• Folate vs. Folic Acid for Male Fertility

    By Margaret Eich, MS, RDN

    Many women thinking of getting pregnant have heard of folic acid or folate, as we know that adequate amounts help prevent neural tube defects like spina bifida when taken in early pregnancy. Folate is vital for DNA synthesis and for DNA methylation. Folic acid generally refers to a synthetic form of folate that is found in many prenatal vitamins and supplements and fortified foods. Folate refers to the natural form found in food. Some supplements include folate instead of or in addition to folic acid. 

    While the impact of folate on pregnancy in women gets a lot of press, the impact of folate on male fertility doesn’t get much attention. Ensuring adequate folate intake in men may have a beneficial impact on sperm quality and pregnancy. Folate is thought to be vital for sperm production due to its role in DNA synthesis and methylation. For example, in one study, men with the highest folate intake from both food and supplements had lower frequencies of aneuploidy (DNA abnormalities) in their sperm compared to men with lower folate intake.

    An additional factor that may impact folate status in men is MTHFR polymorphisms. A MTHFR polymorphism is a change to the methylene tetrahydrofolate reductase enzyme rendering it less effective at producing the active form of folate called 5-methyltetrahydrofolate (5-MTHF). In men with MTHFR polymorphisms, supplying 5-MTHF directly may be more effective for improving sperm parameters and pregnancy rates based on some interesting new case series.

    The impact of 5-MTHF is demonstrated in a case series of 30 couples each with a 4-year history of fertility issues with at least one partner in the couple having a MTHFR polymorphism. Most of the women were treated with high dose folic acid without success. The couples were then treated for 4 months with 600 mcg 5-MTHF, and 13 couples were able to conceive spontaneously without IUI or IVF. 

    In another case report, a couple had a history of 6 failed IVF cycles. The woman was found to have an MTHFR polymorphism, and the couple underwent egg donation and had a successful pregnancy and birth. In trying to conceive a 2nd child, she started a series of failed donor egg cycles. She was then started on 5-MTHF (400 mcg) and did another donor egg cycle, which ended in miscarriage at 8.5 weeks. Her husband had normal sperm parameters, but tested positive for 2 copies of the MTHFR polymorphism and was started on 400 mcg 5-MTHF. The couple conceived spontaneously 8 weeks later and gave birth to a baby girl at 38 weeks. The authors conclude that his really underscores the importance of methylation in egg development and sperm production, and that when either the male or female has a MTHFR polymorphism, 5-MTHF if required as high dose folic acid will not allow the embryo to develop properly.

    It is often the case that men don’t know if they have a MTHFR polymorphism, and if testing is unavailable, it makes sense to take a 5-MTHF supplement to ensure adequate folate in the active form is available for DNA synthesis and methylation to promote conception and a healthy pregnancy.  Learn more about how nutrition and supplements can support male fertility by meeting with our Nutrition Team and book your consult today!

    References:

    • Young SS, et al. The association of folate, zinc, and antioxidant intake with sperm aneuploidy in healthy non-smoking men. Human Reproduction. 2008;23(5): 1014-1022. 
    • Servy EJ, et al. MTHFR isoform carriers. 5-MTHF (5-methyltetrahydrofolate) vs folic acid: a key to pregnancy outcome: a case series. J Assist Reprod Genetic. 2018;35(8): 1431-1435.
    • Jacquesson-Fournols L, et al. A paternal effect of MTHFR SNPs on gametes and embryos should not be overlook: case reports. J Assist Reprod Genetic. 2019;36(7):1351-1353.

  • Guest Blog: The Stress of It All

    by Kellie Stryker MSW LCSW

    According to reproductivefacts.org, “Infertility often creates one of the most distressing life crises that a couple has ever experienced together. The long term inability to conceive a child can evoke significant feelings of loss. Coping with the multitude of medical decisions and the uncertainties that infertility brings can create great emotional upheaval for most couples.” 

    Kristin L. Rooney, BA and Alice D. Domar, PhD with Boston IVF wrote: “Infertility is often a silent struggle. Patients who are struggling to conceive report feelings of depression, anxiety, isolation, and loss of control. Depression levels in patients with infertility have been compared with patients who have been diagnosed with cancer.1 It is estimated that 1 in 8 couples (or 12% of married women) have trouble getting pregnant or sustaining a pregnancy. Despite the prevalence of infertility, the majority of infertile women do not share their story with family or friends, thus increasing their psychological vulnerability. The inability to reproduce naturally can cause feelings of shame, guilt, and low self-esteem. These negative feelings may lead to varying degrees of depression, anxiety, distress, and a poor quality of life.”

    It’s normal to experience times of stress throughout the infertility process. However, it becomes a cause of concern when the feelings become persistent or prolonged. 

    According to reproductivefacts.org, if you experience the following symptoms for a prolonged of time, you may benefit from meeting with a mental health professional. 

    • Loss of interest in usual activities
    • Depression that doesn’t lift
    • Strained relationships
    • Social isolation 
    • Thoughts that are consumed by infertility
    • High levels of anxiety
    • Diminished ability to concentrate or accomplish tasks
    • Change in your sleep patterns, appetite or weight 
    • Increased use of drugs or alcohol
    • Persistent feelings of pessimism, guilt, bitterness, anger or worthlessness
    • Thoughts about death or suicide

    Help Is Out There 

    The following resources are dedicated to helping you improve your Reproductive Mental Health: 

    • RESOLVE: The National Infertility AssociationRESOLVE provides free support groups in more than 200 communities; is the leading patient advocacy voice; and serves as the go-to organization for anyone challenged in their family building. 
    • ASRM : American Society for Reproductive MedicineASRM is a multidisciplinary organization dedicated to the advancement of the science and practice of reproductive medicine. The Society accomplishes its mission through the pursuit of excellence in education and research and through advocacy on behalf of patients, physicians, and affiliated health care providers. The Society is committed to facilitating and sponsoring educational activities for the lay public and continuing medical education activities for professionals who are engaged in the practice of and research in reproductive medicine.
    • Pulling Down The MoonHolistic care for family health and fertility should be highly personal, compassionate, and customized to meet the unique needs and complex challenges of each patient. Founded in 2002, Pulling Down the Moon recognizes the stress and emotional turmoil and fatigue that can come with infertility as well as your day to day health. 
    • Shine Fertility Shine supports women through mentorship, community and education. We empower women by encouraging a proactive approach to fertility health and fertility preservation.

    Taking Care of You

    It’s ok to be sad, frustrated, angry, resentful, bitter and whatever emotions you may be feeling at this very moment. You are allowed to feel all of the above and more. Sit with it. Don’t force yourself to put on a brave face when you are going through unimaginable pain. However, when you are ready, allow yourself to work through the emotions you are experiencing. 

    Georgia Witkin, Ph.D with Progyny wrote: “You may not have control over the physical effects of fertility treatment, but you can take control over many of the psychological effects. What you think and what you do shapes what you feel, so choose thoughts and behaviors that reinforce your sense of control.”

     

     

     

    Kellie Stryker is a Licensed Clinical Social Worker and owner of Rain to Rainbow Counseling. Kellie has over 10 years of experience in the mental health field. Kellie currently lives in Crystal Lake, IL with her husband and 1 yr old daughter who was conceived through infertility treatments. Kellie’s mission as a Reproductive Mental Health Counselor is to provide support to others as they navigate through their infertility journey. 

    Rain to Rainbow Counseling offers supportive services which are focused on all aspects of Reproductive Mental Health which include infertility, grief, loss, miscarriage, stress management, adoption and pregnancy counseling. Rain to Rainbow Counseling is currently in network with Blue Cross Blue Shield of IL and Optum United Health Care. In Person and Online Telehealth Sessions are available.


    Benefits of Online Telehealth: 

    • Confidential: Rain to Rainbow Counseling uses Simple Practice, a secure and HIPAA compliant program.
    • Online Client Portal: No software to download. Private login and password for each client. 
    • Same benefits and techniques: Only difference is we see each other on screen instead of in person.
    • Convenience: Can literally be done from when and wherever you are comfortable.

    References: