Eating a Mediterranean diet and fertility

Whilst a lot of the time, we talk about specific nutrients that are important for fertility, there is no one nutrient that is going to help you get pregnant in isolation. In fact, it’s about your diet and lifestyle as a whole, so no, eating that cupcake isn’t going to stop you getting pregnant!

One dietary pattern that has good evidence about supporting fertility is the Mediterranean diet. And for good reason, with its anti-inflammatory properties, and lifestyle principles. So let’s take a deep dive into what, why, and how!

What is the Mediterranean diet?

The Mediterranean diet is a way of eating that mimics the way people living in the Mediterranean, including Greece, Italy, and Spain, traditionally eat and live. The reason these peoples have a diet, or way of eating, named after them is due to research finding that it has many positive health benefits, as well as being gentler on the environment.

It goes deeper than the food you eat, with key lifestyle principles incorporated into the dietary pattern:

• Active lifestyle: This is more focussed on getting movement into everyday life, including walking to work, doing physical household chores, and of course dancing!

• Social meals: The people of the Mediterranean love to share meals with friends and family, improving the sense of connection, as well as reducing stress levels.

• Eating slowly with minimal distractions: by eating with others, you are more likely to engage in conversations, and therefore, eat slower and remove distractions like TV and/or phones, improving digestion and appetite regulation.

Now onto the food! A Mediterranean diet is based on:

Eating these foods every day

• Vegetables

• Legumes

• Fruit

• Nuts and seeds

• Wholegrain breads and cereals

• Extra virgin olive oil

• Herbs and spices

Eating these foods a few times a week

• Lean poultry

• Low fat dairy

• Oily fish and seafood

• Eggs

Eating these foods occasionally

• Red meat

• Food with added sugars (desserts, biscuits, cakes)

Eating these foods rarely

• Processed meats (ham, salami, kabana, bacon, chorizo, frankfurts)

• Packaged foods

Red wine in moderation, is also a big part of the Mediterranean diet, however, when trying to conceive, I would recommend abstaining from any alcohol consumption.

So why does this way of eating work for fertility?

As the Mediterranean diet (MedDiet) is based off mostly plant foods and seafood, it is high in nutrients like monounsaturated fats, polyunsaturated fats, flavonoids, vitamins C & E, and polyphenols which have been linked to reduced inflammation. It is thought that inflammation is a key area affecting fertility, although exact mechanisms remain unclear (Alesi et, al. 2022).

Two studies have shown higher compliance with a MedDiet, improved outcomes on menstrual cyclicity, including longer menstrual cycles, and reduced primary dysmenorrhea, and menstrual pain (Alesi et, al. 2022). It is thought that the anti-inflammatory effects may help improve blood flow to the endometrial tissue (Alesi et, al. 2022). Conclusions on whether improvements in menstrual cyclicity relate directly to improved fertility need to be further researched before definitive conclusions can be made (Alesi et, al. 2022).

Findings on outcomes for greater MedDiet adherence and IVF outcomes are mixed, with some studies showing minimal differences in rates of clinical pregnancy and live birth. However, a study by Karayiannis et, al. (2018) showed ~2.7 times higher likelihood of clinical pregnancy and live birth with greater MedDiet adherence. Another by Gaskins et, al. (2019) showed that a higher adherence to MedDiet patterns correlated with higher rates of pregnancy and live birth, and a recent meta-analysis showed that higher MedDiet adherence improved ART outcomes (chemical pregnancies and live births) (Winter et, al. 2023).

How to eat more of a Mediterranean diet?

Here are some practical ways to incorporate more Mediterranean diet foods into your daily eating:

• Eat fresh or dried fruit daily

• Snack on a variety of nuts and seeds

• Try a meat free meal, or reduce your meat by half and bulk up with legumes (think curries, bolognese sauce, stir fries etc.)

• Include oily fish twice a week

• Switch your fat source to extra virgin olive oil

• Try a new vegetable each week to increase your variety and colours

• Eat less high fat, high sugar desserts: instead replace for fresh fruit or some Greek yoghurt

• Replace sugary sodas and juices with water

• Eat with your loved ones as often as possible

Meal ideas:

• Homemade granola/muesli with lots of nuts and seeds + Greek yoghurt + fresh fruit

• Vegetable omelette on wholegrain bread

• Greek salad, made with cucumber, olives, tomato, mixed greens, feta, and topped with olive oil and lemon juice

• Salmon and veggie tray bake with capsicum, broccolini, green beans, garlic, and onion

• Quinoa and herb stuffed capsciums

• Baked Mediterranean fish with potatoes, tomatoes, olives and herbs

• Minestrone soup

References

Karayiannis, D.; Kontogianni, M.D.; Mendorou, C.; Mastrominas, M.; Yiannakouris, N. Adherence to the Mediterranean diet and IVF success rate among non-obese women attempting fertility. Hum. Reprod. 2018, 33, 494–502.

Gaskins, A.J.; Nassan, F.L.; Chiu, Y.-H.; Arvizu, M.; Williams, P.L.; Keller, M.G.; Souter, I.; Hauser, R.; Chavarro, J.E.; Team, E.S. Dietary patterns and outcomes of assisted reproduction. Am. J. Obstet. Gynecol. 2019, 220, 567.e1–567.e18.

Winter, H.; Rolnik, D.; Mol, B.; Torkel, S.; Alesi, S.; et al. Can Dietary Patterns Impact Fertility Outcomes? A Systematic Review and Meta-Analysis. Nutrients. 2023, 15(11), 2589.

Alesi, S.; Villani, A.; Mantzioris, E.; Takele, W. Cowan, S.; Moran, L.; Mousa, A. Anti-Inflammatory Diets in Fertility: An Evidence Review. Nutrients. 2022, 14, 3914.