Vitamins & supplements for fertility - yay or nay?

by dee armstrong

I spent last Saturday at the second annual Scottish Information Day organised by the Infertility Network - it was a great opportunity for couples dealing with fertility problems to come to one venue and meet lots of people who may be able to help, to hear about treatment advances and how other patients who have trodden the path before them have coped.  

In the morning a fertility consultant and IVF expert gave a run-down of what couples could expect from their first appointment at a fertility clinic - the various investigations on offer and how their treatment might progress from there.  So far so good.  Towards the end of his presentation he put up a slide about what people could do to help themselves, which was, after all, why they were here. (In Scotland we're still catching up with London in terms of 'coming out' as far as infertility is concerned and this was by no means The Fertility Show - thank goodness, some might say!)  Anyway his slide said: stop smoking, cut back on alcohol, get your BMI into a healthy range.  But it said nothing about food and nutrition and the final bullet point was "no need to take vitamins or supplements", with the consultant dismissing the notion, saying "there's no evidence that they will help you" and then swiftly moving on.  

In the afternoon, however, Dr Marilyn Glenville, a famous and very well respected nutritionist who has years of experience dealing with infertility, stood up and gave a convincing and comprehensive talk about the importance of nutrition, pointing out where she thought supplementation was warranted and presenting a plethora of research evidence.  So why the mismatch?  The case for Vitamin D supplementation alone can hardly be disputed and I heard Prof Iwan Lewis-Jones stand up at The Fertility Show at least three years ago and say that the first thing he does with a man who has poor sperm parameters is put him on Vitamin C & E supplements.  Because there is good evidence that they help!  Indeed there was also an excellent presentation on Saturday from Prof Sheena Lewis about her research on DNA fragmentation in sperm - she concluded by saying she is trying to get government funding to pay for research into the food / vitamins / antioxidants link.  Because that's the next obvious step.

So, of course I couldn't keep quiet and stuck my hand up at the question panel at the end to ask what on earth patients are supposed to think?  Their doctor tells them one thing and we tell them another - time and again couples from all over the UK tell me that when they asked the consultant what they could do to help improve things they are told "nothing".     In answering me, Glenville pointed to the fact that whilst there is plenty of research evidence, (e.g. the 2013 Cochrane review on anti-oxidants and male subfertility) not much of it is of the gold standard randomised controlled trial variety.  And why not?  Because Big Pharma pays for a lot of that research and food and vitamins cannot be patented.  

Unfortunately the doctor who had given the morning presentation had had to leave before the final question panel.  Another IVF doctor present, Dr Marco Gaudoin, said that doctors are taught, based on Hippocrates' teachings, "first do no harm"  - he went on to say that a lack of evidence is not the same as a lack of benefit, just a lack of evidence for that benefit so far.  So he tells his patients to go ahead if they feel it will help.  

But, Doctors, why not go a step further?  You need to keep up with some of this basic 'boring' stuff as well as the sexy IVF stuff.   It wouldn't do any of you any harm to read Glenville's book, Getting Pregnant Faster - you'll have it done and dusted in a weekend I promise.  And if a patient asks you what can they do to help themselves, instead of saying "nothing", why not say "well, the gold standard research isn't there yet but some studies have shown x, y or z and you could read more about it if you're interested". Or, and here's a radical thought, "I don't know - some researchers think this and some researchers think that".  And remember, that as well as saying "first ,do no harm", Hippocrates also said "let food be thy medicine".