It Starts with the Egg: How the Science of Egg Quality Can Help You Get Pregnant Naturally, Prevent Miscarriage, and Improve Your Odds in IVF

Fett positions prenatal multivitamins, especially those containing folate, as a cornerstone of fertility preparation, arguing that supplementation begun months before conception can improve ovulation, egg quality, and pregnancy outcomes. She situates folate’s role historically, noting the controversy that delayed its medical adoption despite strong early evidence of preventing neural tube defects. Fett frames this as a cautionary tale against waiting for “perfect” clinical trials when good-quality evidence and safety data already justify action, especially in time-sensitive fertility contexts. Large population studies, such as the Nurses’ Health Study, and IVF-based trials support her claim that folate and multivitamins reduce ovulatory infertility, boost pregnancy rates, and lower pregnancy loss risk.

A key point of debate is whether to rely on synthetic folic acid or methylfolate. Fett highlights genetic research on MTHFR variants, which affect folate metabolism and may increase pregnancy loss risk through elevated homocysteine levels. She contends that methylfolate is more biologically effective than folic acid, both in reducing homocysteine and in raising red blood cell folate, despite some health authorities continuing to recommend folic acid exclusively. Alongside folate, Fett identifies other vitamins and minerals, like B6, B12, zinc, and selenium, as crucial for supporting fertility and countering oxidative stress.

Fett’s argument reflects a larger shift in reproductive medicine toward preventive, nutrition-based strategies rather than reactive treatments.