How much folate is best for a successful IVF cycle? Folate - also called vitamin B9 - is basically a generic term which is used to refer to both synthetic folic acid from supplements and naturally occurring folate from dietary sources. But these two substances - folic acid and folate - are not truly the same and how much folate women take in every day just may influence the outcome of IVF.
Women are often recommended to simply take a multivitamin or prenatal vitamin prior to conception and most will contain 400 mcg of synthetic folic acid/day. Other women may be advised to take a prenatal vitamin containing twice that amount of folic acid, while some docs prefer to recommend a methylated folate. The question is, does the amount of folic acid/folate taken prior to IVF really make a difference?
A 2014 study (1) found that folate may tip the odds for IVF success after noting that women with the highest levels of dietary folate - from dietary and supplementary sources combined - were found to have a significantly greater likelihood of live birth after IVF.
The study - carried out at the Massachusetts General Hospital Fertility Center - assessed dietary folate intake from a food frequency questionnaire and recorded supplemental folic acid in 232 women undergoing assisted reproduction.
Higher dietary folate levels were linked with key predictors of IVF success such as higher embryo implantation rates, clinical pregnancy and live birth rates. Live birth rates were a whopping twenty percent higher in women with the highest folate intakes - above 800 mug per day - compared to women with folate intakes less than 400 mcg daily. Higher folate intake was also linked with higher fertilization rates, a key factor for IVF success, and the study concluded:
"Higher intake of supplemental folate was associated with higher live birth rates after assisted reproductive technology treatment."
A subsequent study (2) similarly found that women with higher serum levels of folate had a higher chance of successful pregnancy with IVF.
"Women undergoing IVF treatments with higher levels of folate have a higher chance of clinical pregnancy."
If you are undergoing assisted reproduction, ask your physician about which folic acid/folate supplement is right for you. A number of prenatal vitamin products now contain methylfolate instead of synthetic folic acid and may help to increase serum folate levels becuse methyl folate, unlike folic acid, does not have to undergo a somewhat tricky conversion process.
Some studies (3) have found that even when women take the recommended amount of folic acid - 400 mcg - prior to an IVF cycle a substantial percentage of women will not reach ideal serum levles of folate which is worrying given that serum folate seems tied to an uptick in IVF success reates. Taking a pre-methylated form of folate and emsuring a high dietary folate intake may be a wise move to ensure good folate levels in serum.
Women who have a common genetic mutation called MTHFR also benefit from this special methylated form of folic acid - and a diet rich in folate - because the MTHFR mutation can reduce the body's ability to convert folic acid into usable, protective folate!
Dietary folate is an umbrella term for a variety of tetrahydrofolate derivatives, and these natural folate compounds are especially rich in dark green leafy vegetables, asparagus, avocado and dried beans and legumes - especially edamame.
A diet rich in beans and greens will easily provide at least 400 mcg of folate daily, and because folate is water soluble, there is little danger of having too much, excess natural folate is simply excreted in the urine.
This article is for informational purposes and is not intended to provide medical or dietetic advice for which you should consult a licensed physician or dietitian.
(1) Obstet Gynecol. 2014 Oct;124(4):801-9. doi: 10.1097/AOG.0000000000000477.
Dietary folate and reproductive success among women undergoing assisted reproduction.
Gaskins AJ1, Afeiche MC, Wright DL, Toth TL, Williams PL, Gillman MW, Hauser R, Chavarro JE.
(2) Reprod Toxicol. 2018 Mar;76:12-16. doi: 10.1016/j.reprotox.2017.12.003. Epub 2017 Dec 15.
Homocysteine pathway and in vitro fertilization outcome. Paffoni A1, Castiglioni M2, Ferrari S2, La Vecchia I2, Ferraris Fusarini C3, Bettinardi N3, Noli S2, Parazzini F4, Somigliana E2.
(3) Gynecol Endocrinol. 2017 Nov;33(11):861-863. doi: 10.1080/09513590.2017.1334197. Epub 2017 Jul 19.
Folate serum levels in Italian women entering an in vitro fertilization program. Ponzano A1, Tiboni GM1.