Guest blog by Dr. Rachel Corradetti-Sargeant, ND, a fertility-focused naturopathic doctor.
Do you find yourself confused about which preconception supplements to use when you are trying to conceive? You’re not alone. The internet is full of suggestions on what you should be using, the health food store shelves are confusing, your family and friends are telling you all about what they did (and didn’t take) to get pregnant, and your doctor might say its all bunk. What are you to do?
I spending a lot of time counseling my patients on the research-backed supplement options that are out there to help with a wide variety of fertility issues, as well as to simply put you in the best preconception state possible.
We have learned that optimizing preconception status is important for fertility and pregnancy outcomes as are the first 20 weeks of gestation.
Let’s up your knowledge on the top preconception supplements to discuss with your medical provider.
Please Note: This information is not meant to replace that of your medical provider. Please discuss any supplements with your healthcare provider in order to avoid interactions or complications. I am not able to provide information on doses as per my regulatory guidelines.
Preconception Supplements
Prenatal Vitamins (PNV)
Of course prenatal vitamins are on the list. They are an excellent multivitamin to include in your preconception plans. It’s recommended to begin preconception vitamins 3 months prior to when you begin trying to conceive in order to optimize your nutrient levels. Unfortunately, not all PNVs are created equally. One of the key nutrients in prenatal vitamins is folate. This particular nutrient is important for appropriate cell division to allow for proper neural development in the early stages of pregnancy. You’ll want to look for a PNV that contains methylated folate. This will sometimes be listed as l-methylfolate or L-5-MTHF. This form of folate is active and is best utilized by the body. PMID: 25278626 You’ll want to also be sure there is a source of B12 (preferably in the methylcobalamin or tydroxycobalamin form), as well as iron, selenium, and choline. Blood work done by your healthcare provider preconception can also help you understand if you need more B12 or iron beyond what’s in your prenatal.
Folate
I’ll highlight this particular B vitamin on its own even thought it is included in most PNVs. This is because in some cases we want female patients using higher doses of folate than what is typically included in your prenatal vitamin. These populations include females who have experiences previous pregnancies with neural tube defects, those with metabolic disorders like diabetes or obesity, and smokers. Speak with your doctor to see which dose is appropriate for you.
A reminder that folate is required for cell division and supplementing with it helps to lower the risk of neural tube defects in the fetus. As per above, you’ll want to use an activated form of folate in cases of MTHFR mutation in order to properly utilize folate.
CoQ10
This preconception vitamin is a hot topic these days because of its impact of oocyte quality. I like to think of CoQ10 as lubricant on your cell engine (aka. mitochondria). In order to keep that engine young, healthy and functioning at top level, we need to keep it well lubricated. In actual fact, Coenzyme Q10 helps to reduce oxidative damage in order to improve fertility outcomes. PMID: 32767206. There is certainly no time limit on when it can be utilized, but its typically used in cases where egg quality is of concern, or the female is of advanced maternal age (beyond 35 years of age). There are benefits for male sperm parameters, too. PMID: 31408928 Look for a ubiquinol form for best outcomes. PMID: 30302465
Fish Oil
The benefits of fish oil are certainly well known. From a preconception perspective, the omega-3 fatty acids within fish oil (specifically DHA and EPA) are beneficial in reducing inflammation, enhancing blood flow to the uterus, improving egg quality and enhancing fertility outcomes especially in overweight patient populations PMID: 26742065. PMID: 32849890. The benefits also extend into pregnancy with DHA specifically impacting cognitive development of the fetus. PMID: 21364848.
Vitamin D3
Nearly every infertility patient I work with is deficient in vitamin D. We are certainly learning more and more about how this vitamin impacts fertility outcomes. In particular, its impact on female hormone steroidogenesis and regulation of the reproductive process overall PMID: 28500824. Vitamin D status impacts PCOS, Hashimoto’s thyroiditis, endometriosis, egg quality and more PMID: 24717915.
It is very important to have your vitamin D levels tested by your healthcare provider prior to trying to conceive in order to understand your level of deficiency and how best to supplement. You’ll often hear that 1000IU per day is sufficient, but I consistently see high levels of deficiency in my infertility patients and this dose will not correct a deficiency. We often need much stronger doses, but vitamin D is also a fat-soluble vitamin, which means you can take too much and cause toxicity. Repeat testing after 3 months of dosing will help ensure you’re achieving adequate levels without reaching toxicity.
Inositol
This is another one that is certainly increasing in popularity in the fertility world these days. It is a stereoisomer called myo-inositol. It reduces insulin resistance meaning it acts well in many cases of PCOS PMID: 21608442 Sometimes it can cause mild gastrointestinal side effects like bloating and loose stool. I typically recommend it in a powder form for patients to use in the evening before bed to help reduce the side effects. This is a great option to discuss with your healthcare provider to see if it will work in your case.
Probiotics
The importance of the uterine microbiome is becoming more and more clear. Lactobacillus strains are especially important for uterine health and receptivity to enhance fertility outcomes PMID: 32182980. It is especially important to consider in cases of dysbiosis, frequent yeast infections, frequent urinary tract infections, recurrent pregnancy loss, autoimmune disorders, and gastrointestinal disorders. There is still so much to learn on this topic, but it is an excellent option to consider including in your preconception care plan. The specific strains and doses do make a difference so please be sure to discuss this with your healthcare provider.
Iron
I mentioned iron above in the prenatal vitamin section. I wanted to expand on it here because not everyone needs iron, and some people may need more beyond what they are getting from their prenatal vitamin. This is another one of those nutrients that it is important to have tested. You’ll want your care provider to run a CBC, TIBC/iron, transferrin and ferritin assessment in order to be sure the entire iron pathway is being properly understood. Iron is very important for egg quality as well for reducing the chances of miscarriage. In pregnancy it is important for cognitive development of the fetus. If it is deficient in the prenatal period it can lead to mental health issues including anxiety for the child after delivery, as well as cognitive delays – PMID: 26599151. Speak with your care provider to learn if you need more iron beyond what is in your prenatal.
Choline
Choline is extremely important for balancing out homocysteine levels to reduce inflammation preconception. It is also extremely important for the cognitive development of the fetus: PMID: 31394787. You can get choline pretty easily in the diet, but your needs go up while you are pregnant to 450mg per day so we try to increase the levels in the preconception window, too. You can learn more about different sources of choline here. It can be supplemented if your dietary intake is inadequate.
NMN
The newby the preconception party is definitely Nicotinamide mononucleotide (NMN). NMN has been reported to restore NADH/NAD+ function, while also improving the quality of oocytes by maintaining chromosome euploidy, which subsequently improves mitochondrial function and improves fertility outcomes. The early data on NMN has mainly been reported in mouse studies, but the data is promising and is worth discussing with your health care provider (Miao Y, et al (2020). Nicotinamide mononucleotide supplementation reverses the declining quality of maternally aged oocytes. Cell Reports. 32(5): 107987 3. Yang L, et al. (2020). Mitochondrial DNA mutation exacerbates female reproductive aging via impairment of the NADH/NAD+ redox. Aging Cell. 19(9): e13206).
If you’ve made it to the end of this article you can appreciate how many options exist for preconception healthcare and improved fertility outcomes. This is just the beginning, too. We have lots of other agents like NAC, L-carnitine, ashwaghanda, wild yam, chaste tree, and more that we will utilize in different cases.
I highly recommend speaking with your healthcare provider to development a plan that works for you based on your needs.
Dr. Rachel Corradetti-Sargeant, ND is a fertility-focused naturopathic doctor practicing at Conceive Health @ Niagara Fertility in Stoney Creek, Ontario, Canada. She studied at the National College of Natural Medicine in Portland, Oregon and the Canadian College of Naturopathic Medicine in Toronto, Ontario. She is licensed through the College of Naturopaths of Ontario, and is a professional member of the Canadian and Ontario Associations of Naturopathic Doctors, as well as the Endocrinology Association of Naturopathic Physicians. She treats her patients with personalized, functional, and integrative medicine. After her own difficulties with pregnancy loss she is passionate about empowering her patients to make healthy changes that help them conceive and maintain healthy pregnancies. When Dr. Corradetti-Sargeant is not seeing patients, she’s running triathlons, contributing to magazine articles (look for her in Clean Eating and Elle magazines), or making a giant mess in the kitchen whipping up the latest healthy desserts!
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