Read This Before You Take Fertility Supplements

Do you use supplements? Probably. A 2014 survey by the Council for Responsible Nutrition found that 68% of the population in the United States uses supplements. ((Council for Responsible Nutrition 2014 survey http://www.crnusa.org/CRNconsumersurvey/2014/CRN2014CCsurvey-infographic-pages.pdf ))

Our stores shelves are lined with supplements touted to solve this problem, relieve that problem, restore our youthfulness and improve our fertility. Many of these supplements can have a positive impact on our fertility and overall health, but which ones? Can you trust the quality of the ingredients listed? Are there unhealthful fillers or ingredients? Will the supplement do what it claims? Is the recommended dose enough to be therapeutic? In other words, is there quality control?

Although supplement manufacturers are required to adhere to Good Manufacturing Practices (GMP) to regulate supplements, such as truthful listing of ingredients on the label, ((Dietary Supplement Current Good Manufacturing Practices (CGMPs) and Interim Final Rule (IFR) Facts http://www.fda.gov/Food/GuidanceRegulation/CGMP/ucm110858.htm )) the FDA does not “approve” or check supplements for safety or efficacy. ((National Institutes of Health, Office of Dietary Supplements https://ods.od.nih.gov/factsheets/DietarySupplements-HealthProfessional/)) The quality of the supplement and the claims listed on its packaging, therefore, are solely dependent on the company that manufactures it.  There is no standardization or true oversight.

When struggling with fertility we become fiercely committed to optimizing our fertility and supplements are a relatively easy way to positively affect our reproductive system. But there are some ingredients you should try to avoid when choosing your supplements:

Synthetic food coloring listed as: FD&C Color # (such as FD&C Red #40). These chemicals are linked to hyperactivity in children. ((Artificial food colors and attention-deficit/hyperactivity symptoms: conclusions to dye for. www.ncbi.nlm.nih.gov/pubmed/22864801 )) Research in rats shows that neurobehavioral changes occur with prenatal exposure. ((Are there any remarkable effects of prenatal exposure to food colourings on neurobehaviour and learning process in rat offspring? www.ncbi.nlm.nih.gov/pubmed/24257113))

Magnesium Silicate or Talc: Filler and anti-caking agent. Talc has asbestos fibers in it and the FDA has not yet established a safe upper limit for food-grade consumption. ((Select Committee on GRAS Substances (SCOGS) Opinion: Silicates www.fda.gov/Food/IngredientsPackagingLabeling/GRAS/SCOGS/ucm260849.htm))

Titanium Dioxide: Colorant. Associated with immune system dysfunction and DNA damage. ((Makumire, S., Chakravadhanula, V.S., Kollisch, G., Redel, E., & Shonhai, A. (2014, May 16). Immunomodulatory activity of zinc peroxide (ZnO2) and titanium dioxide (TiO2) nanoparticles and their effects on DNA and protein integrity. Toxicol Lett 227(1):56-64. doi: 10.1016/j.toxlet.2014.02.027. Retrieved from www.ncbi.nlm.nih.gov/pubmed/24631018))

Hydrogenated oils: Filler. In supplements it is usually soy-based and unless it’s organic, it is likely genetically modified. Known to increase LDL (bad cholesterol) and decrease HDL (good cholesterol). ((Center for Disease Control and Prevention. (2010). Trans Fat. Retrieved from: www.cdc.gov/nutrition/everyone/basics/fat/transfat.html))

Here are some basic supplements with tips to guide your choices. Keep in mind, it takes about three months for a supplement to reach its optimum effect.

Prenatal vitamins

What differentiates a prenatal vitamin from other multivitamins is the inclusion of adequate amounts of iron and folic acid in preparation for pregnancy. When choosing a prenatal, consider the following:

Iron is important to assure you have adequate stores for pregnancy, when blood cell production increases. It also prevents anemia, reduces the risk of low birth weight and premature birth.   Consider: iron can be constipating in some individuals. If this is the case, choose a prenatal that has below 20 mg and make up the RDA recommended 27mg daily through diet or a plant-based iron supplement.

Folic acid: Folate, also called Vitamin B9, is necessary to reduce the risk of neural tube defects in the baby. Folate is found in green leafy vegetables and folic acid is its synthetically produced counterpart, which is used in fortified foods. Consider: Our body needs to convert both folate and folic acid into their active forms in order to use them. ((Linus Pauling Institute Micronutrient Information Center http://lpi.oregonstate.edu/mic/vitamins/folate )) The enzyme responsible for activating folic acid is called methyltetrahydrofolate reductase or MTHFR for short. A large portion of the population has a variation in the gene that codes for MTHFR, making the conversion sluggish or not functional at all resulting in a less than desired amount of active folate in the body. Folate, as compared to folic acid, does not require the same enzyme so our bodies are able to use it. However, manufacturers may use the term “folate” to mean folic acid.  It is therefore important to choose a prenatal vitamin that has folic acid already in its active form.  Look for prenatals that list the terms: L-5-Methyltetrahydrofolate, L-5-MTHF, Metafolin, Quatrefolic. 

Fish oil

Fish oil has been shown to decrease inflammation, thin the blood and support the acrosome reaction, when sperm penetrates the egg. These are all beneficial to fertility. Consider: Our water sources are becoming increasingly polluted affecting the levels of heavy metals, PCBs and dioxins in our fish. When fish oil is contaminated, or if it has gone rancid (you’ll know by the smell or bad taste), it has the opposite effect on our health: it can increase inflammation. When choosing a fish oil, choose one sourced from small fish such as sardines since contaminants get magnified up the food chain. In addition, ask for a Certificate of Analysis (COA) from the manufacturer. This is a third party verification ensuring that the quality of their fish oil is what it claims on the packaging. In addition, know that fish oil can lower cholesterol, so if you have low cholesterol, you may want to omit this supplement.

CoQ10

CoQ10 is a molecule with the essential role of creating energy in the cells of the body. It is also an antioxidant. Both these functions are critical for egg and embryo development as well as sperm motility. Consider: CoQ10 comes in two forms: ubiquinone and its active form, ubiquinol. Ubiquinol is better absorbed. Ubiquinone is poorly absorbed but more affordable. If you choose ubiquinone, make sure it is in a form that is bioavailable, which basically means the CoQ10 has a chaperone in the form of emulsified fat, which escorts it into the blood stream. Look for wording such as “hydrolyzed with a soy peptide”. This way the absorption of ubiqunone becomes comparable to ubiquinol and you can take about half the dose you would of common ubiquinone. ((Chopra RK, et al. Relative bioavailability of coenzyme Q10 formulations in human subjects. Internat J Vit Nutr Res 1998;68:109-13 )) ((Takeda R, Sawabe A, Nakano R, et al. Effect of various food additives and soy constituents on high CoQ10 absorption. Japanese Journal Medicine Pharmaceutical Science 2011;64(4):614-20.))

Melatonin

Melatonin is a hormone known for its effect on the circadian rhythm: it regulates your sleep-wake cycle. It is mostly used as a natural aid for falling asleep. Research shows that it is also a powerful antioxidant, found in high amounts in maturing follicles and associated with improved IVF outcomes. Consider: Since melatonin is a hormone, its prolonged use at the dose of 3 mg nightly may interfere with the hormones regulating ovulation. It has also been shown to suppress thyroid function. For natural fertility or if you have hypothyroidism, melatonin at the 3 mg dose may not be indicated for you. To support your body’s natural production, however, you can expose yourself to daylight early in the morning (such as taking a walk outside) and at night choose to dim your lights and reduce screen time.

With the plethora of supplements advertised to enhanced fertility, it is often helpful to use the guidance of a healthcare professional versed in the quality and therapeutic dose of supplements and ability to individualize your protocol. If you are the type of person who likes to do things more independently, it is wonderful that there are many high quality supplements on the market. It will simply require due diligence to identify them.