Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, MA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Am J Obstet Gynecol. 2018 Apr;218(4):379-389. doi: 10.1016/j.ajog.2017.08.010. Epub 2017 Aug 24.
The literature on the relationship between diet and human fertility has greatly expanded over the last decade, resulting in the identification of a few clear patterns. Intake of supplemental folic acid, particularly at doses higher than those recommended for the prevention of neural tube defects, has been consistently related to lower frequency of infertility, lower risk of pregnancy loss, and greater success in infertility treatment. On the other hand and despite promising evidence from animal models, vitamin D does not appear to exert an important role in human fertility in the absence of deficiency. Antioxidant supplementation does not appear to offer any benefits to women undergoing infertility treatment, but it appears to be beneficial when it is the male partner who is supplemented. However, the available evidence does not allow discerning which specific antioxidants, or at which doses, are responsible for this benefit. Long-chain omega-3 fatty acids appear to improve female fertility, although it remains unclear to what extent contamination of shared food sources, such as fish with high levels of environmental toxicants, can dampen this benefit. Lastly, adherence to healthy diets favoring seafood, poultry, whole grains, fruits, and vegetables are related to better fertility in women and better semen quality in men. The cumulative evidence has also piled against popular hypotheses. Dairy and soy, once proposed as reproductive toxicants, have not been consistently related to poor fertility. In fact, soy and soy supplements appear to exert a beneficial effect among women undergoing infertility treatment. Similarly, because data from large, high-quality studies continue to accumulate, the evidence of a potentially deleterious effect of moderate alcohol and caffeine intake on the ability to become pregnant seems less solid than it once did. While a complete picture of the role of nutrition on fertility is far from complete, much progress has been made. The most salient gaps in the current evidence include jointly considering female and male diets and testing the most consistent findings in randomized trials.
过去十年间，有关饮食与人类生育力之间关系的文献大量增加，这使得一些明确的模式得以确定。补充叶酸，尤其是剂量高于神经管缺陷预防剂量时，一直与不孕频率降低、妊娠丢失风险降低以及不孕治疗成功率提高有关。另一方面，尽管动物模型的研究结果很有前景，但维生素 D 在没有缺乏的情况下似乎对人类生育力没有重要作用。抗氧化剂补充似乎对接受不孕治疗的女性没有任何益处，但当补充的是男性伴侣时，似乎有益。然而，现有证据尚无法确定是哪种特定的抗氧化剂或在何种剂量下对这种益处负责。长链 ω-3 脂肪酸似乎可以改善女性生育力，尽管尚不清楚共享食物来源（如鱼类）中的环境污染毒素的污染程度会在多大程度上削弱这种益处。最后，遵循有利于海鲜、家禽、全谷物、水果和蔬菜的健康饮食有助于提高女性的生育能力和男性的精子质量。累积的证据也对流行的假说提出了质疑。乳制品和大豆曾经被认为是生殖毒物，但它们与不良生育力之间的关系并不一致。事实上，大豆及其补充剂似乎对接受不孕治疗的女性有有益的影响。同样，由于来自大型高质量研究的数据不断增加，适度饮酒和咖啡因摄入对怀孕能力的潜在有害影响的证据似乎不如以前那么确凿。尽管营养对生育力的作用的全貌还远未完整，但已经取得了很大的进展。目前证据中最显著的差距包括共同考虑女性和男性的饮食以及在随机试验中测试最一致的发现。
