Preconception must haves:
Prenatal Multivitamin: A good prenatal should be taken 3-6 months prior to trying to conceive. This is very important in making sure your body is healthy from the very beginning of pregnancy. Most prenatal vitamins will have folate in them which is key in the very first weeks in fetal development. The better quality prenatals will have a non-constipating form of iron and will be easily absorbed as not to add any digestive issues to your pregnancy.
Probiotics - Probiotics replenish intestinal flora (healthy bacteria) and promote overall digestive and immune health (amongst many other health benefits). The road to health is paved with good intestines. Quality is key with probiotics. A therapeutic dosage of probiotics should be > 10 billion CFU (colony forming units) per day. Lactobacillus acidophilus and Bifidobacterium bifidum are the two strains that best address both small and large intestine. Probiotics work best if the consumer also has regular intake of prebiotics (which feed the probiotics) such as legumes and fruit. *Be sure to drink filtered water as chlorine (an antibiotic) will destroy the probiotics.
Vitamin D - For general overall health and immune function. Vitamin D works synergistically with other vitamins and minerals (without Vitamin D, calcium won’t be absorbed in the hard tissues like the bones and teeth which is essential if you want to get pregnant). It also supports the 'killer cells' of the immune system which may lower your risk of cancer cell growth and help regulate autoimmune conditions. Additionally, Vitamin D may play an instrumental role in changing AMH (anti-mullerian hormone) levels - especially in winter - as well as being vital to the proper growth of the uterine lining. There is also some suggestion that a deficiency of Vitamin D may play a role in the development of metabolic syndrome - therefore supplementation for women with PCOS is indicated.
Iron deficiency and vegetarians:
Iron - Whole food easy to digest non-constipating iron supplements are key, especially for pregnant women diagnosed with iron deficiency. These supplements should also include folate and B12 as deficiencies of these vitamins can cause or further exacerbate an iron deficiency. Supplementation is especially important for most vegetarians or vegans. Iron helps carry oxygen to every cell in your body. If you are iron deficient, your cells (and your little embryo) may not be receiving the essential life force from the breath you are taking.
CoQ10* (ubiquinone, ubiquinol) - A naturally occurring enzyme in each of our cells that helps the mitochondria produce ATP (Turunen, 2004), or cellular energy. Recent research from Toronto, Canada shows that CoQ10 may improve egg quality (Bentov, 2013) through the mechanism of mitochondrial ATP enhancement - the same way some Chinese herbal medicines are thought to increase fertility, as well as being a heavily researched antioxidant extremely beneficial for heart health. Antioxidants such as CoQ10 (commonly seen in skin care products) are thought to slow down or even reverse your biological/ cellular age and can be of great benefit when trying to conceive. CoQ10 has also been shown to improve sperm motility. Researchers from Spain recently performed a ‘meta-analysis’(a study of existing studies on the particular topic of CoQ10 and sperm) and found a global improvement in sperm parameters (Lafuente, 2013). CoQ10 should be in a capsule that contains an oil base and is to be taken with food for optimal absorption. The ubiquinol form of CoQ10 is thought to be better absorbed than the ubiquinone form, but many companies today are patenting forms that are said to have better absorption rates, despite the actual form used. *Currently there is insufficient evidence of CoQ10’s safety during early pregnancy; avoid using.
Folic Acid (folate, B9, 5-MTHF) - Folic acid is used by the body to manufacture DNA, which is required for rapid cell division and organ/ tissue formation in the developing baby. Most expectant mothers are aware of the need to supplement with folic acid during pregnancy to prevent neural tube developmental problems in the fetus. To my knowledge, it may be the one and only supplement recommended by most doctors. 5-MTHF is the most bio-available form of folate available and is what I recommend. The liver and intestines must be healthy for proper absorption of folate (again suggesting the importance of probiotics).
PCOS and Endometriosis:
Omega-3 Fish Oil (EPA and DHA) - Regulates inflammation, promotes circulation and delivers required fats for the proper production of sex hormones - to help normalize your cycle. Reduces inflammation in the pelvic area which is especially important for fertility. Omega-3 fatty acids may reduce sensitivity to prolactin (which can suppress ovulation), increase cervical mucus to help the sperm reach the egg and blood flow to the uterus to help with development of the uterine lining. Strong caution should be taken when choosing a brand of fish oil. Testing for heavy metals, rancidity and purity, as well as ethical fishing practices should all be standard.
Folate/ B12 (homocysteine) - It is thought that women with Polycystic Ovary Syndrome (PCOS) or recurrent loss may have high homocysteine levels (a substance in our body that can cause problems with our circulatory system) due to conversion in the liver. B6, folate, & B12 in combination help convert homocysteine into a non-toxic substance and may help reduce the chances of miscarriage. Interesting to note, Metformin, a blood sugar regulating medication given to women with PCOS and insulin resistance, may actually increase homocysteine levels. This blend of B vitamins is safe and encouraged to be taken during pregnancy if you have tested positive for raised homocysteine levels, have experienced recurrent pregnancy loss or have been diagnosed with PCOS. Folate and B12 are also well known vitamins required for the production of blood and important in women who may suffer from anaemia, another possible cause of difficulty getting and staying pregnant.
Calcium D-glucarate, Indole 3 Carbinol - Both of these supplements have been researched for their use in the treatment of cancer as they aid the liver in the elimination of excess estrogens manufactured from excess adipose tissues or environmental toxins (which in some cases can encourage the growth of cancer). This mechanism may also be helpful in many reproductive health issues that have hormonal imbalance involving excess circulating estrogens (cysts, endometriosis, PCOS, fibroids, post administration of gonadotropic hormone medications used in fertility treatments such as IVF). This can also prevent cellular damage and benefits the body's immune system.
Inositol (Vitamin B8) - Myoinositol has been shown to restore regular ovulation, lower insulin and decrease androgens. Also, can aid in the treatment of anxiety/ panic attacks, insomnia, depression, mood regulation and high cholesterol. This is an important supplement for women with PCOS.
N-Acetyl Cysteine (NAC) - Increase insulin sensitivity and lower androgen levels. A recent study using NAC on women with Endometriosis (500mg 3x/ day for 3 consecutive days per week, i.e., Monday to Wednesday, then a break for the remaining 4 days) showed reduced inflammatory and pain signalling factors, helped keep cells from becoming invasive, kept cysts from growing and even reduced their size (Porpora, 2013). NAC may also protect against health problems such as diabetes, reinforcing its use in PCOS women.
Thyroid Blends - Supplements containing iodine, selenium and tyrosine are known to help support thyroid health and function. It can help manage symptoms of a sluggish thyroid such as: weight gain, feeling tired and cold all the time, hair (including eyebrow) and memory loss, brittle nails/ hair and leg swelling, and most importantly, difficulty conceiving and carrying to term. Be sure to rule out thyroid autoimmune Hashimoto’s (raised TPO antibodies) before taking iodine as it may cause a flare of immune function resulting in destruction of thyroid tissue. In the case of Hashimoto’s autoimmune, thyroiditis supplements for the immune system and inflammation should be emphasized such as Vitamin D, fish oils and probiotics.
Information summarised from "Being Fertile" -Dr. Spence Petland