Preconception planning with fertility supplements and lubricants

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Subfertility issues, in both men and women, contribute to difficulty getting pregnant.1 In the family planning aisle, couples are likely to encounter numerous products that claim to be safe to use while trying to conceive or to increase the likelihood of successful conception. This may leave patients asking pharmacists which products are best. 

Fertility supplements

FertileCM, a dietary supplement containing L-arginine and other antioxidants, is marketed for its ability to “naturally” promote cervical mucus secretions, thus enhancing the uterine lining to support implantation.2 A 2013 Cochrane review analyzed the use of antioxidants in subfertile women. Results showed that antioxidant use was not associated with increased birth or pregnancy rates.

FertilAid is another supplement available in versions for women and men. The women’s formulation contains chasteberry, red clover blossom, Siberian ginseng, PABA, ginkgo biloba, folic acid, and other antioxidants.3 The men’s formulation contains vitamin C, vitamin E, beta-carotene, selenium, CoQ10, grapeseed extract, zinc, maca root, and Asian ginseng.3 

In women, FertilAid claims to promote hormonal balance, whereas in men it is marketed for its ability to increase sperm count and quality.4,5 These claims were based on a few studies with small sample sizes and included no data on live birth rates. It is important to counsel that these supplements are not FDA regulated; thus quality and consistency cannot be ensured. 

Lubricants 

Some women may need artificial lubrication due to decreased cervical mucus production that may be caused by conditions such as diabetes and inflammatory bowel disease or by medications such as antihistamines, stimulants, anticholinergics, and antidepressants.6 Couples may also use lubricants for comfort and to increase sexual satisfaction. 

There are five main types of lubricants: petroleum based, natural oil–based, water based with glycerin, glycerin-free water based, and silicone. While each of these lubricants has respective advantages and disadvantages, they all may impair sperm motility.6

Pre-Seed and ConceivEase are marketed as a new type of fertility-friendly lubricant made of an isotonic hydroxyethylcellulose base that mimics natural fluids and will not damage sperm. A study by Sandhu and colleagues reported that in sperm from 22 donors, commercial products including Astroglide and K-Y were associated with greater decreased sperm motility when compared with Pre-Seed, canola oil, and mineral oil.7 

Although lubricants may affect sperm motility to some degree, using lubricants while trying to conceive has not been demonstrated to affect the likelihood that pregnancy will occur.8 Hydroxyethylcellulose-based lubricants are more expensive options when compared with other products. Of note, baby oil and canola oil may increase the risk of vaginal infections and stain fabric.6 For couples trying to conceive, canola oil, mineral oil, or hydroxyethylcellulose-based lubricants can be recommended based on preference.8 

Preconception counseling points

  • Avoid smoking, caffeine consumption of more than 200 mg per day, alcohol consumption, and exposure to illicit drugs. 
  • Couples should identify when their fertile window occurs, which is usually a 6-day timeframe ending on the day of ovulation. 
  • Engage in intercourse at least two to three times per week during the fertile window. 
  • Take a daily prenatal multivitamin containing at least 400 µg of folic acid. Caution couples using antioxidant agents to not exceed recommended daily requirements for vitamins and trace minerals.

References

  1. Cochrane Database Syst Rev. 2013;8:CD007807 
  2. Acta Obstet Gynecol Scan. 2005;84(9):883–6
  3. http://www.fertilaid.com/. Accessed April 11, 2014
  4. Forsch Komplementarmed Klass Natureheilkd. 2000;7(4):190–9
  5. Clifton GD et al. In: Journal of Andrology; 2009 April 4–7; Philadelphia. Abstract #25
  6. Nurs Womens Health. 2011;15(3):253–7
  7. Fertil Steril. 2014;Jan 23 PMID 2446260  
  8. Fertil Steril. 2013;100:631–7
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