What actually helps, beyond the basics?

Beyond folate and a preconception visit, there's a large body of research on nutrition, supplements, sleep, and environment. Some of it is solid, some is promising, and some is just popular. Every item below carries a label saying which, and links to the underlying study rather than to whoever summarized it. How we grade evidence.

Bring anything you plan to take to your doctor, especially once you're in treatment, and make sure it's on your record.

Do these

• Strong evidence Folate, 400 mcg daily, starting at least a month before trying. The one supplement with unambiguous evidence, for neural tube defect prevention. Folic acid and methylfolate both count; more if MTHFR has come up for you.
• Strong evidence Don't smoke, and skip alcohol while you're trying. Both reduce fertility and raise miscarriage risk, and there's no known safe amount of alcohol in early pregnancy. Partners should quit smoking and cut back on drinking too.
• Strong evidence Treat what's treatable. Thyroid disease and uncontrolled diabetes both have real effects on fertility and pregnancy, and clear fixes. Ask for the tests rather than guessing.

Reasonable to do

Low-risk, and good for your health either way. The labels show how strong the fertility evidence is, which varies.

• Emerging evidence A Mediterranean-style eating pattern. Vegetables, fruit, legumes, whole grains, fish, olive oil, nuts; less processed meat and refined carbohydrate. In a prospective study of non-obese women under 35 doing IVF, higher adherence tracked with substantially higher pregnancy and live birth rates. Observational, so not proof of cause, but consistent across studies and with no downside.
• Emerging evidence Omega-3 fatty acids. A 2022 analysis of women trying naturally found those taking omega-3 supplements had a higher chance of conceiving per cycle. Also observational. Fish two to three times a week or a tested supplement is low-risk either way.
• Limited or mixed Vitamin D sufficiency. A meta-analysis found women who were vitamin D sufficient had higher live birth rates in IVF than women who were deficient. Trials that supplement to raise levels have been mixed, so the honest reading is: test, correct a deficiency, don't expect megadoses to add more.
• Moderate evidence Choline, 450 mg daily in pregnancy. NIH's Office of Dietary Supplements reports that 90 to 95 percent of pregnant women get less than the adequate intake, and that prenatal supplements "typically contain little if any choline." One of the clearest gaps between what's recommended and what's in the bottle. See the choline gap.
• Limited or mixed Myo-inositol if you have PCOS. Improves ovulation and metabolic markers across several trials. The Cochrane review and the international PCOS guideline rate the evidence quality as limited and don't place it above standard treatments like letrozole, but it's low-risk and widely used. Ask how it fits your plan.
• Moderate evidence Moderate exercise and a weight in the healthy range. Both extremes of weight affect ovulation; very high-intensity training can too. Regular moderate movement tracks with better outcomes.
• Insufficient evidence Sleep, seven to nine hours, on a regular schedule. Well established for health generally. For fertility specifically it hasn't been directly tested, though shift work and short sleep track with irregular cycles and lower semen quality — and it costs nothing.

Worth a conversation, not a certainty

• Emerging evidence CoQ10. Popular for "egg quality." A meta-analysis of randomized trials in women doing IVF found CoQ10 pretreatment raised clinical pregnancy rates but showed no significant difference in live birth or miscarriage, and the trials were small. Commonly suggested at 200–600 mg daily for about three months before a cycle, particularly with lower ovarian reserve or age over 35. On the ubiquinol-versus-ubiquinone question that comes up constantly in forums: ubiquinol is the reduced form and is generally better absorbed, but the trials used varied forms and doses and are too small to settle which is better for fertility. Anyone telling you confidently which form to buy is going beyond the evidence. Reasonable to discuss; not proven.
• Emerging evidence Reducing endocrine disruptors. Higher BPA and phthalate exposure tracks with poorer outcomes in observational studies. Less plastic food storage, fewer canned foods, fewer fragranced products: cheap, harmless, not definitive.
• Emerging evidence Creatine, and other things the optimization world is early on. Interesting mechanistic and animal work on energy availability in eggs and in pregnancy, essentially no human fertility trials. This is the category where the enthusiasm is currently ahead of the evidence. Not a reason to avoid it, but not something we'd tell you it will help.

Mixed, or weaker than the marketing

• Limited or mixed Antioxidant supplements for men. Many small studies suggest improved semen parameters, but the overall evidence quality is low, and the largest well-run trial (FAZST, 2,370 men) found folic acid plus zinc improved neither semen quality nor live birth. Diet, weight, not smoking, and avoiding heat and steroids have better support than any pill.
• Emerging evidence Acupuncture, as a sustained course. The picture is more interesting than the headlines: a 2025 network meta-analysis of 96 trials found courses run over about three cycles before egg retrieval were associated with better outcomes, while single sessions around embryo transfer were not. The anxiety evidence is stronger than the pregnancy evidence. Very safe. See the full picture.
• Insufficient evidence Multi-ingredient "fertility blends." Dozens of ingredients at small doses, with no trial behind the blend itself. Buy single ingredients at studied doses instead.
• Insufficient evidence Anything marketed for egg or sperm "quality" without a named study. Ask for the study. If there isn't one, that's the answer.

Be careful

• Safety consideration DHEA without supervision. It's a hormone with real side effects and mixed data. It has a legitimate role in some protocols for diminished ovarian reserve, prescribed and monitored. Not a self-serve supplement.
• Safety consideration Vitamin A as retinol above the upper limit is unsafe in pregnancy. Good prenatals use beta-carotene or stay well under.
• Safety consideration High-dose single nutrients and herbal blends during treatment. Some affect clotting or interact with fertility medications. Tell your clinic everything you take.
• Safety consideration Strict diets, extended fasting, and "detoxes." Under-eating suppresses ovulation. This is one place where optimizing harder makes things worse.

How to use this

Do the strong tier. Choose from the moderate tier based on what you can actually sustain. Bring the emerging tier to your doctor as a question: "I've read about CoQ10 for egg quality; given my results, is it worth trying before a cycle?" That framing gets you a real answer instead of a dismissal.

For what to buy, see how to choose a quality supplement. For the calmer-body side of this, see caffeine, stress, and inflammation.