Folate Intake and Ovarian Reserve Among Women Attending a Fertility Center Open Access
Kadir, Mumta (Spring 2021)
Published
Abstract
Background: Higher folate intake has been linked to shorter time to pregnancy and greater success of infertility treatments; however, the mechanisms underlying the beneficial effects of folate on female fertility have been less studied. Factors such as diet may affect antral follicle count (AFC), a well-accepted measure of ovarian reserve, although the research is sparse.
Methods: Our analysis included 552 women attending the Massachusetts General Hospital Fertility Center (2007-2019) who participated in the Environment and Reproductive Health Study. We measured folate intake using a validated food frequency questionnaire and AFC using transvaginal ultrasonography. Multivariable Poisson regression models with robust standard errors were used to estimate the association of folate intake with AFC adjusting for calorie intake, age, BMI, physical activity, education, smoking status, year of AFC scan, and intakes of vitamin B12, iron, and vitamin D. Non-linearity was assessed with restricted cubic splines.
Results: Among the 552 women (median age 35.0 years, median folate intake 1,005 µg/day), total and supplemental folate intake had a significant non-linear relationship with AFC (P for non-linearity 0.05 and 0.02, respectively). There was a positive linear association with AFC up to approximately 1200 µg/day for total folate intake and up to 800 µg/day for supplemental folate intake; however, there was no additional benefit of higher folate intakes.
Limitations: Due to the sole inclusion of women undergoing infertility treatment, who tended to be of older reproductive age, White, and of high socioeconomic status, the generalizability of our results to all reproductive-aged women is unclear. Given the modest effect estimates, our results may have limited clinical applicability as the reproductive benefits of gaining 1 to 2 additional antral follicles with higher folate intake is unclear.
Conclusions: Our results support current recommendations from the Centers from Disease Control and Prevention that all women planning pregnancy should be consuming at least 400 µg/day of folic acid and suggests that additional benefit may be seen with up to 800 µg/day. Our results provide biological insight into one potential mechanism that could be mediating the positive relationships observed between folate intake and female fertility.
Table of Contents
Table of Contents
Introduction...............................................................................................................................1 Methods......................................................................................................................................2 Results.........................................................................................................................................5 Discussion..................................................................................................................................7 References.................................................................................................................................12 Tables........................................................................................................................................14
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