As patients sit in my office and begin to tell their story of infertility, one thing is clear: they have analyzed every aspect of their lives to see what they could be doing to cause their infertility. While this self-reflection may cause undue stress, it also gives them the opportunity to evaluate their diets and lifestyles and make changes for the better that can have far-reaching effects.

I am often asked questions that pertain to vitamin supplementation.

A Report from the American College of OB GYNs gives us a reliable answer to the question of Calcium and Vitamin D, weighing the pros and cons. An excerpt is as follows:

“The 2011 report by the Institute of Medicine (IOM) lowered some of the recommendations from their earlier report. The recommended dietary allowance for calcium now ranges from 1,000 mg per day to 1,300 mg per day depending on age, and the vitamin D recommended dietary allowance now ranges from 600 international units per day for most of life to 800 international units per day after age 70 years.

The IOM recommends a serum vitamin D level of 20 ng/mL (50 nmol/L) for good bone health because that level covers the requirements of 97.5 percent of the population. Routine screening of vitamin D levels is not recommended.

Both low and high levels appear to carry risks. These risks include cardiovascular disease, some types of cancer, falls, fractures and all-cause mortality. The IOM recommended upper limit of vitamin D intake for adolescents and adults is 4,000 international units/d.

High intake of calcium also has been associated with risks. A 2009 Cochrane analysis of 11 trials reported a statistically significant increase in renal stones or renal insufficiency (relative risk, 1.16; 95 percent confidence interval, 1.02–1.33).

Controversy exists regarding the possible association of calcium supplementation and coronary artery calcification and coronary artery events. The authors recommended dietary sources of calcium as potentially safer sources of calcium than supplements. Other reports, including a meta-analysis, dispute the findings and report no beneficial or detrimental effects to the cardiovascular system.”

Table 4. Institute of Medicine Recommended Dietary Allowances for Calcium and Vitamin D
Age (yr)	Calcium Recommended Dietary Allowance (mg/day)	Vitamin D Recommended Dietary Allowance (international units/day)
9–18	1,300	600
19–50	1,000	600
51–70	1,200	600
71 and older	1,200	800
Data from Institute of Medicine. Dietary reference intakes: calcium, vitamin D. Washington, DC: National Academies Press; 2011.