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Should You Take Nutritional Supplements for Fertility?

Dr. Gleicher discusses CHR's position on nutritional supplements, vitamins, herbs and other over-the-counter "fertility enhancers." It's important to keep in mind that many supplements are really only necessary when a patient demonstrates abnormal levels and the substantial expense this regimen can add to an already expensive treatment plan.

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I want to talk to you today a little bit about nutritional supplements. Those over the counter products have increasingly become popular. And today, their use is so significant that we have to start considering it somewhat excessive. And therefore it seems time to address it a little bit. But before I go into detail, a little point of notice for all of you listeners about the potential conflict that we have here at the Center for Human Reproduction. In the US, we have a rather peculiar legal situation that DHEA (dehydroepiandrosterone) which is a hormone that we all, both men and women, are constantly producing in our bodies, it is considered a food supplement. In most other countries, it is actually a controlled substance because it has been in the past quite widely abused by athletes, particularly body builders. But in the US, for some funny legal reasons, it has for quite a number of decades been considered a food supplement and therefore it is widely available over the counter without prescriptions. CHR is holding a number of patents for DHEA and therefore we have a potential conflict if we want to consider DHEA as a food supplement because we are getting royalties. Some of us physicians and CHR are getting royalties from companies that are producing DHEA with a claim that it enhances female fertility. So I will come back to this point at a later part of this presentation, but I just want everybody to be aware that at least hypothetically, there is such a financial conflict here. Now, coming back to the general use of supplements, obviously those started with supplementing vitamins and vitamins are not only supplemented in infertility patients, but they are widely used and they are widely overused because most people, as many studies have shown, really do not need vitamin supplementation. There are some exceptions. For example, in pregnancy it is very well established that folate (vitamin B) complex vitamin helps in reducing neural tube defects in offspring, so that is widely recommended. Folate supplementation before pregnancy is indeed already indicated and therefore even patients who are in fertility treatment should take folate either as a separate pill or as part of a multivitamin, of a prenatal vitamin for example. Another vitamin that indeed particularly in the northern sphere very frequently can be low in patients is vitamin D because vitamin D is obviously influenced by exposure to sun. Many patients, many infertility patients therefore, when tested, show low vitamin D levels and indeed there have been in recent years a few studies that suggested that low vitamin D may have negative connotations for female fertility. We studied this here at CHR and we actually have a paper coming out in a few weeks to months, where we were unable to show that kind of effect of vitamin D, in other words, when we studied quite a large number of patients, we did not find any effect on IVF outcomes depending on vitamin D levels. We therefore have become much much more cautious in recommending vitamin D supplementation and we definitely supplement only if a patient has proven low levels. And that principle, we believe, should really apply to all vitamins. Don't supplement automatically. Some fertility centers now give their patients a long list. I've see a list of probably 15 or maybe even more supplements from one prominent IVF center. If you just add up the cost of all of these vitamins, you add significant additional expense to your IVF treatment which is, even otherwise more than expensive enough. So, our strong recommendation is don't over do it. If you have abnormal vitamin levels, supplement but otherwise stay away. Now besides vitamins, there are also all kinds of herbs out there that are being promoted for use in fertility or in preparation for pregnancy. Once again, our experience with herbs has not been very encouraging, in other words, we have not seen any particular effect from supplementing with various herbs. As asian, Chinese, medicine has increased in popularity, the use of Chinese herbs has greatly increased and we see lots of patients who are on Chinese herbs when they are coming to us. The problem with Chinese herbs is two fold. First, many of them contain hormones, particularly estrogens, and therefore they can interfere with our hormonasis. A second problem is that at least one study from European colleagues demonstrated quite significantly lower IVF pregnancy rates in patients who used herbal supplements, so we here at CHR are very cautious and recommend to our patients who are on herbs when they come to us that they discontinue those. There are obviously also a whole lot of combination products out there in the market, usually combining various so-called "natural" ingredients. The interesting aspect is, and we studied that, that most of these products have not really been studied And so when they're being sold or advertised to the public as supporting fertility, those claims are really rather tenuous and frequently they are based on claims that have been made in a study here and there for individual components of that combined product. So once again, there is usually no harm in taking those products, except maybe to your pocketbook, but we here at CHR certainly do not recommend most of these products and therefore, if you want to take them, you're welcome but if you are not particularly convinced, take it from us, you probably really don't need them.

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