NIAW: Supplements and Fertility during COVID-19

I already mentioned that women with infertility struggle at the best of times, emotionally I mean. The roller coaster of the TWW (two week wait) and the disappoint when AF (Aunt Flo) shows up. The pressures that their partners may be feeling when the woman announces that they are at their peak and need to make a baby - right now! Now, you add social distancing measures, being stuck indoors with no natural light, no gyms are open, and you may get fined if you go walking around in the parks, and everyone finds they are getting squirrely. For couples who are TTC, their fertility clinics are closed. They are in a race against time before their eggs dry up. Couples that have already had embryos frozen are worried about these delicate offsprings' survival during all of this. No words can relieve this anxiety that they are feeling. Other than awareness, the aim of this post is to give some hope, something to do while we wait for the fertility clinics to re-open. Some women have already hired a naturopath, but sometimes that initial consult isn't in our budget during these uncertain times ($300-$400 - choke). I am not a naturopath, so these links are from naturopaths that I have seen online. I tried to find sources for the information as well to guide you. If you thought eating healthy and maintaining a healthy BMI would be the answer to getting pregnant, it's not all that you need to worry about. During my online search for things that have proven to help with female fertility, while this restricted access to care is going on, I stumbled upon this website with some naturopath directions, and cited research. I have yet to try any of the below naturopathic alternatives. I am just compiling the research to gain more information. I was specifically looking for ways to: 1) increase the duration of the luteal phase, 2) increase progesterone levels naturally, 3) increase the receptivity of the endometrial lining for implantation, and 4) prevention of spotting prior to menses. I've also tried to find primary research to support the use of these natural remedies. Supplements: Antioxidant Effects During maturation of the oocyte (egg) luteinization of the follicle causes a higher cellular metabolism with the mitochondria producing a lot of oxidative stress with reactive oxygen species. Therefore, it seems intuitive that some antioxidants may help with fertility. Melatonin decreases oxidative stress and increases progesterone during the luteal phase. I have heard that Nature's Bounty is a good product (random aside, I have recommended this treatment for dogs with seasonal hair loss). Vitamin C is in higher levels in follicular fluid (where the egg matured) than in serum (blood vessels), which is thought to be important to balance oxidative stress in the follicle. Increase Progesterone If you have a short luteal phase, or the corpus luteum regresses earlier, then the embryo does not have time to implant prior to menses occurring. Vitex is a herbal supplement (also called the Chaste berry), which is suggested to increase progesterone, and subsequent increase in uterine weight. Vitex agnus-castus (170 mg of a 6:1 extract of Vitex fruit daily on rising) boosts progesterone production - White Lotus Clinic I purchased this one recently and just started using it, so I will keep you posted. Vitamin B6 has been known to help with reducing the effects of stress (increased vit B6 decreases glucocorticoid transcription), as well as being associated with higher fertility in women. Omega 3 fatty acids are anti-inflammatory, but also thought to increase uterine blood flow, potentially increasing the endometrial receptivity. Check out MyMindBodyBaby for more information. They suggest to consume at least one source of Omega 3 fatty acids in each meal (3 meals + 2 snacks). I may continue to add more information: CoEnzyme Q is another supplement to help with oxidative stress. Then there is seed cycling. I'll come back to that - in the interest of time really. I hope you find this post helpful. It's hard not to feel anxious or stressed, but having something to focus on can help. Update: April 21 - 5pm I had pre-written these posts about a week ago, and I thought this is actually a good time to inject some more information. I wanted to add a bit about seed cycling and CoEnzyme Q10. I also have my first phone consultation with a reproductive specialist. Again, during COVID-19, everything is in a bit of disarray. I'm feeling hopeful though! Seed Cycling: There are many types of fats in our diet. We sort of have a basic understanding of cholesterol, saturated fats (found mostly in animal fat) and poly- or mono-unsaturated fats (found primarily in plants), and trans-fats (naturally occurring in meat and milk, or chemically modified fats). I first heard about seed cycling through a podcast by a woman who was a fitness competitor. She had such a lean body composition that she lost her period, and then used seed cycling to help get her hormones back into balance so that she could conceive her baby. Seed cycling is using four different plant-based oils (seeds) during different phases of your cycle to try to balance your hormones (estrogen and progesterone). My thought was, well, it can't really hurt to try! The recommendation by naturopaths is to consume 1 tablespoon of flax seeds and 1 tablespoon of pumpkin seeds during your follicular phase (day 1 of menses to the day of ovulation - average day 14 of the cycle). Then, after ovulation to support the luteal phase you consume 1 tablespoon of sesame seeds and 1 tablespoon of sunflower seeds. There isn't a lot of science behind it, but seeds are filled with what we call "good" fats. The oil in flax seeds are primarily alpha-Linolenic acid (ALA; a type of omega-3 fatty acid), Linoleic fatty acid (a type of omega-6) and Oleic acid (a type of omega-9 fatty acid). Flax seeds also contain phytoestrogens thought to promote estrogen, and may help to regulate the menstrual cycle. Though estradiol was not found to be increased during clinical trials, there were more anovulatory cycles when not supplemented with flax seeds. Also note that breast cancer (which can be estrogen dependent) is notably reduced in the mouse model when mice are offered flax seeds, but not as reduced when the phytoestrogen is offered on its own. The mechanism of the effect of flax seeds on the menstrual cycle may not be due to the phytoestrogens, but the fatty acids present. Women who suffer from premenstrual syndrome exhibit an imbalance in their linoleic acids throughout their follicular and luteal phase of their menstrual cycle - though we cannot really say much for the cause and effect of it. There may be an epigenetic component to it (my own thoughts), as poor diet can change the mRNA expression of different processes in the body. While the plural of anecdote isn't data, I think women you suffer from highly fluctuating mood during their cycle will benefit from incorporating flax seeds - whether during their follicular phase, or throughout. Does the lack of scientific evidence for seed cycling discourage me? Not really. As discussed, a diet rich in Omega-3 fatty acids improves health, but also improves oocyte quality - even in the light of advanced maternal age. It's thought that flax seed oil should be added to balance the omega-3 ratio for other oils like sesame and olive oil - so maybe flax seeds would be beneficial throughout the menstrual cycle? Either way, you should probably eat them somewhere in there! The reasoning behind pumpkin seeds for menstrual cycle balancing was thought due to the zinc levels and promotion of progesterone. However, it appears that injections of pumpkin seed extract increases estrogen, progesterone, and FSH (follicle stimulating hormone) - which is produce by the pituitary in the brain. So, the hormone balancing effect noted may not be the primary beneficial effect. However, in zinc-deficient animals, it can promote anti-oxidant activity in the liver (and testes in this report). In the luteal phase, it's said to consume sesame seeds and sunflower seeds. Sesame seeds - specifically the phytoestrogen lignan sesamin - is thought to be more estrogen suppressive than flax seeds - and in your luteal phase, you want to promote progesterone. Interestingly enough, consuming flax seeds throughout the cycle was shown to increase the length of the luteal phase - did I not just mention luteal phase defect?? *shrug* Finally, sunflower seeds are consumed to increase Vitamin E - another antioxidant in the body. Antioxidants as a general overview, have been shown to improve male fertility, but not as much for female fertility. I think eating a healthy diet and exercising are going to be more important than taking a bunch of supplements - but there are a lot of antioxidant rich foods that are healthy for you! CoEnzyme Q10 (Ubiquinol): During my phone call today with the specialist, we talked about the things that we will do once the COVID-19 restrictions are lifted, but the one thing that she said I should do now is take a CoEnzyme Q10 supplement. From her words, the active form is Ubiquinol - so the dosing is lower if you are taking the active form, versus Ubiquinone - which needs to undergo processing in the body to the active form (meaning you will need to take more of it). I won't give dosing information here, as I am not a human doctor, but I can present the science behind it. CoEnzyme Q10 supplementation has been proven to help with both female and male fertility. Since it is easier to do experiments in animals, the science is extrapolated from animal models. It is thought that as a woman ages, the mitochondria in the eggs (oocytes) are not functioning optimally. The mitochondria are responsible for the energy required for proper cell division, and to go from a single cell to a multicellular being requires a lot of cellular energy. CoQ10 also decreases reactive oxygen species - in other words - it's an antioxidant. In the pig model, it was seen to assist in oocyte 'aging' or apoptosis (read death) after ovulation. In human follicular fluid (that's the fluid filled 'home' of the egg prior to ovulation) there was a positive relationship between good quality eggs and higher CoQ10 levels in the fluid. For women undergoing IVF, the results seem promising - though, it can be difficult to get the perfect clinical trial in humans - for obvious reasons. For other obvious reasons, consult your medical doctor prior to taking supplements. More does not always mean better! Update April 24th: I wanted to include these screen shots from a video by Conceive Health. They are a group or naturopathic doctors that work with the fertility clinic that we were be working with to help us conceive. https://www.facebook.com/TRIOfertility/videos/616121328977771?sfns=mo Update May 1st: For women with a short menstrual cycle, or luteal phase defect, head here for some more information. #TTCcommunity #NIAW #COVID_19 #CIAW #CIAW2020 “As an Amazon Associate I earn from qualifying purchases.”

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