I just finished discussing future infertility treatment options with a couple. The woman had lost a fallopian tube to an ectopic pregnancy and suffered from irregular menstrual cycles. The couple had just completed their second cycle of clomiphene (Clomid) with intrauterine insemination (IUI). Due to high stress levels, the couple decided to take a 2 to 3 month “break’ from any infertility treatments.

Following the recent negative pregnancy test, the woman had stopped taking her folic acid supplement. She did not like taking pills, though she found it easy to take folic acid. I advised her to start taking her folic acid again right away. She was confused, thinking that folic acid was only helpful once pregnant. This is a common response that many people have. I often hear that patients stop taking their multivitamin or folic acid supplement when fertility treatments end; they believe they only need to take them when in treatment or once pregnant.

Folic acid and pregnancy guidance

So why take folic acid? Let’s consider why folic acid is advised before pregnancy begins, and why a woman should take it if there is any possibility of her becoming pregnant:

• Folate is a “B” vitamin that occurs naturally in foods, such as leafy green vegetables, beans, whole grains and citrus fruit.
• Folic acid is the synthetic form of folate that is present in many supplements and may be added to fortified foods.
• Typically, most women do not obtain enough folate through their diet alone. Thus, women who are planning to become pregnant, or who may become pregnant, should take 400 to 800 micrograms (mcg) of folic acid daily. Folic acid is found in almost all multivitamins or prenatal vitamins and in a variety of breakfast foods.
• Folic acid can help the body make new, healthy cells. It has been found that women who take folic acid before becoming pregnant can reduce the chances of a neural tube defect (NTD), which is a common birth defect. Neural tube defects can cause birth defects of a baby’s spine or brain (spina bifida or anencephaly). As the neural tube forms and closes in early pregnancy, the first four weeks of pregnancy are critical to normal neural tube development. This means that folic acid should be started before becoming pregnant, to provide the best protection against a NTD. Studies show that if folic acid is started one month before conception occurs, and is continued in early pregnancy, the risk for a NTD may be reduced by as much as 50 to 70 percent.

My advice for any woman who may become pregnant, whether undergoing infertility treatment or spontaneously? Take a daily folic acid supplement of at least 400 micrograms (mcg). Please talk to your doctor to learn more and to find out the right dose of folic acid for you.