Diet & Lifestyle Recommendations for Optimal Fertility - By Dr. Meghan van Drimmelen ND
The old saying goes, we are what we eat, but does this apply to fertility? Do diet and lifestyle changes really impact fertility outcomes?
The short answer is that yes, the evidence suggests that nutrition and lifestyle may play a role in fertility outcomes. However, there are of course caveats to this rule. For instance, if you have structural concerns that are impeding your fertility (ie. blocked fallopian tubes, or uterine abnormalities) diet will not solve your fertility concerns. In these cases working with a fertility doctor to explore your treatment options such as IVF or surgery is of utmost importance.
So, what dietary and lifestyle changes can you make to improve your fertility? Here’s what the evidence says…
Eat a whole foods diet that incorporates aspects of the ‘Fertility Diet’ from the Nurses Health Study, and the ‘Mediterranean Diet.’
These dietary guidelines focus on nutrient dense, anti-inflammatory, and low glycemic index foods, all of which positively effect fertility.
Eat an abundance of fruits and veggies. Enjoy dark green leafy vegetables, berries, grapes, apples, pears, cauliflower, broccoli, cabbage, asparagus, carrots, beets, peppers, and the list goes on!
Focus on healthy, monounsaturated and polyunsaturated fats. Monounsaturated fats include olive, peanut and canola oils; avocados; nuts such as almonds, hazelnuts and pecans; and seeds such as pumpkin and sesame seeds. Polyunsaturated fats include soybean, corn and flaxseed oils; walnuts, flaxseeds, and fish.
Avoid trans fats found in processed, fried, and fast foods.
Limit saturated fat, and incorporate more lean and plant based proteins. Reduce your red meat consumption to once per week, and incorporate more fish, poultry and beans and legumes. Fish is an important source of omega 3 fats, which is a type of polyunsaturated fat. An excellent way of getting more omega 3 fats is eating low mercury fish three times per week (ie. salmon, halibut, sardines, cod, sole, trout, pollock).
Reduce refined carbohydrates and sugar, and focus on slow or complex carbohydrates. Slow or complex carbohydrates break down into sugar in the bloodstream at a slower rate. Examples include squash, yams, beans and legumes, fruits and vegetables, and whole grains such as quinoa, brown rice, oats and spelt.
Incorporate full fat dairy products in moderation (1-2 servings per day), rather than low fat dairy products.
Don’t forget about iron! Make sure to eat iron rich foods, and if your iron is low take an iron supplement. Examples of iron rich foods include beans and legumes, green leafy vegetables, eggs, fish, dairy and poultry. Red meat is also an excellent source of iron, but limit intake to once per week.
If you have celiac disease, strictly avoid gluten.
Untreated or undiagnosed celiac disease may cause female or male subfertility, which resolves by adopting a gluten-free diet. If you are unsure whether or not you have celiac disease, get tested.
If you have PCOS (polycystic ovarian syndrome) eat a whole foods low carbohydrate diet.
The same rules apply as above, but reduce your carbohydrate intake to less than 45% of your diet. For individuals with PCOS, insulin resistance is a contributing factor to ovulatory dysfunction. Reducing the amount of carbohydrates in the diet can help to improve blood sugar regulation and regular ovulation in women with PCOS.
Find your healthy weight.
Achieve and maintain a healthy weight. Having a high or a low BMI can impact your hormones and throw ovulation off schedule. A high BMI in men may also impact semen parameters.
Take a prenatal vitamin.
Ensure that your prenatal vitamin has a minimum of 800mcg of folic acid per day.
Limit alcohol and caffeine to minimal or moderate use. If you are going through fertility treatments, give up alcohol altogether.
Experts agree that there is a dose dependant relationship between alcohol consumption and fertility outcomes, with higher alcohol consumption being associated with more fertility concerns. Reducing alcohol consumption to 4 or less standard drinks per week is recommended when trying to conceive. If you are undergoing fertility treatments such as IVF, it is recommended to cease alcohol consumption altogether, as even small amounts (ie. 4 or more drinks per week) can negatively impact fertility outcomes. Of course alcohol consumption should cease all together during pregnancy, because alcohol has well documented detrimental effects on fetal development, and no “safe” level of alcohol consumption has been established.
Limit caffeine consumption to 1-2 drinks per day (200mg). High levels of caffeine consumption is associated with higher rates of infertility and miscarriage.
Quit smoking and recreational drugs including cannabis.
Smoking is associated with higher rates of infertility and miscarriage in women, and abnormal sperm parameters in men. Cannabis has an effect on sperm counts, and fetal neurodevelopment.
Take care of your mental wellness.
We know that going through fertility challenges can cause distress, anxiety and depression, but does mental health affect fertility outcomes? The evidence is a bit mixed, however it seems that stress reducing interventions such as counselling and mindfulness can improve fertility outcomes in individuals undergoing ART. Having said this, it makes sense to incorporate activities that reduce stress and support mental wellness- this could include going for a nature walk, yoga, meditation, watching a funny tv show, reading a good book, going out for lunch with a friend, or seeking out counselling.
Limit exposure to endocrine disrupting chemicals in food, air, water, and personal care.
Frequent exposure to pesticides, pollutants, and chemical solvents can negatively impact your fertility. Try to incorporate organic foods when possible, or follow the clean fifteen and dirty dozen guidelines from the Environmental Working Group. The Environmental Working Group is also an excellent resource for clean personal care products. Minimize exposure by wearing gloves and a mask when working with potentially toxic materials.
References:
Hornstein M, et al. “Optimizing Natural Fertility in Couples Planning Pregnancy.” Uptodate, 2022.