Diet & Lifestyle patterns in boosting fertility
By Iliana Karagkouni, RD, RN, MSc, MHCM, PhD(c)
Over the last years a large number of people face infertility issues, worldwide. The infertility occurrence is not always clinically relied on the basis of genital system impaired function, as in the majority of couples there is no specific identified infertility cause related to underlying pathology.1 Parental body weight status, diet and lifestyle behaviors seem to play an active role in the metabolic pathways of infertility problems onset, but they have not been fully investigated yet. The major causes of male infertility are related to urogenital system diseases, genital abnormalities or malformations, endocrine system disorders, congenital disorders, environmental exposure to several substances, as well as, causes related to diet and general lifestyle patterns, such as alcohol consumption, smoking and stress.
Obesity constitutes another matter of equal importance related to male infertility issues. Mediators of obesity that may impair negatively the male reproductive system function include hyperinsulinemia, hyperleptinemia, chronic inflammation and oxidative stress. Obesity is known to disrupt male fertility and the reproduction potential, particularly through alteration in the hypothalamic/pituitary, gonad axis, testicular steroidogenesis disruption and metabolic pathways dysregulation, including insulin, cytokines and adipokines.2,3 Similarly, the infertility issues in women are related to a wide range of causes, such as health problems, urogenital system disorders, body weight status, diet and lifestyle habits. Females’ infertility problems may relate to impaired function of hypothalamus, pituitary gland, ovaries, fallopian tube, cervix or vagina.
Endometriosis constitutes another important causal factor of infertility in women. Moreover, the current or past nutritional disorders history, such as anorexia nervosa, diminishes the reproduction ability and impairs negatively female fertility.4 Maternal body weight status constitutes a health parameter that can affect tremendously individual’s fertility capacity. Particularly, women with normal body weight and a Body Mass Index (BMI) ranges between 18,5-24,9 kg/m2 have more chances to achieve fertilization outcome, compared to overweight/obese and undernourished women. It must be noted that excessive body fat percentage and low fat-free mass are highly associated with infertility in women.5
Several studies conclude to individualized diet and healthy lifestyle habits, as possible treatment pathways in couples with infertility problems or those with past history of failed in vitro fertilization/intracytoplasmic sperm injection treatment.6-9 The role of nutrition becomes essential in empowering gametes (reproductive cells) health, whereas studies indicate that several dietary parameters can negatively or positively affect male and female fertility by modifying the pathways of oxidative stress in cells.
Oxidative stress impairs negatively the semen quality and several other parameters related to reproduction cells function in both genders. A diet rich in antioxidants such as α- and β-carotene, lycopene, lutein, zeaxanthin, β-cryptoxanthin and vitamins C, E, B-complex, support effectively the reproduction function quality. Daily consumption of fruits and vegetables constitute the first step for boosting the antioxidant capacity of gametic cells.9-11
Moreover, other nutritional parameters seem to have positive impact on fertility outcome. According to a recent published study, daily dietary intake of foods rich in folic acid and vitamin B12, frequent consumption of dairy products, whole-grain starches and fish/seafood, adequate serum levels of vitamin D, as well as preference for pesticides-free foods were related to higher percentage of successful assisted reproduction techniques outcomes.7 Even more recent data claim that there is no clear association between the dietary carbohydrate quantity and quality and in-vitro fertilization (IVF) outcomes in a cohort of infertile women.12
Moreover, a diet low in carbohydrates seems to have no significant impact on the parameters of reproduction function in overweight and obese women.13 However, glycemic control is extremely important for achieving better function quality of several metabolic pathways and, as a result, a diet with medium carbohydrates consistency (approximately 45-55% of total daily energy intake) and meals characterized by low or medium glycemic load is highly recommended.
Moreover, an enriched diet with n-3 polyunsaturated fatty acids (PUFA) seems to be beneficial in several parameters of reproduction function, but there is need for further investigation about the actual positive effect on IVF outcomes.14 Adequate protein intake should be achieved daily by consuming white eggs, dairy products, lean meat options, such as fish, poultry, lean beef (weekly frequency), and plant-based protein, such as legumes (lentils, beans, chickpeas), quinoa, oats, brown & wild rice and tofu. It must be considered that foods rich in saturated fatty acids (SFAs), such as whipped cream, dried coconut, fatty meats, processed meats, desserts, full-fat cheese, butter and milk chocolate, as well as, foods rich in trans fatty acids, such as bakery goods, hydrogenated vegetable oils, margarines, fried fast foods, potato and corn chips, pies, pizza and canned frosting should be avoided.
|Nutrients diet boosting||By choosing . . .|
|Folic acid (vitamin B9)||Green leafy vegetables (such as spinach, Brussels sprout, broccoli), legumes (especially cooked lentils), quinoa, asparagus, citrus fruits (oranges, grapefruit, lemons, limes), banana, walnuts, flaxseeds, beef liver, wheat germ, papaya, avocado|
|α- and β-carotene||orange-, yellow- and green-colored fruits and vegetables, such as carrots, pumpkin, apricot, tangerines, apricots, cantaloupe, tomatoes, sweet potato, beans, dark green leafy vegetables (spinach, romaine lettuce, broccoli), red bell peppers, peas|
|lycopene||Tomatoes, tomato sauce (cooked tomatoes with some added oil makes easier the lycopene absorption, compared to drinking raw tomato juice), guavas, watermelon, grapefruit, papaya, sweet red peppers, persimmon, asparagus, red cabbage, mangos|
|Lutein & Zeaxanthin||Dark leafy greens, green peas, summer squash, pumpkin, brussels sprouts, broccoli, asparagus, lettuce, carrots, pistachios.|
|Selenium||Brazil nuts, cooked yellow tuna, sardines, shrimps, beef steak, turkey, beef liver, chicken, brown rice, eggs, whole-grain bread, oats, legumes (beans,lentils), dairy products, spinach, cashews nuts, green peas, potato, banana|
|Zinc||Oysters, roast beef, crab, beef patty, lobster, pork, beans, fortified breakfast cereals, chicken, pumpkin seeds, dairy products, cashews nuts, almonds, chickpeas, cheese (Swiss, mozzarella), oatmeal, green peas|
|Magnesium||Spinach, nuts (almonds, cashews, peanuts) pumpkin seeds, dry beans, cereals, soy milk, whole grain starches (bread, rice, pasta), dark chocolate (70% cocoa), peanut butter, raisins, potato, avocado, fortified breakfast cereals, oats, banana, low-fat dairy products, cocoa powder, broccoli, apple, beef, chicken, salmon, carrot|
|Vitamin C||guavas, bell peppers (especially red bell peppers), kiwifruit, strawberries, oranges, lemon, papaya, broccoli, tomatoes, kale, snow peas, pineapple, brussels sprouts, mango, cantaloupe, cauliflower|
|Vitamin E||Sunflower seeds, almonds, peanuts, avocados, vegetables oils (especially olive oil), spinach, butternut squash, kiwifruit, trout, shrimp, hazelnuts, wheat germ oil, broccoli, asparagus|
|Vitamin B12||Fish (salmon, trout, tuna), clams, liver beef, beef, chicken (breast), eggs, dairy products, cheese, fortified breakfast cereals|
|Vitamin D||Salmon, trout, swordfish, cod liver, fish oil, mackerel, mushrooms, canned tuna, halibut, sardines, fortified dairy products, fortified milk substitutes (soymilk, almond milk etc), fortified breakfast cereals, fortified tofu, fortified orange juice, egg yolk (in hard-boiled add some olive oil for better absorption), pork chops|
|Iodine (in women with PCOS, thyroid problems)||Iodized salt, dried seaweed, baked potato with peel, milk, shrimp, fish sticks, turkey breast, canned tuna, navy beans, boiled egg|
|Poly-unsaturated fatty acids (PUFA s)||plant-based oils (soybean oil, corn oil, sunflower oil, canola oil), walnuts, sunflower seeds, fish (such as salmon, mackerel, herring, albacore tuna, trout), tofu, soybeans.|
|Mono-unsaturated fatty acids (MUFAs)||Olive oil, nuts (especially almonds, macadamia, pecans, cashews), canola oil, nut butters, sesame seeds, pumpkin, squash seeds, avocado, olives|
|Plant-based iron||Dried fruits (apricot, raisins, figs), beans & lentils, chickpeas, spinach, quinoa, dark chocolate (70% cocoa), oats, brown rice, mushrooms, pumpkin seeds, flaxseeds, chia seeds, cashews, almonds, fortified breakfast cereals|
Source: National Institutes of Health Office of Dietary Supplements, U.S. Department of Health & Human Services, 2020 – USDA Nutrition Data
The majority of studies conclude that Mediterranean-style dietary pattern constitute an invaluable tool in the effort to enhance fertility capacity among couples. However, the one-side adherence to this dietary pattern seems to be less efficient to achieve better fertility outcomes, especially in the context of IVF efforts. An individualized dietary and lifestyle pattern can be more effective in promoting fertility and managing underlying causes for recurrent fertilization failures. Regarding the major lifestyle parameters that can boost the fertility dynamic, these include daily physical exercise, abstention from smoking and drinking alcohol, stress management and adequate sleep duration. Moreover, the couple should avoid heavy exposure to electromagnetic radiation and materials that may contain heavy metals. Last but not least, recent published studies indicate, also, a potential role of maternal gut microbiota on infertility issues development. It is claimed that may be possible associations between the intestinal microbiota and the microbiota of female reproductive system, correlating specific intestinal bacteria with the development of female reproductive system diseases, such as polycystic ovary syndrome, endometriosis and infertility issues.15 Summarizing, there is a combination of diet and lifestyle parameters that should be individualized according to the actual couple’s needs, in order to achieve the best fertility boosting.
- Eniola, O.W., Adetola, A.A. and Abayomi, B.T. A review of Female Infertility; important etiological factors and management. Journal of Microbiology and Biotechnology Research, 2017; 2(3):379-385.
- Omar, M.I., Pal, R.P., Kelly, B.D., Bruins, H.M., Yuan, Y., Diemer, T., Krausz, C., Tournaye, H., Kopa, Z., Jungwirth, A. and Minhas, S. Benefits of empiric nutritional and medical therapy for semen parameters and pregnancy and live birth rates in couples with idiopathic infertility: a systematic review and meta-analysis. European Urology, 2019; 75(4):615-625.
- Leisegang K, Sengupta P, Agarwal A, Henkel R. Obesity and male infertility: Mechanisms and management. Andrologia. 2020 :e13617.
- Deyhoul N, Mohamaddoost T, Hosseini M. Infertility-related risk factors: a systematic review. International Journal of Women’s Health and Reproduction Sciences. 2017; 5(1):24-9.
- Foucaut AM, Faure C, Julia C, Czernichow S, Levy R, Dupont C, ALIFERT collaborative group. Sedentary behavior, physical inactivity and body composition in relation to idiopathic infertility among men and women. PLoS One. 2019; 14(4):e0210770.
- Jahangirifar M, Taebi M, Nasr-Esfahani MH, Askari G. Dietary Patterns and The Outcomes of Assisted Reproductive Techniques in Women with Primary Infertility: A Prospective Cohort Study. International journal of fertility & sterility. 2019 Jan;12(4):316.
- Gaskins, A.J., Nassan, F.L., Chiu, Y.H., Arvizu, M., Williams, P.L., Keller, M.G., Souter, I., Hauser, R., Chavarro, J.E. and EARTH Study Team, 2019. Dietary Patterns and Outcomes of Assisted Reproduction. American Journal of Obstetrics and Gynecology.
- Mumford, S.L., Sundaram, R., Schisterman, E.F., Sweeney, A.M., Barr, D.B., Rybak, M.E., Maisog, J.M., Parker, D.L., Pfeiffer, C.M. and Louis, G.M.B., 2014. Higher urinary lignan concentrations in women but not men are positively associated with shorter time to pregnancy. The Journal of nutrition, 144(3), pp.352-358.
- Jurewicz, J., Radwan, M., Sobala, W., Radwan, P., Bochenek, M. and Hanke, W., 2018. Dietary patterns and their relationship with semen quality. American journal of men’s health, 12(3), pp.575-583.
- Smits, R.M., Mackenzie-Proctor, R., Fleischer, K. and Showell, M.G., 2018. Antioxidants in fertility: impact on male and female reproductive outcomes. Fertility and sterility, 110(4), pp.578-580.
- Twigt, J.M., Bolhuis, M.E.C., Steegers, E.A.P., Hammiche, F., Van Inzen, W.G., Laven, J.S.E. and Steegers-Theunissen, R.P.M., 2012. The preconception diet is associated with the chance of ongoing pregnancy in women undergoing IVF/ICSI treatment. Human reproduction, 27(8), pp.2526-2531.
- Noli SA, Ricci E, Cipriani S, Ferrari S, Castiglioni M, La Vecchia I, Somigliana E, Parazzini F. Dietary Carbohydrate Intake, Dietary Glycemic Load and Outcomes of In Vitro Fertilization: Findings from an Observational Italian Cohort Study. Nutrients. 2020; 12(6):1568.
- McGrice M, Porter J. The effect of low carbohydrate diets on fertility hormones and outcomes in overweight and obese women: a systematic review. Nutrients. 2017 Mar;9(3):204
- Lass A, Belluzzi A. Omega-3 polyunsaturated fatty acids and IVF treatment. Reproductive Biomedicine Online. 2019;38(1):95-9.
- Quaranta, G., Sanguinetti, M. and Masucci, L., 2019. Fecal Microbiota Transplantation: A Potential Tool for Treatment of Human Female Reproductive Tract Diseases. Frontiers in Immunology, 10.