Are There Ways to Improve Fertility?

One of the most common questions I get asked is about unconventional ways to improve fertility, especially by eating certain foods. I’ve heard everything from papaya and pineapple to french fries (McDonald’s french fries, to be specific). Patients often ask me whether things like getting acupuncture or taking certain supplements can make a difference too. It’s only natural when you’re trying to conceive that you want to do everything in your power to improve your fertility. 

Overall, many of the common questions around fertility have very poor-quality to no evidence around them. Many of them have been studied only on women with infertility who are undergoing fertility treatments. This doesn’t necessarily mean that you shouldn’t try any of these things. Not having data to support something means just that: there isn’t data. You can still try it, but if it adds much more stress to your life, it may not be worth the time and energy.

But as long as a thing is not harmful, I’m an advocate of talking to your provider, partner, and anyone else who helps you make the decision that makes sense for you. That means weighing the risks alongside any potential benefit, and understanding that it may not be a magic fix. 

Let’s break down the data we do have for some of the most common fertility questions:

• Does birth control make you infertile?
• Can certain foods or diets improve your chances of conceiving?
• Can certain supplements increase egg quality?
• Can acupuncture improve fertility? 

Note: I am not going to get into the data on the links between fertility and lifestyle factors (such as alcohol, marijuana, and exercise), BMI, or environmental concerns here. These are more complex topics that need to be addressed separately. 

Does birth control make you infertile?

Let’s start with the elephant in the room: birth control. 

Hormones, generally, get a bad rep. Many people believe that birth control, especially those that contain estrogen — so, your typical combined birth control pills, patches, or vaginal rings — have a negative effect on fertility. This concern is understandable: when birth control pills first came on the market in the 1960s, there were reports that they delayed the normal return of menstrual cycles for more than a year after stopping them (so-called “post-pill amenorrhea syndrome”). These reports have since been disproved, and modern birth control pills contain much less estrogen than those early pills did anyway, essentially making them different medications.

But there’s another reason people believe this: they (or a friend) stop birth control pills and have problems. To be clear, this isn’t common. The majority of people resume normal menstrual cycles right away after stopping, and if not right away, then by the three-month mark. But some people don’t, and it’s not the birth control that causes this. 

There have been many studies that have shown that there is no association between short- or long-term use of hormonal birth control and a delay in return of fertility. This review does a good job of compiling the results from 17 such studies and takes a broad look at what the data says about the fertility impact of all forms of birth control, even those with only progestins (like the hormonal intrauterine device, or IUD). The authors found that pregnancy rates after one year of discontinuation are broadly similar to those of after discontinuation of barrier methods (like condoms) or not using birth control at all. 

There’s also the fact that all birth control methods have a failure rate, which is to say that some people get pregnant even while on birth control (when taken correctly or not). 

We’re so confident that birth control does not have an impact on fertility that many IVF plans start with a course of birth control pills to help with cycle timing, help the eggs grow at a similar rate, and/or prevent cysts on the ovaries. 

If you notice that your cycles are irregular or absent after stopping any form of birth control, or if you end up needing fertility treatments, it is likely that the birth control was masking something else that is going on, like polycystic ovary syndrome (PCOS), by helping to regulate your cycles. This is why it’s a good idea to stop birth control a few months before you are ready to conceive, though you should have a backup method of birth control if you’re not quite ready to get pregnant the moment you stop birth control. 

Can certain foods or diets improve your chances of conceiving?

Overall, there’s no data to support that any specific food improves fertility (sorry, pineapples), but I can’t stress enough that this is an area where better data is needed. There are no randomized controlled trials about diet and fertility, so we have to rely on several small studies that have found only associations (and some that have found no associations). 

With that being said, several small cohort studies have found that maintaining an overall healthy diet may have a beneficial effect on fertility, particularly for infertility related to issues with ovulation (ovulatory dysfunction). 

By a healthy diet, I mean diets with high levels of monounsaturated fats (think: fats that are oils at room temperature, like olive oil), proteins from vegetables (like tofu and beans), low-glycemic carbohydrates (like pasta), high-fat dairy, and iron from plants and supplements — all of which was what this study found was associated with a lower risk of ovulatory dysfunction infertility. Keep in mind that these are all correlations, and it is not clear which of these components mattered. 

Women undergoing IVF (with intracytoplasmic sperm injection, or ICSI, specifically) who strictly adhered to a Mediterranean diet — which emphasizes fruits, vegetables, legumes, and fish and minimizes non-fish meat — were found in this study to be 40% more likely to conceive than women who had a looser adherence to that diet. It’s difficult to know if this is correlation or causality, however, since people who eat this way tend to share many other individual characteristics (i.e. higher education, higher income, etc.). Other specific diets, like vegetarian, low-fat, keto, and paleo, have not been shown to improve fertility.

My take is that even if we haven’t yet found a clear benefit for fertility, we know that maintaining a healthy diet is important. So it’s a good idea to eat as healthily as you can. 

Can certain supplements increase egg quality?

Many people wonder if there are any supplements that they can take to either improve egg quality or prevent or slow down age-related fertility decline. 

When evaluating the efficacy of any particular supplement, it is very important to understand that supplements are not regulated by the FDA, or any other agency for that matter. That means there is no one making sure that what’s on the label is indeed what is in a supplement, in the amount advertised, and that there is nothing else added. There’s also no requirement to prove that supplements do what they are advertised to do, in clinical trials or any other research. Keep that in mind when taking any supplement, let alone those claiming to improve your fertility. 

The most commonly taken supplements for fertility are dehydroepiandrosterone (DHEA) and coenzyme Q10 (CoQ10), so I’ll be focusing on these here. I recommend that you discuss supplements with your doctor and ask about their protocols before starting to take them.

DHEA

DHEA is a hormone that your body naturally produces and is converted to testosterone in the body. Both are important for reproductive function. The thought is that because DHEA levels decrease starting in your late 20s alongside fertility, low levels are detrimental to egg development. 

There has been a lot of research on DHEA and fertility, and this meta-analysis compiles the evidence from the highest-quality studies. The authors conclude that DHEA supplementation is associated with increased pregnancy outcomes in patients with diminished ovarian reserve (DOR) who are undergoing IVF with ICSI. Still, the numbers of patients included in these studies are small — even pooled, the total is fewer than 1,000 — and other studies do not show a benefit. 

This could point to DHEA, if taken in the prescribed amounts, being helpful for only a small group of people who are undergoing fertility treatment, but the data is not quite there to make it really clear who will and won’t benefit. DHEA has not been found to be beneficial for those with normal ovarian reserve; it has been studied only in women with DOR. So this may be one clue, but more data is needed.

But you should use caution with how much DHEA you take. Remember how I said it is converted to testosterone? If taken in too high amounts, it can cause testosterone levels to become too elevated, which can in turn cause irreversible bodily changes — like voice deepening and hair growth on your chin. Too much testosterone can also cause changes in your ovaries that can lead to worse outcomes after fertility treatment. 

CoQ10

CoQ10 works as an antioxidant, decreasing the damaging effects of free radicals — harmful waste products generated as your body reacts to the environment — on the reproductive system. CoQ10 levels also decrease with age, so the idea is that supplementation will help reduce damage to the reproductive system. 

Again, there is no great data here. This randomized controlled trial showed that pretreatment with CoQ10 prior to an IVF cycle resulted in a need for lower doses of medication, a higher chance of healthy embryos, and a slightly higher pregnancy rate compared with not taking CoQ10. Although randomized controlled trials are the gold standard, this is only one trial with small numbers (186 women included total), so we have to be careful with how far we take these results. 

Can acupuncture improve fertility?

Many fertility clinics offer in-house acupuncture as an adjunct to fertility treatment. There has been a lot of research on the use of acupuncture in two settings in particular: for treatment of PCOS and prior to an embryo transfer. 

Acupuncture for PCOS

PCOS causes infertility through irregular or absent ovulation. An egg is needed for a pregnancy, and it can be very difficult to time sex if you can’t predict your ovulation. 

This meta-analysis does a good job of compiling the highest-quality studies looking at this question. In the end, eight randomized controlled trials were included, and they either compared true acupuncture versus sham acupuncture (aka just sticking needles into the body randomly), true acupuncture versus relaxation, true acupuncture versus clomiphene (a medication that can be used to help those with PCOS ovulate), low-frequency electroacupuncture versus physical exercise or no intervention, and true acupuncture versus combined birth control pills.

Overall, the authors note that the main limitations were failure to report important clinical outcomes and very serious imprecision issues. For example, no study reported data on live birth rate or multiple pregnancy rate for the intervention that was being compared with acupuncture. Thus, the authors conclude that the evidence was very low-quality and so they are unable to determine either way whether acupuncture is helpful for PCOS. 

Acupuncture for embryo transfer

Here we have the benefit of another meta-analysis, this time one that includes 20 trials. The authors found that when comparing acupuncture with doing nothing, acupuncture before an embryo transfer improved live birth rates and reduced miscarriage. But when comparing acupuncture with sham acupuncture, there was no difference in outcomes. Again, the authors conclude that more research is needed, especially for women with poorer IVF outcomes.

The bottom line

• There is substantial evidence that hormonal birth control does not have a negative impact on fertility after stopping it. Hormonal birth control can cause a decrease in the markers of ovarian reserve while on it, which can last for three months after stopping.
• There is very poor-quality evidence that diet may be helpful for avoiding ovulatory dysfunction infertility or improving IVF outcomes.
• DHEA supplementation is associated with increased pregnancy outcomes in patients with diminished ovarian reserve, and taking CoQ10 prior to an IVF cycle may help improve outcomes. However, we need more data for both. Discuss these choices with your doctor.
• There is not enough evidence to definitively say that acupuncture is helpful for either treating PCOS or improving embryo transfer outcomes. 
• Overall, many of the common questions around fertility have very poor-quality to no evidence around them. This doesn’t necessarily mean that you shouldn’t try any of these things. Not having data to support something means just that: there isn’t data. You can still try it, but if it adds much more stress to your life, it may not be worth the time and energy. 

We recognize that readers of ParentData identify in different ways — read more about our approach to gender-inclusive language here.

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