LocationAustriaIraqUnited KingdomNetherlandsIranStudy DesignOpen-label pilot study, randomised controlled trialSingle-blind randomised, controlled trialDouble-blind, randomised, controlled trialProspective cohort studyDescriptive longitudinal studyN. of participants100120102235174Inclusion criteriaWomen with BMI > 20, < 28 kg/m2, 19–42 years, undergoing IVFSubfertile women, BMI > 18, < 35 kg/m2, 20–40 years, undergoing IVF, and fresh sperm sample (not aspirated)Women with BMI ≤ 20, ≥32 kg/m2, 18–41 years, undergoing IVF/ICSIWomen undergoing IVF/ICSI treatmentInfertile women undergoing IVF/ICSIExclusion criteriaWomen assuming vitamins or multi-nutrients, other than folic acid alone for the previous 3 monthsWomen who have medical disorders, artificial sperm collection use of any medications in the last 12 weeks that may influence hormonal assay, history of any diet in the previous three months, tobacco and alcohol consumption, and supplementation of n-3 PUFAs in the past three monthsMedical contraindication to ART treatment or to a specific dietary intervention, previously diagnosed diabetes, taking prescribed medication or herbal remedies apart from simple painkillers, and eating oily fish (as defined by the UK Food Standards Agency) more than once a weekWomen experiencing conditions that impair IVF outcomeChange on the diet or following special diet, metabolic disorders, assuming drugs affecting the metabolism, anatomic abnormalities or surgery in the uterus or tubes, using a surrogate, assuming alcohol, smokersExposureOne tablet a day containingOne tablet a day containing 1000 mg omega-3 composed of 180 mg EPA and 120 mg DHADietary intervention with olive oil for cooking, an olive oil-based spread, and a daily supplement drink enriched with Vitamin D (10 µg daily) and marine omega-3 FA (2 g daily)Validated FFQ to evaluate long-chain PUFAs intakeValidated FFQ including 168 food itemsControlOne capsule containing 400 μg folic acidCapsule containing 500 mg paraffinSunflower seed oil for cooking, a sunflower seed oil–based spread, and a daily supplement drink without EPA, DHA, or vitamin D––Duration30–39 days8 weeks6 weeksAssessment of nutritional intake over 4 weeksAssessment of nutritional intake over 1 yearFertility Parameters ExaminedEmbryo quality and pregnancy ratesEmbryo grading and ICSI outcome parametersMean period in hours for CC2Embryo quality, number of follicles and estradiol levelsMII oocytes, fertilization rate, embryo quality, biochemical and clinical pregnancyResultsHigher embryo quality in the study group. No significant difference in pregnancy rates.Higher 2PN zygote, fertilization rate, cleavage rate, grade 1, and endometrial thickness. Higher pregnancy rate but with no significant difference.Overall improvement in the morphokinetic markers of embryo qualityThe number of follicles and E2 response was inversely associated with high intakes of total omega-3.
Significant positive associations between embryo morphology and total omega-3 intake and DHA.
High omega-6-to-omega-3 ratio was positively associated with the number of follicles.Significant increase in MII oocytes in the higher tertile of ALA; lower MII oocytes in the higher tertile of EPA and DHA; higher fertilization rate with higher intake of ALA and EPA.ConclusionA multivitamin supplementation that includes omega-3 FA is beneficial in terms of fertilization rates and embryo qualityA short period of dietary supplementation alters the rate of embryo cleavage by increasing the efficiency of embryo development before the implantA high intake of omega-3-rich oil led to a significant increase in ovulation and follicles developmentDietary long-chain PUFAs significantly contribute to E2 levels, number of follicles and embryo morphologyALA is directly associated with the number of oocytes. A high intake of EPA and DHA is associated with fewer MII oocytes. PUFAs could improve embryo quality.Risk of BiasHighSome concernsLowNANAStudy QualityVery lowVery lowModerateLowLow