By Kim Ross, DCN, CNS, LDN, IFMCP⁺

Supporting Female Fertility with Nutrition

1. Introduction
2. The Role of Diet in Fertility
3. Nutrients that Support Fertility
4. Pure Encapsulations Nutrient Solutions
5. Conclusion
6. Resources

Introduction to Fertility Support

Over 15% of women between the ages of 25-49 are seeking fertility support from their healthcare providers.¹

Fertility refers to the natural ability to reproduce and conceive a child within 1 year of regular, unprotected intercourse. Successful fertility is dependent on factors impacting the male and female, including:

• Healthy production of sperm and eggs
• Unblocked fallopian tubes allowing the sperm to reach the egg
• Fertilization of the egg by the sperm
• Implantation of the fertilized eggs in the uterus
• Sufficient embryo quality

Female fertility also depends on healthy ovulation and reproductive anatomy as well as balanced hormones (estrogen, progesterone, luteinizing hormone, follicle-stimulating hormone). As women reach their 30s, they are about half as fertile as they were a decade before.² Unsuccessful conception resulting from factors impacting female, male or both partners’ health has resulted in as many as 1 in 6 people worldwide adapting their initial fertility plans.^2,3

This blog explores how diet and several key nutrients can impact fertility potential for women.

The Role of Diet in Fertility

Diet is a key modifiable factor influencing reproductive health. Research indicates that dietary patterns and specific nutrient intakes can affect fertility outcomes.⁴ Nutritional status can influence hormone production, ovulatory function and the quality of gametes and implantation environment. Clinically, maintaining a balanced diet and healthy body weight is often recommended as part of preconception care to optimize fertility.

Healthy dietary patterns rich in plant-based foods, such as the Mediterranean Diet, have been associated with higher chances of conception and improved outcomes in those undergoing assisted reproductive treatments. Similarly, a vegan/vegetarian diet, rich in plants and antioxidants, can positively impact fertility by reducing oxidative stress. A ketogenic diet, which reduces high-carbohydrate foods and increases quality fat, appears to be most beneficial for fertility outcomes in women who are overweight.⁴

In contrast, Western-style diets high in refined carbohydrates, saturated fats and processed foods impact fertility potentially through ovulation, changes in glucose and insulin regulation and increased cytokine production.⁴

General Dietary Guidelines:

There isn't one dietary pattern that is ideal for all women!

The best food plan will be one that your patient can adhere to with high compliance and includes personal food preferences and honors cultural beliefs and traditions while supporting overall health.

Nutrients that Support Fertility

Several micronutrients play specific physiological roles in female reproduction. Insufficient intake or deficiencies in these nutrients may impact ovarian function, egg quality or early embryonic development. Here are key nutrients, evidence for their roles in supporting female fertility and common dietary sources (Table A).

B Vitamins (B₆, Folate, and B₁₂)

Physiological role: B vitamins are critical for DNA synthesis, methylation reactions and hormone metabolism. Folate (vitamin B₉) and vitamin B₁₂ work together in one-carbon metabolism to support DNA replication in rapidly dividing cells (such as oocytes and early embryos). Vitamin B₆ acts as a coenzyme in amino acid metabolism and neurotransmitter synthesis, which can indirectly influence hormonal balance. Folate is also known for its important role in neural tube closure. Since this occurs around days 28-29 of pregnancy, usually before a woman knows she is pregnant, preconception consumption of adequate folate intake is critical.

Evidence: In the Nurses' Health Study II, women taking multivitamins with folic acid, as well as the intakes of B₆ and B₁₂, supported fertility.⁹ Another study found that adherence to a folate-rich, vitamin B₆–rich diet correlated with higher folate and B₆ levels in follicular fluid.⁴ Further, adequate folate and B₁₂ help support methylation and the amino acid homocysteine. Elevated homocysteine levels may impact fertility and pregnancy.¹⁰ These findings underscore the importance of B vitamins to support women's fertility.

Choline

Physiological role: Choline is an essential nutrient that supports cell membrane structure (as a component of phospholipids), neurotransmitter production (acetylcholine), and methylation pathways. In the context of fertility, choline is needed for proper neural tube closure and may support oocyte development and early embryogenesis.¹¹ It also has a role in one-carbon metabolism that complements folate. Choline also contributes to the synthesis of phosphatidylcholine in oocytes and embryos, which is important for cell division and signaling.

Evidence: While direct human studies on choline and female fertility are limited, emerging evidence points to its importance. For example, an animal study showed that supplemental choline supported ovarian follicle development.¹¹ In women, adequate choline status is thought to be beneficial during preconception and pregnancy, especially when folate intake is suboptimal, due to its role in reducing homocysteine.¹²

Iron

Physiological role: Iron is essential for oxygen transport (as a hemoglobin component) and cellular energy production. In women, iron requirements are high due to menstrual losses and even higher in pregnancy. From a fertility perspective, iron is required for proper ovulation and placental development; insufficient iron may impact ovulation and lead to poor oxygenation of reproductive tissues.

Evidence: Several studies link iron status with female fertility.¹³ For example, a recent clinical study in women with low iron showed that addressing iron status significantly supported fertility outcomes with an increase in conception rate (from 65% to 77%) and a higher live birth rate, as well as a lower miscarriage rate.¹⁴ A large prospective study of nurses found that women who used iron supplements supported ovulatory function.¹⁵ Caution should be exercised, as iron overload may negatively impact fertility outcomes.¹⁶

Zinc

Physiological role: Zinc is a trace mineral that acts as a cofactor for numerous enzymes and is vital for cell division, DNA synthesis and antioxidant defense. In female reproduction, zinc plays a critical role in oocyte development. A sufficient zinc concentration in the maturing oocyte is necessary to complete meiosis and form a fertilization-competent egg.¹⁷ Zinc also plays a unique role in the fertilization process, known as the "zinc spark," which is the moment of sperm-egg fusion that blocks additional sperm from the egg and activates the embryo.¹⁷ Furthermore, adequate zinc is needed in the early embryo for cell division and implantation.

Evidence: A comprehensive review highlighted that low zinc levels in females leads to changes in oocyte quality and other reproductive functions.¹⁷ Population studies have noted that women with suboptimal zinc levels may experience a longer time to pregnancy, likely due to subtle impacts on ovulation and egg viability.¹⁸

Vitamin D

Physiological role: Vitamin D functions as a steroid hormone in the body, regulating gene expression in numerous tissues, including the reproductive organs. Vitamin D receptors and metabolizing enzymes are present in the ovaries, endometrium and placenta, suggesting direct effects on reproductive processes. In ovarian tissue, vitamin D may influence follicular development and steroidogenesis (e.g., progesterone production). In the uterus, it may promote an optimal endometrial environment for implantation. Adequate vitamin D is also important for immune modulation during pregnancy.^19–22

Evidence: Low levels of vitamin D deficiency is common in women of childbearing age. Studies have found that sufficient vitamin D levels are associated with supporting fertility by supporting healthy, regular menstrual cycles and ovulation while reducing cytokine production.^23–26 Additionally, maintaining sufficient vitamin D during pregnancy is important for optimal outcomes.²⁷

Selenium

Physiological role: Selenium is an essential trace element that is a component of selenoproteins, including antioxidant enzymes like glutathione peroxidases and thyroid deiodinases. Through these enzymes, selenium helps protect cells (including oocytes and sperm) from oxidative damage. Selenium may be most known for its role in thyroid health, which is closely linked to fertility. Thyroid hormones (TSH, T3, T4) are essential for producing and regulating reproductive hormones and organs. Further, selenium's antioxidant role is also important in the ovarian environment, where oxidative stress can impact follicular development and embryo quality.²⁸

Evidence: Women with higher selenium levels tend to have better reproductive outcomes. In one study low plasma selenium in women was linked to a longer time to become pregnant compared to those with selenium levels in a typical range. These findings are consistent with broader observations that low selenium levels may be associated with certain pregnancy-related complications.^{18, 29}

Iodine

Physiological role: Iodine is crucial for synthesizing thyroid hormones (T3 and T4), which regulate metabolism and play a significant role in reproductive health. In women, proper thyroid function is necessary for regular menstrual cycles, ovulation and sustaining early pregnancy. Adequate iodine in the preconception period helps ensure the thyroid can meet the increased hormonal demands of pregnancy, supporting fetal neurodevelopment in the first trimester.³⁰

Evidence: A notable prospective study in the United States found that women with moderate-to-severe low iodine levels had significantly lower odds of conceiving. In fact, these women had about half the per-cycle chance of becoming pregnant compared to women with sufficient iodine levels. They also tended to take longer on average to achieve pregnancy.³¹ These findings are concerning given that approximately 30% of women of childbearing age in the study had iodine levels below recommended concentrations. This is further compounded by 75% of obstetricians not recommending iodine supplementation and about 50% of all prenatal vitamins not containing iodine in their formulation.³²

Omega-3 Fatty Acids

Physiological role: In reproductive health, omega-3s are thought to help with ovarian function and the uterine environment by reducing oxidative stress. They can influence hormone production and may promote better blood flow to reproductive organs. During the early stages of pregnancy, omega-3s support placental development and are critical for fetal brain development, but even prior to conception, they appear to be beneficial for the quality of oocytes and embryos.^33,34

Evidence: Multiple studies have reported on the benefits of omega-3s for women of reproductive years, such as supporting egg quality and endometrial health and increasing the number of follicles and follicular fluid.^35-38

In summary, research suggests that preconception supplementation of multiple micronutrients (via a multivitamin/mineral) supports fertility.^40,41

Pure Encapsulations Nutrient Solutions

PreNatal Nutrients is a multivitamin/mineral complex for women of childbearing age that provides essential vitamins, minerals and nutrients based on scientific evidence that supports maternal and fetal health. Features include Metafolin^® L-5 MTHF, the naturally occurring, universally metabolized form of folate and vitamin D derived from an algae source. It is best when combined with EPA/DHA essentials.^‡

Suggested Dose: Take 2 capsules daily, with a meal.

EPA/DHA essentials is an ultra-pure, microfiltered fish oil concentrate source from sardines and anchovies off the coast of Chile or Norway that supports daily wellness.^‡

Suggested Use: Take 1-2 softgels daily, with a meal.

DHA Ultimate is sourced from sardines and anchovies from the Pacific Ocean off the coast of Chile. The DHA fish oil is produced in a low-temperature, oxygen-free, solvent-free supercritical CO2-based extraction, resulting in a pure, clean and safe product.

Suggested Use: Take 2 capsules daily, with a meal.

Conclusion

Optimizing nutrition is a fundamental aspect of supporting female fertility. The micronutrients discussed (B vitamins, choline, iron, zinc, vitamin D, selenium, iodine and omega-3 fatty acids) contribute uniquely to the complex physiology of reproduction.

An evidence-based understanding of these nutrients helps clinicians guide women in making dietary choices or taking supplements (when appropriate) to address gaps. For integrative health practitioners, assessing nutritional status and ensuring adequacy of these key nutrients should be part of preconception care. While nutrition does not guarantee pregnancy, it lays the groundwork for hormonal balance, healthy ovulation and a receptive environment for pregnancy.

Resources

For additional resources that include diet and lifestyle recommendations for supporting fertility, refer to the protocols listed below:

Women's Fertility Support Protocol^‡: Designed by our scientific and medical advisors to help you deliver the most effective care and support for your patient's fertility.

For more details on the research on the selected nutrient solutions, download the product information sheets:

• PreNatal Nutrients
• EPA/DHA essentials
• DHA Ultimate

Drug-Nutrient Interactions Checker: Provides valuable information on potential interactions between your patients' prescriptions, over-the-counter medications and nutritional supplements.

PureInsight^™: Our streamlined platform easily collects patient data and provides valuable recommendations to help achieve their health goals.

Virtual Dispensary: Our Pure Patient Direct program provides account holders FREE access to our virtual dispensary to help simplify patient sales and reduce in-office inventory.

You can also explore Pure Encapsulations^® to find On-Demand Learning, Clinical Protocols and other resources developed with our medical and scientific advisors.

1. Chandra A, Copen CE, Stephen EH. Natl Health Stat Report. 2013;(67).
2. Pfeifer S, Butts S, Fossum G, et al. Fertil Steril. 2017;107(1). doi:10.1016/j.fertnstert.2016.09.029
3. World Health Organization. April 4, 2023. Accessed February 29, 2024. https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility
4. Cristodoro M, Zambella E, Fietta I, Inversetti A, Di Simone N. Biology (Basel). 2024;13(2). doi:10.3390/biology13020131
5. Stephens T V., Payne M, Ball RO, Pencharz PB, Elango R. J Nutr. 2015;145(1). doi:10.3945/jn.114.198622
6. Gorczyca AM, Sjaarda LA, Mitchell EM, et al. Eur J Nutr. 2016;55(3). doi:10.1007/s00394-015-0931-0
7. Blumfield M, Mayr H, Vlieger N De, et al. Molecules. 2022;27(13). doi:10.3390/molecules27134061
8. Crinnion WJ. Alternat Med Rev. 2010;15(1).
9. Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Fertil Steril. 2008;89(3). doi:10.1016/j.fertnstert.2007.03.089
10. Ogawa S, Ota K, Takahashi T, Yoshida H. Nutrients. 2023;15(17). doi:10.3390/nu15173730
11. Jaiswal A, Dewani D, Reddy LS, Patel A. Cureus. Published online 2023. doi:10.7759/cureus.48538
12. Zeisel SH. Annu Rev Nutr. 2006;26.doi:10.1146/annurev.nutr.26.061505.111156
13. Holzer I, Ott J, Beitl K, et al. Front Endocrinol (Lausanne). 2023;14. doi:10.3389/fendo.2023.1173100
14. Tulenheimo‐Silfvast A, Ruokolainen‐Pursiainen L, Simberg N. Acta Obstet Gynecol Scand. 2025;104(4):738-745. doi:10.1111/aogs.15046
15. Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Obstet Gynecol. 2006;108(5). doi:10.1097/01.AOG.0000238333.37423.ab
16. Zhang J, Su T, Fan Y, Cheng C, Xu L, LiTian. Life Sci. 2024;340. doi:10.1016/j.lfs.2023.122370
17. Garner TB, Hester JM, Carothers A, Diaz FJ. Biol Reprod. 2021;104(5). doi:10.1093/biolre/ioab023
18. Grieger JA, Grzeskowiak LE, Wilson RL, et al. Nutrients. 2019;11(7). doi:10.3390/nu11071609
19. Grzesiak M, Tchurzyk M, Socha M, Sechman A, Hrabia A. Int J Mol Sci. 2022;23(22). doi:10.3390/ijms232214137
20. Voulgaris N, Papanastasiou L, Piaditis G, et al. Hormones. 2017;16(1). doi:10.14310/horm.2002.1715
21. Jeon GH. Nutrients. 2024;16(1). doi:10.3390/nu16010096
22. Grundmann M, von Versen-Höynck F. Reprod Biol Endocrinol. 2011;9. doi:10.1186/1477-7827-9-146
23. Várbíró S, Takács I, Tűű L, et al. Nutrients. 2022;14(8). doi:10.3390/nu14081649
24. Meng X, Zhang J, Wan Q, et al. Reprod Biol Endocrinol. 2023;21(1). doi:10.1186/s12958-023-01068-8
25. Yang M, Shen X, Lu D, et al. Front Endocrinol (Lausanne). 2023;14. doi:10.3389/fendo.2023.1148556
26. van Tienhoven XA, Ruiz de Chávez Gascón J, Cano-Herrera G, et al. Int J Mol Sci. 2025;26(5):2256. doi:10.3390/ijms26052256
27. Liu CC, Huang JP. J Formos Med Assoc. 2023;122(7). doi:10.1016/j.jfma.2023.02.004
28. Brown EDL, Obeng-Gyasi B, Hall JE, Shekhar S. Int J Mol Sci. 2023;24(12). doi:10.3390/ijms24129815
29. Pieczyńska J, Grajeta H. J Trace Elem Med Biol. 2015;29. doi:10.1016/j.jtemb.2014.07.003
30. Kuehn B. JAMA. 2018;319(8). doi:10.1001/jama.2018.1291
31. Mills JL, Buck Louis GM, Kannan K, et al. Hum Reprod. 2018;33(3). doi:10.1093/humrep/dex379
32. Panth P, Guerin G, DiMarco NM. Biol Trace Elem Res. 2019;188(1). doi:10.1007/s12011-018-1606-5
33. Stanhiser J, Jukic AMZ, McConnaughey DR, Steiner AZ. Hum Reprod. 2022;37(5). doi:10.1093/humrep/deac027
34. Saldeen P, Saldeen T. Obstet Gynecol Surv. 2004;59(10). doi:10.1097/01.ogx.0000140038.70473.96
35. Nehra D, Le HD, Fallon EM, et al. Aging Cell. 2012;11(6). doi:10.1111/acel.12006
36. Al-Alousi TA, Al-Allak MMA, Aziz AA, Al Ghazali BS. Biomed Pharmacol J. 2018;11(4). doi:10.13005/bpj/1605
37. Abodi M, De Cosmi V, Parazzini F, Agostoni C. Eur J Obstet Gynecol Reprod Biol. 2022;275. doi:10.1016/j.ejogrb.2022.06.019
38. Trop-Steinberg S, Gal M, Azar Y, Kilav-Levin R, Heifetz EM. Heliyon. 2024;10(8):e29324. doi:10.1016/j.heliyon.2024.e29324
39. Schaefer E, Nock D. Clin Med Insights Womens Health. 2019;12. doi:10.1177/1179562x19843868
40. Keen CL, Clegg MS, Hanna LA, et al. J Nutr. Vol 133; 2003. doi:10.1093/jn/133.5.1597s
41. Gunabalasingam S, De Almeida Lima Slizys D, Quotah O, et al. Eur J Clin Nutr. 2023;77(7). doi:10.1038/s41430-022-01232-0

⁺Kim Ross is a paid consultant for Pure Encapsulations.