Women’s Adherence to Healthy Dietary Patterns and Outcomes of Infertility Treatment
Authors: Salas-Huetos Albert , Mitsunami Makiko , Wang Siwen , Mínguez-Alarcón Lidia , Ribas-Maynou Jordi , Yeste Marc , Souter Irene , Chavarro Jorge E. ,   EARTH Study Team, Hauser Russ , Williams Paige L , Chavarro Jorge E , Minguez-Alarcon Lidia , Ford Jennifer , Keller Myra , Daad Ramace , Souter Irene , Petrozza John , Toth Thomas L , Wright Diane L. , Bormann Charles 
Published: August 2023

ImportanceIncreasing evidence suggests that specific foods and nutrients may improve infertility treatment outcomes in women. However, less is known about the role of dietary patterns.ObjectiveTo investigate whether women’s adherence to a priori–defined dietary patterns promoted for the prevention of chronic conditions is associated with outcomes of infertility treatment.Design, Setting, and ParticipantsThis prospective cohort study was conducted at a fertility center at an academic medical center in Boston, Massachusetts. Women undergoing infertility treatment cycles, including intrauterine insemination cycles and in vitro fertilization with or without intracytoplasmic sperm injection were included. Data were collected from January 2007 to October 2019, and data were analyzed from February to December 2022.ExposuresWomen’s pretreatment diet was assessed with a validated food frequency questionnaire from which 8 a priori–defined scores were calculated (higher score indicates greater adherence): (1) Trichopoulou Mediterranean diet, (2) alternate Mediterranean diet, (3) Panagiotakos Mediterranean diet, (4) Healthy Eating Index, (5) Alternate Healthy Eating Index, (6) American Heart Association (AHA) index, (7) Dietary Approaches to Stop Hypertension index, and (8) plant-based diet.Main Outcomes and MeasuresThe adjusted probability of clinically relevant outcomes (live birth as a primary outcome and clinical pregnancy and pregnancy loss as secondary outcomes) was evaluated across quartiles of adherence to each dietary pattern using multivariable generalized linear mixed models to account for repeated cycles.ResultsThis analysis included 612 women with a median (IQR) age of 35.0 (32.0-38.0) years. There was no association between women’s adherence to the 8 a priori dietary patterns and probability of clinical pregnancy or live birth following in vitro fertilization or intrauterine insemination. However, an inverse association was found between adherence to AHA dietary pattern and risks of total and clinical pregnancy loss. Among women who became pregnant during the course of infertility treatment, the adjusted probabilities of pregnancy loss in the lowest and highest quartile of the AHA dietary pattern were 0.41 (95% CI, 0.33-0.50) and 0.28 (95% CI, 0.21–0.36), respectively (P for trend = .02). The corresponding adjusted probabilities of clinical pregnancy loss were 0.30 (95% CI, 0.22-0.39) and 0.15 (95% CI, 0.10-0.23) (P for trend = .007). A similar pattern was observed for all other dietary patterns, with the exception of the plant-based diet pattern.Conclusions and RelevanceFindings of this cohort study suggest that preconception adherence to the AHA diet may be associated with a lower likelihood of pregnancy loss during the course of infertility treatment.