Does Iron deficiency affect fertility and pregnancy?
The super short answer is yes.
Iron deficiency can affect your fertility and pregnancy, as well as your general energy and emotional wellbeing.
Low iron levels are behind so many symptoms that, alongside Acupuncture and Herbal Medicine, it’s one of the first things we look at in Integrative Chinese Medicine.
See more on how we work with fertility, pregnancy and emotional wellbeing.
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This is how iron deficiency works and what you can do about it!
You may have low iron levels if:
You have light, irregular or very heavy periods
You are vegan, vegetarian or eat minimal red meat, especially if you dont regularly supplement with iron
Exercise most days or exercise intensely
Have had gut issues for a while, you may not be absorbing iron
Are really tired
Often get dizzy or lightheaded
Get floaters (flecks or black dots that come and go in your eyes)
Have dark circles under your eyes
Have hair loss or nails that break easily
Any of the above ring true for you?
Low iron affects fertility
Have some time to get your prenatal health in order?
Are things taking a little longer to fall pregnant? There might be a very good reason for this, that’s easy to fix.
Have you had iron tested and you’ve been told it’s a “little low” or “it looks totally fine” yet you still feel tired and have abnormal periods??
Low iron could be to blame. When iron levels are low, your body stops running properly. This can affect normal hormonal function such as ovulation and proper lining thickness.
Low iron can mean your body doesn’t have the energy to produce or regulate fertility hormones well. It can drive up cortisol (a stress hormone like adrenaline), which decreases pelvic blood flow and redirects the building blocks of fertility hormones to making more cortisol instead of oestrogen and progesterone.
Uterine lining thickness is important for holding a conception. You need a sturdy house to grow a tiny human in! While its oestrogen and pelvic blood flow + iron that determines uterine lining thickness, “thicker endometriums suggest greater iron reserves”.
What happens if you have low iron anemia in pregnancy?
In pregnancy, your iron demands increase, so if your levels are at the low or low end of normal, they will drop as your pregnancy progresses.
It’s hard to supplement with iron in trimester 1 due to morning sickness. This adds to the problem. You also can’t easily get an iron infusion during pregnancy due to safety risks.
Low iron can increase your miscarriage risk, up your chances of small-for-date babies, preterm labour, babies with low iron stores, and increase your odds of post-natal depression - yikes!
Also, this 2019 study of 500,000+ women conducted over 13 years found “Anemia diagnosed earlier in pregnancy was associated with increased risk of the development of ASD, ADHD, and particularly Intellectual Disability in offspring.”
Association isnt necessarily causation so more research is needed. That said, it is a big study of a long period of time.
Ideal iron levels for fertility and pregnancy
Pathology labs in Australia will typically show normal ferritin (iron storage) levels to be from 30 - 300ng/ml & circulating iron levels between 10-30umol/L.
That’s a GIANT range for ferritin (iron storage) to be considered normal.
Again, as ferritin levels will drop in pregnancy (usually despite supplementation), you need them to be well above the prescribed 30ng/mL for you to avoid anaemia in pregnancy.
Integrative and Functional Medicine likes ferritin levels to be between 100 - 250ng/mL & circulating iron levels between 14 - 22umol/L for fertility & pregnancy.
What to do if your levels are low?
Discuss with your doctor what might be causing this and if an iron infusion is needed
Supplement with the right form of iron
Eat more iron rich foods
Avoid gluten
1. Look for easier-to-digest forms of iron tablets such as Iron Glycinate or Iron Amino Acid Chelate forms, rather than Ferrous form as they are gentler on tummies. Either take with a Vitamin C food or supplement or look for a brand with it included. Organic Liver capsules can be great alongside iron tablets as they have many co-factors (like vitamin A) needed to help absorb iron.2. Food sources of iron are important as they contain other vitamins and nutrients that help each other be absorbed but may not be enouch to correct a severe deficiency. To reach the daily recommended iron intake of 18mg or 27mg in pregnancy, you’re going to need a lot of food! An average 215g beef steak only has 4mg. Other meats such as chicken or pork have less than that. A 1/2 cup packed with cooked spinach only has about 3mg of iron. Here’s a list of other iron rich foods.
3. Avoiding gluten (and sugar) may help if you have an inflammed gut, not just for celiacs. Iron is absorbed in your intestines. If there’s any inflammation present, (eg loose, smelly or difficult-to-pass stools) it means less nutrients including iron are being absorbed. Read research more about iron and gluten here.
Why you may need an iron infusion, not just iron tablets
To get your iron to above 14 and ferritin above 100 so it doesn’t drop too much in pregnancy, you may need more iron than you think.
Depending on your starting levels AND your ability to absorb iron, it can take between 6-9 months to raise it to those levels with iron supplements & dietary changes.
Don’t want to wait that long to fall pregnant?? Fair!
You may need an iron infusion to quickly raise iron & ferritin levels. This can help fatigue & hormonal regulation to help you fall pregnant sooner too.
Iron infusions aren’t without risks. This is why any risks that may pertain to you specifically are first discussed and administered by specially trained GPs.
Iron deficiency, Endometriosis and inflammatory conditions
Were you sick around the time you tested your iron?
Have an inflammatory condition or symptoms?
Have Endometriosis?
Your iron levels may be lower than they are showing.
Ferritin is an acute phase reactant. This means ferritin goes up if your body is inflamed. This can be due to being sick (eg a cold) or due to chronic inflammatory conditions such as Endometriosis or Hashimotos for example.
If you were sick or inflamed, it means that ferritin levels will look much higher than they actually are.
This is why it’s best to get full iron studies done instead of just ferritin on its own or haemoglobin.
If ANY markers are low, yet your ferritin levels ‘look fine’ - they most likely aren’t and are falsely elevated. Tidy up your diet & lifestyle to make it less inflammatory & retest in 6 weeks.
If ferritin was falsely elevated due to inflammation, you’ll see a big drop.
Be your own advocate
Been told to have iron supplements? Retest in 6-8 weeks.
If your iron hasn’t gone up much or you don’t have 6 - 9 months to wait before trying to conceive, talk to your doctor about an iron infusion.
There are absolutely awesome GPs out there who have the extra training in all things iron and would like you to avoid the above risks to your pregnancy.
You may need to find one of those instead of your regular one.
There are even out-of-pocket iron infusion clinics you can visit where doctors still assess your needs and risks even if your regular doctor isn’t on board.
Just because fatigue and pregnancy risks are ‘normal’ doesn’t mean you should have to be anaemic in pregnancy when it can be avoided.
Where to test your iron levels privately?
Chat to your GP about testing your full iron studies, this is usually bulk billed in Australia.
If they advise taking an iron supplement, ask for the retesting pathology slip to retest your iron levels at the earliest agreed time ideally 6-8 weeks.
Want to test your iron levels privately? You can do so through companies such as I-screen or Imedical.
Simply pay online, print the referral slip, visit a participating pathology lab, get results emailed to you in less than a week!
You know your body better than anyone and ruling out or fixing iron deficiency is a great step towards general health & fertility.
Not sure where to start & like some assistance with your health?