Micro-video: Dietary Supplements & Fertility: Emerging Evidence and Clinical Guidance
One of the main questions that providers get asked on a daily basis is whether men and women should take a supplement to improve their fertility? And if so…which supplement should they take? What dose? When should they start?
We know that the direct to patient marketing of supplements is a large and growing industry (with several products marketed specifically for fertility). These supplements are also being increasingly used by both men and women. However, there is limited knowledge among fertility care providers on how to counsel patients on supplement use and consuming a healthy diet. So our goal was to review the evidence regarding supplements for fertility, pregnancy loss, and pelvic pain.
Here we present the findings from a Cochrane review on vitamin supplementation for preventing miscarriage. They concluded that though taking vitamin supplements before or in early pregnancy may be beneficial, that there was not sufficient evidence that taking supplements prevented miscarriage. There was some evidence showing that multivitamins plus iron and folic acid had a reduced risk for stillbirth, but overall there was insufficient evidence to examine the effects of different combinations of vitamins.
It is also thought that supplements may play a role in endometriosis through influences on hormones and inflammation. While there is some evidence from animal studies that diet can impact pain, there is very little evidence to support recommendations. A recent Cochrane review found that there is no evidence to support the effectiveness of any supplement for dysmenorrhea and judged the evidence available to be of low or very low quality. Overall, more research is justified.
We were also interested in the role of supplements for female fertility. A recent Cochrane review found that there was very low quality evidence to show that taking an antioxidant may provide benefit for subfertile women. They also noted that there is insufficient evidence to draw conclusions about adverse events, and concluded that there is limited evidence in support of supplemental oral antioxidants.
Overall the evidence is quite limited to support supplementation for fertility, pregnancy loss, and endometriosis. This is of course a challenge to study given the various formulations and dosages available. It is also important to note that supplements are not regulated by the FDA and are only reviewed for adverse effects of potential false marketing, leading consumers to rely on their own research and recommendations from their doctors. There is a real need for further research in this area to determine safety and efficacy of supplements for reproductive health outcomes.