Dietary Patterns and Ovarian Reserve
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)
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
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.
