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Practices before and during IVF

Depending on the medical history, physicians may suggest additional evaluations or approaches. They are not needed for everyone, and the decision is individual.¹

All treatment stages

General health measures

Weight control, stopping smoking and the treatment of other health problems are usually recommended before IVF.² In some cases the physician may suggest hormonal or metabolic treatments, or antioxidant supplements in male infertility.³ These are prescribed only after evaluation.

Before treatment

The uterine cavity may be examined with hysteroscopy, and a biopsy may be taken if needed.⁴
A tubal problem seen on ultrasound may need further imaging, and blocked or swollen tubes may need laparoscopy or hysteroscopy.⁵
After repeated implantation failure, a genetic evaluation or a blood clotting evaluation may be considered.⁶
In endometriosis, medication may be used to suppress the disease before treatment.⁷

During treatment

The protocol or medication doses may be changed if the response to a previous cycle was different from expected.
Genetic testing of embryos (PGT) may be considered in some genetic conditions or after repeated pregnancy loss.⁸
Time-lapse imaging can be used to follow embryo development.⁹
In some cases embryos are transferred in two steps (for example a day 3 transfer followed by a day 5 transfer).
In severe male factor, special microscopy or sperm selection methods can be used in the laboratory.¹

Antioxidants

Antioxidants such as vitamins A, C and E, selenium and L-carnitine occur in nature and are sometimes suggested by physicians. Their use should be discussed with the physician.³

References

ESHRE Add-ons Working Group. Good practice recommendations on add-ons in reproductive medicine. Human Reproduction. 2023;38(11):2062–2104.
National Institute for Health and Care Excellence (NICE). Fertility problems: assessment and treatment. NICE guideline NG257. 2026.
de Ligny W, et al. Antioxidants for male subfertility. Cochrane Database of Systematic Reviews. 2022. CD007411.pub5.
Kamath MS, et al. Screening hysteroscopy in subfertile women and women undergoing assisted reproduction. Cochrane Database of Systematic Reviews. 2019. CD012856.pub2.
Johnson N, et al. Surgical treatment for tubal disease in women due to undergo in vitro fertilisation. Cochrane Database of Systematic Reviews. 2010. CD002125.pub3.
ESHRE Working Group on Recurrent Implantation Failure. ESHRE good practice recommendations on recurrent implantation failure. Human Reproduction Open. 2023;hoad023.
Becker CM, Bokor A, Heikinheimo O, et al. ESHRE guideline: endometriosis. Human Reproduction Open. 2022;2022(2):hoac009.
ESHRE PGT Consortium Steering Committee, Carvalho F, et al. ESHRE PGT Consortium good practice recommendations for the organisation of PGT. Human Reproduction Open. 2020;2020(3):hoaa021.
Armstrong S, Bhide P, Jordan V, Pacey A, Marjoribanks J, Farquhar C. Time-lapse systems for embryo incubation and assessment in assisted reproduction. Cochrane Database of Systematic Reviews. 2019;(5):CD011320.