Monday, October 8, 2012

Questions on IVF and supplements (updated at the end)

I begin IVF in roughly 10 days, on CD1.  I was going to take the CCRM cocktail (see below). This was the list I got by googling.

Folic Acid 5mg 
Myo Inositol, 2 grams, twice daily
Melatonin, 3 mg, bedtime
CoEnzyme Q10, 200 mg, twice daily
L-Arginine, 1000 mg, twice daily

Note: the original posted list also included DHEA for poor responders, which I'm refraining from, since my natural DHEAS levels are super high.

I'm already taking the folic acid, but I'm fuzzy on when to begin the rest. I know people are prescribed different IVF protocols, that complicates it even more.

Slightly veering off point: I've been trying to understand how lupron (GnRH agonist) is used, and my understanding is what you can achieve with it depends on the timing and duration of administration. If anybody wants to take a stab at explanation of the different ways in which lupron can be used in IVF, go for it!Also, if anybody knows of a good website/resource that explains the different IVF protocols available and what they can do, and who they are tailored for, that would be AWESOME. I've been confused by what I found, and that is rare for me!

In my case: I start Lupron from CD1-3, then followed by menagon (FSH with a dash of LH) from CD3-9, and eggs will be harvested a few days later, if all goes well.  Can anybody tell me what this protocol is called? Is it the micro flare?

I'm planning to start my cocktail on CD1. Should I be doing it before? If you were a CCRM patient, what instructions were you given?

I'm also being smart (or stupid) in taking a mini-holiday before starting this-- I head off to Singapore and Indonesia this week! And then, the games begin. I'm not really afraid, I'm excited. One way or the other, this is going to tell me a lot about myself, and that is information I really, really want.

Update: It turns out I've asked this question just a little too late, apparently, yes, CCRM does tell you to take melatonin and argenine PRIOR to the IVF, but tells you to stop during the IVF itself (ie, at the time of GNrH agonist administration). I'm confused if the same does hold true for CoQ10, there appear to be a lot of people who have taken it during medicated IUIs---will read up on IVF.

However,  just FYI, I've seen a study where patients which have prescribed melatonin + myo-inositol DURING the IVF itself. So it can be done. The rationale for melatonin is that it can help minimize free radical damage, which is perfectly plausible in theory.

Also, L-argenine administration may be detrimental during the actual ovarian hyperstimulation, according to this study, which makes sense, because it may result in increased nitric oxide (ie a free radical) buildup.


  1. Jay, Good Luck!

    Yes the protocol you will be using is called flare (micro?) protocol. Lupron used for a short time period will cause the release of your body's natural FSH and this FSH will jump starts your follicles. Hope this protocol works good for you. Normally every protocol works good for women with good ovarian reserve. Are you on BC pills?

    Regarding supplements- I read you are taking metformin and that sounds really good. I just love that drug : ) Folic acid is very important and because of the MTFHR mutation it is good to take 5 mg and you are doing it already. Co-enzyme Q10 sounds good too. Myo-inositol, L-arginine and Melatonin? Do you think it will do any good? I am very skeptical about Melatonin. If you have a good sleep-wake cycle avoid it.

    I hope you decipher all the puzzles you have in your mind regarding your RPL and most importantly may this journey gives you a baby you are longing for!

  2. Hi, for CCRM's DOR supplements, they want you to start around 3 months prior to stims, and then stop everything except prenatal vitamins and 4mg folic acid when you start stims.

  3. Of course I only have the second half of the IVF- the embryo transfer- but lupron is used in my cycle to control the timing.  My RE said that without lupron some women ovulate and lose the cycle.  Because we are already controlling the timing of my new cycle, I will do five weeks of birth control pills and start the lupron shots at the end of the fourth week.    Wishing you luck with the whole process. 

  4. I don't know much about the supplements as I didn't go to CCRM, but as for the RPL, has anyone ever mentioned a steroid such as prednisone??  I had a couple losses and the prednisone seemed to be the magical drug that kept me pregnant.  I don't know if that was it for sure, but I have my suspicions.  Have fun on your vacation! 

  5. I'm sorry I don't have any answers for you but wanted to wish you a happy vacation & very best wishes with your upcoming cycle.

  6. Thanks! I'm not on BC pills. Myo-insoitol, melatonin and argenine come up in studies which show that they may be able to improve egg quality a touch, and god knows, I can't see how it may hurt, though that is always possible in a biological context, but in these studies, the worst thing that happened was that there was no difference between the 2 groups.

    Myo-inositol has also shown some promise in treating non-ovulatory  PCOS, where improvements are easy to spot.

  7. Prednisone could be useful in cases where the cause of infertility is suspected to be the mother's too-active  immune system. In my case, it appears to be egg quality (manifesting in straight out aneuploidy), and  anyway, I'm sidestepping any possible immune issues by using a surrogate.

    I'm really glad stuff worked out for you!!

  8. It sounds like a flare protocol wherre you start on CD1 with Luron and after 2-3 days reduce the dose. The high Luprpn forces the body to suge on its own production of hormones. Enjoy your vacation. Its a good idea to relax and unwind before the procedure, and all the best with your IVF.
    Oh and IVF is more scary sounding that in actuality, the stomach shots are really easy and I for one did not have any emotional issues with the hormones. The stress is more mental relating to how the follies grow and fertilize etc.

  9. I do know that there was a study going on that had women taking CoQ10 during IVF cycles.  I can't find it now, but I think it was a Canadian study.  

    Interesting about the L-Arginine, will now be stopping it!  

  10. Long time lurker here.  One website where you can find an overview on IVF protocols is:

    Yours sounds like the Flare/ Microflare - see here :

    This one explains how lupron works:

    Fertilityforums is a good resource for comparing protocols and people's experiences with the different ones.

    Hope all this helps.


  11. Some links on protocols... some comments may not be relevant if you don't have immunological issues, but since you were referencing the CCRM cocktail, which is their attempt to deal with immune issues while refusing to acknowledge that they exist, lol, I left them in.

    Birth control pills

    It is good to be on bcp's prior to cycling as the estrogen and progesterone in the bcp's reduce NKa and inflammation.

    Bcp's also help avoid lead follicles so that at the beginning of the
    cycle all the follicles start at same sizes and there will be more even
    growth of them and hence more of the eggs will be mature at trigger.

    However, bcp's do suppress quite a bit, so if there is DOR, and no
    overlap with Lupron (such as in an A/ACP protocol), then the bcp's might
    oversuppress and stunt the response too much.


    It is good to be on bcp's prior to cycling as the estrogen and
    progesterone in the bcp's reduce NKa and inflammation. For this reason
    it is useful to also supplement with high doses of estrogen after ER.

    A significant inverse relationship was
    observed between natural killer activity and serum estradiol levels,
    which resulted in moderate and severe disease (r = -0.4, p = 0.009) but
    not in stages I and II.


    It is important to be on very high doses of progesterone after ER, as progesterone reduces inflammation and NKa.

    See the links under "Progesterone" on the TREATMENTS post.

    SIRM protocols

    Details of SIRM protocols are listed here:

    Different protocols

    A good link to read up on different protocols: