Oocyte Maturation and Fertilization-Related Outcomes Following a Pro-Fertility Diet Combined with Omega-3 Supplementation in Women Undergoing Assisted Reproductive Technology: A Secondary Analysis of a Randomized Controlled Trial
Year: 2026
Type: article
Abstract: Purpose: Oocyte developmental competence is a key determinant of IVF success, but randomized evidence on multi-component dietary interventions is limited. This paper reports prespecified secondary outcomes of a registered randomized trial (IRCT20130903014551N13) that examined whether a Pro-Fertility Diet (PFD) combined with omega-3 supplementation affects oocyte-related outcomes in women undergoing IVF/ICSI. Methods: In this randomized, parallel-group, single-blind (outcome assessors) trial at Hazrat Maryam Fertility Center (Isfahan, Iran), 180 infertile women aged 18-42 years were allocated (stratified block randomization by age and BMI) to a PFD plus omega-3 supplementation or to standard dietary advice for 8 weeks before IVF/ICSI. Embryo-related outcomes and fertilization rate from this trial have been published previously. The outcomes reported here for the first time are antral follicle count (AFC), cumulus-oocyte complexes (COCs), metaphase II (MII) oocytes and two-pronuclear (2PN) zygotes, analyzed in 167 women with available outcome data (complete-case analysis; 84 intervention, 83 control). Count outcomes were analyzed using Poisson regression with robust standard errors and fertilization rate (2PN per MII oocyte) using binomial regression, both adjusted for age and BMI. Results: Of the 180 randomized participants, 167 women (84 in the intervention group and 83 in the control group) were included in the complete-case analysis of oocyte counts. Compared with controls, the intervention group had higher MII oocyte counts (adjusted IRR = 1.16, 95% CI: 1.01-1.33; P = 0.035) and 2PN zygote counts (IRR = 1.38, 95% CI: 1.17-1.61; P < 0.001), as well as higher odds of fertilization (OR = 1.92, 95% CI: 1.41-2.63; P < 0.001). No statistically significant differences were observed for AFC or COC counts. After adjustment for multiple comparisons using the Holm and Benjamini-Hochberg procedures, the difference in 2PN zygote counts remained statistically significant (adjusted P < 0.001 with both methods), whereas the difference in MII oocyte counts did not (Holm-adjusted P = 0.104; BH-adjusted P = 0.069). Conclusions: In this exploratory secondary analysis, the combined nutritional intervention was associated with a higher 2PN zygote count, which remained statistically significant after correction for multiple comparisons. Although a higher MII oocyte count was observed in the initial adjusted analysis, this finding did not remain statistically significant after multiplicity adjustment. Further adequately powered randomized controlled trials are needed to confirm these findings.
DOI: 10.2147/ijwh.s646774
Institution: Isfahan University of Medical Sciences
Language: English
Subfield: Reproductive Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,836
OpenAlex ID: W7225195435