Is it safe to take Ashwagandha (Withania somnifera) root 350mg, Maca (Lepidium meyenii) root powder 100mg, and Chaste tree (Vitex agnus-castus) berry 100mg during the luteal phase while undergoing fertility treatment with prescription progesterone?

Safety of Herbal Supplements During Luteal Phase with Prescription Progesterone

The combination of Ashwagandha 350mg, Maca 100mg, and Chaste tree berry 100mg during the luteal phase while on prescription progesterone should be avoided or used with extreme caution, as there is insufficient safety data and potential for hormonal interference with fertility treatment.

Critical Safety Concerns

Chaste Tree Berry (Vitex agnus-castus)

• Chaste tree berry is classified as "possibly unsafe in pregnancy" and has theoretical uterine stimulant and emmenagogue (menstruation-inducing) activity 1
• The herb may have both estrogenic and progesteronic activity based on in vitro studies and expert opinion, which could interfere with prescribed progesterone supplementation 1
• During the luteal phase, when progesterone support is critical for implantation and early pregnancy maintenance, any substance with hormonal activity poses theoretical risk 1
• At 100mg daily, this dose falls within commonly used ranges, but safety during fertility treatment is not established 2

Ashwagandha (Withania somnifera)

• While Ashwagandha has been studied for sexual function and general reproductive health, there is no high-quality evidence supporting its safety specifically during fertility treatment or early pregnancy 3, 4
• The herb affects hormonal pathways including luteinizing hormone and follicular stimulating hormone balance 3
• Any hormonal modulation during the critical luteal phase could theoretically interfere with implantation or early pregnancy development 3

Maca (Lepidium meyenii)

• Maca is commonly used by women seeking fertility treatment, with 6 patients in one academic infertility practice survey reporting its use for fertility purposes 2
• However, there is no robust evidence for safety or efficacy during active fertility treatment with prescription medications 2

Drug Interaction Risks

Moderate-Risk Interactions

• In a survey of women undergoing infertility treatment, 41 moderate-risk supplement-drug interactions were identified, with 12 specifically attributed to infertility therapies 2
• The most common proposed mechanisms were CYP3A4 and CYP2C19 inhibition, which could affect metabolism of prescription fertility medications 2
• Progesterone metabolism may be affected by herbal supplements through these cytochrome P450 pathways 2

Evidence Quality Assessment

Lack of High-Quality Data

• There are insufficient data to recommend herbal therapies for treatment of female infertility based on very low quality evidence 5
• The methodological quality of most studies on herbal therapies for reproductive health is poor, with significant heterogeneity preventing robust conclusions 5
• No high-quality randomized controlled trials exist examining these specific supplements during luteal phase progesterone supplementation 5

General Supplement Evidence

• Multiple micronutrients and antioxidants showed increased live birth rates in women utilizing medically assisted reproduction, but this evidence is of very low certainty 6
• The available evidence is insufficient to recommend nutrient supplementation to improve female infertility in women trying to conceive naturally or utilizing MAR 6

Clinical Recommendations

Disclosure and Communication

• Only 33.3% of patients disclosed supplement use to their healthcare providers in one study 2
• Women should be explicitly asked about all herbal supplement use during fertility treatment 2
• Healthcare providers should counsel patients that 7.9% learned about supplements from general healthcare providers, highlighting the need for specialized fertility-focused guidance 2

Risk-Benefit Analysis

• While there is currently no indication that these nutrients pose significant harm based on available evidence, the theoretical risks during the critical luteal phase outweigh any unproven benefits 6
• The luteal phase is a particularly vulnerable time when hormonal balance must be precisely maintained for implantation and early pregnancy 1

Alternative Approach

• If patients are interested in nutritional support during fertility treatment, focus should be on evidence-based prenatal vitamins and folic acid supplementation rather than herbal products with hormonal activity 6
• Discontinue chaste tree berry, ashwagandha, and maca at least one full cycle before beginning progesterone supplementation 1

Common Pitfalls to Avoid

• Do not assume herbal supplements are safe simply because they are "natural" - many have significant hormonal activity 1
• Do not continue supplements started before fertility treatment without reassessing their appropriateness during active treatment 2
• Do not fail to ask specifically about herbal supplement use, as patients may not volunteer this information 2