IVF Supplements: What You Should and Shouldn’t Use

In a world where infertility affects many individuals, improving one’s reproductive health is crucial. Supplements may be used to potentially improve fertility and the success of IVF treatments. But what should you use, and what should you avoid? In this article, we’ll discuss the options available.

What is infertility?

If a couple can’t conceive a child after 12 months of regular, unprotected sexual intercourse, this may be considered infertility.

Among women of reproductive age (20–44 years), the prevalence of primary infertility (inability to conceive) is 2%, while secondary infertility (inability to get pregnant after having a child) affects about 11%. In the United States, approximately 1 in 8 couples face fertility issues.

A multinational study conducted by the World Health Organization (WHO) concluded that among the causes of female infertility, the most common are ovulation disorders (25% of cases), endometriosis (15%), pelvic adhesions (12%), anomalies of the uterus or tubes (11% each), and hyperprolactinemia (7%).

Meanwhile, the main causes of male infertility are sperm abnormalities (up to 80% of cases), as well as endocrinological causes and sperm transport disorders (closure of the passage for sperm inside the testicles due to infection, developmental abnormality, or other causes) — up to 5% each. In 10% of cases, causes remain unclear.

Age and lifestyle significantly impact the development of infertility. A woman's age notably affects her ability to conceive due to declining ovarian reserve, with a decrease from approximately 30% per cycle before age 30 to 10% by age 40.

Infertility treatment is usually comprehensive, selected individually depending on the cause, and includes:

• Lifestyle changes
• Conservative therapy (use of medications)
• Surgical interventions
• Use of assisted reproductive technologies (IVF)

What is IVF?

IVF stands for ‘in vitro fertilization’, a procedure when female reproductive cells (oocytes) are fertilized by sperm outside the body. The embryo is then transferred to the uterus for further development.

The undoubted achievement and advantage of IVF is the possibility of genetic testing (e.g., for the presence of chromosomal abnormalities) of embryos before transfer.

However, a couple may face certain nuances when it comes to their IVF journey:

• Complications during the IVF procedure (e.g., ovarian hyperstimulation, excessive ovarian response to hormonal treatment that occurs in 1% of cases)
• Multiple pregnancies (about 19% of twins and 25% of triplets are born as a result of IVF)
• Stress, anxiety, and uncertainty when undergoing the process
• The costs of the procedure, which may take a toll on the couple’s budget

How diet may aid IVF treatment

According to a 2007 study, a diet rich in plant protein, full-fat dairy products, monounsaturated fat, and iron may reduce the risk of ovulatory infertility by 66% and infertility because of other causes by 27% compared to women who consumed these foods the least.

Overall, the Mediterranean diet is preferable. The basis of the Mediterranean diet is grains, legumes, vegetables, fruits, fish, and olive oil. At the same time, you might consider limiting your consumption of saturated fats, meat and poultry, alcohol, and dairy products.

According to a 2013 study conducted in Greece, women who followed the Mediterranean diet during IVF had 20.9% higher clinical pregnancy rates and 22.2% higher live birth rates. However, these findings cannot be generalized to the whole reproductive population, to obese women, or to women attending infertility clinics around the world.

In addition, due to the observational study design, causal association may be limited. The effect of supplements on IVF outcomes is still being studied.

IVF supplements: what should you use?

The main purpose of supplements during the IVF process is to enhance the ovarian response and improve the quality of embryos. This may increase the chances of a successful birth, meaning the baby breathes, has a heartbeat, movement, and pulsation of the umbilical cord.

Most supplements recommended for IVF are suitable for the improvement of overall health. Still, keep in mind that taking any supplements during pregnancy should be discussed with your healthcare provider.

Folic acid

Folic acid is a type of vitamin B needed by every cell of the body, especially during cell creation and division. It is one of the most important elements during pregnancy, especially in the early stages. Folic acid supports the formation of important fetal structures such as the brain and spinal cord and helps prevent neural tube defects.

Since the formation of the fetal neural tube occurs in the first weeks of pregnancy — often before pregnancy is even determined — it is important to start taking folic acid during pregnancy planning.

Common recommendations include taking 400 mcg of folic acid per day. This applies to all women, regardless of whether they are undergoing IVF. In addition, you can include foods high in folic acid in your diet, such as leafy greens, beans, or oranges.

A study conducted in 2014 showed the positive effect of folic acid on the process of implantation, clinical pregnancy, and live birth in IVF patients.

Omega-3

Omega-3s are polyunsaturated fatty acids that enter the body with food or supplements. These acids may affect fertility, menstrual cycle, oocyte quality, and implantation process.

Studies have shown that omega-3 fatty acids may have a positive effect on IVF results and the quality of embryos in particular.

DHEA

Dehydroepiandrosterone (DHEA) is a hormone produced in the female body by adrenal glands and ovaries. Its most important function is participation in the synthesis of important sex hormones — testosterone and estradiol.

Research findings regarding the positive impact of DHEA on IVF outcomes have been subject to some inconsistency. However, a 2023 study showed an increase in pregnancy rates and embryo quality in women who received DHEA supplements 1–12 months before the procedure.

Myoinositol (for people with PCOS)

Myoinositol is a natural carbohydrate used in a supplement form to potentially help manage insulin resistance in women with PCOS. Research shows that it may have a positive effect on ovarian function, embryo quality and development, and implantation.

A study conducted in 2020 showed a significant improvement in the quality of embryos and the success of the fertilization process in women with PCOS receiving myoinositol supplementation. However, the dose and the duration of taking the supplement are unknown.

Coenzyme Q10

Coenzyme Q10 (CoQ10) acts as an antioxidant in oocytes. With age, the levels of CoQ10 in cells decrease, which affects the quality of germ cells. This disrupts the division process (the process of formation of several daughter cells from one cell) and can cause infertility.

A study conducted in 2021 showed more favorable results for IVF procedures, potentially attributed to the use of CoQ10.

Vitamin D

Vitamin D is naturally produced in the skin when exposed to sunlight. It can also be obtained from supplements and food. Vitamin D deficiency has been associated with infertility in women.

Data from a 2018 study revealed a decrease in quantitative indicators (such as a decrease in available oocytes and embryo formation rate) during the IVF process among women with vitamin D deficiency. Therefore, it is possible that vitamin D deficiency may lead to unfavorable IVF outcomes.

What supplements should be avoided during IVF?

The use of supplements during pregnancy is widespread, with 77.6% of people in the U.S. and up to 91% in Brazil incorporating at least one into their routine. However, not all supplements are as safe as they may seem. Let's explore when taking additional supplements during pregnancy can actually be harmful.

Supplements with higher-than-recommended vitamin doses

Overconsumption of vitamins can pose health risks, especially during pregnancy. Take fat-soluble vitamin A, for instance, which is generally vital for fetal development and the formation of organs and systems.

It has been found that excessive consumption of vitamin A can lead to fetal developmental abnormalities. Consequently, the recommended daily intake limits for pregnancy were set — 540 µg retinol equivalents (RE) in the EU and 770 µg RE in the U.S.

Weight loss supplements

The safety of weight loss supplements remains uncertain. Many of them contain Vinpocetine or periwinkle extract, flagged by the U.S. Food and Drug Administration (FDA) as hazardous during pregnancy, potentially increasing the risk of miscarriage and low fetal weight.

Herbal supplements

Herbal medicines are used by 57% of pregnant women in the EU and 73% in the U.S. They are easily accessible in pharmacies or stores without a prescription. However, herbs can have active substances that may adversely impact fetal development.

For example, chamomile, which is actively used by pregnant women to reduce symptoms of vomiting and motion sickness, may increase the risk of miscarriage or premature birth.

Keep in mind that supplements are not monitored for safety and effectiveness like conventional medications and may contain substances that may be harmful to pregnant women, such as metals, pesticides, or bacteria. Therefore, it is worth choosing supplements that are more likely to be safe, such as third-party tested or made according to cGMP standards.

Lifestyle tips when undergoing IVF

While supplementation during IVF and pregnancy can offer potential benefits, there are certain lifestyle changes that should be made regardless of your situation. These tips are straightforward and essential for overall well-being.

• Maintain a normal weight during pregnancy. According to a 2023 study, women of normal weight have higher implantation and live birth rates during IVF.
• Give up smoking. Tobacco use may impair fertility and increase the risk of pregnancy complications.
• Quit alcohol and drugs. It goes without saying that any harmful substances must be avoided for a successful pregnancy. The frequency of live births during IVF is significantly reduced in association with substance use and potentially leads to the formation of fetal developmental abnormalities.

Overall, infertility is a rather complex problem in modern medicine, but assisted reproductive technologies such as IVF may help overcome it. Supplements may potentially play an important role in the IVF process. Nonetheless, it's always a good idea to check with your healthcare provider before taking any supplements or making changes to your diet and lifestyle.