As infertility rates rise, it’s becoming more common to eat for fertility. Experts weigh in on the effectiveness of these sometimes extreme regimens.

By Julia Malacoff
Updated Jan 22, 2020 @ 2:15 pm
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When you’re trying to get pregnant, any number of lifestyle factors can impact your chances: smoking status, exercise habits, sleep, stress, and importantly, diet.

But these factors weren’t always such a big part part of the equation when it came to “trying.”

“In the last 10 years, there has been a bigger focus on the importance of diet and lifestyle in relationship to fertility,” notes Alissia Zenhausern, a licensed naturopathic medical doctor. That’s mainly because doctors and researchers weren’t convinced by the amount of evidence available for diet’s impact on fertility.

But recently, the evidence has grown stronger: “To many researchers’ surprise, diet has not only improved general wellness but specifically improved fertility and even improved the success rates of medically-assisted fertility treatments, like IVF,” Dr. Zenhausern says. ”This has been a game changer for both couples wanting to start a family as well as fertility doctors.”

But it’s not just those seeking fertility treatments who are interested in changing the way they eat in order to get pregnant. Dr. Zenhausern says that in the last few years, she’s seen an increase in women coming to her office for preconception counseling, a service that helps them understand and work on any issues they might be having around hormonal imbalances, nutrient deficiencies, diet, and lifestyle before they start trying to get pregnant.

That was exactly what Britt Duffy Adkins, 29, was looking for when she visited a naturopathic doctor in addition to her ob-gyn before trying to conceive. Adkins had a miscarriage previously, and wanted to do everything in her power to improve her chances of having a healthy pregnancy. “I did a three-month prep period before conceiving. The diet was no sugar, grain-free, high-fat, and no caffeine, plus I took herbal supplements,” she says.

Adkins ended up with twins, which she jokingly attributes to her fertility regimen since they don’t run in her or her husband’s families. “Whether the lifestyle changes were actually the cause of a successful twin pregnancy or not, I certainly benefited from feeling like I took positive action where I could,” she says.

Experts in the fertility space think the interest in changing your diet in order to get pregnant makes a lot of sense. “I think we all know that our way of life in general isn't healthy,” explains Amy Klein, author of The Trying Game: Get Through Fertility Treatment and Get Pregnant Without Losing Your Mind. Think: our high-stress, always busy, processed-food-filled lives. “At the same time, we've seen a steady rise in infertility. "Whether that's related to our lifestyle and diet, or more awareness, or people in general having children later in life — well, we don't know.”

Of course, there are medical treatment options out there for dealing with infertility. “But also keep in mind that fertility treatment is very expensive, time consuming, and difficult, putting all those hormones in your body,” Klein points out. That may be part of the reason why eating for fertility has become so commonplace. “If you can do it in a more natural way, or help the process go faster by doing something within your control, then that's really appealing.”

But what exactly does it mean to eat for fertility? And most importantly, does it work? Here, fertility doctors and nutrition pros explain.

What is the fertility diet?

There are several different diets that various practitioners use for fertility. “In simple terms, a fertility diet adds in more nutrition and more balanced meals and snacks into someone’s lifestyle,” explains Tracy Lockwood Beckerman, a registered dietitian and author of the best-seller, The Better Period Food Solution. While some experts advocate for more specific approaches, like the ketogenic diet or going gluten-/dairy-free, most fertility diets look pretty similar: they’re high in healthy fats, colorful fruits and vegetables, nuts, beans and lentils, lean protein, and whole grains.

If you’re familiar with popular diets, this may sound familiar: “The scientific data suggests that a diet similar to the Mediterranean diet may have a beneficial impact on fertility,” says Rashmi Kudesia, M.D., reproductive endocrinologist and infertility specialist at CCRM Houston.

“The term "fertility diet" originated from a large study in 2007 conducted by Harvard researchers that looked at the diets of over 17,000 women trying to conceive,” says Sarah Rueven, a registered dietitian and owner of Rooted Wellness. The study found that consuming a high-quality diet could increase chances of fertility.

Researchers observed that women who ate more monounsaturated fat (and less trans fat), more plant-based protein (and less animal based protein), more complex carbohydrates like whole grains (and less processed carbohydrates), more high-fat dairy (in place of low-fat dairy) had a 66% lower chance of infertility due to not ovulating, also known as anovulatory infertility, Reuven says.

And so, the “fertility diet” was born.

Does the fertility diet work?

It depends who you ask.

The problem with the research mentioned above is that there are many different causes of infertility, and this study mainly looked at anovulatory infertility, which has caused some to criticize the entire premise of a fertility diet. Women can struggle to conceive for a host of reasons including PCOS, endometriosis, issues with egg quality, thyroid problems, and more. But the study did have some findings relevant to all women: It showed a 27% reduced risk of infertility due to other causes when eating a diet similar to the “fertility diet.” Plus, newer data does support a potential impact for all women trying to conceive, Dr. Kudesia says.

But that doesn’t mean the same diet will work for everyone, or that there’s one diet that’s better than the rest. “I think it is really important for women to know that there is little scientific evidence that any one particular food, diet, herb, or supplement will significantly improve fertility in healthy, ovulatory women,” says Temeka K. Zore, M.D., a reproductive endocrinologist at RMA Network in Southern California.

“That said, there is good data to support dietary changes for women who are significantly underweight or overweight or who may have decreased fertility rates, so we advise women to maintain a healthy weight through healthy eating and a regular exercise routine,” Dr. Zore says.

Women with conditions like PCOS and endometriosis may also benefit from changing how they eat, she adds. “The high androgen (male hormone) and insulin levels seen in women with PCOS may also have a harmful impact on egg quality. Therefore, women with PCOS are encouraged to consume foods that are high in fiber and antioxidant rich, and limit processed foods or those with added sugars. In addition to decreasing blood sugar and improving insulin sensitivity, these diet changes may help with weight loss, which can subsequently improve the chance a woman with PCOS ovulates.”

In the case of endometriosis, the exact cause is unknown, but it’s thought to be related to inflammation. ”Therefore, women with endometriosis may see a benefit in their symptoms by choosing antioxidant rich foods, which may reduce inflammation, and avoiding foods that increase inflammation, such as processed foods or those with added sugar.”

And while the evidence might not be conclusive, many doctors do recommend some sort of fertility diet to their patients who are trying to conceive. The rationale is simple: “I can say with extreme confidence that unless someone goes too far and becomes overly restrictive with their dietary choices, an improved diet can only help — and will not hurt — fertility and overall health,” Dr. Kudesia says.

Diet can help, but other factors may matter more.

It’s important to note that a fertility diet can’t “cure” infertility. “It doesn’t take into account underlying medical or structural issues that can prevent someone from conceiving naturally such as anovulation, autoimmune disorders, STDs, endometriosis, amenorrhea or even genetic or chromosomal abnormalities,” Beckerman points out. “It also doesn’t address stress or anxiety levels which may overrule any positive changes that you are making with your diet.”

And for some women, the stress of making changes may actually make things worse. “When trying to get pregnant, I found myself focusing on every single thing I was putting in my body, every additional 1K mark I hit on my Fitbit, how meticulously I washed my face and the products I used, and how early I was getting into bed each night,” remembers Rachel S., a 31-year-old now pregnant with her first child. “I was obsessed with the idea that to get pregnant I had to make my body a temple. I was hyper-focused on eliminating alcohol and eating what I perceived to be super healthy, in addition to walking at least 20K steps a day. I had convinced myself that I was not in shape but had to ‘get in shape’ to get pregnant.”

It was only after five months of unsuccessfully trying to get pregnant that Rachel realized how much stress she had put herself under. She stopped her intense regime and — surprise — got pregnant. “I think taking a step back from all of the diet prescriptions I had imposed on myself, removing the arbitrary stress and pressures that came along with it, helped.”

Rachel’s approach is becoming more common. “Women, more than ever, are taking extreme measures to cut out entire food groups from their diet with hopes of being pregnant faster,” Beckerman says. However, research does not support the notions of removing dairy, sugar, or gluten from the diet in order to get pregnant, she adds.

The only reason to go gluten-free or dairy-free? “If someone is diagnosed with celiac disease or lactose intolerance or has been advised by their doctor who knows their medical and family history,” Beckerman says — otherwise you may actually be hindering your efforts.

“Cutting out food groups could create nutritional gaps like low vitamin D or low folic acid, both of which are influential in powering on reproductive hormones, achieving healthy egg development, and making new red blood cells,” Beckerman explains.

That said, although removing it completely may not be necessary, many physicians do recommend reducing added sugar in your diet when trying to become pregnant — which is a good idea even if conceiving isn't on your to-do list.

And then there are women who, after cutting certain food groups from their diet, discover an intolerance they had all along — which could impact fertility.

That was the case for Cris Pearlstein, after she went through a variety of unsuccessful fertility treatments. “Once a year passed with still not a positive pregnancy test to be seen, I knew I had to try something new, and that's when I started doing acupuncture,” she remembers.

“At my first appointment, my acupuncturist taught me about gut health and said I had to do everything possible to reduce any and all inflammation. He sent me home with pages and pages of reading materials and recommended I try a gluten-free diet.” Pearlstein quit eating gluten cold turkey that week and continued for the next 10 months while undergoing IVF treatment.

“I felt great, and when we finally got a positive pregnancy test in June of 2018, I felt even better knowing that my body was responding to me taking care of it,” she says. “I truly believe my diet (and acupuncture) is what enabled me to get pregnant. If we decide to try to get pregnant again I will 100% have the same strategy: a low-inflammation lifestyle, led by a gluten-free diet.”

How to eat for fertility

Ultimately, the eating style that works best for you will probably come down to what works for you individually rather than a generalized fertility diet. Still, there are some general guidelines that can help anyone interested in eating for fertility.

Choose supplements carefully. “Simply put, there is no one food or supplement, that will radically transform one’s [ability to conceive],” Dr. Kudesia says. While folic acid is a standard prenatal supplement recommendation, others may not be necessary. “It is important to understand that the FDA doesn't regulate supplements, and so all manufacturers are not the same. If someone is thinking of taking a supplement, they should speak with their physician and investigate reputable sources before buying.”

Make one change at a time. “When trying to get pregnant, I always recommend that a client make one or two lifestyle changes for two to three months so they have few opportunities to conceive,” Beckerman says. “That way, they can see the impact (if any) it has.”

Look at the big picture. “Nutrition is just one piece of the fertility puzzle, so don’t put all your eggs in one basket when it comes to fertility,” Beckerman advises. “Focus and engage in other forms of treatment that can also help with fertility like physical activity, stress reduction, proper sleep hygiene, self care, and participating in positive and uplifting hobbies that put you in a good mood.”