Fertility Prep — Women
About this protocol
Where to start
Start a prenatal vitamin at least 3 months before trying to conceive. Choose one with methylfolate (5-MTHF, not folic acid — 30-40% of women have MTHFR variants that limit folic acid conversion). Adequate folate before conception prevents the majority of neural tube defects, which form before most women know they''re pregnant.
Add CoQ10 (ubiquinol) at 200-600 mg daily if you are 35+ or have known diminished ovarian reserve. Trial evidence supports improved egg quality and pregnancy rates after 3 months of use.
Add myo-inositol if you have PCOS, irregular cycles, insulin resistance, or have been told you have poor egg quality. Strong trial evidence in PCOS specifically for ovulation restoration and pregnancy rates.
Vitamin D3 — confirm your 25-OH vitamin D is above 30 ng/mL. Low D status is associated with lower IVF success rates and longer time to conception.
Omega-3 DHA-dominant for embryo development support (DHA is the structural fatty acid of neural tissue in the developing fetus).
Stop everything that crosses the placenta if not safe — most herbs in your wellness stack should be paused. Ashwagandha, chasteberry, melatonin, high-dose vitamin A, and many adaptogens are contraindicated. Continue the stack above plus your prenatal until pregnancy is confirmed, then transition to pregnancy-specific protocols under your OB.
If you''ve been trying for 12+ months without success (6+ months if you''re 35+, or 3+ months if 40+), see a reproductive endocrinologist. Time matters in fertility, and supplements are complementary to medical evaluation rather than a substitute.
5 nutrients
Start here
Strongest evidence — the foundation of the stack.
Prenatal Vitamin (with methylfolate)
1 daily, with breakfast — start 3+ months before trying to conceiveA high-quality prenatal vitamin with methylfolate (5-MTHF) rather than folic acid is the single most-evidenced fertility intervention. Adequate folate status before conception prevents the majority of neural tube defects. Methylfolate bypasses the MTHFR enzyme step, useful for the 30-40% of women with MTHFR polymorphisms. Look for: methylfolate (not folic acid), choline, iodine, vitamin D, methylcobalamin (B12), and adequate iron.[1, 2]
CoQ10 (Ubiquinol)
200-600 mg daily, with a fat-containing meal (split AM/PM for higher doses)CoQ10 supports mitochondrial energy production in oocytes. Egg quality and chromosomal stability are highly mitochondrial-dependent, and CoQ10 levels decline with age. Multiple trials in women 35+ or with diminished ovarian reserve show improvements in oocyte quality, fertilization rates, and pregnancy outcomes after 3 months of supplementation. The ubiquinol form has better bioavailability, particularly in women over 40.[3, 4, 5]
Add if needed
Add these only if the foundation isn't enough.
Myo-Inositol (with D-Chiro-Inositol)
2 g twice daily (4 g/day total), with a 40:1 myo:d-chiro ratioMyo-inositol is a sugar alcohol with strong trial evidence in PCOS — improving ovulation, insulin sensitivity, and pregnancy rates. The 40:1 myo:d-chiro-inositol ratio matches the physiological ratio in healthy ovarian follicles. Useful for women with PCOS, irregular cycles, insulin resistance, or poor egg quality. Evidence is weaker in women without these specific patterns.[6, 7, 8]
Vitamin D3
2000-4000 IU daily, with breakfast — target serum 25-OH above 30 ng/mLVitamin D receptors are expressed in the ovary, endometrium, and placenta. Observational studies link low vitamin D status with longer time to conception and lower IVF success rates. Test before supplementing — target serum 25-OH vitamin D of 30-50 ng/mL. Fat-soluble; take with a fat-containing meal.[9, 10, 11]
Experimental
Emerging evidence — try last, only if curious.
Omega-3 (DHA-dominant)
1-2 g combined EPA+DHA daily with at least 60% DHA, with breakfastDHA is the structural fatty acid of neural tissue — adequate maternal DHA status supports fetal brain and retinal development. Trial evidence in fertility-specific endpoints is mixed, but the broader cardiovascular and cognitive benefits, plus the relevance to early embryo development, make this a reasonable inclusion. Choose a third-party-tested product with low mercury content.[12, 13]
Warnings
Lifestyle improvements
Track your cycle and identify ovulation
A cycle-tracking app (Clue, Flo, Natural Cycles) or ovulation predictor kits help time conception attempts. The fertile window is ~6 days ending the day of ovulation; the highest-probability days are the 2-3 days before ovulation. Track for at least 3 cycles before assuming infertility — many couples conceive within 6 months once timing is correct.
Track basal body temperature
Daily BBT charting (immediately on waking, same time daily) reveals ovulation patterns and luteal-phase length. A short luteal phase (under 10 days) can be an early sign of fertility issues worth investigating.
Aim for a healthy BMI
Both significantly underweight and significantly overweight states reduce fertility. A BMI of 19-29 has the highest fertility rates in observational studies. Even a 5-10% body-weight change in either direction can restore ovulatory cycles for women at the extremes.
Reduce alcohol and quit smoking
Heavy alcohol use (more than 1-2 drinks per day) reduces fertility measurably. Smoking is one of the strongest reversible fertility-suppressors — by ~10-15% per year of attempting conception. Quitting at any point before conception improves outcomes.
Manage caffeine
The evidence suggests caffeine intake under 200 mg/day (one cup of coffee) is fine; over 500 mg/day is associated with longer time to conception. Most women find moderate caffeine intake compatible with fertility.
Reduce stress without obsessing about it
Severe chronic stress affects HPA axis and reproductive hormones. But the "just relax" advice is famously unhelpful. Treat stress with structured approaches — therapy, exercise, sleep — not by trying not to stress about fertility.
Sleep 7-9 hours consistently
Sleep deprivation affects reproductive hormones in both partners. Anchored sleep timing supports normal cycle regularity.
Exercise moderately
Moderate exercise improves fertility; extreme endurance exercise can suppress ovulation. Aim for 150-300 minutes of moderate aerobic activity plus 2-3 strength sessions per week.
Address male factor too
Up to 50% of infertility cases involve a male factor. The man''s preconception health (diet, sleep, weight, alcohol, smoking, supplements like CoQ10 + zinc + omega-3) matters as much. A simple semen analysis is much faster and less invasive than a full female workup.
See a reproductive endocrinologist if needed
If you have been trying for 12+ months (6+ if 35+ years old, 3+ if 40+), have known reproductive issues, or have a history of recurrent loss, see a reproductive endocrinologist. Time matters in fertility, and the evaluation often identifies addressable issues quickly.
References
- ACOG Committee Opinion: Nutrition During Pregnancy. American College of Obstetricians and Gynecologists.ACOG link
- Wilson RD, et al. Pre-conception Folic Acid and Multivitamin Supplementation for the Primary and Secondary Prevention of Neural Tube Defects and Other Folic Acid-Sensitive Congenital Anomalies. J Obstet Gynaecol Can. 2015;37(6):534-552.PubMed link
- Coenzyme Q10 — supplement research overviewExamine.com link
- Bentov Y, et al. The contribution of mitochondrial function to reproductive aging. J Assist Reprod Genet. 2011;28(9):773-783.PubMed link
- Xu Y, et al. Pretreatment with coenzyme Q10 improves ovarian response and embryo quality in low-prognosis young women with decreased ovarian reserve: a randomized controlled trial. Reprod Biol Endocrinol. 2018;16(1):29.PubMed link
- Inositol — supplement research overviewExamine.com link
- Unfer V, et al. Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials. Endocr Connect. 2017;6(8):647-658.PubMed link
- Regidor PA, et al. Management of Women with PCOS Using Myo-inositol and Folic Acid. New Clinical Data and Review of the Literature. Horm Mol Biol Clin Investig. 2018;34(2).PubMed link
- Vitamin D — supplement research overviewExamine.com link
- Lerchbaum E, Obermayer-Pietsch B. Vitamin D and fertility: a systematic review. Eur J Endocrinol. 2012;166(5):765-778.PubMed link
- Chu J, et al. Vitamin D and assisted reproductive treatment outcome: a systematic review and meta-analysis. Hum Reprod. 2018;33(1):65-80.PubMed link
- Fish oil — supplement research overviewExamine.com link
- Wathes DC, et al. Polyunsaturated fatty acids in male and female reproduction. Biol Reprod. 2007;77(2):190-201.PubMed link
Related protocols
Other maternal protocols and protocols sharing ingredients with this one.
Trimester 3 Prenatal
maternal
Weeks 28 to delivery is the home stretch — and nutritionally the most demanding window of pregnancy. Roughly 60% of total fetal brain DHA accumulation happens in trimester 3, iron demand peaks as maternal blood volume and fetal stores complete loading, and the body is preparing for labor, delivery, and the first weeks of breastfeeding. This protocol covers five priorities: continuing a methylated prenatal, iron when ferritin is confirmed low (very common in T3 — many women need supplementation here even if they didn''t earlier), DHA-dominant omega-3 (T3 evidence is stronger than T1/T2 for infant outcomes), magnesium glycinate for the classic T3 trio of leg cramps + sleep disruption + constipation, and a late-pregnancy probiotic for potential infant eczema prevention. Coordinate every supplement with your OB and your hospital''s birth plan. T3 is also when GBS (Group B Strep) screening happens at 35-37 weeks, gestational diabetes monitoring intensifies, and you should be finalizing your delivery and early-postpartum plan. Supplements are one piece — sleep position, birth education, and postpartum support matter at least as much.
Trimester 2 Prenatal
maternal
The second trimester (weeks 14-27) is often described as the "honeymoon" of pregnancy — most morning sickness has resolved by weeks 14-16, energy returns, and the appetite usually improves. Underneath that subjective ease, however, the nutritional demand curve is accelerating sharply: maternal blood volume expands by roughly 40-50%, fetal growth shifts from organogenesis to rapid tissue accretion, and the placenta is now actively pulling iron, calcium, choline, and DHA across the maternal circulation. Iron requirements roughly double in the second half of pregnancy, and many women whose ferritin was adequate in T1 will become deficient by T2 — which is why ferritin re-checks at the 20-week visit matter. This protocol covers the five nutritional priorities for trimester 2: continuing the methylfolate-containing prenatal, supplemental iron paired with vitamin C (most prenatals under-dose iron for this window), choline at the full 450 mg/day target (commonly missed in generic prenatals), DHA-dominant omega-3 (fetal brain DHA accumulation accelerates in T2-T3), and calcium citrate if dietary intake is genuinely low. Coordinate every change with your OB — the anatomy scan at 18-22 weeks and the gestational diabetes screen at 24-28 weeks are key checkpoints where supplement adjustments are commonly made.
Trimester 1 Prenatal
maternal
The first trimester is the highest-stakes window of pregnancy nutritionally. Neural tube formation completes by week 4-6 (often before pregnancy is even known), organogenesis is in full swing, and the most common early-pregnancy symptom — morning sickness — affects 70-85% of pregnancies. This protocol covers the four nutritional priorities for trimester 1: a methylfolate-containing prenatal (the single most-evidenced intervention in obstetric nutrition for preventing neural tube defects), vitamin B6 + ginger for nausea (both ACOG-supported as first-line), choline for fetal brain and liver development (commonly under-consumed), and iron when ferritin is confirmed low. This protocol replaces your Fertility Prep — Women stack once pregnancy is confirmed. Many supplements that were fine pre-conception (ashwagandha, vitex, berberine, high-dose vitamin A, certain herbal blends) are contraindicated in pregnancy. Coordinate every supplement with your OB.
Men's Fertility / Sperm Health
maternal
Up to 50% of infertility cases involve a male factor — yet most fertility workups focus disproportionately on the female partner. The 90 days before conception matter for men too: spermatogenesis takes 72-74 days, so the nutritional and lifestyle environment during that window directly affects sperm count, motility, morphology, and DNA fragmentation. The supplement category here has unusually clear evidence: CoQ10 (ubiquinol) for motility and count, zinc for foundational spermatogenesis, L-carnitine for motility specifically, selenium for sperm glutathione peroxidase activity, and ashwagandha for testosterone + sperm parameters. Effect sizes are real and replicated in multiple trials. If you''ve been trying to conceive for 12+ months (or 6+ months if your partner is 35+) without success, get a semen analysis — it''s cheap, fast, and informative. Don''t default to assuming the issue is female-only.
Postpartum Support
maternal
The postpartum period is one of the most nutrient-depleted phases of a woman's life — and one of the most under-supported. Pregnancy and childbirth deplete iron, omega-3 stores, choline, vitamin D, and B vitamins. Breastfeeding continues that depletion. The supplement stack here focuses on correcting those gaps to support energy, mood, hair retention, and milk supply (when relevant). The mood evidence is strongest for omega-3 EPA and vitamin D — both are linked with postpartum depression risk. If you are experiencing persistent low mood, intrusive thoughts, or difficulty bonding, please talk to your OB or a perinatal mental health specialist — supplements are supportive, not a substitute for care.
Lactation Support
maternal
Galactagogues — supplements purported to increase breast milk supply — are a heavily-marketed but evidence-thin category. Honest framing: most trials of fenugreek, blessed thistle, moringa, and similar herbs show small effects or no effect over placebo when proper lactation support (frequent effective nursing/pumping, hydration, and adequate calories) is in place. The biggest evidence-backed lever for milk supply is FREQUENCY of effective milk removal — galactagogues are a complementary layer at best. Of the available options, moringa has the strongest trial evidence; fenugreek is the most-used but has very mixed results; blessed thistle and goat''s rue have traditional use but minimal modern evidence. This protocol is supportive. If your baby is not gaining weight adequately, please see an IBCLC (International Board Certified Lactation Consultant) — they can identify and address the actual causes (latch issues, transfer issues, hormonal causes, retained placenta, hypoplastic breasts). Galactagogues without addressing root cause is a common dead end.
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Coming to App StoreDisclaimer: These statements have not been evaluated by the FDA. This protocol is educational, not a substitute for personalized medical advice. Talk to your doctor before starting any new supplement regimen — especially if you're pregnant, breastfeeding, on medications, or managing a chronic condition. Last updated 5/20/2026.