The Importance of Folic Acid in Female and Male Fertility

If you've been looking at supplements for fertility, you've likely come across recommendations for folic acid. One of the B-vitamins, folate (or folic acid, as it's known in supplement form) is needed for the development of red blood cells and DNA production. Folate also plays an important role in cell division. Low folate blood levels are associated with a form of anemia.

Folic acid is clearly an essential nutrient in the body. But can folic acid help you conceive? Should men also be taking folic acid? Should you take a supplement, or can you get what you need from diet alone?

The need for folic acid or folate in women of childbearing age is well-known. (More on female fertility and folate below.) But could folic acid improve male fertility?

Before we get an embryo, we need an egg and a sperm. While women are born with all the eggs they will ever have, the man's body creates sperm on a daily basis.

In fact, 1,500 new sperm cells are "born" every second. The process from germline stem cell to sperm cell takes about 60 days. Folate is an essential nutrient when it comes to cell division and DNA synthesis

Folate levels measured in semen have been associated with sperm count and health. One study found that low folate levels in semen were associated with poor sperm DNA stability.

From this, we may learn that folate plays an important role in sperm health.

Could taking folic acid supplements boost your sperm count? The answer is maybe.

One study found that a combined supplementation of folic acid and zinc for a period of 26 weeks increased total sperm count in fertile and subfertile men. In fact, it increased normal total sperm count by 74 percent.

Also interesting in this study, before supplementation was started, seminal folate and zinc levels were not significantly different in the fertile and sub-fertile men. This may indicate that even though low folate wasn’t the cause for lower sperm counts, supplementation still helped.

While research is still ongoing, there does seem to be a correlation between folic acid and semen health.

However, folic acid isn’t a “cure all” for serious cases of male infertility.

A separate study looked at zinc and folic acid supplementation effects in men with oligoasthenoteratozoospermia (OAT). OAT is when sperm counts are low, motility (sperm movement) is abnormally low, and the percentage of normally shaped sperm are low.

This study found that supplementation with folic acid and zinc did not significantly improve sperm health in these men.

If you decide to supplement, how much should you take? You can get a boost of folic acid through a daily multivitamin, or you may consider taking a "male prenatal" vitamin. ConceptionXR®: Reproductive Health Formula comes highly recommended, and contains folic acid along zinc, vitamin C, vitamin D, selenium, and lycopene, all nutrients found to improve male fertility.

Women who don't get enough folic acid in their diet are at a higher risk for having a baby with a neural tube defect. When we consider how a baby begins—a single cell that divides and divides—it makes sense that folic acid could help ensure the cell division, and therefore fetal development, goes well.

Neural tube defects, which occur in about 3,000 pregnancies per year in the United States, include spina bifida, anencephaly, and encephalocele. At best, these birth defects can lead to lifelong disability, and at worst, they can lead to early death.

If you have a family history of neural tube defects, you have an even higher risk of having a child with one of these birth defects.

While folic acid can't eliminate these birth defects, folic acid supplementation started before conception and continued through early pregnancy has been found to cut the occurrence of these birth defects by up to 60 percent. (More on supplementation below.)

Other possible benefits of folic acid supplementation include:

• A lower the risk of congenital heart defects.
• A lower risk of preterm birth and a lower risk of low-birth-weight babies.
• Increased progesterone levels and a lower risk of irregular ovulation.

There are many good reasons for women trying to conceive to be sure they get enough folate.

For your reference, the recommended intake of folic acid is:

• 400 mcg for men and women 14 years and up
• 500 mcg for breastfeeding women
• 600 mcg for pregnant women

Because of the connection between birth defects and folate deficiency, most breads and cereals in the United States and Canada are enriched with folic acid. Enriched cereals and breads are likely the easiest way to get more folic acid into your diet.

Beyond your morning bowl of fortified cereal, here are 10 foods high in folic acid:

• Beef liver, 3 oz.: 215 mcg
• Spinach, 0.5 cup boiled: 131 mcg
• Black-eyed peas, 0.5 cup boiled: 105 mcg
• White rice, 0.5 cup cooked: 90 mcg
• Asparagus, 4 spears boiled: 89 mcg
• Brussels sprouts, 0.5 cup boiled: 78 mcg
• Romaine lettuce, 1.0 cup shredded: 64 mcg
• Avocado, 0.5 cup raw: 59 mcg
• Spinach, 1 cup raw: 58 mcg
• Broccoli, 0.5 cooked: 52 mcg

Other foods with folate include mustard greens, green peas, kidney beans, peanuts, wheat germ, tomato juice, crab, orange juice, turnip greens, oranges, papaya, and bananas.

Despite bread and cereal fortification, most women still don't get enough folic acid in their diet. Because many pregnancies are unplanned, and because this vitamin must be present before you get pregnant, the March of Dimes recommends that all women of childbearing age take a daily supplement that includes at least 400 mcg of folic acid. When pregnant, the recommended daily folic acid supplementation raises to 600 mcg.

Your doctor may recommend a prenatal vitamin to take while trying to conceive, or simply a daily multivitamin. Just check to be sure the multivitamin contains at least 400 mcg of folic acid.

If you have a family history of neural tube defects, your doctor may recommend you take 4,000 to 5,000 mcg of folic acid. However, because these levels are above the recommended upper limits, you should only take this high of a dose under the supervision of your doctor.

Folic acid is a water-soluble vitamin, which means it must be replaced on a daily basis in the body. To get the best results, be sure to take your supplement daily.

One study found that the benefits of folic acid supplementation didn't occur when taken on two or fewer days per week.

You can have too much of a good thing. Unless your doctor prescribes it, your daily supplements shouldn't include more than 1,000 mcg of folic acid.

Taking large doses of folic acid may cover up a vitamin B-12 deficiency, which can cause irreversible damage if not caught early on. Your doctor should test your B-12 levels before putting you on high dose folic acid supplements.

There’s also a concern that high doses of folic acid may actually harm DNA synthesis in sperm.

Folic acid may interact with other medications. For example, folic acid may reduce the effectiveness of the anti-seizure drug phenytoin. Also, some fertility blends include herbs that can interact with fertility drugs. So be sure to speak with your doctor before beginning any supplementation.

Folic acid is an important vitamin for both men and women. Getting enough folic acid can help decrease the risk of birth defects,  and it may improve sperm count in men. They do make fertility supplements for men and women who are trying to conceive, but they are not all equal. Some could contain ingredients that are not good for you, may interact with medications you're taking, or could even be harmful.

Always talk to your doctor before beginning supplementation, and make sure to inform your health care team about any vitamins, herbs, or other supplements you're taking.