In my mind there are three parts to IVF success: the lab, the way ovaries are stimulated to grow eggs, and the quality of the eggs and sperm.
1. Lab conditions and techniques have improved dramatically in the past ten years. We can now video monitor embryo development. We can biopsy embryos to determine whether they are chromosomally normal (called CCS or PGS). Incubators and media for growing embryos replicate the optimum female genital tract nearly perfectly. There is still room for improvement, of course, but the success of embryo growth in the lab is incredibly high.
2. Ovarian stimulation has not changed as dramatically, I will admit. Ultimately, we are giving medications to grow multiple eggs all at once. Sure, we think at Olive we are quite good at stimulating ovaries to grow eggs in several different ways, individualized to the patient's particular situation, but ultimately the ovaries decide how things will go.
3. The quality of eggs and sperm has been a real focus of our attention in the past couple of years. Egg and sperm both take a little more than two months to grow in the body before they are mature enough to be used to create an embryo. The environment they are growing in during those 2+ months matters. We know that toxins such as alcohol (to sperm mainly), certain medications, bisphenol-A, thalates, and other chemicals in our environment can damage sperm and eggs. Most of the damage is "oxidative damage." Oxidative damage can potentially be lessened by giving men and women antioxidants. This is why we recommend coenzyme Q 10 to most of our female patients in particular, prior to IVF. It's also why other supplements, such as melatonin, folate, selenium, and the vitamins C, D, and E are often recommended as part of the pre-IVF "cocktail." What we recommend is based on the patient's history and test results, and more and more we are recommending anti-oxidants to try and optimize the quality of the eggs and sperm we get during IVF.
This month in Fertility and Sterility, a reasonable quality study suggests male sperm might benefit from the antioxidant alpha-lipoic acid (ALA). This is new. ALA is naturally occuring in nearly all the foods we eat, but particularly high in spinach, broccoli, heart, liver, and kidneys. While it is in these foods, it's hard for your body to break down into a usable form; in general, to increase your ALA concentration, you need to take a supplement. In this study, 44 men with low sperm motility took either a placebo or 600mg of ALA for 12 weeks. Their sperm was assessed before they started the pills and again 12 weeks later. The men who took 600mg of ALA had better sperm count and motility than those who took the placebo pill. There were not any serious side effects from taking ALA.
You can buy ALA at most pharmacies (e.g. Shoppers Drug Mart, Finlandia, Choices Food Store, London Drugs) without a prescription.
We often say to patients undergoing IVF that it only takes one good egg and one good sperm to have success. Taking certain supplements might increase the odds that we get a good one!
Reference: Haghighian HK, Haidari F, Mohammadi-Asl J, Dadfar M. "Randomized, Triple-Blind, Placebo-Controlled Clinical Trial Examining the Effects of Alpha-Lipoic Acid Supplement on the Spermatogram and Seminal Oxidative Stress in Infertile Men." Fertil Steril. 2015 Aug;104(2):318-24.
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