Omega-3 Supplementation for Individuals Trying to Conceive
Yes, individuals trying to conceive can and should consider using omega-3 (EPA/DHA) supplements, as evidence suggests potential fertility benefits with an excellent safety profile.
Evidence Supporting Omega-3 Use During Conception Attempts
Fertility Benefits
Women taking omega-3 supplements had 1.51 times the probability of conceiving (95% CI 1.12-2.04) compared to women not taking omega-3s in a prospective cohort study of 900 women attempting natural conception 1
In women with polycystic ovary syndrome (PCOS), omega-3 supplementation during ovulation induction resulted in clinical pregnancy rates of 26.7% versus 13.3% with placebo 2
Among overweight/obese women with PCOS (BMI 25-35), the benefit was even more pronounced: 29.6% pregnancy rate with omega-3 versus 5.3% with placebo (P < 0.04) 2
Lack of Harm to Natural Fertility
Serum omega-3 concentrations showed no negative association with natural fertility, miscarriage risk, or ovarian reserve (AMH levels) in a study of 200 women 3
No harmful side effects from omega-3 treatment were reported in fertility studies 2
Recommended Approach for Preconception
Dosing Recommendations
For women planning pregnancy, consume at least 200-300 mg of DHA daily, with a total of at least 300 mg combined DHA+EPA 4
The omega-3 supplements used in the successful fertility study included various formulations, with one PCOS study using 1,800 mg/day (3 × 600 mg capsules) 2
For cardiovascular benefits in women with hypercholesterolemia/hypertriglyceridemia, EPA 1,800 mg/day may be considered 4
Supplement Selection and Sources
Choose fish oil supplements with added antioxidants (including vitamin E) to prevent oxidation 4
Alternative plant-based options include algal oil supplements for those who don't consume fish 4
Dietary sources: consume fish (especially oily fish) at least twice weekly 4
Avoid high-mercury fish (shark, swordfish, king mackerel, tilefish) 4
Storage and Handling
Safety Considerations
Excellent Safety Profile
Omega-3 supplements can be safely continued throughout the preconception period and into pregnancy without interruption 5, 4
Unlike many herbal supplements that must be discontinued before procedures, omega-3s do not increase bleeding risk and can be continued even through surgery 5
Potential minor side effects are limited to gastrointestinal symptoms (dysgeusia, eructation, nausea), mild dermatological reactions, or minor biochemical changes 4
Monitoring Considerations
For women taking antiplatelet or anticoagulant medications, monitoring of coagulation parameters may be warranted 4
Very high intake may theoretically cause issues, though this is not seen at recommended doses 6
Clinical Context and Mechanism
Why Omega-3s May Improve Fertility
Omega-3 fatty acids play important roles in reproduction, with DHA being a major component (approximately 25%) of brain membrane phospholipids 4
These fatty acids have anti-inflammatory properties that may support reproductive function 5
EPA and DHA are essential fatty acids that can only be obtained from diet, and requirements likely exceed non-pregnant states 7
Target Omega-3 Index
The Omega-3 Index (EPA+DHA in erythrocytes) target range of 8-11% suggested for cardiovascular health may also pertain to pregnancy and lactation 6
Most women have levels below this target range with large interindividual variation, even with supplementation 6
Important Caveats
The evidence base has limitations: The strongest fertility study was observational rather than a randomized controlled trial, and women using omega-3s may represent a more health-conscious population 1. However, the consistent lack of harm combined with potential benefits and the critical role of omega-3s in early fetal development strongly support their use during conception attempts.
Dosing variability exists: Studies used various omega-3 formulations and doses, making specific dose-response relationships unclear 1. Despite this, the recommended range of 300+ mg combined EPA/DHA daily represents a reasonable, evidence-based target 4.