Folate vs. Folic Acid for Male Fertility

As with most nutrients, too much of a good thing can be just as bad as too little of a good thing. In the case of folic acid, it’s far more common to get too little rather than to get too much. Depending on your individual circumstances, the right levels of folic acid for men fall between the range of 400 mcg to 1,000 mcg per day. However, taking folic acid doses higher than 1,000 mcg per day can disguise another vitamin deficiency—vitamin B12 deficiency.‌⁵ Getting too little vitamin B12 can also cause infertility problems in men. Both vitamins B9 and B12 are crucial in making healthy red blood cells and maintaining brain health. In addition to the studies indicating multiple folic acid benefits for men, optimal B12 levels have been shown to improve sperm count, DNA quality, and motility.⁶‌

Working with our fertility nutritionist and our other holistic fertility service providers can help you figure out how to eat and supplement so that you get the best amounts of all the nutrients you need without going overboard or getting too little.

Who Needs Extra Folic Acid?

Everyone should get the right amount of folic acid, but couples who are trying to get pregnant should most definitely consider ensuring that they are getting at least 400 mcg of folic acid a day. Folic acid helps improve both egg and sperm quality and quantity. The benefits of folic acid for men and women also include improved cardiovascular health, stronger red blood cell quality, and a lower risk of stroke. It’s well understood that for pregnant women, optimal folic acid levels reduce the risk of neural tube defects in their babies, but studies also show that correct folic acid intake can also reduce the chances of passing along genetic predispositions for diabetes, autism, and childhood leukemia.⁷‌

There’s one more thing to know about folic acid for men (and women): alcohol consumption can impede your absorption of this critical nutrient.⁸‌ So consider reducing or eliminating alcohol intake while trying to improve your fertility.

The Role of MTHFR Polymorphisms and 5-MTHF in Improving Sperm Parameters and Pregnancy Rates

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!

Benefits of Folic Acid for Men

There are quite a few benefits of folic acid for men that go beyond just fertility, although this is the primary concern we’ve discussed thus far. Some of the other major benefits optimal levels of folic acid can bring include:

1. Mental Health

Mental health is so important for you and your partner as you progress in your fertility journey, and whatever its outcome. Healthy relationships, healthy work-life balance, and even physical health all depend on good mental health. Several studies have shown that people suffering from depression show lower blood serum levels of vitamin B9 in both forms.⁹ Good nutrition is generally connected with better mental health and fertility. It’s all connected.

2. Heart Health

Speaking of how your entire body is an integrated system working together, optimal folic acid levels have also been shown to improve cardiovascular health, specifically in reducing the risk of stroke.¹⁰ Cardiovascular health is integral to reproductive health and erectile function, so again, it makes sense to get a blood test to measure vitamin folic acid and folate levels and then work to optimize them for overall health.

3. Hair Growth

While studies have been inconclusive so far about the ability of folic acid or folate (either form of vitamin B9) to grow more hair, there is a correlation between low levels of vitamin B9 and poor skin, hair, fingernail, toenail, mucous membrane, blood, and gastrointestinal health generally.¹¹

4. Fertility

As we have discussed so far, one of the folic acid benefits for men is that optimal levels can improve sperm count, health, and quality. Folic acid also has another vitally important role in men’s reproductive health, however. Studies have demonstrated that it can help men overcome erectile dysfunction.¹² Apparently, folic acid levels can also help make things happen.

Nutrition for Men’s Fertility

Folic acid and folate are just a small part of the nutrient profile that can help optimize men’s fertility and women’s fertility. Some other crucial nutrients to look into if you’ve been trying to get pregnant include:

• L-arginine
• Choline
• Magnesium
• Omega-3 Fatty Acids

If you and your partner are trying to conceive, schedule a consultation with us at Pulling Down the Moon today. We provide a wide range of holistic fertility services (like acupuncture and massage therapy) that all support both of you as you optimize your health to increase your chances of having a baby.

References

¹Mathieu d’Argent, E., Ravel, C., Rousseau, A., Morcel, K., Massin, N., Sussfeld, J., Simon, T., Antoine, J.-M., Mandelbaume, J., Daraï, E., & Kolanska, K. (2021). High-Dose Supplementation of Folic Acid in Infertile Men Improves IVF-ICSI Outcomes: A Randomized Controlled Trial (FOLFIV Trial). Journal of Clinical Medicine, 10(9), 1876. https://doi.org/10.3390/jcm10091876

²Folate vs. Folic Acid: What’s the Difference? (n.d.). Cleveland Clinic. Retrieved December 8, 2023, from https://health.clevelandclinic.org/folate-vs-folic-acid

³Folate Benefits and 13 Folate-Rich Foods to Try. (2021, November 3). Cleveland Clinic. https://health.clevelandclinic.org/benefits-of-folate

⁴Segre, J. (2023). Methylation. Genome.gov. https://www.genome.gov/genetics-glossary/Methylation

⁵‌Harvard School of Public Health. (2012, September 18). Folate (Folic Acid) – Vitamin B9. The Nutrition Source. https://www.hsph.harvard.edu/nutritionsource/folic-acid/

⁶‌Banihani, S. A. (2017). Vitamin B12 and Semen Quality. Biomolecules, 7(4), 42. https://doi.org/10.3390/biom7020042

⁷‌Khan, K. M. (n.d.). Folic Acid Deficiency (VA MEDICAL CENTER, MATHER , CA, Ed.) [Review of Folic Acid Deficiency]. Folic Acid Deficiency; National Library of Medicine. Retrieved December 8, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK535377/

⁸‌Johns Hopkins Medicine. (2019). Folate-Deficiency anemia. John Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/folate-deficiency-anemia

⁹Bender, A., Hagan, K. E., & Kingston, N. (2017). The association of folate and depression: A meta-analysis. Journal of Psychiatric Research, 95, 9–18. https://doi.org/10.1016/j.jpsychires.2017.07.019

¹⁰Wang, Y., Jin, Y., Wang, Y., Li, L., Liao, Y., Zhang, Y., & Yu, D. (2019). The effect of folic acid in patients with cardiovascular disease. Medicine, 98(37), e17095. https://doi.org/10.1097/md.0000000000017095

¹¹National Institutes of Health. (2022, November 30). Office of Dietary Supplements - Folate. Nih.gov; National Institutes of Health. https://ods.od.nih.gov/factsheets/Folate-HealthProfessional/

¹²Elshahid, A. R. M., Shahein, I. M., Mohammed, Y. F., Ismail, N. F., Zakarria, H. B. A. E.-R., & GamalEl Din, S. F. (2019). Folic acid supplementation improves erectile function in patients with idiopathic vasculogenic erectile dysfunction by lowering peripheral and penile homocysteine plasma levels: a case‐control study. Andrology, 8(1), 148–153. https://doi.org/10.1111/andr.12672

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.