Nutrition and in Vitro Fertilization

What is in Vitro Fertilization (IVF) Treatment?

Before explaining and going into detail about the best diet for in vitro fertilization or IVF, I think it is important to define and understand what an in vitro fertilization process is and what it consists of. This is important, since the nutritional approach is based on accompanying each of the steps that are carried out through what we call a cycle of this Assisted Reproduction treatment (ART) technique.

In vitro fertilization (IVF) is a high-complexity assisted reproduction technique currently used in most fertility centers to help couples or single women who have difficulties achieving pregnancy.

IVF, in vitro fertilization, literally means fertilization “in a test tube outside the body” through a fertilization process where eggs are fused with sperm outside the body, in vitro (in a test tube).

The first baby conceived through an IVF cycle was born in 1980. Since then, more than 5 million babies have been conceived via IVF around the world.

The treatment basically consists of extracting the ‘eggs’ from the woman’s ovaries by follicular puncture and then fertilizing them in the laboratory with the man’s sperm (or, if applicable, from a donor) “in vitro” in a special culture using a test tube or Petri dish, followed by their transfer into the woman’s uterus in order to achieve pregnancy.

Depending on the technique used to fuse the gametes (egg and sperm to develop an embryo), there are 2 types of IVF:

1. Conventional IVF: eggs and sperm are added to the same culture plate, with the expectation that they will be able to fuse naturally on their own.
2. ICSI (intracytoplasmic sperm injection): instead of letting the sperm fertilize the egg naturally in a culture plate, it is carried out by direct microinjection of a single sperm into each of the eggs to achieve fertilization.

Note: performing one or another IVF technique will depend on the infertility conditions and/or preferences of each couple.

CURIOSITY! If you are visiting a fertility specialist for the first time, you may be surprised to learn that there are many other Assisted Reproduction Techniques (ART) currently available and that IVF is not the only option for you. Depending on the cause or origin of infertility, your fertility specialist will recommend one technique or another: Ovulation induction, artificial insemination, gamete intrafallopian transfer (GIFT), intracytoplasmic sperm injection (ICSI), Pre-implantation genetic diagnosis (PGD).

What Does in Vitro Fertilization (IVF) Treatment Consist of?

IVF is a process that consists of several phases that must be gone through to achieve pregnancy. These phases or processes together are commonly known as an IVF CYCLE:

1. Suppression of the natural menstrual cycle: A medication is used to achieve suppression of the natural menstrual cycle. The medication is administered with a daily injection for approx. 2 weeks.
2. Helping your ovaries produce more eggs: once your natural cycle is suppressed, the hormone known as Follicle Stimulating Hormone (FSH) is commonly administered. Since FSH increases the number of follicles that your ovaries produce. This means that more eggs can be collected and fertilized. With more fertilized eggs, you will have a greater variety of embryos to use in your treatment.
3. Checking progress: Your doctor will perform vaginal ultrasounds to monitor your ovaries, and in some cases, blood tests. Before collecting the eggs, you will be injected with a hormone called human chorionic gonadotropin (hCG) that helps the eggs mature.
4. Egg collection: It consists of a simple surgical intervention, in which a needle is used that is passed through your vagina inside each ovary under ultrasound guidance, through which the fluid from the ovarian follicles is aspirated. Subsequently, this follicular fluid is collected in a series of test tubes at 37 degrees of temperature. The specialist will identify the already matured eggs and classify them according to their characteristics to use them in IVF. It is an intervention that requires anesthesia and normally takes around 20-30 minutes.
5. Fertilization of the eggs: The collected eggs are mixed with the sperm from your partner or donor in a laboratory to fertilize them. In the case of performing an ICSI IVF, each egg is individually injected with a single sperm. The fertilized eggs (embryos) will continue to grow in the laboratory for 6 days before being transferred to the uterus. Normally the best 1 or 2 embryos are chosen for said transfer.
6. Embryo transfer: A few days after collecting the eggs, the embryos are transferred to your uterus. The number of embryos to be transferred should be discussed before treatment begins. If there are suitable embryos left over, they can be frozen for future IVF attempts.
7. The “2 week wait”: technically refers to the luteal phase of pregnancy. Embryo implantation during an IVF process takes place between 5 and 7 days after fertilization. When the embryo is implanted in the mother’s uterus, the hormone human chorionic gonadotropin (hCG) is released – known as the pregnancy hormone.
8. Pregnancy test: after about 10-12 days after the embryos have been transferred, the woman can perform the pregnancy test that, as we have mentioned, detects the hCG hormone, which serves to check if pregnancy has occurred or not.

Specific Diet for IVF

Once you understand what in vitro fertilization treatment is and what it consists of, I will tell you about the dietary intervention to be carried out.

If you are about to start an IVF process, it is normal to wonder what is the best diet for IVF to be successful. Or perhaps, it is not your first cycle and you are wondering what you can do differently this time to improve your chances of success, whether in egg retrieval, optimizing the quality of your partner’s sperm, or helping the embryo implant.

The truth is that your diet and lifestyle play a fundamental role in fertility. Eating the right foods and nutrients can have a significantly positive impact on the success of IVF treatment, from the beginning.

Mediterranean Diet for Fertility

You may be surprised to learn that the Mediterranean diet is not only widely considered one of the healthiest ways to eat, but research shows better fertility rates in women seeking pregnancy and better embryonic performance in IVF treatment cycles.

Another study found that women who followed a Mediterranean dietary pattern were two-thirds more likely to become pregnant, compared to women who followed a dietary pattern less similar to the Mediterranean diet. The benefits of the Mediterranean diet for fertility could be summarized in 2 main points: high antioxidant content and its anti-inflammatory effects.

So how should I Proceed?

The first step is to prepare your diet for IVF is:

• Performing a blood test to check your nutritional status.
• Optimize your weight (healthy weight).
• Assess nutritional supplementation, if required (personalized).
• Control any medical or nutritional condition you may have.

Did you know that Researchers at the Harvard School of Public Health have found that by making just 5 dietary changes your fertility can improve by up to 69%? For those women suffering from infertility due to dysfunctional problems in ovulation, this probability resulted in an 80% improvement.

Main Nutritional Aspects to Take into Account to Achieve the Success of an IVF Cycle

As I have mentioned, IVF treatment is a complex process where an interaction and synchronization must occur between a large number of hormones (your own and those administered through treatment), physiological processes and development and growth processes.

However, there are 4-5 large areas in which nutrition will play a fundamental role in achieving the success of an in vitro fertilization cycle, and therefore achieving the final goal, which is pregnancy.

1. Healthy eggs
2. Healthy sperm
3. A healthy and regular ovulatory menstrual cycle
4. Receptive uterus – implantation
5. The “2 week wait”

Quality Eggs

Although your fertility specialist can help identify which of your eggs are of better quality, the goal through nutritional treatment is for all of them to be as healthy as possible.

Our diet has a great impact on the quality of the eggs. Although it is very important that you take into consideration that folliculogenesis (the process of maturation of an egg) takes place over the course of 90-100 days (3 months). Therefore, we know that we need a minimum of 3 months to be able to act and optimize the quality of an egg (so that it ovulates, is released and is fertilized after 90 days).

For this reason, I advise you to follow a diet for IVF for at least 3 months before egg retrieval.

Although there are many changes at the nutritional level and lifestyle that we can carry out to improve the health of the egg, I am going to focus on the essential nutrients that you must provide to guarantee and optimize this quality:

Omega-3 to Omega-6 Ratio: An interesting study has shown that diets rich in omega-3 fatty acids (salmon, mackerel, sardines, tuna, chia seeds, walnuts, hemp seeds, etc.) led to a prolongation of reproductive function in advanced maternal age, while a diet rich in omega-6 fatty acids has been associated with poorer reproductive success in advanced maternal ages. This was also associated with an improvement in egg quality. The sooner we adopt a diet rich in omega-3, the better the results.

Recommendation: Incorporate oily fish (small in size) at least 2-3 times a week: tuna, salmon, sardines, mackerel, anchovies, etc.

Antioxidants: While antioxidants may not directly contribute to improving egg quality, they can help counteract or prevent oxidative damage that may be caused by ovulation disorders, alterations in the fallopian tubes, and endometriosis. The evidence remains limited regarding their role in pregnancy and fertility rates, although we know that a diet rich in antioxidants is beneficial anyway.

Recommendation: Foods rich in antioxidants are plant foods. Make sure your plate contains a minimum of 5 colors; among which should be blue, red, yellow, green, violet, orange and white to obtain the unique and diverse benefits that each color offers. Eat the rainbow!

Zinc: optimal levels of zinc also play an important role in the development, maturation and release of the egg (it seems that this helps the egg progress in the final stages of meiosis and cell division). So, if this is deficient or there is simply not enough intake through our diet it can affect the health of the egg and generally harm our fertility.

Recommendation: foods rich in zinc include seafood, fish, unprocessed meat, eggs, legumes, cereals, dairy products, cashews, etc… Including at least one of these foods daily will help you reach the daily zinc requirements (note: the daily zinc requirements for men are higher than for women).

Co-enzyme Q10 (CoQ10): also known as ubiquinone, is a Co-enzyme that is found in our bodies naturally and plays a very important role in the production of energy in all our cells (mitochondria). The health of the mitochondria is critical, as eggs need a lot of energy. That is why feeding this mitochondria well is a crucial intervention to improve the quality of the eggs.

As we age, our ability to produce CoQ10 decreases, the good news is that we can obtain it through food!

Emerging studies have shown that CoQ10 exerts an impact on the health of eggs (demonstrated in mice and humans) Un status below optimal levels of CoQ10 promotes a decrease in the quality of eggs associated with age, which can significantly contribute to fertility problems associated with advanced maternal age.

Recommendation: Although CoQ10 can be obtained through food, its supplementation is very common, especially for women over 35 years of age. It is normally supplemented a minimum of 1 month before egg retrieval in an IVF cycle.

NOTE: remember you should not supplement on your own. Go to your health professional. Each woman has different needs. The intake of nutritional supplements requires an individual and personalized evaluation and advice). There are certain situations in which CoQ10 supplementation is not appropriate or recommended.

In addition to supplementation, you can also obtain this enzyme by eating protein foods such as red meat, turkey, oily fish, some vegetables such as spinach, cauliflower and broccoli, fruits, legumes, nuts and seeds.

Vitamin D: is an essential fat-soluble vitamin that is obtained mainly outside the context of our diet, through sun exposure. While many people know the benefits of vitamin D in bone health, it should be noted that it also plays a fundamental role in hormonal health and specifically, in the quality of our eggs.

A study carried out in Italy on women who underwent an IVF cycle showed that women with sufficient levels of vitamin D (evaluated by a simple blood test) were more likely to produce higher quality eggs and therefore better pregnancy rates.

Recommendation: Ensure daily sun exposure of 5-10 minutes (before 10 am and after 3 pm to avoid hours of greatest exposure); expose the face, arms, legs and chest. Other dietary sources that can contribute to optimizing your vitamin D levels are: dairy products, fortified dairy substitutes, eggs and mushrooms.

B vitamins: (B9- folate, B6 and B12): Folate is an essential micronutrient for the process of producing new copies of DNA (in epigenetic expression). Together with vitamin B12 and vitamin B6 they serve as a substrate and therefore act as Co-factors in DNA synthesis and methylation reactions (critical processes for reproduction).
Recommendation: Eat at least 2 servings of green leafy vegetables per day (spinach, lamb’s lettuce, lettuce, arugula, chard, etc.) and ensure an adequate intake of foods of animal origin (rich in vitamin B12 and vitamin B6). If you follow a vegetarian or vegan diet, it is best to consult your healthcare professional, as supplementation should be evaluated in that case.

Nutrition and sperm quality

It is important to remember that there is also a male factor in the gestational search process. Sperm will contribute 50% of the genetic material for your future baby. That’s right! In fact, the literature reflects the great impact that lifestyle and diet have on your partner’s sperm. Therefore, no, you don’t have to make dietary changes prior to IVF alone! I encourage you to involve your partner to help give that support also necessary for the correct development of your embryo.

That being said, the latest scientific evidence shows that the key recommendations to improve the quality and health of sperm can be summarized as:

• Limit all those foods that are known to have a high content of trans fats, such as fried foods, pastries and generally processed and ultra-processed foods.
• Choose unprocessed meats over processed meats (which include hamburgers, all types of sausages, hot dogs, etc.)
• Consume oily fish (small in size due to its lower mercury content) 2 times a week: salmon, sardines, mackerel, etc.
• Include variety and color in each of your meals: to ensure a large intake of antioxidants and the supply of vitamin C and vitamin E.

In relation to which nutrients we should pay attention to in order to improve sperm quality, I would like to highlight the following:

Zinc: we must say that it is a crucial mineral in men since certain amounts of it are lost in each ejaculation. It is an essential nutrient for correct spermatogenesis to take place (since it is a co-factor of different proteins and enzymes involved in this sperm maturation process). In addition to also exerting a protective action as an antioxidant (protecting sperm against oxidative stress).

Where do we find it? Meat, fish and shellfish, legumes, nuts and seeds.

CoQ1O: Same as in the case of women (mentioned previously).

Selenium: Its main role in the body is to protect against any oxidative damage that may occur during the sperm maturation process and keep cells healthy (similar to zinc). Lower levels of selenium have been found in the sperm of infertile men compared to fertile men.

How can you acquire it? It is a mineral that is mostly concentrated in Brazil nuts. So, my recommendation is to consume 1 handful of these once a day, either as a snack, in a salad or adding them to a smoothie.

Vitamin E and C: as already mentioned, these two vitamins act as antioxidants, thus playing a very important role in protecting sperm during its maturation process, preventing any damage to the genetic material within the sperm.

In addition, there is some evidence that vitamin E can improve both sperm motility and quantity.

Where do we find them?

Vitamin E: is a fat-soluble vitamin found in extra virgin olive oil, sesame seeds, sunflower seeds, tahini, broccoli, spinach and peanut butter.

Vitamin C: eating enough fresh fruits and vegetables is the best way to obtain optimal levels of this nutrient.

Lycopene: another antioxidant, which has also been seen with low levels in infertile men. Lycopene requires fat for optimal absorption. That is, it needs to be consumed with a fat to help your body absorb it and use it better.

How can I acquire it? Although there are a large number of fruits and vegetables that contain lycopene, such as tomatoes, watermelon, grapes, red pepper, carrots, red cabbage, etc. The easiest way to obtain it is by using the traditional sofrito of our Mediterranean diet, so that the cooked tomato helps to concentrate the lycopene together with the extra virgin olive oil (quality fat) to ensure that we obtain an adequate dose in its most absorbable form.

L-carnitine: is a nutrient that helps in the production of energy by transporting fatty acids to the “power plant” of your cells. It is produced in your body and is composed of two amino acids, Lysine and methionine. A study in men, who were supplemented with 1-3g/day of L-carnitine for 2-6 months, showed improvements in motility, morphology and pregnancy rates.

Where do I find it? Honestly, enjoying a varied diet that includes all food groups. This is the best way to ensure an adequate supply of amino acids that your body needs to produce L-carnitine. Include fruits, vegetables, whole grains, white meat, fish and shellfish, eggs, nuts and seeds, legumes and dairy products.

Folate: just as folate is important in the gestational search for women, it is also important for men. Likewise, it has been suggested that folate helps increase the amount of sperm. We know that folate is important for maintaining healthy cells, including DNA content. So, taking into account that 50% of the genetic content of your future baby will come from one (or two) sperm, it is important to have healthy genes in them too!

Where do we find it? As I mentioned previously, we can find them mostly in green leafy vegetables, whole carbohydrates, legumes and citrus fruits.

A healthy and regular ovulatory menstrual cycle

As I explained previously, in an IVF cycle, depending on your medical history, your fertility specialist may use one medication or another (either oral or injected) to stimulate ovulation. For those who ovulate normally (approximately in the middle of the cycle), they may not even require any medication.

Therefore, knowing when you are ovulating is KEY when it comes to undergoing any assisted reproduction treatment.

Ordering and regulating your menstrual cycles is beneficial either because; you may not be ovulating (anovulatory cycles), you may not be having your menstrual cycle (amenorrhea), or you may have more than one cycle per month, or perhaps you are ovulating later or earlier than you expect to occur (ex. Not at 14 days).

This is vital information in the gestational search. Likewise, for many women losing weight if they are above their healthy weight or gaining weight if they are below a healthy weight, modifying their physical activity, their diet and managing stress can be a key step to initiate ovulation or regulate it. In fact, body fat percentage is more important than a weight number on the scale. What I mean is that women classified as “normal weight or BMI” may still benefit from a change in their body composition for their fertility .

Receptive Uterus – Implantation:

So your healthy egg has met a healthy sperm and your embryo looks healthy overall. Now what?

Now is the time to transfer this embryo with the hope that it will “stick and find a home in your uterus for the next 9 months”. Therefore, we need to create a good home for this embryo to want to live in. You need a good, sufficiently thick endometrium where your future baby will be safe and well nourished.

But what can we do if your endometrium is not thick enough or is not in the right conditions to carry out the implantation? Below I leave you some of the nutrients to concentrate on:

Whole grains: We know that women undergoing IVF treatment who eat more whole grains have a higher probability of implantation compared to those who do not. If you heard right carbohydrates are not the devil for your fertility! However, the quality must be adequate. So, processed and high-sugar carbohydrates must be replaced by low glycemic index whole carbohydrates such as brown rice, whole wheat pasta, whole wheat bread, quinoa, whole wheat flour, whole pearl barley, whole wheat oat flakes.

Vitamin E: this fat-soluble vitamin found in our beloved extra virgin olive oil, peanut butter, sesame seeds, tahini, broccoli and spinach can also help thicken the endometrium so that the embryo implants, improving the thickness and reducing inflammatory markers.

Let’s Talk about Recurrent Implantation Failure (RIF)

Recurrent implantation failure (RIF) refers to cases in which women have had three failed in vitro fertilization (IVF) attempts with good quality embryos.

It should be noted that failure or interruption in implantation may be due to a problem in the uterus or a problem in the development of the embryo. It is also important to consider maternal age and embryonic stage. However, without going into much detail (since we could write another entire blog about implantation failure and its causes) I leave you with some of the most common factors that we know can affect uterine health from a nutrition perspective: anatomical abnormalities (fibroids), thin endometrium, endometritis, autoimmune conditions and obesity. In this case, the nutritional intervention will depend on the determining cause of this implantation failure.

The Dreaded “Two-Week Wait”

Technically, the 2-week wait refers to the luteal phase of pregnancy. Embryo implantation during IVF takes place between the fifth and seventh day after fertilization. When the embryo implants, the mother’s matrix releases the hormone hCG (human chorionic gonadotropin). Alternatively, if implantation does not occur, the corpus luteum detaches and menstruation occurs.

What Dietary Considerations should We Take into Account?

These two weeks are normally endless, generating a lot of anxiety and fear for most women. Totally understandable.

From a nutritional point of view, we treat these two weeks as if we were in the first trimester of pregnancy. What do I mean by this? More than creating more pressure to try to follow a perfect diet, we normally pay attention to adapting hygienic and food safety measures (as we would in the first days of pregnancy). Here are summarized the key recommendations to follow during these two endless weeks:

• Limit caffeine consumption.
• Stop taking the prenatal supplements you were taking during the gestational search that are not safe or suitable for pregnancy. Such as high doses of vitamin E (hence the importance of consulting your professional when starting or taking any supplementation).
• Avoid foods with a high risk of listeria, such as soft cheeses, sausages, raw meats and fish, etc.
• Include a wide variety of whole grains, such as oat flakes, rice and quinoa.
• Ensure an adequate intake of dairy products, vegetables and fruits.
• Continue “eating the rainbow”: ensure a minimum of 3-5 colors on your plate
• Don’t forget folate – ensure a minimum of 2 servings of green leafy vegetables per day.

Don’t be hard on yourself. Give yourself time and prioritize self-care. Nothing you do will spoil the success of IVF. Accept that this is out of your control.

Observe your Lifestyle:

Controlling stress when you are anxiously waiting for a pregnancy test is much easier said than done! I know! But here I leave you with some of the strategies that you could try if you feel that your mental health (not your physical health) needs a little attention:

• Ask for support – call a friend or family member to talk and share.
• Communicate with your partner (if you have one) and explain how you feel.
• Use mindfulness applications such as Headspace or Calm every day to help you find your zen and calm.
• Do something for yourself, it could be something as simple as sunbathing for 5 minutes in the backyard with a book or something more prepared such as booking an appointment at a spa, or taking the time to go get a manicure/pedicure, etc.
• Focus on your breathing – you could benefit from breathing work.

What is the Best Supplement for IVF?

Unfortunately, in this case I must say that there is no supplement that works for everyone. Despite the false belief that exists (even on the part of healthcare professionals), not all supplements are the same and not all work for all people. I hope it has been reflected throughout this article, each woman is a world, each woman has different needs, different circumstances, a different clinic or medical history associated, etc. Therefore, no! Not all women can be treated equally.

In a correct clinical practice to establish a supplement protocol, the following principles and factors should be taken into account as a minimum:

• In the first place, supplements are used to cover those gaps that exist in the diet, that is, when through the intake of food there is no capacity to reach the essential nutritional requirements for the correct development of the person and the development of their future baby.
• Review analytical parameters and other tests if required.
• Review medical conditions and mediation
• Exhaustive evaluation of the current nutritional status.
• Consider allergies or food intolerances.

Please ask your healthcare professional before taking any supplements.

Conclusion

As I hope has been well reflected, it is not surprising that the Mediterranean diet has been established as one of the best strategies to follow to optimize fertility, as long as the Mediterranean diet is carried out correctly.

Is there a Perfect Diet for in Vitro Fertilization?

As you have seen, there is no perfect diet, what is more, what for you is “your healthiest diet” may not be giving optimal support to your fertility, simply because it is not the most suitable for you and your UNIQUE needs.

What I did want to make clear in this article is that we rely on scientific evidence and general recommendations that are intended to optimize your nutritional reserves in preparation for pregnancy. Therefore, we must eat certain foods that we know will support our fertility and pay attention to those nutrients that will guarantee proper development and health of your future baby. Now, will the same dietary guidelines apply to someone with endometriosis as to someone with a history of eating disorders? What happens when there have been previous miscarriages? Or is there a risk of neural tube defects? Will my sister who has an autoimmune problem and is undergoing IVF need the same type of diet as me, who does not suffer from any medical condition? OF COURSE NOT, nutrition goes far beyond just covering nutrients and EACH PERSON MUST BE TREATED INDIVIDUALLY AND COMPLETELY.

Box: Your diet should be unique to you, because you are unique! Request personalized nutritional advice
that adapts to your unique needs.