How to Prepare for IVF: An Evidence-Based Guide
While IVF success depends primarily on age and embryo quality, evidence shows that optimising your body and mindset in the 3 months before a cycle can meaningfully improve outcomes. Here is what the research actually supports.
Diet and Nutrition
The Mediterranean Diet Pattern Multiple studies (including a 2018 ESHRE-published cohort study) found that adherence to a Mediterranean diet in the 6 months before IVF was associated with a 40% higher live birth rate in women under 35. Key components:
- Vegetables and legumes: 5+ servings daily — rich in folate, antioxidants, and phytoestrogens
- Olive oil: Primary fat source — anti-inflammatory
- Whole grains: Oats, quinoa, brown rice — stabilise insulin and blood sugar
- Fatty fish: Salmon, sardines, mackerel 2–3 times per week — omega-3 DHA essential for egg and sperm quality
- Avoid: Processed meats, trans fats, refined carbohydrates, sugar-sweetened drinks
- Moderate: Dairy (full-fat dairy may be preferable to low-fat in fertility — Chavarro et al, 2019)
What to Limit:
- Caffeine: >200mg/day (>2 cups coffee) is associated with slightly reduced conception rates. Reduce to ≤200mg/day.
- Alcohol: No safe threshold established in early pregnancy. ASRM advises abstinence during IVF cycles.
- Processed soy: High quantities of soy isoflavones may affect estrogen balance. Moderate whole soy (edamame, tofu) is fine.
Supplements (Evidence-Based)
Folic acid / Methylfolate: 400–800 mcg daily (start 3 months before) The most evidence-supported supplement for any woman trying to conceive. Reduces neural tube defect risk by 70%. Women with MTHFR gene variants may absorb methylfolate (L-methyltetrahydrofolate) better than synthetic folic acid.
CoQ10 (Ubiquinol): 200–600 mg daily A mitochondrial antioxidant. Two RCTs (Giannubilo et al, JARG 2018; Xu et al, Nutrients 2019) found CoQ10 supplementation improved egg quality and IVF outcomes, particularly in women over 37 with diminished ovarian reserve. The ubiquinol form is better absorbed.
Vitamin D: 1000–2000 IU daily (if deficient) Vitamin D deficiency (<20 ng/mL) is associated with significantly lower IVF live birth rates (Paffoni et al, JCEM 2014). Testing and correcting deficiency before an IVF cycle is strongly recommended. Optimal level: >30 ng/mL.
Omega-3 DHA: 1000–2000 mg daily Supports egg quality and embryo development. Found predominantly in oily fish or algal oil supplements (vegan-friendly alternative to fish oil).
Inositol (Myo-inositol ± D-chiro-inositol): Particularly recommended for PCOS patients. Improves egg quality and ovarian response. Standard dose: 4g myo-inositol + 400mg D-chiro-inositol daily. ESHRE 2023 PCOS guideline supports inositol use.
For male partners:
- Vitamin C + E combination: Reduces sperm DNA fragmentation
- CoQ10: 200–400mg daily improves sperm motility
- Zinc + Selenium: Essential for sperm production
- L-carnitine: Improves sperm motility
Supplements with insufficient evidence: DHEA (only if poor responder with low AMH, under specialist guidance), testosterone priming, growth hormone add-ons (ESHRE classifies these as "add-ons" with unclear evidence — ask your clinic).
Lifestyle Optimisation
Weight: Both underweight (BMI <18.5) and overweight (BMI >30) are associated with reduced IVF success. Achieving a BMI of 19–25 before treatment — even a 5–10% weight reduction if overweight — can meaningfully improve outcomes.
Exercise: Regular moderate exercise (30 minutes most days) is beneficial. Avoid very high-intensity exercise during stimulation (risk of ovarian torsion with enlarged ovaries). Yoga and walking are ideal during stimulation.
Sleep: 7–9 hours per night. Poor sleep disrupts melatonin, which is also an antioxidant in follicular fluid.
Avoid: Smoking (reduces IVF success by 50% — ASRM 2023), recreational drugs, BPA-containing plastics, pesticide-heavy produce.
Mental Health and Emotional Preparation
IVF is one of the most emotionally demanding medical experiences. Studies show high rates of anxiety and depression during IVF — comparable to a cancer diagnosis in some measures.
Evidence-based strategies:
- Mindfulness-based stress reduction (MBSR): A Harvard Medical School-affiliated study found MBSR doubled IVF success rates in women with high baseline anxiety — though the mechanism remains debated.
- CBT (Cognitive Behavioural Therapy): Effective for fertility-related anxiety and depression
- Peer support groups: Associated with lower dropout rates from fertility treatment
- Acupuncture: Some evidence for reducing anxiety and improving endometrial blood flow, though its effect on IVF outcomes remains contested
Setting expectations: Have honest conversations with your partner about:
- How many cycles you are willing and financially able to attempt
- What you will do if own-egg IVF fails repeatedly
- Shared decision-making on single vs double embryo transfer
Reference: ASRM Practice Committee — Optimisation of Reproductive Fitness, 2022. ESHRE Good Practice Recommendations on how to prepare for IVF, 2023.
Frequently Asked Questions
What should I eat before IVF?▾
A Mediterranean diet pattern — rich in vegetables, legumes, whole grains, olive oil, and oily fish — is the most evidence-supported dietary approach for IVF. Avoid processed foods, trans fats, and limit alcohol and caffeine to under 200mg/day. Start dietary changes at least 3 months before your cycle.
Which supplements actually help with IVF?▾
Evidence-supported supplements include: folic acid (400–800mcg daily, start 3 months before), CoQ10 ubiquinol (200–600mg for egg quality, especially over 37), Vitamin D (correct deficiency to >30 ng/mL), and omega-3 DHA. Inositol is beneficial for PCOS. For male partners: CoQ10, zinc, selenium, Vitamin C+E.
Can exercise affect IVF outcomes?▾
Moderate regular exercise before IVF is beneficial. During the stimulation phase (2 weeks of injections), avoid high-intensity exercise as enlarged ovaries are at risk of torsion. Walking and yoga are ideal during stimulation.
Does stress affect IVF success?▾
Severe chronic stress may affect IVF outcomes, though the research is mixed. Anxiety and depression are very common during IVF. Evidence-based approaches include mindfulness, CBT, and peer support. Acupuncture may help reduce anxiety. Having a plan for if cycles fail, and honest partner communication, significantly reduces distress.