Antioxidant Intake and Ovarian Reserve in Women Attending a Fertility Center

Abstract

Background/objectives: The aim of this study was to investigate the association between antioxidant intake and antral follicle count (AFC), a marker of ovarian reserve, in women attending a fertility clinic.

Methods: We conducted an observational study with 567 women undergoing infertility evaluation at the Massachusetts General Hospital Fertility Center, who were enrolled in the Environment and Reproductive Health (EARTH) study. Participants filled out the lifestyle and health questionnaires and a validated food frequency questionnaire (FFQ) for assessing habitual dietary intake and underwent a transvaginal ultrasound to measure AFC. Intake of nutrients with direct antioxidant capacity (vitamin A, C, and E and carotenoids) and intake of antioxidant food sources were estimated from the FFQ. Adjusted Poisson regression models were fitted to assess the relationships between antioxidants and AFC while adjusting for potential confounders. Non-linearity was assessed with restricted cubic splines.

Results: The median (interquartile range) age and AFC of participants were 35.0 (32.0-38.0) years and 13 (9-18), respectively. Our findings revealed a non-linear association between lycopene intake and AFC. There was a positive linear association with the highest AFC among women consuming approximately 6000 mcg/day of lycopene (p for non-linearity = 0.003). An inverse association was observed between retinol intake, predominantly from dairy foods, and AFC among women aged under 35 years (p-trend < 0.001 and 0.01, respectively).

Conclusions: Our findings suggest that lycopene intake might influence the ovarian reserve in fertility patients. The observed inverse association with retinol, if confirmed, may reflect biological mechanisms different from oxidative stress. The underlying mechanisms of these associations remain to be elucidated and warrant further investigation.

Keywords: antioxidants; antral follicle count; female fertility; lycopene; ovarian reserve; retinol.

Figure 1

Restricted cubic spline plot of the association between retinol intake and antral follicle count among 567 women in the EARTH study after multivariable adjustment. p-value for non-linearity = 0.23.

Figure 2

Restricted cubic spline plot of the association between lycopene intake and antral follicle count among 567 women in the EARTH study after multivariable adjustment. p-value for non-linearity = 0.003. After restriction at the 95th percentile of lycopene intake from food distribution, the p-value for non-linearity was 0.003.

Figure 3

Restricted cubic spline plot of the associations between vitamin C intake from food source (a), supplement source (b) and antral follicle count among 567 women in the EARTH study after multivariable adjustment. p-value for non-linearity was <0.001 for food source, and 0.82 for supplement source. After restriction at the 95th percentile of vitamin C intake from food distribution, the p-value for non-linearity was 0.15 for food source.