Infertility is an increasing problem that affects couples attempting pregnancy. For every six couples who try to get pregnant, one pair faces infertility; ovulatory disorders affect 18 to 30 percent of these couples. A growing body of evidence points to a link between diet and female fertility. In fact, data show that a diet high in trans fats, refined carbohydrates, and added sugars can negatively affect fertility. Conversely, a diet based on the Mediterranean dietary patterns, i.e., rich in dietary fiber, omega-3 (ɷ-3) fatty acids, plant-based protein, and vitamins and minerals, has a positive impact on female fertility.
When it comes to fertility, many factors can influence a person’s ability to conceive, some of which may not be immediately obvious. One such factor is insulin resistance, a condition that can impact anyone, not just those with diabetes. Research indicates that insulin resistance can disrupt the hormonal balance essential for conception, leading to fertility challenges in both women and men.
Understanding Insulin Resistance
Insulin resistance is a condition where the pancreas produces adequate levels of insulin, but the cells don’t respond to it as they should. Insulin is a hormone that is produced by the pancreas. Its main job is to control how your body uses and stores blood sugar (glucose). During digestion, insulin stimulates muscle, fat, and liver cells to absorb that glucose. Insulin resistance occurs when the body’s cells become less responsive to the hormone insulin, which plays a key role in regulating blood sugar levels. When the cells stop responding to insulin, blood sugar remains high, prompting your body to keep releasing insulin.
Over time, the pancreas tires of this excess secretion and doesn’t make enough insulin to keep blood glucose levels in the normal range. Put simply, the goal of treating insulin resistance is to make the cells more sensitive to insulin.
The Vicious Cycle of Insulin Resistance
Perhaps one of the most frustrating aspects of insulin resistance is the vicious cycle it sparks. Once insulin resistance occurs, it can lead to overeating, which can lead to excess weight gain, which can lead to increased inflammation, which then promotes insulin resistance. In the presence of excess weight, insulin resistance can also lead to leptin resistance (leptin is a hormone that signals to the brain that you are full). When the brain is resistant to leptin, hunger and satiety signals are disrupted. Excess weight (particularly in the abdominal area) can cause insulin resistance to worsen, so it is important to try to achieve a healthy weight.
Read also: Keto and Insulin Connection
Symptoms and Related Conditions
In some people, insulin resistance may not have any physical symptoms. Did you know that insulin resistance and type 2 diabetes are related? The good news? Insulin resistance and prediabetes are closely related conditions, but not the same. Many people are insulin resistant, but not all of them have diabetes.
The Impact of Insulin Resistance on Fertility
Diabetes is not a foreign term when it comes to infertility, but not everyone knows why it happens, how it affects your body, and what you can do about it. Researchers have found that women and men with elevated blood sugar and insulin resistance are at greater risk for fertility challenges.
Coincidentally, insulin is chemically similar to luteinizing hormone (LH), a fertility hormone involved in egg maturation and ovulation. When insulin levels are high, the body tends to confuse insulin for LH, mistakenly reducing LH production. This disruption in hormonal balance can result in missed or delayed ovulation, a condition known as anovulation.
High blood sugar, which can result from insulin resistance, has also been linked to reduced uterine health. According to research in Australia, excess sugar in the bloodstream can lead to increased levels of harmful compounds called advanced glycation end products (AGEs). These form when proteins or fats interact with sugar circulating in the body. As AGEs accumulate, they trigger inflammation and damage the uterine lining, impairing its ability to support implantation-a necessary step for pregnancy to occur.
While often overlooked, insulin resistance can also have a significant impact on male fertility. Elevated insulin levels and increased blood sugar levels can disrupt the delicate balance of hormones needed for healthy sperm production.
Read also: Herbal Support for Insulin Sensitivity
Dietary Strategies to Combat Insulin Resistance and Enhance Fertility
Understanding the factors that contribute to insulin resistance is essential for addressing its effects on fertility. Each of these factors can disrupt the body’s ability to use insulin effectively, leading to elevated blood sugar levels and hormonal imbalances that impact reproductive health. However, the good news is that many of these causes are modifiable through lifestyle changes, offering a clear path toward improving insulin sensitivity and enhancing fertility outcomes.
An individual diet, which comprises other comorbidities and lifestyle, is especially essential (15). As current studies indicate, a diet based on the Mediterranean diet (MeD) recommendations positively affects mental and physical health. The MeD has also been associated with favorable changes in insulin resistance, metabolic disturbances, and the risk of obesity, which is crucial in the context of fertility (5, 15).
Adopting a Balanced Diet
Try to eat in a way that minimizes glucose (and insulin) spikes. When making a meal or snack, start with a healthy animal or plant-based protein, add fruit or vegetables, and a healthy fat (if not found in your protein source). Tip: When choosing a carb, make sure it's as close to its natural form as possible.
Limit processed foods, refined sugars, and unhealthy fats. PCOS patients should try to limit highly processed foods, sugary drinks, simple carbs that are stripped of fiber and nutrients, and fried foods.
The best foods for PCOS include whole foods that lessen inflammation and don’t spike blood sugar, including:
Read also: Comprehensive Guide to Insulin Resistance Diet
- A wide variety of colorful fruits and vegetables
- Healthy fats, like avocados, nuts, and seed
- Lean proteins, such as turkey, chicken, fish, and beans
- Complex carbohydrates, including whole grains and legumes
- Fiber-rich foods, such as broccoli, apples, sweet potatoes, and berries
The Pro-Fertility Diet
In a large cohort study by Chavarro et al. (19) in 17,544 women planning a pregnancy or who became pregnant during the study, there was an association between adherence to the pro-fertility diet (similar to the MeD) and a lower risk of infertility caused by ovulation disorders. The pro-fertility diet was characterized by a lower consumption of trans-fatty acids (TFAs) and a higher consumption of MUFAs and plant-derived protein, and decreased consumption of animal protein, low glycemic index foods, high-fiber foods, and-interestingly-high-fat dairy.
Carbohydrates, Glycemic Index, and Insulin Sensitivity
Both insulin sensitivity and glucose metabolism can significantly affect ovulation and female fertility. In terms of carbohydrates, glycemic index and load are especially essential. Insulin regulates metabolism but also reproductive functions; it can modulate ovarian steroidogenesis as well as hyperinsulinemia which are correlated positively with hyperandrogenism and ovulation disorders.
High glycemic index and load have been associated with higher fasting glucose concentrations, hyperinsulinemia, and insulin resistance, and therefore with higher concentrations of insulin-like growth factor I (IGF-I) and androgens, which can lead to endocrine disturbances and, thus, may alter the maturation of oocytes (5). A large cohort study conducted in 18,555 women without a history of infertility, who planned or became pregnant during the study, showed that a higher consumption of carbohydrates at the cost of naturally occurring fats and with a high glycemic index was positively associated with infertility due to ovulation disorders (34). These results were confirmed by other studies where the higher consumption of high glycemic index products and carbohydrates, when compared with fiber intake, and a high consumption of simple sugars were related to lower chances of becoming pregnant (33). The main sources of added sugars are carbonated beverages, which can negatively affect fertility (35). Moreover, Machtinger et al. (36) observed that the consumption of sweetened, carbonated beverages-independently of the caffeine intake-can decrease the chances of reproductive success by means of ART.
Fats and Fertility
Fats constitute a vital dietary compound affecting fertility. Furthermore, it seems that the quality of fat is more important than its amount. The Chavarro et al. study (39) comprising 18,555 women planning a pregnancy or who became pregnant during the study demonstrated that increasing the intake of TFAs by even 2% resulted in a significant increase in infertility risk due to ovulation disorders.
TFAs have proinflammatory properties and may increase insulin resistance, increasing the risk of developing type 2 diabetes or other metabolic disturbances, including PCOS, which can negatively affect fertility (39, 44-47). It has been assumed that the direct negative effect of TFAs is associated with their influence on and a decreased expression of peroxisome proliferator-activated receptor γ (PPAR-γ). Moreover, the intake of TFAs was associated with the incidence of endometriosis (48).
On the other hand, ɷ-3 FAs can positively affect fertility, as they play an essential role in steroidogenesis and have significant anti-inflammatory properties (50, 51). Currently, the available studies indicate that ɷ-3 FAs from oily fish or supplements have a beneficial effect on the growth and maturation of oocytes, decrease the risk of anovulation, and improve embryo morphology, and are associated with higher concentrations of progesterone (40, 51, 52). It seems, however, that ɷ-3 FAs-by increasing insulin sensitivity and improving the lipid profile-may be helpful in the treatment of PCOS, although more studies are required (57).
Conversely, MUFAs can bind with the PPAR-γ receptor, thus decreasing inflammation and positively affecting fertility.
Studies investigating the influence of dairy-derived fats on fertility are interesting, although the results are often contradictory. On the one hand, according to the study by Chavarro et al. (63), the consumption of low-fat dairy-including low-fat milk, yogurt, and cottage cheese-increased the risk of infertility due to anovulation, whereas high-fat dairy increased fertility. This may possibly be associated with a higher content of estrogen and fat-soluble vitamins in high-fat dairy. Moreover, it could also be assumed that the beneficial effect of dairy-derived fat may be associated with the presence of the trans-palmitoleic acid, which seems to improve insulin sensitivity (64,…
Beyond Diet: Holistic Approaches to Fertility
Lifestyle-including caloric intake and diet composition in terms of vitamins, protein, lipids, carbohydrates, as well as the mineral content-seems to be especially vital in the context of infertility caused by endometriosis and ovulation disorders (9-12). Interestingly, the frequency and intensity of physical activity may differently affect fertility-intensive sports, influencing the hypothalamus-pituitary axis, may lead to hypothalamic amenorrhea and subsequently lead to infertility. However, moderate physical activity is recommended to improve ovarian function and fertility, especially among women with obesity or unable to handle stressful situations (11, 13). In view of the abovementioned factors, it is vital to adopt a holistic approach to infertility treatment in both women and men, including many specialists (e.g., physicians, dietitians, physiologists, physiotherapists).
Exercise
Exercise is the greatest insulin-sensitizing agent, even in the absence of weight loss. Like any new habit, getting started is hard. Physical activity becomes more rewarding the more you do it.
Stress Management
Chronic stress affects all body systems and kicks off a cascade of hormones (like adrenaline and cortisol) that are insulin antagonists, meaning they "work against" insulin.
Manage Stress: Chronic stress has been shown to raise cortisol levels, which can worsen insulin resistance.
If you are new to these practices, we suggest using an app that offers guided meditation exercises (i.e. Remember that this is a practice, so don't beat yourself up if you find it hard to clear your mind right away. When you get distracted, try to just go back to thinking about your breath. This gentle, stress-reducing form of exercise offers great benefits for those navigating insulin resistance or other hormonal challenges. There is significant evidence that counseling and mental health support during a fertility journey can lower levels of stress hormones and inflammatory markers. One of the best ways to reduce anxiety is to practice a sense of thankfulness on a regular basis. You can do this by journaling or simply thinking about three things you are grateful for before going to sleep.
Diets from Mediterranean cultures - often praised in fertility studies - are about more than the food itself. They emphasize sharing meals, slowing down, and making eating a social, joyful experience.
Medical Interventions
For individuals facing fertility challenges related to insulin resistance, fertility treatments offer an effective way to enhance the chances of conception.
In Vitro Fertilization {IVF}: For both men and women, IVF offers a way to optimize the chances of conception by carefully monitoring and controlling fertilization outside the body.
Combining fertility treatments with lifestyle changes, such as diet and exercise, can maximize the likelihood of success.
A healthy diet can improve the chances of conception for women with PCOS, but it doesn't guarantee pregnancy. Luckily, there are advanced reproductive technologies (ART) like intrauterine insemination (IUI) and in vitro fertilization (IVF) that can assist in the conception process.
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