MIHO Study - Milk drink to Improve the Health of Oocytes

INTERVENTION: Participants will undergo their usual IVF treatment, but from the 3rd day of the IVF cycle they will be asked to consume 250ml of a milk‐based drink in the morning and evening that will contain active components that might increase ovarian blood flow and follicular fluid insulin‐like growth factor 1 concentrations, or a placebo. They will continue to consume the 250ml drink daily until the end of their IVF stimulation cycle. At the start and end of their cycle a blood sample will be collected to measure circulating IGF‐1 concentrations and the concentrations of reproductive hormones. During their routine day 9/10 follicle tracking scan, blood flow to the ovaries will also be measured using ultrasound. When their eggs are retrieved at the end of their IVF cycle the follicular fluid surrounding the eggs will be collected and analysed for IGF‐1 and reproductive hormone concentrations. CONDITION: in vitro fertilisation PRIMARY OUTCOME: insulin‐like growth factor 1 concentrations will be measured in follicular fluid using commercially available kits SECONDARY OUTCOME: insulin‐like growth factor 1 concentrations will be measured in blood serum samples using commercially available kits IVF outcomes will be assessed by granulosa cell function by measuring follicle estrogen, progesterone and testosterone concentration using commercially available kits ; and oocyte competence by measuring fertilisation rate, ability to form a good quality blastocyst embryo. ovarian blood flow by Doppler ultrasound pregnancy rates will be calculated using the number of viable fetal hearts seen on ultrasound per 100 embryos transferred reproductive hormone (Estradiol, progesterone, testosterone, FSH, hCG, AMH), lactacte and glucose concentrations will be measured in follicular fluid using commercially available kits INCLUSION CRITERIA: Undergoing a gonadotrophin‐releasing hormone antagonist cycle of IVF treatment and a poor responder to ovarian hyperstimulation. This includes meeting two of the following three criteria: 1. 40 years or older 2. previously only produced 3 or less mature eggs in response to maximal dose ovarian stimulation during IVF treatment 3. serum anti‐mullerian hormone concentration < 7.8 pmol/l or a total antral follicle count <7 (both being accurate markers suggesting a reduced number of eggs left within your ovaries relative to your age).