Thank you for posting this case here. Anytime one is encountering a chronic painful condition such as endometriosis, and the painful emotional issue of infertility it is important to have a broad range of providers in the support network. If she is not working with a counsellor or therapist to address the emotional challenges that are arising, it should be recommended that she include this as a part of her supportive team. Other activities to support stress reduction such as gentle yoga or meditation are also very important as you support her in these challenges, as well as for the reduction of immune activation.
One of the safest things to do when supporting any client who is seeking to become pregnant is to address diet. And given that antibodies of some form have been found which are associated with her foetal loss, directing this woman towards an anti-inflammatory diet, or an autoimmune-specific directed diet such as the Autoimmune Paleo diet may be supportive.
Autoimmunity and the presence of autoantibodies have been suggested as a possible mechanism of IVF failure. There are contradicting data regarding the importance of certain antibodies to damage directly the preimplantation embryo, interfering with implantation
process or formation of placenta. Consequently, the overall activation of the immune system in female infertility has been suggested. Tissue-specific autoimmunity appears to be additionally dependent on local factors, including infection-related tissue damage and iatrogenic manipulations. The issues of endometriosis and related surgeries thus may be contributing factors, although a higher level of autoantibodies have not been demonstrated in women with endometriosis and infertility.
Haller-Kikkatalo K, Salumets A, Uibo R. Review on autoimmune reactions in female infertility: antibodies to follicle stimulating hormone. Clin Dev Immunol. 2012;2012:762541. https://tinyurl.com/l82tfkx
Martínez-Román S, et al. Immunological factors in endometriosis-associated reproductive failure: studies in fertile and infertile women with and without endometriosis. Hum Reprod. 1997 Aug;12(8):1794-9. https://tinyurl.com/kegze76
It is hard to distinguish from your description of her case if she actually has significant ovarian tissue in her body from which her eggs are being harvested, or if they have been banked prior to removal. I will assume that they are being harvested and thus relay the information that may be pertinent to egg quality as well.
Supplementation with DHEA has been shown to have positive effects on fertility outcomes with IVF. Supplements that support DHEA levels include adrenal cortex glandular, and 7-keto DHEA. DHEA is the major product of the adrenal cortex, and over 99 percent of it is sulfated (seen in serum as DHEA-s) before secretion. As supplementation with glandular substances such as adrenal cortex have not been investigated in pregnancy, supporting her until a missed menses or suspected conception with discontinuation at this time would be appropriate.
Tartagni M, et al. Dehydroepiandrosterone decreases the age-related decline of the in vitro fertilization outcome in women younger than 40 years old. Reprod Biol Endocrinol. 2015 Mar 9;13(1):18. http://tinyurl.com/luw9gbn
Tartagni M, et al. Potential benefit of dehydroepiandrosterone supplementation for infertile but not poor responder patients in a IVF program. Minerva Ginecol. 2015 Feb;67(1):7-12. http://tinyurl.com/kbrefnw
Homocysteine levels have been shown to be significantly higher in infertile women. This may be associated with genetic variants associated with folate pathways. Maternal DNA damage has been shown to be positively correlated with homocysteine. Supporting women dealing with infertility with methylated forms of folate and B12 as well as B6 supports the reduction of homocysteine and may improve fertility outcomes.
Lim MY, et al. Vitamin B Status and Serum Homocysteine Levels in Infertile Women. Korean J Nutr. 2004 Mar;37(2):115-122. http://tinyurl.com/lbmz24w
Forges T, et al. Impact of folate and homocysteine metabolism on human reproductive health. Hum Reprod Update. 2007 May-Jun;13(3):225-38. http://tinyurl.com/lp8sp9q
Bennett M. Vitamin B12 deficiency, infertility and recurrent fetal loss. J Reprod Med. 2001 Mar;46(3):209-12. http://tinyurl.com/pse8nby
Furness D, et al. Folate, vitamin B12, vitamin B6 and homocysteine: impact on pregnancy outcome. Matern Child Nutr. 2013 Apr;9(2):155-66 http://tinyurl.com/mf2w92s
Choline, a component of lecithin, is a methyl donor. Diets rich in choline and betaine were linked to lower levels of inflammatory markers, including C-reactive protein, homocysteine, interleukin-6, and tumor necrosis factor. Choline is important for homocysteine metabolism during pregnancy, and the diets of many are deficient. The choline metabolite betaine is a source of methyl (CH3) groups required for methylation reactions. DNA methylation that occurs during embryonic and foetal development modulates gene expression, cell differentiation, and the formation of organs.
Zeisel SH. Choline and phosphatidylcholine. In: Shils ME, Olson JA, Shike M, Ross AC, eds. Modern nutrition in health and disease. 9th ed. Baltimore: Lippincott Williams & Wilkins; 1999:513-523.
Detopoulou P, et al. Dietary choline and betaine intakes in relation to concentrations of inflammatory markers in healthy adults: the ATTICA study. Am J Clin Nutr. 2008 Feb;87(2):424-30. http://tinyurl.com/ospnksq
Pregnancy and Lactation: Choline. Linus Pauling Institute. Micronutrient Information Center. http://tinyurl.com/ogaq2hf
Up to 50-60% of recurrent pregnancy loss may be attributable to oxidative stress. Observational studies have confirmed a link between antioxidant-poor diet and recurrent pregnancy loss. Antioxidant therapies have been associated with decreased time to pregnancy in various settings. Melatonin has actually been suggested as a possible antioxidant therapy due to beneficial effects on reproductive physiology. Selenium,CoQ10, vitamin E, vitamin C, and beta carotene are some other antioxidants that may have a relationship with fertility.
Ruder EH, et al. Female dietary antioxidant intake and time to pregnancy among couples treated for unexplained infertility. Fertil Steril. 2014 Mar;101(3):75. http://tinyurl.com/lpmkj5u
Tamura H, et al. Melatonin as a free radical scavenger in the ovarian follicle. Endocr J. 2013;60(1):1-13. http://tinyurl.com/qj5n4xy
Sekhon H, et al. Female Infertility and Antioxidants. Current Women’s Health Reviews. May 2010; 6(2):84-95. http://tinyurl.com/qzjmq2t
Mistry HD, et al. Selenium in reproductive health. Am J Obstet Gynecol. 2012 Jan;206(1):21-30. http://tinyurl.com/nd6mby2
With cycling women who seek to improve fertility I also recommend the use of raspberry (rubus) as a tea or other form of supplement. Raspberry has much historical use as a uterine toner, and also has antioxidant effects. I also like to recommend acupuncture with a practitioner who is experienced in working with infertility as this may help to create the energetic shifts that are necessary for a successful pregnancy.
As you work with this woman to support her with concerns of infertility and endometriosis you may wish to review the other discussions on the Clinical Education group as they cover many this topic and many approaches to assessing and supporting clients with these issues. You can find more information on this topic by using the search function on the upper right hand corner of the page (magnifying glass). Some extensive discussions can also be found at the links below:
Female early 30’s stage 4 endometriosis – https://tinyurl.com/grmtwer
Help with endometriosis and unexplained fertility – https://tinyurl.com/zen5bjd
Suggestions on medical journals & evidence based research on NT for supporting fertility – http://tinyurl.com/hm8c9hx
35-year-old woman with fertility issues – http://tinyurl.com/jadw8zh
Female infertility with numerous complications: Sjogren’s Syndrome, Fibroids, Unicornuate uterus and suspected Adrenal Fatigue – http://tinyurl.com/zsavlzn
The following supplements are suggested for you to consider in light of your relevant expertise and understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
Coenzyme Q10 with Tocotrienols (ARG): 3 capsules once a day with meals. http://tinyurl.com/n6g6ryx
Acetyl-Glutathione (ARG): 1 tablet twice daily. http://tinyurl.com/n68cpfy
Se-Zyme Forte (BRC): 1 – 2 tablets daily with food. http://tinyurl.com/k8f4vrh
And on an ongoing basis through pregnancy consider:
Phosphatidyl Choline (ARG): 2 tablets with meal twice daily. https://tinyurl.com/l6rnsh5
Super D3 (ARG) – 1 to 2 capsules daily with food (dosage to be determined by current serum level) – http://tinyurl.com/n4lrrf7
B12 2000 Lozenge (With/B6/Folate) (BRC): 1 sublingual lozenge daily. Provides B12, folate, and B6. http://tinyurl.com/kwaafuh
ProOmega™ (NN): 2 softgels twice daily (2000 mg total combined EPA/DHA). http://tinyurl.com/7t9myqe
Culturelle® Lactobacillus GG (ARG): 1 capsule with breakfast and before bed. http://tinyurl.com/38q7u7x
Please consider these suggestions in light of the other clinical information pertaining to this individual. If you have any more information about the specific problems this individual is experiencing, further refinement of these suggestions may be considered. I hope this information is helpful, and if you have any further questions or information specific to the problems this individual is experiencing, please do provide feedback.
Registered Nutritional Therapist Helen Perks is collaborating with Clinical Education to bring you the first-ever Functional Medicine book club for Practitioners.
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