Mediterranean diet for IVF/ICSI

By Juliana Kassianos, Transformational Fertility Coach, Yoga Teacher and Founder of The School of Fertility

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What with my Greek-Cypriot heritage, I’ve very much grown up on a Mediterranean diet, which incorporates the traditional healthy eating habits of those living in the countries bordering the Mediterranean Sea. It’s a diet with high intake of vegetables, fruits, legumes, pulses, whole grains, nuts, seeds, oily fish and vegetable oils, moderate intake of alcohol, and low intake of meat, dairy and processed food.

One study has shown that a pre-conception Mediterranean diet by couples undergoing In Vitro Fertilisation (IVF) or Intracytoplasmic Sperm Injection (ICSI) contributes to pregnancy success, with a 40% increase in the probability of pregnancy. Another study showed that women who followed a Mediterranean diet for six months before having IVF had a 65-68% greater likelihood of becoming pregnant and giving birth to a live baby than women who did not. An additional study showed a significant association between men who ate a Mediterranean diet and higher sperm concentration, total sperm count and sperm motility. So, why is this?

FOLATE, VITAMIN B6 AND FOLLICULAR FLUID

They believe it’s due to the fact that those on the Mediterranean diet, showed an increase in folate, vitamin B6 and follicular fluid, which is the liquid that bathes the egg in the ovarian follicle. Research has already shown that subfertile women who were given vitamin B6, resulted in 40% increased chance of conception and 30% lower risk of miscarriage early on in pregnancy. So, the results of the two studies are definitely in line with each other.

LINOLEIC ACID

Vegetable oils tend to be high in linoleic acid, a polyunsaturated essential fatty acid, we can only get through our diet. It's used in the biosynthesis of prostaglandins. These regulate the female reproductive system and are involved in the menstrual cycle, the development of preantral follicles, ovulation and the maintenance of pregnancy. Therefore, it may be that the high intake of linoleic acid in the Mediterranean diet, has a positive effect.

OMEGA-3 FATTY ACIDS

A high intake of Omega-3 fatty acids, in particular alpha-linolenic acid and docosahexaenoic acid, has been found to improve embryo morphology in women having IVF/ICSI. Omega-3 fatty acids in the form of alpha-linolenic acid are found in walnuts, flax seeds and pumpkin seeds. Omega-3 fatty acids in the form docosahexaenoic acid are found in oily fish such as Salmon, Mackerel, Anchovies, Sardines and Herring.

ANTIOXIDANTS

What with all the fresh vegetables and fruit, the Mediterranean diet is also high in antioxidants. In healthy men, high antioxidant intake (vitamin C, vitamin E, folate and zinc) has been associated with better semen quality. One study that involved oral antioxidant treatment (vitamin C and vitamin E) daily for two months saw improved ICSI outcomes in patients with sperm DNA damage – the treatment reduced the percentage of damaged sperm.

Whether you're considering IVF/ICSI, currently undergoing treatment or trying to conceive naturally, try adopting more of a Mediterranean diet. Think roasted vegetables, bean salads, stuffed peppers, grilled fish, Greek salad, vegetable frittata and bruschetta.

SCIENTIFIC EVIDENCE

  • The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy. Vujkovic M et al. Fertil Steril. 2010 Nov;94(6):2096-101. https://www.fertstert.org/article/S0015-0282(09)04338-6/fulltext

  • Mediterranean diet may help women receiving assisted reproduction treatment to achieve successful pregnancies, European Society of Human Reproduction and Embryology (ESHRE)

  • Adherence to the Mediterranean diet and IVF success rate among non-obese women attempting fertility,” by Dimitrios Karayiannis et al. Human Reproduction journal. doi:10.1093/humrep/dey003. https://www.ncbi.nlm.nih.gov/pubmed/29390148

  • Association between adherence to the Mediterranean diet and semen quality parameters in male partners of couples attempting fertility”, by Dimitrios Karayiannis et al. Human Reproduction, Volume 32, Issue 1, 1 January 2017, Pages 215-222; https://doi.org/10.1093/humrep/dew288. https://www.ncbi.nlm.nih.gov/pubmed/27994040

  • Ronnenberg, A.G., Venners, S.A., Xu, X., Chen, C., Wang, L., Guang, W. et al. Preconception B-vitamin and homocysteine status, conception, and early pregnancy loss. Am J Epidemiol. 2007; 166: 304–312. https://www.ncbi.nlm.nih.gov/pubmed/17478435

  • Increased preconception omega-3 polyunsaturated fatty acid intake improves embryo morphology. Hammiche F et al. Fertil Steril. 2011 Apr;95(5):1820-3. https://www.ncbi.nlm.nih.gov/pubmed/21130435

  • A randomised controlled trial of a preconceptional dietary intervention in women undergoing IVF treatment (PREPARE trial). Alexandra J Kermack et al. BMC Womens Health. 2014; 14: 130. https://bmcwomenshealth.biomedcentral.com/articles/10.1186/1472-6874-14-130

  • Antioxidant intake is associated with semen quality in healthy men. Eskenazi B et al. Hum Reprod. 2005 Apr;20(4):1006-12. Epub 2005 Jan 21. https://www.ncbi.nlm.nih.gov/pubmed/15665024

  • ICSI in cases of sperm DNA damage: beneficial effect of oral antioxidant treatment. Greco E et al. Hum Reprod. 2005 Sep;20(9):2590-4. Epub 2005 Jun 2. https://www.ncbi.nlm.nih.gov/pubmed/15932912


Juliana Kassianos