Supplements may be used successfully to increase female fertility and conception rates. Not only they can help achieve a pregnancy, but they can also help during the pregnancy to develop a healthy baby and after delivery during the breastfeeding period to support the increased need for nutrients of a lactating woman.
A healthy and balanced diet is fundamental in the prevention of diseases and for overall health. In the general population a healthy diet is sufficient to provide all vitamins and minerals needed, but when the diet is poor and unbalanced, a supplement can make the difference. Moreover, during pregnancy and when breastfeeding the needs for micronutrients change and are increased and the diet alone might not be sufficient anymore. Finally, our lifestyles and environment, such as smoking, sleep deprivation, stress, drinking alcohol, and pollution increase oxidative stress damage by free radicals to our cells, making antioxidant supplementation a good choice to fight off these extra damaging compounds.
Deficiencies of all nutrients cause health issues, but also the excess of some of them can be detrimental for health; it is important not only to avoid deficiencies, but also to avoid taking extra supplements when not needed. Vitamin A for example, also in other forms like retinoids in skincare products, may cause harm to the fetus when taken in excess; the use of creams or supplements containing retinoids should be avoided and discussed with your physician as they have been shown to exert teratogenic effects and cause fetal retinoid syndrome. Other vitamins may interact with some medications: vitamin E for example increases the effects of blood thinning drugs. For these reasons, always consult your doctor and inform your doctor of any supplement you take or plan to be taking.
We will now take a look at the most promising supplements to increase fertility and conception rates based on current medical evidence.
Vitamins and Minerals Supplements for female fertility
Vitamins and minerals are the most widely known form of supplement and are often found in combination and sold as “multivitamins”.
Vitamins are organic elements that can’t be synthetized by the human body, although some can be synthetized to some extent. Vitamins are essential in small quantities for the proper functioning of the organism and are therefore necessary for life.
Minerals are inorganic elements that can’t be synthetized at all by the human body and that are essential for life and proper functioning and health of the human organism.
Both vitamins and minerals are generally obtained through diet. They are known as micronutrients or trace elements due to the small quantity needed daily when compared to macronutrients like proteins that we need in far larger amounts.
Also known as vitamin B9 or as folates, folic acid is a recommended supplement to be taken at least 1 month before getting pregnant and for the first trimester during pregnancy. Folic acid supplementation has been linked to a lower risk of anovulatory infertility and to a shorter time to pregnancy in some studies. Moreover, it prevents major defects of the brain and spine of the baby which occur very early in pregnancy; when planning to have a baby, daily supplementation is advised. The daily recommended supplemental dose is at least 400-800 mcg.
Also known as pyridoxine, vitamin B6 may play a role in unexplained infertility. Fertile women have been found to have higher vitamin B6 levels when compared to infertile women; lower plasma concentrations of vitamin B6 have also been found in women with history of recurrent spontaneous miscarriage. This may be due to the fact the vitamin B6 helps metabolize homocysteine: when this doesn’t happen, a person may experience hyperhomocysteinemia, a medical condition recognized as risk factor for several diseases, including cardiovascular disease and fertility issues. The RDA for vitamin B6 is 1.3 mg, increased to 1.9 mg during pregnancy and 2.0 mg when lactating.
Also known as cobalamin, vitamin B12 is a fundamental vitamin for the development of a healthy fetus during pregnancy and healthy baby when breastfeeding. Vitamin B12 deficiency has also been linked with lower fertility in women and its supplementation is linked to better outcomes when pursuing IVF. Those following a vegan diet are at greater risk of having vitamin B12 deficiency since it is mainly taken from animal meat, dairy and eggs. The recommended dietary allowance (RDA) for vitamin B12 is 2.4 mcg in adults, 2.6 mcg in pregnant women and 2.8 mcg in breastfeeding women.
Also known as ascorbic acid, vitamin C is a strong antioxidant and an essential nutrient for the biosynthesis of collagen in our bodies. This makes it fundamental for the growth of the ovarian follicle and important in the ovulation and luteal phases. Ovarian tissue is also known to contain high levels of vitamin C. In some studies, it has shown to be beneficial in improving fertility; the daily recommended supplemental dose is 500-1000 mg.
Vitamin D is not only beneficial for bone health; its receptors are found in many tissues, including the reproductive organs. Vitamin D is an important factor for the production of progesterone and estrogens, which influence fertility. While vitamin D deficiency is linked to lower fertility, extra supplementation when blood values are within range doesn’t appear to be beneficial.
Also known as tocopherol, vitamin E is another powerful antioxidant. Oxidative stress caused by reactive oxygen species (ROS) commonly known as “free radicals” is a key element in many diseases. Oxidative stress can negatively affect fertility too. Supplementing vitamin E with a daily dose of 200-600 IU (150-400 mg) may have beneficial effects on fertility.
Zinc is a trace mineral that plays a role in reproductive health. Several enzymes involved in DNA synthesis are zinc-dependent and zinc is implicated in the oxidative pathway as well. Its deficiency is linked to longer time to pregnancy. The RDA for zinc is 8 mg for women.
Selenium is an essential trace mineral with multiple functions in the human body. Selenium deficiency is linked with infertility and with many ovarian pathologies and its role in the reproductive system involves the maturation of ovarian follicles. It is also a component of antioxidant enzymes, helping to fight oxidative stress linked to infertility. Currently, the recommended dietary allowance (RDA) for selenium is 60 mcg.
Iron deficiency may contribute to cause ovulatory infertility and its supplementation has been associated with better fertility. Not all iron ingested with food is absorbed by the human body: its bioavailability is about 15% from animal sources (heme iron) and 8% from plant sources (non-heme iron). The RDA for iron for adult women is 18 mg, increased to 27 mg during pregnancy.
Essential Fatty Acids (EFAs) for female fertility
Like vitamins and minerals, essential fatty acids are molecules that can’t be synthetized by the human body and that are required for proper functioning and good health of the organism. The only two essential fatty acids for humans are alpha-linolenic acid (ALA), an omega-3 fatty acid, and linoleic acid (LA), an omega-6 fatty acid.
Omega-3 fatty acids
Omega-3s are polyunsaturated fatty acids especially abundant in fish and seeds. There are three types of omega-3 fatty acids: alpha-linoleic acid (ALA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). ALA is essential, while EPA and DHA can be synthetized from ALA.
Recent studies have shown that endogenous synthesis of both EPA and especially DHA is actually very low, insufficient and inefficient; the only way to increase levels of EPA and DHA appears to be via diet or supplementation of each particular omega-3.
Omega-3 fatty acids are studied for their role in reducing inflammation, for their neuroprotective properties, and for slowing many aging processes.
Fish, one of the main sources of omega-3s, is unfortunately also showing to have high levels of mercury and other poisonous heavy metals due to the polluted environment, so to increase the intake of omega-3s taking a supplement may be more beneficial. Omega-3 fatty acids may improve egg quality and ovarian reserve in women over 35; they may also increase progesterone levels and improve ovulation. The daily recommended supplemental dose of omega-3s is 1 gram.
Antioxidants for female fertility
Antioxidants are molecules that help fight oxidative stress. Oxidative stress is caused by oxidation by Reactive Oxygen Species (ROS) commonly known as free radicals. There is an equilibrium between oxidants and antioxidants and when this is disrupted the consequence is oxidative stress and cell damage. This type of damage is linked to aging and to many diseases involving all systems of the human body, including negative effects on many steps of human reproduction. Antioxidants also help with the immune response.
Reactive oxygen species are increased by smoking, pollution, drinking alcohol, stress, and by many other lifestyle and environmental factors as well as by medical conditions such as chronic diseases and infections.
Antioxidants may be obtained through the diet. Many micronutrients like vitamin A, C and E have antioxidant properties. Other trace elements play a role in fighting oxidation, like selenium, zinc and group B vitamins. Other antioxidants are synthetized by the human body like glutathione. And many more can be obtained through diet, from green tea, wine, fruits, vegetables, … many plants and derivates contain different molecules with antioxidant effects. A lot of studies have proven the beneficial effects of antioxidants, but sometimes diet alone is not enough to experience such effects: resveratrol, for example, is an antioxidant found in wine. Studies have shown positive effects on health with doses between 25 mg and 5 grams of resveratrol. The average wine contains 2 mg of resveratrol per liter, this means that to ingest the lowest doses that have been tried in studies, one should drink at least 12 liters of wine with obvious negative consequences for health. In some cases, supplementation is easier, more convenient, cost-effective and more beneficial than increasing the antioxidant intake through diet.
Also known as ubiquinone or COQ10, coenzyme Q10 is essential for production of energy within the cells and it is also an antioxidant. Its supplementation has been proven beneficial in IVF and ICSI, leading to improved quality and quantity of eggs. A daily supplementation of 600 mg may be beneficial in improving fertility in women.
Also known as maritime pine bark extract, pycnogenol is a member of the group of the anthocyanidins and of the larger class of flavonoids. These substances are responsible for the yellow, red, blue and purple color in plants and fruits. Pycnogenol is an antioxidant that helps fight oxidative stress. Standard dose of pycnogenol is 100-200 mg daily divided into two doses.
Green tea contains a multitude of substances; the antioxidant properties of green tea are due to the abundance of catechins and in particular of one of them known as EGCG. Catechins are also present in berries and cocoa. One cup of tea contains on average 50 mg of EGCG, but studies conducted on humans used dosages 10 times higher than that. Due to its caffeine content and the effects of caffeine on pregnancy and possible effects on fertility, it is advisable to take a green tea extract supplement to increase catechin intake, instead of drinking large amounts of tea. Standard dose of green tea extract (EGCG) is 400-800 mg daily.
Astaxanthin is a carotenoid giving the red color to shrimp, salmon, trout, krill and other marine organisms. Although it is a carotenoid like vitamin A, it is not converted into vitamin A in the human body and for this reason it is non-toxic, safe, and well tolerated with no known side effects. As an antioxidant, astaxanthin provides protection against oxidative stress and against lipid peroxidation. Standard dose of astaxanthin is 5-20 mg daily.
The takeaway on supplements for infertility in women
After reading this long list you might wonder how many of these supplements you should be taking to boost your fertility. So, here’s the take home message:
- Micronutrient deficiencies do cause several health issues and can lower fertility.
- A healthy and balanced diet is generally sufficient to avoid deficiencies.
- Supplements are helpful to avoid deficiencies when the diet is lacking some nutrients.
- Supplements are helpful in supporting increased needs of nutrients, like during pregnancy.
- Supplements are generally safe, but some of them can cause issues when taken in excessive doses and can also interact with other drugs.
- Always ask your physician before taking a new supplement.
- Antioxidants are generally safe and believed to fight aging and other issues that affect multiple body systems. Their role in fertility is still controversial and there is no definitive conclusion yet.
- Diet and Fertility: A Review.
AJ Gaskins, JE Chavarro – American Journal of Obstetrics and Gynecology, Aug 2017
- Diet and female fertility: doctor, what should I eat?
YH Chiu, JE Chavarro, I Souter – Fertility and Sterility, Sep 2018
- The effect of micronutrient supplements on female fertility.
KJ Buhlinga, D Grajeckib – Current Opinion in Obstetrics and Gynecology, June 2013
- Maternal Selenium, Copper and Zinc Concentrations in Early Pregnancy, and the Association with Fertility.
JA Grieger, LE Grzeskowiak, RL Wilson – Nutrients, Jul 2019
- Pretreatment with coenzyme Q10 improves ovarian response and embryo quality in low-prognosis young women with decreased ovarian reserve: a randomized controlled trial.
Y Xu, V Nisenblat, C Lu – Reproductive Biology and Endocrinology, Mar 2018
- Iron Intake and Risk of Ovulatory Infertility.
JE Chavarro, JW Rich-Edwards, BA Rosner – Obstetrics and Gynecology, Nov 2006
- Association between serum folate and vitamin B-12 and outcomes of assisted reproductive technologies.
AJ Gaskins, YH Chiu, PL Williams – The American Journal of Clinical Nutrition, Sep 2015
- The effect of micronutrient supplements on female fertility: a systematic review.
D Grajecki, BC Zyriax, KJ Buhling – Archives of Gynecology and Obstetrics, Feb 2012
- Role of micronutrients in the periconceptional period.
I Cetin, C Berti, S Calabrese – Human Reproduction Update, Jun 2009
- The importance of folate, zinc and antioxidants in the pathogenesis and prevention of subfertility.
IMW Ebisch, CMG Thomas – Human Reproduction Update, Nov 2006
- Role of reactive oxygen species in the pathophysiology of human reproduction.
A Agarwal, RA Saleh – Fertility and Sterility, Apr 2003
- The effects of oxidative stress on female reproduction: a review.
A Agarwal, A Aponte-Mellado – Reproductive Biology and Endocrinology, Jun 2012
- Office of Dietary Supplements (ODS) – National Institutes of Health (NIH)