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Supplements

Incorporating vitamins and antioxidants through food and supplementation can help provide the best possible environment for a woman’s eggs to grow and mature, and science tells us they may help improve the quality of her eggs and embryos.

A 2007 study published in Obstetrics & Gynecology by the Harvard School of Public Health found that making better food choices, achieving a healthy weight and regularly including folic-acid containing multivitamins in the diet were the most important factors for reducing the chances of infertility.1  Doctors have many tools at their disposal for helping us heal, but time and time again, when we talk about improving our fertility potential, research tells us the most significant things we can do are make better food choices, incorporate moderate exercise, and supplement our diets with high quality  vitamins and antioxidants.

At minimum, every woman who is trying to conceive should be taking a prenatal.  The difference between a prenatal and a regular multivitamin is that a prenatal must contain a minimum of 400mcg of folic acid.  Folic acid is a B vitamin and is known to reduce the incidence of neural tube defects such as spina bifida and anencephaly , by 50% – 70%2.  Research also indicates that folic acid may help prevent other birth defects as well as reduce the chances of complications during pregnancy such as preeclampsia and miscarriage.  So, a prenatal is specifically designed to help a woman maintain a healthy pregnancy.

Another option for women who are trying to conceive is a preconception formula.  A preconception formula is a combination of vitamins and antioxidants taken prior to conception in place of a prenatal to try to enhance egg and embryo quality.  The difference between a preconception formula and a prenatal is that while a prenatal is designed to maintain a healthy pregnancy, a preconception formula is designed to make a change.  They usually contain higher quantities of the B vitamins, folic acid, vitamin C, and vitamin D than a typical prenatal plus antioxidants and bioflavonoids such as pycnogenol, grape seed extract, EPA/DHA, inositol, Co-Q10, or Quercetin to maintain a healthy redox balance.

A healthy redox balance is a proper balance of Reactive Oxygen Species (ROS) and Total Antioxidant Capacity (TAC).  In follicular fluid, this balance is critical to fertility potential.  ROS are typically produced as cells go through their normal course of cellular metabolism.  Examples of ROS include peroxides and free radicals.  These molecules are highly unstable and in their efforts to stabilize themselves they steal electrons from other nearby molecules.  When molecules lose their electrons, they themselves become free radicals, creating a chain of free radical formation that causes damage to a cell’s lipid, protein or DNA – ultimately inhibiting its normal cell function.

Antioxidants are molecules that are able to donate electrons to free radicals without becoming unstable themselves.  These molecules act to stop the chain reaction and preserve the integrity of the cell.  When our cells produce an abundance of ROS, or when there is a reduction in the body’s antioxidant defense mechanism, we enter into a state of oxidative stress.  It is well documented that this toxic imbalance can be implicated in many diseases, and when present in follicular fluid, excess ROS can be detrimental to human egg development.9

It is important to note that “free radicals are not all bad, nor antioxidants all good.  Life is a balance between the two,”3 but current research continues to support the fact that adding vitamins and antioxidants to your diet may help to maintain a proper balance and improve reproductive health.

In 2010 researchers reported that “supplementing the diets of older women with mitochondrial nutrients like Co-Q10 may improve oocyte and embryo quality,”6 and more recently, researchers found that myo-inositol “is able to improve oocyte and embryo quality during ovarian stimulation protocols”7 in PCOS women with normal insulin response.  Recently, Ozkaya and colleagues demonstrated that, “Multivitamin and mineral supplementation, modulates oxidative stress and antioxidant vitamin levels in serum and follicular fluid of women undergoing in vitro fertilization.”9  Finally, a 2010 study reported in Gynecologic and Obstetric Investigation that “high ROS levels in follicular fluid are known to have a toxic effect”.8

The egg you ovulate today started to grow and mature within its follicle approximately 150 days ago.4  You can begin taking vitamins and antioxidants at any time, but in order to have an impact on the environment in which an egg grows and matures, you should begin taking them at least 4 – 6 weeks prior to trying to conceive.  To maximize results, it is ideal to take them for four to six months prior to egg retrieval or conception.

Researchers and embryologists know that the content and quality of embryo culture medium is critical in the success or failure of in-vitro fertilization.5  Blood and follicular fluid are the culture medium in-vivo, providing nutrients and antioxidants to every cell in the body.  Because the quality of an egg is dependent on the DNA and the environment in which it grows and matures, supplying the right balance of nutrients and antioxidants prior to trying to conceive may be the difference between having viable and non-viable eggs and embryos.

Study after study tells us that supplementing with the proper vitamins, minerals and antioxidants may strengthen the antioxidant defense mechanism by reducing oxidative stress, and reducing oxidative stress may improve egg and embryo quality.  While you can certainly take each of these supplements individually, a preconception formula can be simpler to use, providing everything in one bottle with fewer than half as many pills to swallow.  Incorporating a complete, high quality, preconception supplementation program should be one of the very first steps in establishing a woman’s fertility treatment protocol.

Vitamins and Antioxidants

Vitamin A – Antioxidant; essential for producing female sex hormones; may help regulate the ovulatory cycle; important for visual function; promotes cellular growth and differentiation

Vitamin B Complex – Involved in the production and regulation of sex hormones; deficiency may inhibit ovulation and implantation; involved in the release of energy from cells; involved in DNA synthesis and cell division; deficiency may result in low birth weight or miscarriage

Folic Acid – Important for several antioxidant functions10; important for DNA synthesis and cell replication; associated with reduced risk of ovulatory infertility11; reduces risk of neural tube defects; required for proper cell division

Vitamin C – Antioxidant; supports healthy blood vessel structure; reduces blood pressure and inflammation; may be involved in the release of progesterone;  enhances iron absorption; effective treatment for luteal phase defect12; may enhance chromium uptake

Vitamin D – Supports estrogen production; may lower blood pressure and restore insulin sensitivity; helps regulate the immune system; required for calcium absorption; deficiency may result in ovulatory disturbances and PCOS13; helps regulate implantation14

Vitamin E – Antioxidant; may improve ovulation in unexplained infertility when taken with vitamin C; may improve the health of the endometrium when taken with vitamin C and selenium; may help prevent miscarriage; improves glandular epithelial growth and development of blood vessels in the endometrium improving thin endometria15

Zinc – Important for several antioxidant functions; involved in nucleic acid and protein metabolism; helps the body use estrogen and progesterone more efficiently; required to promote egg quality and normal cell division; deficiency associated with low birth weight and pre-term delivery; may help prevent miscarriage16

Calcium – Involved in the secretion of hormones such as insulin; required for fetal tissue formation; required for the activation of vitamin K clotting factors

Magnesium – Involved in DNA, RNA and protein synthesis; required for cellular energy production; enhances bone, cell membrane and chromosome structures; required for transport of potassium and calcium across cell membranes

Iron – Essential for the production of hemoglobin; required for DNA synthesis; when taken with food, iron does not appear to inhibit zinc absorption17

Copper - Required for iron transport to bone marrow for red blood cell formation

Selenium – Antioxidant; helps to minimize birth defects; helps regulate thyroid hormones; essential element for normal development, growth and metabolism; selenium spares vitamin E; may help prevent postpartum depression18; may help prevent miscarriage

Chromium – Functions as a regulator of insulin action; involved in glucose and lipid metabolism; appears to decrease fasting blood glucose and insulin levels; may be useful as an insulin sensitizer in the treatment of PCOS19

Manganese – Involved in sex hormones production; critical for proper mitochondrial function as it forms the principal antioxidant enzyme in the mitochondria; activates enzymes for metabolism of carbohydrates, proteins and cholesterol; involved in bone development and wound healing

Iodine – Required for the synthesis of thyroid hormones; deficiency is associated with increased miscarriage, still birth and birth defects; deficiencies of vitamin A, iron or selenium may exacerbate the effects of iodine deficiency

Vitamin K – Required for clotting factors; required for a protein that appears to function in cell proliferation, adhesion and protection against apoptosis

Choline – Choline is used to synthesize the structural components of cell membranes; involved in cell signaling; precursor to the neurotransmitter acetylcholine; helps remove fat and cholesterol from the liver; reduces plasma homocysteine levels20; works synergistically with DCI

D-Chiro Inositol (DCI) – Involved in cell membrane integrity; transports fats from the liver; increases the action of insulin in patients with the polycystic ovary syndrome, thereby improving ovulatory function and decreasing serum androgen concentrations, blood pressure, and plasma triglyceride concentrations21

EPA/DHA – Antioxidant; anti-inflammatory affects; involved in ovulation for follicular rupture and collapse; may help alleviate depression22; found to reduce natural killer (NK) cells; essential for fetal brain development; may help reduce miscarriage due to anticoagulant properties.

Pycnogenol / Grape Seed Extract – Grape Seed extract is typically less expensive than Pycnogenol and equally effective.  Both of these super-antioxidants are effective against both fat soluble and water soluble free radicals; anti-inflammatory affects; supports blood vessel structure23; may improve glucose intolerance24

Coenzyme Q-10 – Antioxidant present in all cell membranes25; required for mitochondrial ATP synthesis; reduces the risk of developing pre-eclampsia26; may help reduce blood pressure; tissue levels of CoQ10 decrease with age27; may improve oocyte and embryo quality28

Bioflavonoids – Improves cellular viability; improves the capillary lining’s permeability and integrity for the passage of oxygen, carbon dioxide and nutrients through the capillary walls

 

References

  1. J. Chavarro, J. Rich-Edwards, B. Rosner, W. Willett: Use of multivitamins, intake of B vitamins, and risk of ovulatory infertility. Fertility and Sterility® Vol. 89, No. 3, March 2009, 668-676.  doi:10.1016/j.fertnstert.2007.03.089
  2. http://www.cdc.gov/ncbddd/folicacid/about.html, Centers for Disease Control and Prevention 1600 Clifton Rd. Atlanta, GA 30333, USA
  3. Halliwell B. Reactive species and antioxidants. Redox biology is a fundamental theme of aerobic life. Plant Physiol. 2006;141:312–322. doi: 10.1104/pp.106.077073
  4. http://www.thefertilesoul.com/pages/Diagnostic_pgs/POOR-EGG-QUALITY.php, Advanced Maternal Age, High FSH, Poor Egg Quality. The Fertile Soul, 26 Glen Cove Rd, Arden, North Carolina 28704.
  5. V. Aoki, A. Wilcox, C. Peterson, K. Parker-Jones, H. Hatasaka, M. Gibson, I. Huang, D. Carrell: Comparison of four media types during 3-day human IVF embryo culture. Reproductive Biomedicine Online. 2005 May;10(5):600-6.
  6. Y. Bentov, N. Esfandiari, E. Burstein, R. Casper: The use of mitochondrial nutrients to improve the outcome of infertility treatment in older patients.  Fertility and Sterility® Vol. 93, No. 1, January 2010, 272-275. doi:10.1016/j.fertnstert.2009.07.988
  7. V. Unfer, G. Carlomagno, P. Rizzo, E. Raffone, S. Roseff: Myo-inositol rather than D-chiro-inositol is able to improve oocyte quality in intracytoplasmic sperm injection cycles. A prospective, controlled, randomized trial. European Review for Medical and Pharmacological Sciences 2011 Apr;15(4):452-7.
  8. R. Chattopadhayay, A. Ganesh, J. Samanta, S.K. Jana, B.N. Chakravarty, K. Chaudhury: Effect of Follicular Fluid Oxidative Stress on Meiotic Spindle Formation in Infertile Women with Polycystic Ovarian Syndrome. Gynecologic and Obstetric Investigation 2010;69:197–202
  9. M. Ozkaya, M Naziroglu: Multivitamin and mineral supplementation modulates oxidative stress and antioxidant vitamin levels in serum and follicular fluid of women undergoing in vitro fertilization.  Fertility and Sterility® 2010 doi:10.1016/j.fertnstert.2010.01.066
  10. J. Chavarro, J. Rich-Edwards, B. Rosner, W. Willett: Use of multivitamins, intake of B vitamins, and risk of ovulatory infertility. Fertility and Sterility® Vol. 89, No. 3, March 2009, 668-676.  doi:10.1016/j.fertnstert.2007.03.089.
  11. H. Henmi, T. Endo, Y. Kitajima, K. Manase, H. Hata, R. Kudo: Effects of ascorbic acid supplementation on serum progesterone levels in patients with a luteal phase defect.  Fertility and Sterility® Vol. 80, No. 2, August 2003, 459-461.  doi:10.1016/S0015-0282(03)00657-5
  12. L. Pal, J. Shu, G. Zeitlian, C. Hickmon: Vitamin D insufficiency in reproductive years may be contributory to ovulatory infertility and PCOS. Fertility and Sterility® Vol. 90, Suppl. 1, September 2008, S14.
  13.  G. Daftary, H. Taylor: Endocrine Regulation of HOX Genes.  Endocrine Reviews 2006 Jun;27(4):331-55. doi:10.1210/er.2005-0018
  14.  A. Takasaki, H. Tamura, I. Miwa, T. Taketani, K. Shimamura, N. Sugino: Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium.  Fertility and Sterility® Vol. 93, No. 6, April 2010, 1851-1858.  doi:10.1016/j.fertnstert.2008.12.062
  15. L. Caulfield, N. Zavaleta, A. Shankar, M. Merialdi: Potential contribution of maternal zinc supplementation during pregnancy to maternal and child survival1-3.  The American Journal of Clinical Nutrition 1998;68(suppl):499S-508S.
  16. S. Lynch: Interaction of Iron with Other Nutrients.  Nutrition Reviews Vol. 55, No. 4, April 1997, 102-110.
  17. N. Mokhber, M. Namjoo, F. Tara, H. Boskabadi, M.P. Rayman, M. Ghayour-Mobarhan, A. Sahebkar, M.R. Majdi, S. Tavallaie, M. Azimi-Nezhad, M.T. Shakeri, M. Nematy, M. Oladi, M. Mohammadi, G. Ferns: Effect of supplementation with selenium on postpartum depression: a randomized double-blind placebo-controlled trial.  Journal of Maternal Fetal and Neonatal Medicine 2010 Jun 8 [Epub ahead of printing].  PMID: 20528216 [PubMed – as supplied by publisher]
  18. M. Lydic, M. McNurlan, S. Bembo, L. Mitchell, E. Komaroff, M. Gelato: Chromium picolinate improves insulin sensitivity in obese subjects with polycystic ovary syndrome.  Fertility and Sterility® Vol. 86, No. 1, July 2006, 243-246.                         doi:10.1016/j.fertnstert.2005.11.069
  19. S. Zeisel: Choline, homocysteine, and pregnancy1-3.  The American Journal of Clinical Nutrition 2005;82:719-720.
  20. J.E. Nestler, D.J. Jakubowicz, P. Reamer, R.D. Gunn, G. Allen: Ovulatory and metabolic effects of D-chiro-inositol in the polycystic ovary syndrome.  New England Journal of Medicine 1999 Apr 29;340(17):1314-1320.
  21. K. Su, S. Huang, C. Chiu, W. Shen: Omega-3 fatty acids in major depressive disorder: A preliminary double-blind, placebo-controlled trial.  European Neuropsychopharmacology Vol. 13, No. 4, August 2003, 267-271.
  22. A. Fine: Oligomeric Proanthocyanidin Complexes: History, Structure, and Phytopharmaceutical Applications.  Alternative Medicine Review Vol. 5, No. 2, 2000, 144-151.
  23. W. Suwannaphet, A. Meeprom, S. Yibchok-Anun, S. Adisakwattana: Preventive effect of grape seed extract against high-fructose diet-induced insulin resistance and oxidative stress in rats.  Food and Chemical Toxicology 2010 Jul;48(7):1853-1857.
  24. F.L. Crane: Biochemical functions of coenzyme Q10.  Journal of the American College of Nutrition 2001 Dec;20(6):591-598.
  25. E. Teran, I. Hernandez, B. Nieto, R. Tavara, J.E. Ocampo, A. Calle: Coenzyme Q10 supplementation during pregnancy reduces the risk of pre-eclampsia.  International Journal of Gynecology Obstetrics Vol. 105, No. 1, April 2009, 43-45.
  26. C. Pignatti, M. Cocchi, H. Weiss: Coenzyme Q10 levels in rat heart of different age.  Biochemistry and Experimental Biology 1980;16(1):39-42.
  27. Y. Bentov, N. Esfandiari, E. Burstein, R. Casper: The use of mitochondrial nutrients to improve the outcome of infertility treatment in older patients.  Fertility and Sterility® Vol. 93, No. 1, January 2010, 272-275. doi:10.1016/j.fertnstert.2009.07.988

Coast Science (http://coastscience.com), developer and manufacturer of physician-tested and physician-approved dietary supplements for men and women, has formulated a prenatal supplement, Total Fertility® Preconception Formula, which meets all of the criteria for an effective preconception supplement as described in the above article.

Approved for use during IVF protocol, Total Fertility® Preconception Formula is a “super‐antioxidant” and preconception supplement that contains specific vitamins and minerals to prepare female patients for fertility treatment. Total Fertility® Preconception Formula is also a complete prenatal supplement that can be taken during pregnancy whether going through fertility treatment or conceiving naturally.

With the rising cost of In Vitro Fertilization it is essential for women to prepare their bodies for fertility treatment to achieve optimum egg and embryo quality. (http://coastscience.com/totalfertility)

Combining complete prenatal balance through nutritional science, Total Fertility® Preconception is the first supplement formulated for women undergoing fertility treatments. Total Fertility® Preconception is not only formulated to boost reproductive health prior to conception or IVF transfer, but it also meets a woman’s post-conception nutritional needs. After conception or transfer, Total Fertility® Preconception Formula can be used as a prenatal vitamin at half the preconception dosage. This allows you to use the supplement until it is gone, saving money and eliminating waste.

In addition, Coast has recently introduced Total Fertility® PCOS, a women’s formula designed to enhance female fertility as it relates to Polycystic Ovarian Syndrome (PCOS).† R.E. approved for use during IVF protocol, Total Fertility® PCOS is a scientifically formulated combination of vitamins and antioxidants specifically designed to improve insulin sensitivity and promote ovarian function. (http://coastscience.com/totalfertilitypcos)

Total Fertility® PCOS is formulated to help prepare the PCOS patient for fertility treatment and can be taken whether going through assisted fertility or conceiving naturally. Total Fertility® PCOS was designed to be taken with Total Fertility® Pre-Conception Formula for complete support. All components are guaranteed for potency and quality, and conform to the United States Pharmacopeia (USP), the official public standard-setting authority for all prescription and over-the-counter medicines and dietary supplements, for strength, purity and quality.

Because of the importance of what is termed “male factor” in fertility, Coast has also developed what might be termed a male prenatal – The Coast Reproductive Male Fertility Supplement – MFS.

Male factor has been shown to be the underlying cause of infertility in 45% of couples so diagnosed. With its proprietary blend of natural ingredients formulated to optimize the critical parameters of sperm count, motility, morphology, and overall integrity, Coast’s MFS formulation has the proven components to advance sperm quality such that many previously diagnosed infertile couples have in fact conceived.

(http://coastscience.com/mfs)