How Naturopathic Medicine Can Support You Throughout Your IVF Journey
June is International Infertility Month and a reminder of the challenges many face on their journey to conception. As infertility rates continue to rise, I find myself increasingly immersed in the world of IVF, guiding patients through its complexities. Many patients are seeking support to optimize their IVF treatment and naturopathic medicine has many tools that can be used alongside IVF in pursuit of this goal. I support my patients going through IVF across 3 main phases of treatment:
Optimizing Egg & Embryo Quality Before Retrieval
We know that based on the way eggs are recruited and developed we want a minimum of 3 months before an egg retrieval to impact egg and embryo quality, and longer is even better. As a naturopathic doctor, I guide my patients on diet and lifestyle changes as well as supplementation that generally has an antioxidant and anti-inflammatory action in this time frame.
Dietary modifications, particularly adopting a Mediterranean-style diet rich in fruits, vegetables, fish, whole grains, and healthy fats, have shown promising results in enhancing fertility rates among IVF patients (1). Lifestyle changes such as reducing smoking and alcohol intake have also led to improved IVF outcomes. Studies have found that alcohol consumption in the month leading up to IVF can impact the number of eggs collected (2). Smoking has been associated with a tendency to produce fewer eggs and a lower embryo score in those going through IVF (3).
Numerous supplements have demonstrated positive effects on egg and embryo quality. Coenzyme Q10 (CoQ10), for instance, is supported by a growing body of research indicating its potential to enhance fertility (4). Additionally, emerging research suggests that antioxidant supplements like melatonin and N-acetylcysteine (NAC) can safeguard eggs from damage and potentially enhance fertilization rates (5)(6). As part of my approach, I often recommend a combination of these egg-quality support supplements to optimize outcomes for my patients.
Preparing for Embryo Transfer
Following egg retrieval, the focus shifts to preparing the uterine environment for embryo transfer.
Achieving an optimal endometrial lining thickness, typically around 8-9mm, is crucial for successful implantation. Some examples of naturopathic treatment we may consider include Vitamin E supplementation which has been associated with improved endometrial thickness and reduced inflammation markers, enhancing the receptivity of the uterine lining (7). Additionally, acupuncture sessions before and after embryo transfer have demonstrated efficacy in boosting implantation and pregnancy rates, particularly in individuals with a history of repeated implantation failure (8).
We also want to consider the health of the uterine microbiome. It used to be thought that the uterus was free of any type of bacteria, but this has been recently debunked. Research shows that a uterus that is dominant in lactobacillus bacteria is most beneficial for implantation and that the use of vaginal probiotics before transfer may reduce miscarriage rates (9). This is something I consider specifically in patients with a history of implantation failure or endometritis.
Lowering Miscarriage Risk
Working on every step of the way, there are some markers I typically want to assess early on in pregnancy to be diligent.
One of these tests includes screening progesterone levels. Progesterone is a hormone that plays a critical role in maintaining early pregnancy (10). We have research supporting the use of progesterone in doses from 200mg to 400mg twice daily and I am commonly using lab work and a patient’s history to determine dosing (10).
Screening thyroid levels in the first trimester is also something I recommend as elevated Thyroid-Stimulating Hormone (TSH) levels have been linked to higher miscarriage rates. Studies have found that miscarriage rates were higher in women who had a TSH value above 2.5 so I am looking for patients’ TSH to be below this cut-off in their first trimester (11,12).
We know healthy vitamin D status is also essential for a healthy pregnancy and this is something I typically assess and treat in advance of IVF but will always rescreen in early pregnancy to make sure it looks ideal. Vitamin D plays an important role in modulating and supporting a balanced immune system (13) and research points to immune system dysregulation as a likely—and often overlooked—cause in many who are experiencing multiple miscarriages (14).
Increase Your Intake of Fruits & Vegetables
A higher intake of colourful veggies and fruits is beneficial for fertility. Veggies and fruits are a major source of vitamins, minerals and antioxidants that are all necessary for healthy hormone production and oxidative balance.
Studies have found that lower fruit intake is associated with increases in time to pregnancy and infertility rates in women (2). We also have research showing that men with the highest intake of fruit and veggies had higher sperm concentration than men with a lower intake likely working by impacting the antioxidant status of semen and blood (7).
A Final Note
This is by no means an exhaustive list of the treatments available and any intervention you undertake in your fertility journey should be targeted and specific to you! Above all, I hope this information gives you some guidance and hope that there is more you can do to support your IVF and fertility no matter where you are in the process.
References:
1. Vujkovic M, de Vries JH, Lindemans J, Macklon NS, van der Spek PJ, Steegers EA, Steegers-Theunissen RP. The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy. Fertil Steril. 2010 Nov;94(6):2096-101. doi: 10.1016/j.fertnstert.2009.12.079. Epub 2010 Mar 1. PMID: 20189169.
2. Klonoff-Cohen H, Lam-Kruglick P, Gonzalez C. Effects of maternal and paternal alcohol consumption on the success rates of in vitro fertilization and gamete intrafallopian transfer. Fertil Steril. 2003 Feb;79(2):330-9. doi: 10.1016/s0015-0282(02)04582-x. PMID: 12568842.
3. Weigert M, Hofstetter G, Kaipl D, Gottlich H, Krischker U, Bichler K, Poehl M, Feichtinger W. The effect of smoking on oocyte quality and hormonal parameters of patients undergoing in vitro fertilization-embryo transfer. J Assist Reprod Genet. 1999 Jul;16(6):287-93. doi: 10.1023/a:1020496330424. PMID: 10394523; PMCID: PMC3455531.
4. Zhang M, ShiYang X, Zhang Y, Miao Y, Chen Y, Cui Z, Xiong B. Coenzyme Q10 ameliorates the quality of postovulatory aged oocytes by suppressing DNA damage and apoptosis. Free Radic Biol Med. 2019 Nov 1;143:84-94. doi: 10.1016/j.freeradbiomed.2019.08.002. Epub 2019 Aug 6. PMID: 31398498.
5. Tamura H, Takasaki A, Miwa I, Taniguchi K, Maekawa R, Asada H, Taketani T, Matsuoka A, Yamagata Y, Shimamura K, Morioka H, Ishikawa H, Reiter RJ, Sugino N. Oxidative stress impairs oocyte quality and melatonin protects oocytes from free radical damage and improves fertilization rate. J Pineal Res. 2008 Apr;44(3):280-7. doi: 10.1111/j.1600-079X.2007.00524.x. PMID: 18339123.
6. Cheraghi E, Mehranjani MS, Shariatzadeh MA, Esfahani MH, Ebrahimi Z. N-Acetylcysteine improves oocyte and embryo quality in polycystic ovary syndrome patients undergoing intracytoplasmic sperm injection: an alternative to metformin. Reprod Fertil Dev. 2016 Apr;28(6):723-31. doi: 10.1071/RD14182. PMID: 25482371.
7. Hashemi Z, Sharifi N, Khani B, Aghadavod E, Asemi Z. The effects of vitamin E supplementation on endometrial thickness, and gene expression of vascular endothelial growth factor and inflammatory cytokines among women with implantation failure. J Matern Fetal Neonatal Med. 2019 Jan;32(1):95-102. doi: 10.1080/14767058.2017.1372413. Epub 2017 Sep 12. Update in: J Matern Fetal Neonatal Med. 2022 Dec;35(25):6841. PMID: 28847198.
8. Shuai Z, Li X, Tang X, Lian F, Sun Z. Transcutaneous electrical acupuncture point stimulation improves pregnancy outcomes in patients with recurrent implantation failure undergoing in vitro fertilisation and embryo transfer: a prospective, randomised trial. Acupunct Med. 2019 Feb;37(1):33-39. doi: 10.1136/acupmed-2017-011483. Epub 2019 Mar 13. PMID: 30864824.
9. Thanaboonyawat I, Pothisan S, Petyim S, Laokirkkiat P. Pregnancy outcomes after vaginal probiotic supplementation before frozen embryo transfer: a randomized controlled study. Sci Rep. 2023 Jul 23;13(1):11892. doi: 10.1038/s41598-023-39078-6. PMID: 37482568; PMCID: PMC10363539.
10. Jacqui Wise, 2021. NICE recommends progesterone to prevent early miscarriage. [online] Available at: <https://www.bmj.com/content/375/bmj.n2896> [Accessed 4 January 2022].
11. Kianpour, M., Aminorroaya, A., Amini, M., Feizi, A., Aminorroaya Yamini, S., & Janghorbani, M. (2019). Thyroid‐stimulating hormone (TSH) serum levels and risk of spontaneous abortion: A prospective population‐based cohort study. Clinical Endocrinology. doi: 10.1111/cen.13979
12. Stagnaro-Green, A., Abalovich, M., Alexander, E., Azizi, F., Mestman, J., & Negro, R. et al. (2022). Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and Postpartum. Retrieved 23 February 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3472679/#B40
13. Gonçalves, D., Braga, A., Braga, J., & Marinho, A. (2018). Recurrent pregnancy loss and vitamin D: A review of the literature. American Journal Of Reproductive Immunology, 80(5), e13022. doi: 10.1111/aji.13022
14. Schröder-Heurich, B., Springer, C., & von Versen-Höynck, F. (2020). Vitamin D Effects on the Immune System from Periconception through Pregnancy. Nutrients, 12(5), 1432. doi: 10.3390/nu12051432