The deficiency of certain micronutrients has been linked to difficulties in conception and fetal malformations. This has been the origin of the safety net culture generated around vitamin and micronutrient supplementation. Since nobody wants to impair their chances, they are very easily convinced that they “need” to supplement their diet. The term supplements have now become synonymous to “better” and the more expensive the supplements taken, even better. This is the reason why nutritional supplements are, by far, the most heavily marketed fertility products.
The truth is that every specialist in nutrition and fertility prefers these micronutrients to be obtained from food instead of pills. This is because the majority of these micronutrients (except for folic acid) are absorbed better from food. The other reason why food is preferred is because governments very poorly regulate supplemental pills since they are not considered medication, but nutritional supplements. For this reason, many of these commercial products do not have the same content as specified on the box.
We want to draw some light around the existing evidence about the need for supplementations versus the potential benefits they could give.
There is enough evidence to support that long chain fatty acids have a beneficial effect on fertility. Of these, the most studied has been Omega-3. This fatty acid has been associated with a shortening of time to pregnancy in couples trying naturally and through treatment. These long chain fatty acids can be obtained through an increase in fish consumption or certain plants like flax seeds, nuts and canola oil. In people that do not ingest a sufficient amount of these foods, supplementation could help with their fertility.
Trans-fatty acids are the evil brother of long chain fatty acids. These are found in most processed foods where vegetable oils are used. There is evidence enough to say that couples with higher consumption of these fatty acids have more difficulties achieving pregnancy.
Saturated fats are fats found in meats and dairy. These have not only been associated to an increase in the risk of cancer and cardiovascular disease, but also a reduction in fertility. Of note, especially in men where studies have shown a decrease in sperm counts in individuals with high consumption of these fats.
Some studies have shown a reduction in fertility in vitamin D deficient women. There have been vitamin D receptors found in the follicles and in the endometrium, and we do believe that it plays an important role in fertility. What we do know is that once this threshold is attained, there is no further benefit in supplementing vitamin D. It is recommended to keep the levels higher than 20-30 and there can be arguments for supplementation with 1000 units or 25 micrograms of vitamin D while trying to conceive. You normally absorb vitamin D naturally through sun exposure, but in Ireland, that occasion is limited, which might lead you to get some supplementation.
Folate and folic acid
The one supplement that is absorbed better through pills than through food is folic acid. This is also the one supplement with the most evidence and the strongest benefits in fertility. Studies have shown that with folic acid supplementation, there is an improvement in natural conception, treatment success, reduction in miscarriage rates and fetal malformations. It is a water-soluble vitamin, which means that it is not dangerous if taken too much, as it would be excreted through the urine. Men on folic acid supplementation have also shown to improve sperm counts, although it has not demonstrated an improvement of this in fertility. These benefits have also proven to be dose-dependent with supplementation of 1000 micrograms having a stronger benefit that those of 400 micrograms.
This is the most expensive dietary supplement sold in pharmacies, which is probably why it is the most commercialized. It works as an antioxidant mainly for the improvement of male factor infertility, PCOS and low ovarian reserve. There is no consistent evidence to support its use, no evidence to support the benefits in male infertility and the proof of its benefits in women is very poor. There are still no arguments to recommend its use outside of scientific investigation scenarios.
Antioxidants in general
Antioxidant is a generic word to group a large variety of molecules that reduce the effects of oxidizing agents that are said to increase DNA fragmentation in the sperm and affect egg quality in women. Not every antioxidant works the same way, and we still don’t have evidence if there is any benefit from their use; or if there is, which of these antioxidants is responsible, at which dose, and for how long must they be taken. With the current evidence, the recommendation of antioxidant supplementation is not supported.
In summary, nutritional supplements seem to have a role in infertility, although other than folic acid, a balanced diet seems to supply these micronutrients better than with pills. If you decide to take supplements, the most expensive brands will not offer you any more benefits than the lower cost ones. Remember that these supplements are not regulated and what is written on the box doesn’t necessarily correspond with the contents on these pills.
We recommend you to intake a healthy even mix of carbohydrates, proteins, vitamins and minerals, keep a healthy diet and exercise frequently. Also, if you are already pursuing a fertility treatment with us, our team of professionals will be able to advise you on what’s best for each part of your treatment.