Can fertility dietary supplements help?

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The United States Department of Health and Human Services’ Office on Women reports CDC findings that about 10% of American women of childbearing age have difficulty becoming or staying pregnant. CDC defines infertility as the condition of not being able to achieve pregnancy within one year of trying, or within six months of trying for women older than 35. Nationwide, infertility affects about 6.1 million women between the ages of 15 and 44.

CDC also notes that about one-third of infertility cases are caused by medical problems in women, and another one-third are caused by medical problems in men. The final third are a combination of female and male reproductive issues and unknown causes.

The market for dietary supplements that support reproductive health in women-and also in men-is established and substantial. Additionally, CDC lists poor nutrition as one of a number of factors contributing to fertility problems, making the argument for supplementation that much stronger.

Nutrition and Fertility: Recent Findings

In April of this year, a review of the current body of scientific literature studying the relationship between diet and human fertility was published in American Journal of Obstetrics and Gynecology by two Harvard professors, Audrey Gaskins, ScD, and Jorge Chavarro.¹ The authors identified some clear patterns:

• Intake of supplemental folic acid, particularly at doses higher than those recommended for preventing neural-tube defects in babies, has been “consistently related to lower frequency of infertility, lower risk of pregnancy loss, and greater success in infertility treatment.”
• Antioxidant supplementation may be beneficial for promoting fertility in the male partner of a woman undergoing infertility treatment.
• Long-chain omega-3 fatty acids appear to improve female fertility.
• Adherence to a healthy diet “favoring seafood, poultry, whole grains, fruits, and vegetables is related to better fertility in women and better semen quality in men.”

Additionally this year, in July, British Journal of Nutrition published a study by Keewan Kim et al. whose findings suggest that low manganese, selenium, and sodium levels increased the risk of sporadic anovulation (no egg release, and therefore, no conception) in women.² Additionally, low levels of magnesium were found to be associated with lower testosterone levels, while very low levels of potassium were associated with higher testosterone levels. (For the study, 259 women aged 18 to 44 were recruited; the women kept food diaries and had blood drawn and tested by the researchers throughout their menstrual cycles.) Taken all together, the findings of this particular study appear to recommend that women seeking to conceive adhere to the recommended daily allowances of these elements to support regular ovulation.

Successful, competitive supplement brands are staying alert to these recent scientific discoveries, formulating products that provide ample amounts of folic acid/folate in combination with other ingredients, such as minerals, antioxidants, omega-3 fatty acids, and herbs.

A Pre-Prenatal Vitamin

One particularly well-known and successful fertility supplement line is Fairhaven Health’s FertilAid, which includes a FertilAid for Women product and a FertilAid for Men. The women’s version is essentially a prenatal supplement containing 600 mcg of folic acid (150% RDA), plus the B vitamins, vitamin D3, vitamin C, vitamin A, vitamin E, minerals, and a blend of herbs intended to both support fertility and maintain a healthy pregnancy. The herbal blend features selections to “stimulate and balance hormones that control ovulation,” according to the company, including chaste tree berry extract and red clover extract. (For more on herbs and botanicals for fertility, see the sidebar on the next page.)

The men’s product contains large concentrations of antioxidants and minerals, and its formulation is supported by clinical trial data presented at the American Society of Andrology’s Annual Proceedings in 2009.³ The randomized, double-blind study was undertaken through 2006 over three months, to determine the effects of FertilAid on men with “abnormal sperm parameters” as defined by the World Health Organization. The researchers noted statistically significant improvements in sperm motility (an indicator of male fertility) for subjects using the dietary supplement, and also suggested that the use of FertilAid for Men may improve sperm count.

In line with findings that omega-3 fatty acid intake is associated with better fertility, Fairhaven’s FH Pro Omega-3 contains “clinical-grade EPA and DHA,” according to company literature. “In women, EPA and DHA are believed to help regulate hormones, reduce inflammation, promote cervical mucus production, and reduce blood clotting, all of which is beneficial for fertility,” the literature reads. “EPA and DHA are also believed to be important for helping to prevent miscarriages and preterm labor and for brain and eye development in the fetus. In men, low intake of omega-3 fats has been associated with poor sperm production and quality.”

Fairhaven also offers a product aimed singularly at improving cervical-mucus quality (another indicator of fertility) and a newer FertileDetox product containing herbs, amino acids, botanicals, and probiotics for the purpose of “promoting the efficient elimination of environmental toxins from the body” by “supporting the body’s own detoxification and cleansing systems”: the liver and the intestines.

Another brand adhering closely to the latest science is Daily Wellness Co., seller of the supplements FertilityBlend for Women and FertilityBlend for Men. The women’s formula contains a blend of folic acid, letter vitamins, magnesium, zinc, selenium, and iron, as well as the amino acid L-arginine plus green tea extract and chaste berry extract. The formula “significantly improves ovulation health and hormonal balance,” says Daily Wellness Co. president Denny Kwock. He cites a double-blind, placebo-controlled study published in 2006 in Clinical and Experimental Obstetrics & Gynecology that he says showed the FertilityBlend women’s supplement improved the success rate of couples trying to conceive by three times over placebo.⁴

The men’s FertilityBlend formula contains vitamins C, E, B6, and B12, plus folate, zinc, and selenium. The supplement also includes the amino acid L-carnitine, plus green tea extract and dong quai extract, for improved sperm quality.

Improving on the Already Proven

Folic Acid

Folic acid is an established star in the trying-to-conceive and prenatal supplement industry. As reported by Nutritional Outlook this summer, a recent small study of 30 couples with histories of infertility or miscarriage found that a full 26 of those 30 were able to conceive after consuming a novel folate ingredient called Quatrefolic (a 5-MTHF glucosamine salt manufactured by Gnosis S.p.A.; Desio, Italy) for four months. The ingredient is a biologically active form of folate (the naturally occurring form of folic acid) “that does not need to be converted by the body via the folate enzymatic pathway that includes the enzyme methylenetetrahydrofolate reductase (MTHFR), which shows common polymorphisms of around 40% in the world population,” according to a number of studies cited by Gnosis. In other words, those persons in whom MTHFR is mutated may not metabolize supplemental folic acid efficiently, in which case, the Quatrefolic ingredient may be a better alternative.

Gnosis also points to studies indicating that folate levels measured in semen have been associated with sperm count and health. “Folate supplementation had a beneficial effect on spermatogenesis, possibly by increasing cellular cohesion within the seminiferous epithelium, thus preventing abnormal release of immature germ cells into the lumen,” Gnosis literature and spokesperson Lorena Carboni assert. “Over the years, a large number of genetic studies focusing on the association between genetic MTHFR polymorphism and male infertility have been carried out with different meta-analyses published. High levels of homocysteine in subjects with MTHFR polymorphism have been associated with low sperm quality,” Gnosis reports. “Notable, different meta-analyses correlated the polymorphism with risk of male infertility,” according to the company, suggesting that men wishing to conceive may also benefit from supplementation with the Quatrefolic ingredient.

Fertility? There’s an App for That

Savvy supplement brands aren’t just following the science of nutrition and fertility; they’re creating whole trying-to-conceive programs that combine technology with supplemental nutrition. One of these is Fruitful Way, a company that offers an app to help users “optimize [their] chances of getting pregnant” via a fertility assessment, an ovulation cycle tracker, a menstrual period calendar, personalized health and lifestyle recommendations, and a nutritional-supplement dosage reminder and tracker. The company’s related supplements include Fruitful Couple (for women and men), featuring omega-3 fatty acids; Fruitful for Her, with folic acid, the B vitamins, and vitamins E, A, and D; and Fruitful for Him, made with the antioxidants L-carnitine, vitamin E, and selenium.

Udi Alroy, Fruitful Way’s CEO and co-founder, tells Nutritional Outlook that his company’s app is “focused on a personalized solution based on the proprietary fertility algorithm developed by Fruitful Way to accommodate [users’] lifestyles and relationship management, reduce stress, and formulate the best nutrition solution on the new-family level.”

He adds, “Our technology enables us to connect the couples on a daily basis, assisting in the trying-to-conceive process, synchronizing the fertility window for both, and optimizing his and her physical condition. The Fruitful Way personalized supplements are science-based with the intention to improve… conditions toward conceiving.”

Another brand combining fertility supplements with tech is Thorne Research, which sells a direct-to-consumer fertility test for just under $400 and provides results and recommendations to the user’s desktop computer or mobile device. The test kit includes materials for at-home blood and saliva collection, and samples are subsequently mailed back by the user. Those samples are tested, and Thorne research sends a digital summary of results and recommendations within three to five days. Biomarkers tested include hormone levels (estradiol, progesterone, testosterone, follicle-stimulating hormone, luteinizing hormone, thyroid-stimulating hormone, triiodothyronine, free T4, cortisol), levels of the sex-hormone-binding globulin protein, levels of thyroid peroxidase antibodies, and levels of DHEA. The personalized plan provided by Thorne is based on test results and includes supplement recommendations; Thorne’s fertility-related supplements include its Basic Prenatal, recommended for women trying to conceive in addition to those who are already pregnant or lactating. It features L-5-MTHF (glucosamine salt), vitamin B12, antioxidants, and minerals. The company also sells a Super EPA omega-3 fatty acid supplement.

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Herbal ingredients for a complementary approach to infertility

Brien Quirk, director of R&D at Draco Natural Products (San Jose, CA), points to a handful of herbs and botanicals used in traditional Chinese medicine to combat infertility. “We have some great recommendations for both female and male infertility,” he says. “For women, in traditional Chinese medicine, dodder seed (Cuscuta chinensis) is the most commonly recommended single herb by clinical practitioners, while the multiherbal formula most recommended is dang-gui-sha-yao-san. That formula consists mainly of blood-moving herbs, such as dong quai, lovage root, white peony root, poria, atractylodis macrocephala root, and alisma rhizome. These address blood stasis, a major cause of female infertility.”

Another formula Quirk cites is Rehmannia 8, which he says “can address polycystic ovarian disease [PCOS], a major cause of female infertility due to excess body weight and metabolic syndrome.”

In men, celery and red ginseng are backed by some studies showing they improve sperm quantity and quality, Quirk says. Herbs that increase sperm production or enhance their health and motility, he adds, include Cuscuta chinensis seed, goji berries, fupenzi or Chinese raspberry fruit, schisandra berry, plantaginis seed, Chinese yam, Chinese foxglove root or prepared radix rehmanniae, Rosa laevigata fruit, and glossy privet berry.

Quirk cites a number of scientific papers in support of traditional Chinese herbs and botanicals marketed for fertility, including one from the journal Complementary Therapies in Medicine in which the authors write, “Our review suggests that management of female infertility with Chinese Herbal Medicine can improve pregnancy rates 2-fold within a 4-month period compared with Western Medical fertility drug therapy or IVF.”⁵

References:

1. Gaskins AJ et al. “Diet and fertility: a review.” American Journal of Obstetrics & Gynecology, vol. 218, no. 4 (April 2018): 379-389
2. Keewan K et al. “Dietary minerals, reproductive hormone levels and sporadic anovulation: associations in healthy women with regular menstrual cycles.” British Journal of Nutrition, vol. 120, no. 1 (July 2018): 81-89
3. Clifton GD et al. “Prospective study of FertilAid vitamin in men with low sperm quality.” Poster 25. Presented at American Society of Andrology Annual Proceedings, April 2009.
4. Ried K et al. “Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: a systematic review.” Complementary Therapies in Medicine, vol. 19, no. 6 (December 2011): 319-331
5. Westphal LM et al. “A clinically proven natural fertility remedy.” Clinical and Experimental Obstetrics & Gynecology, vol. 33, no. 4 (2006): 205-208