Decoding The Fertility Diet, Part 4:
Is Your Prenatal Vitamin
Helping Your Fertility?

Written & Edited by: Dr. Will Haas, MD, MBA & Dr. Ashley Eskew MD, MSCI

Last updated: August 12th, 2020

If you’re trying to conceive, you should take a prenatal multivitamin – no surprise there. 

But, is your multivitamin helping your fertility or just preventing birth defects of your future child? 

Prenatal Helping

It all comes down to the components inside as well as their dose… 

And you might be surprised to learn that only a few of the components in your standard prenatal vitamin play a role in boosting your fertility even though they are all essential for pregnancy.

As you’ve learned in the first 3 parts of the Decoding the Fertility Diet series, avoiding certain foods and consuming others has been scientifically shown to boost fertility and increase your chances of getting pregnant.

Before getting too far into this post, we want to remind you to ALWAYS get as many of your nutrients from a whole-foods, plant-based diet as possible.

Students of our Fertility Foods Formula know exactly what we mean when we say ‘plant-based’, and it’s not a full-on vegan or vegetarian diet or just tossing out the junk food.

We also want you to know that there are many micronutrients and supplements to consider when trying to conceive. And for the purposes of this article, we’re going to focus only on those found in a standard prenatal multivitamin.

Don’t worry, we’ll present a more comprehensive review of other fertility supplements in future posts.

Making the case for multivitamins

The argument has often been made that at the very least we should be taking a daily multivitamin to ensure that we’re getting every nutrient that we need and to fill in any nutritional gaps from our diet.

The real question to ask is not whether your multivitamin fills in any nutritional gaps, but whether it helps prevent disease or improves your health in some way.

When we look at taking a multivitamin for general health and disease prevention, the evidence is actually somewhat unclear… it might help, but then again it might not. It’s actually a fairly controversial topic.

However, when we turn our attention to pregnancy and preventing birth defects, the evidence is quite clear – multivitamins containing folic acid are a MUST when trying to conceive.

Multivitamins containing folic acid generated a lot of attention when they were first found to dramatically reduce the chances of birth defects related to a developing baby’s brain and spinal cord (i.e., neural tube defects).

As the infographic below reveals, there’s a lot of other micronutrients beyond folic acid in your standard prenatal multivitamin. Each and every single one of these are important to help prepare for and thrive during pregnancy.

Prenatal Infographic

But the important question still remains… which of these components matter most when trying to increase your chances of getting pregnant?

The b-vitamin you might need more of when trying to conceive

As you may have guessed, folic acid is the b-vitamin you need to be consuming more of when trying to conceive.

In 1998, the FDA actually required food companies to add folic acid into grain products because the average American woman at the time only consumed 250 mcg of folate per day – 350 mcg below the recommended daily amount in pregnancy.

When the book The Fertility Diet by Dr. Jorge Chavarro and Dr. Walter Willett was first published back in 2009, the recommendation for women trying to conceive was to get at least 400 mcg of folic acid a day. Since that time, additional research has suggested that higher amounts of folic acid may be beneficial, especially in women trying to conceive.

As we will discuss in another post dedicated exclusively to folic acid, 800-1200 mcg of folic acid per day has been shown to be a better target when trying to optimize your efforts to conceive.

Let’s take a quick look at folate and folic acid right now…

When looking at dietary intake, women with the highest consumption of naturally occurring folate were found to have a 64% lower odds of anovulation while trying to conceive compared to women who consumed the least amounts. Similar positive findings for increased dietary folate intake have also been seen among women undergoing IVF – 57% higher live birth rates in fact.

Turning our attention to supplemental folate (folic acid), additional fertility benefits have been seen. Data from the Nurses’ Health Study II showed that women who took a multivitamin with folic acid were noted to have a 35% lower risk of ovulatory infertility compared to women who didn’t take a supplemental multivitamin (note the greatest benefit was seen with daily use).

Data from the Nurses’ Health Study II also revealed that higher folic acid intake from supplements was associated with a significantly lower risk of miscarriage and had an inverse association with stillbirth when compared to lower doses. Similarly, data from Brigham and Women’s Hospital supports this too. Women supplementing with higher folic acid (800 mcg to 1200 mcg) prior to IVF and embryo transfer experienced higher fertilization rates, lower cycle failure rates, and higher live birth rates.

So check your multivitamin bottle and make sure it has at least 800-1200 mcg of folic acid.

And of course, always discuss your decision to add or change a supplement with your physician! Based upon your personal and family history you may require more or less folic acid.

A mighty mineral and its surprising source

Oftentimes we get so focused on vitamins that we overlook the importance of minerals in our bodies…this is especially true when it comes to trying to conceive.

Iron, a powerhouse mineral that’s responsible for carrying oxygen from the lungs to the rest of the body, has been associated with a decreased risk of ovulatory infertility.

It shouldn’t come as a big surprise given that iron also plays an important role in the synthesis of DNA (the molecule that contains your genetic code) and ATP (our body’s most important energy molecule).

Usually, we only get concerned when iron levels drop to the point of creating a decrease in hemoglobin levels, a condition referred to as iron deficiency anemia.

Some studies have suggested that maternal iron deficiency anemia has been associated with reduced fetal brain maturation, pediatric cognitive defects, and maternal depression, outcomes we know everyone in the OvulifeMD community would like to avoid. However, these studies are limited by a lack of control for socioeconomic factors as well as other pre-existing chronic diseases that are likely to play a large part in these outcomes as well.

To complicate matters, up to 1 in 7 women will have below-normal iron levels without notable anemia. Generally this is not regarded as a problem, unless of course you’re working hard at trying to conceive.

Again, findings from the Nurses’ Health Study showed that women who consumed iron supplements had a 40% lower risk of ovulatory infertility compared with women who did not consume iron supplements.

The benefit was noted at a daily dose between 40 – 80 mg, significantly below the amount found in most prenatal multivitamin as well as the FDA’s recommended daily intake during pregnancy (keep in mind gummy vitamins typically don’t contain iron at all). Interestingly, women who got most of their iron from meat weren’t protected at all against ovulatory infertility, a topic we explore closely in the Fertility Foods Formula and our post on protein.

So just as you did with folic acid, look closely at your multivitamin label and discuss with your physician whether or not you’re getting enough iron.

It’s important not to get too much iron as excess amounts can disrupt the health of your liver (an important detoxification organ), so we can’t understate the importance of talking with your doctor.

The benefits your man can get from a multivitamin too

Let’s be real for a moment, most men (up to 80% in fact) don’t get their recommended servings of fruits and vegetables in a given day.

Heck, they might not even get their daily allotment throughout the course of an entire week (unless they love brussel sprouts as much as Dr. Haas). This can lead to significant vitamin and mineral shortages that affect sperm health.

Unfortunately, the research on supplementation for male fertility is not as robust as it is for women’s fertility. Yet despite this fact, you’ll encounter many websites claiming that the antioxidant components of a standard men’s multivitamin have been shown to be beneficial for sperm health. For instance:

However, the studies we’ve seen referenced to support these statements are generally limited by their research design (e.g., small number of participants). Well designed studies are especially important when making claims about sperm health given that the typical semen analysis varies by as much as 400%. Additionally, some of the nutrients referenced are sourced from dietary intake, not supplement form.

When looking at a recent Cochrane Review on this topic, the evidence evaluated from 61 randomized controlled trials was considered low-quality for the use of antioxidant supplements to enhance male fertility. In fact, the authors of the paper go onto state that “subfertile couples should be advised that overall, the evidence [for antioxidant supplementation among men] is inconclusive.”

Given the limitations of the current evidence, we agree with the Cochrane review in saying that more evidence is needed to make definitive recommendations or to justify the cost of specific antioxidant supplements for men who are trying to conceive with their partner. It is important to note that this study does not advise men against taking a broad-spectrum multivitamin for general health purposes. 

Bottom line recommendation – if your man is opting to supplement too, have him stick with a basic multivitamin that contains appropriate doses of folic acid while being careful to avoid ‘proprietary’ fertility supplements that are unlikely to help and may be harmful.  

Make sure he’s also taking one designed for men and not one of yours! Men should not take extra iron without appropriate medical evaluation, especially if they’re not a risk for iron deficiency. 

Of course, the best advice is to always check with a knowledgeable healthcare provider before taking any form of supplement.

Final Thoughts

There are SO many special “fertility boosting supplements” and prenatal vitamin options out there that it can be hard to delineate fact from fiction. 

As we mentioned above, we’ll be doing an entire separate blog post of supplements at a later date to review the EVIDENCE and help you decide what actually matters to you.

However, when it comes to choosing “the right” prenatal vitamin to optimize your fertility while trying to conceive. Look for those with around 800-1200 mcg folic acid and 40-80 mg of supplemental iron, which you now know have been associated with:

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    Decreased risk of ovulatory infertility

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    Decreased risk of miscarriage

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    Higher probability of live birth following IVF

Another post down in the Decoding the Fertility Diet mini-series.

With Love & Empowerment,
Dr. Ashley Eskew and Dr. Will Haas
Whenever you're ready, join us and other women trying to conceive who are optimizing their fertility with a pro-fertility diet.

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