Does low iron impact fertility and conception?

Iron deficiency is the most common nutrient deficiency worldwide, and yes it occurs commonly in meat eaters as well. Assessing iron status is an important part of preconception care, as iron and fertility are linked. In pregnancy, iron also plays a key role in foetal development, and low levels are linked to hypertension, preeclampsia, low birth weight, and postnatal complications.

However simply taking an iron supplement may not be the answer, as both high and low iron can contribute to issues when it comes to reproductive health and fertility.

How does low iron impact fertility?

Research shows low iron increases the risk of anovulatory (meaning not ovulating) infertility, and correcting iron via diet and supplementation decreases the risk. Iron is also essential for optimal thyroid function. Low levels of thyroid hormones can interfere with ovulation, which impacts fertility. Iron is also needed for thickening of the endometrial lining to allow implantation and maintain pregnancy.

Essentially, low iron means your body will use the iron it has available for keeping you alive (attaching to red blood cells for oxygenation) and your body won't prioritise reproduction.

Because iron status is difficult to maintain in pregnancy (iron is used in the huge increase in red blood cells, and massive amounts of iron are transferred to the foetus particularly in later stages of pregnancy), ensuring your iron levels are optimal before pregnancy is helpful to avoid deficiency and complications.

The problem with testing iron status

Iron is really often misunderstood, so sometimes only iron or only ferritin is tested. The issue is that doesn't give a true indication of what is happening with not only the body's iron stores, but how it is utilised, and whether there is iron deficiency anaemia. To properly assess iron, you need to ask your Dr for:

• Ferritin (this is your storage of iron)
• Transferrin (this along with saturation is how well your body is transporting and utilising iron)
• Transferrin Saturation
• Full Blood Count (this shows whether low iron is actually impacting your blood cells, i.e. anaemia)

The problem with high dose iron supplementation (e.g. Maltofer, Ferrograd C)

The issue with iron dose iron supplementation, even in anaemic and iron deficient conditions, is that we aren't able to actually absorb that much iron. Our body needs to regulate iron absorption because iron is a heavy metal, and too much causes oxidative damage, essentially "rusting" organs and tissues. High dose iron increases 'hepcidin' which blocks absorption of iron - worsening low iron.

Maltofer and Ferrograd C also contain forms of iron that cause constipation (its not the iron itself, just the form that causes this), and can cause inflammation of the gut and feed pathogenic gut bacteria, again worsening the issue of low iron.

The second issue with iron supplementation is that for iron to be absorbed we need optimal stomach acid, healthy gut bacteria, and for iron to be effectively transported and utilised by the body (and not get "stuck" in tissues and organs causing oxidative stress) we also need copper, retinol (preformed vitamin A), and magnesium, along with other nutrient that aid absorption of iron - vitamin C, vitamin B12 and folate. Without having an optimal dietary intake of these other nutrients, it is unlikely for iron levels to increase to optimal.

So, should I supplement iron for fertility?

Iron testing should always be done before taking an iron supplement. For fertility, regular testing and starting optimising iron status via the diet and quality iron supplementation early is key to avoiding iron deficiency or the need for iron transfusions in pregnancy or postpartum.

When I recommend and prescribe iron supplementation to clients, I typically use lower doses of high quality forms, alternate day dosing, combine iron with other supplements to support absorption and utilisation of iron, and ensure adequate dietary intake of iron and cofactors.

Another way to increase iron without an iron supplementation is using probiotic Lactobacillus plantarum 299v (LP299v), which research shows increases iron absorption and iron stores, via improve gut absorption. 

Top tips to maintain healthy iron levels

1. Chew your food well - chewing activates digestives enzymes and stomach acid to break down food so we can access iron
2. Eat adequate iron rich foods (RDI for adult menstruating females in 18mg) - meat, fish, poultry (haem iron), legumes, nuts, seeds, green leafy veg (non-haem, which isn't absorbed as well)
3. Support absorption of iron - pair iron rich foods with vitamin C rich foods (berries, broccoli, citrus, tomato, capsicum)
4. Avoid taking iron supplements with zinc or calcium supplements, tea, coffee, dairy, which block absorption
5. Support optimal gut health - prebiotic and probiotic rich foods, avoid food intolerances, reduce/avoid inflammatory and processed foods
6. Address the root cause of the low iron, e.g. the gut, heavy periods and hormone imbalances, supplementation, diet (this needs to be done with a Clinical Nutritionist as it involves thorough testing and assessment of tests, dietary analysis and assessment of your whole body health) 

*Also note if you are currently pregnant or postpartum and have been diagnosed with iron deficiency, please also speak to your healthcare practitioner and follow their medical advice, as iron infusions are at times needed. My tips and suggestions here are to optimise iron status to avoid iron deficiency, but are not personalised medical or treatment advice.

Iron is complex and something worth investigating whether it be for fertility or for chronic low iron. For personalised support, please book a complimentary wellness discovery call to get started - book here.

For fertility preconception care, join 'Balance Nourish Fertile' group fertility program starting Monday 7th November 2022, so you can boost your fertility in just 4 weeks, even if you have PCOS, endometriosis or irregular periods. I'll be covering iron and iron supplementation (and you'll receive a personalised fertility supplement plan), as well as all your preconception care nutrition and lifestyle needs. Details here.

References:

Cure Your Fatigue, Morley Robbins https://therootcauseprotocol.com/book/ 

DOI: 10.1146/annurev-nutr-082018-124213

DOI: 10.3390/biom10081176

DOI: 10.1097/01.AOG.0000238333.37423.ab