The decision to embark on growing a family is an exciting time in a woman’s life. I’m always thrilled when women come to see me to inquire about how to be proactive in preparing their bodies for a healthy pregnancy. In this article, I want to address a common question I receive: “what are the best foods to eat to support my fertility status and hormones?”

For many women, speaking to their family doctors often results in the following advice:

“take a prenatal multivitamin with folic acid” and “just start trying.” Understandably, women like you want more information to feel empowered in supporting your own health, as well as that of your partner’s and your future child. I love supporting women who have a thirst for information and Mother Nature’s wisdom!

To make matters slightly challenging, the available research to describe how or what to eat for fertility is vague, at best. I developed what I call “the Fertility Diet” based on the best available research and nutrient requirements for pregnancy, while also honouring the traditional Eastern medical wisdom. In this article, you’ll find guidelines on what to focus on eating, and what foods you should avoid.

If you have a specific diet, such as vegan or vegetarian, this information will be adjusted in upcoming articles. I also advise that women see their Naturopathic Physician for basic blood testing and health evaluation to better guide specific nutrient and dietary recommendations for their unique bodies.

The Fertility Diet: Foods to Focus on

Increase your intake of plant-focused whole foods. Eliminate or at least greatly reduce your intake of processed and packaged foods and replace them with whole foods. Focus on prioritizing more frequent plant-based meals by incorporating more beans, legumes, nuts and seeds into your dietary routine.

Greatly increase your intake of antioxidant rich, naturally colourful vegetables and fruits. For example, dark leafy green vegetables, veggies that are red, yellow or orange, or dark purple (such as berries). Be sure to get 8 servings of vegetables (and some fruits) per day.

Here are a few examples of ways to incorporate more vegetables into your routine:

• A daily “green smoothie” with 3 large handfuls of spinach or kale, a cup of frozen berries, and any other smoothie ingredients that inspire you
• Have your morning eggs sautéed with peppers and served on a bed of spinach
• Sautéed Swiss chard with garlic and onions to accompany your evening meals
• Chopped fresh vegetables with hummus as a quick and easy snack

Eat foods rich in folate. You’re likely already aware that you need to start taking folic acid if you’re planning on conceiving. Did you know that folic acid is the synthetic form of folate? Natural folate can be found in leafy green vegetables, citrus fruits, beans, broccoli, and bananas. Folic acid can be found in supplements, as well as some fortified foods such as bread, pasta, rice, and some breakfast cereals. It is difficult to get the recommended daily allowance (400mcg) through diet alone, therefore a prenatal multivitamin with folate is recommended for all women planning to conceive. Certain women need even higher doses of folic acid – speak your your ND or family doctor to see if you’re in this category.

Choose organic produce. “But does it REALLY matter if I eat organic??” as it turns out, yes it does. One study showed that both female and male agricultural workers who are regularly exposed to pesticides have higher rates of infertility (affecting women more than men). The EARTH study examined the association between sub-fertile couples attending a fertility clinic, their exposure to environmental chemicals, and pregnancy outcomes. It demonstrated that high pesticide residue fruit and vegetable intake was associated with lower total sperm and lower total morphologically normal sperm in men. I recommend reviewing the Environmental Working Group “Dirty Dozen” and buy those fruits and veggies organic; the Clean Fifteen” list, or any veggies and fruits you can peel, are okay to buy non-organic.

• Dirty Dozen (choose organic for the following): strawberries, spinach, kale, nectarines, apples, grapes, peaches, cherries, pears, tomatoes, celery, potatoes and hot peppers
• Clean Fifteen (safe to choose non-organic): avocados, sweet corn, pineapple, sweet peas, onion, papayas, eggplant, asparagus, kiwis, cabbage, cauliflower, cantaloupes, broccoli, mushroom, honeydew melons.

Get rid of BPA plastics and canned goods. The EARTH study found that among sub-fertile women attending the fertility clinic, those with higher blood levels of Bisphenol A (as well as phthalates – more on this in a future article) experienced decreased egg yields, decreased odds of implantation, decreased probability of pregnancy and live birth, and increased likelihood of pregnancy loss. Interestingly, women with higher dietary intake of folate and soy products had fewer of these negative effects, suggesting a possible protective mechanism from these foods/nutrients.

• BPA is found in the lining of canned goods, plastic, receipt paper, water bottles, and infant bottles. Switch your plastic storage containers to glass or metal, use a metal water bottle, choose dried or bottled goods rather than canned, and bypass your printed receipts where possible.

Increase your intake of healthy unsaturated fats. One study showed that the mono- and polyunsaturated fats in this category are associated with with better fertility outcomes in both men and women. Examples of these excellent healthy fats include:

• Extra-virgin olive oil, avocado, nuts (almonds, hazelnuts, pecans), pumpkin seeds and sesame seeds
• Sunflower oil, flaxseed oil, soybean, walnuts, whole flax seeds, and fish (I recommend wild-caught sources)

Choose healthy sources of saturated fat, in minimal to moderate amounts. Saturated fats include those found in whole milk, animal meat, cheese, coconut oil, and many commercially prepared baked goods. Studies show that diets that are high in saturated fats (i.e. high amounts of animal products) are associated with poor fertility outcomes in men and women, in addition to contributing to higher cholesterol levels. For this reason, focusing on more plant-based meals and healthy, unsaturated fats in beneficial for your fertility. However, bear in mind that cholesterol forms the backbone of the sex hormones estrogen and progesterone, so it isn’t all evil. Small amounts of meat, from grass-fed and pastured animals, are okay if you want to maintain an omnivore diet. Even better would be obtaining small amounts of saturated fat from coconut oil (which I recommend cooking with if you’re heating it on the stove top) and other coconut products.

Increase your intake of whole grains. Focus on wild rice, quinoa, rolled oats, buckwheat, rye and “squirrelly” whole grain bread. If you tolerate gluten, I recommend whole grain or sourdough. For certain women who want to conceive, I recommend gluten-free diets; more on this later.

Eliminate dairy – but if you really want it, choose full fat dairy. As mentioned previously, milk products contribute to increased dietary intake of saturated fat. Replacing it with organic soy milk, or other nut milk products, are great ways to tilt your fat intake in favour of healthy unsaturated sources. The research on the impact of dairy on fertility is limited, but the available data suggests that for those who do eat dairy, high-fat dairy is more fertility promoting than low-fat dairy. I also strongly recommend organically sourced dairy products.

Increase your intake of fish from wild-caught sources. Diets higher in omega 3 are associated with improved fertility for both men and women. Aim to have wild-caught salmon, mackerel, herring, trout, and sardines.

Focus on incorporating anti-inflammatory foods. These include cold water oily fish (herring, salmon, anchovies, sardines), walnuts, flax seeds, pumpkin seeds, olive oil, coconut oil, dark green veggies, cherries, blueberries, kale, broccoli, cabbage, turmeric, ginger, garlic, and green tea.

Bone broth. Marrow is a very powerful food to make you stronger and build your energy, according the Chinese medicine. Ideally use homemade broth and drink 1-2 cups per day, or incorporate bone broth into your soups and stews.

Eat like you live in the Mediterranean. The “Mediterranean style” diet consists of high amounts of vegetables, whole grains (as opposed to white refined flour), lots of cold-pressed olive oil, lots of legumes and beans, some poultry and eggs, and only a little red meat. It is low in dairy, and very low in sugar and processed foods.

The Fertility Diet: Foods to Reduce or Avoid

Decrease saturated fat intake. As discussed previously, high levels of these fats are associated with poorer fertility outcomes in both men and women. Reduce your intake of cheese, dairy products, meat products, processed baked goods, and fast food.

Reduce red meat. Preliminary data suggests that red meat may have an adverse effect on fertility. If you know you are iron deficient, ensure you are taking an iron supplement. If you’re not sure, ask your GP or your ND to test for this (iron deficiency can adversely affect ovulation and pregnancy, too, so a balance must be found for this nutrient).

Reduce sugar. Eliminate sodas, sources of added sugar, and decrease your intake of processed sugar, and rather opt for sweetener options such as maple syrup, whole fruits, and dates. A study showed that women who reported consuming 3 or more servings of soda per day had a 52% lower rate of pregnancy compared to women who did not drink any soda.

Eliminate refined white flour, processed and simple carbohydrates, such a baked goods, pasta, white bread, and white rice. Opt for whole grains instead. Diets low in whole grains are associated with poorer fertility outcomes.

Eliminate low fat dairy products. Low fat versions were associated with a higher risk of ovulation problems in women. Examples of low fat products include skim, 1%, 2%, low-fat yoghurt or cottage cheese. If you eat dairy, opt for the high-fat options such as full fat Greek yoghurt.

Eliminate artificial sweeteners. Use a little honey or maple syrup instead.

Eliminate trans fats. These are found in fast food, fried and processed, packaged foods. Health Canada has now banned the production of trans fats in processed and packaged goods due to their known adverse health effects (for everyone, not just women planning to conceive).

Eliminate high mercury containing fish. Examples include tuna, mackerel, swordfish, sea bass, shark, marlin, and barracuda.

Alcohol. The research on the effect of alcohol of fertility is conflicting. Greater than 2 drinks per day increases the risk of infertility, while less than 1 drink per day (i.e. one drink every other day, or less) appears to have a lower risk of infertility. I recommend that you limit alcohol while trying to conceive to 1-2 glasses of red wine to sip on while at social events, only.

Caffeine. Data on the effect of caffeine on fertility is conflicting. One study found that both men and women who had more that two servings of caffeinated beverages per day had an increased risk of miscarriage. Ideally, no caffeine is the best choice, but a single small cup of coffee in the morning is likely okay. Try gradually switching from caffeinated, to decaf (water-pressed decaf to avoid chemicals), to green tea (less caffeine than a cup of coffee), then to herbal teas only.

Tailoring your diet to your specific needs

The Fertility Diet described above is an excellent starting point for all women, but of course, each unique woman has specific dietary and nutrition needs. As a Naturopathic Physician, I examine my patient’s health history, menstrual cycle and do blood testing to better tailor nutrition recommendations for her specifically. Some examples of conditions or health histories that may require adjustments to the above diet include:

• Women with Polycystic Ovarian Syndrome (PCOS). This hormone imbalance affects blood sugar control in the body. It can also increase the likelihood of developing Gestational Diabetes during pregnancy. For this reason, I make specific recommendations for carbohydrate vs. fat/protein intake for women with PCOS. In addition, specific herbs and supplements can help to support blood sugar and improve fertility for these women (more on PCOS in this article).
• Women with hypothyroidism due to Hashimoto’s Thyroiditis. For these women, I strongly recommend a gluten-free diet.
  
• Women with celiac disease, inflammatory bowel disease, or Irritable Bowel Syndrome. If a woman has a digestive condition that may affect her ability to absorb nutrients, I provide additional guidance and recommendations to improve her digestive wellness (and therefore, her hormones and fertility).
• Women who are underweight (BMI <18.5) or body fat less than 22%. Low body weight can affect hormones and ovulation. I work with women in this category to make healthy supportive changes to their nutrition and lifestyle to support their fertility goals.
• Women who are vegetarian, vegan, have food sensitivities or have other dietary restrictions. Of course, we tailor your fertility diet to your specific needs and values.

I hope this article provides you with the information you’re seeking to empower you in your fertility journey! If you’d like to further discuss your personalized fertility diet and testing options, follow this link to book in for a 15 minute Meet and Greet or your Initial Naturopathic Consultation. Or, follow me on Instagram for more information about women’s health and hormones.

Yours in health,

Dr. Kathleen Mahannah ND

References:

Chiu et al. (2018) Association between pesticide residue intake from consumption of fruits and vegetables and pregnancy outcomes among women undergoing infertility treatment with assisted reproductive technology. JAMA Intern Med, (178)1:17-26.

Snijder, C.A., E. Te Velde, N. Roeleveld and A. Burdorf, 2012. Occupational exposure to chemical substances and time to pregnancy: A systematic review. Hum. Reprod., 18: 284-300.

Messerlian et al. (2018) The Environmental and Reproductive Health (EARTH) Study: a prospective preconception cohort. Human Reproduction Open 2018; 1-11.

Neelima Panth et al. (2018) The influence of diet on fertility and the implications for public health nutrition in the United States. Frontiers in Public Health, 6(211).