Fertility and Nutrition: Who should I trust?

By: Yaffi Lvova, RDN and Dina Cohen, MS, RDN, CEDRD

Note: The following article is informational only and should not be construed as medical advice.  If you would like medical advice, please contact a registered dietitian (RD or RDN), certified nutrition specialist (CNS) or your medical practitioner. You can read an in-depth analysis on different nutrition credentials here.

The journey to motherhood can be painful, exciting, and confusing. It seems like everyone who eats is a nutrition expert, dishing out advice to help you in your fertility struggle. As women who are also dietitians, we understand your confusion, as well as the problems it can cause. We want to help you overcome obstacles in your journey to motherhood while helping clear up the role of nutrition in fertility: where nutrition can help, where nutrition isn’t a factor, and where your nutrition information should come from.

A quick Google search of “fertility and nutrition” will bring up 113,000,000 results – and you may have tried 112,999,999 of those. We live in a culture which blames nutrition for everything while simultaneously looking toward nutrition to solve every health issue imaginable. We like to feel that we have some amount of control over our bodies, but when they seem to fail at the natural process of getting pregnant, we feel a profound lack of control. It is tempting to try to gain power over our bodies by following “the perfect diet”. This comes from the best of intentions, but unless indicated, nutritional changes can range from useless to harmful.

A woman who is considering nutrition modifications should discuss them with an educated and credentialed healthcare practitioner who can make recommendations based on the full picture of her health, taking into account her personal experience, her medical history, and her diagnosis. This is because making changes to food choices may have a profound impact on a woman’s health and fertility. Nutrition choices that benefit one diagnosis can actually worsen another. Additionally, changes to diet can result in increased stress and isolation as menu options become narrowed and social events are missed. Any changes made must be appropriate in the context of a woman’s unique situation.

An initial conversation with your healthcare team may present some clarity, but it doesn’t delve deep enough to warrant changes to your grocery list or menu choices. We seek emotional support from friends and family, and while loved ones (and strangers at the grocery checkout) mean well, the nature of medical and fertility needs means that meaningful nutrition information must come from a source who is well-versed in nutritional science as well as fertility.

By seeking out a registered dietitian (RD or RDN) or certified nutrition specialist (CNS), you can be confident that the information provided will be helpful in identifying nutrition-related conditions such as PCOS, thyroid issues, hypothalamic amenorrhea, or disordered eating. Having a solid diagnosis is the first step toward appropriate treatment. If you do not yet have a diagnosis, the first step is contacting your preferred reproductive endocrinologist for a workup. There is no nutrition plan that will help prior to diagnosis.

Many women embark on weight loss diets with the hope that doing so will improve their fertility. For a woman who feels she weighs too much, dieting may seem like a harmless first step; after all, dieting is so common nowadays that it sometimes feels hard to find someone who isn’t dieting. However, dieting and/or overexercise aren’t innocuous. It isn’t only the stereotypical girl with anorexia who suffers the health consequences of restriction. Rapid weight loss and/or consistent under eating can affect cycles in women of any size.

Functional hypothalamic amenorrhea (FHA), a condition in which a woman stops getting her period, is commonly caused by inadequate nutrition and over-exercising and does not only occur in very thin people. If a woman’s cycles have become irregular or go missing entirely, her eating and activity levels should be examined. She may have FHA or she may meet clinical criteria for an eating disorder. A woman with FHA will benefit from meeting with a dietitian who is experienced in treating this condition, typically a dietitian who specializes in eating disorders. The dietitian will help with modifying her diet and activity levels to restore menstrual function. Because it can be challenging to make these changes and deal with any associated shifts in body size or appearance, it may also be wise to see a psychotherapist. It’s important to recognize that FHA can almost always be resolved with the appropriate lifestyle modifications.

If a woman has an eating disorder, then she will need more intensive treatment, including a team of an eating disorder dietitian, therapist, physician, and sometimes others including a psychiatrist. Resolving an eating disorder may be challenging but full recovery is absolutely possible. A woman who begins the work of eating disorder treatment prior to pregnancy is better equipped for the postpartum stage as well as parenthood.

Polycystic ovarian Syndrome (PCOS) is one of the most widely-known diagnoses affecting fertility. The high circulating levels of hormones called insulin and androgens manifest in a variety of ways and mean that PCOS can affect fertility, metabolism, and overall health. This condition is also associated with chronic low-grade inflammation. PCOS can be improved with lifestyle modifications, which may include changes to diet, but do not require the extreme measures often promoted. Under eating and experiencing increased stress levels are things that can actually worsen PCOS, as well as contribute to rebound overeating.  Consulting with a registered dietitian with experience treating PCOS can help a woman make healthy and appropriate changes. She should seek out a professional with a non-diet philosophy, an experienced professional who sees the number on the scale as one piece of data rather than meaningful or diagnostic information. She might also benefit from seeing a psychotherapist to help her with stress reduction and navigating the emotional challenges of having PCOS and experiencing infertility.

Even if a woman has unexplained infertility, or infertility that is not a result of a nutrition-related condition, she may still fall prey to the many fads that are a part of wellness culture. There is an abundance of  products and protocols that claim to heal a wide spectrum of problems and conditions, including infertility. When a woman is desperate to have a baby, she may be vulnerable to making choices that seem promising in the moment but turn out to be less than wise in the long run. By receiving guidance from a qualified medical professional, a woman can avoid purchasing inappropriate supplements, pursuing restrictive diets that lead to nutrient depletion and/or rebound binge eating, and spending months and months down various dead-end roads.

Who should be advising you? We mentioned registered dietitians (RD or RDN) and certified nutrition specialists (CNS). What about nutritionists and health coaches? Neither is a defined term, meaning the professional in question may have a solid education, but may not. Health coaches are in a similar boat.

When evaluating a professional, you want to ask a few questions:

  • What is your level of formal education?
  • Where did you go to school?
  • What are your credentials?

Although it may be tempting to follow a strict set of food rules when pursuing pregnancy and feeling frustrated, your path will be smoother when following advice given by the appropriate healthcare practitioner and targeted to your individual diagnosis and life circumstances.