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Natural Fertility Support

Vitamin D Supplementation May be the Easiest Way to Prevent Miscarriage

By | Hormone Testing, Natural Fertility Support, Prevent Miscarriage, Women's Health | No Comments

Prior to 2018, two prospective studies had investigated a weak association between lower vitamin D concentration and pregnancy loss. This 2018 study found a fourfold risk of pregnancy loss with low vitamin D status.

In fact, every one-degree of vitamin D deficiency was found to be associated with a 1% increase in risk of miscarriage.

That’s insane right?

How does vitamin D help?

Miscarriage often results from inadequate development of the growing placenta, a process that requires vitamin D. Vitamin D is needed for angiogenesis, the formation of arteries. Learn about the other common causes of miscarriage.

Vitamin D also prevents preeclampsia later on in pregnancy; a condition causing elevated blood pressure and damage to organ systems like the liver and kidneys. It has also shown to prevent low birth weight and slow fetal growth.

Levels of vitamin D lower than 30 nmol/L (that’s 45 points lower than the minimum requirement) are associated with a fourfold increase in miscarriage rate.

If you live in Canada you most certainly are vitamin D deficient due to our brutal winters and lack of sunshine #wethenorth

But don’t guess. Get tested. We need to know how far below the threshold you are to predict your associated miscarriage risk.

A level of 100+ nmol/L has NO association with pregnancy loss.

Here’s an example of my lab work:

I have a modestly low vitamin D status (in the peak of summer I may add, so I can only imagine how low it was in the dead of winter.) My levels are 7 degrees lower than the minimum required level, which puts me at a 7% risk of miscarriage and a whole host of other symptoms like fatigue, depression, muscle pain, poor immune response, hair loss etc.

A note on supplementing with vitamin D

The brand matters. I have seen patients religiously take vitamin D purchased outside of a health food store or naturopathic clinic and the blood levels just don’t increase. Other naturopathic doctors will share the same experience. Don’t take any old vitamin D, use a reputable brand from your naturopath.  Vitamin D is a fat-soluble vitamin so it must come in an emulsified form (mixed with oil).

Want to learn more about lab tests for preventing miscarriage? Book an appointment with me.

What does AMH (ovarian reserve) have to do with natural fertility success? Not a whole lot.

By | Hormone Testing, Natural Fertility Support | No Comments

Let’s start with what AMH means

AMH stands for “Anti-Mullerian Hormone”, which is a hormone produced by developing follicles (aka eggs). AMH is used as a measure of ovarian reserve, as it is secreted by the follicles in the ovaries. The idea is that the more follicles you have, the higher your AMH value will be and the higher your fertile potential. The more eggs you have, the later you’ll go into menopause. A low value means a low number of eggs remaining, which means less fertile potential. This is all to a reasonable extent because there’s a condition that causes a higher than normal AMH value, and is associated with poor fertility, and that condition is Polycystic Ovarian Syndrome. Read about this hormonal imbalance.

AMH is a hormone test often included in a fertility work-up, and the result can scare the &*%$ out of you. We know we can’t change the number of eggs we are born with, so getting a low AMH result can be devastating. I have yet to test mine personally because I just don’t want to know!

But maybe we don’t need to know at all?

Maybe we don’t need to care about AMH?

Here’s why.

A study of 750 women conducted by the National Institutes of Health in 2017 has revealed that low AMH values do not significantly predict fertility outcome after 1 year of trying to conceive naturally. Here are the findings: after six cycles of attempting to conceive, results did not differ significantly between women with low levels (62% chance of conception) and normal levels of Anti-Mullerian hormone (62% chance). Even after after 12 cycles of trying, the difference in conception between high and low AHM was 82% versus 75%.

That’s pretty awesome news.

Even better news: the women in the study ranged from age 30-44. AMH is strongly correlated with age; in fact the reference ranges can be broken down by age in order to deem what is “normal”:

Age AMH (pmol/L)
< 33 15-48
33-37 12-32
38-40 7-21
41+ 3-18


But what we are learning is that even into your late 30s and early 40s, when AMH seems to be lower, it is NOT a predictor of poor fertility outcomes. Unfortunately, after age 45 it’s a different story, low AMH (and age alone) are certainly associated with negative outcomes.

So what’s the purpose of testing AMH?

AMH is a very useful predictor of IVF success and oocyte yield from stimulating medications. It can be used to determine the most effective dose of injections.

Take it home!

AMH is one lab test, and one tiny piece of the very complicated fertility puzzle. If you’re doing a medicated IVF or IUI cycle, your ovarian reserve matters and so does measuring AMH. If you’re trying to get pregnant naturally, and in the first year of trying, ovarian reserve doesn’t matter so much.

Want to learn more about lab assessments and your fertile potential? Book an appointment.

Your Natural Guide to An Easy Egg Retrieval

By | Fertility Acupuncture, Fertility Supplements, Natural Fertility Support | No Comments

Your Natural Guide to an Effortless Egg Retrieval

Did you know that the egg retrieval procedure is considered minor surgery? No to worry though, you’ll be sedated! (Which means don’t go alone, you’ll need someone to drive you home.) This blog is filled with tips and tricks to get you through the procedure with knowledge and ease. No surprises here!

What’s happening exactly?

Your eggs are typically retrieved through transvaginal ultrasound aspiration (the same ultrasound you’re already used to.) A fine needle is inserted into the ovaries to extract the eggs. In certain circumstances, the ovaries are accessed through the abdomen through laparoscopic surgery. The procedure itself typically takes 30 minutes.

Sperm is retrieved at the same time, so make sure your partner abstains for the recommended amount of time and is ready to provide a sample!

You will need to take the day off for the procedure as you’ll be recovering from anesthesia and experiencing a moderate amount of cramping.

Is there anything to do to prepare?

Of course! Here are my top tips on how to prepare for the egg retrieval procedure, and recover like a champ

Before the Egg Retrieval

  1. Sleep peacefully

You’ll have a faster recovery when your body is well rested, but you might be nervous the night before! Ease your nerves with a few soothing yoga poses like lying with your legs up the wall, or doing some deep breathing in child’s pose 10 minutes before bedtime.

  1. Stay hydrated

Dehydrated tissues are more sensitive and pain medications & anesthesia can cause dehydration. I know you’re used to those full bladder ultrasounds so you should be a water drinking pro by now!

  1. Pack your diet with fiber

Pain medications & anesthesia can also cause constipation. If you eat lots of fiber in the days leading up to the retrieval it will make going to the bathroom a lot easier. Incorporate foods like chia, flax, oatmeal, fruits and veggies, lentils, chickpeas, quinoa… the list goes on. While you’re eating those fiber rich foods, prepare your meals for the day of your retrieval ahead of time (or better yet get someone else to make them for you) to make healthy eating easier.

  1. Stay calm with breathing techniques and meditation

You’ll have to be at the clinic early, why not use the wait time to keep yourself calm and centered. There are so many amazing apps you can download that will guide you through quick and easy relaxation techniques to try before the procedure begins. Some of my favourites are: Headspace, Calm, and Aware.

  1. Go for regular acupuncture

If you’ve read my other blogs you’ll already know the incredible benefits of fertility acupuncture and acupuncture for IVF. Not only will it improve the delivery of meds and nutrients to the pelvis with ample blood flow, it will ease your recovery after retrieval through tissue healing and relaxation. One to two sessions per week, leading up to the day of your retrieval, is ideal. If in extreme circumstances you cannot be sedated, acupuncture can be performed during the retrieval procedure for pain management.

After the Egg Retrieval

  1. Ready your heating pad & castor oil

Expect to experience some mild to moderate cramping after the surgery. A heating pad can ease the muscle spasms. To make the relieving effects stronger, lather some castor oil over your pelvis and apply a cloth and heating pad over top.

  1. Invest in ginger capsules

 

You may be prescribed over-the-counter analgesic medications like Advil and Tylenol to ease cramping. Ginger is also an extremely effective analgesic/anti-inflammatory and in high doses does not cause bowel or gastrointestinal symptoms. It will also ease any post-surgery nausea. Fertility supplements can be very helpful.

  1. Have some organic pantyliners handy

You might notice a little bit of spotting the day of the surgery. I find organic liners to be a lot less irritating than conventional liners. Treat yourself to some new ones!

  1. Cue up your favourite movies

You typically won’t need to take more than one day off to recover, but you will need the day of to recuperate. Get in your PJs and slippers and enjoy your favourite chick flicks and Netflix B-list movies (does anybody else watch those but me?)

  1. Get some more acupuncture

Here it is again! You’ve already done 12 sessions of acupuncture to optimize your eggs, now acupuncture can be used to relieve post-surgery symptoms. If you’re experiencing constipation, nausea, cramping, bloating, etc. acupuncture is your best friend.

The more in-control and in-the-know you are regarding the egg retrieval process, the better you will feel. I’m here to support you every step of the way. Book an appointment with me here

How the Right Diagnosis Can Prevent Miscarriage: The Top 10 Causes

By | Natural Fertility Support, Prevent Miscarriage | No Comments

If I had to choose an area of fertility medicine that is most near and dear to me, it’s working with pregnancy loss. I’m fascinated by each of my unique patients, the vast possibilities, and the ever-changing research. There’s just so much that we don’t know about what it takes to carry a baby to term. If you’re working with a fertility clinic you’ll notice there’s a whole lot of observation during the first two weeks of your cycle, and once you’ve ovulated (or post embryo transfer) there’s not much monitoring after that! Rest assured, this article isn’t about what we don’t know but rather what we can. Fifty percent of miscarriages may not have an identifiable cause, but that means 50% of them do.

Let’s go over the stats here for a moment.

Recurrent miscarriage is considered two or more consecutive miscarriages, however diagnosis and treatment is often not suggested until three consecutive miscarriages have occurred. Not because you should have to suffer, or because your doctor doesn’t care, but because there’s a 15-25% chance of any pregnancy ending in miscarriage. The most common cause of miscarriage is fetal chromosome abnormality, which is about 60% of the time. While we’re going over the terminology, a “chemical pregnancy” is considered a miscarriage before 5 weeks, however it’s still a miscarriage to me.

Factors to consider in miscarriage:

  1. Did you have an early loss in the first trimester, or a late loss in the second or even third? Different diagnoses are more likely in late pregnancy versus early pregnancy.
  2. Do you already have a child, and in trying to conceive again have a miscarriage? Having a baby already can rule out some causes of miscarriage.
  3. Do you have a family history of autoimmune, hormonal, or blood disorders? That makes some of the diagnoses more likely.

Factors NOT to consider in miscarriage:

  1. You haven’t “stressed” yourself to the point of miscarriage. I promise!
  2. Exercise is always healthy! You don’t need to avoid physical activity
  3. Progesterone, in any form, is not always the answer. A 2008 Cochrane review found prophylactic progesterone to have no effect on preventing miscarriage, more on this soon.

In my practice I don’t wait the “3-loss” rule to begin treatment and diagnosis, if you’ve experienced a loss and you want support, you deserve that support right away.

Now let’s get into my Top 10 Most Common Causes of Miscarriage. The majority of the list can be diagnosed with blood work or imaging. The entirety of the list can be treated!

  1. Anti-phospholipid syndrome (and other causes of poor placental perfusion)

    This is a syndrome where antibodies attack components of your blood vessels. Anti-phospholipid antibodies include: lupus anticoagulant, anticardiolipin antibody, and anti-B2 glycoprotein. These antibodies interfere with uterine blood flow, more specifically the development of the trophoblast, which are the cells that form the placenta.

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  2. PCOS

    The foundation of PCOS is insulin resistance, which interferes with ovulation, follicle maturation, and maintaining a pregnancy. Insulin resistance, and the corresponding hormonal imbalances, cause poor egg quality, pelvic inflammation, and progesterone deficiency – all which contribute to miscarriage. I will add that metformin has not been found to be beneficial in preventing miscarriage in PCOS, but there are many naturopathic therapies that have!

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  3. Chromosome translocation (it’s not all about the woman!)

    This genetic condition can occur in men or women. If you have a chromosome translocation you won’t have any signs or symptoms, but some of the gametes you produce (i.e. egg or sperm) will also have the translocation. Unfortunately, if you’re conceiving naturally it’s a game of chance as to whether or not you will produce a viable embryo. IVF with PGS (pre-implantation genetic screening) can determine whether your embryo has a viable number of chromosomes.

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  4. Hypothyroidism & thyroid antibodies

    TSH greater than 4.0 during pregnancy is associated with miscarriage, preterm birth, premature rupture of membranes, and placental detachment. Thyroid peroxidase antibody, found in Hashimoto’s thyroiditis, causes similar outcomes.

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  5. Anatomical causes: fibroids, polyps, uterine malformations, cervix incompetence

    Anatomical issues are more commonly at play during second trimester losses, and the outcome depends greatly on the location of the finding. I won’t go into the details here as they are easily diagnosed, and quite obvious, through imaging and pelvic exam.

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  6. Poor quality sperm (it’s not all about the woman!)

    The best test for measuring sperm quality is called sperm DNA fragmentation. Greater than 25% fragmented DNA indicates poor quality. In my experience, beyond lifestyle factors like diet and recreational drug use, medications are the most common culprit of increased DNA fragmentation. Anti-depressant medication, specifically SSRIs, cause statistically significant increases in DNA fragmentation as well as miscarriage.

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  7. Poor quality egg

    If only we had a test for egg quality like we do sperm quality! Age is the number one predictor for egg quality, steadily declining after age 35 – lucky us! But don’t worry, there’s lots that can be done!

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  8. Vitamin D deficiency

    One prospective cohort study identified vitamin D deficiency as a risk factor for miscarriage, preterm birth, and low birth weight. Adequate vitamin D levels, hard to come by in gloomy Canada, are extremely important when it comes to reproductive health. 1 nmol increase in serum vitamin D levels decreases miscarriage rate by 1%. Testing is clearly imperative!

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  9. Inflammation & oxidative stress

    Conditions like PCOS, listed above, and endometriosis cause increased uterine inflammation and oxidative stress. Inflammation can also be elevated in the presence of other autoimmune diseases during pregnancy. However, there is significant research on specific anti-inflammatories and antioxidants increasing live birth rate and preventing miscarriage in these scenarios!

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  10. Progesterone deficiency & hyperprolactinemia

    As I’ve already suggested in this article, progesterone supplementation only appears to be helpful when there is a progesterone deficiency. High dose progesterone supplementation is all too common and I often see the extremely uncomfortable side effects in my patients. It may be indicated in cases of recurrent miscarriage. I’ll also mention hyperprolactinemia here as elevated prolactin levels can suppress progesterone production and lead to deficiency.

Honorable mentions:

  1. MTHFR deficiency & elevated homocysteine

    MTHFR deficiency refers to a mutation in the gene “MTHFR”, responsible for metabolizing folate (a vitamin found in your prenatal supplement to prevent spina bifida). When folate is not metabolized properly, a build up of an amino acid called homocysteine results. Elevated homocysteine can cause blood clotting and inhibit uterine and placental blood flow.

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  2. Immunological cause

    I’m going to throw out some pretty fancy terms here: HLA incompatibility, anti-paternal antibodies, and natural killer cells. They’re all terms for potential immunological conditions that cause miscarriage, meaning the woman’s immune system is attacking the embryo. Currently there’s insignificant research to suggest any of the above cause miscarriage, and the treatment is theoretical as well.

    .

  3. Vaginal infection

    I’ve noticed many fertility clinics test for ureaplasma and mycoplasma, and treat both partners with antibiotics if present. There is no clear data that these infections cause miscarriage. I have mixed feelings about the results, as there are often comorbidities present in my patients who have been treated for these infections. However, untreated bacterial vaginosis can indeed cause early miscarriage.

As I mentioned previously, I wouldn’t provide you with this information if there were not ways to diagnose and treat the possibilities. You have options! Just book an appointment with me and let’s get started.

References
Iqbal, S., Ghani, F., & Qureshi, R. (2016). Frequency of Thyroid Peroxidase Antibody and its Association with Miscarriages Among Pregnant Women. Journal of the College of Physicians and Surgeons Pakistan26(10), 831-834.
Sundermann, A. C., Edwards, D. R. V., Bray, M. J., Jones, S. H., Latham, S. M., & Hartmann, K. E. (2017). Leiomyomas in pregnancy and spontaneous abortion: A systematic review and meta-analysis. Obstetrics & Gynecology130(5), 1065-1072.
Bärebring, L., Bullarbo, M., Glantz, A., Hulthén, L., Ellis, J., Jagner, Å., … & Augustin, H. (2018). Trajectory of vitamin D status during pregnancy in relation to neonatal birth size and fetal survival: a prospective cohort study. BMC pregnancy and childbirth18(1), 51.
Loss, E. P. PRACTICE BULLETIN.
EVALUATE, W. (2012). Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertility and Sterility98(5).
El Hachem, H., Crepaux, V., May-Panloup, P., Descamps, P., Legendre, G., & Bouet, P.-E. (2017). Recurrent pregnancy loss: current perspectives. International Journal of Women’s Health9, 331–345. http://doi.org/10.2147/IJWH.S100817
No, G. T. G. (2011). The investigation and treatment of couples with recurrent first-trimester and second-trimester miscarriage. April 2011.
Haas, D. M., & Ramsey, P. S. (2008). Progestogen for preventing miscarriage. Cochrane Database Syst Rev2.

The Top 10 Questions to Ask Before Starting IVF

By | Natural Fertility Support | No Comments

IVF is a big step, physically and financially, and you likely have questions before you commit but you just don’t know what to ask. Of course, how do you know what you don’t know?! The purpose of this blog is to inform you about the IVF process and provide you with some preliminary questions to ask your Reproductive Endocrinologist (RE). It’s important that you feel empowered and in-control when it comes to the decision of IVF. Don’t be afraid to ask questions and advocate for yourself, you always deserve to be in the know!

  1. What testing has been completed that makes IVF a necessary procedure for me?

    IVF is not typically the first option when it comes to Assisted Reproductive Technology (ART). You may have already gone through several unsuccessful IUIs, or you/your partner may have a specific circumstance that requires IVF. When it comes to female blood work, a low AMH level and/or high FSH level is an indicator of low ovarian reserve and IVF may improve you ovarian response. For men, if there is hypospermatogenesis, IVF with ICSI (injecting the sperm directly into the egg cytoplasm) may be the best option for you. Do make sure your RE walks you through the evidence that supports the need for IVF in your particular case. Learn more about other hormone testing options.

  2. What does IVF involve?

    Ask your RE to go over the procedure with you, including how the medications are administered, the function of each medication (I get asked this one the most!), and how many appointments you will need. You or someone you know will need to be comfortable with the injections! You may also need to adjust your work schedule for the frequent cycle monitoring appointments. The egg retrieval procedure is indeed minor surgery so you should be advised as to how to prepare beforehand.

  3. How much does IVF cost? Do you have funding available?

    This one I’m sure is the most obvious question to ask, IVF is expensive! The funding gets confusing though. In Ontario, one IVF treatment cycle per female patient is funded. However, you are at the liberty of the waitlist at your fertility clinic. Depending on the fertility clinic, you may wait from 6 months to 2 years for your funding. The funding is based on a first come, first serve basis. In order to be eligible you (the woman) must be under the age of 43. The funding does not cover the medications, but it does cover the cost of ALL of your embryo transfers. For example: if you produce 3 viable embryos from your IVF cycle, each embryo will be transferred one at a time; each of these transfers is covered by the funding.

  4. What are the side effects?

    You’ll want to ask about the side effects of the specific medications you are taking as well as the risk of ovarian hyperstimulation syndrome (OHSS) and egg retrieval. Long-term side effects are largely unknown (from my understanding), but you’ll want to know what to expect while taking the medications so you don’t have to resort to “Dr. Google” along the way.

  5. What is the success rate of IVF?

    The success is going to depend on your unique case, as well as your partner’s/donor’s, and both of your ages. The greater the number of high quality embryos produced, the greater your chances for a healthy live birth. The CDC has an amazing tool, based on their compiled data, to calculate your potential success rate. For example, the chance of live birth per embryo transfer between ages 38-40 is 27%. The chance of live birth per egg retrieval procedure between ages 38-40 is 19%.

  6. Based on my lab work how many embryos do you think will be produced?

    This is important for developing realistic expectations for the IVF process. Your RE should be able to predict this for you. To give you a real world example of a female age < 35 using stimulating medications: 10 follicles were retrieved, of these 10 follicles only 7 were mature and viable, of the 7 follicles 5 were fertilized, of these 5 embryos only 3 survived until day 5. That’s a total of 3, day 5 embryos to be transferred.

  7. Do you advise day 3 or day 5 embryo transfer?

    A 5-day-old embryo has more cells than a 3-day-old embryo; it is referred to as a blastocyst. Blastocysts are commonly higher quality embryos than embryos in the cleavage stage (day 3). They’ve survived an extra 2 days on their own! It is worth discussing which practice your RE uses.

  8. Will the embryo transfer be fresh or frozen?

    Frozen embryo transfers are now more common practice, as it gives your body a chance to rest before the transfer. This means you’ll wait until your next cycle to transfer the embryo, rather than right after egg retrieval. The research on live birth rates when comparing fresh and frozen embryos seems to show similar outcomes.

  9. Do you offer PGS (pre-implantation genetic screening)?

    This screening is completed on frozen (and then thawed) day 5 embryos. It is a test to determine whether embryos have an abnormal number of chromosomes. It can be used to prevent miscarriage or lack of embryo implantation. If an embryo has an abnormal number of chromosomes it will not be transferred. Not all clinics offer this technology, and it is an additional cost.

  10. Do you welcome the support of acupuncture and naturopathic medicine during IVF?

    Finally, the most important question of all! Choose an RE who supports a multidisciplinary approach to fertility. It can take a village to make a healthy baby and you deserve access to all tools in that village. Acupuncture and naturopathic medicine have been highly researched for fertility support. We can also help you navigate the IVF process and answer questions your RE may not have the time to answer. You should feel supported every step of the way. Book your appointment here! 

    References
    Hatırnaz Ş, Kanat Pektaş M. Day 3 embryo transfer versus day 5 blastocyst transfers: A prospective randomized controlled trial. Turkish Journal of Obstetrics and Gynecology. 2017;14(2):82-88. doi:10.4274/tjod.99076.
    Aflatoonian A, Karimzadeh Maybodi MA, Aflatoonian N, et al. Perinatal outcome in fresh versus frozen embryo transfer in ART cycles. International Journal of Reproductive Biomedicine. 2016;14(3):167-172.
    Wong, K. M., van Wely, M., Van der Veen, F., Repping, S., & Mastenbroek, S. (2017). Fresh versus frozen embryo transfers for assisted reproduction. The Cochrane Library.
    Mastenbroek, S., Twisk, M., van der Veen, F., & Repping, S. (2011). Preimplantation genetic screening: a systematic review and meta-analysis of RCTs. Human reproduction update17(4), 454-466.

The 10 Foods You Should be Eating During the 2-Week Wait

By | Natural Fertility Support, Prenatal Nutrition | No Comments

You’ve made it through!

Through the countless appointments, medications, and procedures! Now all there’s left to do is wait, and maybe wait a little more. These two weeks are a time for you to do absolutely nothing: love yourself, hug yourself, and reflect on how you’re stronger than was ever thought humanly possible!

I’ve heard from my patients that the hardest part of the 2-week wait is feeling like there is nothing else they can do, which makes the wait that much…crappier. They want to support their body in every way they can and they’re not sure how to do this after the embryo transfer. Luckily there IS something you can do, and that’s optimize diet! There are simple foods you can eat to increase pelvic circulation, build blood, decrease inflammation, and support progesterone. Eat them often and feel confident that you’re supporting your embryo and overall health!

  1. Blackstrap Molasses

    1 tbsp of molasses has the same iron content as half of a small steak! Iron is needed to build nutrient rich blood. You can add it to oatmeal, smoothies, and in place of sugar in baking and cooking.

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  2. Beets

    Beets produce nitric oxide (NO), which dilates the pelvic blood vessels. Beets allow your nutrient rich blood to be delivered to where it matters most – your embryo!

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  3. Spinach

    Not only does spinach contain lots of iron, but it also benefits pelvic blood flow so that you can build a thick and plush uterine lining.

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  4. Lentils/ Beans

    They’re the ultimate vegetarian source of protein, iron, fiber, zinc, potassium, and b-vitamins…everything your growing embryo needs.

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  5. Beef/Tofu

    Organic, grass fed, hormone-free beef for the omnivores and non-GMO, organic tofu for the vegetarians. Both are powerful blood building foods. Beef is a source of heme iron, which is better absorbed than plant based irons for a quick boost. If you’re feeling adventurous, liver and oysters contain even more iron but they’re a hard sell with my patients!

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  6. Oats

    Are you tired of hearing about iron yet? You need a heck of a lot of it to grow a baby and oats are another great source! Oats also contain beta-glucans, which support your immune system which takes a pretty big hit when you’re growing a baby.

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  7. Nuts: Almonds & Walnuts & Brazil nuts

    Almonds and walnuts contain anti-inflammatory fatty acids AND nitric oxide for improving blood flow. The embryo implantation process actually requires a small amount of inflammation to succeed, but too much inflammation is detrimental.

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  8. Salmon

    Alaskan, non-farmed salmon is the healthiest and highest source of omega- 3 fatty acids (EPA & DHA). These fats are found in every cell in your body, even your embryo’s. They support hormone production and cellular regeneration.

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  9. Seeds: Sunflower & Sesame & Hemp seeds

    These 3 seeds have fatty acids that mimic progesterone, thus increasing overall progesterone levels in your body. Progesterone is needed to maintain endometrial thickness.

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  10. Pineapple

    It’s a well-adopted symbol for the fertility community, and for more reasons than one! Pineapple contains an enzyme called bromelain, which can support embryo implantation and endometrial receptivity.

The 2-week wait is all about doing things that support your body and mind and make you feel happy; the hardest part of the IVF process is over. If you can fit in some of these healthy foods too, your embryo will thank you. They’re also all foods that are great for pregnancy nutrition.

Book an appointment to prepare for your upcoming IVF or FET cycle

5 Natural & Effective Ways to Increase Uterine Lining Thickness

By | Fertility Acupuncture, Fertility Supplements, Natural Fertility Support, Prevent Miscarriage | No Comments

During natural cycles, cycle monitoring, IUI, IVF & FET

Uterine (or endometrial) lining thickness is a useful predictor of embryo implantation and miscarriage prevention. It is measured via ultrasound during cycle monitoring, IUI, IVF, and frozen embryo transfers. A thin lining can halt the entire fertility process, and not seeing any growth in thickness, despite medical efforts, can be really frustrating.

The Lining “Norm”


Uterine lining thickness varies depending on the phase of your menstrual cycle and hormonal influence.

On your period: 2-4mm

Follicular phase (before ovulation): 5-7mm

Ovulatory phase: 7-11mm

Luteal phase (after ovulation): up to 16mm

A lining < 8mm is associated with implantation failure, poor receptivity, and low pregnancy rates. The numbers aren’t the only measurement that matters. The endometrial pattern is also relevant; the most receptive lining is called triple-line or tri-laminar (due to its 3 layer appearance).

The most common pharmaceutical approach to a thin lining is supplementation with synthetic hormones; conjugated estrogen, progestin, or a combination of both like the oral contraceptive pill. Viagra is also used to increase pelvic blood flow (it ain’t just for men!) Not all women respond to these options, but thankfully there are natural alternatives. Naturopathic medicine and fertility supplements can be used in conjunction with hormones or alone to optimize your lining.

  1. Vitamin E

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    A 2017 study showed that 12 weeks of low-dose vitamin E supplementation in women with prior implantation failure increased endometrial thickness by 2mm and decreased inflammatory cytokines.

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  2. L-Arginine

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    A pilot study in 2010 used high-dose L-arginine to increase endometrial thickness and pelvic blood flow.

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  3. N-Acetyl-Cysteine

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    NAC is a super-fantastic-marvelous supplement. It has proven to improve endometrial thickness (pertinent here) as well as: induce ovulation, recruit mature follicles, reduce insulin sensitivity, and break down endometriomas! Woah!

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  4. Fruit: lemon, lime, orange, pomegranate, watermelon

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    What do all of these fruits have in common? They are nitric oxide producers. Nitric oxide dilates your blood vessels so more blood can be delivered to your uterus to build up that lining. Viagra works the same way, which means pomegranates are nature’s Viagra!

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  5. Acupuncture (including electro-acupuncture)

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    Fertility acupuncture is used to support embryo implantation and promote pelvic blood flow. It supports endometrial thickness by reducing stress on the uterine artery. Multiple studies have shown a statistically significant increase in pregnancy rates with acupuncture before embryo transfer and on the day of transfer.

When all else fails, remember that lifestyle makes a huge difference! Simple strategies like drinking at least 2L of water daily and moving your body with gravity can increase endometrial thickness.

Book an appointment to support your uterine lining!

References:

Jimenez, P. T., Schon, S. B., Odem, R. R., Ratts, V. S., & Jungheim, E. S. (2013). A retrospective cross-sectional study: fresh cycle endometrial thickness is a sensitive predictor of inadequate endometrial thickness in frozen embryo transfer cycles. Reproductive Biology and Endocrinology11(1), 35.

Zhao, J., Zhang, Q., & Li, Y. (2012). The effect of endometrial thickness and pattern measured by ultrasonography on pregnancy outcomes during IVF-ET cycles. Reproductive Biology and Endocrinology10(1), 100.

Al-Ghamdi, A., Coskun, S., Al-Hassan, S., Al-Rejjal, R., & Awartani, K. (2008). The correlation between endometrial thickness and outcome of in vitro fertilization and embryo transfer (IVF-ET) outcome. Reproductive Biology and Endocrinology6(1), 37.

Hashemi, Z., Sharifi, N., Khani, B., Aghadavod, E., & Asemi, Z. (2017). The effects of vitamin E supplementation on endometrial thickness, and gene expression of vascular endothelial growth factor and inflammatory cytokines among women with implantation failure. The Journal of Maternal-Fetal & Neonatal Medicine, 1-8.

Takasaki, A., Tamura, H., Miwa, I., Taketani, T., Shimamura, K., & Sugino, N. (2010). Endometrial growth and uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium. Fertility and sterility93(6), 1851-1858.

Nasr, A. (2010). Effect of N-acetyl-cysteine after ovarian drilling in clomiphene citrate-resistant PCOS women: a pilot study. Reproductive biomedicine online20(3), 403-409.

di Villahermosa, D. I. M., dos Santos, L. G., Nogueira, M. B., Vilarino, F. L., & Barbosa, C. P. (2013). Influence of acupuncture on the outcomes of in vitro fertilisation when embryo implantation has failed: a prospective randomised controlled clinical trial. Acupuncture in Medicine31(2), 157-161.

What Your Semen Analysis Really Means & How to Get the Results You Want

By | Hormone Testing, Natural Fertility Support | No Comments

A Brief History of the Mighty & Motile

The World Health Organization has the very influential job of determining the reference ranges for semen analysis. These reference ranges were overhauled in 2010 from the previous 1999 ranges, which were much higher. There is no doubt that sperm quality has declined over the past 50 years. Some may argue that it’s due to emerging standards of scientific evidence, but in my opinion the strongest evidence is the western lifestyle: poor diet, toxic exposure, xenoestrogens, electromagnetic frequencies, obesity, sedentary habits, the list is endless.

The 2010 standards are based on the semen of fertile men who fathered children within the 12 months preceding the study. The ranges represent the lowest 5th percentile of these men. Meaning:

1) 95% of men should have higher sperm parameters than the reference range

2) Values deemed “normal” are in fact suboptimal for natural conception

The 5 Ws of Semen Analysis

Who: All men wanting to conceive

What: You ejaculate into a cup. It’s not comfortable, but it’s important. You need to abstain from ejaculation 2 days prior to collecting your sample, but you need to have ejaculated at least 5 days before your sample. This is to prevent DNA fragmentation and death of the sperm, if they sit around for too long they actually kill themselves…

When: Your doctor may advise you to try for a year before going for a semen analysis. This doctor says 6 months is enough waiting, especially if you’re over 35 (it’s not just women who age you know!) Once you’ve completed one semen analysis, repeat testing is recommended in two weeks. Semen is ever changing and one snapshot is not enough.

Where: Most likely in a private room at a fertility clinic (bring your own “motivation”), but you may be given the option of home. If you’re obtaining your sample at home you essentially have to sprint like Road Runner to the lab afterwards because the sperm do not survive long outside of body temperature. It’s not recommended.

Why: To determine if you have sperm (in your semen) capable of natural conception, or if they’re going to need a little help getting to their destination.

The Numbers At a Glance

Parameters WHO 2010 Criteria – 5% percentile What if you want sperm that’s 50% better than your friends?
Volume of semen (ml) 1.5 3.7
Concentration of sperm (per 1ml of semen) 15 million 73 million
Progressive motility *forward moving sperm 32% 55%
Morphology

*normal sperm forms

4% 15%

Other Important Tests For Your Semen

  1. Liquefaction – Your semen should liquefy within 15 minutes so that the sperm can be free to swim
  2. Colour – Semen is grey and opaque. The more translucent it is the less sperm is in it.
  3. pH – Semen has a basic pH of 7-10, this is to help the sperm survive upon ejaculation.
  4. DNA Fragmentation – This is a measure of damaged sperm DNA. A value > 50% is very poor DNA integrity and is linked to poor conception and miscarriage.
  5. Sperm antibodies – These are antibodies the sperm develops against itself. Antibodies affect the sperm’s ability to bind to the egg and for the embryo to develop normally.

 

Beyond Semen: Tests for Whole Body Health

Sperm health depends on whole body health. Blood pressure, blood sugar, cholesterol, thyroid hormones, adrenal hormones, liver health, and weight are all contributing factors to sperm health. Other hormone tests can be run as well.

 

What do the Numbers Mean?

If you score lower than the 5th percentile, the next step is hormone testing and a referral to a urologist to determine the root cause. The most common causes of low sperm counts include:

  • Retrograde ejaculation – semen enters bladder instead of urethra
  • Hypospadias – opening of urethra on underside of penis
  • Cryptorchidism – undescended testes
  • Absent vas deferens – congenital condition
  • Klinefelter syndrome – extra X chromosome without symptoms
  • Varicocele – testicular swelling and block of blood flow
  • STI – chlamydia, gonorrhea
  • Endocrine dysfunction – hypogonadism
  • Metabolic dysfunction – diabetes, high blood pressure, high cholesterol
  • Lifestyle factors – smoking, alcohol, medications, poor diet, sedentary etc.
  • Age – semen parameters decline around age 35-38

What Are Your More Invasive Treatment Options?

Based on sperm concentration:

  • IUI – between 5 and 10 million/ml
  • IVF – less than 5 million/ml
  • Hormone therapy – less than 5 million/ml
  • TESE (testicular sperm extraction) – undetectable sperm but normal testosterone

What Are Your Less Invasive Treatment Options?

It takes 90 days for sperm to mature. Lifestyle has the potential to change EVERYTHING

Lifestyle: YESSES

  • Ejaculate often – every 3 days to prevent DNA fragmentation. Your semen volume may decrease but your sperm concentration will not
  • Wear protection…when playing sports – injury causes the production of sperm antibodies
  • Brush your teeth – periodontal disease is linked to poor sperm quality
  • Sleep well – melatonin is an essential antioxidant for sperm protection
  • Buy organic & filter your tap water – pesticides and chemicals distrust hormones
  • Use a sperm friendly lubricant, like: Yes Baby, Astroglide TTC, and Pre-Seed
  • Foods to incorporate on a daily basis for sperm production & protection: pumpkin seeds, eggs, olive oil, garlic, POM juice, oats, barley, walnuts, almonds, brazil nuts

Lifestyle: NOT SO MUCH

  • Chemical sunscreens – contain benzophenones, which are harmful to your testes
  • Direct Wi-Fi – the frequencies and heat from your laptop are damaging, turn your laptop into a standing desk
  • Extreme heat- the scrotum likes a breeze! Avoid seat warmers, hot tubs, long stretches of sitting, skinny jeans, tighty-whities, long distance biking etc.
  • Extremely strenuous exercise – don’t decide to compete in an Iron Man or train for your first marathon while trying to conceive
  • Smoking – including marijuana, it impairs sperm count and motility
  • Alcohol – no more than 3 drinks a week
  • Coffee – no more than 200mg daily (that’s 1 small Starbucks/ Tim’s)
  • Processed meats – they’re full of crap, need I say more

Naturopathic Strategies

Book an appointment . As a Naturopathic Doctor, I use herbs, supplements, nutrition, and acupuncture to help you produce more sperm and optimize the sperm you already have.

  • Your sperm needs fuel just like any other cell in your body and sometimes it needs a little supplemental support
  • Your sperm also needs anti-oxidants and vitamins to protect it from damage
  • Herbs and acupuncture can improve your libido and decrease erectile dysfunction
  • Most of all, I can answer all of your questions and support you through the conception process. Simple solutions can make all the difference

This is What Infertility Looked Like 30 Years Ago

By | Natural Fertility Support | No Comments

This is what infertility looked like 30 years ago, told through the eyes of an “infertile” couple’s daughter (that’s me!)

In honour of Canadian Infertility Awareness week, I sat down with my parents and asked them what infertility looked like over thirty years ago. You see: I am the very happy ending of a ten-year struggle with infertility. Just as you’ll one day share your journey with your baby to be, my parents shared their overwhelming journey with me. They never would have imagined that their daughter would be telling their fertility story, yet here I am sharing it with you!

Their Story

Thirty years ago the fertility world looked a little bit different than it does today. My parents were never offered IVF, but they did undergo a handful of memorable IUIs. In order to get a semen sample for the IUI, my dad was instructed to use the public washroom across the street and have my mom store the sample in in her bra until her appointment. Bra storage isn’t exactly standard care these days. With a different fertility specialist, my mom underwent a laparoscopy to diagnose endometriosis and the doctor forgot to chart his findings and couldn’t remember the results! Needless to say, my parents went through many fertility doctors and refused to settle for one they didn’t connect with. But forget about doctors, my mom said she was so desperate for answers that she sought the help of an astrologist and a psychic and “if there was a Martian trained in infertility” she would have gone to see him too!

Sacrifice

My parents taught me that infertility is paved by sacrifice. They donated their bodies to be poked and prodded and followed a diet that my dad loathingly refers to as “cardboard and vegetables”. My mom said she once found a receipt for a secret chocolate bar in my dad’s grocery bag and completely broke down, refusing to speak to him for days!

There were really awful and devastating moments. My mom vividly recalls being invited to a baby shower where every single woman who attended was pregnant (all too common for women struggling with infertility). My mom said she cried a lot through all of these awful moments, but that it was really important to her that her friends and family know what she was going through. She wrote personalized letters (remember this was the 80s!) to the people in her life so they could better understand her journey and her ever so deserving tears.

Holding Onto Hope

Throughout my parents’ 6 year struggle with infertility, they never gave up hope. They would buy baby clothing and baby books wherever they went because they knew they would be parents, even if it were through adoption. In fact, the public adoption agencies in Ontario were closed thirty years ago so my mom resorted to some very unconventional methods. She wrote letters to high schools (she’s a teacher) explaining her story and asking if there were pregnant teens giving up their children for adoption! She recalls a news story where a couple had twins but only wanted one of the twins, and she somehow found the couple’s contact information and called them directly to tell them she would take one of the babies! I mean, YIKES, the police would be knocking on her door if she had tried any of this nowadays! She was one determined parent.

And Then There Was Me

Of course there’s a silver lining to this story, and that’s me… and did I mention I have two biological brothers too!?! It wasn’t until they saw a naturopathic doctor (and yes, all of their friends thought they were crazy) that they finally got pregnant. It may not be a surprise to you that I was then raised with naturopathic medicine and here I am as a naturopathic graduate with an immense passion and dedication to fertility. I haven’t personally experienced infertility, so when I first started my naturopathic internship I was determined to build a set of resources to help people like my parents.

After spending some time talking to my parents, I asked them to share some coping strategies that made their journey just a little more bearable. Here’s what they had to say:

  1. Tell people what you are going through
    My mom constantly felt guilty for crying when she was “supposed to feel happy” for her pregnant friends. Instead of burying her feelings, she wrote letters (this was 30 years ago when texting wasn’t available) to her friends explaining what she was going through and how it was affecting her life.
  2. Remove negative people from you life
    My parents were not willing to hold space for people in their lives that were not going to support them. When they were getting approved for adoption, they needed letters of recommendation from their friends. One of their friends said she was “too busy to write it”, that friend is obviously no longer in their lives.
  3. Find support beyond your partner
    Even 30 years ago they saw a fertility counselor, both on their own and together. Nowadays there are many amazing online resources and support groups too!
  4. Try not to put your whole life on pause
    Try new things, find some new hobbies, travel the world. It was important to my parents that they have something in their lives besides fertility appointments. They tried every class possible at the local community centre: pottery, basket weaving, calligraphy, soccer, hockey, you name it.
  5. Acknowledge your strength
    My parents certainly acknowledged their sadness after every failed cycle, but they stayed positive and told themselves they would “just try again in two weeks”.
  6. Hold on to hope and be who you are
    Infertility does not make sense and my parents were damned sure they were never going to give up on parenthood…even if my mom had to call every single news station looking for a baby to adopt!

Evidently, a lot has changed in the past thirty years, fertility technology in particular! But the emotional toll infertility takes on a person remains all too much the same. Ask for support whenever you can, and don’t give up until you feel it’s right for you. Who knows, maybe one day you’ll have a daughter who will share your fertility story.

Learn more about natural fertility support, or learn about my healthy conception program.  

Can coenzyme Q10 supplementation make your eggs act a little bit younger?!

By | Fertility Supplements, Natural Fertility Support | No Comments

It’s an unfortunate fact of life: every single day we get a tiny bit older. I truly believe that you’re only as old as you feel, and just because you’ve hit your 35th birthday doesn’t mean you don’t look and feel 25! Unfortunately our eggs, or oocytes, don’t agree with the theory that feeling young at heart makes us look young at heart. As women, we are born with an unchangeable number of eggs. Over time the quality of these eggs naturally declines, regardless of how we feel about it, but it’s not all downhill from there! Although we can’t change the number of eggs we have, we may be able to change the quality of those eggs and quality is more important than quantity, right?! And while we’re on the topic, we can influence the quality and quantity of sperm too!

How can we influence egg quality?

Even though we’re stuck with a certain number of eggs, we can influence the quality of our eggs because they are arrested in a stage of cell division called meiosis I. This means they are not mature and they have not completed cell division. It’s the maturation process that we can influence! Female eggs remain in the early stage of cell division until a woman reaches puberty. Once a woman has a menstrual cycle, a few of these eggs mature each cycle and compete for ovulation and move into the next stage of cell division. This cell division is responsible for dividing DNA and ultimately influencing the end quality of the egg.

Where does CoQ10 come in?

If you remember grade 8 science class (I know that’s a lot to ask) then you’ve probably heard of the mitochondria being the “powerhouse” of the cell. In order for the oocytes to divide efficiently, they need lots of energy from their mitochondria and coenzyme Q10 is an antioxidant that is essential for providing this energy. Our eggs cannot function without CoQ10, which is why our body naturally makes a certain amount. However, as we get older we produce less CoQ10 and we end up with eggs that aren’t great at dividing and have poorer development.

This lack of mitochondrial energy translates into: difficulty ovulating, trouble conceiving, and in the case of IVF- issues with making an embryo that survives to day 5 to be transferred. Poor quality eggs put you at greater risk of miscarriage due to aneuploidy, a term that refers to an abnormal number of chromosomes in the embryo. Poor egg and sperm quality are major causes of infertility. This can all sound very overwhelming, but CoQ10 plays a role in improving the quality of both eggs and sperm!

The possibilities of CoQ10 for egg development:

  • Decreases the rate of aneuploidy (abnormal chromosome numbers)
  • Boosts mitochondrial function and cell division
  • Increases energy, or ATP, production in the egg
  • Stimulates more eggs to develop in combination with IVF
  • Prevents DNA oxidation, causing damage
  • Induces ovulation in combination with clomid in cases of clomid-resistant women with PCOS
  • Significantly improves endometrial thickness, serum estrogen, and serum progesterone in clomid-resistant women with PCOS
  • Significantly improves clinical pregnancy rates in clomid-resistant women with PCOS
  • Greater concentrations of CoQ10 are associated with higher grade embryos in IVF and better embryo development

The possibilities of CoQ10 for sperm development:

  • Decreases the rate of aneuploidy (abnormal chromosome numbers)
  • Increases energy, or ATP, production in the sperm
  • Prevents DNA oxidation, causing damage (decreases DNA fragmentation)
  • Increases sperm concentration
  • Increases mitochondrial function and sperm motility
  • Decreases abnormal sperm morphology

Wow that’s a lot! Are you hooked on CoQ10? Here’s what you need to know to incorporate it into your life:

If you’ve been to the health food store lately you’ve likely seen the innumerous number of brands and forms of CoQ10. There are two forms of CoQ10 that are important to know: ubiquinone and ubiquinol. They both exist in our cells; in fact our mitochondria depend on the interconversion between the two forms. According to current research, ubiquinol is slightly more readily absorbed in the gut compared to ubiquinone. However, even more important than the form of CoQ10 is the method it is delivered. Since CoQ10 is a fat-soluble substance, it needs to be compounded in a fat-soluble material. This can be tricky to figure out based on a label alone, so it’s best to trust your neighbourhood naturopathic doctor in prescribing the best option for you. You should also refer to a naturopathic doctor to determine the optimal dose to suit your unique needs. Dosing can range from 200-800mg depending on your requirements, but there’s also a maximum amount of CoQ10 your body can absorb at one time.

The take home message:

CoQ10 has the potential to significantly improve egg and sperm quality due to age related decline. It takes both an egg and sperm about 3 months to mature, so if you’re considering fertility supplements you and your partner should begin at least 3 months prior to conception. May you always be ageless, including your eggs!

Book an appointment with Dr. Sumner. Learn about natural fertility support

  References:

Ben‐Meir, A., Burstein, E., Borrego‐Alvarez, A., Chong, J., Wong, E., Yavorska, T., … & Alexis, J. (2015). Coenzyme Q10 restores oocyte mitochondrial function and fertility during reproductive aging. Aging Cell, 14(5), 887-895.

El Refaeey, A., Selem, A., & Badawy, A. (2014). Combined coenzyme Q10 and clomiphene citrate for ovulation induction in clomiphene-citrate-resistant polycystic ovary syndrome. Reproductive biomedicine online, 29(1), 119-124.

Barakat, A., Shegokar, R., Dittgen, M., & Müller, R. H. (2013). Coenzyme Q10 oral bioavailability: effect of formulation type. Journal of Pharmaceutical Investigation, 43(6), 431-451.

Turi, A., Giannubilo, S. R., Brugè, F., Principi, F., Battistoni, S., Santoni, F., … & Tiano, L. (2012). Coenzyme Q10 content in follicular fluid and its relationship with oocyte fertilization and embryo grading. Archives of gynecology and obstetrics, 285(4), 1173-1176.

Bentov, Y., Hannam, T., Jurisicova, A., Esfandiari, N., & Casper, R. F. (2014). Coenzyme Q10 supplementation and oocyte aneuploidy in women undergoing IVF-ICSI treatment. Clinical medicine insights. Reproductive health, 8, 31.

Failla, M. L., Chitchumroonchokchai, C., & Aoki, F. (2014). Increased bioavailability of ubiquinol compared to that of ubiquinone is due to more efficient micellarization during digestion and greater GSH-dependent uptake and basolateral secretion by Caco-2 cells. Journal of agricultural and food chemistry, 62(29), 7174-7182.

Calogero, A. E., Condorelli, R. A., Russo, G. I., & Vignera, S. L. (2017). Conservative Nonhormonal Options for the Treatment of Male Infertility: Antibiotics, Anti-Inflammatory Drugs, and Antioxidants. BioMed Research International, 2017.