Female Fertility Supplements- 101
Fertility Supplements- what can I take?
The use of supplements during infertility treatment intrigue many patients and physicians alike. While there are no magic pills that result in pregnancy, supplements are an interesting area of research and may provide some small benefit to patients who are concurrently undergoing traditional fertility therapy.
Infertility can be a difficult problem to treat, and it’s not surprising that some people look to herbs and supplements as a possible alternative treatment to this troubling problem.
Important points to remember:
- Research on so-called fertility herbs and supplements is not conclusive and is based on a limited number of small studies.
- Conventional infertility therapy has been evaluated more rigorously and remains the best option.
Talk to your doctor about any herbal or nutritional supplements you plan to take or are taking to find out the possible risks and benefits. Until researchers more clearly define the risks and benefits of fertility herbs and supplements, conventional treatment for infertility appears to be the best option.
Who should take supplements for fertility?
- Many patients may benefit from DHA (omega-3 fatty acids) and Vitamin D.
- Additional fertility supplements may be indicated for patients with diminished ovarian reserve or previous failed therapy.
- Patients with PCOS may benefit from Inositol (below).
What is the rationale for supplements?
Vitamin D
The National Osteoporosis Foundation recommends that all adults consume 800-1000IU daily.
Continuous and ongoing research show Vit D levels as a marker of overall health, in addition to the importance of Vitamin D for bone protection. Vitamin D receptors exist in the uterine lining, and preliminary fertility research demonstrates a possible connection to embryo implantation and the subsequent pregnancy.
Normal 25-OH Vit D levels are 30-40ng/ml
- The best form of Vit D is dietary, such as milk (approximately 100IU/ 8 oz)
- The best form of supplementation is Vitamin D3 (such as Centrum)
Antioxidants
Antioxidants reduce oxidative stress (reactive oxygen species or “free radicals”). Antioxidants theoretically may help to improve the ovarian environment and hence egg quality.
- DHA (omega 3 Fatty Acids)– 1000mg once a day. DHA and essential fatty acids help to reduce inflammation and promote overall health. DHA is also essential in the development of the fetal heart and brain.
- Coenzyme Q 10: CoQ10 (ubiquinone or ubiquonol) is found in every cell (“ubiquitous”) and is involved in energy production in the mitochrondria. CoQ10 also acts as an anti-oxidant to reduce free radicals. CoQ10 may assist in division of chromosomes during meiosis, and preliminary evidence suggests this may help to reduce aneuploidy (chromosomally abnormal eggs/embryos). Randomized controlled trials are ongoing.
- Vitamin C and Vitamin E are powerful antioxidants that help reduce reactive oxygen species.
What foods contain antioxidants?
Dietary sources of antioxidants include: kidney beans, pinto beans, blueberries, cranberries, artichoke, blackberries, prunes, raspberries, strawberries, Red Delicious, Granny and Gala apples, pecans, cherries, plums, and dried black beans.
Dietary sources of omega 3 fatty acids include: flaxseeds and flaxseed oil, salmon or fish oil, chia seeds, cod liver oil, grass fed beef, edamame, walnuts, soybeans, kidney beans, and enriched eggs.
Inositols
- Purchased online as Pregnitude, Ovasitol, or MyoInositol.
- Inositols are sugars that act as a second messenger for the insulin receptor and may help patients with insulin resistance.
- Inositols may help improve ovulation and pregnancy rate in patients with PCOS.
DHEA
The use of androgens such as DHEA and testosterone have been investigated for many years in women with diminished ovarian reserve (DOR) or poor response to ovarian stimulation during in-vitro fertilization (IVF). The proposed mechanism is that these steroid hormones improve the ovarian environment and early egg development.
There are conflicting data regarding how much impact DHEA may have. Many centers have adopted it as an adjunctive medication for women undergoing IVF. It has few side effects and is well tolerated. Women with DOR or a history of poor response may have some small benefit; however, DHEA does not conclusively increase pregnancy rates. Further, there is no standardization of over-the-counter DHEA, and the purity of different commercial formulations may vary. DHEA as a fertility supplement is an interesting concept that may provide benefit to a subset of women but requires further research.
Are fertility supplements safe?
Although often marketed as “natural,” this doesn’t mean that herbal products are always safe. Consider these important issues about fertility herbs and supplements:
- They have limited Food and Drug Administration regulation. Herbal and nutritional supplements are subjected to limited regulation by the Food and Drug Administration and are only now starting to be held to higher purity and quality standards.
- They have a potential for drug interaction. Conventional hormone and drug treatments for infertility are complex regimens. It’s not known how herbs or supplements may interact with such treatments.
- They may have side effects. Herbal and nutritional supplements may have side effects, especially when taken in larger doses. For example, too much vitamin C can cause significant gastrointestinal problems, and high doses of vitamins may be toxic rather than therapeutic.
References:
- Rudick, et al. Influence of Vitamin D Levels on IVF outcomes in donor-recipient cycles. Fertility Sterility 2014 101:2; 447-452.
- Raffone, et al. Insulin sensitizer agents alone and in co-treatment with r-FSH for ovulation induction in PCOS. Gynecol Endocrinology 2010 26:4; 275-80.
- Bentov Y and Casper RF. The aging oocyte-can mitochondrial function be improved? Fertility Sterility 2013 99 (1); 18-22.
- Bentov Y, et al. Coenzyme Q10 supplementation and oocyte aneuploidy in women undergoing IVF-ICSI treatment. Clin Med Reprod Health 2014 8:31-6.
- Buhling KJ and Grajecki D. The effect of micronutrient supplements on female fertility. Curr Opin Obstet Gynecol 2013 25 (3); 173-80.
- Garbedian, et al. Effect of vitamin D status on clinical pregnancy rates following in vitro fertilization. CMAJ Open 2013; 1(2); E77-83.
- Ozkan, et al. Replete vitamin D stores predict reproductive success following in vitro fertilization. Fertility Sterility 2010 94(4);1314-9.
- Shiraishi M, et al. Association between the serum folate levels and tea consumption during pregnancy. Biosci Trends 2010; 4(5):225-30.
- Ye R, et al. Tea drinking as a risk factor for neural tube defects in northern China. Epidemiology 2011; 22(4): 491-6.
- Correa, et al. Prenatal tea consumption and risks of anencephaly and spina bifida. Ann Epidem 2000; 10(7): 476-77.