OVUM NUTRIENTS

 

 

 

 

Adjunct drugs in Ovulation induction – Any beneficial role or wastage of money or say spoiling the game of Ovulation induction!!! There are so many ovum nutrients which are used empirically by infertility specialists.. Such names are 1) Bromocriptine (to combat transient hyperprolactinaemia), 2) micro doses if Growth hormone, 3) Thyroid replacement at 12.5 mcg level, 4) Growth factors ( if locally available) , 5) quite frequently insulin sensitizers (Myo-inositol-Metformin) &  Vit D etc .

As because some women are relatively young and mentally not prepared for ART procedure , there are many doctors who co prescribe some agents with the hope and belief that such adjunct drugs along with CC or letrozole will improve the egg quality .My dear members what is your view on empirical supplementation of followings drugs like

1. Bromocriptine even if PRL is normal!!!

2. Insulin sensitizers (Myo-inositol-Metformin) , Vit D even if HB A1c or PPBS are normal and she is of normal BMI.

3. Thyroid replacement at 12.5 mcg level even T4 and TPO are normal!!!

4. Multi vitamins including CoQ(mitochondrial energy supplier)  and lycopene .Such  ovum nutrients may be prescribed as an adjunct even in women with good nutrition and well off family.

6. Low dose of oral decadron to combat any rise of adrenal androgens (even if DHASo4 are Androstenedione are essentially normal and there is no evidence of excessive hair in the androgen dependent areas of female body).

7. DHEA even if AFC and AMH are normal and she is suffering from recurrent abortion of unknown etiology and the couple has roamed from one center to another center for last 10 year with failed IUI and IVF without any evidence of endometriosis of Kochs (Laparoscopy done- NAD). But my take is to  rpt AMH on couple of occasions and when one will be sure of DOR by  repeated induction by different agents including Preinduction (Long Agonist Protocol)  fail to achieve MII oocytes or pregnancy due possibly to fertilization failure  our or embryonic arrest inspite of normal chromosomes and normal metabolic and endocrine profile in such cases I have a feeling that people should repeat AMH and can supplement some of the above quoted seven agents including DHEA but  not all.

Because in such set up with persistently low AMH & AFC ad poor outcome with high dose of gonadotrophins.  In such cases such ovum nutrients have an scope before policy of  Donor is proposed  and provided couple agrees and her age is above 35 years and duration subfertility is more than 12 years.

Day 3 & Day 8 HMG boost up?  The reason why some fertility specialist co prescribe HMG is A) u-FSH- 75 IU on day 3 that such early suppl of HMG may help in additive effect on follicular selection and sometimes after USG on day 8 to day 10 another dose of HMG is supplemented .This second dose can be supplemented if Dominant follicle is less than 10 mm on day 8 of CC/Letrozole cycle.  Even if follicle is at par these concepts of day 8 HMG administration of injection UFSH 75-IM is schedule with the idea that LH content of u-FSH will supplement required LH in late follicular days. We know some amount of LH is essential before final follicular maturation .In some women there is such lag in mid & late follicular phase.