When we think of fertility, we often think of taking a prenatal, drinking more water, maybe eating more salads & protein, but there is so much more nature offers us and so much more to consider! We tend to have a female-centric view of infertility, nutrition and pregnancy in the States, but the truth is, almost 40% of infertility issues stem from male health concerns. In this blog, I focus on nutritional needs and supplements that support both sperm health and egg/endometrial health.
About the author: I am a mother, an athlete, and primary care integrative nurse practitioner. While I am not a conventional fertility specialist, I care for patients daily in my family medicine practice who struggle with conception in addition to their gut health problems, headaches, endometriosis, high blood pressure, low testosterone, insomnia, anxiety, and thyroid disorders, etc. As a provider trained in both traditional and functional medicine, I often start the work up for functional fertility with my patients, sometimes avoiding the need for them to spend thousands of dollars with a fertility specialist on IVF. To read more about my functional fertility work up, read my blog on the top 12 root causes of infertility and what we can do about it: https://www.hearthsidemedicine.com/post/why-can-t-we-get-pregnant-root-causes-tests-nutrients-for-male-female-infertility
Curious about the testing we offer for full functional reproductive health? Check out my blog "Functional fertility testing without a fertility specialist" here: https://www.hearthsidemedicine.com/post/functional-medicine-testing-for-fertility-without-a-fertility-specialist
A word: This is NOT medical advice. Many people believe herbal and micronutrient supplements are “all natural” and therefore not harmful. Do not assume “all natural” means they are safe. Herbs have limited FDA regulation. They aren’t subjected to the same vigorous and strict regulation process as over-the-counter and prescription medications. Because they lack regulation, they could cause some very serious side effects and may interact with any medications, fertility or otherwise, you’re currently taking. Always check with your physician before taking herbal or natural supplements, especially if you are taking fertility medications or have any medical conditions.
In functional medicine, I always encourage my patients to test their actual blood and/or urine levels of nutrients so we know what dose to best advise them to supplement with in either food or pill/tincture form. I often use the micronutrient and antioxidant panels via Quest and/Or the highly detailed NutrEval test from Genova Labs:
However, if my patient has stomach issues, such as IBS, Celiac, SIBO, bloating/heartburn, they may be taking ALL the supplements and not absorbing ANY of them--thus, I often also test for absorption and digestion and overall gut health using the Genova GI Effects Comprehensive Stool Profile test which allows to also support their digestion and microbiome in order to best absorb the nutrients they are taking in--afterall, without a healthy gut microbiome and sufficient digestive enzymes, many expensive supplements and organic foods will just become expensive urine or stool (as in, not broken down and utilized).
Here is an example of a digestion and microbiome test I frequently order: https://www.gdx.net/core/sample-reports/gi-effects-2200-sample-report.pdf
Here are some of what I might test for and suggest to my patients (need and dose is always determined individually based on patient's health needs and test levels).
Crucial for fertility and a healthy pregnancy. Unfortunately, vitamin D deficiency is very common. Studies demonstrate lower pregnancy / IVF success rates in women who are deficient in vitamin D. Vitamin D can influence the ability to maintain a pregnancy and other factors such as endometrial thickness (womb lining thickness). Folks with who live in certain latitudes, have low sunshine exposure, or darker skin are more likely to have a deficiency. I like to test blood levels before advising a dose, but generally 2,000-4,000 IU a day with dinner is the target.
While there are many nutrients and enzymes that impact fertility, Co-Q10 is also an important player. We can use functional medicine tests to determine one's levels and best dosages. CoQ10 supplementation has been shown to improve egg quality, sperm quality, and pregnancy rates. Sperm and eggs both take about 90 days to develop. For best results, fertility specialists recommend taking CoQ10 and other fertility supplements for 90+ days if possible. There are MANY medications that block CoQ10, including some meds used for cholesterol, high blood pressure, diabetes, headaches and depression.
Note: When searching for CoQ10 fertility supplements, you may also come across the term “ubiquinol.” Ubiquinol is a different form—the “active” form—of CoQ10. To put it simply, your body must convert CoQ10 to ubiquinol before use. So if you take ubiquinol, your body may be able to absorb more of the active compound from the same dose
A word on sperm
It is also important to note that the traditional medical focus is mostly on the woman, despite one third (!!) of infertility cases being driven by male reproductive issues (which can be often be improved with diet and lifestyle). According to the American Society of Reproductive Medicine, in 40% of infertility cases it is the male who is the cause of or contributes to infertility, and semen analysis is only one piece of the puzzle. Sperm cell membranes are comprised of polyunsaturated fatty acids which are highly vulnerable to oxidation (damage).
If your sperm donor/partner has chronic stress, chemical or heavy metal exposures, nutrient deficiencies, underlying chronic infection, is overweight, or drinks, this can increase inflammation in the body, damaging sperm cells and reducing their function. Recreational substances such as marijuana have also been found in clinical studies to also impact sperm--current or past marijuana users had more damaged sperm, lower sperm counts and reduced semen volume. Further, marijuana use may impact genes linked to autism in men’s sperm, but the good news is that abstaining from cannabis consumption over time may significantly lower many of those effects
For sperm health, consider the following:
Liposomal glutathione and NAC (By restoring the depleted pool of glutathione often caused by oxidative stress and inflammation, NAC may significantly increase sperm count and motility while also reducing sperm damage)
Fish Oil (for example, 2g EPA + DHA, but dose depends on test levels)
CoQ10 (50-300 mg/day)
Carnitine 2g daily plus acetyl-L carnitine 1g
(Carnitine and acetyl-L-carnitine were both studied and also have positive effect (usually at dose of 3g/day) on sperm function and health)
In men who have significant oxidative stress, carnitine may nearly double the number of motile sperm. It is beneficial for both men and women.
Deficiency of B-vitamins is common in anyone who consumes large amounts of processed foods, grains or sugars. Optimizing B vitamin levels can increase luteinizing hormone and follicle stimulating hormone to improve fertility. Just because your PCP tested your B12 and said it was normal, doesn't mean it is optimal. We like B12 to be <550 and like to check all other B vitamins too. We also advise taking methylated forms of B vitamins for best absorption.
Folate – Folate (not folic acid) is well known as a necessary vitamin in early pregnancy to prevent complications, but it is most beneficial when taken for several month before the pregnancy as well as during. It is important to note that many people have trouble using the synthetic form, folic acid, and do better with folate or methylfolate. Thorne makes a great methylated B vitamin complex. If you are taking a multivitamin, you may want to add in additional folate so you are getting around 800mcg of methylfolate daily. Note: you want the active form of methylfolate instead of the synthetic folic acid.
For women with poor egg quality, melatonin 3mg at bedtime, was found to increase fertility compared to placebo groups in one study.
DHEA supplementation 25-75 mg may support fertility for some women but only under the guidance of a medical provider. We advise DHEA and testosterone and cortisol levels be checked first. DHEA is used by 1/3 of all IVF centers worldwide --Improves ovarian function and ovarian reserve, promotes follicle growth, increases pregnancy rates with IVF , and lowers miscarriage rates, especially in women over age 35
In clinical studies, supplementation with 25 mg three times daily of DHEA significantly improved AMH (Anti-Mullerian hormone) , especially for women under age 38. Improvement of AMH was about 60% ! Longer use showed greater improvement up to 120 days, with significant increases in fertilized eggs.
For women with PCOS, inositol improves insulin sensitivity, improves ovulatory function, decreases testosterone, decreases elevated blood pressure, decreases elevated triglycerides and improves egg quality. Myo-inositol seems to perform better then d-chiro inositol
Standard dosage 4g/day
There’s some evidence that using vitex as a fertility supplement can help lower unnecessarily high prolactin levels and treat luteal phase defects. In one small study, after 3 months of daily treatment with vitex, prolactin release was reduced, short luteal phases were normalized, and deficits in progesterone production during the luteal phase were corrected. In another study, a supplement called FertilityBlend, which contains chasteberry as well as green tea, L-arginine, and other vitamins and minerals, was tested in a small group of infertile women. Of the 53 women in the FertilityBlend group, 14 (26%) became pregnant after three months, compared to just 10% of the women taking a placebo.
In women undergoing clomid-supported cycles, coadministration of N-acetyl-cysteine 1200mg/day cd 3-8 showed improvement in ovulation rate (52.1% vs. 17.9%), mature follicles, endometrial thickness, follicular E2 levels, and luteal P levels.
We advise all women and men to be on a high-quality multivitamin when try to conceive--I like the brands Gaia, Throne, Garden of Life and Pure Encapsulations, among others. It's important to note that not all multivitamins have iron, and this is needed for many women especially. In FM, we prefer to test your nutrient levels so we can counsel you on which supplements /foods are most needed for you and what doses you should take based on your test levels.
Antioxidants (for both men and women!)
If your multivitamin doesn't have sufficient levels of certain nutrients, you'll want to add an antioxidant combo formula with Vit A/C/E/Zinc/Selenium in addition to a multivitamin, especially if you don't have a highly nutritious diet or are losing nutrients from a condition such as Celiac or IBS. The nutrients are needed for healthy reproduction. I always advise getting your nutrients directly from food when able, but testing often reveals some people need to take a supplement when their levels come back very low.
May also improve sperm quality. A few studies have found that men who took 1,000 mg of vitamin C per day experienced significant improvements in sperm count, motility, and morphology Men can also boost vitamin C concentrations by eating more citrus fruit, strawberries, bell peppers, and broccoli.
A mineral with many important jobs for sperm health, essential for healthy sperm production, morphology, count, and testosterone production. Taking a zinc supplement may increase sperm motility. Food sources of zinc include shellfish, beef, seafood, chicken, cashews, and pumpkin seeds.
Can improve sperm motility, morphology, and may even increase the chances of successful conception. Plus, selenium is required to produce enough active thyroid hormones. Thyroid health is crucial for both male and female fertility. In fact, hypothyroidism is commonly associated with impaired sperm morphology. Seafood and brazil nuts are two of the richest food sources of selenium.
100 mg twice a day-- is a powerful antioxidant for both sperm health and female reproductive health. Unfortunately, it is not well-absorbed by the body, but the liposomal form has better success.
Iron deficiencies have been shown to cause poor egg health and an increase in infertility. For a good source of iron, we recommend you eat local, no growth hormone, not antibiotic red meat once a week as well as lots of green leafy vegetables like spinach and kale. If you don't eat meat, you'll likely need to take a supplement. I like the brand Blood Builder. Vitamin C helps you absorb iron, so she suggests squeezing some lemon juice over your spinach salad. I sometimes encourage my patients to buy the "iron fish" which is a fish shaped piece of iron you can drop into whatever you are cooking to infuse it with extra iron. Please note that excess iron is dangerous--always get your baseline levels checked to determine how much you need! **Note: most women think they are getting iron and sufficient vit D in their prenatal and most are NOT.
Probiotics: Not everyone should take a probiotic, for example sometimes those who are immunocompromised or have SIBO--but in general, probiotics are essential for gut health and may improve your chances of getting pregnant. Probiotics help balance out the acidity of your vaginal canal, which may play a factor in conception. They can also restore "good bacteria" needed to make, transform, and absorb critical nutrients and hormones for reproduction. In FM, we prefer to not guess what bacteria you need--we prefer to test and know! This way, we can advise you on a the best gut health healing individualized to YOU!
In general, the best way to get probiotics is via fermented low-glycemic foods like miso, non-dairy unsweetened kefir, low sugar kombucha, yogurt (preferably non-dairy and full fat, no sweetners), kim chi, sauerkraut, etc. If taking a supplement, I like the brands RENEW and Garden of Life. Look for one with at least 8 strains and at least 50 billion count.
Omega 3 fatty acids:
In men, taking a healthy level of omega-3 fatty acids (fish oil, etc) increased sperm count, motility, and overall sperm health. We can test one's levels to advise on how much one should take. I like the brand Nordic Naturals which tests for purity and mercury levels. For both men and women, omega-3 fats can decrease inflammation, making conception more likely.
Ashwagandha has been used traditionally to treat fertility issues in men. It is believed to improve semen quality, erection and sperm count. It helps in improving male sexual health in disorders such as psychogenic impotence and unexplained infertility.
Cinnamon: Cinnamon bark, which makes the cinnamon you sprinkle on your toast, has a positive effect on both sperm production and insulin response. In a study published by the NIH sperm count, viability and motility were all improved by daily doses of cinnamon.
Asparagus is considered a female reproductive tonic. It's rich in phytoestrogens, a group of naturally occurring compounds that has a similar chemical structure to oestrogen, which plays a major role in the reproductive cycle, and helps by reducing stress, which can cause fertility issues. It's also used for menopausal symptoms and to increase lactation. I always like to check one's estrogen levels before starting.
Evening Primrose Oil: In addition to relieving your period symptoms, primrose oil helps you to produce good, fertile cervical fluid. This extra layer helps to protect the little swimmers as they make their way to the egg, leaving a greater chance of fertilization. It’s safe to use from your period to ovulation. For those women who struggle with their fertility due to the quality and quantity of cervical mucus, consider taking evening primrose oil (EPO). Cervical mucus helps the sperm reach the egg. EPO boosts Omega 6 fatty acids which not only supports healthy cervical mucus but aids in balancing hormones. It’s also essential for healthy sperm. There aren't any proven safety issues with evening primrose oil. However, the British National Formulary, which advises healthcare professionals about medicines, says evening primrose oil should be used with caution in pregnancy.
To be cautious: you should only take EPO prior to ovulation as it may contribute to miscarriage
Red Clover: red clover helps to thicken the uterine lining, which leads to better implantation and increases your fertility IF someone has a thin uterine lining.
Maca: Maca is a popular supplement for its adaptive properties which helps the body cope in times of stress. Researchers believe this supplement causes an elevates testosterone in men and women, however evidence is inconclusive. In any case, women who suffer from PCOS, a condition associated with increased testosterone, should err on the side of caution and avoid maca. Good for both men and women to increase fertility, though women should only take between menses and ovulation and discontinue to make sure it is not taken during pregnancy. It is a very potent herb that often has very noticeable effects on fertility. For this reason, I always like to test my patients' hormone levels before starting or advising any particular herb or supplement.
The herb is said to improve female fertility. It's believed to stimulate the ovaries and give ovulation a boost. In some studies, it helps those with a thin endometrial lining. It helps to relieve menstrual cramps. However, it should only be used in the first half of your menstrual cycle to prevent problems and always only with the OK of your OB.
In one study comparing women who took black cohosh vs. women who took clomid, the study found that black cohosh:
lower LH (luteinizing hormone) levels and FSH/LH ratio (follicle stimulating hormone to luteinizing hormone ratio).
An animal study from 2014 showed that black cohosh helps to:
improve insulin sensitivity.
lower blood sugar levels.
In addition, black cohosh has insulin-regulating properties and anti-inflammatory properties, that can help a lot with PCOS symptoms.
Based on a study done with PCOS patients, 20 – 40 mg of black cohosh per day is helpful for fertility. It’s a good idea to use black cohosh for about 2 months before expecting any major improvements.
Also, be aware that most experts recommend using this herb for no more than 6 months. This is because most (but not all) of the studies done on black cohosh lasted for 6 months. There’s not sufficient data showing that it can be used safely for longer periods of time.
**There are many warnings associated with this herb so proceed with extreme caution and only under medical supervision.
Red Raspberry Leaf Tea: In addition to being delicious, red raspberry leaf tea has many positive attributes and sipping a few cups a day provides an antioxidant boost to keep you healthy-always a good thing when you want to conceive. Drinking red raspberry leaf tea also reduces inflammation in your body, including your reproductive system.
I encourage you to work with a Functional Medicine provider in conjunction with a gynecologist or fertility specialist to identify, address and correct and underlying root causes. Havilah Brodhead, FNP, CMO, CEO of Hearthside Medicine Family Care offers virtual visits to residents of Washington and Oregon, as well as in-person visits at her clinic in Bend, Oregon.
About the Author:
Havilah Brodhead, FNP, CEO, CMO
Hearthside Medicine Family Care
Havilah is an integrative, functional medicine nurse practitioner with a solid background in conventional medicine, including women's health, maternal-child health, mental health, gut health, hormones, family medicine, urgent care, men's health. She is passionate about helping patients find root causes to their health concerns and treating naturally whenever possible. She is accepting new patients for functional medicine consultations and care in both Washington and Oregon and accepts most insurances.
Havilah resides in Bend, Oregon and co-owns Hearthside Medicine Family Care with her husband Jeremy Brodhead, NP, who specializes in men's health. Hearthside is an integrative and primary care practice for all ages. She is mom to little girls and loves to mountain bike and practice yoga in addition to being a mommy and medical provider.
Appointment requests can be made easily online here: https://www.hearthsidemedicine.com/schedule-appointment