The dietary supplement

If you want to get pregnant and are undergoing an IVF treatment, it is highly recommended that you start taking folic acid supplements. But why is that so important?

If you haven’t already started taking folic acid supplements, it is a good time to start taking them before your first visit to the clinic. Folic acid (folate) is a form of vitamin B that is necessary for cell metabolism and red blood cell formation.

The recommended dose is an intake of 400 micrograms of folic acid per day until the 12th week of pregnancy to reduce the risk of spina bifida in a fetus. The substance is found in dark green leafy vegetables such as spinach and broccoli but also in carrots, liver, kidney, egg yolk, nuts, apricot, pumpkin, avocado, beans, wheat grains, rye flour, citrus fruits, brown rice, milk and yogurt. But it is not easy to get the right amount of it through your diet alone, therefore supplements are recommended.

This is why folic acid supplements are important during IVF

The lack of folic acid can lead to birth defects

According to researchers from The University of Texas, the lack of critical enzymes in folic acid can lead to neural tube birth defects in developing embryos.

Folic acid before you are pregnant

For several decades, it has been known that folic acid supplementation dramatically reduces the incidence of neural tube defects. They happen in the first month of pregnancy, often before a woman even knows that she is pregnant. So, if you are doing IVF you have a great chance to prepare yourself in advance and reduce the chance of any such defects. The reason for this is that you can start taking the supplements in time compared to if you conceive naturally and don’t know that you are pregnant.

Neural tube defects

Neural tube defects imply that the neural tube of the foetus doesn’t close as it should which can lead to birth defects in the brain, spine, or spinal cord. The two most common neural tube defects are spina bifida and anencephaly.

• Spina bifida
  In spina bifida, the fetal spinal column doesn’t close completely. Spina bifida causes at least some paralysis of the nerves below the affected area of the spinal cord, which can cause walking and other difficulties. Because the lowest spinal nerves control bladder and bowel functions, bowel and urinary dysfunction are common with spina bifida.
• Anencephaly
  In anencephaly, a more severe neural tube defect, most of the brain and skull do not develop.

Folic acid supplements decrease the risk by 70%

Folic acid supplements have helped decrease neural tube defects by as much as 70% in some populations. On the other hand, experts still do not fully understand how folic acid decreases neural tube defects or why folic acid supplementation does not eliminate birth defects in all pregnancies.

Mutation of a key folic acid enzyme

Dean Appling (professor of biochemistry at the College of Natural Sciences at The University of Texas at Austin) has found that the mutation of a key folic acid enzyme causes neural tube defects in mice. According to him, this discovery is the clearest mechanistic link yet between folic acid and birth defects. Appling added that the research reveals that one of the ways that folic acid prevents birth defects is by ensuring the production of formate in the developing embryo and this may explain the 30 percent neural tube defects that cannot be prevented by folic acid supplementation.

Research on other important nutrients

Moreover, the mice provided researchers with a strong model system that they can use to further understand folic acid and its role in birth defects in humans. In fact, humans share the same gene for the folic acid enzyme with the mouse and all other mammals. Consequently, Appling and his team would like to use the mouse system to begin looking for nutrients that could be given to pregnant mothers to avoid those neural tube defects that cannot be prevented by folic acid. Eventually, steps could be taken to improve their chances for developing embryos free of neural tube defects through further nutrient supplementation.

(Step 5: More rarely performed examinations)

Depending on your situation you may have to do a hysteroscopy to look for uterine disease and a laparoscopy to identify endometriosis, scarring, blockages or irregularities of the fallopian tubes, and problems with the ovaries and uterus. These are, however, more rare examinations.

Key takeaways if you want to do or are doing IVF:

1. If you haven’t already started taking folic acid supplements, it is a good time to start taking them before your first visit at the clinic!
2. Getting enough folic acid, a type of B vitamin, before and during pregnancy can prevent most neural tube defects.
3. Doing an IVF means you have a great chance of minimizing these risks compared to conceiving naturally.
4. See the list below for tips on what you can eat to get your folic acid through nutrition.

Difficult to get the needed amount of folic acid through nutrition

A daily intake of 400 micrograms of folic acid through nutrition is not easily achievable. Here is a list of foods containing folic acid. Note that these foods contain the amount of folic acid listed below when they are raw, that is, when they are uncooked. The level of folic acid decreases during heating and cooking.

Amount of folic acid in certain foods (micrograms per 100 grams):

• Spinach 194
• Broccoli 175
• Red pepper 77
• Peas 65
• Brussels sprout 61
• Iceberg lettuce 56
• Rye bread 32
• Orange 30
• Green beans 30
• Cloudberry 26
• Tomato 20
• Banana 19
• Carrot 14
• Olives black / green 10
• Apple 2