22 modifiable factors that improve IVF outcomes

Andreia Trigo, RN BSc MSc
Founder of Enhanced Fertility Programme, Enhanced Fertility Programme

Emotions and Support

Improving IVF outcomes with various factors
From this video you will find out:
  • What is the best weight range for fertility (BMI)?
  • What nutrition tips should I follow?
  • What physical activity is recommended and what should I avoid?
  • Can I drink caffeine and alcohol during my IVF cycle? How much?
  • What is mindfulness and how can I use it to my advantage?
  • What are mindfulness-based interventions?



What factors have a real impact on the result of my IVF?

In this session, Andreia Trigo, RN B.Sc. M.Sc., Fertility Nurse Consultant, TEDx Speaker and Founder of Enhanced Fertility Programme has talked about 6 factors that can improve your IVF outcomes.

Modifiable risk factors

1. Weight

According to the speaker, regardless of the recommendations to either gain or lose weight to improve fertility. However, neither a mechanism nor support is usually given to patients to help them achieve that goal. Research is said to state that the best range for fertility is a body mass index (BMI) of 20 to 24 known as the fertility zone for weight.

The risk of infertility is highest among those at the lowest and highest ends of the BMI distribution. A higher risk of ovulatory disorder infertility was observed for underweight women as well as women with obesity.

  • Women who have a body mass index of 30 or over are likely to take longer to conceive.
  • Women who have a BMI of less than 19 should be advised that increasing body weight is likely to improve their chances of conception
  • Men who have a BMI of 30 or over should be informed that they are likely to have reduced fertility

2. Nutrition

According to a study by Harvard University. It identified what matters when trying to conceive.

  • Avoid trans fats
  • Use more unsaturated vegetable oils
  • Turn to vegetable protein (broccoli, avocado, peas)
  • Choose slow carbs (whole grains, vegetables, whole fruits)
  • Make it whole milk
  • Take a multivitamin (folic acid)
  • Get plenty of iron from plants
  • Drink to your health

3. Physical activity

Physical activity is defined as any body movement produced by skeletal muscles that requires energy expenditure. However, exercise is a type of physical activity that is planned, repetitive, and structured to maintain or improve one component of physical fitness. In addition, sedentary behavior tendencies should be reconsidered as they comprise time spent in periods of little or no movement while awake.

Depending on the intensity of physical activity, a series of benefits were associated with the duration of it. For instance, vigorous and moderate exercise is associated with a reduced risk of miscarriage and an increase in the chance of having a baby in women who undergo ART. In the same way, even low to moderate exercise is also associated with increased implantation rates in women undergoing assisted reproduction techniques.

  • To try:
    • Yoga
    • Dancing
    • Leisure bike riding
    • Aerobics
    • Jogging
    • Swimming
    • 30 minutes walks
  • To avoid:
    • Hot Yoga
    • Boot-camp training
    • Extreme running

4. Caffeine & Alcohol

Caffeine is said to be one of the most psychoactive components that is also easily distributed in the body. Drinking no more than two cups of coffee per day is recommended for individuals trying to conceive.

As regards alcohol, the current recommendations are known for dismissing the consumption as much as possible.

  • Heavy drinking increases the time it takes to get pregnant and can affect a developing baby’s health
  • For women trying to conceive, not drinking alcohol is the safest option
  • Men trying to conceive should limit alcohol to no more than 14 units a week

5. Mindfulness

It is usually described as a process of paying attention on purpose, in the present moment non non-judgmentally to allow the unfolding of the moment-by-moment experiences, highly recommended for couples with infertility.

Emotional adjustment in couples with infertility is complex as couples have to deal with:

  • Stress of infertility diagnosis
  • Infertility associated with identity crisis
  • Dealing with the ongoing fertility treatment
  • High possibility of unsuccessful treatment cycles
  • Choosing treatment options
  • Uncertainty of outcomes of consecutive cycles
  • Unwanted effects (e.g. repeated cycles, multiple gestations, high rates of miscarriage)

Evidence shows that mindfulness-based interventions can have a positive impact on experiences of infertility. These consist of one session per week and the duration may range from 8 to 12 weeks.

- Questions and Answers

My BMI is 25,5. Could it be a problem?

You’re just slightly above the recommended fertility zone for weight. What I would like you to notice is whether it’s having any impact on your body. Are you aware of any hormonal problems that you have any ovulation problems, irregular cycles, etc.? If the answer is yes, it could be that the BMI could be a problem, but if the answer is no, then it could be okay because it’s just slightly above the recommended fertility zone for weight.

I like to make green juice with parsley and ginger and drink it daily. Is it a good habit when trying to get pregnant with IVF?

All of those things seem to be good. Parsley, ginger, they are naturally occurring products that are not processed, so I think everything that you can eat or drink that is poorly processed, and it’s a vegetable or anything healthy, then it can be quite good to give your body the right nutrients it needs to get pregnant.

I have a question about your journey. Please, feel free to answer or not. At the beginning of your presentation, you told us about your struggle. Did you find a way to create a family with the choices that we have today?

I’ve struggled with that question, so I’ve been diagnosed 20 years ago, and at the time, I wasn’t trying to get pregnant. I was just 17, but I do have a very big family, and I was hoping that one day I would have children naturally, so when that didn’t happen, I think it took me a long time to come to terms with the fact that I would never be able to get pregnant. The choices that I have today are either surrogacy, adoption, or not having children. I’ve chosen now, not to do anything, and this was an incredibly hard choice because I had the realization that none of the choices I had was like a band-aid to cure the wound of infertility, and they wouldn’t take away the pain of not being able to carry my children. I think it’s great to have choices and the choices that we have or the choices that we choose to go ahead, needing to feel right with us, and for me, I don’t think it’s right for me at the moment. I’m okay with changing my mind. My husband and I, talk about it every year at the beginning of the year, and we ask ourselves how are we feeling about it. Do we want to pursue a choice or not? So far, for the last couple of years since we’ve been married, we’ve also felt I’m okay, I’m happy as I am, I don’t want to face another struggle, so the choice has been, no, I don’t want to have another struggle and I haven’t gone ahead with another choice. I do have a husband, I’m very happy, and I have a puppy, which keeps me busy, and I feel that my way of having my babies is almost what I’ve been doing as a fertility nurse by helping so many other couples have their babies that gives me so much meaning, and that’s what I have chosen to do. I have thought about egg freezing, and at the moment because it’s been so long since I was diagnosed, my head is open to all those choices that are available. I think if I ever decide to go ahead with surrogacy, I will deal with that, I don’t want to think about the future. If I want to do surrogacy and my eggs are not good at that point, I will go ahead with egg donation. I’m completely fine with that because, for me, motherhood is more than the genetic connection with the baby, it’s more about passing your values, your beliefs, and growing together, so I’m not going to freeze my eggs for now.

Will you recommend taking ubiquinol as a supplement? If yes, how much?

Ubiquinol can be a powerful supplement, that is one of the modifiable factors that I was talking about, so I think you can go to the app to check it, but it depends on your condition, what you have been diagnosed with. On Monday, go to the app (Enhanced Fertility Programme App), go to the supplements section, find ubiquinol, coenzyme q10, and check if it fits with your conditions if you should have it or not.

In Portugal, a study was done about the correlation between the consumption of alcohol and the quality of sperm. A reduction in the quality of sperm has been identified. But since men are able to produce sperm their entire life, this effect of alcohol consumption in early days can be better after reduction of the consumption in late days?

I am aware of that study. They’ve realized that when men drink a lot of alcohol, sperm are very sensitive, so there was some impact on sperm, but men produce sperm since they reach puberty almost throughout their all lives, until they die, so once men start producing sperm, they will produce sperm every day. There will be certain sperm that will be in the beginning stages of development, and there will be older sperm, so there’s a whole process of spermatogenesis from a single cell, which is the format of a new sperm with the head, the midsection, and the tail, so as it forms into a big, normal sperm, it takes 74 days. They’ve noticed that men who are consuming that alcohol, they had changes in their sperm, but after a full spermatic cycle which is 74 days, the sperm came back to being normal again. There’s a chance of making changes to your lifestyle if you are a man, if you stop drinking today or drinking less than in 74 days you will notice the differences in the quality of your sperm.

I have a problem with the thickness of the endometrium – only 6-7mm on the day of ovulation. Is there anything that I can do to solve this problem? Maybe food enriched with estrogen?

The hormone that impacts the thickness of the endometrium is called progesterone and it’s produced by the corpus luteum. When your eggs are developing in your ovaries, the eggs are inside the follicles, and we have hundreds of follicles developing with eggs inside, in every cycle, and there is one egg that will be fully mature and will be ovulated, and all the other eggs will degenerate. Once the egg is ovulated, the follicle that was around it will become the corpus luteum, and the corpus luteum will produce the progesterone that will prepare the endometrium lining to implant the egg that has been fertilized. If the thickness is not enough, there could be one of two reasons. Either, the corpus luteum is not producing enough progesterone in which case you could either take progesterone medication or you could receive certain medications to induce ovulation. And then create bigger follicles that would then create more progesterone, once the follicle becomes corpus luteum. The second problem might be that the endometrium is not responding to the progesterone that you are producing. This is a very important distinction to make. You need to understand what is the reason why the endometrium thickness is not enough. I would say probably, measuring your progesterone levels would be the next step, to understand whether you’re producing enough progesterone or not during that phase of the cycle.

Recently, we had a failed ICSI cycle because we had 7 eggs retrieved, 3 were viable but did not fertilize, unfortunately. What can I do? Could it have been the protocol and stims I was on, or is it more likely to be the quality of the eggs and sperm?

If you have 7 eggs, 3 were viable, but none of them fertilized even with ICSI, which tells me that it’s likely to be the quality of the sperm or eggs. There’s something there that is preventing the egg and sperm to fertilize because of what they’re doing with ICSI is they are putting the sperm inside the egg, but they still need to react and recombine their DNA to develop into an embryo, so that leads me to believe that it might be the quality of the eggs and sperm.

How can I know the quality of my eggs? I have a regular cycle every month. What type of signs could imply good eggs, for example?

We usually talk about the number of eggs, and we can sort of ascertaining the number of eggs with certain, medical tests usually, AMH and an AFC ultrasound, however, how good the eggs are? There’s only one way of seeing it and is whether the eggs are fertilized or not. There is no other way of knowing, and I understand that these eggs didn’t fertilize, but before we assume that the problem was in the eggs, we need to look at the sperm as well. Was the sperm normal? Was there a DNA fragmentation done on the tests? Were they normal that we can say that the problem is with the eggs? I don’t know, but the only way of knowing if the eggs are viable is through fertilization rates.

Do you believe you can change egg quality, or is it fixed?

I believe you can change it because we are born with 1 to 2 million eggs, so when we are babies ourselves, we already have 1 to 2 million eggs. By the time we reach Huberty, we have around 400 000 eggs left only, every month we’re losing lots of eggs. These eggs are like in a sleeping state, in our ovaries, so every cycle there’s a certain number of eggs that will grow and mature, it’s not like they’re already ready to be ovulated, so they need to grow and mature in every cycle. All the things that we’re doing like our nutrition, our lifestyle, the products that we are putting in our skin, or physical activity can impact the ability of these eggs to grow and mature properly. To have a better quality to be ovulated, fertilized, and to generate into a healthy baby. There is an amazing book that talks about egg quality that you should read, it’s called ‘It all starts with the egg’ and it has so much good information about it, all evidence-based, so I highly recommend that book.

On which day of the cycle, progesterone should be measured?

We are ovulating, and then you need to allow a couple of days and then you should measure your progesterone. In order to identify ovulation, you need to do one of two things. Either, you have a scan when you think you should be ovulating and the doctor identifies yes, you’re ovulating, come in a couple of days to take some blood and measure your progesterone. Or you can use an ovulation test, like measuring your LH in your urine, so you know you’re going to be ovulating in a couple of days, and then you allow another couple of days, and then you measure your progesterone and then at the same time you can do an ultrasound to measure the endometrial thickness as well, so that would give you the full picture of what is happening during that stage of the cycle.

Is it normal to have a cycle that varies? 28 to 30 days? Why does it happen?

A cycle of 28 to 30 days, so that means this month you might have 28 days, the next cycle, might be 30, it’s absolutely normal for it to vary a couple of days from cycle to cycle. If they vary more than just a couple of days, so let’s say this month was 28 and next month is 40, that is not normal and you need to understand, what’s the reason, but if it’s just a couple of days, it’s absolutely normal. The main variable phase of the cycle is that phase before ovulation when it’s just very variable from women to women and even from the same woman from cycle to cycle. We know that the luteal phase, the progesterone phase lasts between 12 to 14 days after ovulation, but the phase before ovulation can be quite variable, and that brings that variety of a couple of days, but it’s absolutely normal.

Is it possible to take too many supplements, which can hurt the quality of the sperm and egg?

I’m not sure, is the honest truth. I’m not sure if you have the chance of hurting the quality of sperm and egg, but you can hurt your overall health if you’re taking more supplements than it’s recommended dose. That’s why you must look at the labels and see what the supplements have. Some supplement might come in a form of a multi-supplements where they have a lot of items in it, and then if you’re taking something else that also has, for example, the same vitamins in it, you don’t want to be doubling up, so read the labels and just take the recommended doses.
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Andreia Trigo, RN BSc MSc

Andreia Trigo, RN BSc MSc

Andreia Trigo is a multi-awarded nurse consultant, author and TEDx speaker. Combining her medical experience and her own infertility journey, she developed unique strategies to help people undergoing similar challenges to achieve their reproductive goals. Her mission is to improve accessibility to fertility care and support worldwide at minimal cost to populations. She is also The Founder & Director of Enhanced Fertility Programme, the evidence-based programme that improved help for fertility, currently in use by several clinics and patients worldwide.
Event Moderator
Caroline Kulczycka

Caroline Kulczycka

Caroline Kulczycka is managing MyIVFAnswers.com and has been hosting IVFWEBINARS dedicated to patients struggling with infertility since 2020. She's highly motivated and believes that educating patients so that they can make informed decisions is essential in their IVF journey. In the past, she has been working as an International Patient Coordinator, where she was helping and directing patients on their right path. She also worked in the tourism industry, and dealt with international customers on a daily basis, including working abroad. In her free time, you’ll find her travelling, biking, learning new things, or spending time outdoors.
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