Preconception Supplement Guide

Wondering which supplements are best when you’re working to try to conceive? I’ve listed my go to supplements here to help you learn more.

Please Note: This information is not meant to replace that of your medical provider. Please discuss any supplements with your healthcare provider in order to avoid interactions or complications. I am not able to provide information on doses as per my regulatory guidelines.

Prenatal Vitamins

Of course prenatal vitamins are on the list. They are an excellent multivitamin to include in your preconception plans. Ideally, it’s recommended to begin preconception vitamins 3 months prior to when you begin trying to conceive in order to optimize your nutrient levels. One of the key nutrients in prenatal vitamins is folate. This particular nutrient is important for appropriate cell division to allow for proper neural development in the early stages of pregnancy. You’ll want to look for a prenatal vitamin that contains methylated folate. This will sometimes be listed as l-methylfolate or L-5-MTHF. This form of folate is active and is best utilized by the body. PMID: 25278626

Not all prenatal vitamins are created equally. You’ll want to also be sure there is a source of B12 (preferably in the methylcobalamin or tydroxycobalamin form), as well as iron, selenium, and choline.

Folate

I’ll highlight this particular B vitamin on its own even thought it is included in most prenatal vitamins. This is because in some cases we want female patients using higher doses of folate than what is typically included in your prenatal vitamin. These populations include females who have experiences previous pregnancies with neural tube defects, those with metabolic disorders like diabetes or obesity, and smokers. Speak with your doctor to see which dose is appropriate for you.

A reminder that folate is required for cell division and supplementing with it helps to lower the risk of neural tube defects in the fetus. As per above, you’ll want to use an activated form of folate in cases of MTHFR mutation in order to properly utilize folate.

CoQ10

This preconception vitamin is a hot topic these days because of its impact of oocyte quality. I like to think of CoQ10 as lubricant on your cell engine (aka. mitochondria). In order to keep that engine young, healthy and functioning at top level, we need to keep it well lubricated. In actual fact, Coenzyme Q10 helps to reduce oxidative damage in order to improve fertility outcomes. PMID: 32767206. There is certainly no time limit on when it can be utilized, but its typically used in cases where egg quality is of concern, or the female is of advanced maternal age. There are benefits for male sperm parameters, too. PMID: 31408928

Look for a ubiquinol form for best outcomes. PMID: 30302465

Fish Oil

The benefits of fish oil are certainly well known. From a preconception perspective, the omega-3 fatty acids DHA and EPA are beneficial in reducing inflammation and enhancing fertility outcomes especially in overweight patient populations PMID: 26742065. PMID: 32849890. The benefits also extend into pregnancy with DHA specifically impacting cognitive development of the fetus. PMID: 21364848.

Vitamin D3

Nearly every infertility patient I work with is deficient in vitamin D. We are certainly learning more and more about how this vitamin impacts fertility outcomes. In particular, female hormone steroidogenesis and regulation of the reproductive process. PMID: 28500824. Vitamin D status impacts PCOS, Hashimoto’s thyroiditis, endometriosis and more. PMID: 24717915

It is very important to have your vitamin D levels tested by your healthcare provider prior to trying to conceive in order to understand your level of deficiency and how best to supplement.

Inositol

This is another one that is certainly increasing in popularity in the fertility world these days. It is a stereoisomer called myo-inositol. It reduces insulin resistance meaning it acts well in many cases of PCOS. PMID: 21608442 Sometimes mild gastrointestinal side effects like bloating and loose stool. I typically recommend it in a powder form for patients to use in the evening before bed to help reduce the side effects. This is a great option to discuss with your healthcare provider to see if it will work in your case.

Probiotics

The importance of the uterine microbiome is becoming more and more clear. Lactobacillus strains are especially important for uterine health and receptivity to enhance fertility outcomes. PMID: 32182980. It is especially important to consider in cases of dysbiosis, frequent yeast infections, frequent urinary tract infections, recurrent pregnancy loss, autoimmune disorders, and gastrointestinal disorders. There is still so much to learn on this topic, but it is an excellent option to consider including in your preconception care plan. The specific strains and doses do make a difference so please be sure to discuss this with your healthcare provider.

Iron

I mentioned iron above in the prenatal section. I wanted to expand on it here because note everyone needs iron, and some people may need more beyond what they are getting from their prenatal vitamin. This is another one of those nutrients that it is important to have tested. You’ll want your care provider to run a CBC, TIBC/iron, transferrin and ferritin assessment in order to be sure the entire iron pathway is being properly understood. Iron is very important for the cognitive development of the fetus. If it is deficient in the prenatal period it can lead to mental health issues including anxiety for the child after delivery, as well as cognitive delays - PMID: 26599151. Speak with your care provider to learn if you need more iron beyond what is in your prenatal.

Choline

Choline is extremely important for balancing out homocysteine levels to reduce inflammation preconception. It is also extremely important for the cognitive development of the fetus: PMID: 31394787. You can get choline pretty easily in the diet, but your needs go up while you are pregnant to 450mg per day so we try to increase the levels in the preconception window, too. You can learn more about different sources of choline here. It can be supplemented if your dietary intake is inadequate.