Optimizing natural fertility: review of recommendations

[sam_august_92]

@mcg1102 Have you seen anything in regards to obesity and specifically insulin related impacts? I've been trying to do some research into it and it's been freaking me out because it's said a lot about insulin and egg quality. However, I've also seen that insulin resistance is likely to cause hormonal imbalances and, besides slightly elevated prolactin which I have had under control for months now with the help of cabergoline, the rest of my numbers (fsh, amh, thyroid, estradiol) were all good. My diet has been terrible, which I am working to change, but I'm concerned about starting IUI next month if this could make it useless. I plan to talk to my doctor about it if this clomid cycle is unsuccessful but I was just wondering if you know anything about this.

 

[mcg1102]

@sam_august_92 So I think one important thing to remember is that virtually all of these lifestyle factors are nudges to your odds in one direction or the other. Even with the most extreme insulin resistance or diet conditions, there would never be a point where you'd say, oh, there's absolutely no shot. These recommendations come out of studies where people with {thing] are compared with people with {not thing}, and it's never perfectly black and white, people with {thing} never get pregnant and people with {not thing} get pregnant 100% of the time -- the reason that it's necessary to do the studies is that you can't always pick out the factors that are helping or harming chances by eye.

If there's anything you have been thinking about doing to improve, re: insulin resistance/obesity, now's a great time to do it. But don't feel like you're doomed if you don't do a total 180. Small positive choices add up -- think of it as extra credit, rather than trying to meet some impossible standard.

I was just reading a study where they gave participants some olive oil and a nutrition drink with vitamin D and fish oil for six weeks before their IVF cycles, and that intervention (which seems unbelievably tiny to me) significantly improved embryo quality. Positive choices matter, even if they're little.

 

[sam_august_92]

@mcg1102 Thank you so much for responding. I take fish oil, vitamin D, and eat healthy fats (especially avocado) so hopefully that's been helping.

 

[noahturner09]

@mcg1102 Many thanks for this!!

The caffeine bit is interesting. I never thought of it as something to consider while TTC. While I drink tea for the most part, my coffee intake can get a wee bit high some days (December required a LOT of coffee to happen).

 

[aaroncito]

@mcg1102 Youre a star!
I'd nominate you for a promotion IRL if I could!

 

[willsgranny48]

@mcg1102 I read something on this subreddit about NSAID use and fertility. Did you happen to come across any data for or against in this review?

 

[mcg1102]

@willsgranny48 There's some, but it hasn't generally made it to the level of the big reviews yet.

1. NSAID use around the time of ovulation can prevent the actual process of ovulation -- the bursting of the egg through the follicle. This works well enough that high-dose NSAIDs are being tested as emergency contraception. It is not clear that OTC-level doses of OTC NSAIDs would have the same effect -- most studies have been done in people taking powerful NSAIDs for disorders like RA. But it's not crazy to think that OTC NSAID use could prevent ovulation at least some of the time.
2. NSAIDs work by (very effectively) inhibiting the production of molecules called prostaglandins, which are required on the uterine side for implantation to occur. As a result, it's very plausible that they could prevent implantation, even of a capable embryo. To my knowledge, there is no direct data to support or refute this possibility.

These are more circumstantial arguments than one would prefer to make, obviously. There's not a ton of positive evidence. Personally, I avoid taking ibuprofen around the end of the fertile window, and also in the mid-luteal phase, but I do not avoid taking it at other points in the cycle.

 

[internetperson]

@mcg1102 Very interesting. I get ovulation pain bad enough to need medication. Might be worth switching to Tylenol, instead.

 

[willsgranny48]

@mcg1102 Thanks for that detailed reply! Makes a lot of sense. I’ll probably try to avoid ibuprofen around the same time periods.

 

[gossippk10]

@willsgranny48 Not dev, but here goes:

There is a body of research that shows that regular use of NSAIDs (eg daily) increases the risk of luteinized unruptured follicle syndrome (where the egg is not fully released from the ovary but otherwise progesterone is released so the body acts as though ovulation occurred). Sporadic use is unlikely to cause this but many here choose to try and avoid NSAIDs after AF is done just in case.

There is also some animal research (sourced in this review article03022-X/fulltext)) showing “mice with deletions of the gene that encodes COX-2 have decreased ovulation rates, low fertilization rates, failure of implantation, and incomplete decidualization.” NSAIDs block both COX-1 and 2 (some prescribed only block COX-2) and so while you generally can’t apply animal research directly to humans, it shows that COX-2 is needed for fertility, so routinely blocking it is in theory harmful. There was another study last year that linked cumulative NSAID dose in women in a cycle to decreased fecundibility (cycle odds of pregnancy) in a dose-response fashion, which fits with this research.

Note that aspirin does not necessary fit into this - some people with recurrent pregnancy loss are instructed to use it. It’s not quite the same as other anti-inflammatories.

 

[willsgranny48]

@gossippk10 Thanks for your detailed response (and the review article!). Since I tend to use NSAIDS frequently it may be prudent for me to be selective about timing. I’ll read more into the research you mentioned as well.

 

[gossippk10]

@mcg1102 As usual, this is gold! Saving this to link to for future Wondering threads.

 

[sisi]

@mcg1102 This is awesome! This line stood out to me:

Although some lubricants adversely affect sperm parameters in vitro, the use of lubricants in couples attempting conception was shown not to affect the cycle fecundability.

I knew that sperm-friendly lubes didn't help but just didn't cause harm, but it's extra interesting that even the "harm" is only in vitro, and doesn't actually affect pregnancy rates in real life. Makes the whole TTC lube question seem only more like much ado about nothing. Also we're not lube users but good to know that if the need arises, we can just grab the bottle of canola oil from the pantry in a pinch.

 

[mcg1102]

@sisi Yeah, it's not really clear that standard lubes are actually problematic in practice. The reference they cite is this one, and there's also this one that cites the first one.

Re: the pantry, just stay away from the vinegar, right /@ppaul?

 

[ppaul]

@mcg1102 Oh gawd someone still remembers...

 

[eclipsedangel]

@mcg1102 Maybe this is a dumb question, but what about saliva as lube? Is that an established no-no? We have always started sexy times with a BJ and my hubby is finding it difficult trying without one

 

[skitta]

@eclipsedangel There are no dumb questions!! Unless you're using your vagina like a spittoon, saliva really isn't that bad, especially if a BJ helps get things rolling. The amount of saliva involved isn't going to have a major impact to his sperm or your chances in a case like that

 

[eclipsedangel]

@skitta Haha ok, thanks! I had heard or read somewhere at one point that it was harmful, so I've had that in my head. But that's reassuring, thanks!!

 

[skitta]

@eclipsedangel Yeah like it isn't nice to sperm BUT it is going to take A LOT of saliva to actually make a real difference, thus the spittoon analogy. A BJ isn't going to hurt your chances any.

 

[zacariah88]

@mcg1102 This is such helpful info! And somehow...makes me feel less crazy. I drink occasionally even though we’re TTC and I’ve had people chastise me for it. I’ve cut out a lot of caffeine but not all of it bc, coffee. Thanks for this, it’s amazing!