Research Article|Articles in Press

Adherence to the Mediterranean diet and the risk of unexpected poor response to ovarian hyperstimulation in IVF cycles

Published:March 17, 2023DOI:


      Research Question

      What is the impact of dietary habits on ovarian response to hyperstimulation? Can preconception adherence to the Mediterranean diet influence the rate of poor ovarian response? The impact of dietary habits on the success of IVF is controversial. Inconsistencies may be explained by confounders associated to the use of pregnancy as an outcome as well as by a reductionist view of diet that focuses on single components rather than on food patterns.


      This cross-sectional study analyzed the adherence to the Mediterranean diet in women with unexpected poor response to ovarian hyperstimulation. Main inclusion criteria were the following: age 18-39 years, normal weight, preserved ovarian reserve and starting dose of gonadotropins of 150-225 IU/day. The adherence to the Mediterranean diet was assessed through a Mediterranean Diet Score (MDS). Unexpected poor ovarian response was defined as the retrieval of ≤3 suitable oocytes.


      Three hundred and three women were included, of whom 48 (16%) showed an unexpected poor response. We did not observe a frank dose related association with tertiles of MDS at univariate analysis. However, at multivariate analysis, the risk of unexpected poor response was significantly lower for women in the second tertile of MDS compared to the first tertile (adjusted OR=0.29, 95%CI: 0.11-0.76) and for women in the second and third tertile, grouped together, compared to the first one (adjusted OR=0.34, 95%CI: 0.14-0.82).


      Low adherence to Mediterranean diet could be a as risk factor for unexpected poor response.


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      Stefania Noli graduated in Medicine at the University of Milan, Italy, in 2010. She completed her residency in Obstetrics and Gynecology at the same University in 2016. She works as clinical researcher of the University of Milan, at the Infertility Unit of the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico.