Episode 260 – Nutrients for Female Fertility

Nutrients for Female Fertility

Fertility is multifactorial. No single nutrient, supplement or food will be the difference between getting pregnant or not getting pregnant. Genetics, age, hormonal health, body composition, stress and partner health can all play a role. However, nutrition still matters. Certain nutrients support reproductive health, early pregnancy and the development of a healthy baby.

This is especially relevant during the 90-day preconception window. While 90 days is not a perfect cut-off, it roughly lines up with the life cycle of both eggs and sperm. Because of this, it can be a useful timeframe to focus on improving nutrient status before trying to conceive.

Folate and Folic Acid

Folate is one of the most well-known nutrients for fertility and early pregnancy. It is also one of the most well-established interventions in reproductive health. Folic acid is mainly recommended for neural tube defect prevention, including conditions such as spina bifida. It also supports DNA synthesis and cell division, which are both important in the early stages of pregnancy.

The standard recommendation is around 400 micrograms of folic acid per day. This is often recommended one to three months before conception. It is also worth knowing the difference between folate and folic acid. Folate is the food form, while folic acid is the synthetic supplement form.

MTHFR and Folic Acid

There is often concern around the MTHFR gene variant and whether folic acid is still the best option. Around 40-60% of people carry a variant on the MTHFR gene. If this was a major issue at that scale, standard advice would likely not still recommend regular folic acid.

There are some cases where it may be more relevant. For example, someone may have two copies of a variant or a build-up of homocysteine. In those cases, methylfolate may be considered instead of folic acid. However, most larger conservative fertility organisations still strongly prefer folic acid in most cases. This is mainly because there is a much larger evidence base for folic acid. Not supplementing with folic acid due to MTHFR concerns is likely a bigger risk than supplementing in most cases. Methylfolate may be completely fine, but the evidence base is not as strong yet.

Iron and Ferritin

Iron is another important nutrient for fertility. It supports thyroid function, red blood cell production and healthy cell replication. Women of reproductive age have a higher risk of iron deficiency due to monthly blood loss from their period. For this reason, checking ferritin levels can be helpful. Ferritin reflects iron stores and can show whether supplementation may be needed.

One 2025 study from a fertility clinic in Helsinki followed 292 women with infertility and iron deficiency who received IV iron infusion. Live birth rates improved meaningfully after the treatment of iron deficiency. Iron status also matters before pregnancy because iron needs increase during pregnancy. A ferritin level of 30 micrograms per litre is often used as the cut-off to avoid deficiency. However, a safer target may be at least 50 micrograms per litre.

Omega-3

Omega-3 can support fertility and pregnancy outcomes. It has evidence for helping with ovulation and regular cycles in people with PCOS. Higher omega-3 status has also been linked with better IVF outcomes. Beyond fertility, omega-3 may also support the baby. It can reduce the risk of preterm birth by around 11% before 37 weeks and around 42% before 34 weeks. It also supports brain development.

Omega-3 may also help reduce the risk of pre-eclampsia and postpartum depression. Because of this, it makes sense to start pregnancy with a good omega-3 baseline. Omega-3s also have anti-inflammatory effects. This may be relevant for people with conditions such as PCOS or endometriosis who are trying to conceive. The recommendation during pregnancy is usually 200–300 milligrams of DHA omega-3 per day. If someone eats oily fish, such as salmon, sardines, mackerel or anchovies, two to three times per week, they may meet this through food. If not, omega-3 may be included in a prenatal supplement or added separately.

Vitamin D

Vitamin D is commonly linked with fertility and reproductive health.

In people with PCOS, low vitamin D is common. It is estimated that around 67–85% of women with PCOS have low vitamin D. For fertility, one of the key areas of interest is implantation. Vitamin D helps regulate the genes that control the implantation window. When vitamin D is lower, the uterine lining tends to be thinner on average, and implantation rates tend to be lower. In IVF populations, a meta-analysis found that people with high vitamin D had around 33% higher odds of pregnancy.

Vitamin D deficiency is common and relatively easy to address. For fertility-focused research, pushing serum vitamin D above 100 nanomoles per litre may be beneficial. This is tested through a 25-hydroxy vitamin D blood test. If someone is deficient, supplementing with 1000–2000 IU of vitamin D3 is common.

Vitamin B12

Vitamin B12 is another nutrient to consider, especially alongside folate. High folate with low B12 can contribute to issues with homocysteine. Low B12, alongside folate-related issues, may also contribute to fertility concerns and miscarriage risk. This is especially important for people following a plant-based diet.

Vitamin C

Vitamin C is a potent antioxidant. It also plays a practical role in iron absorption. If someone is not eating many colourful fruits and vegetables, supplementing with vitamin C may make sense. However, this is usually one of the easier nutrients to get through food.

Choline

Choline works alongside folate for neural tube development. It also supports brain development. This is an area where the evidence may have moved faster than many supplement formulas. Some prenatal supplements still contain low amounts of choline or no choline, even though the evidence suggests it may be helpful.

Selenium

Selenium supports thyroid function. This matters because the thyroid plays a role in hormone regulation and fertility. Brazil nuts are a very concentrated source of selenium. In many cases, one to two Brazil nuts per day is enough to meet requirements. Selenium deficiency is rare in Australia. However, suboptimal levels are more common. This may still be relevant for some people. Around 10% of women on fertility journeys have subclinical hypothyroidism. Another 2–4% have diagnosed hypothyroidism. This makes thyroid-supporting nutrients worth considering.

Zinc

Zinc plays a role in most steps of reproduction. Low zinc is associated with irregular cycles, poor egg quality and increased miscarriage risk. Because of this, zinc status can be another piece of the fertility puzzle.

CoQ10

CoQ10 is getting more attention, particularly for older women who are trying to conceive. CoQ10 is involved in mitochondrial energy production within eggs. This function declines with age, which is why it may be more relevant in older women.

More evidence is still needed in general population studies. However, it may be considered in relevant cases. In the research, CoQ10 dosages are often 400–600 milligrams per day. This is higher than many standard supplement doses. It is usually used across the full 90-day preconception window.

Practical Recommendations

A good-quality diet is still the foundation. While this episode focused on individual nutrients, broader dietary patterns also matter. From a nutrient perspective, a varied and high-quality diet helps cover more bases.

In many cases, supplementation will still be useful. A prenatal supplement can help cover many key nutrients. However, it may not cover everything. For example, many prenatal supplements do not contain enough omega-3. CoQ10 may also need to be added in specific cases. Baseline blood work can also be valuable. This may include ferritin, vitamin D and B12. Testing helps identify deficiencies so they can be addressed properly, rather than guessing.

A Common Misconception

One common misconception is that eating well means supplements are not needed. In reality, it can be hard to get enough of certain nutrients through food alone. Iron can be difficult to optimise, especially once pregnancy starts. Folate can also be hard to reach in the recommended amounts without supplementation. Unless someone tracks every step of the process carefully, it is easy to fall short in some areas.

When to Get Individual Support

Some people may benefit from a more personalised approach. This is especially relevant for those with PCOS, endometriosis, hypothyroidism or a history of miscarriage. In these cases, working with a GP or dietitian can help tailor the approach to the individual.

Key Takeaway

Nutrients can play an important role in fertility and early pregnancy, but they are not the whole picture. Folate, iron, omega-3 and vitamin D are some of the main nutrients to consider. B12, vitamin C, choline, selenium, zinc and CoQ10 may also be relevant depending on the person. A strong starting point is a good-quality diet, an appropriate prenatal supplement and baseline blood work to check key nutrient levels.

Relevant studies

Relevant Blog Post

MTHFR – What Should You Know About It? | Ideal Nutrition