Fertility Supplements Explained: What Helps, What’s Unclear, and What Matters Most

In this episode, we take a clear, evidence-based look at fertility supplements — what may support reproductive outcomes, what remains uncertain, and where it’s important to proceed thoughtfully.

We review foundational nutrients such as folic acid, vitamin D, iron, calcium, and DHA, along with commonly discussed supplements including CoQ10, melatonin, DHEA, and inositols. We also touch on supplements for sperm health and why lifestyle factors often play a much larger role than any single product.

This conversation is designed to help you make informed, balanced decisions and focus your energy on what truly matters throughout your fertility journey.

This episode is part of Season 1 of The Love & Science Fertility Framework: The Biology Beneath the Surface — a clinical series examining the physiology that drives reproductive outcomes.
If you found this conversation valuable, book a consult call with me using this link:

https://calendly.com/loveandsciencefertility/discovery-call

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Please don’t let infertility have the final word. We are here to take the burden from you so that you can achieve your goal of building your family with confidence and compassion. I’m rooting for you always.

In Gratitude,

Dr. Erica Bove

Transcript:

Hello, my loves, and welcome back to the Love and Science podcast. Today, we're going to talk about
supplements and how to know what to take wherever you're at on your journey. And I approached this
topic, I approached it with a lot of curiosity because I really wanted to see if there was anything
in the literature since I last looked. that could help my patients, my people, my clients to have
better outcomes. I have to preface this by saying that I think that the data are still pretty early
and there's not a ton of strong, high quality research that's showing that a ton of supplements
actually make a difference. It's hard because we're always looking for something that we can
control and we let go of the things that we can't control. I will say after my review of the
literature, It still is a pretty tough parting line that supplements are probably a very small
piece of the picture, but let me share with you what I reviewed. Okay, so we know that there are
many, many things we can put into our bodies that have been touted to improve outcomes. And as I
look at everything, I think about the fact that we know that folic acid has been helpful to prevent
neural tube defects. I'll go through the data. That is certainly something that's important.
There's a lot of questions about like, what prenatal do I take? Does the form of the folic acid
matter? It doesn't seem to based on my review of all the literature, but also when you're taking
supplements, it's really important because supplements are not regulated by the FDA to know that
you're getting a quality product. And also from my perspective, not spending too much money on that
product, because we all know that we can all have very expensive urine, as I like to say,
and it's just not worth it to be spending that money on. these very expensive supplements that may
not be helping your situation. I always say, go out to dinner, save money for a vacation, whatever,
put it into retirement, whatever it is. But I don't want people leaking money because they feel
like they have to take these expensive supplements. So that is my bias. And I think it's based in
science, actually. But we know that there's 13 essential vitamins, which are vitamin A,
C, D, E, and K. And there's also the B complex vitamins,
right? B1, B2, B3, B5, B6, B7, B9, and B12, which we all learned about in medical school.
And those are essential, right? We have to get them. If we are eating a balanced diet,
we're probably going to get most of those supplements, but there are a few caveats. There's also
all the essential minerals, right? Which come from the soil. for example, iron and calcium and
iodine and magnesium and phosphorus, like all those things. But the reality is at least where we
are in the world without food scarcity, we are getting most of what we need from our diets alone.
You know, I think that when we look at the fact that folic acid deficiency is related to increase
in neural tube defects. That is one thing that is definitely in our control as we approach this
topic. And people ask me all the time, what is folate? What is folic acid? Should I be screen-free
for MTHFR? What do I take? I've looked at all the data.
Truly, truly, if you look at folate, that's what's in the diet. You get it from green leafy
vegetables. You get it from whole foods, whole grains, beans, fruit. But we never know if we're
getting enough. And because that is truly the one supplement that has been linked to worse outcomes
when we have a deficiency, it's really important to pay attention to make sure that you're getting
enough. So for all pregnant women, excuse me, all women who are trying to get pregnant, we
recommend that they take 400 micrograms at least of folic acid,
which is the synthetic or simpler version of it. I love to help people understand that most people
don't need a huge prenatal vitamin. For me, they make me nauseous, right? You can take the gummies,
but oftentimes those have additives in them. You can actually just purchase folic acid over the
counter. Those pills are very tiny. In my world where sometimes the side effect of what I do is I
create twins. I always try for one at a time, but we do unintentionally create twins sometimes. You
know, we recommend 800 micrograms or a milligram because the recommendation for people with twins
is a milligram. So I like people to kind of be already. overcompensating in the event that I do
create twins. But anyway, the folic acid, the recommendation is 400 micrograms a day.
Like I said, 800 micrograms to a milligram can be done. Although there are some situations in which
some women need more folic acid. So for instance, if somebody has a personal or family history of a
neural tube defect, then that dose gets increased. to 4,000 milligrams,
right?
Excuse me, elephant, four milligrams. If somebody has a history of seizure disorder and is on
medications, there's also some evidence that because of the way that those medications work and the
pathways, that that same dose of increase in folic acid is also warranted to help people have their
lowest chance possible of a neural tube defect. And that can be anything from like spina bifida all
the way to anencephaly. And so these are things we really do take very seriously. But there are
some data that too much folic acid may not be helpful as well. And so for people who don't have
those other conditions, really sticking to the recommendation is what we recommend,
or at least what I recommend in my practice. Okay, so moving on. Well, before I do that,
I should say that the MTHFR debate... most of us actually will have something in that pathway that
is altered. There's some data that like 25 to 50% of women will actually have a mutation in the
MTHFR pathway. This does not seem for most women to meaningfully affect outcomes. And so,
you know, unless somebody comes in with that diagnosis and knows about it, like I truly think that
many people over test the MTHFR phenomenon. And so... Generally speaking,
I don't recommend testing. I don't recommend really anything down that pathway because I think it
really just increases anxiety. And if you actually look at the CDC's recommendation for folic acid
for women, it is that same 400 micrograms that we talked about. Okay, moving on. So when we look at
some of the essential vitamins like vitamin A, vitamin D, vitamin E, these are antioxidants.
And if we remember, they... help with free radical formation. So they provide the missing
electrons. Vitamin D, especially in some populations is helpful. I mean,
if you look at it, most of us are vitamin D deficient, especially in the winter time. I live in
upstate New York and Vermont, and we have these very long, dark winters with short days.
And so if somebody comes with a diagnosis of PCOS or say they live in a climate like I do,
I think some sort of vitamin D supplementation can be helpful. We know that people with vitamin D,
with PCOS actually do sequester vitamin D in their fat cells. And so there's not as much available
for use. There's some evidence that vitamin D supplementation can be involved in like having a
better uterine lining and also can beneficially affect mood as well. And so I don't think that
vitamin D is like the cure-all for everything. But I do think that making sure that our vitamin D
levels are sufficient, that can be helpful. And so I typically check it when I see my new
infertility patients. Insurance companies, unfortunately, are getting more and more stingy about
not paying for this test. But I try to get creative with my diagnosis codes because,
again, at the end of the day, vitamin D levels do seem to be important. And what dose should people
take? Well, if the vitamin D level is super, super low, then we can give that 50,000 international
units. eight weeks. But for most people, some sort of dose between a thousand and 5,000
international units a day is going to be helpful. Also in people who struggle with obesity,
same thing because of the fat cells they sequester the vitamin D definitely recommend screening and
also supplementation for those folks as well. There's actually some data that having normal vitamin
D levels decreases the risk of preeclampsia and gestational diabetes. And it also can make sure
that the birth rate is in a like a better a better place and so for those reasons also for having a
healthy pregnancy outcome i think that vitamin d screening and treatment is warranted um okay let's
talk about iron if we look at iron What does iron do, right?
We know that it carries oxygen to the blood cells. We can get a lot of our iron through dietary
sources, like red meat especially is very bioavailable, although many of us are looking into a more
plant forward diet. And so, yes, we can get iron from plants. It's just a little bit harder to
absorb it that way. Also, so when we think about pregnancy, there's more and more data that anemia.
is not great for pregnant women so i always get a cbc at the very least uh when i start to see
somebody for infertility because i want to know what are the hemoglobin levels like how do all
those things look um and i think that As we look at the second trimester,
our blood volume goes up so much in pregnancy that oftentimes we can have a dilutional effect.
It's helpful to be tanked up in the beginning. Maybe you have a borderline hemoglobin,
you have an egg retrieval, and you drop just a little bit. Whatever it is, it's such a simple thing
to do. Although iron supplementation can lead to constipation. So if I ever supplement somebody
with iron, I'm always making sure that I have a plan on the other side for, you know, a bowel
regimen so that people don't come to me with a new problem. You know, vitamin A and E,
those vitamins, there's some weak data for, you know, lining generation,
uterine lining generation for higher doses of vitamin E. Although again, like a lot of these
vitamins and supplements, like in theory, it sounds great to make sure that people are getting
enough of those things, but generally dietary sources are sufficient for those vitamins. Looking
at, you know, calcium, iodine, vitamin D and K, those are involved in bone formation and fetal bone
formation. So just thinking about. So pregnancy is a state that leaches the calcium from our
systems for good reason. And so again, making sure that we're having dietary sources.
Dairy is a great source of calcium and also vitamin D. But if not, then making sure that we're
supplementing those as well. Okay. So let's talk about DHA because there has been more and more
discussion recently about whether people need that with their prenatal vitamin. It does seem that
DHA... helpful for fetal brain development and also specifically the eye development of the fetus
and can also have beneficial effects on vision even in the first year of life um so generally
speaking 200 milligrams of dha you know can be helpful as people are looking you know what to take
as a newly pregnant person there's some data that it also can reduce the risk of preterm delivery
that is extremely weak data but it exists it's out there so if you are taking folic acid and you
want to add DHA to that, or say you're taking your prenatal vitamin and it comes with a DHA
supplement, that is something that I think there's enough preliminary data where it doesn't seem to
be harmful at all. And there may be some benefit in terms of fetal brain development and eye
development. Let's talk about CoQ10. CoQ10 is actually one of my favorite supplements.
Again, like I said, I do not believe that people should be wasting their money on supplements that
don't make a difference. However, this is a supplement that really does seem to make a difference
in terms of the antioxidant nature and improving egg number and egg quality.
So I talk about this all the time. We know that eggs are one of the largest cells in the body and
we need egg energy to be able to shuttle the chromosomes where they need to go to have healthy eggs
at the end of the day. We also know that eggs have a lot of mitochondria in them and those
mitochondria are the energy sources for a lot of the cell division. We know based on animal studies
that when we give animals, mice specifically,
CoQ10, that there's an increased number of mitochondria and that the function of the eggs is better
and those cell divisions are more efficient. So that's super interesting. And if we look at humans,
when we give humans CoQ10 in a dose of 600 milligrams a day, so 200 milligrams,
three times a day. and we compare that to placebo, there's some data that people have more euploid
embryos, which is fantastic because, gosh, we all know how hard it can be to generate a euploid
embryo, especially at older ages. There's also some data that there's more mature eggs and better
cellular divisions. And in IVF specifically, there's more data to suggest that there's better egg
and embryo quality. and increase in live birth rates. And so I truly feel this should be in the
water for people who are 35 and older. I recommend it actually to all of my patients just because
there's actually data that makes a difference. And it's also biologically plausible. And so if you
look at all the review studies, all the data, this is something where there does seem to be a
beneficial effect. And so why not, right? So let's take CoQ10.
Keep it with you because it is 200 milligrams three times a day. I do find that many people are
just, even if they're taking it, they're taking like 200 milligrams a day. It's not quite enough
based on the research. And so that is one thing I do think it's worth spending some money on.
Although I will be very clear that one brand does not seem to be better than another. And so
definitely take that into account. Costco is a great place. I have no affiliations,
but you can get things in bulk and it can save you some money. All right, let's talk about
melatonin. Melatonin, I mean, I have other podcasts in the science series about sleep,
and we know that increased sleep has a beneficial effect on the fertility process. So it's
biologically plausible that melatonin could potentially have a beneficial effect,
especially if women are getting better sleep throughout the process. We know that melatonin is
created in the pineal gland. It's also in eggs, mitochondria, and follicular fluid.
And we also know that it decreases with age. And so again, like I said, you know, it's an
antioxidant. There is biological possibility that can make a difference. If you look at it,
there was one study looking at how three milligrams a day can increase the number of mature eggs.
And that was versus placebo. Also, there's some evidence that melatonin consumption can lead to.
higher grade embryos, but this is actually based on very weak evidence and there's truly not enough
evidence to officially recommend it at this time. So if you want to take some melatonin and it's
helping with your sleep, it may have a beneficial effect on your egg number and your egg quality.
But again, looking at the data, I always try to be evidence-based. I don't think there's a harm
here. There's maybe a potential benefit. We need more data is the bottom line. Um,
let's talk about DHEA. So when I was a fellow, when somebody had a bad, you know, IVF or
disappointing IVF outcome, we said, okay, at CoQ10 and DHEA, that was like the parting line.
Now I rather be proactive than reactive. I do think that people should be taking CoQ10 as soon as
they meet me or even beforehand. DHEA, I mean, I will say that it is a part of the steroid pathway.
We as REIs love. the steroid pathway. It is a testosterone precursor.
So there's biological plausibility. If people have more testosterone, we know that testosterone is
a substrate for estrobial. And so, you know, thinking about all the downstream effects of the
beneficial ways that this could play out, there's very limited data that it can increase egg and
mitochondrial function. Overall data shows that it's not overtly helpful. And I will tell you,
like I said, in my fellowship, I gave a ton of people DHEA. So I saw the natural history of what
happened and people came back to me with back acne. They were taking 25 milligrams three times a
day. And I don't like acne. I like back acne even less,
right? I think that it's so awful to give somebody that side effect,
especially when there's not great data that it's making a difference. And so I don't generally
recommend DHEA in my practice just because there's not enough data that it's really a robust
effect. And most people, their problem is not low testosterone, right? And there's a pretty harsh
side effect profile. So again, you can take it if you want to take it, but just know that that's
what's downstream potentially. And there's not really great data that it makes a difference.
All right, let's talk about the inositols. So there are this group of substances called inositols.
They started to hit the landscape, I want to say, definitely in the last 10 years. It's been fairly
recent. They are involved in cell signaling, cell formation. They help with oxidative stress.
They're also related to insulin metabolism. So they are an obvious target for people with PCOS. Now
here's where I caution, because I think that we are all looking for ways for people with PCOS to
reduce inflammation, to have better insulin pathways, to have better egg quality. And I don't think
it's wrong to try these medications, but. If we look at it, sure, myonositol has helped people have
more regular cycles, but it has not yet been shown to help people have increase in live birth. Kind
of like the Metformin data, right? People will cycle regularly. They will start to ovulate. But for
various reasons, like the live birth rate isn't higher, which is what we care about at the end of
the day. And so for some people, it makes them like feel good to have a regular cycle, et cetera.
But again, I don't think that like we can truly recommend it in the absence of live birth data. It
does seem that myonositol and d-chironositol work together. A 40 to 1 ratio seems to be the best
ratio if people are going to entertain taking this substance. There are actually brands that have a
40 to 1 ratio. So like for instance, 2000 milligrams of myonositol and 50 milligrams of d
-chironositol. There's some thought that this helps with estrogen production. There's a little bit
of weak data that it helps with insulin pathways in terms of lowering blood sugar and decreasing
even some of the hormones involved in reproduction. LH, testosterone, prolactin. But again,
we definitely need to see more data before we start routinely recommending this. And again, it's
money out of your pocketbook. So just thinking about if you're trying to conceive outside of IVF,
I don't think it's wrong to try it. All these medications might have interactions with other
medications. And so just running it through the tracker and making sure that nothing that you're
taking is interacting in a negative way with other substances. It does worry me a little bit that
these substances are not really regulated. And so could there be potential harm downstream,
especially if we are affecting different pathways? There is that possibility. But I think it can be
considered, especially with a diagnosis of PCOS. But again, we don't have great data that it makes
a huge difference. And so I would say proceed with caution. All right. Only up until now,
I've been talking about egg health. I get a lot of questions about sperm health and what can
improve sperm health, especially from a supplement perspective. So what I will say is in terms of
sperm, we think a lot about free radicals. And so the male reproductive tract is actually fairly
long. We all memorize that acronym seven up when we were med students. And when we look at it,
there has been a lot of sort of trials of supplements that have. had some biological plausibility.
And so people are like, well, if my husband takes this supplement, then our sperm problems are
going to be better. What I will say is all the data have not really panned out in terms of a
beneficial effect on sperm. There's some very, very weak evidence that coenzyme Q10 can be helpful
for men as well. So my running joke in the clinic is that, you know, the husband and wife can share
the bottle and like divvy it out wherever they're going that day, obviously in a heterosexual
relationship. Um, there was even a study that we looked at for MOC a couple of years ago, which
looked at magnesium and those men actually had worse outcomes as well. So again, in the vein of
like, we want to be doing something, but sometimes when we add more things, we add a new problem or
maybe there's worse outcomes. So we really have to be looking at like maybe less is more. So all
the data about vitamin A, vitamin C, vitamin E. selenium, L-carnitine, NAC,
melatonin, like you can read about it, but nothing as of yet has been shown to have a beneficial
effect on sperm other than maybe coenzyme Q10. Now, lifestyle changes, I will put in a plug for
those. It does seem that lifestyle changes can have actually a very positive effect on sperm as it
can for eggs as well. We know that smoking and marijuana use are very, very bad for sperm. And I've
seen this clinically that when men stop smoking marijuana, the caveat is that any change that men
make takes a full three months to, to show itself because that's when the new sperm are made and
then finally exit the male reproductive tract. And so if we're looking at that, you know, looking
at, you know, maybe it's like decreasing hot tubs and saunas, or maybe it's,
you know, stopping smoking or marijuana use. Like we have to wait the full three months to,
to check a semen analysis. like again, after varicocelectomy, like those things take time to see an
effect. But I will say that, you know, a lot of the people I see in my office,
their partners, their mom partners are engaging in all sorts of substances that are not helpful to
the process. And so if we're talking about antioxidants as maybe being helpful, dietary sources,
CoQ10, but then somebody is smoking and kind of wrecking those good effects. it's gonna have a lot
more benefit to say to stop the toxic habits and to reduce those toxins in the body so that there's
not as many free radicals and that the diet and the lifestyle and the supplements don't have so
much work to do to clean up that process, if that makes sense. So in summary, what I would say is
that I do think that there is some hope that maybe at some point, some of these supplements will
have borne out in terms of beneficial effects on fertility. I think we're not there yet. If you're
looking at what is going to give you the best overall bang for your buck,
so to speak, definitely folic acid, probably coenzyme Q10, both for men and women.
thinking about like vitamin D supplementation, absolutely. And then possibly some of the inositols,
if you have a PCO diagnosis, melatonin plus minus, again, I don't think there's harm. It may help
with sleep and there's some weak data to suggest that it may be helpful. So you can think about
adding that, but please, please, please do not spend too much on your supplements because, you
know, I know that there are some people who, you know, really do believe in them or,
you know. Even some people who maybe have affiliations with the companies of the vitamin clinics
and all those things. I have no affiliations. I really look at the data and try to make my best
recommendations for my people. And that is a summary of this, which is recorded in 2026.
So when we have more data, I will record again. But until then, stay healthy, stay well,
eat a good diet. Don't put bad things in your body. And you know how much I love you. Bye.