This week, there is (finally) a new nutrition study worth discussing. It was recently published in Fertility and Sterility. Called “Dietary patterns and ovarian reserve among women attending a fertility clinic,” this study sought to learn if a woman's diet is associated with her reproductive potential. 

Study Background

WHAT? How does a woman’s diet impact her ovarian reserve, as measured through antral follicle count (AFC)?

WHY? It’s currently unknown how diet overall impacts ovarian reserve.

WHERE? The fertility center at Massachusetts General, a Harvard-affiliate in Boston, Massachusetts

WHEN? 2007-2017 as part of EARTH study

WHO? Women ages 18-45 seeking fertility treatment. There were few exclusion criteria, with the two exclusions of polycystic ovary syndrome (PCOS) or ultrasounds completed on Lupron removing the greatest number of participants.

HOW? Ovarian reserve was estimated using the antral follicle count (AFC), which was learned by transvaginal ultrasound on menstrual cycle day three.

Women filled out at a validated food frequency questionnaire that asked about food, drink, and supplement use in the past year. Based on the food/drink responses, the scores were matched to see how closely they fit into one of three diets: the Mediterranean diet, the Fertility Diet, and the Profertility Diet.

• Mediterranean Diet

  • very high weekly consumption of non-refined cereals, potatoes, fruits, vegetables

  • high weekly consumption of legumes and fish

  • low weekly consumption red meat (max one serving) and poultry (max three servings)

  • daily use of olive oil

  • daily alcohol intake < 300 mL (36 g ethanol = 3 glasses of wine)

• Fertility diet

  • based on risk factors related to ovulation & infertility

  • high ratio monounsaturated fat to trans fat

  • weekly multivitamins (at least six tablets, doses and ingredients unstated)

  • animal protein >11.5% of daily calories

  • vegetable protein > 5.7% of daily calories

  • glycemic load < 107 / day

  • iron > 54.3 mg/day

  • dairy

    • high fat at least once weekly

    • low-fat max once daily

• Profertility diet

  • based on risk factors related to successful assisted reproductive technology outcomes (IVF/ICSI)

  • folic acid supplements

  • Vitamin B12 + Vitamin D

  • low-pesticide fruits & vegetables

  • whole grains

  • higher ratio of seafood/meat

  • high dairy

  • high soy foods

Results

• 363 female participants

  • average age 35 years (most were 32-38 years)

  • average BMI 23 kg/m2d (most were ~21–26 kg/m2)

  • 84% Caucasian

• No dietary patterns were associated with antral follicle count (AFC)

  Authors’ Conclusions

• Study limited by lack of data on other markers of ovarian reserve

• Questionnaire subject to recall bias

• Time period to truly capture impact of diet on ovarian reserve may be different than time period of one year selected for study

  This Pharmacist’s Conclusions

• No recommendations to change dietary practice

• Serves as a framework for future studies to test diet and ovarian reserve

Resources

Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstet Gynecol. 2007;110(5):1050-1058. doi:10.1097/01.AOG.0000287293.25465.e1

Fisher S. The fertility diet: Groundbreaking research reveals natural ways to boost ovulation & improve your chances of getting pregnant. J Clin Invest. 2008;118(4):1210. doi:10.1172/JCI35350

Gaskins AJ, Nassan FL, Chiu YH, et al. Dietary patterns and outcomes of assisted reproduction. Am J Obstet Gynecol. 2019;220(6):567.e1-567.e18. doi:10.1016/j.ajog.2019.02.004

Kim K, Purdue-Smithe A. Dietary patterns and ovarian reserve. What's the relevant exposure window? [published online ahead of print, 2020 Jul 30]. Fertil Steril. 2020;S0015-0282(20)30536-7. doi:10.1016/j.fertnstert.2020.06.001

Maldonado-Cárceles AB, Mínguez-Alarcón L, Souter I, et al. Dietary patterns and ovarian reserve among women attending a fertility clinic [published online ahead of print, 2020 Jul 22]. Fertil Steril. 2020;S0015-0282(20)30391-5. doi:10.1016/j.fertnstert.2020.04.030

Shahrokh Tehraninezhad E, Mehrabi F, Taati R, Kalantar V, Aziminekoo E, Tarafdari A. Analysis of ovarian reserve markers (AMH, FSH, AFC) in different age strata in IVF/ICSI patients. Int J Reprod Biomed (Yazd). 2016;14(8):501-506.