are often absent, or at most the symptom may be the very general fatigue associated with iron deficiency anaemia. This means that it can be a significant length of time before diagnosis, and hence treatment is initiated.
3. Before and after studies have been done on women with celiac disease and the number of children they were able to have before and after diagnosis. Before diagnosis women with celiac disease were found to have less numbers of children than women without celiac disease. After diagnosis and treatment this number returned to similar numbers. This indicates that treatment of celiac disease and eating a gluten free diet is beneficial to aiding fertility in women with celiac disease and seemingly reverses the destructive mechanisms.
4. There are two suggested mechanisms by which celiac disease limits fertility: firstly causing malabsorption and nutrient deficiency and secondly, the accompanying automimmune reactions.
It is believed by preventing the absorption of nutrients an imbalance in the reproductive hormones such as luteinising hormone and follicle stimulating hormone is experienced. This in turn prevents normal ovarian functioning and hence causes infertility. Deficiency of nutrients such as folic acid also ultimately leads destruction of the rapidly growing embryo as it needs this acid to develop neurons and develop normally.
The second mechanism being autoimmune factors effects fertility in two ways. One possible way is that the antibodies produced by women with celiac disease destroy the outer layer of the blastocyst. This prevents the embryo from implantation and forming the placenta as it is this outer layer of the blastocyst that gives rise to the developing placenta. Another possible way is that the antibodies prevent the endometrium from growing new blood vessels, again preventing implantation resulting in a BFN once again.
5. Women with celiac disease also show an increased risk of miscarriage, intra-uterine growth restriction, low birth weight and preterm delivery. This indicates that the implications for having celiac disease go far beyond difficulties at conception and that a long term gluten free is essential in women with celiac disease who achieve preganancy.
Take action!
Especially if you have ‘unexplained’ infertility or recurrent miscarriage, at your next appointment ask your doctor if you have been screened for a sensitivity to gluten. The symptoms are not always the typical responses and can easily be missed. One of the first screens to do is to test for endomysial and anti-TG antibodies (Tersigni, 2014)
Check out the possibility of eating a gluten free diet. Although on the one hand it has never been easier to knowingly eat gluten free – there is pretty much a gluten free substitute for EVERYTHING these days, on the other hand it is nearly impossible to cut out all the hidden gluten – it sometimes seems gluten is everywhere… there is wheat syrup and hence gluten in that Cadbury’s chocolate bar you have just eaten!
If you are just starting out to eat gluten free the big things to avoid are foods containing wheat. That includes pretty much all cereals, baked goods, bread, cakes, pastry, noodles and pasta. Vegetables, fruit and meat are fine as is rice and some other non-wheat grains. Like I said though, the ‘hidden’ gluten is in a lot of things including salad dressings, soups and beer. If you are serious about going gluten free it is therefore essential to check the back of the pack before eating.
As for me, although I did decide to stop eating gluten I have not yet been tested for the specific antibodies that often present with a gluten sensitivity. I will request these at my next appointment but in the mean time I found it ‘worthwhile’ eating gluten free if for no other reason than knowing that I had given things my ‘best shot’. Anyway, as previously discussed, for a significant number of women with infertility the idea of eating a gluten free diet is perhaps based in science and not so ‘tin hat’ as what I first thought.
Reference
Tersigni, C., Castellani, R., deWaure, C., Fattorossi, A., De Spirito, M., Gasbarrini, A., Scambia, G. & Di Simone, N. (2014) Celiac disease and reproductive disorders: meta-analysis of epidemiologic associations and potential pathogenic mechanisms. Human Reproduction Update. 20 (4) 582–593