This article highlights the critical role of nutrition in enhancing fertility for both men and women, emphasising plant-based, low-GI diets rich in antioxidants, essential nutrients, and healthy fats.

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Infertility is an illness that affects 20-30% of the world's reproductive-age women. However, in up to 50% of recorded cases, problems with infertility are ascribed to men; therefore, it is important to popularise healthy eating also in this group.

During the last decade, society's lifestyle has changed dramatically: reduced energy expenditure in physical activity per day, increased consumption of hypercaloric and high-glycemic-index foods with high trans fat content, and decreased consumption of dietary fibre, all of which hurt fertility. Growing data suggests a link between food and fertility.

It is becoming clear that well-planned nutrition can also contribute to the effectiveness of ART. The low-GI plant-based diet appears to have a positive effect, especially when it is based on Mediterranean dietary patterns: rich in antioxidants, vegetable protein, fibre, MUFA fatty acids, omega-3, vitamins, and minerals.

Importantly, this diet has been demonstrated to protect against chronic diseases linked to oxidative stress, which also correlates with pregnancy success. Because lifestyle and nutrition appear to be major variables influencing fertility, it is worthwhile to educate couples who are attempting to have a child about these topics.

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Common causes of infertility in men and women

Men

• Low sperm count
• Poor sperm motility or morphology
• Testosterone deficiency
• Varicocele (enlarged veins in the scrotum)
• Hormonal imbalances (e.g., low FSH, LH, or testosterone)
• Blockages in the reproductive tract
• Exposure to environmental toxins (e.g., pesticides, heavy metals)
• Lifestyle factors (e.g., smoking, alcohol consumption, drug use)

Women

• Hormonal imbalances (e.g., low estrogen, progesterone, or high FSH)
• Polycystic Ovarian Syndrome (PCOS)
• Endometriosis
• Anovulation (failure to release eggs)
• Blocked fallopian tubes
• Uterine fibroids or abnormalities
• Thyroid dysfunction (hypothyroidism, hyperthyroidism)
• Autoimmune conditions (e.g., Hashimoto’s thyroiditis)
• Lifestyle factors (e.g., stress, poor diet, smoking)

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Common symptoms of infertility

• Irregular menstrual cycles (women)
• Absence of periods (amenorrhea) or very painful periods (dysmenorrhea)
• Low libido or sexual dysfunction (men and women)
• Difficulty achieving or maintaining an erection (men)
• Unexplained weight gain or loss
• Acne or excessive hair growth (women)
• Fatigue, low energy, and mood changes
• Difficulty conceiving after 12 months of unprotected sex (or 6 months if over 35)

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Interventions to address infertility

1. Personalised nutrition plan: Focuses on nutrient-dense, whole foods that support reproductive health. Nutritional plans can help regulate hormones, improve egg and sperm quality, and reduce inflammation. Specific nutrients like folate, zinc, and omega-3 fatty acids are essential for fertility.
2. Hormonal balancing: For both men and women, addressing hormonal imbalances such as low testosterone, high estrogen, or irregular thyroid function is key to improving fertility outcomes.
3. Stress management techniques: Chronic stress is a significant factor in infertility, disrupting hormones and reproductive function. Practices such as yoga, mindfulness, and meditation can help manage stress and improve fertility.
4. Herbal and botanical therapies: Herbs like maca, ashwagandha, vitex (chasteberry), and shatavari help support hormonal balance, improve reproductive health, and enhance fertility in both men and women.
5. Functional medicine testing: Comprehensive fertility assessments include hormone panels, genetic testing, and analysis of sperm quality for men. Women may undergo ovarian reserve testing (AMH, FSH) and assessments for ovulatory function and uterine health.
6. Mind-body therapies: Acupuncture, biofeedback, and fertility-specific cognitive-behavioural therapy (CBT) address both the physical and emotional aspects of infertility, enhancing overall well-being and improving the chances of conception.

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Nutrition plays an important role in fertility, and a healthy diet can improve reproductive health. Some nutrients that are important for fertility include:

• Zinc

Helps with egg fertilisation and development, and sperm quality. Low zinc levels can lead to low sperm quality and a longer time to conception in women.

• Omega-3 fatty acids

Improves sperm quality, count, and motility. It can be found in fatty fish like salmon, mackerel, and sardines, and in nuts and seeds like walnuts, flax seeds, and chia seeds.

• Vitamin D

It's also known as the "sunshine vitamin" and is essential for conception. It improves ovulation, hormonal balance, and insulin resistance.

• Antioxidants

Can increase sperm count and seminal volume. They help protect sperm from free radicals, which can damage sperm and increase DNA fragmentation.

• Folate

Helps with red blood cell production and function, which is important for sperm replication. It's found in dark leafy vegetables, fruit, and whole grains.

• Folic acid

Important for women attempting to conceive to avoid neural tube abnormalities.

• Vitamin C

1. Improves sperm quality and ejaculate volume. It can be found in papaya, peppers, broccoli, strawberries, pineapple, kale, cauliflower, and cabbage.
2. A healthy dietary pattern, like the Mediterranean diet, can also support fertility. Reducing processed foods in your diet can also help.

Sources: Lean meats, spinach, legumes, and fortified grains. Zinc helps male fertility by promoting healthy sperm production and motility. Zinc is essential in women for hormone balance and egg quality. Zinc insufficiency can result in lower fertility in both genders.

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How does nutrition affect the fertility of both men and women?

Nutrition can have a negative or positive effect on fertility in both men and women, and the impact is determined by both quantitative and qualitative diet properties, such as the caloric content of each macronutrient (carbohydrates, fat, and protein), as well as the specific acid profiles of fats and proteins. Diets low in protein, vitamins, and minerals impair ovarian function. Nutrients are necessary for eggs and sperm to mature and join properly.

Considering these facts, a diet based on plants with a low glycemic index has great potential for reproductive health for both men and women. However, its components and sources of individual micro- and macro elements are important because they determine the influence of the diet on fertility.

Fast food can be vegan, but as everyone knows, it has a bad impact on reproduction. The quality of plant-based diets is also crucial. On the one hand, a plant-based diet may aid in weight loss in those suffering from fertility difficulties. On the other hand, in women with low body weight, a poorly planned iron-deficient diet may have a detrimental impact on ovulation. As a result, it is critical to identify the specific components of plant-based diets that promote fertility.

An unhealthy hypercaloric diet, excessive consumption of saturated and trans-fatty acids, a high glycaemic index, and a low nutrient density have been proven to enhance oxidative stress, which produces carbohydrate disruption. Insulin resistance and diabetes mellitus are linked to worsening of fertility in both men and women, owing to the formation of excessive oxidative stress, which is the primary cause of infertility and hormonal abnormalities.

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Antioxidants from supplements and diet

1. Men with reduced fertility have been found to have lower levels of antioxidants in their sperm than fertile guys. In such cases, dietary antioxidant supplementation may increase sperm concentration and motility, as well as the impact on DNA fragmentation and even pregnancy rates. Several studies have found that eating more antioxidant-rich fruits and vegetables is connected with a larger percentage of motile sperm in both fertile and infertile males.
2. Vegetables and fruits are the foundation of healthy nutrition patterns that enhance the quality and fertility of sperm. There are currently no well-planned studies on men that investigate the effect of antioxidant supplements on good pregnancy outcomes. However, according to seven randomised studies, such supplementation in infertile males may improve fertility.
3. Zinc is an important dietary component for male fertility since an acceptable level of it in semen is required for proper steroidogenesis and testicular growth, as well as sperm generation, normal function, morphology, and cell count. Finally, it is required for the appropriate course of fertilisation. This is due to its high antioxidant impact; an adequate level of zinc in semen plasma provides protection. 
4. On the other hand, supplementation with folic acid and zinc by males seeking therapy with their partner at an infertility clinic did not result in a significant improvement in semen quality when compared to a placebo. These findings do not support the use of these substances by male partners in the treatment of infertility.
5. Selenium also appears to be crucial. Several studies have reported lower amounts of selenium in the sperm of infertile males than in the healthy population. It is worth noting that both selenium deficit and excess can cause aberrant sperm parameters and reproductive issues.  Selenium enhances sperm motility and vitality, increasing the likelihood of conception, while also protecting sperm DNA from oxidative damage.
6. Furthermore, vitamin C and tocopherol have strong antioxidant properties, therefore a FAV-rich diet is essential. Lycopene, a potent antioxidant that decreases oxidative stress-induced DNA damage while simultaneously increasing sperm count and survival, appears to have a promising effect.
7. Reduced consumption of animal proteins on a vegan diet can lead to vitamin B12, zinc, calcium, and selenium deficiencies, which can have a severe impact on reproductive health. It has also been demonstrated that plant-based diets lack vitamin D, iodine, and iron. As a result, supplements may be required in certain situations.

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Carbohydrates and a diet with a low glycemic index and load

1. When describing a fertility-promoting eating pattern, both insulin sensitivity and glucose metabolism should be considered, since both can have a substantial impact on male and female fertility.
2. When discussing carbs, the glycaemic index and load are very important. Consuming foods with a high glycaemic index and meals with a high glycaemic load has been proven to raise the risk of metabolic problems such as insulin resistance, diabetes, dyslipidaemia, and oxidative stress, all of which have a negative impact on fertility and reproductive function.
3. In the case of men, however, a high glycaemic index diet may indirectly contribute to fertility difficulties, primarily due to the development of oxidative stress, which is regarded as one of the primary causes contributing to poor sperm quality and an increased risk of infertility. Hyperglycemia reduces sperm motility and may raise the risk of hormonal and immunological diseases. Furthermore, obese men with insulin resistance and type 2 diabetes have been demonstrated to be significantly more prone to develop hypogonadism.
4. A study focused on the examination of 18,555 women who had no history of infertility. All of them planned or became pregnant during the trial, and the findings revealed that women in the top quintile of total carbohydrate consumption had a 78% higher probability of anovulatory infertility. The study's authors argue that the amount and quality of carbs in the diet may be important factors of ovulation and fertility in women.
5. Continuing on this theme, it has been demonstrated that a high glycaemic index diet with low dietary fibre content is closely associated with inflammation, which has a negative impact on both sexes' fertility. Furthermore, fructose is thought to have a substantial pro-inflammatory effect. 
6. Consumption of sweetened, carbonated beverages has also been shown to have a deleterious effect on fertility, perhaps reducing the chances of reproductive success with ART. Furthermore, the use of sugar-sweetened beverages was associated with poorer sperm motility in healthy young males. It has also been proven that eating more fruits and vegetables improves sperm parameters.
7. In a prospective cohort study of 3628 women wanting to conceive, women who reported drinking three or more soda beverages per day had a 52% lower pregnancy rate than women who reported no soda use. Interestingly, there was no link between coffee consumption and fertility. In this context, the findings indicate that sugar consumption has a negative impact on female fertility. Furthermore, there is evidence that excessive sugar consumption is connected with poor sperm quality and increased male infertility.
8. Dietary fibre intake in excess of the recommended amount has been linked to an increased risk of anovulation. It has been proposed that this is related to decreased hormone concentrations as a result of excessive fibre consumption, particularly the water-soluble component. Each 5 g/d increase in total fibre consumption was linked to a 1.78-fold increase in the likelihood of anovulatory cycle. It has also been discovered that infertile women eat too few high-fiber foods, such as FAVs.
9. Based on the research, it is also vital to stress the role of fibre in the context of male fertility; a sufficient quantity, together with a healthy diet, is required to maintain reproductive function. The beneficial mechanism of action is most likely also dependent on the binding of unconjugated oestrogens, which is directly associated to a decrease in oestrogen levels in the plasma. On the other hand, a high-fibre diet may have a good influence on reproduction since it lowers blood glucose levels, which is connected with a reduced dietary glycemic load and index.

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Plant and animal protein

In contrast, the literature has contradicting reports on the effects of a high-protein diet. Furthermore, increased protein consumption may result in a proper carbohydrate-insulin balance, which may be significant in the treatment of anovulatory infertility in women.

It was shown that protein consumption, particularly animal protein, was adversely linked with testosterone concentration in healthy women, implying that androgens play a critical role in the regulation of ovarian function and consequently female fertility. Furthermore, excessive androgen signalling appears to be a crucial role in androgen-related reproductive diseases, as it disrupts the pathways that regulate ovarian follicle dynamics. Interestingly, protein intake had no effect on oestradiol, progesterone, LH (luteinising hormone), or FSH (follicle-stimulating hormone) levels.

This study also found no link between total, vegetable, and animal protein diet (excluding dairy protein) and the number of antral follicles in women with infertility. On the other side, excessive protein intake from dairy products resulted in fewer antral follicles, a biomarker that predicts the number of primary ovarian follicles.

Summing up, based on the research carried out, it can be speculated that a higher proportion of plant protein than animal protein is more favourable in terms of fertility.

Fats

Saturated and trans fatty acids (TFAs) have been shown to have a particularly deleterious influence on ovulation. It was also discovered that women with PCOS ate more animal fat and saturated fat, which had a negative impact.

Avocados are an important part of the reproductive diet because they contain significantly higher amounts of the vital minerals folate and potassium, which are typically underutilised in a mother's diet. Avocados, while not part of a "traditional" Mediterranean-style diet, meet the requirements for antioxidant- and fibre-rich fruits and contain a fatty-acid profile that is naturally high in monounsaturated fats (MUFAs), which have been associated with better pregnancy outcomes. MUFAs can bind to the PPAR-γ receptor, decreasing inflammation and promoting fertility.

Walnuts have a good influence on fertility due to their omega-3 concentration. Consuming 75 grammes of walnuts each day for 12 weeks was connected with increased sperm viability, motility, and morphology. Interestingly, according to another study, adding 60 g of a nut mix to the Western diet improved the above-mentioned metrics while also increasing the number of sperm.

Interestingly, low-fat dairy products, particularly low-fat milk, were related to increased sperm concentration, while cheese consumption was associated with decreased sperm concentration, but only among former or current smokers. Furthermore, fish consumption was associated with total sperm count and shape.

Overall, diets high in monounsaturated and polyunsaturated fatty acids appear to improve fertility, in contrast to diets heavy in trans fats and saturated fats. A plant-based diet should include fewer processed foods, sweets, and fast food.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article:  Pallavi Dubey has done a Master's in Clinical Nutrition & Dietetics, currently working as a Senior Clinical Nutritionist at Recoup Health, Bangalore.