After about a year of trying to conceive, a failed IVF transfer and a few embryos on ice, I decided to call in the experts, and by experts I mean a really reputable naturopath dealing with fertility patients. Why a naturopath and not my GP you ask? Because in my part of the universe (British Columbia, Canada), there is a health care and housing crisis and you may wait for years for a family doctor. So, Naturopath it was. Not to mention, most GPs will not support the use of supplements because they aren’t FDA or Health Canada approved or monitored for quality control – I learned this recently, apparently supplements can completely lie about what’s in them (within reason) and get away with it. Shop at your own risk.

Not everyone believes in supplements, and that’s totally fine. I don’t in a lot of cases, however in the case of my infertility, I am of the mind that it cannot harm my odds. Especially those backed by science. So here I’ll do my best (as a person who failed science in high school) to break down what science I found around taking these mysterious pills.

Currently my IVF supplement list is as follows and has come from a few sources – I have found scholarly articles and studies on some of them, my naturopath suggested others, and the book “It Starts with the Egg”, which is highly controversial, recommended a few others. I didn’t take this book as gospel by any means but it has helped break down some of the science for me.

Also note, some of these are good for pregnancy as is, or trying to conceive, while others benefit blastocyst production and the endometrium for IVF/Assisted Reproductive Technology patients.

• Daily Prenatal Vitamin (not brand specific, although I am currently taking Materna because it also contains a small amount of Iron and I need as much Iron as I can get without taking a hefty supplement (IBS be damned).
• Fish Oil/Omega 3-6-9 – I am taking 1000mg of this a day. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9308390/, https://www.fertstert.org/article/S0015-0282(19)30810-6/fulltext)
• CoQ10 in the form of the readily absorbed Ubiquinol – a very large dose during egg retrievals of 600 mg a day, split into 3 doses a day of 200mg each. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5870379/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6210096/)
• Active Folate – Methylated Folic Acid 1mg (also more readily absorbed than regular Folic Acid) (more so for regular pregnancy should it occur, but it could also help IVF https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4172634/)
• L-Arginine – MASSIVE dose of this for egg retrieval – 6000 mg a day. It can get costly. I find the capsules to be the easiest to stomach, but you can also consider a powder supplement mixed in liquid, but it is BITTER. I mix with a ton of lemon or lime juice and water when I do the powder. I try to do capsules whenever possible though. I also try to mix this throughout the day to make it easier to handle. (https://academic.oup.com/humrep/article/14/7/1690/2913125, https://pubmed.ncbi.nlm.nih.gov/32977253/)
• Vitamin E – 400 mg (https://www.imrpress.com/journal/CEOG/48/2/10.31083/j.ceog.2021.02.2207/htm, it is also good for sperm quality (https://pubmed.ncbi.nlm.nih.gov/34671676/)
• Zinc 15-25 mg (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8599883/, also good for male fertility and immune response)
• Vitamin C 1000 mg (Great for post FET https://www.longdom.org/open-access-pdfs/effect-of-post-embryo-transfer-vitamin-c-supplementation-on-the-outcome-of-invitro-fertilization.pdf, https://egyfs.journals.ekb.eg/article_170463_2d039f08729155c6101049ea92985f35.pdf)
• Women’s Probiotic – I take Renew Life Ultimate Flora Women’s Extra Care Probiotic because it has a really good mix of the flora you want for your lady bits, and it is a large dose at 50 billion. (the studies are mixed on this, but I take it as a just in case, and for my IBS and gut health. Some doctors will actually recommend a vaginal suppository of probiotics specific to the vaginal flora to help balance bacteria, mine included. This dose is a ten day of FloraSAP and it is taken before FET).
• NAC (n-acetyl-l-cysteine) 600 mg (https://egyfs.journals.ekb.eg/article_170463_2d039f08729155c6101049ea92985f35.pdf, https://www.fertstert.org/article/S0015-0282%2804%2901904-1/fulltext)
• Vitamin B12 200 mcg (https://raf.bioscientifica.com/view/journals/raf/4/3/RAF-23-0015.xml)
• Vitamin D3 2500 IU (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8969598/)
• 81mg Aspirin (low dose – NOTE – check with your doctor before taking this, and absolutely advise any medical professionals that you’re taking it as it can effect your procedures (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5604627/,
  
  This is also a really good article on a number of supplements and their uses for fertility: https://academic.oup.com/humupd/article/13/2/163/661418

A caution for those taking supplements for egg retrieval and FET – consult your fertility doctor because some of these supplements should not be taken during pregnancy or in preparation for it. Some may simply have no effect, and there’s no need to take them once retrieval has been completed (or IUI!).

So there we have it, the 700 pills I take a day. I recommend doing the research yourself to decide if any of these are right for you or not. At this stage in our IVF journey I’ll take any help I can get so I was willing to use the kitchen sink approach.

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I started my stims on Saturday Nov 11th for our third egg retrieval. I joked last cycle that I could do egg retrieval stims forever, I just hated transfers. But then we had a cycle failure, and now it all feels a lot more stressful to endure with the knowledge that it very well could fail again.

“Think positive thoughts!” they say. I have tried my friends, oh have I tried. I do have hope, but it’s not blind. It’s realism with a sprinkle of hope. Annnd maybe a sprinkle of pessimism at times. But I swear I try to keep it skewed towards hope.

The thing that surprises me about this attempt is that I am in it, but it doesn’t feel like I am in it. I guess I have gotten slightly desensitized to the act of injecting myself multiple times a day, and I have gotten so used to being on this rollercoaster that it all just feels normal to me. That is a bit sad to think about. I never wanted this to be my normal.

So far the medications this cycle have been tolerable. My priming meds had zero side effects, which is WONDERFUL, because I had primed with birth control previously (this time testosterone and estrogen), and birth control is my nemesis. It did such a number on my mood and thoughts. I felt depressed and moody constantly. I felt normal, maybe even better than normal on this new combo. I stopped my priming meds on November 7 and began my stims on Nov 11.

Stims so far have been… okay. This time I have to take injections in the AM and PM (diff meds). Right now, one injection in the morning, along with 5 pills, and then supplements (19) mid day, and another two injections and 2 pills before bed. I felt great day 1-2. Day 3 I started to get fatigued and also got really stomach sick (could have been IBS, but it hasn’t been bad lately so not totally sure). It sure beats constipation though, which I know is on its way. Day 4 (today) I have been wiped of energy entirely. Just tanked. Walking the dog was a feat and I was yawning all day.

There are a few things/rituals I am doing this cycle. I figured I’d share my routine here in case it helps anyone on their own journey.

– I am taking 8 million supplements (I’ll do a deep dive into these in my next post). I will mention that my doctor has me on CoQ10 (Ubiquinol 600mg a day, taken 3x daily, and 2x 81mg Aspirin – not recommended unless your doctor directs you)
– I have been doing acupuncture with a fertility specific practitioner who also did IVF herself, initially weekly during priming, and now twice weekly during my stim protocol. Some people doubt the effectiveness of acupuncture since it doesn’t give super immediate or visible results, but studies have shown it can help with blood flow to the uterus, and it has benefited those doing embryo transfers (some studies below).
– Exercise – I have been *trying* to do a minimum of 20-30 mins of low intensity exercise daily. Whether I am working my butt off at a photo session, or walking the dog on a brisk walk, having the goal helps. This also gets the blood flowing.
– My acupuncturist (actually, her alternate who I booked during her time away) suggested doing a hot foot bath in the evening, covering up to your lower calf with hot water for 10-15 mins, then laying down and elevating the legs above the chest/head for 10-15 mins. Apparently in Chinese medicine this can be shown to help with blood flow and getting fluids moving through your body/liver. It also helps with sleep!
– Fluids – Lots of them. I am notorious for not getting thirsty but during stims I have to be careful with my liquid intake, or I’ll get suuuuuper constipated. More on the in the next point.
– Fibre. So much fibre. I try to add things that are bulking agents to my diet during stims, whether its psyllium husk, or more nutritionally dense things like chia seeds, hemp seeds (this combo always gets things moving along), peas, etc. It’s better to have soluble fibre or bulking nutrient rich foods than things like colace, restoralax or similar. Pro tip – start fibre long before you *need* it. Even with my regimen I still get painfully backed up by retrieval time.
– Sleep – Sleep as much as humanly possible. I sleep a lot anyway. I have always been this way, requiring 8-9 hours minimum a night – during stims I sleep 9-10 ideally.

So my schedule has basically been monopolized with all of these tasks each day. If I am lucky I have time to go to the bathroom or get some work done (jokes, but it feels this way some days). It makes me wonder how so many people do it. I am grateful I make my own schedule and have nobody to answer to but myself and my clients (who are the best for the record).

What are your rituals/habits for Egg Retrieval in IVF? I’d love to hear them!

Acupuncture studies for IVF and FET:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458185/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142313/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6918533/

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