If your path to pregnancy includes fertility treatments such as intrauterine insemination (IUI) or in vitro fertilisation (IVF), you should know that these do not bypass the need for improving egg, sperm and uterine health with dietary and lifestyle changes or other natural healing modalities. “Natural” & “Fertility treatments” are not mutually exclusive and have the potential to support each other
The purpose of this article is to explain some of the emerging science around supporting fertility through nutrition and lifestyle changes. It is not to give a comprehensive education or individualised support. We recommend working closely with a functional medicine practitioner to give you bio-individual guidance (book a discovery call with us here).
Assisted reproductive technologies (ARTs) such as IVF have fundamentally contributed to reproductive health over the last few decades, and the science continues to evolve. IVF and IUI work by overcoming some of the more physical obstructions to conception such as
Low sperm motility
Excess endometrial tissue (from endometriosis)
Blockages in the uterus or uterine tubes
Lack of cervical mucous or inability of sperm to pass through the cervix
Antibody issues that may damage egg or sperm
However, “by and large, ARTs do not address the fundamental issue of reproductive aging in women: age-related decline in egg quality.” (1)
As we have explained in more detail in our article on the science of egg health, aging of the egg may include other factors besides the age of the woman. The role of mitochondria is an essential component of egg (and sperm) health that may be contributing to chromosomal abnormalities or fertility challenges.
A growing body of literature shows that both egg and sperm health can be improved through dietary changes, supplementation and avoiding exposure to toxins, as well as through other technologies such as mitochondrial transfer (2). It is interesting to note that these studies are largely funded and conducted not by natural practitioners but by conventional fertility clinics looking for ways to improve outcomes of IVF.
The 4 months leading up to ovulation are critical for egg maturation and health. Sperm maturation takes slightly shorter at approximately 72 days. Of course, while we recommend that dietary and lifestyle changes are more long term than this, these months do provide us a critical window of opportunity for improving chances of conception. Whatever treatments your path to pregnancy may include, maximising optimal nutrients and limiting exposure to harmful chemicals during this time has been shown to improve chances of conception and positive pregnancy outcomes.
In our practice we work with various nutritional and lifestyle indicators that may support your fertility journey. These include:
Exposure to BPA, Phthalates & other chemicals (3,4,5,6)
Vitamin D (7,8)
Folate versus folic acid, genetic variation (MTHFR) (9)
Vitamin B12 (10,11)
Antioxidants such as COQ10 (12,13)
Magnesium (14)
Myoinositol (15,16)
DHEA (17,18)
Other Antioxidants: vitaminE, vitamin C, selenium and zinc (19, 20)
BPA and phthalates compromise egg quality by interfering with meiosis and causing chromosomal abnormalities in eggs. They are also endocrine disrupters and as such interfere with the carefully orchestrated hormones which coordinate the reproductive system.
Folate and vitamin B12 (methylcobalamin) in their bioavailable forms, not only prevent birth defects but also contribute to restoring ovulation and improving egg quality. They play a significant role in creating new DNA, proteins and play a critical role in detoxification. Vitamin B12 has been shown to contribute to better embryo quality.
CoEnzyme Q10 (and other antioxidants), is an essential raw ingredient for energy production required for meiosis and ovulation. It preserves egg quality and has been shown to prevent decline in egg quality and even the potential to reverse the aging process.
Zinc and selenium are important for thyroid function and zinc deficiency interferes with completion of meiosis, a critical pre-ovulatory step.
Energy production, vital for the energy required for meiosis and ovulation, is a magnesium intensive process, and improves pre-implantation blastocyst development. Magnesium also improves motility of sperm.
Myo-inositol is effective in normalizing ovarian function, improving oocyte and embryo quality in PCOS
In our practice we work with high quality, practitioner grade nutritional supplements when appropriate. This means that ideally pathology testing has been done and measured against functional medicine optimal standards, and close attention has been paid to your symptomatology and medical history. Supplements are just that; they supplement a long term nutrient dense diet and a lifestyle that does not include over-exposure to endocrine disrupting chemicals, antibiotics and stress. We work with all of these factors; meeting you where you are at and taking small steps that will lead to big positive changes for you and your family’s long term health.
Liu, X.J. Targeting oocyte maturation to improve fertility in older women. Cell Tissue Res 363, 57–68 (2016). https://doi.org/10.1007/s00441-015-2264-y
Schatten, H., Sun, QY. & Prather, R. The impact of mitochondrial function/dysfunction on IVF and new treatment possibilities for infertility. Reprod Biol Endocrinol 12, 111 (2014). https://doi.org/10.1186/1477-7827-12-111
Can A, Semiz O, Cinar O. Bisphenol-A induces cell cycle delay and alters centrosome and spindle microtubular organisation in oocytes during meiosis. Mol Hum Reprod. 2005 Jun;11(6):389-96. (“Can 2005”). https://pubmed.ncbi.nlm.nih.gov/15879462/
Brieño-Enríquez MA, Robles P, Camats-Tarruella N, García-Cruz R, Roig I, Cabero L, Martínez F, Caldés MG. Human meiotic progression and recombination are affected by Bisphenol A exposure during in vitro human oocyte development. Hum Reprod. 2011 Oct;26(10):2807-18. https://academic.oup.com/humrep/article/26/10/2807/609912
Duty S. M., Singh N. P., Silva M. J., Barr D. B., Brock J. W., Ryan L., Herrick R. F., Christiani D. C., Hauser R. 2003b. The relationship between environmental exposures to phthalates and DNA damage in human sperm using the neutral comet assay. Environ. Health Perspect. 111, 1164–1169.https://pubmed.ncbi.nlm.nih.gov/12842768/
Wang W, Craig ZR, Basavarajappa MS, Gupta RK, Flaws JA. Di (2-ethylhexyl) phthalate inhibits growth of mouse ovarian antral follicles through an oxidative stress pathway. Toxicol Appl Pharmacol. 2012 Jan 15;258(2):288-95. (“Wang 2012”); C.f. Ambruosi 2011. https://www.sciencedirect.com/science/article/abs/pii/S0041008X11004443
Rudick B, Ingles S, Chung K, Stanczyk F, Paulson R, Bendikson K. Characterizing the influence of vitamin D levels on IVF outcomes. Hum Reprod. 2012 Nov;27(11):3321-7. (“Rudick 2012”). https://pubmed.ncbi.nlm.nih.gov/22914766/
Ruddick 2012). Rudick B, Ingles S, Chung K, Stanczyk F, Paulson R, Bendikson K. Characterizing the influence of vitamin D levels on IVF outcomes. Hum Reprod. 2012 Nov;27(11):3321-7. https://academic.oup.com/humrep/article/27/11/3321/807686
Enciso M, Sarasa J, Xanthopoulou L, Bristow S, Bowles M, Fragouli E, Delhanty J, Wells D. Polymorphisms in the MTHFR gene influence embryo viability and the incidence of aneuploidy. Human genetics. 2016 May 1;135(5):555-68. https://pubmed.ncbi.nlm.nih.gov/27068821/
Gaber KR, Farag MK, Soliman SE, El-Bassyouni HT, El-Kamah G. Maternal vitamin B12 and the risk of fetal neural tube defects in Egyptian patients. Clin Lab. 2007;53(1-2):69-75. PMID: 17323828. https://pubmed.ncbi.nlm.nih.gov/17323828/
Bennett M. Vitamin B12 deficiency, infertility and recurrent fetal loss. The Journal of Reproductive Medicine. 2001 Mar;46(3):209-212. PMID: 11304860 https://europepmc.org/article/MED/11304860
Akarsu, S., Gode, F., Isik, A. Z., Dikmen, Z. G., & Tekindal, M. A. (2017). The association between coenzyme Q10 concentrations in follicular fluid with embryo morphokinetics and pregnancy rate in assisted reproductive techniques. Journal of assisted reproduction and genetics, 34(5), 599-605. https://pubmed.ncbi.nlm.nih.gov/28185121/
Akarsu S, Gode F, Isik AZ, Dikmen ZG, Tekindal MA. The association between coenzyme Q10 concentrations in follicular fluid with embryo morphokinetics and pregnancy rate in assisted reproductive techniques. J Assist Reprod Genet. 2017 May;34(5):599-605. doi: 10.1007/s10815-017-0882-x. Epub 2017 Feb 9. Erratum in: J Assist Reprod Genet. 2017 May;34(5):607. PMID: 28185121; PMCID: PMC5427661. https://pubmed.ncbi.nlm.nih.gov/28185121/
Liyou Ana et al Magnesium is a critical element for competent development of bovine embryos Received 15 May 2019, Revised 19 July 2019, Accepted 12 August 2019, Available online 13 August 2019 https://www.sciencedirect.com/science/article/abs/pii/S0093691X19303553#!
Viski S., Szöllosi J., Kiss A.S., Csikkel-Szolnoki A. (1997) Effects of Magnesium on Spermiogenesis. In: Theophanides T., Anastassopoulou J. (eds) Magnesium: Current Status and New Developments. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-0057-8_69
Chiu TT, Rogers MS, Law EL, Briton-Jones CM, Cheung LP, Haines CJ.Follicular fluid and serum concentrations of myo-inositol in patients undergoing IVF: relationship with oocyte quality.Hum Reprod. 2002 Jun;17(6):1591-6. (“Chiu 2002”). https://pubmed.ncbi.nlm.nih.gov/12042283/
Galletta M, Grasso S, Vaiarelli A, Roseff SJ. Bye-bye chiro-inositol - myo-inositol: true progress in the treatment of polycystic ovary syndrome and ovulation induction. Eur Rev Med Pharmacol Sci. 2011 Oct;15(10):1212-4. https://www.researchgate.net/publication/51874992_Bye-bye_Chiro-inositol_-_Myo-inositol_True_progress_in_the_treatment_of_polycystic_ovary_syndrome_and_ovulation_induction
Fouany MR, Sharara FI. Is there a role for DHEA supplementation in women with diminished ovarian reserve? J Assist Reprod Genet. 2013 Sep;30(9):1239-44. https://pubmed.ncbi.nlm.nih.gov/23737215/
Gleicher N, Barad DH. Dehydroepiandrosterone (DHEA) supplementation in diminished ovarian reserve (DOR). Reprod Biol Endocrinol. 2011 May 17;9:67 (“Gleicher 2011”). https://www.researchgate.net/publication/51140383_Dehydroepiandrosterone_DHEA_supplementation_in_diminished_ovarian_reserve_DOR
Ross C, Morriss A, Khairy M, Khalaf Y, Braude P, Coomarasamy A, El-Toukhy T. A systematic review of the effect of oral antioxidants on male infertility. Reprod Biomed Online. 2010 Jun;20(6):711-23. https://pubmed.ncbi.nlm.nih.gov/20378409/
Kim, A., Vogt, S., O'Halloran, T. et al. Zinc availability regulates exit from meiosis in maturing mammalian oocytes. Nat Chem Biol 6, 674–681 (2010). https://www.nature.com/articles/nchembio.419