LE Standard or PCOS?

Hi Atomic, sorry I totally missed your reply!

My BMI is 18.8 at the moment I gained a bit but not a lot still lower then when I started (19.4 back then). I have been eating brown rice and drinking whole fat milk the whole time but you are right that I need superb egg quality to go into IVF. Having this option gives me hope but at the same time I am so scared that I end up with only boy embryos or no embryo to transfer. I kept seeing stories where they had 20+ eggs retrieved but ended up with only 1-2 viable embryos for transfer. I couldn't help but wonder if my egg quality is also on the poorer side too since we are having a hard time to conceive. I have not done any pretesting yet so I guess we will only know when we start the process right?

Since last week, I have cut out all the white carbs and sugary food (mainly biscuits, bread and cake) and I make my own 100% wholewheat bread with nuts and seeds. I have added 1 egg and 1/2 avocado a day for some good fat and eat small portion of meat (mainly chicken breast or salmon) with every meal and drinks 1-2 cups of full fat fresh milk. No alcohol nor coffee and increased my water intake. I take prenatals, folate 1600mg and ubiquinol everyday as well. I read that vit D is good fertility, should I add that to my supplement? DHEA? What else can I do to improve my egg quality?

Husband just started working out (weight lifting) as well so he has been drinking protein shake and taking omega 3 for his workout. He also takes L-carnitine and L-arginine. I couldn't find the one a day for men 50+ here, would the general version one a day for men work?

Ok. We have a potential concern on the horizon. You're too thin and if you try to cut out all refined carbs, it could very well be that weight flies off. We CANNOT have that. We need your weight to stay stable and it would be better for you to gain some back to your previous weight of 19.4. Being too thin can also mean you are less likely conceive with IVF, so we want to avoid you getting too thin if possible. It's fine for you to cut back on sugary treats, but you may NEED some carb intake to keep weight on (or even add some). Just be very very cautious not to lose weight at all. Obviously whole grains are best overall, but some people just need to include some refined carbs to keep weight on.

I don't think you need to worry about egg quality right now. Being that thin indicates to me that you've got a good insulin response and probably do not have chronically high blood sugar that would make for bad egg quality.

If I had to pick a "most likely" reason you've not conceived my most likely contender is the low weight. While you're not under my "cutoff" of 18.5, we do see people who just cannot get pregnant when their weight drops too low, even when ovulation continues. I would love to see you add a few lbs.

Vitamin D, I recommend up to 1000 IU (250%). This is often the amount in many vitamins and prenatals already. If you want to take more, I would have my levels checked beforehand.

Don't take DHEA without having your levels checked. This is VERY IMPORTANT, far more important than having your Vit. D levels checked. People who are making enough DHEA will get a kind of PCOS-lite from the DHEA and it WILL harm your egg quality. Only people who have low DHEA, that is tested and monitored by doctors, should be taking DHEA. Everyone else will see their chances actually diminish from the DHEA - and this is MOST people.

Yes, the general Men's one a day still works!!!

Thanks for the info! I will make sure that I don't loose any weight. I have replace my white carby snacks with healthier snacks, like wholemeal toast/Ryvita flatbread with butter/cheese/peanut butter or muesli/oatmeal with milk, are those ok? Sounds like I am eating a very blue diet now but I guess what needs to be done needs to be done. I eat at 7, 1 and 6 and no snacking in between so at least there's that.

I just checked my prenatal and you are right it has 800IU of Vit D already so I don't think I need to add more and I will not take DHEA. Thank God I checked with you!

My cycles have been pretty regular (ovulating somewhere between CD14-18 and LP around 13 days) on the diet a so I never thought my weight would be the issue too. I conceived my 1st with BMI 20.2 (while travelling and gaining weight) and lost some weight after birth, preg with my 2nd with BMI 18.8. If I gain back all the weight I lost on LE diet and got pregnant does it sway strongly blue? I really want to get pregnant naturally but I still hope that I'd have a chance to get pink (or perhaps its mutually exclusive?)

Yes I'm glad you checked with me too.

Those snacks are great!

That is still not a very blue friendly diet. Not at all. You're eating only 3 times a day, less calories, protein, and fat.

I agree that's enough Vit. D!

That's the thing, even when people have had regular cycles, sometimes they've not conceived when their weight was too low, so we just want to avoid that pitfall, especially the pitfall of dropping any lower.

We have had lots of people have girls after having to regain some weight (and gain weight deliberately on a blue diet, and have girls anyway). Weight loss has not been super predictive of who has a girl and who has a boy.

I have been a week on no sugar & white carb diet now and I have been super irritable, feeling depressed and just very tired with headaches. Not sure if that's from giving up sugar or something else. So far I have gained some weight so I guess that's good progress too! I am not tracking my cal/protein/fat, should I?

I actually experience that myself when I try to cut out refined carbs too. Just stay the course, it does get better over time BUT with the headaches, I think that can signify your blood sugar is low, so if you're experiencing headaches that's a sign you need to eat something.

As long as you are sure you're getting about 40% protein, 30% healthy fat, and 30% healthy carbs you don't need to track. Remember, we don't want you to be eating too many carbs, and to be getting enough protein and healthy fat, so if you need to track to ensure that's happening, then do so. If you can manage without it, then no need.

So i tried to input what I eat in a day in the app and I've been eating about 1600 cal now but only 20% protein (80g), 35% fat (60g) and about 45% carbs. It's a lot higher in protein than in LE but still far from enough. If I need 40% protein I need about 165g on a 1600cal diet, does that sound about right? There is no way I can get that much protein without going over carbs and fat unless I eat lots of chicken breasts (like 300g a day). Is that OK?

Another "combination" is to do 30% protein and fat, and 40% carbs. Or 35 g fat and protein, 30 percent carbs. or 1/3, 1/3, 1/3. If you can't get up to that amount, just eat more than you were. The point is to cut back on carb intake. You can have some flexibility with that, but you don't want to be eating gobs of carbs any more.

Some IVF doctors even suggest going onto a VERY low carb diet. 80g protein is considered by many people who are big protein people, to be a fairly low protein intake. I personally disagree with that advice for most people (and you are NOT someone who would benefit from a very low carb diet, in fact quite the opposite so even if they tell you to do that, don't!) You should be eating some meat, to get yourself a lot of protein for not a lot of calories, but if you really, truly can't get up to the 30-40% range, just do what you can to cut carbs and replace that from protein and healthy fat.

Is agave syrup ok on the diet? I read that it is low in GI but still quite high in carbs. I use it in my milk + cocoa powder. Life is better with it but I can live without it too.

Yes it's fine to continue that given your low weight and the fact that we're basically doing this as a preventative measure (and not, for example, because you have severe PCOS!)

Hi Atomic, I just got my lab results, all in the normal range apart from my testosterone which is lower then normal. Can you help me take a look? These are taken on the 3rd day of my period.

AMH 3.29ng/ml
TSH 0.755uIU/ml
T4 7.64ug/dL
LH 4mIU/ml
FSH 5.9mIU/mL
Prolactin 9.7ng/ml
progesteron 0.16ng/ml
estradiol 32.49pg/ml
testosterone 6.71ng/dL

Did i miss any important marker?

Semen analysis results are pretty much the same, normal sperm count but lower than normal concentration, low motility (slightly improved) and low morphology (this one did not improve at all over the last 10 months).
Concentration 14x10^6/ml
count 56x10^6/ejac
PR motility 28%
morphology normal 1%

We will see the andrologist tomorrow and hopefully the fertility specialist next week to get second opinion and inquire about possible fertility treatments.

You need to eat a little more fat. I know you've already been trying to eat more, but that is the reason why your testosterone is low.

The biggie is the HSG test to look for blockages in your uterus and tubes. I really urge you to get that done even though these tests have come back good.

Hi Atomic, we did some more tests in the past week and to my surprise, my Cholesterol came back higher than normal (Total 243mg/dL and LDL 161mg/dL, the HDL is normal 77mg/dL). Is high cholesterol mainly caused by diet? I couldn't think of any food that may be the cause...too much butter and dairy? So if I need more fat, I need to get them from nuts and seeds that sort of food? I am also lower on Vit D 23.1ng/mL, should I be on Vit D supplement? What dosage is safe?

High cholesterol is genetic. The idea that diet raises cholesterol has fallen out of favor.

There is no way you're getting high cholesterol from what you've been eating. HOWEVER, there is another secondary cause of high cholesterol and that is anorexia. I am very concerned when someone who has been on a diet as long as you have has high cholesterol, because I honestly cannot know if you guys are eating enough from here, and I strongly urge you to follow up with your doctor to rule out a liver issue caused by being too thin for too long.

Yes PLEASE take 1000 mg Vit. D daily for 6 weeks (or a higher dose if your doctor recommends it) and then go to 2x a week maintenance dose. That may help you get pregnant as well. Don't worry about your sway, when you're low in something the rules change.

(((please take this seriously because you need to rule out seriously damaging your health)))

By anorexia do you mean because I am not eating enough and starving myself? I think I'm eating pretty ok...at least I never felt hungry ever since I started LE. Thank you for the heads-up though, I have booked a consultation with endocrinologist and see what is wrong with me. My dad used to have high chol but I think it was from his diet/lifestyle. After he changed his diet it was pretty much under control. I thought my diet is bland enough so it means that I can continue consuming milk/butter?

Past months we did scrotal USG and hormonal tests for DH and no significant issue found was in the result. We were referred to IVF treatment by our andrologist so I will book an appointment with IVF clinic after my AF starts in a few days. We are going back to Taiwan for the treatment where we can apply for government subsidy but unfortunately gender selection is illegal there so I think all I can do now is eat as healthy as possible so I can make more high quality eggs and hopefully get more girl embryos right?

Wishing you the best! I hope you can get some answers and get the little girl you are dreaming of!

Thank you Treens, it's still pretty overwhelming and I still have hard time believe we have secondary infertility. But I guess we will take baby steps at a time and pray that I get plenty good girl embies! Good luck to your attempt this month!! And so so sorry to hear about your lost...

Yes, that is exactly what I mean. A woman who is very thin, eating very little, with high cholesterol may have it genetically, but anorexia/bulimia/disordered eating is also a possible cause, as is malnourishment. There is NO WAY given what you're eating that diet is causing you to have high cholesterol, and if you start limiting your diet more so, you're going to potentially exacerbate the underlying issue if it's related to your overall food intake. We need to talk to that endocrinologist about that possibility - please bring it up to him/her when you're there. Many doctors will just handwave cholesterol away as genetic but that may not be the case here.

Scientists are proving more and more that diet really isn't the root cause of high cholesterol. While some people, like your dad, who have high cholesterol, can lower it some via diet, the reason they have high cholesterol to begin with has more to do with their genes than their diet.

You probably need that fat intake to get and stay pregnant since the sex hormones are made from fat and cholesterol. I don't want you to now start starving yourself trying to eliminate fat. You need fat to stay healthy.

Not feeling hungry doesn't mean anything. Your body can adjust to inadequate food intake over time. A person can be overweight and still be malnourished. I really hope your endo is able to rule these things out and then we can decide what to do from there.

And yes, that's exactly right. We want you to be healthy as possible to be sure you can make a lot of eggs, because IVF is a numbers game and the more eggs we get, the more can be fertilized, upping our chances of getting XX!! FXFXFXFX!

I have been adding alot of nuts, seeds, avocado, olives, lots of lean meat, veg and daily egg to my meal. Continuing whole fat milk and reducing my carbs to 1 toast and fruits. I am taking CoQ10, Vit D, folate, prenatal and omega. Really want to do cardio but no energy :( I have cut down sugar/carbs and up my protein for probably 2 months but not with the additional nuts and seeds and eggs. Is enough to boost the egg quality? If I can start the IVF cycle next month, do you think I should go ahead or wait a few more months on the diet?

Can I ask for your opinion? Do you think I should choose a clinic with high success rate but cannot choose gender, or an average clinic but can choose gender with PGT? The fact that the clinic I am going cannot choose gender makes me anxious. I think I should go for the the clinic with better lab because they can yield more viable embryos and therefore more chance of getting XX? Even if I go to a clinic where GS is applicable, without enough embryo to choose from I might end up with no XX to transfer. Am I thinking right?

That is fabulous that you're eating more healthy fats.

You don't need to reduce your carbs, that's not what I am saying. You need to continue to eat carbs to keep weight on and stable, and also because being very low carb has actually made some people's cycles go missing (even when not losing weight.) That is very likely why you have no energy right now. PLEASE increase your carb intake to a normal level like we discussed where you're getting 30-40ish percent of cals from carbs, and be sure you're getting enough calories as well.

There is a HUGE difference between a swaying diet where you're eating a lot more carbs, and a healthy for IVF diet. You can have, and indeed should have, a reasonable intake of fruit and whole grains. You don't need to load up on things like gummy worms and marshmallows, but 1 piece of toast is not enough.

BAD diet for IVF: skim yogurt for breakfast, bagel with fat-free cream cheese for lunch, pasta and salad for dinner (very high carb, very low fat and low protein)

GOOD diet for IVF: whole grains, nuts, seeds, fruit and veg, full fat dairy, meat, eggs, but you don't need to be and in most cases shouldn't be eating very low carb!

I think you should go where you can choose gender. I think that at this point if you go through all this and end up with a child that is not your desired gender, you will be extremely upset and disappointed. As long as the success rates are reasonable I would personally go where I could select the gender I wanted.

Hi it's a good thing you are super conscious about your diet and doing everything for the sway. I hope you get your baby girl! Regarding clinics it is always best to go to one that has up-to-date tech in their labs. Like the one I'm going to in Cyprus.

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Originally Posted by Walkerbabies

Hi it's a good thing you are super conscious about your diet and doing everything for the sway. I hope you get your baby girl! Regarding clinics it is always best to go to one that has up-to-date tech in their labs. Like the one I'm going to in Cyprus.

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Thank you, have you had your cycle yet?

Hi Atomic, I just want to thank you for urging me to get on the ivf diet asap. I never planned to start cycling this early but this journey is really about learning to cope with the unknown (and I think I am getting better at it!) and the result would not have been as good had I not listened to your advice and made all the changes. Update on my cycle so far, I had 28 eggs retrieved, 16 mature, 12 fertilized and 10 made to day 5 blactocyst. We biopsied all 10 and sent 9 of them to PGS. The gradings are 3BAx3, 6BBx3, 3BBx2, 3BCx1, 3CCx1. Doc says I get 1 out of 3 normal embryos for my age. Hopefully I can get some good girl embies :pray:

WOW that's fantastic!!! fXFXFXFX for lots of pink!

Wow your numbers are great! Yes I started my cycle last March. The donor had egg collection this April and I will have my transfer this May. Having delays due to lining issues.

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Originally Posted by Walkerbabies

Wow your numbers are great! Yes I started my cycle last March. The donor had egg collection this April and I will have my transfer this May. Having delays due to lining issues.

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I am quite shocked that they retrieved 28 eggs too...was expecting something around 10-15 because my amh is 3.2. I think the lab did a great job developing the embryos and now just hope that there are plenty of them normal and pink.

This May you mean this month? Soon? Has your lining issues been solved? Good luck! I will have my transfer when my period starts next cycle...end of june to early july. keep me posted how it worked out!

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Originally Posted by onelittlewish

I am quite shocked that they retrieved 28 eggs too...was expecting something around 10-15 because my amh is 3.2. I think the lab did a great job developing the embryos and now just hope that there are plenty of them normal and pink.

This May you mean this month? Soon? Has your lining issues been solved? Good luck! I will have my transfer when my period starts next cycle...end of june to early july. keep me posted how it worked out!

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Yeah, 28 is a great number! Yes this May. My transfer is scheduled for May 31. I will be flying to Cyprus May 29. That way we will have time to relax and see the sights before transfer.

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Originally Posted by Walkerbabies

Yeah, 28 is a great number! Yes this May. My transfer is scheduled for May 31. I will be flying to Cyprus May 29. That way we will have time to relax and see the sights before transfer.

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It's a FET right? Do you take meds for this cycle prior to transfer? And you can schedule the transfer already? I was given estrogen meds and I need to take them from day 3-11 of my next cycle but they only tell me the possible transfer dates because they need to look at lining. Is it different with your procedure?

Atomic, is there anything I can do to improve my uterus environment for implantation? I’ve been eating alot of good fats (nuts seeds salmon avocado) and alot of lean meat (chicken and fish), 1 cut of full fat fresh milk, 1 egg a day and i startef walking 1hr a day. Ive gained some weight and my bmi is 19 now (so proud of myself!!). Is there anything else I should or should not do to prep my body for embryo transfer?

Fingers crossed for you onelittlewish. You are doing so great :))))

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Originally Posted by onelittlewish

Atomic, is there anything I can do to improve my uterus environment for implantation? I’ve been eating alot of good fats (nuts seeds salmon avocado) and alot of lean meat (chicken and fish), 1 cut of full fat fresh milk, 1 egg a day and i startef walking 1hr a day. Ive gained some weight and my bmi is 19 now (so proud of myself!!). Is there anything else I should or should not do to prep my body for embryo transfer?

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Most of the stuff that is marketed as "aiding implantation" does nothing at all, and when people take too high a dose or take many things all together it can actually be harmful. Please run everything past me before doing it as some of the supplements are actively harmful. Eating a lot of good food and following the doc's guidelines for how long to rest after transfer are most important. Your body knows how to implant a pregnancy. If you really want to do something you can eat fresh pineapple including the core and the brazil nuts, which are harmless.

I am so happy you gained a little weight back!

I got my PGS result back and had a teleconsultation with my doc on saturday. The appointment was rescheduled last min so had the call in my car. I hope I heard the results correctly...out of the 9 tested embryos 6 came back normal, 2 mosaic and 1 abnormal. If I heard correctly I have 2 normal girl embryos! Not a whole lot but at least there's 2 chances of getting my girl. So my new cycle starts in two weeks or so and we will start my FET cycle. Est transfer sometime early July. The doc says there's 70% chance of success and he is pretty confident that I will get preg. I cannot believe it's happening!

Oh gosh that's great news!! Please keep us posted and wishing you the very best of luck!