The Benefits of Eating a Mediterranean Diet for Fertility

Rich in fruits, vegetables, whole grains, and heart-healthy fats, there is growing evidence that eating a Mediterranean diet may also be beneficial for fertility. Here's what you should know.

In this article:

• What is the best fertility diet plan?
• Introduction to the Mediterranean Diet
• Benefits of the Mediterranean Diet for Fertility
• Mediterranean Diet Meal Plan
• Mediterranean Diet Recipe Ideas
• Mediterranean Diet Salad Dressing
• Mediterranean Diet Casseroles
• Mediterranean Diet Pizza
• Can you eat tofu on the Mediterranean diet?
• Is white rice OK on the Mediterranean diet?
• Can you have popcorn on the Mediterranean diet?

What is the best fertility diet plan?

Spoiler alert - there simply isn't one perfect fertility diet plan! However, there are ways of eating that have been shown to positively impact male and female fertility. 

Whether you've just started trying to conceive or have been on a fertility journey for some time, you have likely wondered if what you are eating is the most beneficial for your preconception health. 

While getting individualized nutrition recommendations is essential, it is clear that some "diets" (note: not the restrictive type) are typically more impactful than others. One of the most popular fertility diet plans is the Mediterranean diet, which has proven benefits for fertility - as well as overall health.

Introduction to the Mediterranean Diet

The Mediterranean diet is a way of eating based on the traditional cuisine of countries bordering the Mediterranean Sea, including France, Spain, Greece, and Italy. It has been widely recognized for its health benefits, particularly for heart health and longevity - but is often recommended to those working to optimize preconception health as well.

A Mediterranean type of diet is one that focuses on lean protein, healthy fats, and fiber-rich foods, while limiting red meat and more processed foods. It also stresses the importance of socialization, community, and exercise - finding daily movement that you enjoy.

Note: The Mediterranean diet also frequently includes moderate consumption of red wine - we recommend holding off on drinking alcohol while trying to conceive.

How to Follow the Mediterranean Diet

Want a quick reference guide to help you get started? Here are the basics:

• Prioritize: Vegetables, fish, whole grains, fruits, nuts, seeds, legumes, potatoes, herbs, spices, seafood, and extra virgin olive oil
• In moderation: Poultry, cheese, eggs, and yogurt
• Limit or avoid: Red meat, sugar-sweetened beverages, added sugars, processed meat, refined grains, other highly processed foods, beers, and liquors

Movement & Exercise

As always, don’t forget to include different types of movement that you enjoy. If you're someone who grew up doing sports, running, or have an established exercise routine, this will simply be a continuation of what you're used to.

If you don't currently have any type of movement practice, we encourage you to try various forms of exercise until you find something that sticks! Here are a few ideas to get you started:

• Yoga class (virtual or in-person)
• At-home dance workouts (lots of free videos on YouTube)
• A daily walk with your dog
• Swimming
• Hiking on the weekend
• Strength training

Join us for an upcoming virtual Fertile Yoga class - they're always free and open to all!

Benefits of the Mediterranean Diet for Fertility

There is growing evidence that eating a Mediterranean diet may improve your reproductive health, due to its positive impact on blood pressure and lipid panels, as well as its ability to increase antioxidants and decrease inflammation. The diet also has a positive effect for patients with diabetes and insulin resistance.

A case-controlled study found that patients who carefully adhered to a Mediterranean diet had enhanced fertility, while data shows that a diet high in trans fats, refined carbohydrates, and added sugars can negatively affect fertility.

According to a separate study published by the Journal of the American Heart Association, the Mediterranean diet can decrease adverse pregnancy outcomes such as preeclampsia and gestational diabetes, particularly for Black women. 

Now that you have a basic overview of the Mediterranean diet, let’s break down three nutritional pillars of this style of eating and their known benefits on fertility.

I. Healthy Fats

1. Omega-3 Fatty Acids

These polyunsaturated fats are essential, but the body cannot make them on its own, so you need to get your omega-3s from food sources. They play a role in building cell membranes (including sperm cells), maintaining hormone balance, and fetal brain development during pregnancy.

Omega-3s can also decrease inflammation and lower triglycerides (the "bad" type of fat that can build up in your blood and lead to heart disease). There is also evidence from a 2021 study that by increasing insulin sensitivity and improving the lipid profile, omega-3s may be helpful in the treatment of polycystic ovary syndrome (PCOS).

Think you might have PCOS? Take our short quiz to learn more.

Where to find them:

• Fish (such as salmon or sardines)
• Nuts (such as walnuts)
• Seeds (such as chia and flax seed - use these in limited amounts when trying to conceive)
• Some fortified foods, including eggs

How much to eat:

Health organizations typically recommend eating at least two servings of fatty fish per week to meet omega-3 fatty acid needs. However, for specific health conditions or dietary preferences, supplements may be considered under the guidance of a healthcare provider.

How to eat when TTC:

A nutritionist explores nutrients to focus on, which foods to limit or exclude, and how to adjust your diet for optimal fertility.

2. Monounsaturated Fats

Monounsaturated fats are considered one of the healthier fats, along with polyunsaturated fats (omega-3s). These fats are liquid at room temperature and can turn solid when chilled. Monounsaturated fats are known for their health benefits, especially when they are replacing saturated fats or trans fats in your diet. 

Some of the recognized benefits include reducing "bad" cholesterol levels (LDL) in your blood, which can lower your risk of heart disease and stroke, weight management (since foods rich in monounsaturated fats can be satisfying and help control hunger), and increasing insulin sensitivity (helpful in the treatment of PCOS and preventing Type 2 diabetes).

Where to find them:

• Olive oil, olives
• Avocados
• Nuts like almonds, peanuts, macadamia nuts, hazelnuts, and pecans
• Seeds (such as pumpkin seeds and sesame seeds)

How much to eat:

The inclusion of monounsaturated fats as part of a healthy diet is encouraged. However, because all fats are calorie-dense, it's important to consume them in moderation. Replacing saturated and trans fats with monounsaturated (and polyunsaturated) fats is a heart-healthy choice.

Some easy ways to incorporate these "good" fats are cooking with olive oil, choosing avocados as a spread instead of butter, or snacking on nuts instead of processed foods high in saturated fats. 

Types of Fats to Avoid

The Mediterranean diet limits foods high in saturated fat and trans fats, such as red meat, more processed meats, butter, and coconut oil. A 2017 study analyzed cases of infertility in men with poor semen quality and found that increased consumption of meat and processed foods correlates with poor semen quality.

Diets high in saturated fat can also negatively impact heart health, according to study performed by Harvard researchers in 2016. 

Trans fatty acids have been found to negatively affect ovulation function in women, promoting insulin resistance, and their increased consumption leads to an increase in inflammatory markers - while adopting a Mediterranean diet appears to positively affect ovulation.

II. Plant-Based Proteins

Incorporating more plant-based proteins into your diet has been linked with various health benefits, including potentially improving fertility for several reasons:

• They are a valuable source of dietary fiber, which can help regulate blood sugar levels. Stable blood sugar and insulin levels are important for hormonal balance, which is crucial for fertility.
• They full of many important nutrients (such as folate, which is critical for conception and fetal development).
• Studies show that choosing plant-based proteins over animal proteins decreases the risk of anovulatory infertility.  
• Plant-based foods are high in antioxidants, which can protect the body (including reproductive organs) from damage by free radicals. This oxidative stress protection is important for both male and female fertility.
• Plant-based proteins are generally lower in saturated fats compared to animal proteins. High intakes of saturated fats have been associated with poorer fertility outcomes in some studies.

Where to find them:

Some great plant-based protein sources include legumes, tofu and tempeh, edamame, beans, lentils, nuts and nut butters, and seeds. When incorporating plant-based proteins into your diet, it's important to consume a variety of these sources to ensure you're getting all essential amino acids and a wide range of other nutrients.

Do I need to eat meat? Not necessarily! Plant-based diets can be nutritionally complete and offer numerous health benefits with thoughtful planning.

III. Whole Grains & Complex Carbs

Whole grains are always a better option when compared with more refined grains (think: white bread) when trying to conceive.

Foods like brown rice, quinoa, oats, high-fiber cereal, and potatoes have more fiber, which can slow digestion of carbohydrates and therefore decrease large blood sugar (and insulin) spikes. Impaired glucose tolerance and/or insulin resistance can significantly impact ovulation and fertility.

Studies have shown that high-glycemic carbs such as white bread, white rice, or white pasta can have a negative effect on ovulation. It is important to not eliminate carbs when trying to conceive, even with insulin resistance or impaired glucose tolerance, but instead include smaller portions of complex carbs/whole grains with each meal to improve glucose metabolism.  

Mediterranean Diet Meal Plan

Here are some helpful tips for building your Mediterranean diet-friendly plate:  

1. Choose lean protein, such as chicken breast, turkey, or fish (while limiting more processed meats and red meats)
2. Make some meals using vegetarian forms of protein, such as legumes, nuts, seeds (chia and flax should only be consumed in limited amounts for fertility) and dairy
3. Include fiber-rich complex carbohydrates and whole grains
4. Add lots of colorful vegetables and fruits
5. Include healthy fats such as olive oil and avocado (when cooking or in dressings) 

Sample Menu: Mediterranean Diet

Want some ideas to kickstart your Mediterranean diet? Here's a sample menu to reference:

• Breakfast: Oatmeal with walnuts and berries
• Lunch: Vegetarian grain bowl with beans, quinoa, and veggies
• Snack: Yogurt with small amount of flax sprinkled on top, berries, and cinnamon
• Dinner: Salmon with asparagus and brown rice
• Beverage: Water throughout the day

Intuitive Eating 101

Learn the 10 principles of intuitive eating and the benefits of this framework for those navigating fertility treatment.

Mediterranean Diet Recipe Ideas

There are countless delicious meal and snack ideas to choose from that adhere to Mediterranean diet principles. Here are some of our favorites:

Mediterranean Diet Salad Dressing

Those following a Mediterranean diet often discover a new love of hearty, fresh salads! This lemon olive oil dressing called ladolemono is perfect for dressing salads, as a marinade, or as a sauce to finish anything from fish to chicken to grilled vegetables. 

Ingredients:

• ¼ cup fresh lemon juice (2 large lemons)
• 2 tsp dry oregano for a little more flavor
• 1 fresh garlic clove, minced
• Kosher salt and black pepper to your liking
• Extra virgin olive oil

Mediterranean Diet Casseroles 

Casseroles are an easy way to meal prep and ensure that you can stick to your nutrition goals on busy days. Here are a few recipe ideas to get you started:

• Baked Enchilada Casserole
• Mediterranean Chicken Casserole
• Mediterranean Chickpea Casserole with Spinach and Feta

Mediterranean Diet Pizza

Yes, you can still eat pizza while following the Mediterranean diet! The following recipes offer tasty takes on everyone's favorite food:

• Mediterranean Diet Margherita Pizza
• Easy Mediterranean Pizza

Mediterranean Diet Snacks

In any style of eating, good snacks are key to maintaining balanced blood sugar and ensuring you don't go too long between meals. Thankfully, there are lots of yummy snack options that will fit into your new Mediterranean diet!

Mediterranean Diet FAQs

Note: Always consult with your doctor (and ideally, a registered dietitian nutritionist) before making dietary or lifestyle changes. They will be happy to support you.

As you explore the benefits of this style of eating, you will likely run into quite a few questions. Here are some of the most common queries about the Mediterranean diet:

Can you eat tofu on the Mediterranean diet?

Yes, you can eat tofu on the Mediterranean diet. While tofu doesn't traditionally feature prominently in Mediterranean cuisine, it's a plant-based protein source that aligns well with the diet's emphasis on plant-based foods and healthy eating patterns.

Tofu is low in calories but high in protein and contains beneficial fats, vitamins, and minerals. It's a versatile ingredient that can be used in a variety of dishes, from salads and stir-fries to smoothies and desserts, making it easy to incorporate into the diet.

Is white rice or pasta OK on the Mediterranean diet?

You should aim to limit white pasta, white rice, corn, and white potatoes, instead opting for non-starchy vegetables and whole grains. You can also swap white pasta with a more nutrient dense and fiber-filled choice, such as chickpea pasta. Some popular protein pasta brands include Barilla and Banza.

Can you have popcorn on the Mediterranean diet?

Yes, popcorn can be enjoyed as part of the Mediterranean diet, provided it's prepared in a healthy way that aligns with the diet's principles. The Mediterranean diet emphasizes whole grains, and popcorn is a whole grain snack. However, the key is how the popcorn is prepared and what additions are used.

In a Mediterranean diet-friendly version, popcorn should be air-popped or cooked in a small amount of a healthy fat, such as extra virgin olive oil, instead of butter or coconut oil, which are high in saturated fats. Olive oil is a staple of the Mediterranean diet and is favored for its health benefits, including heart-healthy monounsaturated fats.

To align with the Mediterranean diet, it's also important to avoid or minimize added salt and butter. Instead, you can season your popcorn with a variety of herbs and spices such as rosemary, garlic powder, or smoked paprika for flavor without adding excessive sodium or unhealthy fats.

Find What Works for You

Exploring the many benefits of the Mediterranean diet for fertility and overall health may encourage you to incorporate some new foods into your daily routine - whether or not you decide to adhere to Mediterranean eating principles.

If you're trying to conceive (whether it be on your own or via fertility treatment), consider meeting with a registered dietitian nutritionist to discuss your goals and concerns. Having a strong Care Team supporting you as you work to build your family will make the journey far more enjoyable - and any lifestyle changes more sustainable.

Always talk to your doctor before embarking on a new diet or exercise regimen.