Female Fertility and the Nutritional Approach: The Most Essential Aspects Original paper

What was reviewed?

This comprehensive narrative review focused on the relationship between dietary factors, nutritional supplementation, and female fertility, with an emphasis on how dietary patterns and specific nutrients influence reproductive outcomes. The authors synthesized current evidence regarding the effects of macronutrients (carbohydrates, fats, proteins), micronutrients (vitamins, minerals), phytoestrogens, gluten, antioxidants, caffeine, alcohol, and the gut microbiota on female fertility. Special attention was given to the Mediterranean versus Western-style dietary patterns and their associations with ovulatory health, metabolic disorders such as polycystic ovary syndrome (PCOS), endometriosis, and assisted reproductive technology (ART) outcomes. The review also detailed how specific nutrients and bioactive food components interact with underlying hormonal, metabolic, and inflammatory pathways relevant to the reproductive system.

Who was reviewed?

The review encompassed a broad population of reproductive-aged women, including those planning pregnancy, experiencing infertility (of both known and idiopathic causes), and those undergoing ART. Studies drawn upon in the review included healthy women, women with metabolic and reproductive disorders (notably PCOS and endometriosis), and subgroups with dietary deficiencies or excesses. The review also referenced evidence regarding women with specific conditions such as celiac disease and those with varying levels of micronutrient status. While primarily focused on the female population, some comparative insights referenced male fertility or lifestyle factors, though male infertility was not the core subject.

Most important findings

The review underscores that dietary patterns have a significant impact on female fertility. Diets high in trans fats, refined carbohydrates, and added sugars are associated with higher risks of ovulatory disorders, insulin resistance, PCOS, and reduced ART success. Conversely, adherence to the Mediterranean diet, rich in dietary fiber, plant-based proteins, omega-3 fatty acids, vitamins, and minerals, is linked to improved ovulatory function, better metabolic profiles, and higher fertility rates, including among women undergoing ART. Micronutrients such as folic acid, vitamin D, iodine, and iron are particularly important, with deficiencies in these linked to impaired fertility, increased time to conception, and adverse pregnancy outcomes. The review highlights inconsistent findings regarding dairy fat, protein sources, and phytoestrogens, noting the need for individualized dietary recommendations. Importantly, the composition of the gut microbiota emerges as a potentially critical mediator of fertility, with Western diets promoting dysbiosis and inflammation, while fiber-rich, plant-based diets foster beneficial microbial shifts (notably increased Bifidobacteria and Prevotella). The review also finds limited evidence for the routine exclusion of gluten in non-celiac women and suggests routine supplementation of folic acid and vitamin D for women planning pregnancy.

Key implications

For clinicians, the review highlights the necessity of a holistic and individualized approach to female fertility, integrating dietary assessment and intervention as core components of preconception and infertility care. The findings support recommending Mediterranean-style dietary patterns, ensuring adequate intake (and, if necessary, supplementation) of key micronutrients such as folic acid, vitamin D, and iodine, and promoting gut health through fiber-rich, plant-based foods. Given the intricate links between diet, metabolic health, reproductive hormones, and the gut microbiome, multidisciplinary collaboration, including the involvement of clinical dietitians, is crucial. The review also suggests the importance of monitoring micronutrient status and considering celiac disease screening in infertile women. Current evidence does not support universal exclusion of gluten, caffeine (within recommended limits), or moderate alcohol prior to conception, but underscores the risks of excess. Future research should focus on clarifying the roles of specific nutrients, gut microbiota signatures, and developing standardized dietary recommendations for women planning pregnancy.