Infertility — can fasting help where medication has failed?

Aim of the study: There are conflicting results on the effect of diet on fertility. This study aimed to assess the effect of different dietary patterns on fertility outcomes in populations who conceive spontaneously and those requiring assisted reproductive technology (ART).

Results: Adherence to various healthy diets was associated with improved ART outcomes (the ProFertility diet and Dutch Dietary Guidelines) and natural conception outcomes (the Fertility diet). However, because the components of healthy diets varied, the results were not pooled. Studies showed preliminary evidence that dietary patterns or whole diets may improve pregnancy and live birth rates. However, because the literature is heterogeneous, it is currently unclear which dietary patterns are associated with improved fertility and ART outcomes.

Aim of the study: The Mediterranean diet (MD) is a dietary pattern with evidence of positive health impact, and some nutrients in this diet have already been researched for their effectiveness in fertility. However, there are still questions about whether high adherence to the MD could be a factor that contributes to positive fertility outcomes in infertile men and women.

Results: A total of 11 studies met the inclusion criteria (n = 13 157 women and 1338 men). Greater adherence to the MD was associated with live births (I2 = 83.16%; odds ratio [OR], 0.652; 95%CI, 0.408-3.194), pregnancy rate (I2 = 93.83%; OR, 1.192; 95%CI, 0.349-4.325), sperm concentration >15 × 106/mL (I2 = 32.97%; OR 2.862; 95%CI, 1.583-5.174), and sperm count > 39 × 106/mL (I2 = 48.1%; OR, 2.543; 95%CI, 1.319-4.904); however, the meta-analysis results were inconsistent. Current evidence on high adherence to the MD and fertility markers is insufficient to support clinical application, even though it indicates improved sperm parameters and a possibility of better pregnancy outcomes.

Aim of the study: Environmental pollution, sedentary lifestyles, and unhealthy dietary patterns have been hypothesized as the main modifiable factors of human semen quality decline. The study aimed to assess the associations between an a priori-defined Mediterranean diet (MedDiet) adherence and semen quality parameters or medically assisted reproductive (MAR) outcomes in males.

Results: Total MedDiet adherence showed a significant positive association with sperm count (24.37 M spz.; 1.30-47.44; I2 = 89%), total motility (8.81%; 2.26-15.37; I2 = 88%), progressive motility (7.49%; 1.47-13.50; I2 = 86%), and normal morphology (1.02%; 0.21-1.82; I2 = 77%). Evidence from 2 randomized clinical trials evaluating the effect of MedDiet on semen parameters is consistent with the primary results. Evidence from observational studies and clinical trials suggests a potential benefit of adhering to a MedDiet for semen quality parameters, but not fertility outcomes. This study was registered at PROSPERO as CRD42024584003.

Aim of the study: Infertility is a global health concern affecting 48 million couples and 186 million individuals worldwide. Infertility creates a significant economic and social burden for couples who wish to conceive and has been associated with suboptimal lifestyle factors, including poor diet and physical inactivity.

Results: A key mechanism described in the literature concerns the adverse effects of inflammation on fertility, which may contribute to irregular menstrual cycles, implantation failure, and other negative reproductive outcomes. Therefore, dietary interventions that reduce inflammation may improve fertility outcomes. This review consistently shows that adherence to anti-inflammatory diets such as the Mediterranean diet (specifically, increased intake of monounsaturated and n-3 polyunsaturated fatty acids and flavonoids, and reduced intake of red and processed meat) improves fertility, assisted reproductive technology (ART) success, and sperm quality in men. Therefore, adding anti-inflammatory dietary patterns as low-risk complementary fertility treatments may partially or fully improve fertility and reduce the need for prolonged or intensive drug or surgical treatments.

Aim of the study: There is growing acceptance that nutrition may be related to fertility and specifically to assisted reproductive technologies success in women; however, there is still no specific dietary guidance. The objective of the study was to evaluate the relationship between pretreatment adherence to various dietary patterns and outcomes of assisted reproductive technologies.

Results: Higher adherence to the alternate Healthy Eating Index 2010 and Fertility Diet was not related to live birth following assisted reproductive technologies. Women in the second through the fourth quartiles of Mediterranean diet adherence had significantly higher probability of live birth (0.44, 95% confidence interval, 0.39-0.49) compared with women in the first quartile (0.31, 95% confidence interval, 0.25-0.39); however, there was no additional benefit of adherence to the Mediterranean diet above the second quartile. Increased adherence to the profertility diet was linearly associated with assisted reproductive technologies outcomes. The adjusted odds (95% confidence interval) of implantation, clinical pregnancy, and live birth were higher by 47% (21%, 77%), 43% (19%, 72%), and 53% (26%, 85%), respectively, per SD increase.

Aim of the study: Nutrition during the reproductive years shapes women's immediate health, fertility, pregnancy outcomes, and long-term offspring well-being. This position paper narratively synthesizes and critically appraises evidence on how dietary patterns, macro-/micronutrients, and supplementation influence women's health, female fertility, and reproductive outcomes, to inform practical recommendations.

Results: Balanced, diverse diets rich in whole and minimally processed foods support hormonal regulation, ovulatory function, healthy gestation, and chronic-disease risk reduction. Priority nutrients include iron, folate, calcium, vitamin D, zinc, vitamin B12, and long-chain omega-3s (DHA), with supplementation considered when dietary intake or bioavailability is inadequate. Evidence consistently links Mediterranean-style eating to improved metabolic health, insulin sensitivity, IVF success, lower gestational diabetes risk, and favorable neonatal outcomes. High UPF consumption is associated with poorer diet quality, inflammation, adverse pregnancy outcomes, and potential reproductive impairment, warranting a reduction in favor of nutrient-dense foods.

Aim of the study: Infertility is a major clinical problem that affects people psychologically and medically. For the past 40 years, studies have linked nearly 50% of childlessness to male infertility. It is worth noting that unlike other factors contributing to infertility, diet is a tunable factor and can be applied in counseling infertile men.

Results: Results of this study stated that greater adherence to the healthful plant-based diet index (hPDI), can significantly increase sperm density and motility in men, as well as greater adherence to the PDI dietary pattern is related to a lower risk of sperm volume deficiency, and ultimately more adherence to the unhealthful plant-based diet index (uPDI), can reduce the risk of sperm motility. In this study, for the first time, the relationship between PDI, hPDI, uPDI and male infertility was evaluated. Altogether, this study demonstrated that nutrition has an impact on semen quality and fertility of men.

Aim of the study: Azoospermia, defined as the absence of spermatozoa in the ejaculate, is a severe form of male infertility, and the potential effects of intensive lifestyle modification on sperm production remain uncertain.

Results: Complete etiologic assessment, genetic testing, objective adherence measures, and uniform documentation of semen-analysis methods were not available for all participants. This uncontrolled case series documents a clinically notable temporal association between initiation of an intensive lifestyle programme and subsequent detection of spermatozoa in men with previously reported azoospermia. Causality cannot be established, and the individual contributions of diet and other programme components remain uncertain. Prospective controlled studies using standardized andrologic assessment, comprehensive etiologic investigation, objective adherence measures, and prespecified reproductive outcomes are warranted.

Aim of the study: The relationship between dietary patterns aligned with the EAT-Lancet reference diet, which promotes both human and planetary health, and female infertility remains unexplored. This study aimed to investigate the association between adherence to the plant-based diet index (PHDI) and infertility among United States women of reproductive age.

Results: These associations persisted after adjustment for age, ethnicity, poverty income ratio, marital status, smoking status, alcohol use, body mass index, secondhand smoke exposure, hypertension, and total physical activity (MET/week). Sensitivity analyses, including models incorporating survey sample weights, and stratified analyses by age and body mass index, yielded consistent results. Greater adherence to the planetary health diet (higher PHDI) was associated with lower odds of self-reported infertility in this nationally representative sample of United States women. Given the cross-sectional design, causality cannot be established; however, the results underscore diet quality as a potentially important factor in self-reported infertility.

Aim of the study: Lifestyle Medicine leverages evidence-based health behaviors: nutrition, physical activity, restorative sleep, stress management, social connection, and avoidance of risky substances to prevent, treat, and often reverse chronic disease. Nutrition is underutilized in routine care.

Results: Some patients can benefit from protein intakes above the Recommended Daily Allowance (RDA) of 0.8g/kg/day for adults in a variety of settings. Well-planned plant-based diets can achieve significantly higher levels of protein intake, achieved through diverse sources such as legumes, soy, grains, nuts, and seeds. Adequate and well-distributed protein supports fertility, fetal growth, lactation, and preservation of lean mass through perimenopause and aging. Implementing WFPDs with individualized protein guidance can extend health span, enhance functional independence, and reduce medication dependence, reaffirming wholesome food as a cornerstone of modern medicine.