Vitamin Recommendations for Conception and Pre-pregnancy

I believe it is beneficial for all women, pre-pregnancy, as a general rule to take the following:

1. Prenatal vitamin with 800-100 micrograms of folic acid or a general multi-vitamin that has this is in. These can be obtained over the counter and reading labels will provide the appropriate information.
2. Omega 3 capsule 1000 mg, two per day. These can be obtained over the counter also.
3. A B-complex vitamin (also over the counter) that has folic acid, B-6, B-12 at minimum. One such simple B-complex vitamin with the combined prenatal vitamin/multi-vitamin noted above is a good recommendation.
4. Calcium/Vitamin D 1000-1200 mg per day (any over the counter supplement is sufficient).
   
   These are simple, general recommendations that, for most patients, are sufficient and beneficial. If you are taking specific medications, it is always wise to speak with your physician regarding such medications and vitamin supplementation. Other supplements (like soy, etc) we do not feel to be detrimental, but their benefit is not known either. The supplements above and otherwise that you may be taking are not thought to be the ‘make or break’ for fertility treatments, but are a general health recommendation.
   
   Please feel free to contact me via e-mail at pahlering@sherinstitute.com or via phone at (314) 983-9000 if you have questions regarding any of this information. Visit the SIRM website at www.haveababy.com for additional information on fertility and conception.

Important Fertility Considerations For Patients Getting Chemotherapy

• Chemotherapy/ radiotherapy always adversely affects reproductive function
• At least 3% of patients with breast cancer are peak reproductive age (25-35 years)
• We can preserve fertility for future; this is for females (egg freezing and other techniques) and males (sperm freezing)
• Although chemotherapy may not always result in premature menopause, it always has some affect on fertility, namely loss of ovarian follicles to some degree. It often causes ‘pre-menopause’ which can be reproductively devastating as well. FSH level alone is not a good indicator of ovarian problems or premenopause.
• Chemotherapy adds at least 10 years to ‘real age’ or ‘ovarian age’ in terms of reproductive function. A 30 year old now behaves reproductively like someone that is 40 years old.
• With women that have breast cancer and carry the BRCA gene, we can detect this gene in embryos using preimplantation genetic diagnosis (PGD) techniques through IVF, reducing if not eliminating the risk of transmission of the gene to offspring.
• Ovarian dysfunction post-chemotherapy is related to patient age at the time, type of chemotherapy/radiotherapy, and ovarian function at start of therapy (this can be assessed rapidly - generally in one day - with simple tests prior to therapy)

Please contact us at SIRM-St. Louis at 314-983-9000 if you are preparing to undergo cancer chemotherapy or radiotherapy. We will expedite a consultation and provide you with information and options for fertility preservation. You can email me directly at: pahlering@sherinstitute.com

ENHANCING EGG QUALITY

We all understand the concept of the biologic clock and how it affects fertility and reproductive potential. Unquestionably the so-called biologic clock is the single most important influence on fertility potential for any given couple. Problems with quantity and quality of eggs are the most important issues to be assessed and discussed with any couple considering fertility future or reproductive abilities. This is regardless of any male factor infertility that may or may not be present.

Ultimately, egg quantity and quality are the major determinants of success in natural conception or any other treatment for a couple (Clomid, IUI, injectable medications, and even IVF).

Patients often ask me, “How do we improve egg quality?” People often ask about diet, exercise, etc., and how this may improve egg quality/competence. Certainly, as with male factors, environmental and lifestyle issues may influence ovarian function and subsequent egg quality. However, assessing this scientifically and making the determination of how these influences affect eggs is quite difficult. All doctors would advocate a so-called “healthy lifestyle” with diet, exercise, etc. This is not only potentially beneficial for egg quality, but certainly beneficial on several other levels and therefore, is recommended.

When people ask about improving egg quality, what they usually mean is improving the chance that any given egg that is fertilized will develop into an embryo that will subsequently make a baby. Again, this is very difficult to determine and obviously very complex. In the end, there is some evidence in the context of IVF that may be beneficial to some patients, depending upon the details of their situation:

1. Human growth hormone. HGH has been shown in the context of IVF to have a positive influence on egg factors, thereby increasing the probability of success in certain cases with IVF.
2. Antioxidant supplements. The evidence supporting the use of antioxidants in female factor is early but there may be some suggestion that it is beneficial. Obviously, there may other health benefits from taking these supplements; and therefore we often use them a lot.
3. Lifestyle Factors. Not doing things that can have a negative influence such as smoking, exposure to toxic chemicals, etc. Discontinuing such lifestyle factors may remove negative influences and in the end have a net positive effect on oocyte quality and fertility potential. In males we often recommend the same; if there is any level of male factor, the principles are similar.

Hopefully, this is of assistance with information. Please feel free to contact me or visit the the Sher Institute website at www.haveababy.com and my male infertility blog at www.maleinfertility.info. There are lots of other informational tools on many subjects at these sites as well.