Omega-3 Supplementation for Fertility
Women trying to conceive should take omega-3 fatty acid supplements containing at least 250 mg combined EPA and DHA daily, as this is associated with a 51% increased probability of conception compared to no supplementation. 1
Evidence-Based Recommendations for Women
Omega-3 Fatty Acids (EPA and DHA)
- Take 250 mg combined EPA + DHA daily as a minimum baseline for cardiovascular and reproductive health 2
- Add an additional 100-200 mg of preformed DHA specifically for reproductive optimization, bringing total DHA to approximately 300-400 mg daily 2
- The most robust prospective cohort data shows omega-3 supplementation increases fecundability ratio to 1.51 (95% CI 1.12-2.04), meaning a 51% higher probability of conceiving per cycle 1
- A 2024 meta-analysis of 10 trials involving 4,396 women demonstrated significant improvements in both natural conception (OR 1.36) and assisted reproduction pregnancy rates (OR 1.74) with omega-3 supplementation 3
Practical sources: Consume 8-12 ounces per week of low-mercury seafood (salmon, sardines, anchovies) or take fish oil/algae-based DHA supplements 4. Avoid high-mercury fish including tilefish, shark, swordfish, and king mackerel 2, 5.
Omega-6 Fatty Acids
- No specific supplementation is recommended for omega-6 fatty acids when trying to conceive 6
- Serum omega-6 concentrations (including linoleic acid and arachidonic acid) show no association with probability of conception or miscarriage risk in natural fertility studies 6
- Most Western diets already contain excessive omega-6 relative to omega-3, creating a pro-inflammatory state 7
- Focus on improving the omega-6 to omega-3 ratio by increasing omega-3 intake rather than adding omega-6 supplements 7
Omega-9 Fatty Acids
- No supplementation is necessary for omega-9 fatty acids (oleic acid) as these are non-essential and synthesized by the body 2
- Omega-9 is commonly used as a placebo control in fertility trials, indicating no specific reproductive benefit 6
Comprehensive Preconception Supplement Protocol
Essential Supplements (Start 3-6 Months Before Conception)
Beyond omega-3s, women planning pregnancy require a complete preconception regimen 8, 9:
Folic Acid Dosing Algorithm:
- Standard risk: 400-800 mcg (0.4-0.8 mg) daily 2, 8
- High risk (BMI >30 kg/m², diabetes, prior neural tube defect, antiepileptic drugs): 4-5 mg daily starting 3 months before conception, continuing through 12 weeks gestation, then reduce to 400 mcg 2, 8, 5
Daily Multivitamin Must Contain:
- Iron: 45-60 mg elemental 2, 9, 5
- Vitamin D: Maintain serum ≥50 nmol/L 8, 5
- Calcium: 1200-1500 mg in divided doses (separate from iron by 2+ hours) 8, 9
- Zinc: 8-15 mg 2, 9
- Copper: 2 mg 2, 9
- Selenium: 50 mcg 2, 9
- Thiamine: >12 mg 2, 9
- Vitamin E: 15 mg 2, 9
- Beta-carotene (NOT retinol): 5000 IU 2, 9
Recommendations for Men
While preconception care for men is less well-defined, the following factors impact partner fertility 2:
- Address modifiable health conditions: diabetes, erectile dysfunction, testicular disorders 2
- Eliminate tobacco smoking and treat sexually transmitted infections, as these directly affect partner pregnancy outcomes 2
- General omega-3 supplementation (250 mg EPA+DHA) may be beneficial based on cardiovascular data, though fertility-specific evidence in men is lacking 2
Monitoring Requirements
Before conception, check every 3 months: 2, 9
- Serum folate or red blood cell folate
- Serum vitamin B12
- Ferritin and complete iron studies
- Complete blood count
- Serum vitamin A levels
Before conception, check every 6 months: 2, 9
- Serum 25-hydroxyvitamin D with calcium, phosphate, magnesium, and PTH
- Zinc, copper, and selenium levels
- Liver and renal function tests
Critical Caveats
Timing is essential: Neural tube closure occurs within 28 days after conception, often before pregnancy recognition, making preconception supplementation mandatory rather than optional 2, 8. Starting supplements after a positive pregnancy test is too late to prevent neural tube defects 2.
Avoid retinol form of vitamin A: Use only beta-carotene during preconception and pregnancy due to teratogenicity risk of preformed vitamin A 2, 9.
Calcium-iron interaction: Separate calcium and iron supplements by at least 2 hours to prevent absorption interference 9.
Quality matters for omega-3 products: Choose supplements with appropriate antioxidant content and verified low levels of dioxins and PCBs 7. Third-party testing certification is advisable.
Conflicting serum level data: While supplementation studies show benefit 3, 1, one study found no association between baseline serum omega-3/omega-6 concentrations and natural fertility 6. This discrepancy likely reflects that supplementation actively modifies the inflammatory balance, whereas a single serum measurement may not capture dynamic changes across the menstrual cycle 6.