Written by Dr. Jordan Robertson, ND
Formal fertility assessments don’t usually start proactively. Couples need to show that they have been “trying” without success before being offered testing and need to experience multiple miscarriages before they are considered high risk for miscarriage and looked at more closely.
Even though couples aren’t candidates for a thorough investigation before 6-12 months of attempting pregnancy1, there are many habits, nutritional supports and supplements that couples can consider to help support their fertility. Cycle tracking (can we hype link the other articles?) and well-known nutrients such as folic acid and vitamin D have been shown to help support women in the preconception phase.
There are some lesser-known nutrients that can have a positive impact on egg quality, ovulation and fertility in women that can be included in a couple’s fertility plan. These nutrients can help support women in who are not ready for a formal fertility assessment, but who want to take control of their fertility health and put their best foot forward. Women and couples may also benefit from earlier testing and screening than the typical 6–12-month timeline. In this article we’ll share some lesser-known nutrients to consider for fertility health and when to be screened before waiting a full year.
Inositol, PCOS and Fertility
Inositol is a lesser-known nutrient in the B-vitamin family that has actions on insulin and blood sugar and lowers testosterone, especially in women who we suspect Polycystic ovarian syndrome (PCOS). Inositol has been shown to improve egg quality in couples undergoing egg retrieval for IVF2 in PCOS patients. Studies have shown that inositol improves egg quality in women with PCOS3,4 and also supports healthy pregnancy by reducing the risk of gestational diabetes5.
Melatonin is a sleep-hormone that is produced by the pineal gland in the brain. Although melatonin is well known as a nutrient to help individuals fall asleep, it has many other actions in the body, including supporting the reproductive cycle6. The ovaries have melatonin receptors, and in one study, higher levels of melatonin in the fluid around the ovaries had positive effects on fertility in women undergoing IVF.9 Women who work shift work have disrupted melatonin release have more cycle irregularity and may have more difficulty falling pregnant.10,11
When To Consider Testing
Even though most public health screening for fertility challenges only occurs once couples have been trying to fall pregnant without success for 6-12 months, a couple can look for signs to help them understand their fertility health and advocate for earlier or special testing to help more subtle causes of infertility and miscarriage risk be discovered. Testing can include blood tests to confirm ovulation or look for high testosterone and insulin resistance in the case of polycystic ovarian syndrome. PCOS women may not ovulate every month and are at risk for miscarriage12. Thyroid testing, including thyroid antibodies, can identify Hashimoto’s thyroiditis, which is a common cause of infertility in couples who already have one child13. Women with painful menstrual cramps should consider being tested for endometriosis with their doctor15. Basic fertility testing also includes screening for STIs, elevated hormones such as prolactin and may include testing for ovarian reserve with the test AMH (anti-mullerian hormone).
Although many couples will fall pregnant on their own in the first 6-12 months, we should be curious about the need for more advanced testing in couples with a history of low fertility or signals that the menstrual cycle, ovulation or hormonal health is interfering with conception. Early and proactive testing combined with a health and supplement plan can give couples a head start on their fertility journey without waiting a year to be supported. Couples can also consider improving their nutrition and nutrient intake to have a positive impact on fertility rates and be proactive partners in their fertility journey in their first year of trying to conceive.
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- Canada, P. H. A. of. Fertility. aem https://www.canada.ca/en/public-health/services/fertility/fertility.html (2012).
- Ciotta, L. et al. Effects of myo-inositol supplementation on oocyte’s quality in PCOS patients: a double blind trial. Eur. Rev. Med. Pharmacol. Sci. 15, 509–514 (2011).
- Gupta, D., Khan, S., Islam, M., Malik, B. H. & Rutkofsky, I. H. Myo-Inositol’s Role in Assisted Reproductive Technology: Evidence for Improving the Quality of Oocytes and Embryos in Patients With Polycystic Ovary Syndrome. Cureus 12, e8079 (2020).
- Facchinetti, F. et al. Breakthroughs in the Use of Inositols for Assisted Reproductive Treatment (ART). Trends Endocrinol. Metab. TEM 31, 570–579 (2020).
- Facchinetti, F. et al. An update on the use of inositols in preventing gestational diabetes mellitus (GDM) and neural tube defects (NTDs). Expert Opin. Drug Metab. Toxicol. 0, null (2020).
- Olcese, J. M. Melatonin and Female Reproduction: An Expanding Universe. Front. Endocrinol. 11, (2020).
- Zheng, M., Tong, J., Li, W.-P., Chen, Z.-J. & Zhang, C. Melatonin concentration in follicular fluid is correlated with antral follicle count (AFC) and in vitro fertilization (IVF) outcomes in women undergoing assisted reproductive technology (ART) procedures. Gynecol. Endocrinol. Off. J. Int. Soc. Gynecol. Endocrinol. 34, 446–450 (2018).
- Tamura, H. et al. The role of melatonin as an antioxidant in the follicle. J. Ovarian Res. 5, 5 (2012).
- Genario, R., Morello, E., Bueno, A. A. & Santos, H. O. The usefulness of melatonin in the field of obstetrics and gynecology. Pharmacol. Res. 147, 104337 (2019).
- Gamble, K. L., Resuehr, D. & Johnson, C. H. Shift work and circadian dysregulation of reproduction. Front. Endocrinol. 4, 92 (2013).
- Mills, J. & Kuohung, W. Impact of circadian rhythms on female reproduction and infertility treatment success. Curr. Opin. Endocrinol. Diabetes Obes. 26, 317–321 (2019).
- Sha, T., Wang, X., Cheng, W. & Yan, Y. A meta-analysis of pregnancy-related outcomes and complications in women with polycystic ovary syndrome undergoing IVF. Reprod. Biomed. Online 39, 281–293 (2019).
- Min, Y., Wang, X., Chen, H. & Yin, G. The exploration of Hashimoto’s Thyroiditis related miscarriage for better treatment modalities. Int. J. Med. Sci. 17, 2402–2415 (2020).
- Zhang, H. et al. Meta-analysis of the effect of the maternal vitamin D level on the risk of spontaneous pregnancy loss. Int. J. Gynaecol. Obstet. Off. Organ Int. Fed. Gynaecol. Obstet. 138, 242–249 (2017).
- Tsamantioti, E. & Mahdy, H. Endometriosis. StatPearls (2021).