What to Eat to Increase Your Odds of Success with IVF

What foods and supplements help improve fertility for those trying to conceive naturally and for those undergoing fertility treatment. We talked with Dr. Jorge E. Chavarro, Associate Professor of Nutrition and Epidemiology at the Harvard School of Public Health and Medicine at Harvard Medical School. Dr. Chavarro’s research is focused on understanding how nutrition and lifestyle impact human reproduction. He is the Principal Investigator of the Nurses’ Health Study 3 – an ongoing prospective cohort of young professional women started in 2010 designed to investigate the role of lifestyle and biologic factors on women’s health – and leads the nutritional component of the EARTH Study, an ongoing prospective cohort of couples undergoing infertility treatment at the Massachusetts General Hospital.

Transcript

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* Note that this is an automatic transcription, please forgive the errors.* Note that this is an automatic transcription, please forgive the errors.

spk_1:   0:05
Welcome to Creating a Family. Talk about Infertility. Today we will be talking about what to eat to increase your odds of success with IVF. We'll be talking with Dr Jorge Navarro. He is associate professor of nutrition and epidemiology at the Harvard School of Public Health and Medicine at Harvard Medical School. Dr Navarro's research is focused on understanding how nutrition and lifestyle impact human reproduction. He is one of the principal investigators of the NURSES HEALTH Study three, which is an ongoing perspective co heart of young professional women starting in 2010 designed to investigate the role of lifestyle and biologic factors on women's health. And he leads the nutrition component of the Earth study and ongoing respective co heart of couples undergoing infertility treatment at the Massachusetts General Hospital. Welcome Dr Navarro to creating a family. Thank you so much for being with us today.

spk_0:   1:01
Thank you for having me today down.

spk_1:   1:04
This is the topic of well of personal, great interest. I am fascinated by it, but it's also a topic of interest to both patients and nurses and other medical professionals, so we will just dive right in. How does nutrition impact fertility? We know that a women with that women are born with all the eggs that they're ever going to have. So have this nutrition impact, female fertility and egg quality. It seems like the most important attrition would be those of our mothers when we were being just stated. But so why is it important after the fact?

spk_0:   1:38
Well, you're correct that a woman's over every service, especially determined the euro and a ll the ex that you're gonna have the house already happened. However, that doesn't mean that the quality of any individual egg is determined that birth already or that we're not women populating into one particular cycle is also the terminal berth. There are many other things that influence they bring Larry. If menstrual cycles draw the life and the regularity of obligation, as well as the quality of individual extrovert, a woman's life on that's where nutrition places all and that's a nutritionist is really a very broadly defined exposure. There's no one thing that nutrition is, and we have now on some ass house on aspect of nutrition in fertility for a very long time, starting with body weight on exercise on the which are kind of lead the opposing ends off energy balance I'm by. Over the last decade or so, we have also gained an enormous amount of understanding about how the quality of diet me also in fertility. And let's not forget that reproduction is a team sport. So yes, we've been are the wind do get president? But until we figure out a different way to it, we still manage for reproduction on men's, as promotion is, somebody's have much more active phenomenon.

spk_1:   3:08
How often do we trance at what will a man produced a completely new set of sperm

spk_0:   3:13
about it every three months over of ivory? Three months? There's a completely new self sperm that are being created. So they did some much, much more active crosses and much more on differ, much more susceptible for intervention and much more susceptible to external environmental cues.

spk_1:   3:32
Okay, so if a woman is wanting to impact the quality of her eggs, as well as her general fertility, not far in advance, which you need to change her diet

spk_0:   3:47
independents, so the best with what we're talking about. And there's actually not a lot of 30 on that one particular point on how soon do I need to be doing things? So the way I like to I like to think about nutrition on reproduction is trying to break it down into one of the big things that we have a lot of information about what it was fairly confident on them and more seldom, things where we are just getting information on. There's less confidence than votes. So the things that we know a whole lot about the 1st 1 is definitely impact off body. We found that for decades and way have just gone much, very more refined. Understanding how wait impacts, fertility so that the earliest study, some way infertility date back to the 19 seventies. And we're looking at extremes, mostly a very low body weight, so associate it with extreme levels, exercise on how they impact that valuation on dhe menstrual cycle regularity. And from that we know that both being underway but also being over on beasts, which was evidence that was not a few a few years later. I'm not that good in terms off relation to be somewhere in the middle. Now what does that mean in terms if you happen to be one on one of the extremes like you, you're either mean or over wake. How soon do you doing to start changing the way they're gaining weight or losing weight? If you're trying to start a family and those are effects are relatively weak, right? So we've seen a few months. You can start seeing a regulation off formulation of the resumption of the moments. He's in case the men have been interrupted and, in many cases, resumption of fertility. And where that has bean talking to the best piece, I'm a women with Closes takeover syndrome where we know that weight loss actually improves. Uh, it's resumption off men sings on Bruce for Kill Buddy. Where Dad does not seem to be the case, However, some of the men were undergoing its history production, so there have Bean afford the longest time based on their other studies. I'm a women were trying to get pregnant their own. The assumption Have bean that women were undergoing fertility treatment were overweight for bees would also benefit from losing weight immediately before treatment. However, in the past for four years that have bean to run advice trials, testing these specific hypothesis, asking women who are overweight to lose weight immediately before starting fertility treatment. And what both trials found is that even though there's no improvement being spontaneous pregnancies, meaning women who were having fertility problems, I'd lose weight on our train under own. I were scheduled for a sister production and started trying to run. Some of them don't get pregnant by women who actually make it to fertility treatment. Do not benefit from losing weight immediately after infertility treatment.

spk_1:   6:56
Why do we have a theory as to why?

spk_0:   6:59
So I think that for two to America's history, corruption is such an intense intervention that the benefit off weight loss is probably you weakened. Given the the house interesting to rent Ernie's, that's one possibility. The other possibility is that you so if you think you are losing weight, is a closer to going into starvation mode right than that. Our interest of the reproductive axes are things. So yes, you do. You do that. I'm gonna Balkan prevents, right? So your blood glucose in your sleep it's gonna get better. But the messenger brains getting injured reproduction is that there is a shortage of food. It's probably not the best time to be trying to get pricked, and therefore it is possible that when if you need to lose weight for Astra production, you probably do these way ahead of time. It's not not just two or three months before, as thieves trails have done. But it is possible that that if weightless is effective for some women, it is a weightless that happens years before starting treatment. When people are not even thinking that they're gonna be meeting trip, so it it becomes kind of cut straight through them for for practical implications, it's it's not. There doesn't seem to the match benefit in terms off the ability to get pregnant. If there is a benefit in Terms off for a dose would do get pregnant, they do get better pregnancy outcomes.

spk_1:   8:34
Yeah, that would make sense. And has there been any new researcher or any research on how someone loses weight? From what I'm hearing, you say, if for natural conception without fertility treatment, weight loss is effective. But for fertility treatment not, doesn't matter how you lose away gastric bypass versus diet

spk_0:   8:58
no, so that the two trials that have that have addressed this question in a couple of women were undergoing for treatment. They tried to very different approaches one waas more asunder calorie reduction with making all your portion smaller but a lot less. The only line was a much more intense intervention in terms of restriction on West. I didn't they We men who participated in the active arm were given in liquid diets for around 700 calories per day. So it's a very, very severe color restriction. And in nighter, try a ll. These was effective. There have been some studies looking up, no trials, but a handful of these reports looking at what happens to women who lose weight that through bariatric surgery and then go on to fertility treatment. And the literature is very mixed over. Not that it's a good idea, but so there's not a clear consensus wearing only how to lose weight matters they're having. Some studies on women's PC artist looking at were in dark. Different diets make a difference, right? So if you have like a standard diet with your calories versus is they have a low protein or low carb, I retire. Things like these doesn't make any friends, and the answer is no, no, the most important thing is to lose weight in the PC with this context, not so much how?

spk_1:   10:23
Okay. And we'll be talking further later on about specifics on the food and diet. There's a lot of interest now in the human microbiome and how it affects really all parts of our lives, including our fertility. And we know in fact, we have ah course on this about how the microbiome and the reproductive track impacts fertility. So we know that the microbiome we know that our reproductive tracts are full of microorganisms. So do we know anything about what type of diet is effective at maintaining a healthy ballots within the microbiome is and I reproductive tract. I mean, they're different from there, not necessary, connected to our our intestinal track, which, of course, is also full of micro biotics.

spk_0:   11:14
Yeah, that's actually fascinating Question So and everybody seems to be interesting in understanding the Microbiome Tuesday. It's verities, the gut microbiome where my karam specific organs So we actually just started studying cooking a piece looking at were not one might think the reproductive tract microbiome and to what extent that might explain differences across evening success rates and the women who want to bring for to treatment. So there is some emerging evidence suggesting that the vaginal on dhe microbiome on the microbiome recovered from transfer catheters from women undergoing a sister. Production may be different between women who succeed. Now remember, we're not succeeding that based honest production, and there's also some evidence we just didn't get. The Microbiome may also different on women who are experiencing problems with fertility according to their primary infertility diagnosis. What's not clear is, what are they? What extend the lax tower environmental factors might be he is able to inflict on Michael we're not. You could intervene on change either directly or indirectly by providing. So I think this is Busan area, where we're just starting to depart posing, too. But we'll be learning a lot more next 5 to 10 years.

spk_1:   12:37
Yeah, but we will. It's a It's a really hot area for research right now, huh? Let me pause and remind everyone that this show is brought to you by our corporate underwriter bearing pharmaceutical bearing wants you to know about a new tool available for meme. It's actually not that new, has been out for a year or two. Now it's the further strong act for two. Strong is a self help fertility support at for your phone. It's specifically designed for men, although I'll have to admit that most men find out about it from the women in their lives. So I'm talking to you women out there. Let your men know about this. The act provides techniques to empower men with knowledge and self help skills throughout the stressful journey of infertility. It helps him in to cope with their own stress, but it also gives them techniques to help cope with the women in their lives the stress of the women in their lives. To learn more about for too strong for yourself or for the man in your life, you could go to Earth a strong dot com f e r t I S t r o N g. Not calm. Now I want to talk about what research is showing about specific foods or diets that are best for enhancing fertility, and I mean both natural fertility as well as the fertility of those going through fertility treatment. And then we'll circle back to talking about what the research is showing about what we should actively be avoiding. So I know that you have done a tremendous amount of research in this area. So generally speaking, what are we supposed to be eating, or what are we supposed to be eating and consuming? What type of diet should be following if we want to give ourselves the highest chances, either at a natural conception or or through fertility treatment? Sure.

spk_0:   14:26
So I just like to focus on the things that have been consistent across dice and across I'll Come So this things that seem to be equally good boat for couples were trying to go around that on the mail and appear to in person in quality. And that almost took you to be beneficial couples undergoing in inverted treatment. So why don't think that has the most consistent throughout is how we got three fatty acids in particular per minute through failure as a marine origin. So the ones that kept from fish the ones the longer fatty acids, which are E. P a nd and shay how they appear to be beneficial across a spectrum. So they're squaring. But literature on male and showing those that consumption of fish seems to be related, embarrassing in quality that brand mice trials were. Men are supplement that with fish oil also and show that men some of the official and they're having better sound quality and that he doesn't necessarily have to be fish oil. So I'm not her source for those who do not like fish and other source from the after fatty acids says, but important are not so There have been several around mice trails we not past few years, showing that you've seen very similar effects when men are supplemented with nuts on sperm parameters. So in addition to that, we have seen that among couples who are underground for two treatment women who have higher blood levels, omega three fatty acids, which she's some marker off century after Indy do have better outcomes are more like to have life birth than women with lower levels, and this is, for the most part reflect think their intake of fish in these bird country.

spk_1:   16:21
So do we know that the fatty that the higher levels of omega three fatty acid in the blood is coming from marine sources.

spk_0:   16:29
So when you find omega three long channeling of three fatty acids in your blood that there's only two ways that they Why does you aktham right then that's That's the most straightforward away and the only way we should eat in the same period. Fitch. There's no other way. There's not a natural source for you to get your fish or or Creole, or some are off marine source of American fatty acids. You could also convert them from shorter Shane Omega three fatty acids. So from plant sources, we got three fatty assets. She put nuts, which some oils and flaccid and things like these. But they conversion off shorter Shane with three fatty acids. The longer shimmering essence is firmly inefficient in humans. So for the most part, you see Oh my God, you're funny as it's to function only of your fatty acids in someone's blood or adipose tissue or wherever. It's because they ate them. So it's what? That's why they can be, for the most part, interpretive aside, mark or feet.

spk_1:   17:33
Okay, fascinating. Okay, So apparently there's good research that would indicate that increased consumption of fish and nuts, perhaps are good for both men and

spk_0:   17:45
women, men and women. And we've seen that both in men and women, both men in the general population. That's why this man in couples from presenting to fertility treatment. We've seen the benefit of life birds on women undergoing for to treatment. And we have also seen something somewhere among couples trying of the Rome. So comparing when both partners comes from fish at least price per week, we see their chances off their 10th pregnancy being much, much shorter. Then the times pregnancy couples where neither one's them off them. He's come to fish, and it translates to about 10% or risk off. Having tempt pregnancy greater in 12 months, we should stop this mission of infertility. So it seems to be quite a remarkable effect, size in terms off both consistency and being able to impact the wide range of outcomes that are relevant for both men.

spk_1:   18:45
Just out of curiosity, has there been research on vegans to say whether they have a lower overall fertility rite?

spk_0:   18:54
Not that I'm aware of, So it's studying seven vegetarianism, veganism. It's actually very difficult. Just be full, even though there are technical definitions of whatever your charities and with the honeys, no, everybody understands the same when they say they are vegetarian Rubik. The clearest example of that is from my own personal. My personal experience by I come from I was born and I raced in Colombia in South America. Well, she's a very high mediating country. Wait a lot of beef, so I probably 1/10 of the beef that I used to eat when I was younger, but you wouldn't be every single day. So when people in Colombia say they're vegetarian, what they usually mean is that they're going to beef. But that doesn't necessarily mean that they don't eat meat. So if somebody says vegetarians, it all, don't worry, we have chicken. We have facing your fine because that's so across many different context, what it means to be vegetarian or vegan or lacto vegetarian or elicit Terry and eat. Not everybody understands the same way, so it's very people to study in large populations. That's a one thing that I'm very happy. You asked me about visions because it gives me a portrayed about something else that has bean quite a quite important. Infertility is, as all begins, no one thing that they have to be aware off is vitamin B. 12 deficiency because the on lee so most fast git R B 12 by eating meat. But if you do not any meter and animal products, you do not have any natural sources. Oh, vitamin B 12 year die and the problem that he's that vitamin B 12. Another nutrients related Vitamin B 12 including but it would be seeks and full of cast. It are part of these men aboard athlete called the One Carbon Metabolism, which, among other things, is in charge off producing the building blocks of the day and off, producing on off meth awaiting guinea, meaning putting the reading code on top of the show. It's extremely, extremely important, forgetting production machines that is extremely, extremely important. Form a committee genesis and for cell division, so of the male end. If you need to be replacing your entire population of sperm and possibly every three months being able to have a state supply off the way he is critically important on the couple end of things. Once you have a friend, my SAG, it's not gonna be able to have to produce its own machinery to actively incorporate either falling or be six or 12 himto eats into into the cells until its own genome. He's activated. So whatever wasn't Waas whatever falling B 612 waas in the egg was absorbed with rumors. And yet that's what that embryo is gonna have. Four to support all cell divisions during the 1st 3 if I base of embryonic life. So those nutrients are critically, critically important for both sperm emergencies in the middle. And I'm for supporting the embryo through the first few days of life. Wish is important. This is to reflection. But it may also be what underlies some cause of infertility that can identify us unexplained infertility or recurrent pregnancy loss with.

spk_1:   22:26
And so that's that is B 12 which we know we can get through. Meek. Does all meat have the same amount? Um, is there some meat that is ah, higher in the 12 B six full? Get well, just say b 12

spk_0:   22:41
because so, no, you don't have to be that Tiki Bar B 12 And one thing that is quite fortunate is that you don't have to. We treat that much meat or you have to eat that meat at all to do. B 12 most prenatal supplements include B 12. So there's some street Vegans will actually not use standard prenatal supplements because of that, 12 came from an animal product. But there are ways around that. So there are ways to get Ba 12 through supplements that are okay for vegans. And most prenatal supplements will include a combination off Full CASS. It he stinks something and what most prenatal, overrated. Multivitamins include our waking day intake levels that would be required for sustaining boats, promote agencies from the mail and for sustaining the embryo through its first few days of life.

spk_1:   23:35
Okay, and let's talk protein. In general, there was some research a long time ago that was indicating that higher percentage when your diet has a higher percentage of protein that enhanced, and I honestly don't remember now. Whether it was, I think it was women. I think it was people going. Women's fertility going women's success rate going through IVF have that. Has that been substantiated? Do we know what type of what percentage of protein will talk about the type of protein here in a minute? But how much protein should you be aiming for when you are trying to get pregnant naturally or when you're going through fertility

spk_0:   24:12
treatment. So I know exactly what study you were talking about because I waas These was an abstract that was presented. It is for him yet I was one of the moderators in death session. Remember it? I remember it quite well. So we

spk_1:   24:28
and I was in the audience

spk_0:   24:29
okay for us. So I know exactly which one and it was. It was a very interesting study. So these came from a group that's very much hands on on advice in their patients on their diets, and they can't remember the exact amount that they kind of fairly high intakes off protein to their patients. And what they presented out of his room was quite interesting in treatment right away. So we waited and waited to see the paper published than that picture was never published. A separate reviewed article, huh? So we decided to take a looking in. Our data was published last year looking at different protein sources on and for the amount in relation to come stuffing for treatment. When we found was that as a whole protein, it didn't matter that much so. And when you

spk_1:   25:21
look type or quantity

spk_0:   25:24
Quantity. Okay. And when you start looking at the source of a major source of protein, there were only a handful things that stood out. So one, uh, west fish wish we've talked about, right? So if you were hiring your protein intake because maybe eating a lot of fish that he didn't matter, but it didn't seem to be an effective program by West efficient cell. Um, the order stores was something we have published before last when we're getting a category that we called being some of the girls have rights, so that seems to make some difference. But interestingly, most of the association waas because of intake of soy, which is something that gets a lot off Calmund, the blogosphere on how it might really to fertility and what we and others have found, he's actually that's either soy, which we look, the story foods and others who have done BRANDEIS trials of so supplements. When we find these, that it's actually beneficial improves like birds in women under one assist reproduction, which is kind of the opposite of what you see in the vase literature about art and fish and soy and lizards that order the games and be on nuts. There didn't seem to be much on protein making a big difference. There were some. A quick critical findings were looked at red meeting. Think so when he waas, modeled in one way, looks like he was beneficial. But he's been borrowing. Take different where you didn't. So we reported I was like It's there's not there is definitely not a cure. Signal off either harm or benefit with Britney Orbit. Architects of foods there didn't seem to be at your signal. Darius. A source of protein with chicken or our culture as a source of protein of you're the only to your signals were with fish on wheat soy.

spk_1:   27:14
And then you're not clear whether that's the protein itself or the type of protein and other other factors in the soy or the

spk_0:   27:22
fish. Correct. So we deficient may be the case that it has absolutely nothing to do with the approaching itself, but rather with human three. For the assets that we have discussed before and practical, it doesn't really matter if it's the protein and you're eating the fish thing, you got benefit. If it's gonna go through failure as it's under getting fish, you're still gonna benefit. So on a practical standpoint, it doesn't matter that much. Same thing we story, right? So what? We have been able to study story food intake. And if it happens to be this story in protein itself, then sign and you're getting the the graphic for meeting So protein the other groups that have studied So we have used toy supplements specifically I I still flame also women. So extracting the fighter estrogens are a story, and using data supplement on does seem to be beneficial both for couples undergoing in for tutoring. And we air tr reid, are you? Why? So if it is the fighter estrogen's itself that are beneficial, then you'll get the benefit. Very disaster food or rarities are, or if you'd supporting you would still get the benefit as biting us.

spk_1:   28:35
So what about carbs? You know, we hear it's the total talk of the town. Yeah, maybe, as you call it, the blogosphere is through. The Internet is full of talk about low carb or process carbs or complex carbs. What does the research show as far as the intake of carbs are? Perhaps the percentage of carbs in your diet and does it matter whether it's simple? Carbohydrates are complex carbohydrates?

spk_0:   29:05
Great. So So Okay, thanks for asking, Balan, because that's another area which has been somewhere if I consistently Tru Tru blood for men, couple straining your own on couples underwriting for treatment s. So let's start with couples trying on their own these time so that once one of our earliest publications were looked at carbohydrate quality and quantity, relation to infertility to tribulation problems. What we found back then was that women were hired by seeing me clothes, meaning that they had either very high carbohydrate intake for modest everything. But most of these carbohydrates were coming from rapidly digestible carbohydrates. They had about twice the risk off having fertility celebration problems than women with the low in the lowest end off by scenic load he tick. These has been recently reproduced in another court records burners that thesis and ineffective pregnancy are supposed to specific causes off infertility. They also see that their quality combined with not necessarily the total amount of our wives rates, but having better pod car buyers meaning work lights in the carbohydrates, more fighter less rapidly than just the Trooper also seems to be beneficial perfectly. And it has also been seen for men in styles. Looking at somebody s, I don't come. So we know that the main contributor to Mycenae glowed are rapidly digested sugars, right? So added sugars on one of the top of a country were spotted troopers at our sugar sweetened beverages. And there's now a growing body of research showing that traditional villages of privation bowers in Bali and it's it in some senses, those it shows Lower County. Another study that shows lower utility but definitely not good for us. A foursome in quality. And there have bean, some studies looking at a fertility and couples right under our own that have found that both the male partner intake and the female partner intake of sugar sort of ever just is the interiors to fertility in the family of each other. So at least true sugar, very years are definite. Not a great deal for fertility, where water eighties on the male end or female, and when we looked in couples undergoing fertility treatment again, the same story appears the same pattern. So even though the total amount of carbohydrates doesn't seem to be that. Make that much of a difference between the Rangers who didn't think that we see people in Boston. The quality of carbohydrate does seem to matter. So the more whole grains that are part of total couple hundreds, the better Our comes Looking for Katrina. Well,

spk_1:   31:53
what about then? If you, rather than sugar sweetened sodas are What about shifting to diet sodas where you're using where they would use artificial

spk_0:   32:02
sweetener? So that's a great question. So we've there. There's not a lot off research on artificially sweetened beverages. So whoever really first papers we looked at these because we're interested in caffeine natural. We're looking at different sources of caffeine, and we ended up looking also at sodas as one of these sources of caffeine. I mean, that study, when we see, is that so does so. Sugar so does indeed appear to have the Algiers effect on fertility. But the association with sugar sodas was very similar to the association with diet sodas, but that hasn't bean always the casing across that. So I would say that there hasn't been asked missus the literature with diet sodas that they're has beans with sugared sodas and increasing believe the culprit Easter itself. That should work. So, however, one of the people with whom I collaborate often is the group of 70 environmental chemicals environmental contaminants on one thing that Schubert sodas on diet soda share his package chic and several of the shared packaging are known sources self, environmental chemicals that are known to impact fertility. So you could always do a water that's that.

spk_1:   33:25
That's just say it is like to campaign for less s replacement. Well, okay, but let's talk about another drink then. And there's, um for me it was fairly interesting research, and that is consumption of whole milk products. And if I remember correctly from the research, it didn't hold over. It's not just the dairy product itself because it didn't hold over when we were looking at low fat or skim. Yeah, has that held up in the research

spk_0:   33:51
that has been one of the most inconsistent ones? So we didn't know that was one of the first things that probably so again, was this in our initial starting looking at infertility to an ovulation. That's enough. And what we found back then was that women who had hiring takeoff high for their foods. And this was primarily whole meal had a lower risk of infertility tribulation. But the office it was true for low fat dairy, so loaf of their rest, primarily in pickles, and they seem to have the exact opposite relation. West I really was a real head scratcher trying

spk_1:   34:26
to was a head scratcher and said that

spk_0:   34:29
it was a total head. Screws like we should be code in this thing correctly is a month or going back, making sure that made no mistakes before we aren't. You have to put in paper on Dhe. Say yes. Here's my name attached to this finding, huh? But wait, just no matter what we need, that was a fine. We have kept on the story of their units and very, very inconsistent across our comes. So we've revisited the very story, looking at seeming quality, and it's not consistent. So wave looked at in three studies, now, in three different populations, and we're on. Our findings are different in each other, three populations. So it's not just that I don't own direction to see my body. It has been docked in relation to type the pregnancy and couples trying to get pregnant. And again, it's not asked. There doesn't seem to be asked here. Relationship with them to pregnancy. And these distinction between lo fi versus high fat dairy doesn't seem to hold out. We looked at it in relation to outcome, somethinfor to treatment, and we do see some benefit but for low fat milk that for skim milk. So it has bean very Oh, and the last one we didn't last for ovarian reserve. Look, that, uh, you think very in relation to a very reserved and then it was a very intense itself was very to lower to pour over reserve, but he didn't really matter what, that their warranty was Darius a hole. So I think that there is. This has been a very, very inconsistent story throughout the literature. So

spk_1:   36:02
jury is still out sandwich for telling.

spk_0:   36:04
Yeah, I think I think the jury's still out on, but the space it's gonna be still gonna be out for a while.

spk_1:   36:11
You mentioned caffeine. What do we know about caffeine consumption? Infertility.

spk_0:   36:17
Well, you were expected that we should be pretty clear, so different. Caffeine has been one of the most studied nutritional factors in relation to fertility. The problem has bean that until fairly recently there has bean a pervasive problem with studies, spying on students looking a caffeine infertility. So the typical study has being going to the fertility clinic and then asking about your diet. So did you drink coffee over last year? Something like that during specified entering a zero where people who are undergoing infertility treatment are facing fertility problems. They are excellent study participants because they remember everything. They're very very reporters

spk_1:   37:01
that that is so true

spk_0:   37:02
and they're very aware of even the smallest things they do. So you haven't opened. And the pressure is like the dream coffee that sure it free coffee like fine weeks of her life during come with a cup of coffee and I turned on again. But if he becomes like he has no answer, and you have no choice but to report, yes. And then then the investigators would go to the labor and delivery room on something as yes. I mean like, did you drink cover? Don't know, Patrick, I have a baby. So So if that is the information that you're collecting your old security to find an association between coffee friend King come infertility. So ask more high quality studies have started to accrue the association between coffee infertility has become more questions. So there's, uh you look at the the more recent hire body studies. Most of them report absolutely no relationship between caffeine. Anything a neater sitting body powers makes absolutely no difference. There doesn't seem to be a relationship back to pregnancy, either. There doesn't seem to be a relationship with success In their tea setting, we collaborated with a Japanese RO, uh, recently wish we get a really interesting state because, unlike the estates in Israel, there's not the social bias for its drinking coffee during pregnancy. So people continue to dream coffee throughout infertility treatment. And what we found in this study in Israel is that coffee drink made absolutely no difference in terms stuffing for treatment outcomes. But there was only one caffeinated beverage that made a difference, which waas Sure, so this on. So we think that he was the sugar and not the soda. I'm not the captain of the Fabia, right that made the difference. And recently, a couple of months ago, there was another state publishing, fertility and sterility. Looking again at a different population with that doesn't share the same biases around caffeine that we have. So these was couples undergoing fertility treatment in Denmark and what they seize Absolutely nothing. So couples undergoing fertility treatment in Denmark coffee seems to make no difference whatsoever. And when they look separately at couples who are doing IVF versus I Do I The cocoa's doing, are you? I trust you to do a little better when they drink coffee on, but the couples will not drink. So I think if you look at, if you're not on, look at the head comes right, they come papers and say, Well, what's their conclusion? But he also take into account the quality off the studies, and we're not. They being thoughtful about designing their study, it has become less clear. We're not a coffee. Is that years of fertility? And there is one big exception, though, which is that coffee does seem to be related to our miscarriage in couples, in calls, we get pregnant under oath. So the the question is, will. If this is true, what? How this it's so it doesn't impact our ability to get pregnant, but it may increase like it the chance of losing a pregnancy. So how do you balance those two things and this? Studies that have identified problems we presidency lost. Most of them suggest that that that pierce effective caffeine starts right around the time that they recommend that intake. The eight o'clock and other sensations suggest, as the maximum level thing take for women. Where President trying to get pregnant. She's around 300 prints of coffee of caffeine per day, so roughly 2 to 3 cups of coffee per day so that the Reese appears to have happened beyond that, do you think? But not before that.

spk_1:   40:58
Okay, that's interesting. So again it would go back to fairly moderate coffee consumption. This show would not happen without the generous support of our partners. And these are organizations and clinics who believe in our mission to providing unbiased, medically accurate information to the patient community. I'm gonna tell you about two such partners. One is Cooper Surgical, Cooper, Surgical Fertility, Genomic Solutions, our global leaders in IVF and Reproductive Genetics. They offer a whole host of genetic testing P g t A M. R. and they also do some in Dmitri A. Ll, receptivity testing for individuals and couples. And Cooper Genomics is very proud to provide comprehensive genetic counseling to all of their patients. Another partner is Wall Grains and Elias Rx Walgreens Prime. They provide specialized fertility. Pharmacy service is throughout a network of a carrot team, and they are available 24 7 And they truly are devoted to helping patients achieve successful outcomes. They understand the importance of timing and the need for personalized treatment and are committed to compassionate care and support throughout a patient's journey. Again, the blogosphere is full of, ah, information about supplements that women and men should take if they're wanting to get pregnant. And even it ratchets up even more when people are in fertility treatment and are truly googling and trying to find information. So I want to talk about the impact of supplements for people conceiving naturally and the impact of supplements for people undergoing fertility treatment. We've already talked about the importance of prenatal vitamins. Almost been much time on that. Let's talk about I think that that's pretty much universally agreed now that you should be 100 prenatal buying. Let's talk about some of the other potential supplements. You mentioned the importance of vitamin B 12 now that is included, Generally speaking and prenatal vitamins. Is this a case where, if a little, which is included in your prenatal vitamin is good, a little bit more might be better? Should women considering pregnancy or undergoing infertility treatment supplement with additional vitamin

spk_0:   43:22
B 12? The answer is, I don't know. Eso like coffee on, uh, micro interest supplements have Bean investigated a lot. There's tons of run mice trials among infertile couples reporting the effect of the supplement or dots help him in May. And so much of there's Bean to Cochran reviews on the effects off

spk_1:   43:46
to what type of reviews, just from

spk_0:   43:48
the conquering collaborations reviewing the effects off. They're called antioxidants, although these they're not really all on tax yesterday, mainly micronutrients implementation of both female fertility ins feel fertility, and what they need is among couples undergoing fertility treatment. And they come to the conclusion that, yes, there's a lot of trails up there of the ocean home. Problem is that pretty much every single trial that's out there has been done because somebody is promoting their own supplement, right?

spk_1:   44:21
Yeah, exactly.

spk_0:   44:22
I run the trial and they say, Okay, if the main purpose of the trials able to supplement A that I'm going to sell $100 a bottle or whatever work yes or no? Then you're gonna run your stance. Turn away your maid, Robbie. Like Americans, placebo are supposed to something that you wish is not something you would necessarily do. Real life, right? You would for a couple of strength get pregnant, you would not give up. Please give them the minimum recommendations for my creditors of limitation to support a pregnancy and seven fall. Because everybody's interested in your own blend of supplements, it is really not possible to identify where the effects of any one individual mutual. So I think that that the for both of them in both the male review on the female review But they find is that if you pull the data across all these trials together, you induce your signal on during doesn't seem that supplementing both men on women. Well, uh, my furniture supplement can be beneficial for improving fertility. Menachem, the problems are that in either review, there's no two trials that are actually testing the exactly intervention. So there's no two trials. They're testing the exact same thing, so you cannot tell. Well, what is it exactly? The supplements that's helping, right? And second, because you do not have a success in two trials, it becomes really, really difficult to define. Well, maybe the best supplement is something that has these things or things. And so you gonna tell where things are better working? But you can also not things where you can also not identify what are the components of the supplements. They're doing nothing or may be harmful, Right? So you were just in the average effect that crosses many different supplements across many different trials, none of which are the same one to the other. So the optimistic view is we know something works. We just don't know what it is, right. And our job is to try to figure out what is it that's helping. So we've talked a little about already. The one cover metabolism. So full 8 12 Andi seeks, and I think that the evidence is actually growing in strength, supporting role for both fully down be trouble for you having a very, very important role in females specifically. So you would think so if if I'm already taking a multivitamin, which already asked Floyd already have 12

spk_1:   46:58
right cause because most free needles did.

spk_0:   47:00
All right, let's do then how is this is important to me on where we've been able to find is that even we think the range of him take on cobbles under burning for to treatment. We do see the slightly different doses of forecasted on B 12 do make a difference in terms of who is more successful versus not now, to clarify this question, what we need is another trial. Distant, different doses off fully Cassidy and Different does to be 12 to see where our findings course stand up to the ultimate test of off. We're not their truth, but they definitely are suggested. There's E. I think it's also important to mentions where things they're unlikely to make more benefit right dunder and like me to help you much more in terms of fertility. On one of them is a very popular vita, which is vitamin D, so there has now fairly consistently trouble. You know, the effects of vitamin D on reproduction, so most of the initial Lisa shirt on animal production. Looking up at the underlying biology has shown that kind of these actually crucial for brushing you're really deficient. Then you do. Definitely. It's a vitamin D deficiency is not consistent with reproduction. You Tony violently for reproduction.

spk_1:   48:24
But what? How do we define deficient? Isn't that kind of? Therein lies the rub

spk_0:   48:29
that is one of things. But you folks specifically on studies among couples undergoing a RT, which is right, there is actually a surprising amount of research. What the literature has shown is that when you use heater, the Iowa mortgage and open society carbs or our efficiency, it doesn't matter which one of these. You do see a benefit of biting off Mindy when you're comparing. Women who are deficient versus women were not bright, meaning you have really most force of me. The government says you had a vitamin D supplement on Get your troubles beyond the very low thresholds. But when you look at couples who are we came to replete range off serum vitamin D, there doesn't seem to be much more benefit to gain right, so you may gain in terms off other potential benefits but probably not interested in production. So if you get screening could ever divide us where the fish were insufficient, then a prominent vitamin D problem makes sense if you're within the normal range already getting additional vitamin D A probably already would be getting from diet plus phoner and the others thinking he's probably not gonna make much more difference in approach.

spk_1:   49:47
Okay, let's talk about fish oil. You've talked about the importance of fish for people who do not eat two or three servings of fish. And let's be honest, it needs to be the high fatty fish to really get the most value out of it. Way run into problems with contaminants and and medals and things such as that. So for people who are wanting to increase and get the omega six fatty acids of fish, does fish oil supplementation help?

spk_0:   50:16
So the investments And, uh, we haven't Daddy's on the milk on on the male end, we do know that official supplements do have a point and a full effect off fish itself. If anything, they might do Ah, little better. Yeah, done. Fish itself. So so official. Something has worked really, really well on man turned something prudence in Bali on Fino. And there's less data at the moment, right? So, for example, something wrong. Mice, trials and crew in that quote crime reveal where fish wolf trials. But there's so few official trials on exclusively that it's hard to tell where not the official specifically are supposed to are things that are being clearing in supplements that include officials. Part of formulation might be the thing that's been tricked.

spk_1:   51:09
Okay, what about Coke You, Tim

spk_0:   51:12
and Cokie? Then there's lots of evidence on the mail and that eating proof, singing quality S O If thats target, that's fine. But there are no trials looking Coke. A tent on the male end. We like bird for pregnancy of the outcome, even

spk_1:   51:29
if you mean the female and didn't

spk_0:   51:31
both male and female rapper S O. The president got males in trials of Lucas's body has outcomes of variables comet. But there's also trials where the man he's being supplemented but not the woman to look at a couple welcomes. Right to say Well done are supplementing demand Li er, fish, oil or multimillionaire whatever impacts the couple's ability to become pregnant. So in

spk_1:   51:57
the same. You're speaking of Kojak, you 10 as well, so it may improve semen quality, but there hasn't been any indication that improves pregnancy rates in

spk_0:   52:06
general. Exactly. On the question is what the white stand doesn't prevent. Soon body improves your chances of becoming prayer. Yeah, and it turns out it's it's it depends indefensible. How Where do you start? Where do you in? All right, so let's say, because it's very, very friend. Thio, let's say that you're improving Senate body by an absolute Monda. You're improving sperm concentration by a 20 million sperm per mil, Right? Great to start with five million, I go to 25. That's an enormous change. And to start with 150 I end up with 100 75,000. It's the same change, but the person was definitely benefit the most. Is the guy who served five months and following the first guy that's coming out of enormous difference in his chest? Father in a pregnancy. But this on the second guy, he probably no different

spk_1:   53:03
for women. Is there any indication from the from the research that you've read and you read it all, is there the indication that co Q 10 would be Ben, a supplement that women who are undergoing treatment we're trying to conceive naturally.

spk_0:   53:18
So again, it's one of us. Those I put in the same bag off. We don't know, right? So it's There have been some trying to get a Coke you 10 specifically or in combination with our with other. And there's air, not enough nutrients. Eso as a whole and everything the same bag and say We'll just feeding this givens somebody appeal. We saw my furniture and help me was like Yes, he said Coca 10. But we don't know. Maybe, but we will.

spk_1:   53:48
Okay, what about? And this 1 may be more controversial than the other ones. D h e a and I can't pronounce the the scientific that the chemical name.

spk_0:   53:59
Yeah, again, I'm gonna sit down, going to goes for die one. There's I think we were still for the same bag off. We really don't know and for the most part, there many of the trials that have been done at these particular supplements as well as under something. Then tell us frond how strong commercial bias so even summarizing the evidence is is difficult So it leaves us with the unfortunate conclusion, saying, Well, we know something helps. We just don't know what it's

spk_1:   54:32
Okay, So what supplements Then we'll let you have the final say. Then what supplements would you recommend other than a basic prenatal vitamins?

spk_0:   54:41
I actually think nothing. I think that that most of benefit well, they probably comes from what you would find on a standard pre natal day. Really, even the ones for which we find the strongest evidence, which we think Akasaka Barber to treatment wishy, aren't they transcend both the one carbon metabolism so falling six b 12. The differences are between going from a standard pre me as a standard multivitamin to a standard prenatal or to even prescription prenatal, which has a little bit more forecast over 12. So it's nothing that it's not available rate and the differences so they're getting getting the specific information on what's the right does is something that probably be figured out. But it's not gonna happen in the next. This is gonna happen any time soon, so in the meantime, you're after making a decision for yourself today. I think that if you go with a standard prenatal, probably just us good on up to they with science that you spend hundreds of dollars for something that may be just same thing but sold under a different brown.

spk_1:   55:59
Well, thank you so much, Dr Jorge Navarro, who is the associate professor of nutrition and epidemiology at the Harvard School of Public Health and Medicine at Harvard Medical School. We really appreciate your input and your in your wisdom and your ability to have dissected and read through all of this research. It was great. Let me remind everyone that views expressed in this show are those of the guests and do not necessarily reflect the position of creating a family, our partners or underwriters. Also keep in mind that the information given in this interview is general advice. To understand how it applies to your specific situation, you need to work with your infertility professional thank you guys for listening, and I will see you next week