Common Fertility Supplements: A guide to the Natural Fertility Medicine Cabinet

Fertility treatments are commonly centered around the use of acupuncture and Chinese Herbs.  Even so, nutrition and lifestyle counseling is also a core part of a holistic treatment plan.  Often times this includes the use of supplements.  I may suggest a supplement, people may come to me having been given supplements by another healthcare provider or they may simply be going off of a recommendation from a friend, book, or website.  It can be difficult to sort through the information about many of these supplements and very few have reliable research to back up their claims. 

I wanted to write a guide to supplements that might be a reference for my patients as well as for other health practitioners.  This is not meant to be a be-all and end-all list, but should give an idea of when a supplement might be considered and what cautions might also be present, to help narrow down the field of possibilities.  I have for the most part refrained from giving dosing information in this guide in part because I want to encourage patients to always have a discussion with their health care provider before starting a new medication or supplement.  I hope to continue to add to this list so if you have any suggestions or resources for additional information, please forward them along.  I could add many Chinese Herbs to this list, but for now I am keeping that information separate.

Prenatal Vitamins:  I am in favor of a prenatal vitamin in most cases.  Unless your diet is impeccable, most of us could use the boost from a well-rounded multivitamin.  I often get asked about recommended brands and the whole foods versus traditional multivitamins.  I like the idea of whole food vitamins, though I am not convinced that they choose the most bioavailable forms of vitamins like some other brands do.  Overall, I am in favor of whole foods vitamins though.  This is in part due to the fact that they seem more likely to have folate in them as opposed to folic acid.  I find this to be important because of the high prevalence of MTHFR gene mutations and the relevance of this condition to fertility, miscarriage and fetal defects.  I cannot go into the condition further here, but in these cases methylfolate is an important supplement and synthetic folic acid should be avoided. 

Who should consider taking it?  Most women of childbearing age

Cautions/Considerations Avoid folic acid in favor of methylfolate

Vitamin D:  Vitamin D (D3) is not necessarily recommended in cases of infertility, but this important nutrient is vital for so many body processes, including many aspects of female reproduction, and most people are deficient.  One study, conducted at an IVF center, found a four-fold difference in pregnancy rates among Vitamin D replete and Vitamin D deficient women.  It is believed that the benefit of Vitamin D may be at the level of the uterine lining, but because this nutrient is involved in so many physiological processes, it is hard to say where the benefit lies.

Who should consider taking it?  Anyone with low Vitamin D levels.  The amount found in a multivitamin is general insufficient to raise levels, so doses of 2-5,000 IU daily may be recommended.  In some cases even higher doses are recommended temporarily.

Cautions/Considerations Toxicity is rare.  What is of more concern is making sure the Vitamin D is absorbed appropriately.  Vitamin D is fat soluable so it needs to be consumed with fats.  I prefer taking it in oil based drops, which makes dosing easily adjustable.  Additionally, recent research supports a synergistic affect with Vitamin K and Vitamin D, specifically Vitamin D3 and K2, both helping with proper absorption of calcium. 

Omega-3 Fatty Acids:  DHA and EPA are important fats that make up the membranes of all cells.  There are many health benefits to taking an Omega-3 supplement.  Maternal DHA levels directly impact brain and eye health in a developing fetus.  Omega-3s are also potent antioxidants with anti-inflammatory qualities.  Our diets tend to be too high is Omega-6s, another essential fatty acid, when compared with Omega-3s.  Supplementing Omega-3s has been shown to improve fertility outcomes with higher rates of conception, decreased rates of miscarriage and a lower risk of preterm birth.

Who should consider taking it?  Everyone.  It is difficult to eat enough fish or flax to achieve optimum levels and mercury levels in many fish make it inadvisable to eat fish more than 1-2 times per week.

Cautions/Considerations  Good sources of Omega-3s are fish oil, from cold water fish that is wild caught, not farmed, or krill oil.  Quality is important.  For women who are pregnant or trying to conceive, seek an Omega-3 with an amount of DHA comparable to the amount of EPA.  Most supplements contain greater amounts of EPA.

Cod Liver Oil/Fermented Cod Liver Oil:  Fermented cod liver oil is a traditional super food, which may have additional benefits beyond those of cod liver oil.  In either case, cod liver oil is a potential source of Omega-3s, though amounts may vary.  It is also a good source of vitamins A, D & K.  My skin is much smoother when I am consuming cod liver oil, most likely from the Vitamin A.  But most physicians advise against cod liver in pregnancy because of the high Vitamin A; it may be toxic to the liver of the developing fetus.  

Who should consider taking it?  Anyone might want to consider taking this superfood, supported by many in the traditional food movement, as a source of multiple nutritionals - quality fats and vitamins to support cognitive and emotional health, as well as immune function.

Cautions/Considerations If you are taking cod liver oil, I would discontinue it when you become pregnant.  While I have heard some say it is okay to continue, I think most physicians would advise against it.

Evening Primrose Oil (EPO):  Evening primrose oil is a source of gamma-linolenic acid (GLA), an Omega-6 fatty acid.  This Omega-6 is generally hard to come by in the diet.  It is believed that GLA, as a series 1 prostaglandin, can really slow inflammation, particularly as related to spikes in Estrogen that happen when people are estrogen dominant, as well as the resulting insulin and testosterone spikes. 

Who should consider taking it?  People with signs of estrogen dominance or endometriosis might consider EPO while trying to conceive or for PMS, irregular periods, fibroids, breast tenderness and acne.  It is also used to increase cervical mucous.

Cautions/Considerations  Because EPO has historically been used to promote uterine contractions, it should be discontinued once pregnant.  Some sources also recommend stopping after ovulation while trying to conceive.

Coenzyme Q10:  CoQ10 is an antioxidant that fuels the mitochondria, the energy producing organelles within all of our cells.  Human eggs contain more mitochondria than other cells because they require a lot of energy.   Some believe that CoQ10 can support the functioning of eggs in the ovaries, making them less susceptible to chromosomal changes, particularly in older women.  Metformin, a drug that is often given for diabetes or PCOS, may deplete CoQ10, so individuals taking metformin should also consider supplementing CoQ10 also, along with B12 & folate.

Who should consider taking it?  Women trying to conceive who have low ovarian reserve.  Individuals who are taking metformin.

Cautions/ConsiderationsSide effects are uncommon.

Vitex Agnus-Castus/Chaste tree berry: Vitex has a long history of use for fertility issues.  Many sources say it helps to balance hormones, but as this is rather vague, I have sought a better explanation.  It is possible that Vitex acts on the hypothalamic-pituitary axis, increasing LH and inhibiting release of FSH, indirectly increasing progesterone levels and normalizing prolactin levels.  Vitex - Longwood Herbal Task Force

Who should consider taking it?  Women with irregular cycles or amenorrhea, particularly with low progesterone levels or elevated prolactin levels.

Cautions/ConsiderationsMay need to be taken for 3-6 months to be effective. 

 DHEA: A hormone produced by the adrenals, and to a lesser extent the ovaries and testes, that is a precursor for testosterone and the estrogen hormones.  Production of DHEA declines beginning in a woman’s twenties.  Supplementing with DHEA appears to improve egg quality by raising androgen levels into normal range.

Who should consider taking it?  Good for older women with diminished ovarian reserve.

Cautions/ConsiderationsAndrogen levels should be monitored while taking DHEA.  While it is available in the US without a prescription, man other countries require a prescription.  7 Keto DHEA, a DHEA byproduct, appears to be a safer form of DHEA, but there is no research to support it having the same fertility enhancing potential.  It is used more often for its metabolic effects with weight loss.

N-Acetylcyteine (NAC):  A powerful antioxidant, NAC is a precursor to glutathione production, therefor it helps protects cells from free radical damage.  NAC is often given to women with polycystic ovarian syndrome (PCOS), as it improves insulin sensitivity much like the drug metformin.  Therefore, in the PCOS population, it can help restore a normal ovulatory menstrual cycle.  It also appears effective in reducing endometriosis adhesions and improving pregnancy rates in women with endometriosis.  N-Acetylcysteine: A Powerhouse Natural Remedy

Who should consider taking it?  Women with PCOS or endometriosis.  Glutathione may also be beneficial for those with MTHFR gene mutation.

Cautions/ConsiderationsToxicity with high doses.

Maca: Maca has been used for centuries in the Andes to enhance fertility.  It is often used to increase libido and improve sexual function.  It has been studied for erectile dysfunction and sperm function with positive results.  It is often said to boost energy.  Maca is considered an adaptogen, which means it helps the body adapt to stress and maintain normal physiological functioning.  NIH Maca Research

Who should consider taking it?  Women or men with low energy, low libido, high stress, possibly with adrenal fatigue.

Cautions/ConsiderationsMaca is a staple of the Peruvian diet.  Side effects are uncommon.  Ashwaghanda is another adaptogen with similar applications.

Royal Jelly: Another super food, Royal Jelly is produced by bees, who then feed it to their young larvae and queen.  It is rich in amino acids and many other nutrients.  With estrogenic – like effects, it is often used for perimenopausal symptoms and well as infertility.  Biological Activities of Royal Jelly

Who should consider taking it?  Older women who are trying to conceive with lower estrogen.

Cautions/ConsiderationsIndividuals allergic to bee products should not consume royal jelly.