What to eat when you feel like a storm cloud

retaking Sex Ed to learn more about the connection between diet and fertility

Disclaimer: I am incredibly lucky to have a loving partner, support system, and generous health insurance policy. That is, unfortunately, not true for everyone going through IVF. There are great support resources for navigating the ups and downs: Headspace has a fertility-specific offering, IVF reddit has a goldmine of tips and stories, and your doctor will have more recommendations for local groups. I am not a health professional, but my DMs are open.

This newsletter covers my experience, as well as the science and business, of the intersection of fertility hormones and diet. If you think this would be helpful to anyone you know, please share it. Later this week, we’re back to some lighter topics!

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My only memory of 7th grade Sex Ed haunts me: the gym teacher pulled out a package of Oreos and handed a cookie to Katie O. He told her to pass it to the person behind her, and so on, until all 23 students had held the cookie. He took that cookie in his left hand and pulled out another cookie with his right. “Which Oreo would you rather eat?” he asked the class, “this fresh one? or this one? That’s right, you don’t want a used cookie.”

Never mind what that class did for my early opinions of virginity, it didn’t include much helpful insight into fertility. Over the last few months, I’ve mentioned that I’ve been going through the beginning of the IVF process. It has been tough:

I’ve had a lot of questions: What is happening to my body? What should I be eating? What does this industry look like? In this newsletter, I set out to answer them. But first, a science primer! If you were lucky enough to have a more thorough Sex Ed class, you can skip ahead.

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Fertility Hormones 101

Four hormones are most critical for women’s fertility:

• Estrogen: prepares the uterus for pregnancy and supports overall reproductive function

• Progesterone: prepares the uterus for pregnancy

• Follicle-stimulated hormone (FSH): stimulates the growth of eggs

• Luteinizing hormone (LH): triggers ovulation

During a typical menstrual cycle, the four main hormones do a choreographed dance ensuring the maturity and release of eggs to be fertilized. During the first phase of IVF, the egg retrieval, you typically receive additional FSH and LH to mature and release multiple eggs (called oocytes). Many regimens also include additional hormones to mature the eggs safely (e.g. human chorionic gonadotropin (HCG)).

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Impact of Diet on Fertility Hormones

The gut-brain axis, the communication system between the gut and brain, plays a significant role in regulating reproductive hormones. Emerging evidence suggests that the gut microbiome, the ecosystem of microorganisms that helps in the break down and absorption of nutrients and hormones, influences fertility, by:

• Reducing inflammation in the reproductive organs

• Metabolizing estrogen effectively

• Absorbing critical nutrients (including folate, iron, and vitamin D)

• Regulating stress (cortisol, in particular, can disrupt the balance of fertility hormones)¹

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The Action Plan

I turned to a few dietitians (including

Sophia Deahl, MS, RDN

), my endocrinologist, friends who had gone through the process, and my beloved JAMA to learn more about what I could do to influence the outcomes. Here’s what we came up with:

1. Invest in the microbiome: fiber, pre- and probiotics to improve microbiome diversity, hormonal regulation and metabolism.² Since hormone levels are artificially elevated during the first phase of IVF, metabolizing them efficiently post-extraction would be critical for recovery.

2. Stick to the Mediterranean diet: proven to decrease inflammation, maintain hormonal balance, and increase insulin sensitivity:³

   1. Omega-3 fatty acids⁴: tinned fish girlies, you’re in luck

   2. Folate⁵: many a dense bean salad

   3. Vitamins A, E, D, and polyamines⁶: full-fat dairy⁷, hard cheeses

3. Cut out the fun stuff: alcohol, excess sugar, processed foods, saturated fats, and cannabis are all linked to decreased fertility outcomes.⁸

4. Men, don’t think I’ve forgotten about you!

   1. Walnuts: help you get that nut. One study found eating one handful of walnuts daily for three months produced healthier, more concentrated sperm.⁹

   2. Lycopene: improves sperm count and movement.¹⁰ It’s time to load up on cooked tomatoes.

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Three Additional Tips

Everyone’s experience is unique, but mine went like this:

In addition to this salmon recipe (and so much kimchi), these helped:

1. Loading up on electrolytes: to flush the excess hormones, remain hydrated, and decrease bloating in the days around the extraction.¹¹ I went through gallons of watermelon juice and coconut water.

2. Acupuncture: some research shows that it might egg quality and yield.¹² I found the forced mindfulness helpful.

3. More chocolate chip cookies than I’d like to admit.

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Industry Outlook

Femtech innovation has gone through waves over the years, and investors are still a bit gun-shy given the lack of major returns. That aside, there are many important, life-changing businesses to be built for a TAM of over 50% of the world’s population. A few themes I am interested in:

• Managing overall hormonal health (e.g., cycle tracking, PCOS, metabolic health, menopause):

  • Companies like Allara and Muse provide labs, personalized diet plans, and supplement recommendations for a variety of hormonal health conditions.

  • I’ll be curious if major players like Maven, which is positioning itself to be the end-to-end solution for women’s telehealth, will expand and market its offerings in this space. Midi, in particular, is branching out into weight management along with its core menopause (hormone replacement therapy) services.

• Making care more comfortable — even luxurious:

  • Chiyo: provides personalized meal delivery for IVF, prenatal, and postpartum.

  • Lushi: recently raised $5M for an IVF concierge service (they mix and inject medications for you)

  • After seeing the popularity of postpartum hotels in Asia, I know there’s a there there — but the American attitude toward motherhood is not there yet. In the meantime, Boram has expanded from hotel-only to a digital education product. Helpful! People will still learn most of their tips from TikTok.

• A few others:

  • Expediting the fertility process (e.g., Gameto is cutting the egg maturity process from 14 days to three)

  • Integrating family and financial planning services

  • Personalized treatment for conditions that affect women differently or disproportionately (e.g., autoimmune diseases, migraines)

  • Revising Sex Ed in public schools :)

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More Stuff to Chew On

• The microbiome continues to make headlines — this time, in the debate over the cause of autism. “We demonstrated that gut metabolites impact the brain, and the brain, in turn, affects behavior. Essentially, the brain acts as the intermediary between gut health and autism-related behaviors,” said first author Lisa Aziz-Zadeh, a professor at the Brain and Creativity Institute at the USC Dornsife College of Letters, Arts and Sciences. So… not vaccines?

• All this hype about The Pitt has me wondering what real-life Noah Wyle has to eat all day. Thankfully,

  Ruth Reichl
  , Nancy Silverton, and
  Laurie Ochoa
  have an answer to why hospital food is so bad.

• The cool kids in Chinese cities have turned to “ganking” (killing) plants for fun — they’re foraging in public parks.

• In the latest of what I refer to as “gross marketing partnerships,” KFC teamed up with hismile to make fried chicken-flavored toothpaste and toothbrush. It has already sold out.

Sophia

1. Ahmad, F., Ahmed, S.H., Choucair, F. et al. A disturbed communication between hypothalamic-pituitary-ovary axis and gut microbiota in female infertility: is diet to blame?. J Transl Med 23, 92 (2025). https://doi.org/10.1186/s12967-025-06117-x

2. Ahmad, et al.

3. Skoracka K, Ratajczak AE, Rychter AM, Dobrowolska A, Krela-Kaźmierczak I. Female Fertility and the Nutritional Approach: The Most Essential Aspects. Adv Nutr. 2021 Dec 1;12(6):2372-2386. https://doi.org/10.1093/advances/nmab068

4. Stanhiser J, Jukic AMZ, McConnaughey DR, Steiner AZ. Omega-3 fatty acid supplementation and fecundability. Hum Reprod. 2022 May 3;37(5):1037-1046. https://doi.org/10.1093/humrep/deac027

5. Gaskins AJ, Afeiche MC, Wright DL, Toth TL, Williams PL, Gillman MW, Hauser R, Chavarro JE. Dietary folate and reproductive success among women undergoing assisted reproduction. Obstet Gynecol. 2014 Oct;124(4):801-809. https://pmc.ncbi.nlm.nih.gov/articles/PMC4172634/

6. Lefèvre PL, Palin MF, Murphy BD. Polyamines on the reproductive landscape. Endocr Rev. 2011 Oct;32(5):694-712, https://doi.org/10.1210/er.2011-0012

7. Chavarro JE, Rich-Edwards JW, Rosner B, Willet WC. A prospective study of dairy foods intake and anovulatory infertility, Human Reproduction 2007 May; 22(5):1340–1347, https://doi.org/10.1093/humrep/dem019

8. Ahmad, et al. Klonoff-Cohen HS, Natarajan L, Chen RV. A prospective study of the effects of female and male marijuana use on in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT) outcomes. Am J Obstet Gynecol. 2006 Feb;194(2):369-76. https://pubmed.ncbi.nlm.nih.gov/16458631/

9. Robbins W, Kim H, Houman J, Lee GW. Randomized Clinical Trial: Effect of Walnuts on Semen Parameters and Male Fertility (P18-042-19). Curr Dev Nutr. 2019 Jun 13;3(Suppl 1):nzz039.P18-042-19.https://pubmed.ncbi.nlm.nih.gov/34139003/

10. Durairajanayagam D, Agarwal A, Ong C, Prashast P. Lycopene and male infertility. Asian J Androl. 2014 May-Jun;16(3):420-5. https://pmc.ncbi.nlm.nih.gov/articles/PMC4023371/

11. Spring Fertility. Recovery After Egg Retrieval: What to Expect and How to Expedite Healing. https://springfertility.com/theblast/recovery-after-egg-retrieval-what-to-expect-and-how-to-expedite-healing/

12. Kim J, Lee H, Choi TY, Kim JI, Kang BK, Lee MS, Joo JK, Lee KS, You S. Acupuncture for Poor Ovarian Response: A Randomized Controlled Trial. J Clin Med. 2021 May 18;10(10):2182. https://pubmed.ncbi.nlm.nih.gov/34070086/