Folic Acid vs. Folate vs. Methyltetrahydrofolate: Which One is Better for Your Fertility, Pregnancy, and Baby Goals?

Folic Acid Vs. Folate Vs. Methyltetrahydrofolate: Which One Is Better For Your Fertility, Pregnancy, And Baby Goals?

Hello there, Mama. I’m Dr. Cleopatra, the world’s leading fertility, pregnancy, and intergenerational health scientist. I empathize deeply with every woman who has faced fertility challenges and pregnancy complications. I lost my own mother at birth and became obsessed with understanding how to help reproduction go well for women and families. Over the past 27 years, I have worked with thousands of women who struggled with getting pregnant, miscarriage, and/or failed IVF cycles. I take a unique epigenetic approach to fertility, pregnancy, and having healthy children that aren’t available anywhere else in the world. This approach is called the Primemester Protocol, and it has helped women (ages 23 to 48) in 41 countries on 6 continents finally have the healthy babies they’ve been dreaming of. I’d like to extend my years of dedication and expertise to you today, Mama, and share some amazing resources with you.

Today, I want to talk to you about a crucial component of your fertility and pregnancy health: Vitamin B9. Vitamin B9 is a nutrient that is crucial for cell division and DNA synthesis (Buhling et al., 2014). It is especially significant during the early stages of pregnancy, helping to prevent birth defects in your baby’s brain and spine (De-Regil et al., 2015). The neural tube forms within the first 17 days of pregnancy before many Mamas even know that they’re pregnant, which is why it’s so important to start supplementing with B9 before pregnancy, Mama. (Moretti et al., 2015; Williams et al., 2015).


There are many nutrients that are important for having healthy fertility, pregnancy, and babies, and B9 is one of the most important, Precious Mama. Getting B9 in the correct form and dosage can mean the difference between having a healthy baby or not.

Seventy-percent of all neural tube defects (or defects of the brain and spine) are preventable using B9 (CDC, 2019). In addition, B9 supplementation both before and during pregnancy can protect your baby from developing autism, ADHD, and other neurocognitive disorders. B9 has also been shown in scientific studies to improve egg and sperm quality and to protect against Down syndrome and other chromosomal abnormalities (Gaskins et al., 2014, Sweeney et al., 2015). For these reasons, This vitamin is critical for both healthy natural conception as well as for successful IVF.

Mama, are you a woman who is worried about being able to have a healthy baby at 35+? You’re in the right place because B9 becomes even more important as Mamas and Dadas get older due to a greater likelihood of problems with egg and sperm, as well as compromised methylation and detoxification. Each of these age-related pathways increase risk of fertility and pregnancy problems that B9 can help to protect against.

See what I mean, Mama? Vitamin B9 is a big deal! Come with me, so that I can teach you what you need to know about getting your B9 right.

The Importance of Folic Acid, Folate, and Methyltetrahydrofolate for Healthy Fertility, Pregnancy, and Baby

Vitamin B9 comes in different forms. You probably know this vitamin as folic acid; however, folic acid is only one form of B9. Folate and methyltetrahydrofolate are also forms of B9. Not all forms are created equal, and their absorption can be affected by various factors like autoimmune disorders, digestive disorders, high stress, genetics, and more (Hiraoka & Kagawa, 2017).

Folic acid is the most commonly known form of B9. That’s because it is the cheapest, most widely available form of B9, and is a synthetic form of the vitamin. Because of its low cost and high accessibility, folic acid is the form of B9 that is used in most prenatal vitamins and in fortified foods, such as cereals, breads, enriched grains, and processed vegan foods (e.g., nutritional yeast). Fortification is a practice that was started in 1998 to ensure that all women of child-bearing age meet the required daily intake of B9 to prevent neural tube and other birth defects. Folate is the naturally occurring form of B9 found in foods like leafy greens, beans, and citrus fruits.

Methyltetrahydrofolate, on the other hand, is the bioidentical form of B9. It is the active form of folate that is naturally present in your body and that can be readily utilized by your cells. Because methyltetrahydrofolate is the biologically active and metabolically active form of folate, it is more efficient in supporting various biological processes, including DNA synthesis and cell division, Mama. Its bioidentical nature allows for optimal absorption and utilization by your body. Unlike folic acid and folate, your body does not have to convert methyltetrahydrofolate in order to use it and benefit from it. The methyltetrahydrofolate form of B9 plays a pivotal role due to its ability to cross the placenta and provide the developing baby with the active form of B9 (Sweeney et al., 2015).

The Crucial Conversion of Folic Acid and Folate into Usable Form (with and without MTHFR Gene Variant Concerns)

The major distinction underlying folic acid, folate, and methyltetrahydrofolate differences is their metabolic pathway in your body. Both folic acid and folate (albeit to a lesser degree) need to be converted by your liver and other tissues into methyltetrahydrofolate before your body can use it. This conversion process is facilitated by enzymes, including dihydrofolate reductase (DHFR) and methylenetetrahydrofolate reductase (MTHFR).

This is especially important for women and men with certain variants of the MTHFR gene. Individuals who carry the C677T variant may have reduced activity of the MTHFR enzyme, leading to decreased conversion of folic acid and folate into MTHF. Similarly, individuals with the A1298C variant may also experience impaired enzyme activity, although to a lesser extent compared to the C677T variant. Methyltetrahydrofolate, as the bioactive form, requires no conversion, making it the most efficient variant of the vitamin.


Linking Polycystic Ovary Syndrome (PCOS) with Folic Acid, Folate, and Methyltetrahydrofolate

Up to 20% of women have PCOS (Deswal et al., 2020). PCOS is a hormonal disorder and can affect the absorption and assimilation of folic acid and folate. This makes the methyltetrahydrofolate form of B9 even more important for Mamas with PCOS (Badawy et al., 2007). Research indicates that women with PCOS may need to supplement with higher doses to meet their daily needs and achieve healthy reproduction.

Vitamins and Supplements for Preconception and Fertility

Preparing your body for pregnancy starts in the primemester, the 120+ days before conception. For Mamas who want to get pregnant, the bioidentical form of Vitamin B9—methyltetrahydrofolate—is crucial. It can improve egg quality, and it reduces the risk of miscarriage and other types of pregnancy complications due to its role in preventing abnormalities (Gaskins et al., 2014). Other key vitamins to support your healthy fertility, pregnancy, and babies include Vitamin D3 with K1 and K2, DHA, glycerophosphocholine, and a broad-spectrum probiotic. All of these vitamins have been found to support healthy hormone balance, egg and sperm development, and immune function. These are fundamental for a healthy pregnancy and baby, Beloved Mama (Rajabi et al., 2020; Kermack et al., 2015). Both Mamas and Dadas need these foundational fertility and pregnancy nutrients during the primemester.

Prenatal Vitamins Aren’t Just for Women: Pre-Pregnancy and During Pregnancy

Starting a bioidentical prenatal vitamin regimen during your primemester (at least 120 days before pregnancy) ensures that your body receives all necessary nutrients for conception, maintaining pregnancy, and birthing a healthy baby (Shah et al., 2010). This is vital for you as the Mama, but it’s also vital for your partner (or the person providing sperm for your baby). Vitamin B9 influences the health of both egg and sperm, and healthy egg and healthy sperm are equally important for having a healthy pregnancy and baby (Gaskins et al., 2014). During pregnancy, prenatal vitamins help ensure that both mother and baby receive all the nutrients needed, while also preventing birth defects and supporting healthy fetal growth and neurocognitive development (De-Regil et al., 2015).

Getting Folic Acid and Folate from Food

While it is possible to source folic acid and folate (but not methyltetrahydrofolate) from food, most people are not meeting the daily recommended intake of B9 from food alone (Kelly et al., 1997). It is important to note that the processed and fortified foods that provide folic acid often contain added sugars and are high in phytic acid, which depletes the nutrient stores that are so important for your healthy fertility, pregnancy, and babies, Mama (Kelly et al., 1997).

The synthetic folic acid form of B9 also competes with the more efficient form, methyltetrahydrofolate, for space in cell receptors—meaning that eating processed foods or taking the wrong type of prenatal vitamin can interfere with deriving optimal benefits from your methyltetrahydrofolate supplement. Methyltetrahydrofolate also does not carry risks of accumulating in the blood the way that folic acid does (Ferrazzi et al., 2020).

Therefore, a two-pronged approach to B9 is critical to healthy fertility, pregnancy, and babies:
(1) supplementing with adequate levels of the methyltetrahydrofolate form of B9
and (2) avoiding processed foods and poor quality fertility/preconception supplements and prenatal vitamins.

Recommended Daily Intake of Folic Acid, Folate, and Methyltetrahydrofolate

The average woman needs 400-800 micrograms of folic acid and 600-800 micrograms of folate daily (Shah et al., 2010). The recommended daily intake of methyltetrahydrofolate varies, with many supplements providing 400-1000 micrograms. However, some individuals may require higher doses due to specific genetic or health conditions (Sweeney et al., 2015). According to the Centers for Disease Control and Prevention (CDC), a daily intake of 4000 micrograms of Vitamin B9 is recommended for women with a history of known or suspected neural tube defects or abnormalities (CDC, 2019). This recommendation is also relevant to women with a history of pregnancy loss and/or failed IVF cycles due to lack of blastocysts or genetically healthy embryos. Remember to always consult with your healthcare provider for personalized advice, Mama.

Informed Choices: The Importance of Selecting Quality Supplements for Fertility, Primemester, Pregnancy, and Postpartum

When choosing fertility and pregnancy supplements, careful consideration is imperative. Look for brands that are backed by rigorous scientific research, use bioidentical forms, and are developed by people who truly understand and genuinely care about your fertility, pregnancy, and intergenerational health. Our methyltetrahydrofolate supplement and entire Superbaby Nutraceuticals line are medical-grade nutrients crafted specifically for fertility, primemester, pregnancy, and postpartum. They are designed and developed by the leading scientist in fertility, pregnancy, and intergenerational health who has dedicated her life to helping families have the babies they’ve been dreaming of for as long as they can remember.

Integrative Fertility, Pregnancy, and Neurocognitive Support: The Role of Psychophysiology, Epigenetics, Nutrigenomics, and Nutrient Supplementation

The Fertility & Pregnancy Institute (FPI) believes in a complex network systems approach that cares for your fertility starting from the primemester (the period leading up to conception), pregnancy, and throughout parenting. Our unique strategy is built on the science of epigenetics and emphasizes both psychophysiology and precise nutrient supplementation. Psychological stress can influence epigenetic modifications and subsequently fertility, pregnancy, and offspring health, signifying the interplay of these domains. Our unique primemester strategy is designed to support and rejuvenate your biological clock and reproductive function.

Summary: Folic Acid, Folate, and Methyltetrahydrofolate for Healthy Fertility, Pregnancy, and Baby

Understanding the role of B9 in healthy fertility, pregnancy, and babies empowers you on your path to becoming a Mama. Although all of the conversation and education centers around the synthetic folic acid form of B9, the bioidentical methyltetrahydrofolate form is the most efficient form. As you embark on your journey, remember that understanding your body’s needs can provide a profound sense of empowerment and hope. May your journey be short, sweet, and easy. I am here with you.

Sending you love, warmest wishes, & superbaby dust,

Dr. Cleopatra

Founder and Chief Scientific Officer of The Fertility & Pregnancy Institute
(and the only other person who’s as obsessed as you are with the details of your fertility, pregnancy, baby, and family!)


About Dr. Cleopatra

The Fertility & Pregnancy Institute, the Primemester Protocol, and Superbaby Nutraceuticals

As the founder and chief scientific officer of The Fertility & Pregnancy Institute, Dr. Cleopatra leads the charge in the emerging field of fertility biohacking and the creation of ‘superbabies’ using the lived science epigenetics. Renowned for her groundbreaking Primemester Protocol, she is an NIH-funded scientist and a retired tenured professor at the University of Southern California. Having supported thousands of women from 40+ countries across six continents to have their ‘superbabies’, her influence spans globally. Dr. Cleopatra’s dedication to women’s health extends beyond academia and The Fertility & Pregnancy Institute; she is also the founder of Superbaby Nutraceuticals, a line of impeccably researched and sourced, medical-grade supplements for fertility, primemester, pregnancy, and postpartum.


Badawy, A., State, O., & Abdelgawad, S. (2007). N-Acetyl cysteine and clomiphene citrate for induction of ovulation in polycystic ovary syndrome: a cross-over trial. Acta Obstetricia et Gynecologica Scandinavica, 86(2), 218-222.

Buhling, K. J., Grajecki, D., Cerne, P., Aarabi, M., & Stepan, H. (2014). The effect of micronutrient supplements on female fertility: a systematic review. Archives of gynecology and obstetrics, 289(5), 965-973.

Centers for Disease Control and Prevention. (2019, September 6). Recommendations: Women & folic acid. CDC.

Czeizel, A. E., & Dudás, I. (1992). Prevention of the first occurrence of neural-tube defects by periconceptional vitamin supplementation. New England journal of medicine, 327(26), 1832-1835.

de Benoist, B. (2008). Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies. Food and nutrition bulletin, 29(2_suppl1), S238-S244.

De-Regil, L. M., Peña-Rosas, J. P., Fernández-Gaxiola, A. C., & Rayco-Solon, P. (2015). Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database of Systematic Reviews, (12).

Deswal, R., Narwal, V., Dang, A., & Pundir, C. S. (2020). The prevalence of polycystic ovary syndrome: a brief systematic review. Journal of human reproductive sciences, 13(4), 261.

Ebisch, I. M., Pierik, F. H., de Jong, F. H., Thomas, C. M., & Steegers-Theunissen, R. P. (2006). Does folic acid and zinc sulphate intervention affect endocrine parameters and sperm characteristics in men?. International journal of andrology, 29(2), 339-345.

Ferrazzi, E., Tiso, G., & Di Martino, D. (2020). Folic acid versus 5-methyl tetrahydrofolate supplementation in pregnancy. European Journal of Obstetrics & Gynecology and Reproductive Biology, 253, 312-319.

Gaskins, A. J., & Chavarro, J. E. (2018). Diet and fertility: a review. American journal of obstetrics & gynecology, 218(4), 379-389.

Gaskins, A. J., Rich-Edwards, J. W., Hauser, R., Williams, P. L., Gillman, M. W., Ginsburg, E. S., … & Chavarro, J. E. (2014). Prepregnancy dietary patterns and risk of pregnancy loss. American journal of clinical nutrition, 100(4), 1166-1172.

Hiraoka, M., & Kagawa, Y. (2017). Genetic polymorphisms and folate status. Congenital anomalies, 57(5), 142-149.

Kelly, P., McPartlin, J., Goggins, M., Weir, D. G., & Scott, J. M. (1997). Unmetabolized folic acid in serum: acute studies in subjects consuming fortified food and supplements. The American Journal of Clinical Nutrition, 65(6), 1790-1795.

Kermack, A. J., Calder, P. C., Houghton, F. D., Godfrey, K. M., & Macklon, N. S. (2015). A randomised controlled trial of a preconceptional dietary intervention in women undergoing IVF treatment (PREPARE trial). BMC Women’s Health, 15(1), 1-8.

Moretti, M. E., Caprara, D., Drehuta, I., Yeung, E., Cheung, S., Federico, L., … & Koren, G. (2015). The fetal safety of fluoxetine: a systematic review and meta-analysis. Journal of Obstetrics and Gynaecology Canada, 37(5), 362-369.

Palma-Gudiel, H., Córdova-Palomera, A., Leza, J. C., & Fañanás, L. (2015). Glucocorticoid receptor gene (NR3C1) methylation processes as mediators of early adversity in stress-related disorders causality: A critical review. Neuroscience & Biobehavioral Reviews, 55, 520-535.

Rajabi, S., Bold, J., Gong, J., Kellems, M., Kwon, E., Taylor, B. D., & Trumble, B. C. (2020). Maternal micronutrient supplementation and long term health impact in children in rural Gambia. PloS One, 15(6), e0234579.

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Sweeney, M. R., Staines, A., Daly, L., Traynor, A., Daly, S., Bailey, S. W., … & Scott, J. M. (2015). Persistent circulating unmetabolised folic acid in a setting of liberal voluntary folic acid fortification. Implications for further mandatory fortification? BMC Public Health, 15(1), 1-8.

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Williams, J., Mai, C. T., Mulinare, J., Isenburg, J., Flood, T. J., Ethen, M., … & Kirby, R. S. (2015). Updated estimates of neural tube defects prevented by mandatory folic acid fortification—United States, 1995–2011. Morbidity and Mortality Weekly Report, 64(1), 1.

Vitamin B9, Folic Acid, Folate, and Methyltetrahydrofolate Frequently Asked Questions (FAQs)

Even though two-thirds of the U.S. population is overweight or obese, too many children and adults have nutrient deficiencies. We are just beginning to scratch the surface of our understanding of how nutritional deficits get passed down intergenerationally and affect fertility.

There is a lot of confusion, misinformation, and noise when it comes to the role of nutrition in fertility and pregnancy.

Over the next several weeks, I am going to take you on a journey to improving your fertility and pregnancy IQ through the lens of micronutrients and nutrigenomics.

I will teach you about primemester and perinatal programming (i.e., when and how our exposures during the primemester and pregnancy epigenetically modify lifetime genetic functions in our children and grandchildren). This is an involuntary process, but it’s one that we can do much more deliberately so that we favor the right direction of modification. This is what primemester and pregnancy epigenetics are all about.

Using cutting-edge scientific data, we will set the record straight on the following:

Settling the controversy over too much B9 and B12 during pregnancy as a neurodevelopmental risk factor (e.g., for autism)

Why the RDA (recommended daily allowance) for choline is grossly inadequate for your superbabies (and supergrandbabies)

Why there can be too much of a good thing when it comes to Omega 3s

What prenatal vitamins should and should not contain, and in what amounts

Whether supplements are actually even needed during the primemester and pregnancy

And so much more

This is a series I have been wanting to do for you for a very long time because it is THAT important.

Our modern world is overfed and undernourished. This is a huge piece of the fertility puzzle and the modern world–reproductive biology mismatch that I talk to you about so often. In the next several weeks, you will learn things that you have never before been taught about how nutrition affects your fertility and pregnancy health.

  1. 1. What is the Primemester?

    As a noun, primemester is the crucial 120-day period leading up to conception that the Primemester Protocol optimizes epigenetically for improved fertility health and outcomes. During this window, the Primemester Protocol primes your body with the nutrients and holistic health you need to alter your genetic expression, allowing your genes to work in your favor for the healthiest pregnancy, postpartum, baby, and long life.

  2. 2. Where can I learn more?

    I teach you about how to understand and use your genetic expression (also known as epigenetics) to overcome age-related declines in fertility and other of the most complex fertility challenges to have your healthiest baby in my world-renowned Primemester Protocol. If you want to learn more about how the Primemester Protocol can help you reach your family goals, please go here.

  3. 3. What is the role of Vitamin B9 (commonly known as folic acid) in pregnancy?

    Vitamin B9, which includes folic acid, folate, and methyltetrahydrofolate, is crucial for neural tube development in the fetus, which can prevent birth defects such as spina bifida (De-Regil et al., 2015).

  4. 4. Why should I take prenatal vitamins before pregnancy?

    Starting a preconception vitamin regimen at least 120 days before conception can help reduce the risk of neural tube defects and other abnormalities in the baby (Buhling et al., 2014).

  5. 5. Can men benefit from prenatal vitamins?

    Yes, the health of sperm is just as important as the health of the egg for fertility. A preconception vitamin regimen for men can support healthy sperm parameters (Gaskins et al., 2014).

  6. 6. What are the recommended daily intake levels of folic acid, folate, and methyltetrahydrofolate?

    For most women, the daily recommended intake is 400-800 micrograms of folic acid and 600-800 micrograms of folate. The dosage for methyltetrahydrofolate varies, but supplements often provide 400-1000 micrograms (Shah et al., 2010).

  7. 7. Are there food sources of folic acid, folate, and methyltetrahydrofolate?

    Green vegetables and citrus fruits are good sources of folate, while fortified foods often contain folic acid. However, it’s challenging to meet daily requirements solely from food, and folic acid needs to be converted into a usable form by the body (Kelly et al., 1997).

  8. 8. Are there any risks associated with taking too much folic acid, folate, or methyltetrahydrofolate?

    High doses of these vitamins should be administered under the guidance of a healthcare provider, as they can sometimes mask symptoms of vitamin B12 deficiency or interact with certain medications (Sweeney et al., 2015).

  9. 9. What is PCOS and how does it relate to B9 vitamins?

    Polycystic ovary syndrome (PCOS) is a condition that affects hormonal balance in women. Women with PCOS may need higher doses of B9 vitamins due to potential difficulties with absorption (Badawy et al., 2007).

Remember to always consult with a healthcare provider or a dietitian for personalized advice regarding nutrition and supplementation.

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