A Sea of Supplements

When you are 42, almost 43, you know it's not going to be easy to get pregnant on your own, never mind the fact that DH has no swimmers, except for those under deep freeze. While I was going through my FET, I thought, "well at least I don't have to worry about egg quality!" I wasn't as careful about what I ate. It was kind of nice not to freak out about having chocolate or a beer (gluten free, of course) once in awhile without worrying, "OMG! This is going to affect my egg quality!! I'll never be a mother!" Oh yes, I can't tell you how many times I've had this internal chastising with myself.

I'm back to the optimizing egg quality campaign, which I have dubbed "Mission Impossible" IVF. Let's just call it MIIVF (is that pronounced miffed?!) for short. You know how it goes - the darning impossible chase/escape scenes, but the good guy always wins, right? That's pretty much how it goes in my MIIVF fantasy too.

My campaign involves forking out a lot of money for acupuncture and supplements, but in reality, it's all a lot cheaper than IVF. I have acupuncture once a week. I will start acupuncture twice a week at least 4 weeks before egg retrieval.

In this post, I will just discuss the supplements I am taking, and what I think they are doing or supposed to be doing. Keep in mind that this is constantly a work in progress. I work with my health care providers on what I am taking, which is mainly my two acupuncturists at this point. I also do my own research and get approval from my acupuncturists before I add something else into the already complicated mix.

Supplements Specifically for improving Egg Quality
Pregnenolone 30mg twice a day
L-arginine 2g
Gamma Linoleic Acid (GLAs), roughly 2g
Proanthocyaniadins in the form of Grape Seed, standarized to 109 mg; once a day
CoQ-10 90mg daily

Chinese Herbs:
Liu Wei Di Huang Wan for nourishing Kidney Yin before ovulation
Jia Wei Xiao Yao Wan after ovulation

I discussed in this post about the reason I take pregnenolone, which is a precursor to DHEA, and not DHEA itself. I go into a big long discussion about why DHEA doesn't work for me, mainly because of it's affect on my heart and how it makes me feel like I'm going to die. If you have already read the post, I edited it because I discovered that part of it got deleted in some weird code error, so you may want to re-read it. Pregnenolone can have similar side effects as DHEA, but they don't seem to be as severe in my experience. I think you basically take as much pregnenolone or DHEA as you can tolerate to improve egg quality, and that is different for every woman. Not everyone can tolerate 75mg of DHEA twice a day, which is what was recommended to me by my RE at BigShotFertilityClinic. DHEA is not harmless, and here is one study in which it proved harmful. My adrenal gland health also seems to be improved, as I am no longer taking the adrenal gland supplement (Iso_Cort) and I have lowered my dose of pregnenolone. I could tell I was taking too much when I felt as if I was on caffeine high, which I never drink, and also means I felt like crap.

I could write a whole post just on L-arginine. There were two studies done on L-arginine and IVF, one in 1999 and one in 2003 by similar authors. The studies are essentially the same, with the difference of the first one having a mean age of 40 for the IVF participants and the second study having a mean age of 33. The first study showed success in using a whopping 16 GRAMS of L-arginine on number of eggs retrieved, number of day 5 embryos, and pregnancy rates. The second study also used the insane dose of 16 GRAMS of L-arginine, but the IVF protocol was different. The results were almost opposite as the first study, and the authors concluded that L-arginine might be detrimental to IVF outcomes. L-arginine is precursor to human growth hormone, so you will see it in formulas for body builders. The idea for older women and poor responders is that human growth hormone will help with egg quality, hence the reason HGH (Sai.zen) is used in some protocols for IVF. The problem with JUST studying L-arginine is that a drug model is applied to a nutritional building block that has synergistic effects with other substances. Meaning that just giving L-arginine alone might not help, but including other nutritional factors may increase the absorption and effectiveness of L-arginine. So, I would say the jury is out on this one. It does seem that the research on L-arginine and IVF has come to a screeching halt, which is a shame. Other studies are done with L-arginine to help with circulation and heart issues, which I am speculating may help with blood flow to the ovaries and uterus.

My acupuncturist recommended that I take evening primrose oil to increase my AMH. I have not figured out what the difference is between evening primrose oil and borage oil in terms of effectiveness. Randine_Lewis seems to think that evening primrose oil is better, but borage oil has more Gamma Linoleinc Acid, which is the main active ingredient in evening primrose oil. For now, I am focusing on taking a flax oil/borage oil combo. I try to take 4 Tablespoons a day, spaced throughout the day. It definitely affects my, uh, bowel movements, hence the reason I don't chug it all at once, not like I could stomach that anyways. I did discover a bulk omega oil product, Barlean's_Total_Omega_Vegan_Swirl, that has lots of GLAs and is flavored to taste like a smoothie. The whole family has discovered it, and I have to beat off my DH and stepsons now from sucking it all down at once, it's that good. I might also add in some evening primrose oil to cover all my bases.

The proanthocyaniadins (also called pycnogenol or OPCs) and the CoQ-10 are also recommended by Randine_Lewis to improve egg quality for older women. These are both supposed to help with circulation, again, with the idea of improving blood flow to the ovaries and uterus. They also help with free radical damage. Here's what Randine has to say about it:

"One of the hallmarks of aging is damage to mitochondrial DNA caused by oxygen metabolism and the presence of free radicals in the system. This damage has also been shown to contribute to age-related decline in egg quality. A way to improve cellular function is to supplement your diet with enzymes like Co Q-10. Antioxidants (vitamins C, E, A, zinc, and selenium) and superantioxidants (pycogenol) also help prevent free-radical damage to cell mitrochondria."

They also have the side effect of lowering my blood pressure. I went to my GP the other day, and my blood pressure was 104/60! The dose on both is 100mg a day. With the proanthocyaniadins, you want to make sure you are getting 100mg of this standarized ingredient, and not just 100mg of grape seed or whatever the ingredient is.

The Chinese herbs I take are for Kidney Yin deficiency with Liver stagnation. If you don't have the same Chinese medicine diagnosis as me, don't take these herbs!! I never recommend self-prescribing on Chinese herbs anyway. Always have an acupuncturist who specializes in fertility prescribe your Chinese herbs!

Supplements for Mental Health
Zinc 20 mg
Neuro_Replete
Fish oil/EPA-DHA

Again, I could write a whole 'nother post about the supplements I'm taking for my mental health. Why am I taking supplements for my mental health? Well, we all know how uplifting and calming infertility treatments are. This will just be a summary post on another complicated issue.

I found an interesting article last year on mental health supplement research. I thought it was going to be another recommendation to take fish oil, but it wasn't. Go over an read the article when you have time. It's a fascinating read. William_Walsh (PhD) was doing research on convicts to try to understand how chemical imbalances and nutritional deficiencies or toxicities were affecting their mental health. Here is an excerpt from the interview with him:

"We’ve found that nearly all women with a history of postpartum depression have a tendency for very high copper levels in their blood. It is especially problematic for women, because estrogen and copper are proportionately related."

When I read this, all sorts of bells and whistles started going off. I had the same symptoms of postpartum depression, except I had it while pregnant. Was there a solution in here for me?

Awhile back, I had some hair testing done for metals. I was mainly concerned about toxic mercury levels, which I seemed to be ok. I had all my mercury fillings removed before I did IVF to improve egg quality. The problem with removing mercury fillings is that you can mobilize a lot of mercury in the process, but I did it with a dentist who specializes in mercury amalgam removal. Still, I'm sure I got more exposure to mercury at the time. I did some mild chelation with chlorella, but nothing more. Mercury toxicity can cause mental illnesses, but my hair analysis didn't indicate that I have a mercury toxicity problem. My copper levels were also tested, and they seemed to be ok. However, my Zinc/Copper ratio was abnormal. I was basically deficient in zinc, which could mean I have too much copper in my system. William_Walsh says this about treating excess copper in the interview:

"By normalizing a protein that removes excess copper from the body. We slowly, gradually introduce the nutrients that stimulate the synthesis and the functioning of that protein. People who are high in copper invariably are zinc deficient as well, so we also slowly and gradually normalize their zinc levels. Then the protein begins to function and, in most cases, the copper levels return to normal. It’s about a two-month procedure for most people. If we did it very suddenly, and we gave them high doses of everything, the excess copper would be dumped from tissues and the blood levels would go even higher. You could see a decline in health before the patient got better, as all the excess copper is exiting the body. So you have to be somewhat careful with overloads."

My zinc deficiency was confirmed by the hair analysis testing and muscle testing with my chiropractor.

I recently started taking the supplement Neuro_Replete at the recommendation of Dr. F. Last year, I was on the antidepressant Well_butrin for about four months. I was on the verge of looking to take another antidepressant after our FET failed, but Dr. F put me on this stuff. I was skeptical in taking it because of the amount of 5-HTP in it. I had taken 5-HTP before to help me sleep. It is a precursor to seratonin and seratonin helps you sleep. If you take too much, you can end up with seratonin syndrome, which manifests in disturbing dreams/nightmares. The Neuro_Replete website has lots of fascinating information on neurotransmitters, their precursors, and how antidepressants eventually deplete your neurotransmitter levels. For example, I learned that just taking 5-HTP alone will deplete your dopamine levels. The Neuro_Replete has a blend of neurotransmitter precursors. It works on a synergystic level, and not just adding in one precursor or supplement, similar to as how I described the L-arginine example above. I've been sleeping better and feeling more calm since taking the Neuro_Replete.

Other Stuff I take for General Health
Multivitamin without iodine and iron
Iron supplement, since my multi doesn't have it
Vitamin E, mixed tocopherols, 1000 mg daily
Vitamin D, 5000iu daily
Calcium for osteopenia, 1200 mg daily
additional Magnesium, 300 mg at bedtime for my heart, muscles, and to help me sleep
Probiotics for my sensitive digestive system

The multivitamin is a double edged sword. I found one without iodine. I don't take any iodine and I try not to get extra in my diet. None of the salt in my house has iodine anymore. I tend towards hyperthyroidism, and iodine seems to exacerbate it. The multi also has copper in it. I could take a multi without copper, but then it would have iodine. I can't win.

Whew, I think I covered it all! Now I think it's time for me to go choke down another another pill. I'd love to share notes about what you are taking, or not taking, to improve your egg quality and chances at IVF.

AMH and Adrenals

Ed note 5/30/09: I discovered that I mysteriously lost part of my post, so I added it back in. If you read this post before this date, you might want to read the beginning again.

Tomorrow will be day 3 of my cycle. I know it seems like yesterday when I posted on my day 3 results, but since I have the world's shortest luteal phase (a whopping 7 days this time), day 3 has come around again. I will be waiting one more cycle to do my official day 3 testing at BigShotFertilityClinic. You see, I've been holding out on you. I did have my AMH tested after all, and let me tell you, it was grim. BigShotFertilityClinic likes to see a level above 0.6, and I think that is even kinda borderline. Mine was 0.1. At least I didn't get back a result of less than 0.1, so I guess it could have been worse. AMH is used to predict resting follicle levels and sometimes IVF success. The predictive use of AMH for IVF is fairly new. Basically, what this means is that my ovaries need some serious resuscitation! Skip the CPR, and fire up the electro-shock pads!

I immediately consulted Dr. Google when I got the bad news. I wanted to know if the AMH number could change with Chinese medicine and acupuncture. I did find some information that it can change, and that women with low AMH do get pregnant! My acupuncturist EM wants to increase my kidney yin, and thereby AMH, by taking more evening primrose oil. In Chinese medicine, when they talk about an organ, like kidney or spleen or liver, they don't necessarily mean the actual organ. For example, a kidney deficiency, either kidney yin or kidney yang deficiency, usually refers to one's fertility. It can also refer to adrenal function, and the adrenal glands sit on top of the kidneys. I was comforted when EM said, "we treat the patient, not the number."

Part of my strategy of improving my fertility was to have my adrenal glands checked. I have a friend who finally had success getting pregnant at age 42 with her own eggs after battling infertility for seven years. She had one failed IVF with her own eggs and one failed IVF with donor eggs. She never gave up and kept looking for answers. Her success came when she was treated for her adrenals and sub-clinical hypothyroidism. Her thyroid numbers were normal, but she had all the symptoms of hypothyroidism. She gave birth to her daughter at age 43.

I did a test with Dr. F, my other acupuncturist, to test my "Adrenal Stress Index" through Diagnos_Techs lab. I was diagnosed with adrenal fatigue. The good news is that I have a mild case of it, so it will be fairly easy to treat. I dusted off my copy of "Adrenal_Fatigue, The_21st Century Stress Syndrome" by James_Wilson. It had some interesting things to say about taking DHEA and pregnenolone for adrenal fatigue:

"It is my clinical experience that women often do not do well on DHEA unless their adrenals are very fatigued. Levels as low as 10-25 mg have produced symptoms of excess DHEA, such as facial hair and acne. A safer and more successful way of raising DHEA levels in women is to have them take either progesterone or pregnenolone, although some studies of women with chronic fatigue syndrome or lupus have found benefit from using 200 mg of DHEA/day."

I have problems with taking DHEA. It raises my testosterone levels and gives me heart palpatations. I already have high testosterone, as expressed by my "sexy"_Lauren_Bacall voice, and I certainly don't need anymore! I take pregnenolone instead, about 60 mg a day, though I'm experimenting with taking up to 120 mg per day. When I have taken DHEA, I can only tolerate 5 mg a day, and only for about 5 or 6 weeks, before I have to switch back to pregnenolone. BigShotFertilityClinic recommends 75 mg of DHEA twice a day to improve egg quality. I would drop dead if I took this dose, or start growing a beard, neither of which appeals to me. I respond much better to the pregnenolone.

"Progesterone and pregnenolone are hormones that are manufacutred in the adrenal cascade as well as in the ovaries and testicles before they are metabolized into DHEA. Both can be converted into several other adrenal hormones besides DHEA, including the sex hormones, aldosterone and cortisol. Thus, taking replacement hormones like pregnenolone and progesterone that occur early in the adrenal cascade lets your body's wisdom choose which other hormones it will make from them, according to your body's needs. With adrenal fatigue, the sex hormone levels often fall because your adrenal glands are not able to manufacture adequate levels of hormones."

Pregnenolone is a precursor to DHEA, as you can see in the flow chart below. Pregnenolone is also a precursor to other hormones, and that's why it's safer than DHEA. Your body can determine where you need it the most. Maybe your adrenal glands have to heal before you can produce more of the sex hormones. We all know how stressful infertility can be!



I am also taking a cortisol supplement called Iso_Cort, though I have already had to cut back on that after taking it for a couple of weeks as I'm starting to get symptoms that I am getting too much cortisol, such as rapid heartbeat and anxiety.

Another strategy for me to improve my adrenal health is to go to bed by 10:00pm. This is very hard for me, and I have had to set limits on my internet use at night. In fact, I am already past my "internet bedtime"! Couple this with my busy schedule at work, and I've been a pretty lame commenter this week for ICLW. I will post more about the other supplements I have been taking to improve egg quality and to improve my mental health.