diet to improve egg quality, ovarian reserve and IVF success

fertility nutrition - the latest research

So far in 2019 we’ve seen evidence for the Mediterranean diet helping IVF, Vitamin D improving pregnancy rates in PCOS, and DHEA helping women with reduced ovarian reserve. Reviews have shown that obesity reduces live birth rate but exercise improves pregnancy rates in women with fertility problems.

This builds on last years research showing that the Mediterranean diet improves live birth rates in younger women, seafood improves fertility, co-enzyme Q10 helps IVF success, Vitamin D is important for both preconceptual care and PCOS, DHEA helps IVF success in poor responders, and higher levels of folic acid and omega 3 helps pregnancy rates with IVF.

Mediterranean diet helps fertility and IVF success - Growing research evidence

A study published in September shows that following a Mediterranean diet improves embryo count with IVF (Sun et al. 2019). The authors suggest that the diet helps by improving ovarian response and oocyte quality. This fits with studies showing the diet improves sperm count and quality.

Previous studies of the relationship of Mediterranean diet to fertility show

foods affecting egg quality and IVF success are...

Protein - we need protein to build healthy eggs and sperm and healthy babies. Carbohydrates and fats just support the process.

  • Eggs are an excellent source of protein, they contain all essential and non-’essential amino acids. During the stimulation phase of an IVF cycle you can eat them every day. Eating eggs for breakfast will help control blood sugar and hormone levels throughout the day (Ratliff et al. 2010)

  • Fish intake has been linked to a higher live birth rate with IVF (Nassan et al. 2018) and couples who eat more seafood achieved pregnancy quicker (Gaskins et al. 2018)

5 a day - the Mediterranean diet has a high intake of vegetables and fruit

  • higher fruit and veg consumption had a positive effect on IVF fertilisation rate (Firns et al. 2015)

  • women who ate more yellow and green fruit started their menopause over a year later (Pearce & Tremellen, 2016). If you have PCOS aim for more veg than fruit.

Healthy fats - olive oil, avocados, nuts, seeds and oily fish

  • Omega-3 has been linked to higher IVF birth rate - sources include oily fish, flax seeds and chia seeds

Hydration - drink plenty of water while trying naturally or throughout your IVF cycle

Foods to avoid

  • processed foods - processed meats are known to decrease sperm quality (Xia et al. 2015) and it’s reasonable to assume that the same is true for egg quality

  • too much sugar - both female and male fertility was reduced with the more sugary drinks they had (Hatch et al. 2018)

  • artificial sweeteners which have been linked to poorer embryo development (Setti et al. 2018)

  • pesticides - eat organic where reasonable. Pesticide residues on fruit and vegetables have been linked lower pregnancy and live birth rates with IVF (Chiu et al. 2018)

supplements to improve egg quality, ovarian reserve and IVF response

I recommend all women to take

  • a preconception multivitamin while trying to conceive. This will contain the essential level of folic acid together with B vitamins that enable the folic acid to work.

  • Vitamin D if your levels are low. It’s a good idea to have your GP check your Vitamin D as low levels can affect both pregnancy and miscarriage rates. The dosage you need will depend on your blood levels. Vitamin D may be especially important for women with PCOS as it can help insulin resistance - and deficiency is quite common in the UK as we don’t get enough sunlight!

  • Omega 3 as it has been linked to better embryo quality, pregnancy and live birth rates. A 2018 Cochrane review suggests it lowers risk of pre-term birth, though a large Australian study this year doesn’t confirm this. It is thought that anti-inflammatory properties of Omega 3 may help during IVF cycles. It takes time for omega levels to build up in your body so this is good preparation for pregnancy - especially as I don’t see many women wanting to eat fish while pregnant! If you are taking medicine to effect your blood clotting factors you should tell your doctor if you are taking omegas.

And if you have low ovarian reserve

  • CoQ10

  • DHEA may be helpful

vitamin d and fertility - how important is it?

  • adequate Vitamin D levels improve embryo quality and pregnancy rates in women with PCOS and insulin resistance undergoing IVF (Zhao et al. 2019}

  • high dose Vitamin D - 50,000iu fortnightly (works out to 3,570iu daily) for 8 weeks improved AMH, insulin resistance and lipids in women with PCOS (Dastorani et al. 2018)

  • preconception levels of Vitamin D are associated with higher pregnancy and live birth rates - highlighting the importance of preconceptual care (Mumford et al. 2018)

does Higher dose folic acid help fertility?

  • women with higher folate levels had a higher clinical pregnancy rate with IVF (Paffoni et al. 2018)

  • 232 women undergoing IVF showed higher implantation and live birth rates with 800 mcg doses (Gaskins et al. 2014) 

  • but this study found higher intake of folic acid did not improve live birth rates at IVF (Murto et al. 2014)

Folate is the natural form we get from food, and folic acid is the form you will usually see in supplements. A high intake of vegetables and fruit will give a naturally high supply of folate and so for most women good diet plus the standard 400mcg folic acid supplement would be sufficient.  Green leafy vegetables and avocados are a good source. Folic acid should be taken as part of a preconception multivitamin as other B vitamins especially B12 enable it’s action.

Some women have a genetic variation which affects their ability to produce an enzyme called MTHFR which is needed for the body to use folic acid. Research has looked at whether this can effect their miscarriage risk

  • for 16 women with the MTHFR variant and a history of 3 or more miscarriages, taking 5mg folic acid plus B12 and B6 resulted in live births for 7 women (Serapinas et al. 2017)

omegas for egg quality and IVF success

  • higher omega 3 levels were associated with higher pregnancy and live birth rates with IVF (Chiu et al. 2018)

  • preconception omega intake was associated with higher pregnancy rate in overweight and obese women undergoing IVF (Moran et al. 2016)

  • higher dietary omega 3 in the month before IVF stimulation related to better embryo quality, the study recommends eating fish twice a week especially during the IVF cycle (Hammiche et al. 2011)

  • animal study showing lifelong intake of higher omega 3 associated with prolonged reproductive life, and short term treatment with omega 3 in older animals improved egg maturation (Nehra et al. 2012)

  • animal study showing that higher intake of omega 3 from flaxseed oil or fish oil improved follicle numbers, and increased the number of embryos developing to blastocyst (Moallem et al. 2013)

coenzyme Q10 may improve ovarian response, egg quality and embryo quality - the research

  • Coenzyme Q10 dosage

    • 200mg Ubiquinone for 30 days before IVF egg retrieval showed better fertilisation rates and higher grade embryos (Giannobilu et al. 2018)

    • 600mg Ubiquinone for 60 days before IVF in younger women with poor ovarian reserve resulted in needing less stimulation drugs, higher oestrogen levels, more eggs retrieved, better fertilisation rates and more high quality embryos (Xu et al. 2018)

  • an IUI and IVF study combining coenzyme Q10 with DHEA resulted in a higher antral follicle count and better ovarian response than DHEA alone (Gat et al. 2016)

  • higher coenzyme Q10 in follicular fluid at IVF was related to higher grade embryos and pregnancy rates (Akarsu et al. 2017)

  • women with higher levels of coenzyme Q10 in their follicular fluid at IVF egg retrieval had more mature eggs and better grade embryos (Turi et al. 2012)

DHEA may help women with reduced ovarian reserve or response

review studies

  • a new meta-analysis of 9 RCT’s using DHEA in women with reduced ovarian reserve having IVF showed increased rates for egg retrieval, pregnancy and live births (Xu et al. 2019)

  • 21 studies showed pre-treatment with DHEA in IVF increased antral follicle count, implantation, pregnancy and live birth rates and a lower miscarriage rate (Zhang et al. 2016)

  • 8 studies using DHEA for women with reduced ovarian reserve showed improved clinical pregnancy rate (Li et al. 2015)

DHEA dosage used in clinical trials

  • 90mg a day for 3 months prior to IVF increased embryo count and quality, pregnancy and live birth rate in poor ovarian responders (Chern et al. 2018)

  • 90mg daily for at least 2 months prior to IVF increased the number and quality of embryos in women diagnosed as poor ovarian responders (Lin et al. 2017)

  • 25mg 3 times a day for 12 weeks prior to IVF increased egg count, fertilisation rate and pregnancy rates in women with low ovarian reserve (Kotb et al. 2016)

DHEA doesn’t appear to help women with normal ovarian response going through IVF (Yeung et al. 2016) and not all studies show positive results with reduced ovarian reserve or response. Different types of DHEA exist and they have quite different effects on the body so this should only be taken in consultation with your specialist.

how weight loss and exercise help natural fertility and ivf success

A new review of 21 studies shows a BMI of 30 or over reduces live birth rates following IVF (Sermondade et al. 2019). Previous IVF studies show women with BMI of 25 or over had lower pregnancy and live birth rates, and a higher miscarriage rate (Rittenberg et al. 2011) (Chavarro et al. 2012) and higher BMI is related to lower egg retrieval and embryo counts in younger women (Ramezanzadeh et al. 2012).

does exercise help fertility?

  • a review of 18 studies shows exercise improves pregnancy rates in women with fertility problems (Mena et al. 2019)

  • meta-analysis of 8 studies shows regular physical exercise prior to IVF cycles improves pregnancy and live birth rates (Rao et al. 2018)

  • regular physical exercise before the IVF cycle showed pregnancy rates improved by threefold in obese women (Palomba et al. 2014)

weight loss and fertility

  • losing 1 stone resulted in more natural conceptions in women with a BMI of 30 or over waiting for IVF treatment (Einarsson et al. 2017)

  • a review of 40 studies shows weight loss and exercise increases pregnancy rates in overweight and obese women (Best et al. 2017)

  • weight loss improves pregnancy rates for overweight and obese women undergoing IVF (Moran et al. 2011)

why breakfast is important if you have PCOS

  • eating a large breakfast and a small dinner improved ovulation rate and decreased testosterone in lean women with PCOS (Jacubowitz et al. 2013)