What dietary recommendations can help improve fertility in individuals experiencing infertility?

Nutrition for Infertility: Evidence-Based Dietary Recommendations

For individuals experiencing infertility, prioritize weight optimization (BMI 18.5-25), smoking cessation, alcohol avoidance, and a Mediterranean-style diet rich in fish, vegetables, whole grains, and antioxidants, while avoiding trans fats, processed meats, and high-glycemic foods. 1, 2

Essential Preconception Nutritional Interventions

Universal Recommendations for Women

• Take 400-800 mcg of folic acid daily starting before conception and continuing through 12 weeks of pregnancy to reduce neural tube defects 3
• Consume a balanced diet of folate-rich foods in addition to supplementation 3
• Avoid fish with high mercury levels 3
• Completely abstain from alcohol, tobacco, and recreational drugs 3

Weight Management (Critical for Both Sexes)

• Achieve and maintain normal BMI (18.5-25) as both underweight and overweight/obesity significantly impair fertility 4, 5
• Weight loss in overweight or obese men enhances sperm parameters and is strongly recommended by the European Association of Urology 1, 2
• Obesity causes insulin resistance in women (impairing ovulation) and disrupts the hypothalamic-pituitary-gonadal axis in men with elevated estrogen and decreased testosterone, LH, and FSH 6, 5

Dietary Pattern Recommendations

Optimal Fertility Diet (Mediterranean-Style)

Follow a low-glycemic, plant-based Mediterranean dietary pattern which has the strongest evidence for improving fertility outcomes 5, 7:

• Increase consumption of:

  • Fish, shellfish, and seafood (rich in omega-3 fatty acids) 6, 7
  • Poultry and plant-based proteins over red meat 7
  • Whole grains and high-fiber foods 5, 7
  • Vegetables and fruits (high in antioxidants) 6, 7
  • Nuts and seeds 6
  • Low-fat or skimmed dairy products 7
  • Monounsaturated fatty acids from vegetable sources 4

• Avoid or minimize:

  • Trans fats (industrially produced cakes, sweets, crisps, fast-foods, hard margarines) 4
  • Processed and red meats 7
  • Full-fat dairy and cheese 7
  • High-glycemic foods and sugar-sweetened beverages 5, 7
  • Soy foods (may negatively affect sperm quality) 7
  • Excessive caffeine (limit to <5 cups/day) 3, 7

Key Nutrients and Antioxidants

For Male Fertility

While supplement evidence is limited, certain nutrients show promise for sperm quality (though not definitively for live birth rates) 3:

• Zinc and selenium act beneficially on sperm quality 4, 6
• Omega-3 fatty acids minimize oxidative stress and inflammation 6
• Antioxidant vitamins (vitamin E, vitamin C, β-carotene, cryptoxanthin, lycopene) are inversely associated with low semen quality 7
• Vitamin D and folate may improve sperm parameters 7
• Carnitine supplements and coenzyme Q10 show promise 6

For Female Fertility

• Iron supplementation may prevent infertility 4
• Vitamin B12 is important for preventing early miscarriages 4
• Antioxidants promote reproductive function 4

Critical Caveats and Timing Considerations

Important Warnings

• Never use testosterone therapy in men seeking fertility as it suppresses FSH and LH, causing azoospermia that can take months to years to recover 1, 2
• Discontinue kava kava when planning pregnancy due to potential effects on pelvic blood flow and significant drug interactions with fertility medications 8
• Hold kava for at least 2 weeks before any fertility procedures 8

Realistic Expectations About Supplements

The American Urological Association and American Society for Reproductive Medicine state there are no clear, reliable data supporting supplements for improving fertility outcomes, though they are likely not harmful 3, 1. The evidence quality remains low and conflicting for live birth rates 3, 1.

Timeframe for Results

• Spermatogenesis requires 74 days (2.5 months), so any nutritional intervention needs at least this timeframe to show effects 1, 2
• For severe oligospermia with no improvement after 3-6 months of lifestyle modifications, proceed directly to fertility specialist evaluation and consider IVF/ICSI rather than prolonged supplement trials 1

Lifestyle Modifications Beyond Diet

Essential Behavioral Changes

• Complete smoking cessation improves sperm quality and is recommended for men trying to conceive 3, 1, 2
• Regular physical exercise improves sperm parameters and overall health 1, 2
• Avoid exogenous testosterone and anabolic steroids 1
• Reduce heat exposure to testes 3

Fertility Optimization Counseling

For couples not meeting infertility criteria (12 months of unprotected intercourse, or 6 months if woman >35 years), counsel on maximizing fertility 3:

• Time intercourse to the 6-day fertile window ending on ovulation day 3
• Have vaginal intercourse every 1-2 days after menstrual period ends 3
• Consider ovulation prediction methods (kits, apps, cycle beads) 3