There’s a bunch of fertility diet advice on the internet, but most of the advice has no evidence to support it. Most claims have not been tried and tested. Or, it’s general nutritional advice, not tailored for fertility.
And fertility advice is not a one size fits all approach. Shouldn’t be anyway. Some women’s fertility issues are related to their lining, some to their hormones, some to their eggs. And 50% of the time, it’s a male fertility issue.¹
The dietary recommendations below are to help improve a woman’s hormonal balance, egg quality and reduce miscarriage risk.
High blood sugar and insulin levels are a big problem for fertility because it disrupts the balance of other hormones that regulate the reproductive system. They also compromise egg quality². And increase the risk of miscarriage³.
The first step is to slightly reduce overall carbohydrate intake. And increase protein intake. A good ratio appears to be around 40% of calories from carbohydrates, 30% from protein, and 30% from fat. This represents a healthy, balanced diet and most people will be able to reach these ratios simply by changing just one meal per day. Such as having eggs for breakfast, rather than toast or cereal.
An even lower carbohydrate diet is likely helpful for those who are very overweight, or have PCOS, insulin resistance, or diabetes. For most women though, it is probably not beneficial to adopt a very low carbohydrate diet. In some cases, it may even have negative consequences for fertility, by elevating cortisol levels, and suppressing thyroid function. 4
Avoid refined carbohydrates: the white flours, pastries, potatoes, white bread. Swap out for lower GI carbs such as brown rice, wild rice, steel-cut oats, quinoa or buckwheat. There are many pastas available these days made out of quinoa or buckwheat. This will help to balance your blood sugar and insulin levels.
Avoid refined cane sugar, in all it’s forms. There is clear evidence that excess sugar consumption compromises fertility.5 Minimise all types of sweeteners, and foods with significant amounts of added sugar. Whole fruit is OK in moderation (2 serves daily). If you find yourself craving a sweet treat, and fruit won’t cut it, a small amount of dark chocolate is a good choice. Also keep in mind that it is long term daily habits that matter most. The occasional indulgence is not worth feeling guilty about.
Have lots of different vegetables. Aim for 4 different colours each day.
Eats nuts and seeds
Include olive oil in your diet
Eat fish twice per week
Avoid saturated fats – typically found in butter, red meat, coconut oil. Appear to negatively impact egg development. A higher intake of red meat has been associated with lower embryo quality.
What about gluten and dairy?
There is some concern that both gluten and dairy can contribute to autoimmunity and inflammation in those with a sensitivity, even in the absence of celiac disease. For those with endometriosis, a history of recurrent miscarriage driven by immune factors, it does make sense to avoid gluten and diary. For everyone else, these foods may not be problematic. One option is to eliminate them from your diet for 2 weeks, and see how you feel. If you feel better, it may indicate that you do have a sensitivity and will benefit from avoiding gluten and/or dairy longer term.
What about alcohol?
Numerous studies have indicated that drinking regularly during pregnancy can increase the risk of miscarriage. However, low to moderate alcohol consumption ( 6 drinks per week or less) before you become pregnant is not an issue. The safest option is avoiding alcohol after ovulation, in case you become early pregnant without realising, or before testing.
What about caffeine?
Unfortunately, caffeine can increase miscarriage risk. Even caffeine intake before pregnancy. Studies indicate that miscarriage risk begins to rise with just one cup of tea or less than half a cup of coffee per day.
I appreciate that this advice could be alarming for some of you. It could suggest that a big diet overall is needed. If so, I suggest you start at the top of the list, and slowly make your way through, once you’ve got a handle on each. A more tailored dietary approach is often useful, taking into account your history, your microbiome and your genetics. So it’s best to ask your practitioner at Freedom Chinese Medicine for specific advice or to help guide you through any changes needed. Most of us have nutritional training and have lots of experience with healthy diets.
Dr Elaine Hickman
B.H.Sc.TCM (Acupuncture), Cert.Cl.Ac. (Beijing)
Elaine has trained and worked in various settings, both in Australia and China. She has over 20 years experience in treating many health problems. Elaine loves to provide a health care experience for people that is respectful, effective, empowering and enjoyable. Elaine’s acupuncture treatments are gentle, powerful, amazingly relaxing and incorporate Japanese & Chinese techniques, as well as Medical Qi Gong if appropriate. Elaine has a particular interest in Gynaecology, Fertility, Obstetrics, Family Medicine, Wellness promotion and Mental Health. She brings extra expertise and understanding to the table as she’s been through infertility herself.
1 Esteves SC, Agarwal A. Novel concepts in male infertility. Int Braz J Urol. 2011 Jan-Feb;37(1):5-15. doi: 10.1590/s1677-55382011000100002. PMID: 21385475.
2 Jinno M, Takeuchi M, Watanabe A, Teruya K, Hirohama J, Eguchi N, Miyazaki A. Advanced glycation end-products accumulation compromises embryonic development and achievement of pregnancy by assisted reproductive technology. Hum Reprod. 2011 Mar;26(3):604-10. doi: 10.1093/humrep/deq388. Epub 2011 Jan 12. PMID: 21233108.
3 Tian L, Shen H, Lu Q, Norman RJ, Wang J. Insulin resistance increases the risk of spontaneous abortion after assisted reproduction technology treatment. J Clin Endocrinol Metab. 2007 Apr;92(4):1430-3. doi: 10.1210/jc.2006-1123. Epub 2007 Jan 23. PMID: 17244790.
4 Kose E, Guzel O, Demir K, Arslan N. Changes of thyroid hormonal status in patients receiving ketogenic diet due to intractable epilepsy. J Pediatr Endocrinol Metab. 2017 Apr 1;30(4):411-416. doi: 10.1515/jpem-2016-0281. PMID: 28076316.
5 Machtinger R, Gaskins AJ, Mansur A, Adir M, Racowsky C, Baccarelli AA, Hauser R, Chavarro JE. Association between preconception maternal beverage intake and in vitro fertilization outcomes. Fertil Steril. 2017 Dec;108(6):1026-1033. doi: 10.1016/j.fertnstert.2017.09.007. Epub 2017 Oct 3. PMID: 28985907; PMCID: PMC5716855.
Hjollund NH, Jensen TK, Bonde JP, Henriksen TB, Andersson AM, Skakkebaek NE. Is glycosylated haemoglobin a marker of fertility? A follow-up study of first-pregnancy planners. Hum Reprod. 1999 Jun;14(6):1478-82. doi: 10.1093/humrep/14.6.1478. PMID: 10357963.
Chavarro JE, Rich-Edwards JW, Rosner BA, Willett WC. A prospective study of dietary carbohydrate quantity and quality in relation to risk of ovulatory infertility. Eur J Clin Nutr. 2009 Jan;63(1):78-86. doi: 10.1038/sj.ejcn.1602904. Epub 2007 Sep 19. PMID: 17882137; PMCID: PMC3066074.
Karayiannis D, Kontogianni MD, Mendorou C, Mastrominas M, Yiannakouris N. Adherence to the Mediterranean diet and IVF success rate among non-obese women attempting fertility. Hum Reprod. 2018 Mar 1;33(3):494-502. doi: 10.1093/humrep/dey003. PMID: 29390148.
Mirabi P, Chaichi MJ, Esmaeilzadeh S, et al. The role of fatty acids on ICSI outcomes: a prospective cohort study. Lipids Health Dis. 2017;16(1):18. Published 2017 Jan 21. doi:10.1186/s12944-016-0396-z
Moran LJ, Tsagareli V, Noakes M, Norman R. Altered Preconception Fatty Acid Intake Is Associated with Improved Pregnancy Rates in Overweight and Obese Women Undertaking in Vitro Fertilisation. Nutrients. 2016 Jan 4;8(1):10. doi: 10.3390/nu8010010. PMID: 26742065; PMCID: PMC4728624.
Chen LW, Wu Y, Neelakantan N, Chong MF, Pan A, van Dam RM. Maternal caffeine intake during pregnancy and risk of pregnancy loss: a categorical and dose-response meta-analysis of prospective studies. Public Health Nutr. 2016 May;19(7):1233-44. doi: 10.1017/S1368980015002463. Epub 2015 Sep 2. PMID: 26329421.
Huang H, Hansen KR, Factor-Litvak P, Carson SA, Guzick DS, Santoro N, Diamond MP, Eisenberg E, Zhang H; National Institute of Child Health and Human Development Cooperative Reproductive Medicine Network. Predictors of pregnancy and live birth after insemination in couples with unexplained or male-factor infertility. Fertil Steril. 2012 Apr;97(4):959-67. doi: 10.1016/j.fertnstert.2012.01.090. Epub 2012 Jan 23. PMID: 22270557; PMCID: PMC3319287.