Folic Acid for Fertility
Are You Getting Enough?

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

Last updated: August 12th, 2020

Almost every woman knows that folic acid is one of the most important vitamins for pregnancy. 

But what about when you’re trying to conceive?

vitamins

What’s often missed is that the standard folic acid dose recommended for pregnancy may NOT be enough if you’re trying to boost your fertility potential. 

Let’s take a closer look at folic acid as it relates to your reproductive health.

Folic Acid versus Folate - A Subtle Yet Important Difference

If you find yourself asking what’s the difference between folic acid and folate, or perhaps you didn’t even realize there was a difference, you’re not alone. 

Many medical professionals mix up the terms or use them interchangeably. So, you’re not the only one that gets it confused. 

To keep things simple (we’re big believers in keeping it simple around here), folic acid is the man-made version, while folate is found naturally in foods. You may also see or hear both of these names referred to as vitamin B9, one of the many B vitamins in the body. 

So, if folate occurs naturally in foods, why do we have a synthetic version and why are we consuming so much of it? 

That’s because more than 20 years ago (in 1998 to be exact) the FDA mandated that folic acid be added to processed grain products (i.e., bread, pasta, rice, and cereal). 

This was deemed necessary due to overwhelming evidence that folic acid supplementation before and during early pregnancy could protect against neural tube defects (NTD) in newborns. NTD is a fancy medical term referring to issues with spinal cord and brain development during a very early period of growth in the womb.

We know it goes without saying, but this is a big deal. 

What Does Folic Acid Do In The Body?

Aside from protecting against neural tube defects, folic acid, or folate for that matter, is essential for the synthesis of DNA, production of new cells in the body (e.g., red blood cells), and the support of proper brain and immune function. 

Folic acid also works with vitamins B6 and B12 to control blood levels of the amino acid homocysteine. High levels of homocysteine are associated with heart disease and well as recurrent pregnancy loss. But alas, we digress… back to folic acid and fertility.

Folic Acid For Female Fertility…What Does The Evidence Tell Us?

Now that you understand the difference between folic acid and folate as well as the reason they get lots of attention around pregnancy, let’s look at an often overlooked benefit of folic acid – increased fertility

The EARTH (Environment and Reproductive Health) study, conducted at Harvard Medical School, was one of the initial studies to report an association between higher blood folate levels and an increased chance for live birth, specifically among women undergoing assisted reproductive treatments.

In case you’re curious about the details, the researchers found a 62% greater probability of live birth among women with the highest levels of folate in their bodies (>26.3 ng/mL) compared to the women with the lowest levels of folate (<16.6 ng/mL). 

And as you’ve just learned, folate occurs naturally in foods, thereby raising an important question… “what happens when you supplement with folic acid?” 

Two different studies, one based out of Harvard and another out of the University of Buffalo, have both shown that supplemental folic acid taken before pregnancy is associated with a lower risk of ovulatory infertility and a shorter time to pregnancy. Awesome news if you’re struggling to conceive as anovulation is one of the most common causes of infertility.

Folic Acid For Male Fertility

Now before we move on to our action items for this post, let’s take a look at folic acid and the male-factor. 

And yes, while we’re confident you know who runs the world (sing it Beyonce), Dr. Haas wants to make sure that men are doing their part too. 

In a study published in the journal Human Reproduction, it was found that men who consume high levels of folic acid through their diet (over 700 mcg/day) reduced their risk of sperm aneuploidy (abnormalities of genetic material) by up to 30 percent. This means a lower chance of problems that can lead to miscarriages or birth defects. 

Switching over to the supplementation side of things, researchers in the Netherlands have demonstrated that men who took a combination of 5mg of folic acid and 66mg of zinc, increased total sperm count by 74 percent. 

Keep in mind that this was a very high dose of folate compared to the recommended daily intake of 400 mcg (and zinc was also included), so make sure your man talks with his healthcare provider before supplementing with such a high dose. Don’t forget to ask about the need for supplemental copper if using a supplement with zinc in it!

How Much Folic Acid is Enough for Women Trying to Conceive?

As you’ve just read, one of the few studies on folic acid supplementation in men used an exceptionally high dose for optimizing fertility parameters. Studies on supplemental folic acid among women trying to conceive, on the other hand, have used much more moderate doses, with positive results noted around 800 mcg per day

In fact, women taking 800 mcg of supplemental folic acid daily (instead of the standard 400 mcg per day amount) have shown significantly better fertility outcomes, including higher implantation rates, higher clinical pregnancy rates, and a 20% higher probability of live birth

And among women undergoing IVF, higher folic acid supplementation has been associated with higher fertilization rates and lower cycle failure rates prior to embryo transfer.

Another quick, yet super-relevant fact about taking folic acid… it’s a water-soluble vitamin, which means it must be regularly replenished in the body. To get the most benefit from this vitamin, make sure to take your supplement daily.

For your reference, we’ve listed the recommended daily intake of folic acid beyond fertility optimization below:

Foods Rich in Folate

If you’re looking to get in some extra folic acid beyond supplement form, there are plenty of foods rich in this vitamin. 

As mentioned in the beginning of the post, most breads and cereals in the United States are fortified with folic acid. That means you’re likely getting some amount of folic acid into your body if you eat those sorts of foods.

If you’re a student of the Fertility Foods Formula or you regularly follow our blog, you know why we don’t recommend these foods and how they can harm your reproductive health.

Instead of relying on folic acid added in processed foods, try incorporating some of these items into your diet that are rich in natural folate:

food rich

Need a little more direction? Consider one of these simple substitutions to boost your folate:

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    Use spinach instead of iceberg lettuce in your wraps

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    Sprinkle chickpeas on your salad in place of bacon or eggs

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    Spread mashed avocado on your toast instead of butter

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    Add lentils to your stew in place of beef or chicken

A Word of Caution When Supplementing

Anytime you’re thinking about taking a supplement, treat it with the same respect as using a prescription medication – there are always potential adverse effects if used incorrectly. 

As a general word of caution, you should NOT take more than 1,000 mcg of folic acid per day across all your supplements without first discussing it with your doctor.  

Large doses of folic acid may mask a vitamin B12 deficiency, which can cause irreversible nerve damage. It’s a good idea to have your doctor test your B12 levels if you need to start a high dose of folic acid.

Unless you have a family history of neural tube defects or take certain medications, you will not generally be instructed to take high-dose folic acid, so this shouldn’t be an issue for most women. 

You should also know that folic acid can interact with other medications, most commonly anti-seizure medications (e.g., phenytoin) as well as methotrexate (an immunotherapy agent). And although folic acid does not typically interact with fertility medications, some supplement combinations with folic acid in them contain other herbs that can affect these medications. 

So, at the risk of sounding like a broken record, always make sure to talk with your doctor before starting any supplement.

MTHFR and Fertility

Some of you might be familiar with MTHFR and others are probably wondering what foreign language we’re speaking. A detailed synopsis regarding the enzyme methylenetetrahydrofolate reductase (MTHFR) is a bit beyond the scope of this post, but it’s important to mention as you’ll see it talked about if you spend enough time searching the internet. 

In short, it’s been suggested that some people may not gain benefit from folate or folic acid due to a genetic issue. More specifically, due to mutations in the genes that code for MTHFR. When the MTHFR enzyme is not working optimally, folic acid is unable to be converted into its biologically active form. 

We’ve come across some buzz surrounding the use of pre-activated folic acid (5-methyltetrahydrofolate or 5-MTHF) for women struggling to conceive. 

This has centered largely around a small, case-series publication. For those of you familiar with statistics (a source of excitement for Dr. Eskew and a source of pain for Dr. Haas), you’ll recognize that it’s not the best type of study from which to make bold statements. 

With that said, we believe there might be something more to the story of using 5-MTHF as another well-designed study found a strong association between an MTHFR gene mutation and recurrent pregnancy loss

All-in-all there’s much to learn about the use of 5-MTHF among women struggling to conceive before we feel comfortable suggesting you should replace it for conventional folic acid.

Final Thoughts

Folic acid is an important vitamin for both men and women, especially when trying to conceive. Beyond protecting against the risk for certain birth defects, folic acid can optimize many aspects of your fertility. 

Remember that folic acid and folate are not the same thing, and despite the need for folic acid supplementation, there are many healthy food sources of folate. 

Disclaimer alert… always talk to your doctor before beginning any supplement, and make sure they understand the potential risks and benefits of their use. The goal is to optimize your fertility as well as your overall health, not put it in harm’s way.

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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