Written by Jenny Wordsworth, LLB (Hons). Reviewed by Phoebe Howells. 

Dr. Phoebe has been a doctor since 2012 with a decade of experience in Obstetrics and Gynaecology focusing on fertility. She's undertaken a clinical fellowship in Reproductive Medicine at a top London fertility clinic alongside authoring articles, sharing insights at global conferences, contributing to fertility trials for women with adenomyosis and working as the Co-Chief Medical Officer for OVUM.

Why your body needs targeted support, not a watered-down 3-in-1 blend.

“Take one single pill for every stage of your journey!” Sounds convenient, doesn’t it? Preconception, pregnancy, postpartum - all neatly wrapped up in a single capsule. The trouble is, your body doesn’t work that way. When trying to conceive, pregnant, or postpartum, your body undergoes significant changes, each with distinct nutritional requirements. That’s why many aspects of preconception supplements and prenatal supplements aren’t interchangeable. 

At OVUM, we’ve reviewed over 550 clinical studies for our preconception formulation, and 141 clinical studies for our upcoming prenatal formulation, and the evidence is clear: each stage has very different nutritional demands. What fuels healthy egg quality before conception is not the same as what supports your baby’s brain development in pregnancy, or your recovery once they arrive.

All supplement formulation involves a degree of compromise; the limitations of capsule size and number of capsules we are willing to take per day are the most common limiting factors. Trying to squeeze everything into a 3-in-1 compounds the compromises, missing some key nutritional support altogether and reducing doses of others to allow an acceptable capsule size and number.  When it comes to fertility and pregnancy health, compromising on a controllable variable like nutrition support simply isn’t good enough.

In this blog, we’ll unpack:

• What your body actually needs at preconception, pregnancy and postpartum stages.
  

• Why “all-in-one” products can’t deliver the proper doses.
  

• How to choose supplements that genuinely support you at each stage.

Preconception: Optimising your Fertility

For a woman, a preconception supplement is formulated to support fertility and optimise egg health while you are actively trying to conceive. This phase requires a very unique formulation of nutrients to promote reproductive health and optimise for fertility, but also at the correct doses as established from a review of the latest studies in fertility, where they detail not only the nutrients studied, but the dose amount too. Let’s walk through examples of some of the most essential nutrients for the preconception stage: 

Key Nutrients for Preconception

CoQ10 

This antioxidant plays a vital role in mitochondrial function, which is essential for energy production in eggs. 

Think of mitochondria as the egg’s energy-producing structures, which play a central role in the process of an egg maturing with the correct number of chromosomes (which is our goal here). Each egg contains more than 15,000 mitochondria, over 10 times more than any other cell type. Damaged mitochondria can’t produce the energy needed to get the job done, which compromises egg development and embryo viability. Supporting mitochondrial health is therefore critical for improving egg quality. 

CoQ10 is probably the highest single impact nutrient in the preconception phase. A meta-analysis of 6321 women identified as poor responders undergoing IVF and taking CoQ10 found that the CoQ10 supplementation improved the clinical pregnancy rate with an odds ratio of 2.22 (i.e. CoQ10 appeared to more than double the pregnancy rate). Higher CoQ10 levels have also been linked to improved egg quality and ovarian function, and it may help prevent or reverse age-related decline in egg quality.

Higher CoQ10 levels have also been linked to improved egg quality and ovarian function, and it may help prevent or reverse age-related decline in egg quality. It has also been shown to improve embryo development and increase fertilisation rates. 

From the evidence, we know a daily dose of 600mg (at a minimum, it’s higher with a confirmed diagnosis for Diminished Ovarian Reserve or Premature Ovarian Insufficiency) is needed, although that can be less when using a patented form of CoQ10 (such as Micro Active CoQ10) due to higher absorption rates.

A 3-in-1? Well, one we reviewed contains a gobsmacking none, yet claims to be vital support for egg health. As for the others we reviewed, they contained on average 50mg-75mg per dose.  A big miss on the key target.   

Vitamin D

We’re learning more and more about what optimal levels of Vitamin D are for those trying to conceive, and keeping up to date with the latest evidence in this space is a measure of just how science-led any brand in this space is. 

Vitamin D acts on granulosa cells, cells that surround the ovary, altering AMH signalling, FSH sensitivity, and progesterone production and release. Whether Vitamin D supplementation can increase AMH levels has conflicting evidence, but being sufficient in Vitamin D levels has been shown to improve menstrual cycle parameters and increase the birth rate in both spontaneous conception and in IVF. A 2016 Cochrane review concluded that Vitamin D deficiency and insufficiency are associated with miscarriage. A meta-analysis of Vitamin D status in IVF found a significant increase in the live birth rate.

Most ‘all-in-ones’ we reviewed contained 1,000 IU (international units). Based on the latest evidence on Vitamin D levels and optimal fertility, we know that a daily dose of around 4,000 IU is more likely to be optimal.  A level of 1000IU will maintain your vitamin D level in the UK in winter but evidence suggests it is insufficient to increase levels, 4000IU in the preconception phase can increase levels to an optimum level (but as this is the maximal over the counter dose it may not be appropriate for over nine months without blood test monitoring). 

Antioxidants

Fertility supplements for egg health should include a strong antioxidant profile to counteract oxidative stress, which can negatively impact egg quality. 

The type and amount of antioxidants to include during the preconception stage require great consideration and are a critical balancing act. Why? Antioxidants have what is known as a ‘synergistic’ effect, which means the combined effect is greater than the sum of the individual effects of the antioxidants, and too many can actually cause more harm than good. But too little and you’re not getting what your body needs.

Some antioxidants you would want throughout all three stages: Vitamin C, Zinc and Vitamin E, for example. Alpha-Lipoic Acid (ALA) and N-Acetylcysteine (NAC) have evidence strongly supporting their use in preconception, but limited evidence of benefit in pregnancy, and a lack of evidence on lactation in the postpartum stage. 

We know that antioxidants neutralise free radicals, preventing oxidative damage, and that eggs from older women have a greater need for antioxidants due to increased free radical production from ageing mitochondria. Higher antioxidant levels are linked with improved IVF outcomes and a shorter time to pregnancy. 

None of the ‘3 in 1s’ we reviewed contained the optimum amounts, or mix, of each antioxidant as is suggested by the evidence to be needed when trying to conceive: doses of ALA and NAC at 50mg rather than evidence based 600mg, or they’re absent from the formulation entirely. Worse still, some compound supplements still contain L-Arginine (an essential amino acid), but one of very few nutrients that actually have evidence of worse outcomes - a recent randomised controlled trial demonstrated it led to poorer embryo quality and lower pregnancy rates.  

For Vitamin C, an optimal dose would be nearer 500mg. On average, brands offering a 3-in-1 sit anywhere between 80mg to 200mg. For Selenium, an optimal dose for the preconception stage would be around 100mcg, yet the products we reviewed hovered anywhere between 18mcg and 77mcg. 

Facts about Folate

While Folic Acid is the form of folate recommended once pregnant, a more bioavailable form (Methylfolate) can be beneficial for the preconception stage, and the majority of preconception products now include this form. 

This is particularly relevant for individuals with genetic variations that affect folate metabolism. The optimal dose of Methylfolate when trying to conceive is 600 - 800mcg per day. We found one 3-in-1 product that contained 800mcg, and others sat between 400-500mcg.

Once pregnant, however, the NHS guidelines specifically recommend Folic Acid as the form of folate for the first 12 weeks of pregnancy. The longstanding evidence for a reduction in neural tube defects in pregnancy is supplementing with 400mcg of Folic Acid. Any ‘3 in 1’ or standalone prenatal product that does not at least include 400mcg of Folic Acid is therefore not compliant with UK or NHS guidance. 

At OVUM, our determination of the evidence, and best practice based on clinical insights from working with IVF Doctors, is that a prenatal formulation (so once you’re pregnant) should contain both formulations: 400mcg as Folic Acid and 200mcg as Methylfolate to comply with NHS guidance (and US recommendations of 600mg of folic acid) and to gain the potential benefits of the methyl form, especially in those with unknown abnormal folate metabolism. 

Pregnancy: Supporting Foetal Development

Once you conceive, your body’s nutritional needs shift dramatically to support the rapid growth and development of your baby. It’s essential to transition from a preconception supplement to a pregnancy-specific prenatal vitamin that contains the right balance of nutrients for this stage. Key takeaway here is: a preconception supplement is for when you’re ttc, and a prenatal supplement is for once you have conceived. 

Vitamin D and Folic acid are important nutrients already covered in the previous section but three new nutrients stand out as key in pregnancy but with no requirement, or evidence, to take them in the preconception phase. Iodine and Choline for the baby’s brain, Calcium for mum and baby’s skeletal development.

Key Nutrients for Pregnancy

Vitamin D

There are over 150 meta-analyses of Vitamin D supplementation and pregnancy. It has been shown to be beneficial in numerous outcomes, including reducing maternal depression, reducing premature birth rates, reducing gestational diabetes and pre-eclampsia. 

It’s an outstanding little vitamin and we’re really just on the precipice of understanding not only how vital it is for preconception and pregnancy, but that actually higher doses than originally thought to be needed are the new optimum. The dose of 4000 IU in pregnancy was shown to be the most effective dose in bringing women into the sufficient range for serum levels of D3. Most ‘3 in 1s’ we reviewed contained 1,000 IU (international units), only one contained 2,000 IU. But our medical team consider a level of [2,000 IU] to be more appropriate. 

And as for postpartum? If you’re breastfeeding, the latest evidence suggests that a daily dose of 4,000-6,000IU is necessary to ensure that the baby gets all they need.

Choline

Never heard of this one? It should be considered a critical pregnancy nutrient. Yet, many prenatals or ‘3 in 1s’ fail to include it altogether, or at the optimum dose, and 90 to 95% of pregnant women do not consume enough choline to meet their dietary needs. 

Based on the latest evidence on Choline, it is crucial for the brain development of your baby. What’s even more essential is to be taking a daily dose that is rooted in the latest evidence. Experts recommend 400 milligrams in the first 12 weeks of pregnancy, and the published evidence sits anywhere between 350mg to 450mcg as being the optimal daily dose, increasing to at least 550 milligrams for the remainder of the pregnancy. And beyond that, taking a 550 milligram dose for the first year of postpartum.  Some research suggests that upwards of 900mg is needed during pregnancy to support optimal perinatal and infant health outcomes.

Doses amongst ‘3 in 1’ products ranged from 80mg to 200mg. The real paradox of such low doses of Choline being included in a ‘3 in 1’? There’s no evidence of any need or benefit in taking Choline whilst trying to conceive, so it’s of no use to you at that stage - and that capsule space could be better used to instead, say, increase the level of CoQ10 that we know is needed during the preconception stage. 

Calcium

Calcium is not required in a preconception supplement. However, it is essential in the prenatal phase, and a significant proportion of the population consumes insufficient dietary amounts. 

Calcium demands increase during gestation as women lose stored calcium due to foetal skeleton development. Especially during the third trimester, when maximal calcium accretion occurs for rapid mineralisation of the foetal skeleton. A Cochrane review (the highest level of medical evidence) found that calcium supplementation before and early in pregnancy may reduce the risk of women experiencing either pre‐eclampsia or pregnancy loss at any gestational age.

The recommended daily allowance (RDA) is 1000 mg. Studies show 1000-2000mg/day calcium halves the risk of pre‑eclampsia and reduces the risk of pre-term birth in women with low baseline intake. The UK average dietary calcium is around 700 mg; thus, a 500 mg supplement is prudent, but there are significant fill constraints due to the bulk of calcium. Some brands have supplementary tablets with calcium, and some include lower doses. 

Postpartum and Breastfeeding

We won’t cover this in great detail for now (this blog is getting quite lengthy!). The top three nutrients to supplement when breastfeeding are Vitamin D, Iodine, and Omega-3 (DHA), but Choline, Calcium, Iron and the B Vitamins also make an appearance. 

Why One Product Isn’t Enough

Three Stages, One Pill? Nice Idea, but terrible science. A single supplement cannot adequately support both preconception, pregnancy and postpartum. The nutritional demands at each stage are vastly different because your body is undergoing completely distinct biological processes.

Nutritional needs during pregnancy skyrocket as your body focuses on growing a baby and trying to meet these demands with a supplement also designed for preconception and postpartum? Hopefully, we’ve been able to showcase, with just a few examples, why this isn’t serving you. 

What to Look Out For When Selecting A Supplement 

No surprises here, but we wouldn’t advocate for taking a ‘3 in 1’. Yes, they’re a cheaper product - but that’s because they don’t include all that you need, in the right dose, the right nutrient, and at the right time to support where you’re at on the journey.

If you are trying to conceive, look for a product that is clearly and purposefully focused on your egg and reproductive health, with optimal doses of CoQ10, antioxidants, and key vitamins tailored to support egg quality and hormonal balance. It is also essential to check that the formulation is suitable for early pregnancy too.

We even reviewed one product that claimed to be a combined food supplement for men and women! An unusual choice given the differing evidence-based recommendations for sperm health and egg health…but that’s for another day.

For further information, then we advise reading our previous blog on the Science Behind Supplement Timing by the women’s health writer Valicia Burke-France, who has over 10 years experience in the field. 

We recommend checking the ingredients list in full to avoid unnecessary fillers, such as stearic acid, magnesium stearate, potassium sorbate, silicon dioxide, titanium dioxide, carrageenan, artificial colours and flavours, and corn maltodextrin. 

Make sure the brand behind your preferred product is worthy of your trust.

The Key Takeaways

When one product tries to cover all bases, something has to give. The reality is simple: you can’t include every nutrient, at every evidence-backed dose, for three completely different stages of life. 

Decades of research, thousands of peer-reviewed studies, and clinical guidelines exist to show women what works. To ignore that evidence and churn out a watered-down “all-in-one” is more than just misleading, it undermines the very progress we’re all trying to make in women’s health.

At OVUM, we think women deserve better than shortcuts.

• Preconception vs pregnancy nutrition are two entirely different things, and your supplements should reflect that. While trying to conceive, you need a supplement designed to support fertility and egg health. Once pregnant, your focus shifts to foetal development, requiring different nutrients in higher doses. For postpartum, it’s all about recovery and ensuring you pass on what’s needed to your baby too, if breastfeeding.

• A ‘3 in 1’ is marketing magic, with no basis in science. When it comes to nutrition for fertility, pregnancy and beyond, it’s important to consider that targeted support matters far more than catch-all claims.

• Instead of opting for a one-size-fits-all approach, choosing stage-specific prenatal vitamins ensures you’re giving your body exactly what it needs at the right time.

• For a single product to genuinely cover even the minimum evidence-backed nutrients we’ve listed here, you’d be looking at around 11 capsules a day. No brand on the market comes close to that, so it’s worth asking: Is your “all-in-one” really an all-in-one at all? Or is it just giving you a tick-box list of nutrients, each at too low a dose to have an impact?