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The Modern guide to prenatal vitamins and fertility supplements

The Modern guide to prenatal vitamins and fertility supplements

11 min read

The fertility supplement market in the US is big — like, $400-million-a-year big, and has been steadily on the rise over the past decade. This increase in spending on fertility supplements has been attributed to things like the number of people planning for kids later in life, increases in people getting treated for fertility issues, and rising awareness around reproductive health in general and the role that supplements may play. Much like fertility hormone testing, taking a prenatal supplement is considered one major way to get proactive about your reproductive health.

With so many over-the-counter (OTC) options, we created this comprehensive guide to fertility supplements. We sifted through the science from academic articles, society guidelines such as the American College of Obstetricians and Gynecologists (ACOG), and reports from consumer groups to summarize some of the dos and don’ts when it comes to vitamins and supplements that claim to support a healthy pregnancy and improve your reproductive function more generally.

Main takeaways

  • Unlike drugs and many over-the-counter (OTC) medications, vitamins and supplements don’t undergo the same level of US Food and Drug Administration (FDA) scrutiny. It’s important to be proactive and do the research on how products stack up against other options.
  • Science and doctors back vitamins — like folate and vitamin D — that provide the body with nutrients that help support a healthy pregnancy.* These may be covered by insurance, depending on your provider.
  • A prenatal vitamin with folate should be taken a month before trying to conceive (at a minimum!) to support fetal neural tube (brain and spine) development — but depending on the formulation, some prenatals may be balanced enough that you can take them way earlier than that.*
  • What science and doctors don’t support: supplements that claim to treat medical conditions like anovulation and infertility. For conditions like these, it’s better to stick to evidence-backed, FDA-approved treatments.

What’s considered a vitamin or supplement?

The words “vitamin” and “supplement” are often used interchangeably, but they’re not quite the same thing. Here’s the low down: Vitamins are naturally occurring nutrients, and while we should aim to get vitamins from the foods we eat, they can also be taken in pill/tablet/liquid/powder form. (Think vitamin A, vitamin C, etc.)

Over-the-counter vitamins have a single vitamin, and multivitamins have — you guessed it — multiple vitamins. Supplements are products that often have a combo of vitamins, minerals, and phytonutrients in them. (So... vitamins can be included in supplements — but not all supplements are vitamins.)

How are vitamins and supplements regulated?

In the United States, the Food and Drug Administration’s (FDA) job is to monitor our food, medications, medical devices, and cosmetics to make sure these products are safe for use and consumption. This monitoring process looks really different across categories — for example, the FDA’s monitoring process for mascara is entirely different than its monitoring process for your prescription birth control.

The FDA’s rules and regulations for vitamins and supplements are the same. According to the FDA, something falls under the category of “vitamin” or “supplement” if it is not marketed for the purpose of treating, curing, diagnosing, or preventing a disease or medical condition.

This is where the Federal Trade Commission (FTC) steps in: The FTC looks at the truth and accuracy of any claims made in dietary supplement advertising and marketing — and the FTC and FDA work together to monitor claims made on websites or in other online marketing. Vitamins and supplements can’t be marketed with claims like “will treat infertility" because that would be seen as a treatment/cure. Despite these regulations, it's always important to be a critical and careful consumer when evaluating your options for vitamins and supplements.

Here, we’ll review two main classes of products marketed toward women planning to conceive: prenatal vitamins and supplements, and infertility supplements.

Prenatal vitamins and supplements

Prenatal vitamins and supplements get two thumbs up from the medical community. Even for those of us eating the healthiest of meals, our food likely falls short of several crucial vitamins that are important for developing follicles and embryos.

Your typical prenatal supplement contains good stuff like folate, vitamin D, calcium, and iron, and it can be beneficial to take one even if you aren’t actively trying to conceive (TTC). It’s also possible (though not certain) that if you take a women’s daily supplement not specifically formulated for prenatal health, adequate amounts of this good stuff may already be included.

When should you start prenatals?

You should begin taking prenatal supplements before actively trying to have kids (or undergoing IVF procedures) because it may take time for the vitamins and minerals to get to optimal levels in the body. The American College of Obstetricians and Gynecologists' (ACOG) official rec is to get in 600 micrograms (mcg) of folate per day during pregnancy. But because folate can be hard to get enough of from food alone, ACOG suggests starting a prenatal with at least 400 mcg of folate at least one month before pregnancy to support fetal neural tube (brain and spine) development.*

Though there’s variability between brands, many prenatals (including our Prenatal Multi) have the same all-star lineup of active ingredients. Let’s briefly get acquainted with each.

Ingredient 1: Folate

Prenatal folic acid (a form of folate) supplementation is a big deal — such a big deal that it’s been praised as one of the greatest public health breakthroughs of the 20th century. A 1991 study of folic acid supplementation among women trying to conceive was actually stopped midway through because folic acid was so effective at supporting fetal neurodevelopment that they decided to give it to all of the women in the study.*

The recommended minimum amount of folate you should look for in a prenatal is 400 mcg so you can make sure you're getting that full 600 mcg a day (when combining supplementation with folate-rich foods). There are some reasons why more than the typically recommended amount of folate might be suggested to you (like medical history), so if you have questions about what's right for you, make sure to talk to your doctor.

Folic acid, folate, or methylfolate?
You may be hearing some buzz about the differences between folate, methylfolate, and folic acid in prenatal supplements.

Folate, also known as vitamin B-9, is the umbrella term for all forms of the nutrient, including the lab-made versions used in supplements:

  • Folic acid is the form of folate commonly found in processed foods, prenatal vitamins, and other dietary supplements.
  • Methylfolate (aka L-methylfolate, 5-MTHF, 5-methyltetrahydrofolate) is a biologically active form of folate, meaning it's easy for your body to absorb.

Ingredient 2: Iron

Iron is the building block for hemoglobin, which is a protein in blood cells that shuttles oxygen to organs and tissues throughout the body. The amount of blood you have increases by 30% to 50% during pregnancy; translated into raw numbers, if you had about 4,500 milliliters of blood while not pregnant, you’d have between 5,850 and 6,750 milliliters (mL) when pregnant. Extra iron is required to support this extra blood volume — recommended iron levels rise from 18 mg for nonpregnant adults to 27 mg during pregnancy — but national health data suggests that many people enter pregnancy already at an iron deficit (also called anemia).

To avoid iron deficiency during pregnancy, ACOG recommends all pregnant people get 27 mg of iron a day.* You can either get your daily iron levels from prenatal vitamins, iron-rich foods, or a combination of the two.

We designed the Modern Fertility Prenatal Multivitamin with 18 mg (the level set by the FDA for pre-pregnancy) of ferrous bisglycinate (which research demonstrates is associated with the fewest GI symptoms) so you can keep taking it long term. The balanced dose and iron form help minimize uncomfortable side effects — and vitamin C, which we also included, is shown to improve the absorption of any iron you're already getting.* When paired with iron-rich eating, the Prenatal Multi can help you meet your daily iron needs while keeping things easy on the tummy.

Ingredient 3: Choline

Prenatal nutrition has focused almost exclusively on folate (aka folic acid) for supporting fetal neural tube development.* However, recent research suggests that choline is equally essential in neurodevelopment, as well as for many other crucial functions.*

Juxtaposed to the increasing awareness of the importance of choline, national health data shows that 90%-95% of pregnant people in the US are not getting enough. How much is enough? For adults with ovaries, the recommended amount of choline is 425 mg per day. If you’re pregnant, ACOG's recommendation increases that level to 450 mg per day. During lactation (whether or not you're breastfeeding/chestfeeding), needs shoot up even higher to 550 mg per day. This is because growing another human is nutrient intensive — as that brain grows and develops in utero and postpartum, prenatal choline is required to build the brain cells and neural pathways.*

Widespread choline deficiency is partially attributable to the lagging supplement industry, as few prenatal vitamins provide choline — but the Modern Fertility Prenatal Vitamin is one of the few that does include it (along with 11 other key nutrients for before, during, and after pregnancy). We packed in as much choline as possible, 100 mg, while keeping the daily dose to 2 capsules and maintaining a balanced formulation.

Ingredient 4: Vitamin D and/or calcium

Vitamin D and calcium work together to promote the development of bones and teeth, and further work together in a second way: Vitamin D actually helps with calcium absorption.* Because developing babies get their calcium and vitamin D from their birthing parents while pregnant, it’s important for everyone's health to have adequate levels of these compounds. What are adequate levels? 600 international units (IU) of vitamin D, and/or 1,000 milligrams (mg) of calcium.

Many prenatal multivitamins don't have calcium in them — including the Modern Fertility Prenatal Multivitamin. That's because calcium can block the absorption of iron and absorption of calcium supplementation maxes out at ~500 mg. Both of these factors can make it difficult to put calcium alongside other nutrients in a prenatal. Instead, Modern Fertility opted for the calcium booster vitamin D.* (Read more about the decision here.)

Comparing prescription and over-the-counter prenatal vitamins

No matter how you get your prenatal vitamins, chances are they’ll have similar main ingredients. The main differences between prescription versus over-the-counter (OTC) prenatals come down to small differences in doses and how you pay for them.

Prescription prenatals often contain closer to the upper end of the recommended amount of a vitamin or mineral. For example, prescription prenatals may contain closer to 1,000 mcg of folic acid compared to the 400 mcg found in many OTC formulations — though the Modern Fertility Prenatal Multivitamin contains the full 600 mcg of folate recommended during pregnancy.

Depending on your insurance plan, prescription prenatal vitamins and supplements may be covered. You can also use your FSA and HSA dollars (refresher on what those are here) toward OTC prenatal vitamins. (Fun fact: You can also use those dollars for all Modern Fertility products, including the Prenatal Multi!)

Prenatals: Takeaways

  • Prenatal vitamins are designed to help you bridge the gap between what you're already getting from food and what nutrient levels are recommended at the time of conception.
  • Taking a prenatal supplement daily at least one month before conception (and then throughout at least the first trimester) is key to supporting healthy fetal development.*
  • The Modern Fertility Prenatal Multivitamin is packed with 12 essential nutrients recommended by OB-GYNs to help you support your body before, during, and after pregnancy.

It’s always a good idea to talk to your doctor (especially if you have any diagnosed medical conditions) before making any decisions or starting a supplement regimen to figure out what’s best for you.

Infertility supplements

Here’s where things get a little less… scientific and thus, recommendations aren’t so clear. The supplements that we talked about above are supplements that help support a healthy pregnancy, but they don’t make any claims about helping you get pregnant in the first place. There are, however, a whole host of supplements that do make such claims — claims like “promotes natural fertility,” “improves ovulatory performance,” and “improves your pregnancy chances.” Now, don’t get us wrong: It would be exceedingly great if there was scientific evidence to support supplements doing those sorts of things. Unfortunately, as of today, that evidence just doesn’t exist.

(Small caveat here: if you are severely malnourished and depleted, some of these supplements might help get you back to baseline. But this would only be the case for a small minority of women.)

In a recent market scan, scientists at the Center for Science in the Public Interest dug for evidence of effectiveness for 39 different women’s fertility supplements (you can see the full list here). They scoured company websites and contacted company service reps directly to get their hands on data showing these supplements did anything they claimed — made women ovulate more regularly, shortened TTC, prevented miscarriages, or otherwise helped cure infertility.

To their credit, a (very, very small) minority of companies did actually reference scientific studies. But overwhelmingly to their discredit, not a single referenced study found positive effects on ovulation, time to pregnancy, or pregnancy outcomes in women. In fact, most didn’t even look at these outcomes. One company referenced one published study (yay) that was conducted 78 years ago (yikes)… in men (double yikes).

The majority of companies pointed the investigating scientists to their customer reviews as evidence for their product being effective. While people’s experiences and opinions are certainly valuable (I for one spend entirely too long reading customer reviews before buying anything!), they are simply not a stand-in for science. They are not a stand-in for all the stuff us researchers nerd out over: large-scale, well-controlled, double-blind studies assessing different clinical endpoints like ovulation frequency and regularity, time to pregnancy, or pregnancy outcomes.

The danger in these so-called infertility supplements doesn’t lie in their ineffective chemical composition, but rather in the false sense of hope they may engender for those trying to conceive. Many of these supplements position themselves as “perfect natural alternatives to fertility drugs.” While FDA-approved fertility drugs might not be “natural,” we know they work and we know how they work — if we didn’t know these two key things, the drugs wouldn’t have gotten the FDA stamp of approval. Further, by suggesting women use infertility supplements rather than science-backed treatments, women are spending time and money on these supplements, both of which are precious and finite resources when it comes to reproductive health.

Infertility supplements: Takeaways

Supplements that claim to do things like cure infertility aren’t up to snuff when it comes to being backed by good research. If you or your partner think you may have a condition that could interfere with fertility, talk to a doctor who can help you get to the bottom of things and direct you toward treatments and interventions that do get the science thumbs-up.

Your best advocate in the fertility supplement world = you

Some companies may make some pretty bold claims about their products — and many claims around fertility often aren't backed by science. It's important to do your research on the company and formulation before spending money on something that might not work the way you're hoping it will.

If you're planning on trying to get pregnant in the next year or so, you can schedule a preconception appointment and talk to your healthcare provider about any supplements you're considering. While prenatal vitamins will absolutely be a top recommendation, they might be able to provide insight into any other supplements or vitamins you're thinking about taking. Make sure to mention all the medications, vitamins, and supplements you're currently taking so they can keep all that in mind while providing guidance.

Taking a prenatal supplement is one major way to get proactive about your fertility. If you’re looking for more ways to plan ahead, you can consider things like fertility hormone testing to check in with your hormones. Our goal is to give you everything you need to be proactive about your reproductive health and start important conversations with your partner, your friends, and your doctor.

This article was medically reviewed by Dr. Nataki Douglas, the Chair of the Modern Fertility Medical Advisory Board, as well as Dr. Jane van Dis, co-founder and CEO of Equity Quotient, and Medical Director for Ob Hospitalist Group.

*This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease.

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Talia Shirazi, PhD

Talia is a clinical product scientist at Modern Fertility. She's passionate about reproductive health + behavioral neuroendocrinology. Talia received her PhD in biological anthropology at Penn State.

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