Oocyte Enhancement and Implantation Enhancement
Ask our staff! We want to help all of our clients understand some of the new protocols that we have implemented recently. In order to continue to provide our clients with first class service, Dr. Kiltz continually reviews the latest research in Assisted Reproductive Technology. At CNY Fertility we have labeled our new protocols as Oocyte Enhancement (OE) Protocol and Implantation Enhancement (IE) Protocol. The protocols include a diet plan, supplements and the addition of medications to enhance both oocyte quality and implantation.
The OE/IE protocols include Dr. Kiltzs’ recommended Ketogenic Diet Plan. The Ketogenic plan is a high fat, adequate protein, low carbohydrate diet. The idea is that glucose, and carbohydrates that covert to glucose, cause inflammation. The inflammatory process of our bodies has been known to interfere with ovarian function, ovulation and luteal function.
Below are a list of the medications and a brief description of each to hopefully provide some clarity to the recommended medications.
Human Growth Hormone (HGH) :
Human Growth Hormone is used in addition to gonadotropins before and or during ovarian stimulation. The proposed purpose of HGH is to improve the ovarian response in those that have a history of previous failed cycles that did not result in pregnancy. The hope is that the HGH will improve the quality of the eggs and therefore improve embryo quality. There are several journal articles that support this; however, it is considered an off-label use of the medication by the FDA. Clients are requested to inform our providers of any history of cancer. Clients cannot be treated with HGH if they have a personal history of cancer. Also, diabetics will need to monitor their glucose closely during HGH treatment. Generally the HGH is started 30 days before stimulation or on the first day of stimulation and continued until the trigger shot.
Low Dose Naltrexone (LDN):
LDN is a therapy that has shown promise in a variety of health issues including infertility and other symptoms associated with PCOS. LDN boosts the immune system, the mechanism for which we do not entirely understand. LDN makes the immune system begin working at optimum levels again which includes the correction of the many imbalances which plague our body. Studies have also helped to uncover some relationships between the immune system, the hormonal imbalance of the body and the problems experienced by women with PCOS and infertility in general.
LDN therapy requires taking 1.5mg-4.5mg by mouth at bedtime. The medication will cause a blockage of endorphin receptors throughout the body. The brief blockage every night appears to be enough to effect a prolonged change in many aspects of the immune system and increases the body’s ability to heal itself. Although LDN is noted for being side-effect free because it stimulates the body’s own mechanisms, there are clients for whom it is not well-suited especially those being treated for addictions. LDN should not be used if you are taking Methotrexate or any Narcotics. LDN is taken at the start of stimulation or before and stopped with a positive pregnancy test. It will be temporarily stopped 4 days before oocyte retrieval and resumed the following day.
Intralipids are a liquid emulsion of fat. It is mainly composed of soybean oil and egg fats. Intralipids can be used along with conventional fertility treatments. Researchers believe it acts to suppress the body’s Natural Killer Cells. These cells may attack the sperm or egg and possibly the cells of the developing fetus. This is an IV infusion that is performed in our office and generally takes approximately 20-30 minutes. The current recommendation is to infuse Intralipids before IUI/Egg Retrieval/Embryo Transfer and weekly thereafter to 12-14 weeks gestation.
Intralipids need to be used with extreme caution in patients who have diseases that may affect the function of the liver or kidneys. These may include but are not limited to diabetes, liver failure, hepatitis, cirrhosis, kidney disease, or metabolic disorders. People who have an allergy to soybeans or eggs are unable to receive Intralipid therapy.
Neupogen is a medication that causes the body to generate neutrophils, a type of white blood cell which plays and important role in the immune system. An individual may benefit from Neupogen if they have experienced multiple miscarriages or failed implantation with IVF. This medication is also useful in many cases for the purpose of improving egg quality and improving the tissues of the uterine lining. The most commonly observed adverse reaction is mild to moderate bone pain after repeated administration and local skin reactions. Neupogen is administered either in injection form or as a uterine wash.
Neupogen is increasingly utilized for other conditions including the treatment of recurrent miscarriage and/or implantation failure. Neupogen is not yet approved or disapproved by the Federal Drug Administration (FDA) for these conditions or diagnoses.
We are also recommending COQ10 400 mg daily, Fish Oil 3 Grams daily, Vitamin D 2000-4000 IU’s daily, Folic Acid 1-2 mg daily and Prenatal Vitamins daily. We encourage our male clients to supplement with preconception antioxidants to improve sperm quality. For our clients that do not respond well to hormones or are of advanced age, we recommend DHEA 25mg three times per day.
Please ask any member of our CNY Fertility Team about the Oocyte Enhancement/Implantation Enhancement Protocols! We are here to answer any questions and assist you in making informed decisions regarding your individualized protocol.