Read the attached paper and provide feedback on your peer’s Chapters 1-3 using the RISE model for meaningful feedback as shown here: RISE_infographic-peer-web-1.pdf
Creation of nutritional educational materials promoting
a Mediterranean diet for women struggling with infertility
By
Brianna Stewart
Applied Project Committee:
Christy Alexon, PhD, RD
Christina Shepard, MS, RDN, FAND
ARIZONA STATE UNIVERSITY
August 2023
CHAPTER I
INTRODUCTION
More couples are struggling to conceive now more than ever. Infertility rates are on the rise and globally,
1 in 6 people worldwide are being affected. (1) Studies show that there is no correlation between
socioeconomic class and infertility, leaving us to question why so many are struggling to become
pregnant. (1) This concerning rise in prevalence has left thousands of couples feeling frustrated and
defeated. However, current research shows promising benefits to implementing a preconception period of
at least three months prior to trying to conceive as a way of preparing the body and optimizing one’s
chance of successful conception. Not only does implementing a proactive approach to one’s pregnancy
journey improve chances of a healthy pregnancy outcome for maternal and child well-being, but also
establishes a sense of empowerment and self-advocation.
Evidence agrees that the healthier state of being a woman is prior to conceiving, the healthier her
pregnancy will be. (2) However, there are many ways to approach this concept and with the
overabundance of contradictory information floating around, it can quickly become overwhelming to sort
through the research. Nutrition is one of the leading factors to one’s state of health and wellbeing.
Therefore, implementing a nutrient rich diet during one’s preconception period will have a greatly
beneficial impact on pregnancy in general as well as maternal and child health outcomes. (2)
There are many arguments for what nutritional approach is optimal, however the Mediterranean diet has
been well researched with plenty of evidence to support its implementation. The Mediterranean diet is
characterized by its abundance of antioxidants and omega fatty acids, all of which have been widely
correlated as beneficial to reducing risk of cancer, cardiovascular disease and even cognitive health. (3)
By following this plant based dietary approach that is high in leafy greens, fruits and fish the consumer is
more likely to increase intake of vital nutrients needed for optimal reproductive health, thus optimizing
fertility. (4)
Research into the beneficial implementation of a Mediterranean diet on fertility is not limited to the woman
but also has been linked to the males’ sperm health and motility. (5) Further supporting this evidence
based, accessible and non-invasive approach to better fertility, maternal and child health outcomes. By
exploring the correlation of a nutrient dense Mediterranean dietary approach for a couple’s preconception
period and increased rates of conception in couples struggling with fertility, we can contribute valuable
educational material that is widely attainable.
By targeting women of reproductive age (18-45 years old) who are actively trying to conceive, the
utilization of social media platforms will boost substantial reach. While limitations do arise with the spread
of medical information often being misleading on these sites, the inclusion of well researched approaches
and tools along with their sources will be of utmost importance. With such promising evidence-based
research of the positive impact of implementing a nutrient dense Mediterranean dietary approach in the
three months prior to a couple trying to conceive, this educational material will not only bring healing to
couples struggling with fertility but also a renewed sense of hope and optimism.
Purpose of Study:
The purpose of this study is to examine the potential impact of a nutrient dense Mediterranean diet on the
rate of conception for women of reproductive age who are actively trying to conceive but have been faced
with unexplained infertility. By diving into the literature correlating a Mediterranean diet and fertility, we will
be able to gain greater insight into dietary impacts for women in the months leading up to planned
conception. This study will present educational materials to guide and support these women via social
media platforms and searchable website databases.
Hypothesis:
Generating educational material that is easily accessible to women trying to conceive will encourage the
normalization of a preconception planning period. Implementing a nutrient dense Mediterranean diet
during this preconception period will positively affect fertility.
Definitions:
Conception = when a sperm fertilizes an egg, the beginning of pregnancy (6)
Mediterranean diet = plant based dietary pattern high in leafy green vegetables, fruits, legumes, nuts,
seeds and oils such as extra virgin olive oil. Includes moderate consumption of fish, meat, dairy products
and red wine. (4)
Infertility = failure to become pregnant after at least 12 months of consistent unprotected sexual
intercourse (7)
Preconception period = a minimum of three months prior to trying to become pregnant (2)
Limitations:
This study will aim to create accessible and relatable educational materials targeted to reach the
appropriate age range of females trying to conceive. While social media platforms will generate
reachability and engagement, ethical guidelines in regard to the spread of medical information on such
platforms remains in question.
Analysis and
Interpretation
of the
Research
Meets
Nearly Meets
Does Not Meet
60.0 to >54.0 pts
54.0 to >41.0 pts
41.0 to >0 pts
It is always clear that this
student understands his/her
research well enough that
he/she can put it into his/her
own words.
It is usually clear that this
student understands his/her
research well enough that
he/she can mostly put it into
his/her own words.
It is never clear that this
student understands
his/her research well
enough that he/she can
put it into his/her own
words.
The research presented
supports the research aim.
The research presented
mostly supports the research
aim.
The first section of the
general introduction (before
The first section of the
general introduction (before
the purpose of the study) is
at least 1-1.5 pages
The research presented
does not support the
research aim.
The first section of the
general introduction
(before the purpose of the
study) is less than 1 page.
the purpose of the study) is at
least 1.5 pages
Organization of
the research
20.0 to >17.0 pts
17.0 to >13.0 pts
13.0 to >0 pts
Research is always clearly
organized with appropriate
headings throughout. Flow of
the research always make
sense and appropriate
transitional phrases are used.
Research is usually clearly
organized with appropriate
headings throughout. Flow of
the research usually make
sense and some appropriate
transitional phrases are
used.
Research is not clearly
organized with no
appropriate headings
throughout. Flow of the
research doesn’t make
sense and appropriate
transitional phrases are
not used.
The introduction includes all
of the required sections
including a general
introduction, purpose of study,
research aim, hypothesis,
definitions and limitations.
In-Text
Citations and
Reference
Page
The introduction includes all
of the required sections
including a general
introduction, purpose of
study, research aim and
hypothesis and definitions
and limitations.
1 or more of the required
sections are missing
(introduction, purpose of
study, research aim and
hypothesis and definitions
and limitations.)
10.0 to >8.0 pts
8.0 to >6.0 pts
6.0 to >0 pts
In-text citations are always
provided where appropriate
and are in the correct format
both in-text and on the
reference page.
In-text citations are usually
provided where appropriate
and are mostly in the correct
format.
In-text citations are rarely
provided where
appropriate and are not
provided at the end of the
paper.
All definitions are cited.
Most definitions are cited.
2 or more of the definitions
are not cited.
Integrity of
Writing
10.0 points
9.0 to >6.0 pts
6.0 to >0 pts
Writing is free of grammatical,
punctuation, capitalization
and spelling errors.
Writing contained 1-5 errors.
Writing was disorganized
and contained more than 5
errors.
CHAPTER II
EVIDENCE ANALYSIS
A review of the literature on the positive impact of implementing a Mediterranean diet during the preconception period of women
who are trying to conceive but struggling with infertility is presented in the following evidence analysis tables. The quality of each
study was assessed along with the type of study, the demographics of the participants, the interventions, and major research
findings. In addition, each table delineates the strengths and limitations of each study.
Author and
location
Include first author
last name, location
(U.S, Italy etc) and
include a
superscript citation
number.
Study Design
Participant Details
Method Details
Findings
Randomized
Control,
Experimental,
Cross-Sectional,
Cohort.
Number, gender, age, other
identifiers
Methods in your own words – length of
study, exact intervention details, what
were they looking to measure.
Include all appropriate
outcomes, p-values for each
and if it reached statistical
significance
Strengths and
limitations
Consider population size,
study design,
participants, length of
study etc.
1. Sun,
Guangd
ong,
China
2. Muffone
, Oxford
Universi
ty
Prospective
cohort study
Systematic
review with
meta analysis
of cohort study
678 women who
were seeking IVF
therapy due to
infertility. Inclusionary
criteria: 40 years of
age or younger, body
mass index (BMI)
≤30 kg/m2, ovarian
stimulation via
antagonist protocol or
long protocol and no
change in dietary
intake for at least 12
months leading to
study
This study used a food
frequency questionnaire (FFQ)
to assess adherence to the
implementation of a MedDiet
and a scoring system was
established to track
consumption of certain food
groups. Standard IVF protocol
was carried out and patient data
including demographics,
hormone levels, embryo quality,
and clinical outcomes were
collected. SPSS software was
used to evaluate statistical
relationship between MedDiet
adherence and IVF outcomes.
Participants were divided
into two groups: high
adherence to MedDiet and
lower adherence. The high
adherence group had a
statistically significant
increase in available
embryos during IVF
treatment. This association
remained significant even
after adjusting for
confounding factors such
as age, duration of
infertility, and BMI.
11 studies were
included that in total
consisted of 13,157
women and 1,338
men.
Studies that included infertility
and MedDiet were included in
this study. “Risk-of-bias
assessments” were performed
according to the Preferred
Reporting Items for Systematic
Reviews and Meta-Analyses
guidelines.
This meta-analysis resulted
in inconsistent findings, as
indicated by the high I2
values, suggesting
substantial heterogeneity
among the included
studies. However, results
did indicate that a higher
adherence to the MedDiet
was associated with an
increased pregnancy and
births as well as higher
sperm concentration (>15
× 10^6/mL) and sperm
count (>39 × 10^6/mL).
Strengths:
prospective cohort
study, large sample
size, validated
assessment tools
and comprehensive
data collection.
Limitations: Self
reported dietary
information,
observational in
nature,
Strengths: risk of
bias assessment,
large sample size,
strategic study
search, biomarker
data collection and
inclusion
Limitations:
inconsistent
findings, likely need
to focus
research/study
inclusion criteria
3. Szmidt,
Warsaw
Poland
Narrative
review
4. Vujkovic Observational
,
prospective
Erasmu study
s
Universi
ty
Medical
Centre,
Rotterda
m, The
Netherla
nds
13 studies were
included consisting
of: a case-control,
cross-sectional,
prospective cohort,
experimental and
meta-analysis study
design
A search was conducted on
PubMed, Google Scholar and
Science Direct for studies
correlating a MedDiet with
women’s reproductive health
161 couples
undergoing IVF/ICSI
therapy
Assessment measures
included: dietary patterns, blood
concentration levels of vitamin
B12, vitamin B6, homocysteine,
and folate as well as fertilization
rate, embryo quality, and
pregnancy outcomes
This review concluded that
there is some correlation of
positive outcomes
implementing a MedDiet
and women’s reproductive
health however more
research is needed
Strengths: Quality
assessment
measures,
encompassing
inclusionary criteria
Limitations: search
criteria included
lifespan and less
specificity
Of the 161 couples, two
groups were formed and
assessed. One group
consumed a health
conscious low processed
dietary pattern and the
other group adhered to a
MedDiet. The group
consuming a MedDiet had
higher rates of successful
IVF treatment with a ratio
increase of 1.4
Strengths: decent
sample size, clear
focus topic,
validated
questionnaires,
biomarker
measurements and
statistical analysis
Limitations:
Observational
nature, self reported
dietary information,
potential for bias,
limited population
(participants only in
the Netherlands)
5. Dimitrio
s,
Athens,
Greece
6. Kermac
k,
United
Kingdo
m
prospective
cohort study
double-blind
randomized
controlled trial
244 non-obese
women age range
between 22–41 years
with a BMI < 30
kg/m2) who have
undergone one IVF
treatment.
111 couples
undergoing IVF or
IVF-ICSI. Females
were between 18–41
years old with a body
mass index (BMI) 18–
32 kg/m2. Partners
sperm was used.
A validated food frequency
questionnaire was used to
assess the dietary intake of
participants using a
MedDietScore ranging from 055.
Participants in the study group
received olive oil for cooking, an
olive oil based spread and a
daily supplement drink enriched
with EPA, DHA and vitamin D.
Meanwhile the control group
received sunflower seed oil, a
sunflower seed oil based spread
and a daily supplement drink
without EPA, DHA or vitamin D.
The dietary intervention lasted
for a minimum of 6 weeks
Outcomes were measured
including oocyte yield,
fertilization rate, embryo
quality, implantation rates,
pregnancy and live birth.
No statistically significant
correlations were made.
Women under the age of
35 years with adherence to
MedDiet did have a 5 point
increase in likelihood of
achieving pregnancy and
live birth.
102 couples completed the
study. Compliance with the
assigned interventions was
reported by 62% of women
and 50% of men. The
study group showed
significant increases in red
blood cell fatty acids (EPA
and DHA) and serum
vitamin D levels compared
to the control group.
However, there were no
Strength: participant
size, validated
questionnaire,
focused research
question and
clinical data
collection
Limitations:
observational, self
reported dietary
patterns,
generalized
population, limited
causal interference
Strengths: nonbias;
The participants
had similar
demographic
characteristics
including age, body
mass index, dietary
habits, and exercise
levels.
7. Caruso,
Naples,
Italy
randomized
controlled trial
160 males aged 1830 years old
before the IVF treatment cycle.
Compliance was monitored
through regular communication
with the research team. Women
underwent ovarian stimulation,
and the embryos were cultured
and analyzed using
morphokinetic markers. The
primary endpoint was the time
taken to complete the second
cell cycle (CC2). Secondary
endpoints included blood
measurements of fatty acids
and vitamin D, as well as other
validated parameters of embryo
development. Statistical
analysis was conducted using
various methods, including
ANOVA and mixed-effects
models to assess the impact of
the intervention on embryo
development.
significant differences
between the groups in the
number of oocytes
retrieved, fertilized
embryos, blastocyst
formation rates or the
average number of
blastocysts suitable for
cryopreservation.
80 participants were assigned a
Mediterranean diet while the
other 80 participants were
assigned a low fat diet.
Participant’s semen parameters
were measured after 6 months
consuming assigned diet.
The Mediterranean diet
group had significantly
higher improvements in
sperm concentration (1.93
M/mL, 95% CI [1.22 to
3.64], P=0.027) and total
sperm count (8.02 M, 95%
CI [1.51 to 15.45] P=0.035)
compared to the low-fat
diet group. There were no
significant differences in
Limitations: trial
length, only 6
weeks, no follow up
for long term effects
Strengths:
randomized control
trial, sample size,
parameter
measurements,
significant
outcomes
Limitations: limited
generalizability, self
reporting, lack of
other semen parameters
between the two groups.
8. SalasHuetos,
randomized
controlled trial
9. Hernáez Randomized
, Spain
controlled trial
A total of 119 healthy
men (aged 18-35
years)
A total of 4189
participants both men
(55–80 years) and
women (60–80 years)
at high
cardiovascular risk
but free of
cardiovascular
disease at
enrollment, with type-
Participants were assigned to
one of two intervention groups:
a nut group and a control group.
The nut group consumed the
usual Western-style diet
enriched with 60 g of a mixture
of nuts per day, while the
control group followed the same
diet but avoided nuts. Baseline
and post-intervention semen
and blood samples were
collected from all participants.
Dietary information was
recorded throughout the trial.
The nut group showed
significant improvements in
total sperm count, vitality,
motility and morphology
compared to the control
group. The nut group also
had increased
consumption of beneficial
nutrients and a reduction in
sperm DNA fragmentation.
No significant changes
were observed in reactive
oxygen species, sperm
chromosome anomalies or
DNA methylation between
both groups.
Three intervention arms were
compared: MedDiet-EVOO,
MedDiet-Nuts and a low-fat
control diet. The MedDiet
interventions encouraged the
consumption of vegetables,
fruits, pulses, nuts and fish,
while reducing the intake of
sugary drinks, pastries and
red/processed meats.
A Mediterranean diet
(MedDiet) helped maintain
normal platelet counts and
reduced the risk of
thrombocytopenia. The
MedDiet also attenuated
the association between
thrombocytopenia and allcause mortality. These
results highlight the
other dietary
assessment
Strengths:
randomized
controlled trial
design, participant
size,
comprehensive
biological data
collection
Limitations: Short
term intervention
without long term
observation, self
reported data,
potential for bias
and or confounding
factors
Strengths:
randomized
controlled trial
design, large
participant count,
long term follow up
Limitations:
exploratory, self
10. Montan
Randomized
controlled trial
2 diabetes or multiple
cardiovascular risk
factors.
Participants in the MedDietEVOO group received extravirgin olive oil and those in the
MedDiet-Nuts group were
provided with mixed nuts. The
low-fat control group was
advised to increase the intake of
specific foods while reducing
consumption of oils, bakery
goods, sweets and fatty meats.
potential of the MedDiet in
regulating platelet counts
and its clinical significance
in preventing adverse
health outcomes (including
fertility).
263 young healthy
men
137 of the participants followed
a MedDiet coupled with
moderate physical activity for a
four-month period while the
remaining 126 were assigned to
the control group. Semen
parameters were measured at
baseline and end of
intervention.
Statistically significant
results showed an increase
in semen parameters for
the intervention group from
t0 to t4. While the control
group showed a decrease
in antioxidant capacity
Participants were divided into
three groups: Mediterranean
diet (n=407), stress reduction
(n=407) and usual care (n=407).
The Mediterranean diet group
received monthly educational
sessions and free provision of
olive oil and walnuts. The stress
Implementing a
Mediterranean diet or
stress reduction program
for pregnant individuals at
high risk for SGA newborns
significantly reduced the
percentage of newborns
with low birth weight.
o, Italy
11. Crovetto Parallel-group
,
randomized
Barcelo clinical trial
na,
Spain
1221 women with
singleton
pregnancies (19-23
weeks' gestation) at
high risk for small for
gestational age
(SGA)
reported bias,
exclusion criteria
Strengths:
randomized
controlled trial
design, objective
measures, sample
size
Limitations:
potential for bias
and or confounding
factors,
generalizability,
Strengths:
randomized clinical
trial design, large
sample size, large
completion rate,
12. AssafBalut,
San
Carlos
Madrid
13. Al
Wattar,
London/
Birming
ham
Randomized
controlled trial
874 pregnant women
at 8-12 weeks
gestation
pragmatic
1,252 women with
multicentre
metabolic risk factors
randomised trial such as chronic
hypertension,
obesity, etc.
reduction group participated in
an 8-week stress reduction
program. The usual care group
received standard pregnancy
care.
Further research is needed
to confirm these findings
and assess their
applicability to different
patient populations.
Participants were assigned to
either the intervention group
following a Mediterranean diet
supplemented with extra virgin
olive oil and pistachios or the
control group following a
standard diet with limited fat
intake. The primary outcome
measured was the incidence of
GDM at 24-28 gestational
weeks. Secondary outcomes
included gestational weight
gain, pregnancy-induced
hypertension, cesarean section,
preterm delivery, perineal
trauma, small and large for
gestational age newborns and
neonatal intensive care unit
admissions.
The intervention group
following the
Mediterranean diet had a
lower incidence of GDM
and improved maternal and
neonatal outcomes
compared to the control
group.
593 of the women were
assigned to the intervention
group and implemented a
MedDiet while the remaining
612 women were assigned to
the control group. Individualized
nutritional guidance was
The intervention group
showed increased
consumption of beneficial
foods and reduced intake
of unhealthy foods. While
there was a reduction in
the odds of gestational
well structured
intervention,
Limitations:
Generalizability, self
reported data, short
term followup
Strengths:
randomized
controlled trial
design, adherence
assessment,
sample size
Limitations: limited
generalizability,
potential for bias or
confounding factors
Strengths: study
design, multicenter
trial, large sample
size
14. FlorAleman
y
Secondary
analysislongitudinal
152 pregnant women
assessed three times during
pregnancy.
diabetes and lower
gestational weight gain in
the intervention group,
there were no significant
differences in the primary
composite maternal and
offspring outcomes. The
study's limitations include
reliance on self-reported
adherence instead of
objective measures.
Participants dietary habits were
assessed using a food
frequency questionnaire and
adherence to the Mediterranean
Diet was determined based on
this information. The study also
measured the participants'
psychological well-being and illbeing using established selfreported questionnaires. The
researchers analyzed the crosssectional associations between
MedDiet and mental health at
16 weeks gestation, as well as
the longitudinal associations at
the 34th week (using linear
regression models).
Higher adherence to the
MedDiet was linked to
lower levels of negative
affect and anxiety and
therefore associated with
improved mental health
during pregnancy.
Limitations:
adherence was self
reported, low rate of
follow up,
Strengths:
longitudinal design,
established
questionnaire, focus
Limitations: smaller
sample size,
potential for bias
and confounding
factors, self
reporting
15. Melero,
Spain
16. RamosLevi,
Europe
Randomized
controlled trial
Nutritional
intervention
544 women were
assessed
1573 participants,
including 272 with
gestational diabetes
(GDM) and 1301
without GDM
Groups were randomized at 1214 weeks gestation, two groups
one intervention group was
supplemented with olive oil and
nuts and one control group that
was recommended to limit fat
intake.
A dietary intervention
focused on the MedDiet
during pregnancy is
associated with improved
maternal and neonatal
outcomes, including a
lower incidence of GDM
and reduced risks of
complications such as UTIs,
emergency CS, perineal
trauma and abnormal fetal
growth.
Genotyping of 110 selected
genetic variations was
performed using the Agena
platform. Statistical analysis
were conducted using SPSS
software, while genetic
association tests were
performed using PLINK
software. Bioinformatics
analysis, including SNP
mapping, was performed using
STRING software.
Approx 40% of the
variations were
significantly associated
with GDM. In Caucasians,
certain variations
increased GDM risk
(IGF2BP2, MTNR1B, etc.),
while others decreased risk
(GCKR, COBLL1, etc.). In
Hispanics, different
variations increased
(CDKAL1, GIPR, etc.) or
decreased (PROX1, IRS1,
etc.) GDM risk. These
findings suggest that
specific genetic variations
Strength:
Randomized
controlled trial
design, large
sample size,
Limitations: lack of
follow up long
term, potential for
bias and
confounding factors
Strength: large
sample size, long
duration, genetic
analysis,
Limitations: Limited
genetic variations,
generalizability,
potential for bias
and confounding
factors
can affect GDM risk in
different populations.
17. Papandr Randomised
eou
Controlled
Clinical Trial
40 healthy pregnant
women
20 women were assigned the
Clinical Decision Support
System while the other 20 were
assigned the control group.
Biochemical and medical
markers were assessed over 3
month intervention.
Women in the CDSS group
showed greater adherence
to MedDiet nutritional
guidelines and a reduction
in anxiety an depression
levels.
Strengths:
randomized
controlled clinical
trial, focused,
multiple
assessments
Limitations: small
sample size and
duration of
intervention
Chapter 2 Rubric (since the scores noted are ranges, please type the score in the appropriate box).
The first draft submission needs to include at least 5 studies and follow the basic guidelines of the rubric below that will be used for
the final submission. The first draft starts at 25 points.
Meets
Nearly Meets
Does Not Meet
Author/location
3 points
2 points
0-1 point
Each study has an author last name listed and
75% of studies include an author's last name and
Studies do not include a citation number.
includes a citation superscript number that
correct citation number.
matches with the reference list at the end.
Less than 13 studies may have been included on
At least 14-19 studies were included on the
Study Design
the table.
At least 20 studies were included and cited.
table.
7 points
5-6 points
0-4 points
Correctly identified the study design on all
Correctly identified at least 70-99% of the
Correctly identified less than 60% of the studies
studies included in the table.
studies included in the table.
included in the table.
At least 20 studies were included on the
table.
Less than 13 studies may have been included on
14-19 studies may have been included on the
table.
the table.
Participant
Details
10 points
7-9 points
0-6 points
Provided details on number of study
Provided details on number of study
Provided details on number of study participants,
participants, age, gender, and any other
participants, age, gender, and any other
age, gender, and any other important details on
important details on 100% of the studies
important details on 70-99% of the studies
less than 60% of the studies included (disease
included (disease state, BMI etc)
included (disease state, BMI etc).
state, BMI etc).
14-19 studies may have been included on the
Less than 13 studies may have been included on
table.
the table.
30 points
21-29 points
0-20 points
Described the key components of the
Described the key components of the methods
Described the key components of the methods as
methods as well as what the researchers
as well as what the researchers were studying on
well as what the researchers were studying in
were studying on 100% of the studies
70-99% of the studies included.
less than 60% of the studies.
At least 20 studies were included on the
table.
Method Details
included.
This was mostly succinctly described in the
students own words.
This was succinctly described in the students
own words.
This was not described clearly on the studies or
At least 14-19 studies were included on the
table.
appeared to be taken directly from the paper (in
which case this would be a score of a 0)
At least 20 studies were included on the
table.
Findings
Less than 13 studies were included on the table.
30 points
21-29 points
0-20 points
Referenced statistical significance and p-
Referenced statistical significance and p-values
Referenced statistical significance and p-values
values on all results and everything was in
on all results and everything was in the students
on all results and everything was in the students
the students own words on 100% of the
own words on 70-99% of the studies included.
own words on less than 60% of the studies
studies included.
included.
14-19 studies may have been included on the
At least 20 studies were included on the
table.
table.
Less than 13 studies may have been included on
the table.
Strengths and
Limitations
20 points
14-19 points
0-13 points
Strengths and limitations are clearly labeled
Strengths and limitations are clearly labeled on
Strengths and limitations are clearly labeled on
on 100% of the studies included and it’s clear
70-99% of the studies included and it’s mostly
60% of the studies included and it’s not always
that the student understands what makes a
clear that the student understands what makes
clear that the student understands what makes a
strong study design and how it relates to the
a strong study design and how it relates to the
strong study design and how it relates to the
original research question.
original research question.
original research question.
At least 20 studies were included on the
14-19 studies may have been included on the
Less than 13 studies may have been included on
table.
table.
the table.
CHAPTER III
METHODS
Through the thorough evaluation of current literature, research, expert consultation and evaluation, we
have generated highly valuable educational materials that support the planning of preconception with at
least three months of implementing a Mediterranean diet for optimal fertility outcomes. This systematic
approach to gathering the scientific literature has ensured that only evidence-based recommendations
are included in our education so that our target audience can gain the most targeted approach in their
pregnancy journey.
To gain a better understanding of our target audience we utilized highly regarded women’s health
accounts on Instagram to carry out online polling. Additionally, randomly selected responses were further
encouraged to take a more in-depth and anonymous survey to further asses current knowledge of fertility,
current dietary habits and willingness to implement a preconception planning period of at least three
months. All individuals surveyed were both actively planning for pregnancy as well as open to making
lifestyle changes to optimize conception and pregnancy outcomes. In addition to our online surveys, we
also reviewed the existing literature on nutrition’s impact on fertility with an emphasize on the
Mediterranean diet specifically.
Along with these surveys and review of literature, our team conducted interviews with expert nutritionist
specializing in the field of women’s reproductive health as well as women who have successfully given
birth after implementing a Mediterranean diet prior to conception. The experts gave great insights into the
current needs of our target audience and the strategies of educational materials this audience is most
likely to implement and engage with. The women who have successfully given birth after implementation
of these protocols gave personal experiences and stories that will helped our team to not only develop
content that was educational in nature, but relatable and attainable as well.
In our review of the current scientific literature, accuracy and relevancy was of utmost importance. Our
research team utilized PubMed, Google Scholar and other reputable databases to pull peer reviewed,
randomized control trials that have been published within the last ten years. All studies focused on
nutritional approaches in regard to all phases of pregnancy and preconception with a particular emphasis
on those that studied the impact of a Mediterranean approach of eating. All articles were reviewed
critically to ensure validity of study and publication. Our team utilized the Academy of Nutrition and
Dietetics quality review checklist to ensure that our educational materials provide our target audience with
accurate and evidence-based information. The quality review checklist serves as a valuable tool, guiding
us through the key aspects of educational content development. By adhering to this checklist, our
resources are supported with credible sources and free of any bias or conflict of interest.
Based on the findings of our literature review, expert interviews and personal accounts we were able to
create a series of educational materials for women who are looking to optimize their fertility as they
embark on their conception journey. The educational materials were designed to be engaging, accessible
and easy to follow. The content was divided into Instagram posts and accompanied by online learning
modules that provided detailed information on each step to implement a Mediterranean diet during the
preconception period. The modules incorporated interactive quizzes, prerecorded lecture videos and
downloadable resources to enhance the learning experience. Downloadable resources will consist of
lecture video summary and recipes to inspire this new way of eating. All literature is referenced to
establish validity of all suggestions and module content.
The educational materials underwent several rounds of review from volunteer target audience members
as well as nutrition and women’s health experts to ensure clarity and accuracy of information and
protocols.
The creation of educational materials for planning a preconception period that includes shifting to a
Mediterranean diet was comprehensive and rewarding in its entirety. By utilizing experts and volunteers
from the target audience, we believe our team generated concise materials that will be highly valued. This
material has been distributed via the social media platform, Instagram to encourage and support women
looking to optimize their fertility journey.
Explanation of
the process
Meets
Nearly Meets
Does Not Meet
90 points
63-89 points
0-62 points
Clear, methodical explanation
of the process to get to the
final product (of a lesson plan,
cookbook etc).
Somewhat clear explanation
of the process to get to the
final product.
Unclear explanation of the
process to get to the final
product.
Length is 1-1.5 pages.
Length is less than 1 page.
10.0 points
9.0 to >6.0 pts
6.0 to >0 pts
Writing is free of grammatical,
punctuation, capitalization and
spelling errors.
Writing contained 1-5 errors.
Writing was disorganized
and contained more than 5
errors.
Length is 1.5 pages
Integrity of
Writing
CHAPTER IV
RESULTS
Briefly explain the materials (Appendix ____). This will be just a few sentences since the bulk of the
results are in the the materials that you created that you will include with your results section.
Chapter 4 Rubric to be completed by the peer reviewer (first 2 sections only), mentor and instructor (since
the scores noted are ranges, please type the score in the appropriate box).
Explanation of
the final
product
Meets
Nearly Meets
Does Not Meet
30 points
20-29 points
0-19 points
Clear, methodical explanation
of the final product (of a
lesson plan, cookbook etc).
Somewhat clear explanation
of the final product.
Unclear explanation of the
final product.
Length is 0.25-0.5 pages.
Length is 1 sentence.
10 points
7-9 points
0-6 points
Writing is free of grammatical,
punctuation, capitalization and
spelling errors.
Writing contained 1-5 errors.
Writing was disorganized
and contained more than 5
errors.
10 points
7-9 points
0-6 points
Provided at least 3 items of
Provided 2 items of
Did not provide positive
positive feedback
positive feedback
feedback
Provided at least 3 items of
Provided 2 items of
Did not provide
corrective feedback
corrective feedback
corrective feedback
Provided corrections on
Provided few corrections
Did not provide
grammatical and spelling
on grammatical and
corrections on
errors (or noted that there
spelling errors (or noted
grammatical and
weren’t any)
that there weren’t any)
spelling errors (or noted
Length is 0.5 pages
Integrity of
Writing
Peer Review
that there weren’t any)
Provided a summary
Provided a sentence to
Did not provide a
paragraph to the author of
the author of how to
summary paragraph to
how to improve writing flow
improve writing flow and
the author of how to
and content
content; or the paragraph
improve writing flow and
did not suggest
content
improvements
CHAPTER V
DISCUSSION
Describe the materials in more depth and refer to the literature review with citations on why the
educational tools were created.
CHAPTER VI
CONCLUSION
Brief wrap up on the potential next steps for the materials and additional research that could be
conducted to make the materials even more successful for the population being discussed.
Chapters 5&6 Rubric to be completed by the peer reviewer (first 2 sections only), mentor and instructor
(since the scores noted are ranges, please type the score in the appropriate box).
Meets
Nearly Meets
Does Not Meet
Discussion of
Materials/Conc
lusion
30 points
20-29 points
0-19 points
Discussed the next steps
Somewhat clear explanation
of the final product.
Unclear explanation of the
final product.
Length is 0.25-0.5 pages.
Length is 1 sentence.
10 points
7-9 points
0-6 points
Writing is free of grammatical,
punctuation, capitalization and
spelling errors.
Writing contained 1-5 errors.
Writing was disorganized
and contained more than 5
errors.
10 points
7-9 points
0-6 points
Provided at least 3 items of
Provided 2 items of
Did not provide positive
positive feedback
positive feedback
feedback
Provided at least 3 items of
Provided 2 items of
Did not provide
corrective feedback
corrective feedback
corrective feedback
Provided corrections on
Provided few corrections
Did not provide
grammatical and spelling
on grammatical and
corrections on
of the materials
Discussed the utility of the
results of the review in
practice or future research
Length is 0.5 pages
Integrity of
Writing
Peer Review
grammatical and
errors (or noted that there
spelling errors (or noted
spelling errors (or noted
weren’t any)
that there weren’t any)
that there weren’t any)
Provided a summary
Provided a sentence to
Did not provide a
paragraph to the author of
the author of how to
summary paragraph to
how to improve writing flow
improve writing flow and
the author of how to
and content
content; or the paragraph
improve writing flow and
did not suggest
content
improvements
REFERENCES
1.
1 in 6 people globally affected by infertility: WHO. www.who.int. Published April 4, 2023.
https://www.who.int/news/item/04-04-2023-1-in-6-people-globally-affected-by-infertility
2.
Stephenson J, Heslehurst N, Hall J, et al. Before the beginning: nutrition and lifestyle in the preconception
period and its importance for future health [published correction appears in Lancet. 2018 May
5;391(10132):1774]. Lancet. 2018;391(10132):1830-1841. doi:10.1016/S0140-6736(18)30311-8
3.
Davis C, Bryan J, Hodgson J, Murphy K. Definition of the Mediterranean Diet; a Literature Review.
Nutrients. 2015;7(11):9139-9153. Published 2015 Nov 5. doi:10.3390/nu7115459
4.
Mentella MC, Scaldaferri F, Ricci C, Gasbarrini A, Miggiano GAD. Cancer and Mediterranean Diet: A
Review. Nutrients. 2019;11(9):2059. Published 2019 Sep 2. doi:10.3390/nu11092059
5.
Karayiannis D, Kontogianni MD, Mendorou C, Douka L, Mastrominas M, Yiannakouris N. Association
between adherence to the Mediterranean diet and semen quality parameters in male partners of couples
attempting fertility. Hum Reprod. 2017;32(1):215-222. doi:10.1093/humrep/dew288
6.
https://www.cancer.gov/publications/dictionaries/cancer-terms/def/conception. www.cancer.gov. Published
February 2, 2011. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/conception
7.
World Health Organization. Infertility. World Health Organization. Published September 14, 2020.
https://www.who.int/news-room/fact-sheets/detail/infertility
Raise to a higher degree or purpose in future iterations
EX: “Perhaps you can expand this in X capacity to further address Y” OR
“Perhaps you can re-purpose X as Y for Z”
Introduce ideas for improvement of current iteration
EX: “You might consider tweaking X for Y effect” OR
“You might want to include supporting information from X resource – Here’s a link”
Seek information and/or provide ideas through questioning
EX: “Have you considered looking at X from Y perspective?” OR
“When you said X, am I understanding you to mean XY?”
Recall, ponder and communicate
EX: “I relate/concur/disagree with X because…” OR
“I liked what you did with X because…”
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