Dietary Folate and Reproductive Success Among Women Undergoing Assisted Reproduction

Abstract

Objective To evaluate prospectively the associations of folate with assisted reproductive technology outcomes within a U.S. population. Methods This analysis included women (n=232) in a prospective cohort study at the Massachusetts General Hospital Fertility Center. Diet was assessed before assisted reproductive technology treatment using a validated food frequency questionnaire. Intermediate and clinical endpoints of ART were abstracted from medical records. Generalized linear mixed models with random intercepts to account for multiple cycles per woman were used to evaluate the association of folate intake with ART outcomes adjusting for calorie intake, age, BMI, race, smoking status, infertility diagnosis, and protocol type. Results Among the 232 women (median age=35.2 years, median folate intake=1,778 μg/day), higher folate intake was associated with higher rates of implantation, clinical pregnancy, and live birth. The adjusted percentage (95% CI) of initiated assisted reproductive technology cycles resulting in a live birth for women in increasing quartiles of folate intake were 30% (21, 42%), 47% (35, 59%), 42% (30, 35%) and 56% (43, 67%)(P-trend=0.01). Live birth rates were 20% (8, 31%) higher among women in the highest quartile of supplemental folate intake (>800μg/day) than among women in the lowest quartile (<400μg/day). Higher supplemental folate intake was associated with higher fertilization rates and lower cycle failure rates before embryo transfer (P-trend=0.03 and 0.02). Conclusions Higher intake of supplemental folate was associated with higher live birth rates after assisted reproductive technology treatment.

Association between serum folate and vitamin B-12 and outcomes of assisted reproductive technologies

“…Previously, we reported that pretreatment intakes of folate and vitamin B-12 were related to a higher probability of live birth among women undergoing ART in the United States (15). Whereas our results were intriguing, our assessment of folate and vitamin B-12 was limited to self-reported dietary assessment with a food-frequency questionnaire.…”

Serum 25-hydroxyvitamin D concentrations and treatment outcomes of women undergoing assisted reproduction,

“…Tests for trend were conducted across categories by using the median 25(OH)D concentrations in each category as a continuous variable in the regression models. To account for potential confounders, multivariable models included terms for age, race, BMI, infertility diagnosis, season when the sample was taken, dietary factors previously related to treatment outcomes in this population (20), and overall food choices as captured by 2 dataderived dietary patterns (21). The dietary patterns were identified via factor analysis with orthogonal transformation based on 40 predefined food groups by using the FACTOR procedure with Varimax rotation option in SAS (SAS Institute Inc.) as previously described (21).…”

Supplementation during pregnancy: beliefs and science

“…In addition to the welldocumented association between folate supplementation and prevention of neural tube defects (NTDs) [23,24], periconceptional folic acid use is associated with epigenetic changes in insulin-like growth factor 2 in the child that may affect intrauterine programing of growth and development with consequences for health and disease throughout life [25]. Supplemental folate was also associated with higher live birth rates after assisted reproductive technology treatment [26], and reduced risks of spontaneous abortion [27], and congenital heart defects [28].…”