Welcome & Introduction
Welcome to the IVF Success Plan. We’re glad you’ve decided to join us.
This Plan is the result of over 6 years research into science-backed steps we can take to improve our chances of IVF success.
Not only that, we’ve been there and done it. We took the results of the research, applied it and, against the odds, have two beautiful children.
We left no stone unturned in looking for steps we could take to boost our success. In this Plan we’ll take you step-by-step through everything we did.
There’s a lot of information I want to share with you so let’s get started.
An IVF Success Story
It was April Fools’ Day in 2005.
My wife, then girlfriend, had been feeling unusually tired for a few months and had developed a huge cold sore on her lip. It was clear that she was tired and run down. In the days leading up large, red circular lesions had appeared on her body and the tiredness had escalated to such an extent that she passed out whilst having a shower. I took her to the Emergency Ward at our local hospital, she was admitted and 3 days’ worth of tests were carried out. No one could tell us what was wrong. The final test involved using a corkscrew device to drill into her hip bone and suck out some bone marrow for analysis. We did not think anything of it at the time as it was the latest of probably 20 tests.
My employer had been good enough to allow me to spend time with my wife as she was exhausted and emotionally frazzled. One day, as I was driving to the hospital, she called me and said that some results had come back but the doctors were waiting for me to arrive before discussing them. My first reaction was “that sounds ominous” but I reasoned that, although it seemed odd, if it was bad news they would not have said what they said as it would just cause her to worry.
About 10 minutes after I arrived at hospital a consultant, a junior doctor and a nurse came into the room. The first thing the nurse did was to close the blind on the window between my wife’s room and the corridor. I realised immediately that the news was going to be bad. After introducing himself as a consultant in the haematology department the doctor came out with it: “you have a type of blood cancer called leukaemia”.
I am recording this 14 years later yet I can still picture the scene in minute detail, such was the power of the emotion. It hit like a sledgehammer and we were both crushed. My wife’s first reaction was to scream my name, turn to me and begin sobbing uncontrollably. I held her close and immediately tried to change our focus to something vaguely positive: “ok, so that’s what it is, how do we sort it?”
The doctor explained the type of leukaemia and the treatment options, along with the side effects. It was clear that my wife was going to have a lengthy spell in hospital and that her fertility may be affected.
The treatment involved 5 cycles of intensive chemotherapy. Her immune system was virtually destroyed after each cycle so she had to remain locked in a hospital room for 4-6 weeks at a time until her blood counts improved sufficiently to allow her back into the real world. She had a week out of hospital before the process started all over again.
Thankfully, she went into remission and was discharged from hospital 6 months after diagnosis. As she was young and had what is usually an old person’s illness, the prognosis was relatively positive. If she was going to relapse it would happen within 2 years.
Fast forward 3 years and, despite the prognosis, she relapsed. We had long since put that time behind us so needless to say it came as a massive shock. My wife had not experienced any symptoms as such, it was just picked up as part of a routine check-up. This time the prognosis was not great. The only other treatment option was a bone marrow transplant but as my wife is an only child and of mixed race finding a tissue match had been impossible previously. Even if they were able to find a match the drugs given in preparation for the transplant would almost certainly render her infertile.
We had married the year before and, whilst we were not thinking of starting a family immediately, it was always our plan to have children. The news of the relapse and the side effects of the only treatment that could lead to a cure were hammer blows.
We were both devastated but resolved to investigate options with a fertility specialist. Fortunately, we were living in London at the time and a world-renowned fertility specialist worked at a different hospital in the city. My wife’s haematology consultant was against the idea and wanted her to commence treatment immediately to give her the best chance of survival. He also told us that as she had already undergone 5 cycles of chemotherapy the likelihood was that the damage had been done and we would not be able to have children.
It was an awful decision to have to make but we decided to at least speak with the fertility specialist to see if there were any options. Thankfully there were. He went through a number of possibilities ranging from removing and storing ovaries in the hope that science may in the future develop a way of extracting eggs to undergoing an IVF cycle to assess the impact of the previous treatment and, if possible, to create some embryos that could be stored for the future. He made no promises.
Whilst the odds were low amongst the gloom there was a glimmer of hope.
We persuaded the haematology consultant to allow us to delay treatment for a short time whilst we underwent an IVF cycle. Over the next few weeks we went backwards and forwards between two hospitals on a daily basis. The leukaemia had suppressed my wife’s immune system and her blood counts were very low so she received blood and platelet transfusions to keep her alive during this period.
We began the cycle and as the days passed and my wife received daily hormone injections things seemed to be working. Follicles were growing on her ovaries (which indicated that they may be producing eggs) and the IVF doctors were cautiously optimistic. They were proved right as my wife ended up having 8 eggs extracted, of which 4 were successfully fertilised and then frozen. We were absolutely delighted.
A few days later my wife was admitted to hospital for the first of 3 further cycles of chemotherapy. We didn’t tell the haematology consultant at the time but we formulated a plan to undergo further IVF treatment in the breaks between cycles, assuming the first cycle put her back into remission. Whether we could achieve this in part depended on how quickly her immune system recovered and the stage of her monthly cycle. However, it would also mean an extra week’s break in between cycles which would increase the chances of the leukaemia returning.
Unsurprisingly the consultant was dead against it. He did not mince his words. I can recall vividly my wife calling me in floods of tears as I was walking up to the hospital. He had made he views very clear to her whilst I was not there. When I arrived at the hospital the head nurse had spoken to her and told her that she should do what she felt was right, irrespective of the consultant’s views. With the nurse’s support we underwent another IVF cycle and obtained a further 8 eggs which again produced 4 embryos.
We now had options. Provided, of course, we could get my wife through the relapse. It was going to be very difficult but we were determined to remain positive and to take each day as it came.
It was after her second cycle of chemotherapy that the second piece of good news arrived. We knew that the odds of finding a suitable adult donor for her were many millions to one but the doctors had referred in passing to a new, experimental form of bone marrow transplant using stem cells from the umbilical cord of a newborn baby. For various reasons the tissue match criteria are less stringent for this type of transplant and it turned out that cells donated by the parents of a baby in Singapore were a sufficiently close match. She now had a chance of survival. Compared to the seemingly hopeless position we were in a few weeks before there was a chance of having the life we had both dreamed of.
The preparation for the transplant and the recovery from it was a long and often difficult process. The drugs given to prepare for the transplant were so damaging that my wife was looked after by the palliative care team. Fortunately, though, things worked out as planned. On her release from hospital we then returned for weekly blood tests to check that the leukaemia hadn’t returned. Sitting in a waiting room full of leukaemia patients awaiting the results of their blood tests was not a pleasant experience… and I was only a bystander. I cannot begin to imagine what it was like for my wife.
Slowly but surely her new immune system from the transplant took root and her blood counts returned to normal levels. In parallel with this, the hospital visits became less frequent. As I record this it is over 10 years since the transplant and we are down to annual check-ups. Through the miracle of modern medicine and a steely determination to succeed my wife is cured.
With the first piece of the jigsaw in place we then began the process of using the embryos we had stored at the time. The treatment leading up to the bone marrow transplant had indeed rendered my wife infertile and whilst we had 8 embryos, it was a finite amount. We were not going to able to produce any more. If we were not successful with these then that was it as far as having our own children was concerned. Given what we had been through we were hugely thankful for having the opportunity but we knew that we had to approach things carefully. This was underlined when we met with the fertility specialist that had treated us previously. He was keen that we “managed our expectations” because whilst the embryos were of sufficient quality they were very early stage and it was impossible to say how my wife’s previous treatment had affected them. She was also 38 by this point so time was not on our side.
So, why am I telling you all this? What relevance does it have to preparing for IVF treatment?
The reason I have described our past is to show what is possible from even the darkest situations. We realised that we had a limited number of chances to have our own children so we did everything in our power to give ourselves the best chance of succeeding. We spent thousands of hours researching every aspect we could think of. We reviewed thousands of scientific studies relating to IVF covering nutrition, supplements, fitness, psychology and more. We also consulted Chinese medicine practitioners to understand how their philosophy and practices could assist.
We put together a detailed plan to follow over the coming months to get us into the best shape possible, adopting the philosophy of Sir Dave Brailsford, a hugely successful sports coach:
“It is often difficult, if not impossible, to find one or two things that will make a large difference to your chances of success. It is, however, possible to find many small things that each increase your chance of success by a small percentage but added together make a massive difference.”
We had adopted this philosophy to help cure my wife of leukaemia and I am pleased to say that it also worked with our IVF treatment. After spending several months preparing we achieved pregnancy at the first attempt and our daughter was born in September 2015.
In mid-2017 we decided to try for a second child. The Plan had worked the first time so we followed the same steps again. To our delight it worked a second time and our second daughter was born in December 2018.
We were given a 1% chance yet have two children. We have achieved this from only two IVF cycles each involving single embryo transfers.
The joy that our daughters have brought to our lives is immeasurable and it is this joy that is the inspiration for putting together this Plan. If we can help just one other couple with the information contained it will have been worthwhile.
I don’t know you and I don’t know your situation. You may be contemplating your first IVF cycle or you may have already tried and not succeeded. What I do know is that science suggests there is a huge amount that you can do to increase your chances of success. These are typically lifestyle things that many fertility doctors are not aware of. In this Plan I will explain step-by-step everything that we did to achieve success.
I wish you well.
The Plan is split into 8 sections:
- Our minds
- Traditional Chinese medicine
Each section describes the steps that my wife and I took and discusses the scientific evidence that was the basis for our actions. As you read the Plan you will come to realise that we did a lot of things! Whether you follow some or all of these steps is a decision for you to make in consultation with your medical team. You should think of this Plan as a blueprint or a toolkit from which you can choose the steps to take. It is deliberately straight-to-the-point and is not padded out with any waffle. You may decide to take all the steps or you may have a specific issue and take the steps shown to address that. The aim is to empower you to give you the best chance of succeeding with IVF, whatever the cause of your fertility issues.
We’re in it together
When I refer to “you” I am talking about both you and your partner. Many seem to have the impression that infertility is a “female issue” however that is not necessarily the case. Studies show that 20-30% of infertility cases are caused by female issues, 20-35% of cases are due to male issues, 25-40% of cases relate to problems with both partners and 10-20% are unexplained.
I was very conscious when we started preparation for IVF that my wife and I were “in it together”. First and foremost, I wanted to be there for her and to provide support through what had the potential to be a difficult time. I was also aware of studies that showed that people that have good support do better when it comes to treatment outcomes. I would strongly recommend that, wherever the fertility issue lies, you and your partner adopt the same approach.
The 3 keys to IVF success
IVF success comes down to getting three things right: egg quality/quantity, sperm quality/quantity and womb receptivity. If any of these are not optimised your chances will decrease.
The phrase “weakest link in the chain” is very appropriate here: your chances of success are only as good as the weakest link.
Whatever the cause of your fertility issues, be it endometriosis, PCOS, low sperm counts or another problem, the quality and quantity of your eggs and your partner’s sperm together with the receptivity of your womb are critical to success. This being the case you should strongly consider taking steps to optimise them all.
Of course, if you are aware that you have a specific issue or condition that affects one of these you should pay particular attention to the steps to help improve it. But don’t neglect the other things.
To help guide you to the most relevant steps I have used the following key in each section:
Egg Quality & Quantity
Sperm Quality & Quantity
Some IVF studies focus purely on the main outcomes, pregnancy rates and live birth rates. They do not always look at whether an increase in the main outcomes is due to improved egg quality/quantity or womb receptivity. Where this is the case I have taken the positive effect to impact both so there is no risk of missing out on a potential benefit.
It became apparent through all our research that many steps simply make us healthier generally and that it is through becoming healthier that our fertility and our chances of having a baby improve. This is the reason why many of the steps can help with all three things.
What your doctor doesn’t know
To reiterate, it is important that you discuss any step you want to take with your doctor. Many are well informed when it comes to lifestyle measures that can assist with IVF success. Unfortunately, it is also the case that many doctors are not so knowledgeable. Because of this I have included references to all the scientific studies included in this Plan. This will give your medical team the opportunity to see the effectiveness of the steps for themselves.
Why are some doctors not aware of these things? There are a couple of reasons. Firstly, medical training does not typically cover the types of things included in this Plan.
Secondly, the way the pharmaceutical and medical industries work means that doctors are bombarded with information about drugs but receive very little information about other things. To explain why I need to set the scene so bear with me!
Pharmaceutical companies are in business to make money. No surprise there. They do this in various ways but the big one is the development of new drugs. These businesses invest billions of pounds in research and development to do this. Clearly, they would only do so if there was a return on their investment.
Next, we need to understand how pharmaceutical companies protect their investment in new drugs. The laws of each country provide protection for something called “intellectual property”. Intellectual property is a term used to describe many things including new drug inventions. Once developed, new drugs can be protected by something called a patent. The effect of obtaining patent protection is that the owner has a monopoly on producing and selling the drug. No one else can then produce or sell that drug so the pharmaceutical company receives the benefit of all the sales.
Not everything can be protected by a patent however. Examples include naturally occurring substances, such as foods, vitamins and minerals and lifestyle measures generally. If a pharmaceutical company cannot obtain a patent for something then it cannot stop others from selling similar products. So, for example, if it were to invest heavily in R&D and find that a certain vitamin was beneficial to IVF it could not be sure of receiving a return on its investment as anyone could sell that vitamin. For this reason, it is not in the interests of pharmaceutical companies to focus on naturally occurring substances, unless they believe that they can tweak/enhance them in some way to constitute a new “invention”.
Still with me?!
So, how does this dynamic impact the medical profession? Pharmaceutical companies spend billions of pounds on marketing to doctors. There are many pharmaceutical companies and often multiple drugs designed to treat similar issues. There is therefore a lot of competition between them to encourage doctors to prescribe their drug rather than the drug of a competitor. They have sales and marketing teams that develop marketing campaigns, provide training courses, host conferences and generally push their products. My father-in-law is a doctor and he tells me that he is bombarded by pharmaceutical salesmen, marketing materials and invitations.
On top of this, pharmaceutical companies fund scientific studies designed to show how well their products work. They clearly have a financial interest in showing impressive results. I’m not suggesting that they seek to influence the results of these studies, I am simply making the point that they have the funds to pay for them whereas there is no incentive for them to pay for studies of things that they cannot generate revenue from. This fact alone means that the number of studies of drugs exceeds the number of studies for naturally occurring substances and lifestyle measures many times over.
The result of all this is that the only information that the typical doctor receives relates to drugs and little, if anything, that relates to lifestyle steps. Doctors are busy people so it is little wonder that many are not aware of how effective such things can be.
Backed by studies
In addition to the references to scientific studies, I have included a brief summary of the results of the studies. The reason for doing this is that research shows that people who are fully engaged in their treatment feel more empowered which in turn leads to better treatment outcomes. In other words, by simply being aware of the possible benefits of taking certain steps people ultimately experience better results.
Ensuring we maximise our chances
As I mentioned above, the approach that my wife and I took was one of seeking marginal gains: small steps that individually may make a small difference but collectively add up to a significant difference. In this spirit we also took steps that were based on science where different studies showed conflicting results, some showing benefit and others not. Provided that there was no downside, only upside, to taking those steps we decided to take them.
Inflammation, the modern epidemic
In the Plan you will hear me talk a lot about “inflammation”, or more specifically chronic inflammation, and the importance of taking steps to minimise it. Chronic inflammation is different from acute inflammation which is a critical part of our make-up. Acute inflammation is part of the body’s immune response designed to defend itself against things like viruses and bacteria and to repair damaged tissue. Without it we would die from things as innocuous as the common cold. Chronic inflammation is a different beast.
It is not quite as simple as saying acute inflammation is good and chronic inflammation is bad but it is true to say that the persistent, low-grade, chronic inflammation can be problematic to health. The problems arise when our bodies are tricked into believing there is an issue but the perceived threat does not actually exist. We have all these substances released by our bodies and with no real threat to deal with they sometimes end up attacking healthy cells.
If this does not sound scary enough studies have shown that chronic inflammation contributes to many of the leading causes of death in the western world: heart disease, cancer, diabetes, stroke, Alzheimer’s disease and kidney disease.
Serious stuff and to maximise our chances of IVF success we need to deal with it.
How long should you follow the steps set out in the Plan? It depends, in part, on whether you have a specific underlying issue that you would like to address. If, for example, you are well outside the ideal bodyweight range for IVF (see Section Five: Bodyweight) then it may take some time to address the situation. My wife and I spent 11 months preparing for our first transfer and 8 months preparing for the second but I am not suggesting that you spend this long. To an extent the longer you follow certain steps the better but we have to be conscious that advancing age is a factor for many.
The best guide may be to look at our bodies’ natural fertility cycles. Women are born with all the eggs they will ever have. Around 3-4 months prior to ovulation a number of these eggs will undergo a critical transformation to develop into mature eggs.
In men the situation is slightly different as sperm is produced every day but it takes 2-3 months for them to reach maturity.
Based on these factors a preparation period of 4 months would seem to be a reasonable minimum. However, all things considered, if my wife and I were to undergo another IVF cycle we would spend at least 6 months preparing to ensure an optimal environment is created in our bodies well in advance of these windows.
I have tried to avoid using medical jargon in the Plan. The aim is to take what are often complex issues and studies carried out by scientists and present them in plain English. Occasionally though, I have used medical terminology where I think it may be helpful to do so. In these cases, I have explained the meaning alongside the first use of the term and have included an easy-reference guide in the Resources section below which provides the plain English meaning.
Prevalence of lifestyle issues
Finally, the power of adopting a holistic approach to IVF such as the one in this Plan is demonstrated by a Dutch study of 130 women attending an IVF clinic. The researchers looked at all areas of the women’s lives and found that 96% of them had 3 or more lifestyle issues that could hamper their chances with IVF. The other 4% had 2 lifestyle issues. Based on these results it is fair to say that couples looking to undergo IVF would be well advised to take time to address their lifestyle to maximise the chances of having a baby.
This Plan will help you to do just that.
I’ve tried to avoid using medical terminology in this Plan but sometimes it is helpful to do so. It can help bridge the gap between what our doctor tells us and our understanding. Of course this only works if the terminology is explained to us!
In the Plan, wherever medical terms are used, I have explained what they mean. I have also put together this guide for you to download and use as a reference point.
 ART fact sheet (July 2014). European Society of Human Reproduction and Embryology
 Association between social support and health outcomes: a meta-analysis. Kaohsiung J Med Sci. 2003 Jul;19(7):345-51
 Why does choice enhance treatment effectiveness? Using placebo treatments to demonstrate the role of personal control. J Pers Soc Psychol. 2013 Oct;105(4):549-66
 Inflammatory markers in population studies of aging. Ageing Res Rev. 2011;10(3):319–329
 Inflammation and cancer: how hot is the link? Biochem. Pharmacol. 2006;72(11):1605–1621
 Recent advances in the relationship between obesity, inflammation, and insulin resistance. Eur. Cytokine Netw. 2006;17(1):4–12
 Inflammatory markers in population studies of aging. Ageing Res Rev. 2011;10(3):319–329
 Inflammation in Alzheimer Disease—A Brief Review of the Basic Science and Clinical Literature. Cold Spring Harb Perspect Med. 2012 Jan; 2(1): a006346
 Platelet/Leukocyte activation, inflammation, and uremia. Semin Dial. 2009;22(4):423–427
 Integrating preconceptional care into an IVF programme. Journal of Advanced Nursing 68(5), 1156–1165