Navigating Fertility Supplements

Infertility affects over 50% of people worldwide according to the World Health Organization - and chances are you’re fielding questions about the role of supplements to help. Here's what you need to know about some popular choices.

Despite its popularity, the evidence for DHEA doesn’t support its use for infertility. Tell patients that some studies show mixed results on outcomes like egg retrieval and fertilization, but the bottom line is that DHEA isn’t shown to improve pregnancy or live birth rates or reduce miscarriages in women undergoing fertility treatment. While it’s generally safe for patients when used appropriately, short-term, counsel to stop DHEA once they’re pregnant, as elevated androgen levels could potentially affect the pregnancy.

Melatonin is another supplement patients may bring up. While some studies suggest modest improvements in egg maturity or embryo quality, the takeaway is the same - research doesn’t demonstrate an increase in pregnancy rates or a decrease in miscarriage rates. Regarding safety, high-dose melatonin (75-300 mg) may interfere with ovulation, but lower doses (2-3 mg) haven’t shown the same effect. Additionally, we don’t have enough safety data regarding use during pregnancy. Therefore, those trying to conceive should avoid high doses and frequent use of melatonin, and women who are already pregnant should avoid melatonin.

N-acetyl cysteine (NAC) is also frequently mentioned for improving fertility. But limited data shows that it doesn’t help women with unexplained infertility. A clinical trial combining NAC with clomiphene showed no improvement in pregnancy rates or miscarriage reduction. Explain that NAC has not been associated with fetal harm, but its use in pregnancy should be saved for rare cases when needed such as treatment for acetaminophen toxicity.

Overall, if patients inquire about DHEA, melatonin, or NAC, let them know the evidence doesn’t support these as an effective fertility treatment. That said, these conversations are valuable, and patients should be encouraged to share everything they are taking so you can guide them on interventions that are safe and effective.

For additional information on supplements for infertility, our “Effectiveness by Condition” tool provides evidence-based guidance to help navigate these discussions.