IVF Series, part II: What should I try before IVF?

IVF Series, part II: What should I try before IVF?

Nicole Knight, AHCJ | February 11, 2020 | Getting Pregnant

After years of avoiding pregnancy, when it comes time to actually try to conceive (TTC), you may be among the countless women who quickly realize that conception isn’t a slam dunk the instant you actively try to get pregnant. 

It can feel discouraging when you don’t get pregnant right away. But doctors suggest trying for up to 6 months for women over 35 and up to a full year for women under 35 before having a fertility evaluation (1).

Wherever you are in your fertility journey — if you have just started TTC or if you have been trying for some time — you might be curious about what you can do to take charge of your fertility before pursuing in vitro fertilization (IVF). We’ve rounded up 10 easy, noninvasive steps to test-drive before visiting the fertility specialist.

 

Pinpoint Your Fertile Window

Find your fertile window and have sex during this time for 3-6 months (2). Your fertile window is the 5 days prior to ovulation and ovulation day itself. Mountains of research over the years confirms these 6 days are when nearly all pregnancies occur.

If you’re not already, track your individual fertility cues to identify your fertile window. Traditional approaches include tracking basal body temperature, cervical mucus, cervical position, and luteinizing hormone (LH); however, each comes with limits. (Side note: Read here about potential problems with urine-based ovulation predictor kits.) 

The most accurate way to identify your fertile window is by tracking your continuous core body temperature (3, 4). Doing so pinpoints the subtle temperature patterns that occur 2-4 days before ovulation. Before this was basically impossible, but a device (coming soon!) called Priya® can actually do this. 

Priya comes with a sensor you put in your vagina where it measures your core body temperature every 6 minutes, and then sends the temp reading to a connected app on your smart device (3, 4). By continuously tracking and analyzing actual data from your body, Priya predicts your fertile window an average of 2.6 days before LH urine tests. The upside? This advance notice may give you and your partner a better shot at having sex on the days when you’re most likely to conceive.

 

Eat for Fertility

Eating specific foods while skipping others has been scientifically proven to help with fertility. According to a study in Fertility and Sterility, couples undergoing fertility treatment who ate a diet rich in fish, fruit, whole grains, and vegetable oils had a 40% better chance of conceiving than couples who indulged in snacks and meat products (5). (Read here for clinically proven fertility foods.)

Science unfortunately doesn’t always agree on the best foods to eat. For example, some studies say that soymilk will increase the risk of developing uterine fibroids while other studies say the opposite. The same conflicting information can be found regarding fibroids and the hormones found in meat and dairy products (31).

 

Maintain a Healthy Body Weight

Your weight — whether too high or too low — affects your fertility (6). Doctors calculate weight with a body mass index (BMI). A BMI under 19 is regarded as underweight, while a BMI between 25-29 is labeled overweight, and 30 and above is considered obese.

Being underweight and overweight is associated with irregular menstruation and anovulatory cycles, which are cycles where you don’t ovulate (6). Research has tied obesity to lower pregnancy rates, higher miscarriage rates, and an increased risk of complications in pregnancy. 

Losing a few pounds may help regulate your cycle or restore ovulation (7). In one limited study of 13 women with obesity and polycystic ovary syndrome (PCOS), losing 13.2 pounds was enough to restore ovulation in 12 of the women within a few weeks. Eleven women in the study went on to become pregnant.

 

Make a healthy weight a team effort

Excess weight may also harm male fertility (6). Research found lower sperm counts and less motility (movement) in men who were overweight or obese.

 

Get Moving

Combining exercise with dietary changes may also correct irregular menstrual cycles, potentially increasing the odds of conceiving (8, 9). 

In a small study published by Human Reproduction, 89.5% of women who were both obese and anovulatory resumed ovulation after losing an average of 22.5 pounds through diet and exercise (8, 9). More than 75% also went on to get pregnant. Similarly, a 2017 review linked 30-60 minutes of vigorous exercise daily to a reduced risk of anovulatory infertility.

 

Try Fertility Supplements

You’re probably already taking prenatal vitamins, which typically contain at least 400 mg. of folic acid to prevent neural tube defects. Now, research suggests folic acid is also a fertility booster, with the potential to help you to get pregnant and maintain a pregnancy by increasing the level of progesterone in the luteal phase (10, 11, 12). Sufficient progesterone in the luteal phase (read about the Phases of the Menstrual Cycle here) helps make your uterine lining the ideal environment for implantation and pregnancy. 

Supplements, such as vitamins C, D, and the antioxidants Coenzyme Q10, Acetyl L-carnitine, and L-carnitine, also may improve female fertility (13, 14, 15, 16, 17). 

Your partner might want to consider taking fish oil. A 2020 paper in the Journal of the American Medical Association showed that fish oil, which is rich in omega-3 fatty acids, increased sperm volume and sperm count in the men who took the supplement for at least 60 days (18). 

Men who took vitamin C plus beta carotene (found in carrots) also had higher fertilization rates than men who didn’t take the supplements, according to a 2019 study in the Journal of Nutrition (19).

Read about supplements and your fertility in more detail here.

 

Check Your Progesterone Level

Progesterone is the hormone released right after ovulation, and it’s what prepares the uterus to receive a fertilized egg. Without sufficient and sustained levels, there is no chance at conception. Proov is an at home progesterone tracking kit that you can use along with Priya to get a clear picture of your fertility and chances of conception each month. Priya will be available to the public in spring, 2020. Sign up for product updates here, and learn more about Proov here

 

Use the Right Lube

If you and your partner use a lubricant, read the label — some well-known brands contain ingredients that may affect sperm motility (20, 21). Do some comparison shopping and choose a lube that specifically states it’s sperm-friendly. When a research team compared 9 different brands of lubricant, they found that Pre-seed® and Conceive Plus® had the “least negative effect” on sperm function.

 

Check Your Ovarian Reserve

One of the best tests to check your ovarian reserve is the anti-mullerian hormone (AMH) test (22). AMH is secreted by ovarian follicles. An AMH test can tell you about the number of eggs you have left, although not the quality. Even though AMH tests are now readily available online, think twice before making major family-planning decisions based on your results without chatting first with your OB/GYN.

 

De-stress

Stress is taxing on your body, triggering a primal fight-or-flight response that may affect fertility (23, 24, 25, 26, 27). Stress may lower the sperm count of your partner and reduce your likelihood of conceiving during the fertile window. According to a large prospective study published in the American Journal of Epidemiology, women with higher levels of stress had slightly lower rates of conception (but stress didn’t affect their partners’ fertility). 

For natural stress relief, try yoga and stretching, which not only ease stress but also have the potential to lower the amount of cortisol, a stress hormone, in your system (28, 29, 30, 31).

These 10 steps are by no means an exhaustive list — but they're a good start if you’re curious about fertility-boosting alternatives to try before IVF. 

There are medical options as well, such as the oral drug clomiphene, which stimulates ovulation (32). One study of clomiphene demonstrated ovulation stimulation in 71% of participants within 2 years of use. (34) Gonadotropins, which are injectable ovulatory stimulants, contain follicle-stimulating hormone alone or in combination with LH (33). Check with your doctor for the best approach for you, as all medications come with potential side effects.

If you do consider IVF down the line, contact your insurance provider first to see if you have fertility coverage. If you do, they may require you and your partner to first undergo a few cycles of intrauterine insemination (IUI) before they’ll authorize IVF.  

 

IVF Series

Part I: The Basics of the IVF Process

Part II: What should I try before IVF? (you are here)

Part III: When should IVF be done? Why would IVF be recommended? 

Part IV: Will IVF work for me?

Part V: What are benefits and risks? What can I expect in IVF process? (coming soon)

 

References:

  1. American College of Obstetricians and Gynecologists. (2017, October). Evaluating infertility.
  2. Mu, Q., Fehring, R. (2014, January). Efficacy of achieving pregnancy with fertility-focused intercourse. Marquette University. 
  3. Data on file, Prima-Temp, Inc.
  4. Brown, E.N., Cho, Y., Luithardt, H., & Czeisler, C.A. (2000, September). A statistical model of the human core-temperature circadian rhythm. American Journal of Physiology, 279, E669-E683.
  5. Vujkovic, M., de Vries, J.H., Lindemans, J., Macklon, N.S., van der Spek, P.J., Steegers, E.A.P, & Steegers-Theunissen, R.P.M. (2010, November). The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy. Fertility and Sterility, 94(6), 2096–2101.
  6. American Society for Reproductive Medicine. (2015). Weight and fertility.
  7. Clark, A.M., Thornley, B. (1998, June). Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Human Reproduction, 13(6), 1502–1505.
  8. Hakimi, O., Cameron, L.C. (2017, August). Effect of exercise on ovulation: a systematic review. Sports Medicine, 47(8), 1555-1567.
  9. Michels, K.A., Wactawski-Wende, J., Mills, J.L., Schliep, K.C., Gaskins, A.J., Yeung, E.H. ... Mumford, S.L. (2017, August). Folate, homocysteine and the ovarian cycle among healthy regularly menstruating women. Human Reproduction, 32(8), 1743–1750.
  10. Chiu, Y.H., Chavarro, J.E. (2018, September). Diet and female fertility: doctor, what should I eat? Fertility and Sterility, 110(4), 560–569.
  11. Mesen, T.B., Young, S.L. (2016, March). Progesterone and the luteal phase. Obstetrics and Gynecology Clinics of North America, 42(1), 135-151.
  12. Thomson, R.L., Spedding, S. (2012, May). Vitamin D in the aetiology and management of polycystic ovary syndrome. Clinical Endocrinology, 77(3), 343-350.
  13. Trummer, C., Theiler-Schwetz, V., Kollmann, M., Wölfler, M., Münzker, J., Pilz, S. ... Lerchbaum, E. (In press). Effects of vitamin D supplementation on metabolic and endocrine parameters in healthy premenopausal women: A randomized controlled trial. Clinical Nutrition. 
  14. National Cancer Institute. (2019, April). Coenzyme Q10–patient version.
  15. Xu, Y., Nisenblat, V. (2018, March). Pretreatment with coenzyme Q10 improves ovarian response and embryo quality in low-prognosis young women with decreased ovarian reserve: a randomized controlled trial. Reproductive Biology and Endocrinology, 16, 29.
  16. Agarwal, A., Sengupta, P. (2018, January). Role of L-carnitine in female infertility. Reproductive Biology and Endocrinology, 16, 5.
  17. Jensen T.K., Priskorn L. (2020, January). Associations of fish oil supplement use with testicular function in young men. JAMA Network Open, 3(1).
  18. Li, M.C., Chiu, Y.H. (2019, November). Men's intake of vitamin C and β-carotene is positively related to fertilization rate but not to live birth rate in couples undergoing infertility treatment. Journal of Nutrition, 149(11).
  19. Agarwal, A., Deepinder, F. (2008, February). Effect of vaginal lubricants on sperm motility and chromatin integrity: a prospective comparative study. Fertility and Sterility, 89(2), 375–379. 
  20. Mowat, A., Newton, C. (2014, March). The effects of vaginal lubricants on sperm function: an in vitro analysis. Journal of Assisted Reproduction and Genetics, 31(3), 333–339. 
  21. Kyweluk, M.A. (2020, January). Quantifying fertility? Direct-to-consumer ovarian reserve testing and the new (in)fertility pipeline. Social Science & Medicine, 245.
  22. Ebbesen, S.M.S., Zachariae, R. (2009, September). Stressful life events are associated with a poor in-vitro fertilization (IVF) outcome: a prospective study. Human Reproduction, 24(9), 2173–2182.
  23. Breen, K.M., Karsch, F.J. (2006, May). New insights regarding glucocorticoids, stress and gonadotropin suppression. Frontiers in Neuroendocrinology, 27(2), 233-245.
  24. Buck, L., Germaine, M. (2011, June). Stress reduces conception probabilities across the fertile window: evidence in support of relaxation. Fertility and Sterility, 95(7), 2184 - 2189.
  25. Mayo Clinic. (2018, September). Low sperm count.
  26. Wesselink, A. K., Hatch, E. E., (2018, August). Perceived stress and fecundability: a preconception cohort study of North American couples. American Journal of Epidemiology, 187(12), 2662–2671.
  27. Hofmann, S.G., Andreoli, G., Carpenter, J.K., & Curtiss, J. (2016, September). Effect of Hatha yoga on anxiety: a meta‐analysis. Journal of Evidence-Based Medicine, 9(3), 116-124.
  28. Grensman, A., Acharya, B.D., Wändell, P., Nilsson, G.H., Falkenberg, T., Sundin, Ö., & Werner, S. (2018, March). Effect of traditional yoga, mindfulness-based cognitive therapy, and cognitive behavioral therapy, on health related quality of life: a randomized controlled trial on patients on sick leave because of burnout. BMC Complementary and Alternative Medicine, 18(1), 80. 
  29. Hylander, F., Johansson, M., Daukantaitė, D., & Ruggeri, K. (2017, March) Yin yoga and mindfulness: a five week randomized controlled study evaluating the effects of the YOMI program on stress and worry. Anxiety, Stress & Coping, 30(4), 365-378.
  30. Coreya, S.M., Epela, E., Schembria, M., Pawlowsky, S.B., Colec, R.J., Aranetad, M.R.G., Barrett-Connord, E., & Kanaya, A.M. (2014, July). Effect of restorative yoga vs. stretching on diurnal cortisol dynamics and psychosocial outcomes in individuals with the metabolic syndrome: The PRYSMS randomized controlled trial. Psychoneuroendocrinology, 49, 260-271.
  31. Lama, S.C. (2020, January). Foods to avoid with fibroids on the uterus. Livestrong.com.
  32. American Society for Reproductive Medicine. (2012).  Multiple pregnancy and birth: twins, triplets, and high order multiples (booklet).
  33. American Society for Reproductive Medicine (2012). Side effects of injectable fertility drugs (gonadotropins).
  34. Seyedoshohadaei, F., Zandvakily, F., & Shahgeibi, S. (2012, November). Comparison of the effectiveness of clomiphene citrate, tamoxifen and letrozole in ovulation induction in infertility due to isolated unovulation. Iranian Journal of Reproductive Medicine, 10(6), 531–536.

 

Priya® is a registered trademark of Prima-Temp, Inc.

Proov® is a registered trademark of MFB Fertility, Inc.

Pre-seed® is a registered trademark of Elkem-ASA

Conceive Plus® is a registered trademark of Mancini-Holdings Pty Limited