Preparing for IVF: what really matters in the three months leading up to treatment

When a patient contacts me saying, ‘I’d like to start next month’, I always ask her the same question: what stage are your tests at? Nine times out of ten, it’s the paperwork, not biology, that determines the date. Here’s how to make the most of the three months leading up to IVF.

Why three months?

An egg takes several months to progress from the reserve stage to that of a mature follicle; the final weeks are the most sensitive to environmental factors. Sperm production takes around 70 to 80 days. So any changes you make today will affect the gametes of the cycle in three months’ time — not those of next week.

Month 1: medical records

• Up-to-date baseline assessment: AMH and follicular ultrasound, semen analysis, serological tests (HIV, hepatitis B and C, syphilis), blood group. Further details can be found in the article on fertility testing.
• Validity: Greek clinics generally require serological tests to be no more than 3 to 6 months old. Check the expiry date before having them done.
• Cervical smear and, if necessary, a mammogram depending on age.
• Translations: a report in English is sufficient at most Greek clinics. An official translation is rarely required.

Months 1 to 3: habits with a proven effect

• Smoking: this is the most important modifiable factor. It accelerates the loss of ovarian reserve and impairs sperm quality. Giving up, even at a late stage, improves outcomes; this also applies to the partner.
• Alcohol: reduce intake significantly; ideally, stop drinking altogether during treatment.
• Folic acid: 400 µg per day for at least one month before conception, to reduce the risk of neural tube defects. Sometimes a higher dose is prescribed (depending on medical history, high weight, or certain treatments).
• Weight: a weight loss of 5 to 10 per cent in an overweight patient can improve ovulation and reduce the risks associated with pregnancy. I discuss this in the article on weight.
• Vitamin D: a blood test is useful; a deficiency can be easily corrected.
• Heat exposure for the partner: avoid saunas, very hot baths and using a laptop on your lap; do not take testosterone or anabolic steroids, as these block sperm production.

As for dietary supplements, there is little evidence to support most of them; I sort through them in this article.

Vaccinations

Check your immunity to rubella and chickenpox: these live vaccines must be administered at least one month before becoming pregnant. Vaccinations against flu and whooping cough should be discussed depending on the season and the schedule.

Current treatments

Ask your doctor to review your prescription: certain medicines (isotretinoin, certain anti-epileptics, methotrexate, oral anticoagulants) are incompatible with pregnancy or require a change of treatment. Any thyroid imbalance must be corrected beforehand; see thyroid and fertility.

Month 2: organisation

• Choosing a clinic and the first remote consultation: I explain in detail how to prepare for it.
• Time off work: identify the likely dates for egg retrieval and allow for flexibility, as the exact schedule depends on your response to stimulation. See IVF and work.
• Budget: ask for a detailed written quote; allow for medication costs and the possibility of an additional embryo transfer.
• Coverage: European Health Insurance Card, travel insurance, and possibly an S2 form if you are coming from a European Union country.

Month 3: the final stretch

• The pill or any pre-treatment as per the clinic’s protocol.
• Flexible bookings: changeable tickets, cancellable accommodation.
• Ordering or purchasing medication: see medication in Greece.
• Sleep and mental load: now is the time to delegate whatever can be delegated.

What’s pointless

‘Detoxes’, highly restrictive diets, unfounded lists of forbidden foods, and completely cutting out coffee (one to two cups a day have not been shown to cause any problems). Preparing yourself isn’t about punishing yourself.

Frequently asked questions