- FOLATE aka FOLIC ACID (most important)
- +/- Iron (this can also be supplemented separately as needed, such as for anemia)
- Folate reduces risk of neural tube defects (birth defects), such as spina bifida
- Iodine optimizes thyroid health and fetal brain development
- Optimal to start about 3 months prior to conception
- Take 1 serving (number varies by vitamin) daily
- At least 400 mcg folate per day, but individual needs may be higher
- 150 mcg per day of iodine
- Any pharmacy or grocery store, or available online
- Limited evidence for other ingredients, but they are usually not harmful.
- It is important to avoid excessive quantities, such as for Vitamin A or B vitamins.
Which are legitimate products?
- Prenatal vitamins can be given as a prescription from your doctor
- Prescription brands are FDA-regulated
- Direct-to-consumer (aka over-the-counter, or OTC) brands are not as strictly regulated
- If you buy it OTC, check for the following certification standards:
- Look for NSF (National Sanitation Foundation) certified
- Or look for USP (United States Pharmacopeia) verified
We here at the blog are big proponents of vitamin D supplementation to enhance your fertility. New research suggests that vitamin D supplementation may also be important for couples that have difficulty staying pregnant, also known as recurrent pregnancy loss (RPL). One of the causes of RPL has been attributed to an autoimmune condition. In this study, researchers evaluated the immune cells thought to be involved in pregnancy loss. They found that women who had low levels of Vitamin D were more likely to have abnormalities in the immune cells involved in pregnancy loss. This suggests that vitamin D supplementation may be a tool we can use to reduce the risk of pregnancy loss.
What you can do:
- Check your vitamin D before trying to conceive
- Talk to your physician about the evaluation of RPL and treatment options if you have had two ore more pregnancy losses.
My goal as a REI is to help provide patients with the information they need to not only boost their natural fertility, but also to help them have a healthy pregnancy and to, ultimately, bring home a happy healthy kiddo. Those of you who know a family affected by autism, know how terrifying the condition can be. Autism is a neurodevelopmental disorder characterized by impaired social interaction, impaired verbal and non-verbal communication, and restricted and repetitive behavior.
Autism is thought to develop during pregnancy. Many neurodevelopmental disorders, like problems with the baby’s spinal cord, are known to be impacted by maternal nutrition during pregnancy. New research suggests that what mom eats during her pregnancy may alter the risk of her child developing autism.
In this large study of over 270,000 mother-child pairs, women were screened for vitamin use and their children were followed to see if they developed autism throughout childhood. Maternal multivitamin use with or without additional iron or folic acid, or both was associated with lower odds of having an autistic child with intellectual disability in the child compared with mothers who did not use multivitamins, iron, and folic acid (odds ratio 0.69). This study suggests that maternal multivitamin supplementation during pregnancy may be something women can do to decrease their risk of having a child with autism.
What you can do:
- Take a prenatal vitamin when you are trying to conceive and throughout your pregnancy
Unexplained infertility is a frustrating diagnosis and 15% of couples are affected by unexplained infertility. It means that despite undergoing all the costly evaluations, we don’t know why you are having trouble getting pregnant. Many cases of unexplained infertility are probably caused by the presence of multiple subtle factors, each of which on their own do not significantly reduce fertility, but reduce the pregnancy rate when combined.
Research is now suggesting that your nutrition could be a potential reason for unexplained infertility. A recent study compared women who had the diagnosis of unexplained infertility to women who conceived naturally. They found that women with unexplained infertility had significant abnormalities in their dietary habits. These differences ranged from minor imbalances in micronutrients to severe combined macronutrient and micronutrient imbalances. This study suggests that paying attention to your diet could potentially cure cases of unexplained infertility, improve IVF treatment, and even restore natural fertility.
What you can do:
- Take a daily prenatal vitamin to help your micronutrient balance
- Eat a well-balanced meal when trying to conceive
- Consider talking to a nutritionist for formal recommendations about your diet if you are concerned you may have an imbalance in your macronutrients
Probiotics have been all over the news recently and many of my patients ask me about them in our visit. Probiotics are live bacteria and yeasts that may be beneficial to our health, especially our gut health. We are learning that our gut health can impact our overall health including health conditions like diabetes and autoimmune conditions. Emerging studies are demonstrating that what we eat can alters our gut health can impact our natural fertility.
A recent study provided the probiotic, Lactobacillus rhamnosus, to obese mice and found that the mice lost weight and had improved sperm function. This could mean that adding more probiotics to your diet, could help you boost your naturally fertility and help you lose weight, too.
I’m cautiously optimistic with this study. Improving obesity and sperm function in mice is not the same as improving sperm function in humans so more studies are needed to prove that this actually works. In the meantime, consider adding probiotics and pre-biotics to your diet. You will probably feel better, but it may help you get pregnant sooner, too.
For more information about probiotics, consider checking out this.
We are learning more and more about the important role that Vitamin D plays in terms of our fertility. We have previously discussed the role of vitamin D and your sleep/wake cycle in terms of optimizing your health. Recent studies have added to this to demonstrate just how important Vitamin D is when trying to conceive.
Vitamin D may improve your ovarian reserve, a marker of how many eggs women have compared to others their age. Vitamin D may help support your ovarian function.
Similarly, women with higher vitamin D levels, are more likely to conceive than women with low vitamin D levels.
Vitamin D may also be important for treating hormone imbalances, particularly if you have polycystic ovarian syndrome (PCOS). If you are undergoing fertility treatments like IVF, Vitamin D may even help decrease your risk of ovarian hyperstimulation syndrome (OHSS) and prevent dangerous complications from OHSS.
Why not consider taking a vitamin D supplement to boost your fertility naturally?
What you can do:
- Ask for your vitamin D level to be checked annually when you are trying to conceive
- Consider starting a supplement of at least 2000 IU of vitamin D to help support ovarian function
- Target a serum 25-hydroxyvitamin D level of >50 nmol/L to enhance your fertility
We all get excited about new things. But most people remain skeptical when you suggest that something old may be better. In fact, what if something VERY old may be one of the hottest developments in a high tech field like fertility treatment? That’s what has been quietly happening with the medication known as metformin.
Metformin has been used since the time of the pharaohs (around 1500 B.C.E.) but it was extracted from the plant Galega officinalis (see image). From then until the discovery of insulin; this was the primary treatment for diabetes. Unfortunately, like many plant extracts there were many other compounds present as well—some with serious and/or troubling side effects. The modern synthesized version of metformin has been purified making it safer and easier to study.
The best known use of metformin in reproductive medicine is in the treatment of women with polycystic ovarian syndrome (PCOS). But we’re now learning that there are many other ways that his modern version of an herbal remedy can help improve the outcome of fertility treatment. Although I’m not a fan of lists, the complexity of this treatment is beyond a simple blog post. So here is what you may want to consider when planning your treatment with your doctor:
In summary, pregnancy is a very multifaceted process. Sometimes, we still have a lot to learn about something that has been around for a long time.
My neighborhood pools opened this week for summer and my family couldn’t be more excited. Unfortunately, mosquitos are popping up again and reminding me of the importance of discussing insect repellants with my friends, families, and patients.
Many women who never wear insect repellants have recently become interested in these products because of the news coverage of the Zika virus. The Zika virus was introduced to the world during the most recent Olympic games in Brazil. Mosquito bites were linked to severe birth defects and the Zika virus was identified.
The number of pregnant women with laboratory evidence of possible recent Zika virus infection and the number of fetuses/infants with Zika virus–associated birth defects continues to increase in the United States. About 1000 pregnant women in the US were diagnosed with Zika virus infection last year. Of these pregnancies, birth defects were reported in 15%. Congenital microcephaly, or severely small head in the affected child, has been a hallmark of intrauterine infection with Zika virus. However, the full clinical spectrum and severity of Zika remains unknown. Others have recently reported much lower rates of confirmed Zika virus in other parts of the US and no confirmed fetal or neonatal infections, which puts some doubt on the true prevalence of this widely publicized virus. The field of perinatal Zika virus infection is evolving and we continue to learn more about the virus as well as the risk of disease.
Insect repellants can be a good option for reducing your exposure to mosquitos and tics. The EWG has published excellent resources for consumers to learn about what is in their bug repellent.
My family uses DEET. It protects you against tics and mosquitos. DEET is the only insect repellant that has been tested on pregnancy women. The children of mothers who used DEET in their second and third trimesters showed no birth defects, changes in body size or developmental problems. No studies have examined the children of women who applied DEET during their first trimester. However, at toxic doses, DEET has been associated with seizures and neurological damage. Although this risk is scary, The EPA reports that this risk is very low- 1 per every 100 million persons. As with medications, I tend to recommend limiting the use of multiple products in order to limit exposure to multiple chemicals. Choose one insect repellant and stick with it.
A more natural alternative is also available as oil of lemon eucalyptus. The tree extract is refined to intensify the concentration of the naturally occurring substance para-menthane-3,8-diol (PMD) from 1 to 65 percent. The resulting oil is very different from unprocessed tree oil. Some testing shows that concentrations of 20 to 26 percent PMD may perform as well as 15 to 20 percent DEET against both mosquitoes and ticks (Barnard 2004, Consumer Reports 2010). I think it is important for us to recognize the limited safety data available on essential oils in pregnancy and in children. Refined oil of lemon is classified as a possible biochemical pesticide. Oil of lemon eucalyptus and essential oils have disadvantages but is a good choice for people who want a botanically based bug repellant. EWG recommends that consumers who are in high-risk areas for bug-borne disease or need long-lasting, effective bug protection avoid botanically-based bug repellents, aside from Oil of Lemon Eucalyptus. In other cases, you may find it worth your while to try botanical repellents to identify one that works well for you.
What you can do:
- Avoid exposure to mosquitos: use insect repellants with <50% DEET when trying to conceive and during pregnancy. More is not better. My family uses 30%.
- Wash your hands well after applying insect repellant. Wash repellant-coated skin at the end of each day.
- You and your partner should avoid travel to areas with Zika virus when trying to conceive and during pregnancy. Discuss your travel plans with a physician if there is any question about the safety of travel. Talk to your physician if you or your partner are concerned that you have been exposed to the Zika virus.
For more information:
I still remember feeling completely overwhelmed the first time I shopped for prenatal vitamins when I was ready to try to conceive. I’m sure I was putting too much thought into it, but like many others, I was going to take my fertility seriously and I wanted the BEST option. So why did my drugstore have over 5 different types of prenatal vitamins, all with a different concoction of what they claimed was “best?” Some of my friends reported using “prescription prenatal vitamins” and swore they were worth the cost.
I ultimately ended up buying prenatal vitamins that contained docosahexaenoic acid (DHA) since they were advertised as “supporting neurodevelopment” and who wouldn’t want a smarter baby? DHA is an omega-3- fatty acid that is important for brain development. It has been recommended to eat foods which are high in omega-3 fatty acids for women who want to become pregnant or when nursing. Although vegetarian sources are now available, fish and fish oil are often utilized for DHA supplementation. For months, I endured gross fishy tastes in my mouth and a fishy odor to my breath; all in the sake of helping my baby’s brain develop. Was it worth it?
The sale of prenatal supplements with DHA continues to increase, despite limited evidence that it actually helps brain development. A recent study suggests that DHA may not be all that it was chalked up to be. This group evaluated pregnant women who took DHA supplements and compared them to women who didn’t. There was no difference in cognitive, language, or motor development in the children from moms who took DHA compared to those that didn’t at 18 months, and 7 years- DHA doesn’t seem to result in smarter kids. This data is strong enough for me to recommend that you can skip the DHA supplement in your prenatal vitamin, especially if you are having undesirable side effects like gross fish burps.
So what does a good prenatal vitamin need, anyway?
- Folic acid- at least 400 micrograms; some patients require higher doses of folic acid
Although a prenatal vitamin will help supplement your diet with extra amounts of vitamins and minerals, your diet should be the primary source. Iron, calcium, and vitamin D are particularly important in pregnancy.
My advice to anxious patients (like myself a few years ago) is simple: eat a well-balanced diet, stay healthy, and find an inexpensive prenatal vitamin that you like so that you remember to take every day.
Here’s another fascinating study for women with PCOS; 1500 mg of the potent antioxidant from red wine can reduce testosterone levels by nearly 25%. This can not only improve egg quality and pregnancy rates but also reduce other symptoms of PCOS as well!