Saturday, August 30, 2014

The problem with IVF supplements

Prescription placebos used in research and pra...


Lots of infertile patients take supplements in the hope that these will increase their chances of getting pregnant . Lots of doctors also prescribe these supplements, for many reasons. Some are designed to improve egg quality; others to improve endometrial receptivity; while others are supposed to boost sperm quality.

Most of these supplements are “natural products” which is why doctors are quite liberal about prescribing them . Also, the FDA does not need the manufacturer of these nutraceuticals and supplements to prove their efficacy. Most doctors and patients believe that since these are natural herbs, they are unlikely to do much harm, so why not go ahead and prescribe them. At least the patient is happy that “something is being done”, even if there is no proof that they help.

The problem is that some of these are extremely expensive . While they many not cost much on a daily basis, since the “course of treatment” lasts for many months, the costs add up very quickly !

Even worse, practically none of them have been proven to work. While it’s true that some patients will get pregnant after taking the supplement, this could very well be a placebo effect – and prescribing expensive placebos is hardly good medial practice !

No controlled clinical trials have ever been carried out to check the efficacy of these supplements . They are actively promoted by flashy websites , which do a great job of marketing by playing on the emotions of infertile couples. Many articulate women on bulletin boards will inadvertently promote these supplements by describing how they got pregnant after taking them.

The problem is that one swallow doesn't make a summer – and just because a supplement works for someone doesn't mean it will work for everyone.

The problem is that when women take supplements , they don't take just one – they take an entire box full, to cover all their bases ! It’s impossible to make out what worked and why, which means we do not learn anything useful from all these N=1 clinical trials women are carrying out on themselves.

The big danger is that anything which has helpful effects can also have harmful effects  ! This means that these supplements can actually reduce a patient's fertility , rather than increase it . We are seeing this in our practice. Thus, myoinositol is being actively promoted for treating patients with PCOD, where it has been shown to be effective. However, because it is being marketed under clever brand names such as Oosure, many doctors are mindlessly prescribing it for all patients who have ovulatory dysfunction – including those with poor ovarian reserve ! If doctors are confused as to which supplements to prescribe when, you can imagine the plight of the poor patients !

Patients get confused. When the doctor prescribes them with supplements such as DHEA to be taken for 6- 12  weeks prior to starting their IVF cycle in order to improve their ovarian reserve , they feel that if these supplements can improve IVF success rates, they may be able to help them to conceive naturally as well. They end up wasting a lot of time and money taking these supplements, and then get fed up and frustrated when they do not work.

This causes them to lose precious time – and the risk is that the false hope these supplements create may actually end up reducing the patient’s chances of having a baby.


Confused as to whether your supplements are helping you or harming you ? Please send me your medical details by filling in the form at http://www.drmalpani.com/free-second-opinion so I can guide you sensibly ?







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