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| Vaginal ultrasound showing a thin endometrium |
I always had great endometrial lining during all
my IVF cycles (greater than 8mm, mostly between 10-12 mm). In FET cycle too
there was no problem. So, what went wrong this time? Even though I can just
speculate, I know deep within me that my speculation is right. I have lost lots
of weight during the past 5 months. I was insulin resistant before. I had a
HOMA IR (a measure of insulin resistance) of 4.1. There is no standard value for HOMA-IR.
The current studies consider that HOMA-IR < 2 is normal, HOMA-IR ≥ 2 is
pathological, with HOMA-IR > 4 reflecting the pre-diabetic stage. My fasting insulin was 17uUnits/ml
(although a fasting insulin of 5-25uUnits/ml is considered normal, anything
above 10uUnits/ml is not so good. People with fasting insulin of less than
5uUnits/ml are found to live longer). I have a family history of diabetes in my
dad’s side. I was diagnosed with PCOD at the age of 25 and I am on metformin
(1500mg) for a long time. I stopped metformin for the past year because of
gastrointestinal problem. After stopping metformin my BMI was 26.2. I was
overweight. Lack of implantation in my previous ART cycle made me to ponder
what can be done to improve my chance of conceiving. The only sore point I had
is my weight and perhaps insulin resistance because of it. My blood glucose was
normal. I also became aware of the fact that calorie restriction has a positive
impact on egg quality. This made me to think seriously about removing the
excess weight. My boss is an endocrinologist. I used to discuss with him about
the weight issue and ask him whether carbohydrate rich meals are the culprit.
He used to say-eat anything, but eat less. I started a very strict calorie
restriction diet and jogging. I limited my calories to 800-1000 for the first 2 weeks. I
achieved this by intermittent fasting. To my surprise my fat deposits around my
waist started to melt. After two weeks I upped my calories to 1200-1500
calories. I avoided sugar, sweets and carbohydrate rich foods. I avoided
rice as much as I can. I took only 300 calories per meal. I started metformin
1000mg. I stopped non-vegetarian all together and I am not planning to eat it
anymore during my lifetime :). Within 5 months my weight dropped from 68 kg to
61 kg. The best point is I lost all the excess fat. For the first time I had a flat stomach. My energy levels improved. I can skip a meal
easily without any trouble. I attribute it to my lowered insulin levels. In short I
felt great. Received mixed comments from friends. Some are worried. They said I
have lost the charm. But my DH is happy. He said I looked better now. I am
happy too :)
Everything sounds good, right? Then, where lays
the problem? Calorie restriction is good. It was found to prevent aging in
experimental animals. It also delayed egg cell aging and extended fertility in
experimental mice. Metformin is a calorie restriction mimetic too. It can also
improve egg quality (both by preventing egg cell aging and by decreasing
insulin levels). I do not think short time calorie restriction will have
any effect on egg quality in humans. If calorie restriction is started
in 20s it might extend fertility into your 40s. The same is true with metformin
usage. Long term metformin intake can preserve egg quality via preventing
genetic defect accumulation, while short term intake can increase egg quality
by decreasing insulin levels. It was found that exercise and weight loss is
much effective than metformin in decreasing insulin levels. So bringing down
your weight at any point of your lifetime will have positive effect on your
overall health by decreasing insulin, glucose and harmful triglyceride levels. This will keep your hormones balanced which is necessary for optimal
fertility. As a result egg quality (not genetic but physiological parameters) and endometrial health improves. Consider calorie restriction if you are suffering with infertility due to overweight and
PCOD (high insulin!). Reduce your weight through calorie restriction and proper exercise. Continue exercise regimen and increase your calorie intake for maintaining the appropriate weight. BUT never do calorie restriction when you are on
fertility medicines, if you are underwieght or when you are trying to conceive. Never be on very restricted calories (less than 1500
calories) when you are trying to conceive. This is the mistake I did this
cycle. Even after starting fertility medicines (progynova) I continued with
fewer calories. Lesser calories actually signal your body to go into the
survival mode (during which only minimal bodily functions are maintained).
Reproduction is an extremely energy consuming process. Once your body senses that
you do not have enough calorie supply (as in times of food scarcity) it
switches on mechanisms which prevents energy expenditure. It tries to switch off high energy demanding functions like
reproduction. In short all the anabolic activities which require high energy
are switched off and catabolic processes which produce energy are switched on. Since
I took less calories my estrous cycle is severely affected leading to poor
endometrial development. My body in short doesn’t want to get ready for
performing reproductive function.
I got this information from a website:
Reproduction: Feeding the
reproductive cycle
Energy
metabolism is known to affect reproductive cycles, acting as an evolutionary
oversight to ensure that reproduction occurs only in favorable nutritional
conditions. A recent study characterizes a mechanism through which the liver
integrates metabolic responses to control ovulation (Cell Metab. 13, 205–214).
Investigating
the link between estrogen and food consumption in mice, Sara Della Torre and
colleagues found that caloric restriction decreased hepatic estrogen receptor-α (ER-α) activation in the
liver and arrested estrous cycle progression. Interestingly, amino acid
supplementation was sufficient to rescue mice from this metabolic block of the
estrous cycle.
The
authors found that ER-α activation
led to increased hepatic expression of insulin growth factor–like-1 (IGF-1) and
increased the amount of circulating IGF-1. Increased IGF-1 expression was
required for E2-induced proliferation of uterine lumen epithelial cells and for
estrous cycle progression in vivo.
The
findings highlight a crucial role of hepatic ER-α as an integrator
of metabolic and reproductive functions. The exact mechanisms by which IGF-1
and E2 promote progression of the estrous cycle remain to be determined, but
this study might provide insights into infertility conditions, especially those
linked to metabolic dysfunction.
On the other hand there must be a connection
between fat reserve and estrogen function. It is known that estrogen is stored
in fat reserves. I have read that people who are obese are prone to estrogen
sensitive breast cancers. Overweight people are also more prone to endometrial
cancer. You need healthy fat reserves for your estrogen to function properly. Dr.Malpani
sent me the Frisch hypothesis paper which talks about the connection between
body weight and onset of menarche.
In short I learned a lesson which is
invaluable. Do not change your diet or exercise regimen extremely during IVF or FET cycles. Do not loose weight especially fat reserves when undergoing fertility treatment. Increase your intake of healthy fats. Do
not restrict calories. The above said are very important for proper functioning of your reproductive harmones which intrun is important for your treatment success.
Another interesting information to ponder : In certain regions of south India, daughter-in-law who enters husband's home for the first time, after marriage, is given cow's colostrum. Perhaps a nice way of preparing her to carry their generation :) Milk is know to increase IGF-1 levels. When I say this I do not want to make IGF-1 master of all reproductive functions, just a note because I am talking about IGF-1 in this post. Our ancestors do have lots of wisdom :)
Another interesting information to ponder : In certain regions of south India, daughter-in-law who enters husband's home for the first time, after marriage, is given cow's colostrum. Perhaps a nice way of preparing her to carry their generation :) Milk is know to increase IGF-1 levels. When I say this I do not want to make IGF-1 master of all reproductive functions, just a note because I am talking about IGF-1 in this post. Our ancestors do have lots of wisdom :)
Stupid me ! Dr said –don’t beat yourself up! He asked
me to read ‘Shoulda, Woulda, Coulda’ :). I will try not to regret. Hopefully
G-CSF works and perhaps everything happened for my good :) Otherwise I will
not have had a chance to use G-CSF which is supposed to increase pregnancy
rates atleast in a couple of studies :)
