I learned so much at the Integrative Fertility Symposium this year, but it wasn’t too difficult to decide which information to share with you first. Dr. Mark Ratner, MD gave a very thorough presentation on the state of the current research when it comes to micronutrients and their impact on fertility. Any of you who have gone down the google rabbit hole, trying to decide which supplements to take, know how quickly it can become overwhelming, not to mention expensive. Spend enough time online and you can easily start to believe you need to be downing handfuls of supplements a day. At the clinic I am always trying to help women narrow down what supplements are indicated for their specific fertility challenge, and sometimes find myself warning them that what they are taking may be doing more harm than good.
Before reading further, I must remind you to check with a healthcare professional before starting any new supplement routine. This is especially true if you are taking prescription medications or have any known health conditions.
Dr. Ratner focused on 4 main fertility micronutrients, Vitamin D, DHEA, Inositol, and CoQ10. He focused on these because all of the micronutrients are found in our tissues naturally, and have been studied in Randomized Control Trials (RCT’s), which gives us credible data to rely on in terms of their safety and effectiveness.
Did you know that vitamin D is not actually a vitamin, but a hormone!? No wonder a deficiency of it is linked to anovulation, and other factors leading to subfertility. A sufficient amount is also critical for a healthy pregnancy. I learned that vitamin D deficiency in pregnant women is associated with premature birth, preeclampsia, and higher rates of C-sections.
Have you had your levels tested yet? I see many patients in the clinic whose levels aren’t necessarily tested as part of their initial hormone work-up for fertility issues. This is one test you typically have to advocate for yourself. Below 20ng/ml is deficient, between 20-30ng/ml is insufficient, and above 30 is normal. Dr. Ratner shared studies suggesting between 30-50ng/ml is the ideal range for your fertility, but 65-70% of US women are below this range. Yikes!
When it comes to Vitamin D levels and IVF, there have been 9 published studies since 2010. 6 of these studies showed a strong positive correlation between vitamin D status and pregnancy. Meaning, the higher your serum levels, the higher chance at conception. Here is the link to the largest of those studies: Rudick, et al, “Influence of vitamin D levels on IVF outcomes in donor-recipient cycles.” Fertility and Sterility, 2014 101:2, 447-452.
When supplementing with vitamin D to get your levels up into the optimal range, it is important that you look for D3 and not D2. D3 is the human form, and D2 is the plant form, which your body can’t assimilate as effectively. Then there is the question of how much to take and for how long. Dr. Ratner is confident that doses as high as 10,000IU per day are safe. However, 2,000IU per day is an appropriate daily dose once you have achieved optimal serum levels. His recommendations were as follows:
- If your levels are around 30ng/ml, supplement with 2,000IU D3 daily for 8 weeks.
- With levels between 20-25ng/ml, you should supplement with 4,000IU D3 daily for 8 weeks.
- If your level is below 20ng/ml, then you would want to take 6,000IU D3 daily for 8 weeks.
DHEA is another hormone. It is a steroid hormone produced by the adrenals and the gonads. I have had many fertility patients ask for my thoughts on this supplement, so it was good to get some up-to-date information on where it stands in the current research, as there has been some back and forth in recent years – it helps, it doesn’t help. The current research has pushed DHEA further into the it-helps category, but it is important to remember that this is only true for one specific set of patients, those using IVF who have been diagnosed with Diminished Ovarian Reserve (DOR), or who are 36 years of age and older.
Another important consideration is that we are one of the only countries who categorizes DHEA as a dietary supplement, making it available over the counter. In most countries, it is available by prescription only, and this really does seem appropriate. And, again there really isn’t any evidence that it is helpful, in fact it can be downright counterproductive if it is used in a non-IVF setting. Add to that, concerns about potency and compounding from over-the-counter sources, and this is really a please-do-not-try-at-home type of supplement!
Myo-inositol (MI) and D-Chiro-inositol (DCI) are a couple of micronutrients that have had a lot of excitiment around them in the past couple of years, but research regarding their role in regulating insulin resistance, a common underlying pathology in PCOS dates back to 1999. The research indicates that MI, and DCI act as messengers in insulin receptor signaling thereby improving insulin sensitivity. Further studies have also shown that supplementing with them also reduces serum testosterone levels as well as reducing clinical signs of excess testosterone such as acne, and hirsutism (women with male pattern hair growth).
More importantly for women with PCOS who are trying to conceive, they increase the frequency of ovulation. A 2010 study comparing MI and DCI supplementation with use of metformin (a prescription medication for type II diabetes that is also frequently prescribed to women with PCOS) found MI and DCI out performed metformin both in rates of ovulation and in pregnancy outcomes! Here is a link to that study: Raffone, et al, “Insulin sensitizer agents alone and in cotreatment with r-FSH for ovulation induction in PCOS women.” Gynecol Endocrinology, 2010, 26:4, 275-80.
It is important to note that MI and DCI do have different functions in the body. MI improves ovarian function, while DCI improves metabolic function. Women with PCOS have the best results when they use both together. The ideal ratio is 2-4 grams of MI daily in combination with 50-100mg of DCI.
You may know CoQ10 as an important antioxidant, which it is, but it also a critical intermediary in mitochondrial energy production. This means it is present in almost every cell of your body playing a role in the production of energy occurring in every cell, which of course is essential for their functionality. Can you think of a time with more rapid and critical cell division than early pregnancy?
Research has confirmed the idea that mitochondrial energy production in the oocyte and early embryo are critical factors in the body’s ability to become and stay pregnant. CoQ10 levels in the oocyte decrease with age, leading to a decrease in mitochondrial energy production, making those diagnosed with DOR or those 36 years of age or older good candidates for supplementing with CoQ10. Reduced energy production in the oocyte may even be associated with pregnancy loss related to chromosomal abnormalities. Here is a link to one of those studies: Ben-Meir, et al. Coenzyme Q10 restores oocyte mitochondrial function and fertility during reproductive aging. Aging Cell, 14:5, 887–895.
Most of the studies were done using 600mg oil-based capsule of CoQ10 daily. However, Dr. Ratner pointed out that finding a CoQ10 supplement delivered in a colloidial suspension would improve absorption significantly.
Another interesting bit of information regarding CoQ10 is that statin drugs, the one’s prescribed to manage “high cholesterol” diminish your body’s levels of CoQ10. If you are taking a statin drug you should be supplementing with CoQ10 regardless of your desire to conceive. This goes for the men in your life too!
Do you have any dietary supplement questions you would like to see covered in future newsletters? If so send me an email. I am curious to know what you are curious about!