Natural products and fertility

Dr Charmaine Ma, BSc(Pharm), MD, Dip Fam Med (HK), CCFP

Natural health products are often a topic that comes up during consultations. Many people are interested in improving their health through non-medicinal supplementations. But do we really need them? And when we buy them, do we know if they are safe?

Natural Product Number

The first thing I tell my patients when looking for a natural health product is to check its source. Back in the 2004 the Government of Canada implemented the Natural Health Products Regulation under the Food and Drugs Act to protect the public and ensure that all self-claimed natural products contained the ingredient it claimed in the amount published. The stringent licensing process also ensures safe production facilities prior to granting an NPN (natural product number).

Are there specific brands that are better than others?

Various drug companies make different natural health products. The most important thing is that the product receives proper licensure and regulation from our FDA (through a Natural Product Number- see previous section). Furthermore it is important to make sure to compare ingredients and also read the instructions on the label. Some companies make products that require it to be taken multiple times a day or in multiple doses to reach its ideal dose. Price is often not a major defining point when differentiating between ‘good quality’ vs. ‘poor quality’ products, especially in common supplements (such as folic acid or vitamins and minerals). Some private companies will have a hefty price tag claiming better absorption or safety but lack regulation from the government. 

Check for interactions

If you are taking prescription medications or other over the counter products make sure you check with your pharmacist or doctor before starting any new supplements. Although a natural health product is called ‘natural’ it can potentially be very dangerous for you if it competes with the way your medications works or is cleared from your body. Side effects from medications or natural products may potentially be accentuated if they interact.

How much is enough?

When I worked as a pharmacist I would often see patients on multiple supplements or over the counter medications that contained the same product. This runs a risk of exceeding our “tolerable upper intake level” of any given supplement product. The government of Canada has released a good reference guide for some common vitamins, elements and nutrients (see Dietary Reference Intake Tables below). When in doubt ask your pharmacist or doctor about how much you should be taking and be aware of taking multiple products containing the same ingredients. 

Check your own eating habits

The question of whether you need supplements really depends on whether or not your body is lacking them. Out of all the vitamins only vitamins A,D, E and K are stored in our body when taken in excess of what it needs. In other words, other vitamins are simply cleared out of our body through liver or kidney. Taking too much of a product runs the risk of harm to the body while taking too little runs the risk of deficiency. So if you keep a specific type of diet, or a restricted diet of any sort, talk to your physician or dietitian about whether you need to supplement.

Can I get some supplements from food?

Other than some specific supplements that I recommend in particular circumstances (e.g. Folic acid in women thinking about pregnancy or iron supplementation in iron-deficiency anemia) I usually encourage my patients to seek food sources of nutrients. The Dietitians of Canada website has comprehensive lists of food sources of many nutrients such as calcium, folic acid and iron. They specify how much is needed in each age group and follows with a long list of food sources as well as serving size and amount of nutrients per serving (see below for link). This is a website that I often go back to even for nutritional planning for my own family.

Fertility effects?

There are no conclusive human trials in literature currently to support the use of specific supplements. But there is ongoing research for the effectiveness and safety of various products including:

Vitamin E- One study showed improved pregnancy rates with oral Vitamin E supplementation in men with low sperm count or poor motility. Another study of men in IVF trials showed increased fertilization rates after three months of Vitamin E. The combination of Vitamin E and Selenium or Vitamin C, however, did not appear beneficial.

L-carnitine- Studies show conflicting results but some clinical studies show L-carnitine (especially when taken orally in conjunction with acetyl L-carnitine) increases sperm count and mobility in men with infertility.

Coenzyme Q10- Preliminary research shows that taking daily oral coenzyme Q10 300mg may increase sperm mobility and density in men with low sperm count and poor sperm motility but this did not seem to significantly increase pregnancy rates.

Also there is some evidence that in a 600mg oral daily dose, it may improve egg quality. More research needs to be done before a definitive recommendation can be made regarding coenzyme Q10.

Vitamin C- There is preliminary evidence that suggests women who do not ovulate or have low progesterone may increase their progesterone levels with oral intake of Vitamin C.

Vitamin D- There is some evidence that 2000IU of oral Vitamin D daily can improve egg quality.

Inositol- This supplement when taken at 4g daily may improve insulin sensitivity in women who are diabetic or have problems with polycystic ovarian syndrome (PCOS). 

Zinc- Men should consider a multivitamin with vitamins C, E and zinc to help in sperm production.

Omega oils- There is some potential in omega oil supplements being beneficial to both men and women.

 

References:

  1. Government of Canada. About Natural Health Product Regulation in Canada. Available at: URL: https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-non-prescription/regulation.html
  2. Government of Canada. Dietary Reference Intake Tables. Available at: URL: https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/dietary-reference-intakes/tables.html
  3. Dietitians of Canada. Food sources. Available at: URL: https://www.dietitians.ca/search.aspx?searchtext=food+sources&searchmode=exactphrase
  4. Vitamin E. Natural Medicines Database. Accessed July 5, 2019. Available at: URL: https://naturalmedicines.therapeuticresearch.com
  5. L Carnitine. Natural Medicines Database. Accessed July 5, 2019. Available at: URL: https://naturalmedicines.therapeuticresearch.com
  6. Coenzyme Q10. Natural Medicines Database. Accessed July 5, 2019. Available at: URL: https://naturalmedicines.therapeuticresearch.com
  7. Vitamin C. Natural Medicines Database. Accessed July 5, 2019. Available at: URL: https://naturalmedicines.therapeuticresearch.com
Dr. Charmaine Ma, BSc(Pharm), MD, Dip Fam Med (HK), CCFP