The final blog in this series covers key supplements to support fertility and pregnancy, and how to choose them and maximise the absorption and benefits.
Knowing which supplements to take support your fertility can be a bit of a minefield. Unfortunately, there is not a definitive supplement list you stock up on, and take, that will give you the positive test result you are longing for.
That said, research in this area has identified key nutrient and doses that are essential for fertility, pregnancy and for breast feeding women.
All pregnancies require a healthy, balanced diet with an adequate supply of energy, protein, vitamins, and minerals for the mother and developing baby. However, poor dietary intake can lead to nutrient deficiencies along with impaired digestion, malabsorption, or chronic diseases.
When nutrient deficiencies develop over time, they are not always resolved during a short window of supplementation. So, beginning supplements in the first or second trimester of pregnancy may not be a sufficient time to affect your developing baby.
Lots of blogs, podcasts and books list fertility supplements, and how they support women to get pregnant. Great in theory – but how do you know if these are the supplements that are going to help you to get pregnant? How do you know if you are going to even benefit from them? How much of them you should take? And for how long?
I am going to help answer these questions for you, and will tell you some important supplements your body needs to get, and stay pregnant.
Which Fertility and Pregnancy supplements are right for you?
There are so many different supplements on the market, knowing which to take can be a challenge and end up costing you a lot of money. Not only that, taking too much of something your body doesn’t need can also be potentially harmful, especially if they interact with medications or underlying health conditions.
Chances are, by the time you are reading this blog, you have visited many Fertility and Pregnancy blogs, books, podcasts and online forums all talking about a whole raft of supplements and how they boost fertility levels including Vitamin D, B Vitamins, Omega 3, CoQ10, DHEA, Melatonin, Myo-inositol, NAC, Glutathione, Alpha-Lipoic Acid, Vitamin A, Iron … the list goes on.
Some of these supplements can be really helpful, for some people, at some point on their fertility journey. However, some, like Vitamin A and Iron, can be harmful to you and your baby if taken in the wrong dose or form and cause unwanted side-effects.
Bear in mind what someone else’s body needed to get pregnant, is not necessarily going to optimise your hormones or support conception and pregnancy for you. Please check with your GP or a nutritionist before starting to supplement.
It is also really easy to over-supplement. You can only absorb certain amounts of nutrients at any one time, and our bodies and personal DNA traits mean some biochemical pathways can be bypassed or struggle when there is too little or too much of a particular nutrient.
Food Supplements are exactly that – they supplement your diet and can help provide the nutrients your body needs to be able to function optimally, when you can’t or aren’t obtaining them from food. So, the starting point for deciding what to supplements to take, is always to look at your diet, and identify key nutrients that are missing.
So it seems obvious that people who do not eat oily fish would benefit from taking Omega 3 fatty acid, and Vegans need to supplement the nutrients that are only available in animal products.
Currently, the only pre-conception support the NHS recommend is Folic Acid and Vitamin D, outlining for certain health conditions people may require a higher daily dose.
There is a strong evidence base to support these and they provide a Recommended Daily Allowance (RDA). This is calculated for a healthy person; however this is not the same for someone who is either insufficient or deficient in the same nutrient.
In my pervious blog Key Hormone & Nutrient Tests for Fertility and Pregnancy, I discussed some of the key nutrients for fertility and pregnancy – Folate, Vitamin B12 and Vitamin D and explained optimal levels, and how to test for them. Keep reading below to find out different ways to optimise these, and the best ways to do it.
Nutrient & Vitamin Absorption and Metabolism
The daily amount of vitamins and nutrients we ingest from food or supplements, unfortunately doesn’t equate to how much we absorb and metabolise. This is very individual and depends on many factors ranging from what, how and when we take supplements to whether they are water soluble (e.g. B Vitamins) or fat soluble e.g. (Vitamin D).
Other factors effecting nutrient absorption and metabolism include underlying health conditions and the quality and variety of the food in our diet. Our gut health has a huge impact on the nutrients we absorb. Also, our genetic blueprint and predispositions, such as the MTHFR variance, impact fertility and pregnancy. And let’s not forget, our lifestyle choices also impact on our health and hormone levels.
Choosing Supplement Checklist
When thinking about taking any supplements – not just for fertility – but to support your overall health, run through this checklist to ensure the supplement is right for you. Please email me if you would like a copy of the following –
The importance of Testing Nutrient Levels
Based on my training, and what I see in clinic time and time again, I firmly sit on the side of the fence that takes away any guesswork, and opts to test nutrient levels in order to determine if and how much of a supplement your body needs to optimise fertility, and for a healthy pregnancy.
I work with you to understanding how your body absorbs and processes nutrients and vitamins, so you can make an informed choice about which nutrients your body needs, and the best methods, dose and brands to opt for. This avoids starting your pregnancy on a back foot and instead have a healthy pregnancy and, importantly, a healthy baby.
3 Key Supplements to boost and support Fertility and Pregnancy
In my blog Key Hormone & Nutrient Tests for Fertility and Pregnancy, I discussed Folate, Vitamin B12 and Vitamin D and the strong evidence base which means the medical profession recognise them as essential for fertility and pregnancy. Now we are going to take a deep dive into each if them.
Folate
It is recommended to take Folate supplements for at least 3 months before pregnancy. Folate (Vitamin B9) comes in 4 forms. The first form is a synthetic version called Folic acid, the second is Folate from food sources, the third is Folinic acid, which is a prescription medication in the UK used alongside certain medical treatments, and the fourth is Methyl-Folate, the form of Folate your body readily uses. This is more bio-available, so people can require less of it and care must be taken avoiding over-dosing to avoid unwanted effects.
Folate can be found in leafy green vegetables, sprouts, citrus fruits, liver, and yeast. It is highly absorbable, but also water soluble so not stored in the body. It is really important to make sure you maintain your Folate levels daily from your diet. If you don’t, then you need to supplement it.
You may have heard of MTHFR. This is one of the genes in our body that helps support the conversion of the first 3 types of Folate into Methyl-Folate. This is part of an important process in the body called Methylation, where the body takes hydrogen and carbon from Folate and this switches on and off certain reactions in the body.
If you have been DNA tested, you may already know whether you have a MTHFR variance which can slow down Methylation in your body. You may be worried and stressed about this – please don’t be. I want to explain that there are other ways to maximise your Methylation pathways, and support your body. And it is not an all-or-nothing process. Over and above your genetic imprint are the Epigenetic factors that affect how your genes are expressed and to what extent. Your genetic traits do not define you. They are impacted on hugely by diet, lifestyle and your environment.
Folate and MTHFR are super important for fertility and pregnancy, because they are crucial in the Methylation process for both mother and baby. However, Methylation is complex and involves many other genes and biochemical processes, not just MTHFR.
Supporting the whole Methylation cycle involves providing the other substrates your body needs including Vitamin B12, and other cofactors including Zinc, Magnesium and Vitamins B3, B6, and Vitamin C – all in the right amounts. So, depending on which MTHFR variance you have, you may require more than the 400 micrograms of Folic acid the NHS recommend, and increase this to 600-800mg of Methyl-folate each day.
However, studies suggest that adverse effects of an excessive intake of Folic Acid under certain conditions, have been linked to promoting cancer, interacting with medications, and impairing foetal development. Please do not over supplement forms of Folate.
Also, don’t rush to take Methyl-folate. Your body is clever, and it has a back-up Methylation pathway that doesn’t involve Folate and instead uses Choline and Betaine, both of which can be sourced from food. The average egg yolk contains ~250mg of Choline, so eating 2 eggs per day equates to 450-500mg, the recommended daily requirement. This is more Choline than is contained in many pre-natal supplements.
Betaine can be sourced from beetroot, so if you have an MTHFR genetic trait, support your body methylating by roasting it, making soups with it, putting it in smoothies and buying beetroot shots.
Vitamin B12
Vitamin B12 (cobalamin) is a crucial for your fertility and a healthy pregnancy, and also the baby’s physical and neurological health. Vitamin B12 is found in animal products such as red meat, oily fish, poultry, dairy products and eggs. It is bound to protein in food and needs to be liberated in your gut by the glycoprotein Intrinsic Factor, in order for you to absorb Vitamin B12.
Therefore, if you have gut health issues including IBS, Dysbiosis or Gut Permeability or conditions which effect your ability to produce Intrinsic Factor, this may affect your Vitamin B12 levels. Additionally, over the counter medicines including PPIs and NASAIDs can impact your gut health and how well your body can absorb Vitamin B12.
Tests that measure your levels of Vitamin B12 include Serum Vitamin B12, which measures the amount in the blood circulating around your body, the standard test used by the NHS. Unfortunately, 85-90% of this Vitamin B12 is strongly bound to the protein haptocorrin.
The small fraction of the total Vitamin B12 available to enter your cells is called holotranscobalamin (holoTC) or Active Vitamin B12. We store Vitamin B12 much more readily than we store Folate. It is this reason that the Vitamin B12 stores in our blood can mask when our Vitamin B12 stores in our tissues are depleted. That is why it is best practice to test for both types of Vitamin B12 to learn how bioavailable it is.
Folate and Vitamin B12 are inter-dependent, and need to be relatively well matched in their activity.
Symptoms of Vitamin B12 Deficiency
If you have a condition effecting your gut health, or your ability to produce Intrinsic Factor, you may be deficient, and it is important to discuss this with your GP and have your levels tested. If deficient, you may need supplements or if severely deficient a prescription for Vitamin B12 injections.
Some of the symptoms experienced include-
- extreme tiredness
- a lack of energy
- pins and needles
- a sore and red tongue
- mouth ulcers
- muscle weakness
- problems with your vision
- psychological problems, which can range from mild depression or anxiety to confusion and dementia
- problems with memory, understanding and judgement
NICE confirm that serum cobalamin of less than 200 nanograms/L is sensitive enough to diagnose 97% of people with vitamin B12 deficiency. Also, that <350 nanograms/L Serum Vitamin B12 or 25-70 picomol/L Active B12, both indicate a possible deficiency, and should be investigated further. enough to diagnose 97% of people with vitamin B12 deficiency. Also, that <350 nanograms/L Serum Vitamin B12 or 25-70 picomol/L Active B12, both indicate a possible deficiency, and should be investigated further.
Supplementing Vitamin B12
If poor gut health is an issue for you, then you can optimise your Vitamin B12 levels with sublingual liquid or spray supplements as they bypass the stomach and allow Vitamin B12 to enter your blood directly. There is interesting research that sublingual drops taken over a 3-month period at the correct dose, can be as effective as intra-muscular injections.
The different forms and formats of Vitamin B12 can impact how well you absorb it. There are 4 types. Methylcobalamin & Adenosylcobalamin are naturally occurring and both work well together, and are required for multiple biochemical functions; although Methylcobalamin is retained better in the body.
Cyanocobalamin is a synthetic form of Vitamin B12, which is converted into the previous two forms. This is frequently found in supplements due to its low cost, but it needs to be converted before your body can use it. Hydroxocobalamin is very bioavailable and is the form the NHS use when someone has a deficiency and prescribed Vitamin B12 injections.
Optimal daily intake of both Folate and Vitamin B12 range from 400-1000mcg. Sometimes more Folate is required for infertility, and more Vitamin B12 for deficiency symptoms.
**Vegan and Vegetarian readers will find it difficult to obtain the recommended amounts of Vitamin B12, and Choline from diet alone, so supplementing both of these pre-conception and during pregnancy is really important for both your health, and the health of your baby. The NHS provide guidance on additional nutrients which may also need to be supplemented including Iron, Iodine, Calcium and Vitamin D.
Vitamin D
As I said in my pervious blog, Vitamin D is actually a hormone, and not a vitamin at all! For fertility and pregnancy, low levels of Vitamin D are linked to lower fertility rates and pregnancy complications including low birth weight, pre-eclampsia, neonatal mortality and infant asthma.
Vitamin D has other really important functions in the body, one of the main roles is to help absorb Calcium from the intestines and help “mineralise the skeleton” and make and maintain hard, healthy bones.
Supplementation in pregnant women is frequently required to achieve the sufficient vitamin D status recommended in nutritional guidelines.
Forms include Vitamin D3 (cholecalciferol) and Vitamin D2 (ergocalciferol) with food sources to increase your Vitamin D3 including fatty fish, cod liver oil or egg yolk and vitamin D2 found in mushrooms and yeast. Important co-factors are Vitamin K and Vitamin A. The Main difference between them is their molecular structure, and Vitamin D2 is derived from plants, fungi, fortified foods and sometimes referred to as pre-vitamin D. Whereas Vitamin D3 comes from animal-sourced foods and sunshine.
Vitamin D2 is more widely available and less expensive than Vitamin D3 however, experts believe less effective at raising vitamin D levels, so D3 seems to be slightly superior to Vitamin D2. Vitamin D is converted in the body to 25-hydroxyvitamin D (25-OH-D) by the liver and it is this that is measure in blood tests.
You can also increase your Vitamin D levels with direct sun exposure on bare skin, due to receptors on the surface of your skin. Depending where you live in the world, 30 – 60 mins of daily exposure can produce as much as 10,000iu, more than 3 times the amount obtained via high dose supplements!
The D Minder phone APP can help you track your daily exposure to the sun based on where you live, and the time of year. D Minder also explains the types of rays that produce Vitamin D, the angle they need to be at times of the day. This is important for winter months when the sun is lower in the sky.
I live in Scotland, so in the winter it is very difficult to obtain enough sun exposure to create enough Vitamin D in the body. This is the reason supplements are really important during winter months. Supplementing is also important for night shift workers who sleep during the day.
Vitamin D is stored in the body’s fat cells, where it remains inactive until needed, so stock up during the summer months before going into the winter. Optimal levels are higher than Clinical levels used in the NHS. Aim to maintain your levels between 70 – 100 nmol/L. To put this into context, the NHS regard <25nmol/L as deficient.
Studies have shown women trying to get pregnant, are pregnant, or breastfeeding should consume between 50-100 mcg or 2000iu – 4000iu daily. The NHS recommend 400iu per day which equates to 10mcg.
It costs £31 to check your Vitamin D levels with an NHS postal finger-prick blood test.
Some people are born with a genetic predisposition making it more difficult to metabolise and transport Vitamin D around their body to the cells. For these people, it is really important to ensure your levels are high enough for a health pregnancy.
Take Away
- When TTC and when pregnant, it is really important to make sure both you and your baby are getting the key nutrients required for optimal health and growth
- Don’t guess – get tested and find out your actual nutrient levels and then optimise accordingly with diet, lifestyle and supplements
- Consider the format, dose, brand and quality of the supplements you choose are correct for your absorption and metabolism
- Run down the supplement check-list and make sure you are taking the right fertility and pregnancy supplements for you
Hopefully this blog has prompted you to think more deeply about which supplements are going to benefit your fertility levels and pregnancy.
If you have any questions about supplements for fertility and pregnancy then get in touch. I am happy to run through the information, and sources used in this blog and where you can find out more.
To find out about working with me to support your fertility and future pregnancy, you can book a FREE mini consultation here.
My FREE guide 16 Ways to Boost your Fertility Naturally to get Pregnant covers lots of other ways to boost your fertility levels – download here.
