My Mhx includes endo (stage 3, laparoscopy check), female antisperm antibodies) and a bit of PCOS type 2.
I have had 6 completed ICSI cycles and 2 cancelled cycles (over stim prior to pick up AND eggs released prior discovered at pick up).
My Doctor gets me to do 5 day blastocyst then transfers.
With going to mild stimulation and I beleive diet changes (apparently I am sensitive to carbs) my egg numbers have dropped from 25 to 5, of course this means nothing does it when they still don't take. The closest think I have got to being pregnantwas a blighted ovum (exactly like that scene out of Marley and Me).
I am staring down the barrel of donor egg and it is not what I had imagined.
I tried accupuncture then my FS said it was detimental. I think he means certain alternative therapies as the article he gave me did not say accupuncture specifically.
I have heard of invitro maturation however my clinic doesn't do this.
I have heard of screening eggs however my clinic doesn't do this and would it be of any use anyway, if it just meant they thought my eggs all looked dodgy?
What should I be asking my FS at my next appt?
Can someone explain please whether i should be focussing on reducing carbs, or just going Low GI?
Also how do I not know it is my lining that is the problem? Should progesterone be monitored? I have done the pessaries and the gel, and my clinic doesn't do the injection. If you have your period when it is due is that sufficient to say that it held together appropriately and it was the egg problem?
thanks
Last edited by Sophie Baby Makes 3; March 9th, 2010 at 03:54 PM.
: missed a word or 2
Another one with PCOS here. I'd had two full cycles that ended up being freeze all due to OHSS and ended up with crap eggs all around.
When I did my third cycle, my FS got me to follow a very strict low-carb, low-GI, high protein diet... and we also were struck with low egg numbers, but apparently got better quality and my 14 month old son is the result.
Sorry I can't go for a longer reply, but I honestly believe that it's not just a matter of cutting carbs - make sure the carbs you do eat are low GI and make sure you're getting good quality protein as well. Made a huge difference for me.
Thanks BW!
My FS told me to use the Calorie King website. Actually I did make a suggestion in the clinics survey that Dietician support should come as part of the deal if this impact so significantly on the outcomes.
It was my FS that made me do calorie king as well. He actually got my username and password and checked everything I'd done in the 4 weeks between appointments at one stage. He used slightly different dietary guidelines to what calorie king suggested for me, though.
I had a long list of "do not eat" foods, but after the first week or so it wasn't too bad. I'm not a person who does well with a diet that specifies what things to eat at which meal on what day, so being able to choose my own foods to fall within certain limits actually worked well for me, but I can see how some people would prefer the other kind of diet.
Have a bit more time to post a reply at this time of night...
With that third cycle, I still ended up on daily blood tests with the puregon injections. After spending a week in hospital with OHSS, I was pretty happy to do anything to avoid another case of it. I distinctly recall one Sunday - I'd had blood taken that morning, my levels were fine, but they dropped my puregon dose again and had me come back again on the Monday for more blood. I was tired, over it and generally craving some junk food - so I ate a hamburger and chips for lunch. My first and only slip up during the entire cycle. My results the following day were not so good and I very nearly got my E2 levels up high enough to need yet another freeze all cycle. That was the point where I was convinced! I still got OHSS again - but it was mild, and only set in with a positive pregnancy test.
One question - do you take metformin to help with the PCOS/insulin resistance? It's the insulin problem that mucks up the hormones and makes OHSS more likely (less insulin spikes means less likelihood of getting OHSS from sky-rocketing E2 levels) so it could quite possibly help a bit if you're not already taking it.
Thanks heaps for sharing!
Yes a big fat green and blacks chocolate bar the night before my final blood and ultrasound had my first cycle cancelled! There I was rewarding and comforting myself for my perfect cycle when I really just sabotaged it.
Can I hazzard a guess Dr David Knight might be your guy? If not at least it means others are doing this as well. The thing that had me confused was he told me off one day right in the beginning saying you eat to many carbs but really didn't explain why. I really don't understand the PCOS thing myself or if I have a subtype or if it runs or scale or what. Contrary to the usual type, I am very slim 168.5cm and 49kg, and not somebody who needs to lose weight - for the life of me i eat the same as my husband if not more and it won't budge. I understand it has something to do with insulin resistance and the impacting the hormones. And I do overstimulate easily and produce the immature eggs.
This is my final question as I am already trying to find a dietician to give me some ideas (I want a pick from list as well and to understand it a bit bettter).
I have been following the "eating plan" through my cycles, I don't religiously every day enter my into C/King - maybe a week at a time then a few day off and on again. I am trying not to get myself stressed if my % don't add up perfectly as it is hard to reverse it. Obviously I try to eat all the right things during cycle. The thing that confused me is you are told a % of protein, carbs, and fats you can have. Does every meal in the day need to be balanced this way? I have found myself cramming down cheese, silverside or say fruit in the night just to try and bring my % in to line. To me this seems like I am getting it wrong already even if I am going low GI .. and finally yes I know it is question number two..did you stick to the plan after transfer, how important is this?
BTW, I am not taking metformin. I'll ask about that at the next appt then.
Thanks again!
Last edited by Sophie Baby Makes 3; March 9th, 2010 at 09:18 PM.
: forgot something
Got it in one! But I seriously doubt I'd go back to him if we decide to try for number two (don't really like some of the things about the way the new clinic does things).
I'm a bit like you - not overweight and really don't have any of the usual physical signs of PCOS, but when I was sent to do a glucose tolerance test David just about fell out of his chair at my results. He usually only does the eating plan thing with people who are overweight but my insulin levels were so high that he made me do it as well. After transfer and through the early stages of pregnancy I still stuck to the plan as much as I could. It made sense to do so - PCOS can increase the chance of miscarriage and I'd already had three, so I still did what I could to keep the PCOS and my insulin levels under control.
I would balance what I ate over the whole day. Sometimes I would try to eat eggs for breakfast to lift my protein levels, but I'm very much a cereal girl so I would often have my usual cereal for breakfast and then have virtually no carbs for the rest of the day (apart from what you find in fruits and vegies - I would avoid bread, pasta, rice, potato, etc) and stick to things like meat and salads or stir fries with lots of vegies. I even managed to have pizza once without killing the entire day, and I wouldn't stress if one day was a bit high in carbs, as I'd often have others which were low so it would tend to balance out over a week. Except for during that last stim cycle - I was absolutely rigid with it and didn't allow any "carb borrowing" from one day to another. I did it from when I started lucrin right through until I was so ill with morning sickness that the constant need for a ginger nut biscuit to nibble on meant I really had no hope of keeping carbs under the limit.
But it does work. And I know David likes to tell you that and he'll often tell stories about different patients who got nowhere until they followed the plan... and sometimes it helps to actually be able to talk to one of those patients and find out that it is actually true.
One thing I do want to comment on - I was told that the only chance I had of getting pregnant was to use a frozen blastocyst and that I just had to get used to the hyperstimulation because that's what my body just liked to do. Well, I did a cycle without hyperstimulating - and thought all was lost when out of my 20 eggs only 12 were mature and of those only 3 fertilised. We didn't have enough embryos to grow to blastocyst so we transferred at day 3 (and I think this is one thing that his clinic no longer does)... so after being told my only hope was a frozen blast, I got pregnant and stayed pregnant with a fresh day 3.
I do find he can be a bit confusing. You know one week he says one thing and the other his approach is different. I even asked him the other day, so what is more important gi or no. of carbs and he said something like "well... not so much gi, more no. of carbs. actually these days it is more about the protein".
From having more of a read on PCOS last night, I believe the bit I am sabotaging is implantation phase and certainly it sounds like if I didn't carry through with the diet I would probably end up having an MC.
My problems is that as soon as I have had pickup I let loose on the diet as I am absolutely craving something, then am trying to be sensible but in no way at all stict as I should following transfer.
I feel terrible about my shocking will power, however I now know what I need to do to get an outcome!
BTW he hasn't mentioned anything to be about saying I should hyperstimulate or only use frozen embryos.
I suspect that he was referring to my specific situation. At the point where he'd said that I needed a frozen blast, I'd done two stim cycles and got quite bad OHSS with both. I'd had a total of 11 blasts frozen, but had a lot fail to thaw. Only 4 of those 11 blasts had been able to be transferred and from those 4 blasts I had three miscarriages. He'd decided that my body just liked to hyperstimulate and suggested that I just get used to getting very sick with each egg pick up and having all my embryos frozen. He also suggested that we had some chromosomal issues leading to the thaw failures and the miscarriages (one at 9 weeks the others very early) but when we asked about PGD he said it couldn't check enough chromosome pairs to be confident that it would fix the problem and that we should just rely on freezing and thawing to weed out a lot of our crap embryos and hope we eventually got one that would implant and go on to give us a successful pregnancy.
But in another appointment - the miscarriages and thaw problems were down to crap eggs which were crap because of the OHSS and that we needed to avoid OHSS and improve DH's sperm as much as possible (low count, poor motility and complete crap morphology)...
Personally - I suspect he had no idea at all and was just spinning theories to keep me happy. He did keep working towards avoiding OHSS or at the least trying to minimise it as much as possible, and we did eventually get there.
But I'd also consulted with a few other specialists - and David insisted that I stop metformin with a positive pregnancy test (but stopping metformin coincided with my first miscarriage) and that I didn't need aspirin (but we only had successful implantation when aspirin was added)... and that the prednisone I was taking for the arthritis was completely irrelevant to the conception situation (but if I reduced my prednisone dosage below 10mg while pregnant I would bleed).
Happy to have others take what they can from my experience, just glad that I can help. I honestly didn't believe the diet would work - but just did it in order to be able to tell him "told you so!", but to my complete surprise, it ended up being him telling me. However, I think the other meds had a role to play as well (I've got a few other health problems which make me a unique and complicated situation) and I never was brave enough to tell him that I was following another doctor's instructions in relating to them!
I hope you don't mind me asking but I seem to be in a somewhat similar situation, I have PCO but not the syndrome and don't have a weight problem, and I have trouble producing mature eggs. At my last 2 EPU's I have only had 1 mature egg (about 5 follicles both times) which failed to make it to day 5.
BW thankyou so much for mentioning the calorie king website, I have had a look into it but was wondering if you would be able to share some more info about how much protein you were meant to be eating each day. I'm really interested in changing my diet to see if it helps things as I often eat quite erratically and I know my sugar levels go up and down quite a lot when I skip meals.
Yeah I don't have the syndrome just a bit of PCO, so it is a bit weird to know what to research.
The % of where your energy comes is 20% fat, 30% protein and 50% carbs (from the brochure on the website as I have lost my bit of paper). A bit tricky to balance at times so practice makes perfect. Protein and fat tend to go up and down together so never eat a sausage just lean stuff, and always go for low fat dairy. The website doesn't reflect GI and your efforts there. So you might eat some nice low to mod gi nuts thinking you have carbs and protein sorted, then up goes your fat%.
It might we worth having a look through some of the patient information brochures on his site. The MedicaIVF site is not yet up and running, so you have to go in through the be healthy website or type in David Knight and Georgiana Tang.
Well I am off to see the Dietician at Designer Diets in Kogarah for alot more clarity.
Good luck
Last edited by Sophie Baby Makes 3; March 19th, 2010 at 12:04 PM.
: error
Hi Ladies,
I now know why my FS has put me on a diet! I am 10kg overweight. I do have a fats metabolic issue,eg High cholesterol. My FS just said, the weight loss/ would help my IVF chances. That was it. Obviously doesnt know about the Calorie King program. Balancing, Carbs/Sugars/Protein.
My insulin resistance is within range, but I think its on the higher end, and I have a mother/heriditary with Diabetes 2.
I overstimulate, and FS uses med to stop me loosing eggs before E/P. At ET I only get 1blastocyst to transfer. Ive had 6 stim cycles now and 2 Early miscarriages.
Its obvious my eggs are getting knocked around by the hyperstimulation too. My FS, firstly wants me to loose the weight before we do PGD for chromosomal issues.
Glad I found your discussion ladies, and if I follow the diet we may get some embryos to freeze. Obviously the Freeze cycles dont cause hyperstimulation.
I dont have PCOS, but an endocrinologist I seen, said I fit into that category.
Ive had mild endrometriosis, which is an oestrogen dominance. And my FS said, my oestrogen rises quickly... (HYPER OVARYS).
Its obvious Endo is a fats metabolic issue. And an Insulin resistance is a PCOS.
Do any of you the Big word EXERCISE? I dont, and thats been my problem too.
If any of you have any other suggestions of improving Egg Quality. I would love to know.
Lets get our eggs ready for EASTER BUNNY!!! HA AH.
Milly's mummy - looks like your question has been answered. That's what I get for being at work now! Thank you, Sophie.
Bub - exercise does make a huge difference. Not only to weight loss, but in keeping insulin and all the rest of it under control. I have issues with severe arthritis so it is difficult, but I do try to keep as active as possible. Even during IVF cycles - at least up until the enormous ovaries slow me down.
Thankyou so much for all the information!!! I really appreciate it. Sometimes I get so confused about what exactly I should and shouldn't be doing and it can be hard searching through all the info on the internet! Hopefully I can give my ovaries a helping hand by adjusting my diet along with the drugs next stim cycle!
As well as diet, I wanted to throw in the idea of fresh royal jelly to improve egg quality.
It's like honey (but certainly doesn't taste like that) and you can get it in health food shops.
Just thought I would mention for those in Sydney, that I found Fardoulis Honey Merchants (the same place the make the chocolates ironically) on the Princes Hwy in Kogarah are selling royal jelly. I assume it is fresh as they are selling other by products. I will have a look around there. You can google them if you want to ring and price it.
Just thought I would ask, I started my low gi diet on the weekend (I also looked up the brochures on the medicaivf website that had diet info too).
Anyway the past few days I have been feeling dizzy with slight blurry vision. Has anyone else had this? I thought it might go away after my body re-adjusts but I wasn't sure. I hate calling up my FS or nurses to ask questions and I'm still not due back for an appointment for a few weeks.
Milly's Mummy, I don't remember experiencing any of the problems you have mentioned. I know when I went low GI I had energy consistently throught the day. Perhaps just a signifcant change for you body or otherwise are you eating enough and regularly? Somebody else might know....
I thought I might share my experience below if anyone is interested:
I did go to a Dietician, Geraldine Georgou, on Tuesday for an assessment appt. She has lots of expereince in the area and has filled me with some confidence and seem very passionate spending a thorough 1.5 hours with me and very much put her investigative hat on. She also knows of my FS and rang him during the appt. She gave me lots of articles to reference the subjects. I feel alot of relief actually she seems to want to sort this out as much as I do.
Her assistant rang all the various pathology places and obtained my old blood test results. My Glucose Tolerance Test that the FS sent me for about 18 months ago did not have any insulin results just the glucose levels. My glucose was consistently low at the three test periods instead of showing a peak. This led her to two hypothese:
1) malabsorption (glucose not adequately getting across to the blood)
2) insulin dysfuntion (??uptake of glucose too quick), but then I produce the immature eggs so not very clear
I look like a classic ceoliac, however it appears the endocrinologist I once went to about being a light weight, ordered only 1 of the 3 tests and ruled me out for it. It got a bit interesting from here: there are links between endo and ceoliac (i have endo), plus also ceoliacs and myeloma (my dad has myeloma). Importantly there are links between ceoliacs and infertility and miscarrigage (i figure this is due to poor nutrient levels) so I would have to get this sorted. My FS was not interested in knowing whether I had Ceoliacs so we are going to work on this on the side.
So the action plan for me is:[*]A diet plan based upon 40% carbs, 40% protein, and 20% fats. This is in grams and not in relation to sources of calories like Calorie King will show you. Whilst low GI can be helpful, according to the dietician, having protein or even fat with a carb makes it low GI eg having a piece of fruit and a box of nuts. Proteins sources should be low fat. The diet plan is soo easy, nothing weird.
EG. breakfast
For breakfast you could have burgen bread with vegemite and low fat cheese. You could have scrambled eggs on toast.The LSA mix (linseed, almond and sunflower seeds) in the health food section can be spinkled on your Special K and low fat milk to make it a perfectly balance dish and it tastes nice.
It is important to note each meal or snack needs to be balanced rather than trying to make it all balance out at the end of the day on calorie king. Therefore I am not using Calorie King
[*]Blood tests to explore malabsorption.
[*]Looking to delay my cycle whilst I get this sorted out[/LIST]
I would suggest that anyone who has diet related fertilty problem find a dietician/nutritionist with lots of experience in infertilty/PCOS/endocrine problems rather than being left to fend for yourself with limited advice and support from an FS. You don't need a referral, however if you get the FS to write a note stating their aims then at least you can all be on the same page.
I've been to see a dietician too now after being inspired by you who also was keen on the low gi diet - but they told me I could eat a little chocolate as apparently its low gi!!! I'm not sure if i'l risk it though. They also told me about the gi website you can enter foods into check to see which foods are low or high its The Glycemic Index
I also got the patient information off the website that said no pasta? but apparently pasta is low gi so I'm a bit confused.
improving egg quality
Reply With Quote
Bookmarks