This post by Kimberly King, FNTP, reviews nutritional strategies that increase the success rates of assisted reproductive technology (fertility treatments).

Can you increase ART success rates using nutrition?

Probably! There have been many research studies done on how nutrition and nutrients affect fertility overall, fertility treatments, egg health, sperm health, and reproductive success. While there is no one large study specifically about nutrition and ART success, there are many studies about various aspects of fertility and ART and nutrition. You will find I have referenced several of them throughout the article.

What do all these research studies and articles tell us?

When taken as a whole, most of the studies and reviews of studies indicate that nutrition plays a vital role in a couple’s ability to conceive and carry a baby to full term. In men, many of the studies focus on antioxidants in particular because semen should be full of antioxidants to protect the maturing sperm. In women, quite a variety of nutrients have been examined for their impact on healthy egg development, maintaining healthy hormone levels, and overall building up the body for the precious job of creating a baby.

In this article, I focus on foods you can add to your diet that will help support your hormones and your eggs or sperm. You can take supplements, and for some people, this is a great idea, but if you want lasting change (and lasting health), you need to start adding in more healthy foods. Adding in these foods will help you now, as you start this journey, and long into the future as you improve your overall health.

There is no one diet or food that is right for everyone, but there are many foods that promote health and vitality. Working with a competent and experienced nutrition professional can help you to figure out where to start, which foods would give you the biggest bang for your buck, and if you should consider supplementing. If you are preparing to conceive, I recommend choosing a practitioner with extensive experience in the area of reproductive care.

Some examples of how foods/nutrients affect reproductive success and fertility

This is just a sampling of some of the research out there, both for men and women.

• The more closely a woman followed a Pro-Fertility Diet, the higher her ART success rate.[i]
• After undergoing counseling in a Health Promoting Lifestyle, ART success was 46% compared to the control group with 19%.[ii]
• Based on a recent Cochrane review, a man could improve his fertility (sperm) fourfold by taking antioxidants.[iii]
• Iodine, selenium, omega-3 fatty acids, and magnesium are crucial for successful fertility.[iv]
• The majority of infertility cases due to ovulation disorders may be preventable through modification of diet and lifestyle.[v]
• A relatively low-carb diet (43%) improved the metabolic profile of women with PCOS within 16 days.[vi]
• Patients with diminished ovarian reserve undergoing IVF or ICSI were more likely to become pregnant and less likely to undergo pregnancy loss when taking DHEA.[vii]

How can nutrition and foods help with ART success rates?

Women

1. 1. Healthy hormones are quite the catchphrase right now, but it is true. To have a successful ART fertility treatment and then to carry a baby to term requires a woman’s hormones to be healthy and working well.
   2. If your eggs are going to be used during fertility treatment, there are several nutrients and foods that can nourish and protect your eggs as they mature.
   3. Preparing your body to carry a baby is crucial. We all desire a safe, uncomplicated pregnancy and birth. It is a good idea for every woman to spend some time making sure her body is in good condition for the hard work of building and nourishing a baby.

Men

1. 1. 1. If your sperm is going to be used, there are several foods you can add to your diet that will help nourish and protect your sperm.
      2. DNA fragmentation inside sperm is often present in men with fertility problems. In fact, it can be a better marker for determining ART success or failure than just sperm count or sperm motility.
      3. These same foods will often make you feel better and give you more energy. Some foods are also needed for testosterone creation, and you may be surprised to know they are healthy fats.

What foods and nutrients should you focus on adding?

Foods and Nutrients for Women Undergoing ART

What foods and nutrients are going to prepare your body for pregnancy? We want to include foods that are good for your hormones, for egg development, and for your uterus and other reproductive organs.

Supporting Female Hormones

An easy and effective way to support your female hormones to by making sure you are eating healthy fats and protein with each meal. Blood sugar fluctuations can wreak havoc with female hormones. Insulin is a hormone, and when it fluctuates wildly, it can cause your thyroid and sex hormones (like estrogen) to get out of whack.

Also, healthy fats and cholesterol are needed for the production of both male and female sex hormones. As a bonus, eating more healthy fats and protein will make you feel fuller and more satisfied. You will want to eat around 1 to 2 Tablespoons of fat with each meal.

What are some healthy fats and proteins to support female hormones?

• Olive oil, avocado oil, coconut oil
• Butter
• Animal fats-lard and tallow
• Seed/nut oils-like flaxseed oil, almond oil, walnut oil, macadamia nut oil
• Omega 3s from fish, like salmon, or from fish oils, like cod liver oil
• Nuts count as both fat and protein
• Full-fat dairy also counts as both fat and protein
• Proteins from fish, grass-fed beef, free-range chicken
• Eggs are an extremely good source of protein and fat
• Seafood – wild-caught

Supporting Egg Development

In addition to having a healthy, functioning hormone system, it is important for eggs to be protected as they develop. Most people do not realize that eggs take about 90 days or so to mature. During that time, you want to keep them safe from damage. This is where antioxidants come into play.

Antioxidants protect your cells and your eggs from damage. You want to make sure you are eating high in antioxidants like vitamins A, C and E, and selenium.

Some foods that are high in antioxidants – good for women or men

• Berries – all kinds
• Kale and other dark green veggies
• Red cabbage
• Orange foods like sweet potatoes and butternut squash
• Colorful foods – the more color, the better

Supporting your uterus and your whole body by supporting your liver

Female reproductive organs function best when hormone levels are normal AND when the liver is doing its job of recycling those hormones. If you struggle with breast tenderness, uterine fibroids, chronic bad breath, or itchy skin, then your liver might not be recycling your hormones correctly. The liver plays a crucial role in estrogen metabolism by recycling estrogen before it builds up in the system. Fiber also helps the body to get rid of excess estrogen.

Foods that support reproduction by supporting the liver

• High-fiber foods such as dark leafy greens, quinoa, beans
• Beets are one of the top foods for the liver and gallbladder
• Cruciferous vegetables like broccoli, kale, and Brussels sprouts
• Berries
• Healthy fats – see above
• Water
• Liver

Foods are almost always going to be the best way to nourish your body, but in some instances, it may be wise to supplement. Please talk with a nutrition professional specializing in the reproductive years about how to get started adding these foods to your diet and if supplementing may be right for you.

Foods and Nutrients for Men Undergoing ART

For men, it is critical to provide nutrients that support healthy sperm development and healthy testosterone levels. You may be surprised to learn that it takes around 74 days for sperm to mature. As you can imagine, we need to choose foods and nutrients that not only protect the sperm but also ones that help the sperm to develop properly. For successful ART, it is best if the sperm count is high, they can swim well (motility), and the sperm morphology (shape) is good.

When you read about healthy sperm, the literature often refers to studies of “semen parameters.” The scientific terms relevant to infertility include oligozoospermia (low sperm count), asthenozoospermia (poor motility), and teratozoospermia (undesirable morphology). Sperm that scores poorly in all three of these areas is called oligoasthenoteratozoospermia (OAT). What a mouthful!

Another important factor is for the DNA inside the sperm to be protected. Some researchers and doctors believe that DNA fragmentation plays a major role in male infertility. DNA fragmentation can be a major factor in fertility success, especially with IVF.[viii] [ix] In fact, it is now recognized that the sperm of many infertile men have damaged DNA, resulting in low semen quality.[x] [xi] It is believed that sperm quality may be caused by oxidative stress when free radicals attack the DNA molecules.[xii] In fact, antioxidants have been shown to improve DNA fragmentation in men with low fertility.[xiii]

Quite often, when looking at research, you will find that researchers look only at semen parameters, but sometimes they include DNA fragmentation as well. Others only look at DNA fragmentation. These two are closely linked and probably should always be looked at together. What I mean by this is that if your sperm has fairly high levels of DNA fragmentation, then it probably also has poor morphology and motility. Conversely, in men whose sperm are not healthy, the amount of DNA fragmentation is probably high as well.

Does sperm health really affect fertility and the ability of a couple to become pregnant?

When doing research on fertility, it came as a surprise to me that it takes around three months for sperm to fully mature. As you can imagine, there are many opportunities in that time for the sperm to become damaged, so we need to protect those sperm as they mature. Men’s bodies are designed to keep the sperm protected with things like anti-oxidants in the semen. But many men are not eating enough foods that are high in these antioxidants. Sperm also need specific nutrients to fully mature, just as eggs do in women. Here is a study that found that low concentration and motility of sperm on the day of IVF led to less successful fertilization.[xiv] And here is a study that discusses how the father’s diet affects sperm quality.[xv]

What damages the sperm as they mature?

Some things that can cause damage to sperm are smoke, sunlight, food preservatives (think sandwich meats and most processed foods), and chemicals like alcohol, cleaners, and chemicals in personal care items like lotions.

Supporting sperm development (sperm count, morphology, and motility) and improving semen parameters

What are some of the foods and nutrients that researchers have found to support healthy sperm? First off, healthy fats are needed by the body to produce sex hormones, so the first things on the foods list are various types of fats that are good for the body. Other foods that have been found to have a positive impact are various vitamins and minerals, as well as omega-3 fatty acids, probably because they reduce inflammation.

Here are some studies that talk about specific nutrients or diets that improved sperm form and function:

• In one study of 690 infertile men, they found that Selenium and vitamin E improved sperm form and function in over 50% of the men.[xvi]
• A study of 225 men who were part of a couple attending a fertility clinic found that the men who most closely followed a Mediterranean-type diet had around 30% better scores of their semen parameters (sperm count, shape, and motility).[xvii]
• A review of 35 studies determined that healthy diets rich in omega-3s, vitamins E and C, beta-carotene, selenium, zinc, and other nutrients usually resulted in better semen quality parameters.[xviii]

Preventing DNA fragmentation of sperm

Several research studies have shown that antioxidants can help prevent DNA fragmentation.

• In another study, albeit small, the researchers found that sperm DNA fragmentation in infertile men was improved from 22% down to 9% after treatment with vitamins C and E.[xix]
• A review of research showed that in five studies, antioxidants helped reduce DNA fragmentation.[xx] Some of the studies showed direct improvements in DNA integrity, while others showed an increase in pregnancy rates.

Foods that support sperm development and/or may help reduce DNA fragmentation.

Nutrients that support sperm development and that reduce DNA damage are often the same, so I have listed them all together. Antioxidants like vitamins A, C, D, and E; the amino acid L-carnitine; the antioxidant Co-Q10; and selenium have been shown to be helpful. Another very important anti-oxidant component of semen is zinc. Low zinc levels are closely associated with male infertility. Supplementing with zinc has been shown to improve sperm health.[xxi] It is the second most abundant metal in the human body after iron. If you talk with holistic nutrition practitioners, they will tell you that most of their clients test for zinc deficiencies.

• Healthy fats for healthy hormones – Olive oil, avocado oil, coconut oil, butter, animal fats like lard and tallows, seed/nut oils-like flaxseed oil, almond oil, walnut oil, macadamia nut oil
• Omega-3s – like mackerel, salmon, cod liver oil, flaxseeds, chia seeds, walnuts
• Vitamin A – Liver, cod liver oil, salmon, sweet potatoes, kale, collard greens
• Vitamin C – chili peppers, yellow peppers, fresh thyme, kale, kiwi, broccoli, Brussels sprouts, lemon, papaya, strawberries, oranges
• Vitamin D – while there are some foods with vitamin D, the best way to get vitamin D is to get out in the sun. Some foods with vitamin D are salmon, cod liver oil, tuna, oysters, shrimp, egg yolks from pasture-raised chickens, mushrooms (some varieties have very high levels)
• Vitamin E – sunflower seeds, almonds and almond oil, hazelnuts, salmon, avocado, red peppers, brazil nuts
• L-carnitine – beef, chicken, dairy products, cod, beans, avocado
• Co-Q 10 – liver, beef, mackerel, spinach, cauliflower, broccoli, oranges, strawberries, sesame seeds, pistachios
• Zinc – meat of all kinds, shellfish, beans, pumpkin seeds, sesame seeds, cashews, eggs, sweet potatoes
• Selenium – brazil nuts, salmon, shrimp, pork, beef, turkey, chicken, eggs, brown rice, sunflower seeds, mushrooms, spinach

Foods are the best way to get the nutrients you need, but you may want to consider supplementing some of these. Consider working with a Feed Your Fertile Body!^TM practitioner. For more about the program and to find a practitioner, please see the program outline.

About the Author

Kimberly King is a certified Nutritional Therapy Practitioner and a Microbiologist. She owns Discover a Healthier You and is an instructor for the Feed Your Fertile Body!™ and Feed Your Pregnant Body!™ programs. Helping couples and women achieve better health so they can realize their dreams is her goal. She lives in Idaho Falls but also works with clients online.

References

[i] Dietary Patterns and Outcomes of Assisted Reproductions, Am J Obstet Gynecol. 2019 Feb 8. pii: S0002-9378(19)30345-X. doi: 10.1016/j.ajog.2019.02.004.

[ii] The effect of health-promoting lifestyle education on the treatment of unexplained female infertility, Eur J Obstet Gynecol Reprod Biol. 2016 Dec;207:109-114. doi: 10.1016/j.ejogrb.2016.10.050. Epub 2016 Nov 2.

[iii] Nutrient supplementation: improving male fertility fourfold, Semin Reprod Med. 2013 Jul;31(4):293-300. doi: 10.1055/s-0033-1345277. Epub 2013 Jun 17.

[iv] The Role of Nutrients Crucial in the Infertility of Couples, Journal of Nutritional Health & Food Sciences 2017 Dec.

[v] Diet and lifestyle in the prevention of ovulatory disorder infertility, Obstet Gynecol. 2007 Nov;110(5):1050-8.

[vi] Role of diet in the treatment of polycystic ovary syndrome (PCOS), Fertil Steril. 2006 Mar; 85(3): 679–688.  doi: 10.1016/j.fertnstert.2005.08.045

[vii] DHEA use to improve likelihood of IVF/ICSI success in patients with diminished ovarian reserve: A systematic review and meta-analysis, JBRA Assist Reprod. 2018 Oct-Dec; 22(4): 369–374. doi: 10.5935/1518-0557.20180046

[viii] What should be done for men with sperm DNA fragmentation?, Clin Exp Reprod Med. 2018 Sep; 45(3): 101–109.

[ix] A mathematical model predicting the individual outcome of IVF through sperm-analysis: The role of the HaloSpermG2® DNA fragmentation test.

[x] Correlations between two markers of sperm DNA integrity, DNA denaturation and DNA fragmentation, in fertile and infertile men.

[xi] Sperm chromatin damage impairs human fertility. The Danish First Pregnancy Planner Study Team.

[xii] Sperm DNA damage caused by oxidative stress: modifiable clinical, lifestyle and nutritional factors in male infertility, Reprod Biomed Online. 2014 Jun;28(6):684-703. doi: 10.1016/j.rbmo.2014.02.004. Epub 2014 Mar 4.

[xiii] The role of sperm oxidative stress in male infertility and the significance of oral antioxidant therapy, Human Reproduction, Volume 26, Issue 7, 1 July 2011, Pages 1628–1640,https://doi.org/10.1093/humrep/der132

[xiv] Semen parameters on the day of oocyte retrieval predict low fertilization during conventional insemination IVF cycles, Journal of Assisted Reproduction and Genetics, 10 Nov 2018

[xv] Epigenetics in male reproduction: effect of paternal diet on sperm quality and offspring health, Nature Reviews Urology volume13, pages584–595 (2016)

[xvi] Selenium-vitamin E supplementation in infertile men: effects on semen parameters and pregnancy rate, Int J Gen Med. 2011; 4: 99–104. doi: 10.2147/IJGM.S16275

[xvii] Association between adherence to the Mediterranean diet and semen quality parameters in male partners of couples attempting fertility, Human Reproduction, Volume 32, Issue 1, 1 January 2017, Pages 215–222, https://doi.org/10.1093/humrep/dew288.

[xviii] Dietary patterns, foods and nutrients in male fertility parameters and fecundability: a systematic review of observational studies, Hum Reprod Update. 2017 Jul 1;23(4):371-389. doi: 10.1093/humupd/dmx006.

[xix] Reduction in the Incidence of Sperm DNA Fragmentation by Oral Antioxidant Treatment, Journal of Andrology, 02 January 2013, DOI:10.2164/jandrol.04146

[xx] Antioxidants and sperm DNA damage: a clinical perspective, J Assist Reprod Genet. 2009 Aug; 26(8): 427–432. doi: 10.1007/s10815-009-9343-5

[xxi]Zinc levels in seminal plasma and their correlation with male infertility: a systematic review and meta-analysis, Sci Rep. 2016; 6: 22386. doi: 10.1038/srep22386