When it comes to preparing for an IVF, I would say it’s the same routine that someone, for example, was planning to start a family and was trying to conceive naturally. As a nutrition I would probably give the same advice to both of them. Some nutrients to consider taking are zinc, CoQ10, Vitamin C, vitamin B12, vitamin D and of course, folic acid. So, these are very important for pregnancy and before pregnancy and will probably help DHEA as well for IVF and in general. So, these would be some nutrients to consider taking before pregnancy and before IVF. For men it would be more like focus on lycopene, zinc, vitamin C and again, changing some lifestyle factors and for both of them – those lifestyle factors like drinking, smoking, exposure to pesticides would play a huge role in success or successful IVF.
Another important part of our diet is macro elements, and one of them is carbohydrates. We know that the quality and quantity of dietary carbohydrates influence glucose homeostasis and insulin sensitivity, and these may influence ovarian androgen production and ovarian function. So, right now we have pieces of evidence that suggest that a diet low in glycemic loads and containing greater amounts of whole grains may benefit fecundity, and diets rich in fiber will reduce estrogen levels and may affect either the risk of infertility or assisted reproductive technology outcomes. So we need to study what we eat. And now the other important food is fatty acids.
Before starting to think about the supplements, let’s think about the diet. Ensure that you have that mediterranean dietary approach, that we are rich in all the nutrients that we want from that dietary perspective and when considering supplements, we want to take a prenatal supplement. Within that prenatal supplement, it will include important nutrients such as folate, such as vitamin D. There are other supplements that can be taken as well, for example, myo inositol which has been linked to improved outcomes in IVF but that is one of several. Therefore, I would say go and speak to your fertility specialist or fertility dietitian or nutritionist who will be able to guide you on what supplements are the best for you.
There are many supplements on the market that need to be taken before IVF. Vitamin D is very important, so we need to make sure that it has to be replaced if it is low. Folic acid needs to be taken by any woman who is trying for a baby, it protects the baby from abnormalities, it can also reduce the chances of miscarriage.
There are many supplements available for the woman and man that needs to be taken before IVF, like carnitine, zinc. Many other supplements are used to improve sperm quality. Coq10, DHEA-S in a woman with poor ovarian reserve, according to some studies, can improve the quality and the follicular recruitment, and by improving it with these supplements if they are properly used you may earn one or two eggs before IVF. It has been proven though, that DHEA does not change the chances of success in IVF.
Inositol, for example, in combination with other supplements, can help in ovulation in women with PCOS. Melatonin, according to some studies, can also play a role. There are many supplements, many multivitamins on the market available. Even supplementation needs to be done on the patient to patient basis, and it needs to be personalized.
The supplements, we usually recommend are very similar to the ones patients take to get pregnant naturally. There are no specific supplements unless there is a lack of vitamins. For example, in the blood test, so normal conditions what we do recommend is taking folic acid, which is the standard substance recommended for anyone who wants to get pregnant.
There are a lot of compounds that contain a lot of vitamins like vitamin B 12, B6, B1, selenium magnesium, zinc, and things like that. These can help you start the pregnancy in your best condition, but the direct effect on the cycle outcome is very controversial, and it has very little effect. There has been a recent study trying to see if there was any correlation between taking supplements before IVF and live birth, especially women, and there were no differences at all suggesting that even the antioxidants do not help to improve the egg quality. It’s true that in certain cases, for example, in patients with PCOS, it may make sense to take things like a Myo-inositol because it has been suggested that this may increase the percentage of mature eggs. Also, in cases where you have done a first egg collection, and the mature eggs’ percentage has been really low compared to the one we were expecting, it could make sense to give Myo-inositol. It’s never going to be a problem, and in some cases, it may help obtain more mature eggs. Anything else could help to start in a better condition, but it’s not going to change the outcome significantly.
With men, it’s slightly different. Some supplements may indeed improve the quality of the sperm, but once more, we are facing the same problem as always, thus this improvement translates into more babies? So far, no one has been able to demonstrate that.
Antioxidants, for example, in men may sometimes help us to change the treatment, and if there is a kind of mild severe male factor, it could happen that if we improve the quality of the sperm, we may change from an IVF to an IUI and then make it simple, easier for the patients. Once you are just doing IVF, the fact that you get 23 million sperm, or you get 45 million sperm is not going to change the outcome, it’s not going to improve, and the other factor that has been related to supplements is DNA fragmentation, which is a condition in which the DNA inside the head of the sperm is fragmented, and this may make things really difficult for the eggs because the eggs have to deal with this fragmentation. It has been suggested that taking antioxidants may improve DNA fragmentation. Once more, the evidence that we have is quite weak and is not going to be an issue, so we do recommend taking antioxidants to someone that have a high DNA fragmentation rate because most of the DNA fragmentations are related to oxidative stress, so taking antioxidants may improve the conditions, but you need to take them for at least 2 months until you may find any benefit.
Since most of the time, patients are not willing to invest these 2 months to get a result that may be better or not, there are other ways of dealing with DNA fragmentation like IMSI, which in our opinion is really useful, so despite giving these antioxidants, we tend to work differently to try to start the treatments as soon as possible.
