Vitamin E and Reproductive Health

The key element in the pathogenesis of most of the diseases is oxidative stress [1]. Oxidative stress occurs when there are too many pro-oxidants (a.k.a. free radicals) and too few antioxidants to balance their effects [1]. Vitamin E (α-tocopherol) is a powerful fat-soluble antioxidant with countless benefits throughout the body. A group of these benefits happen to revolve around male and female reproductive systems, and fertility.

In males, a vitamin E deficiency can contribute to low sperm viability and motility, reproductive dysfunction, and testicular damage [2,3]. Vitamin E is involved in the regulation of testosterone biosynthesis in spermatogenesis [3]. It also protects the integrity of the membrane surrounding individual sperm in the face of oxidative stress [2]. 

In females, the fluid around developing eggs naturally contains vitamin E, which provides antioxidant protection. Deficiencies in vitamin E have been linked to poor female fertility [1]. Supplementing with vitamin E has been shown to help prevent miscarriage in women who have a history of recurrent miscarriages [4]. It also supports a healthy amniotic sac in pregnancy and prevents the premature rupture of the membranes in pregnancy [5].

Vitamin E supplements may also support a healthier thickness of the endometrium [1]. Endometrium, (the uterine lining), can be thin for a number of reasons, such as low estrogen levels. When the uterine lining is too thin, it can reduce the likelihood of successful implantation. 

Vitamins for PCOS Support

Polycystic Ovarian Syndrome (PCOS) is a condition affecting between 4-8% of females of reproductive age, according to the NIH [5]. PCOS is characterized by symptoms of hyperandrogenism (e.g. acne, hirsutism, and alopecia), anovulation (e.g. irregular, infrequent, or absent menstrual cycles), and the growth of cysts on and around the ovaries [6]. 

There is not one, singular root cause of this syndrome. However PCOS is associated with imbalanced hormones and multiple metabolic conditions [6]. Somewhere between 44-70% of patients with PCOS also experience insulin resistance and hyperinsulinemia [6]. They are also at a higher risk of cardiovascular disease due to the high prevalence of dyslipidemia [6]. 

While a balanced diet and regular exercise are the most common prescription for natural PCOS management, vitamins for PCOS can offer support. Magnesium and vitamin E co-supplementation for 12 weeks has been shown to provide beneficial effects on insulin metabolic parameters, and markers of cardio-metabolic risk in women with PCOS [6]. 

Omega-3 fatty acids and vitamin E co-supplementation for 12 weeks has been shown to significantly improve insulin resistance, and both total and free testosterone levels in women with PCOS [6]. 

Vitamin E for PCOS fertility

Of all the recommended vitamins for PCOS, vitamin E alone has been shown to improve the overall hormonal profile by decreasing testosterone and LH levels, and increasing progesterone and FSH levels [6]. A healthy hormonal profile will likely contribute to better fertility. 

But how does this work? What is the mechanism behind vitamin E’s actions?

Increased levels of reactive oxygen species (ROS), as a result of oxidative stress, likely play a key role in the pathogenesis of PCOS [7]. PCOS may actually cause its own oxidative stress, creating a vicious cycle [7]. ROS may negatively affect pregnancy rates, by interfering with oocyte maturation, progesterone production, and luteolysis [7]. Luckily, vitamin E supplementation can decrease oxidative stress in cases of PCOS [6].

Ischemia modified albumin (IMA) is a marker of oxidative stress. IMA levels are often found to be elevated in infertile PCOS patients [7]. IMA may impact the quality of oocytes by changing the balance of critical follicular fluid factors. 

A recent fertility study showed that while ongoing pregnancy rates did not change, supplementation of vitamin E for women with PCOS did reduce both the gonadotrophin requirement and risk of ovarian hyperstimulation syndrome (OHSS) [7]. For this reason, and those described above, vitamins for PCOS, and specifically vitamin E, is likely a beneficial choice for PCOS women undergoing ovarian induction.

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  1. Mohd Mutalip, Siti Syairah, Sharaniza Ab-Rahim, and Mohd Hamim Rajikin. “Vitamin E as an antioxidant in female reproductive health.” Antioxidants 7.2 (2018): 22.
  2. Keskes-Ammar, L., et al. “Sperm oxidative stress and the effect of an oral vitamin E and selenium supplement on semen quality in infertile men.” Archives of andrology 49.2 (2003): 83-94.
  3. Kutlubay, Recep, et al. “Vitamin E protection from testicular damage caused by intraperitoneal aluminium.” International Journal of Toxicology 26.4 (2007): 297-306.
  4. Mesdaghinia, Elaheh, et al. “The effect of vitamin E and aspirin on the uterine artery blood flow in women with recurrent abortion: A single-blind randomized controlled trial.” International Journal of Reproductive BioMedicine 15.10 (2017): 635.
  5. Woods Jr, James R., Mark A. Plessinger, and Richard K. Miller. “Vitamins C and E: missing links in preventing preterm premature rupture of membranes?.” American journal of obstetrics and gynecology 185.1 (2001): 5-10.
  6. Tefagh, Ghazale, et al. “Effect of vitamin E supplementation on cardiometabolic risk factors, inflammatory and oxidative markers and hormonal functions in PCOS (polycystic ovary syndrome): a systematic review and meta‐analysis.” Scientific reports 12.1 (2022): 1-16.
  7. Chen, Jie, et al. “Effect of a short-term vitamin E supplementation on oxidative stress in infertile PCOS women under ovulation induction: a retrospective cohort study.” BMC women’s health 20.1 (2020): 1-9.