Velmahos, A. H., Kuohung, W., Wang, T., & Wise, L. A. (2026). The Association Between History of Infertility and Dietary Practices: A Cross-Sectional Study Among Preconception Females. Journal of Restorative Reproductive Medicine, 2(1), 1-10. https://doi.org/10.63264/s9kw1069
Velmahos AH, Kuohung W, Wang T, Wise LA. The Association Between History of Infertility and Dietary Practices: A Cross-Sectional Study Among Preconception Females. Journal of Restorative Reproductive Medicine. 2026;2(1):1-10. doi:10.63264/s9kw1069
Velmahos, Andriana, et al. "The Association Between History of Infertility and Dietary Practices: A Cross-Sectional Study Among Preconception Females." Journal of Restorative Reproductive Medicine, vol. 2, no. 1, 2026, pp. 1-10.
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Boston University Chobanian and Avedisian School of Medicine
Slone Epidemiology Center at Boston University, Boston, Massachusetts and 2Lombardi Comprehensive Cancer Center at Georgetown University Medical Center, Washington, District of Columbia05vzafd60
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RRM Academy Synopsis
Ketogenic diets were more common among women evaluated for infertility
Women who saw a doctor for infertility were more likely to report following a ketogenic diet. The study surveyed 7,227 pregnancy planners across North America at one point in time. About 87 out of 100 reported following no particular diet. Women with a 12-month infertility history were less likely to report Paleo or Weight Watchers diets.
Key Findings
Of 7,227 women, 1,862 reported trying for twelve months or more without becoming pregnant, and 2,184 had visited a doctor because of difficulty becoming pregnant.
Overall, 86.6% reported following no particular diet. Vegetarian (4.6%) and ketogenic (2.8%) were the most common named diets, followed by Weight Watchers (1.7%).
With a 12-month infertility history, adjusted prevalence ratios (PR) were 0.43 (95% CI 0.19-0.98) for Paleo and 0.55 (95% CI 0.34-0.91) for Weight Watchers. A PR below 1 means less common.
Women who visited a doctor for infertility were more likely to follow a ketogenic diet (adjusted PR 1.56; 95% CI 1.17-2.09).
Versus women with no infertility history or doctor visit, ketogenic adherence was higher with ovulatory factor (PR 2.01; 95% CI 1.38-2.94) and tubal factor (PR 2.22; 95% CI 1.09-4.49) causes.
Interpretation
A cross-sectional study measures everything at one time point. The authors could not tell which came first, infertility or the diet, and they state the associations may not be causal. Women reported both themselves, so some misclassification is likely. Participants were pregnancy planners not using fertility treatment. The authors note the group had more non-Hispanic White women and a higher socioeconomic status than the general population. Most followed no named diet, so single-diet estimates rest on small groups: 59 women followed Paleo. For 12-month infertility alone, the ketogenic PR was 1.31 (95% CI 0.95-1.79), an interval that includes 1.
RRM Context
Restorative reproductive medicine looks for the cause of infertility. Diet is one lifestyle factor in that search. Of 1,860 women who reported a doctor's diagnosis, 51% reported an unidentified cause. That means a cause not yet found. The study recorded diet choices and no fertility outcomes, so the effect of any diet on conception remains untested here.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To evaluate the extent to which a history of infertility is associated with adherence to specific diets among reproductive-aged females.
Design
Cross-sectional analysis
Subjects
Between 2017–2023, 7,227 North American female pregnancy planners aged 21-45 years enrolled in PRESTO (Pregnancy Study Online), a preconception cohort study. Participants completed self-administered baseline questionnaires during preconception.
Exposure
Infertility history, defined as: 1) self-reported 12-month clinical infertility, 2) history of visiting a clinician for an infertility work-up, and/or 3) clinician-identified cause of infertility (e.g., ovulatory or tubal).
Main Outcome Measures
Adherence to specific diets, including vegetarian, vegan, Mediterranean, Paleo, Weight Watchers®, ketogenic, dairy free, gluten free, Atkins®, South Beach®, Zone®, raw foods, or other at baseline. Multivariable log-binomial regression models estimated the prevalence ratios (PRs) and 95% confidence intervals (CIs), adjusted for age, income, and body mass index (BMI).
Results
The percentage of participants with a history of infertility was 26% based on the 12-month clinical infertility definition, 30% based on visiting a physician for infertility evaluation, and 26% based on an infertility diagnosis following a physician visit. Overall adherence to any particular diet was low (4.6% vegetarian, 2.8% ketogenic, 1.7% Weight Watchers®, 1.4% Mediterranean, 1.3% vegan, 0.8% Paleo, and all other diets: <0.8%); 86.6% reported not adhering to any particular diet. A history of 12-month clinical infertility was associated with lower adherence to vegetarian (PR=0.78; 95% CI: 0.60-1.03), Paleo (PR=0.43; 95% CI: 0.19-0.98), and Weight Watchers® (PR=0.55; 95% CI: 0.34-0.91) diets. An infertility history involving a medical work-up was associated with a higher prevalence of adherence to a ketogenic diet (PR=1.56; 95% CI: 1.17-2.09). Participants whose infertility was attributed to ovulatory or tubal causes were nearly two times more likely to adhere to a ketogenic diet (PR=2.01; 95% CI: 1.38-2.94; PR=2.22; 95% CI: 1.09-4.49, respectively).
Limitations
The cross-sectional design cannot establish temporality or causality. Data on dietary patterns and infertility history were self-reported, which can introduce misclassification. Generalizability may be limited because participants were pregnancy planners not using fertility treatments; participants were also more likely to be non-Hispanic White and of higher socioeconomic status than the general population.
Conclusion
The ketogenic diet was more prevalent among females with an infertility history, while vegetarian, Paleo, and Weight Watchers® diets were less prevalent. These associations mirror the results of studies evaluating the reverse relationship, suggesting that some patients with infertility seek information for behavioral modifications via evidence-based medicine.
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