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Ways to Improve IVF Success: Evidence-Based Strategies

Dr. Senai Aksoy · · 8 min read
Medically reviewed on 30 August 2026 - Dr. Senai Aksoy
An embryologist reviewing embryo-monitoring images in a modern laboratory

Key Takeaways

There is no universal shortcut to IVF success. Meaningful improvements come from matching treatment to age, ovarian reserve, sperm factors, and previous cycle response. An individualized stimulation and transfer plan matters far more than stacking weakly supported add-ons.

Key evidence: ESHRE ovarian stimulation guideline ASRM guidance on embryo-transfer number (2021) ESHRE add-ons recommendations (2023)

There is no single trick that raises IVF success for everyone. What tends to help is a plan that matches the diagnosis, avoids preventable problems, and follows published evidence rather than the marketing around extras.

To understand the main biological drivers — maternal age, ovarian response, embryo quality, sperm integrity, and uterine receptivity — see our guide on what most influences IVF success. The IVF success rates by age page gives clinic-level context. Neither page offers a guarantee; both give realistic benchmarks.

1. Start with an accurate diagnosis

Before another cycle, it helps to know where the last one lost ground. Repeating the same protocol with one extra add-on attached rarely fixes the real bottleneck.

IVF results still rest on age, ovarian reserve, sperm findings, and the uterus and tubes. Reviewing those points before stimulation helps the team plan the next cycle instead of simply attaching another add-on.

Key elements include:

Without that review, a new cycle can look different on paper and still repeat the same shortfall.

2. Individualize ovarian stimulation

The right stimulation protocol depends on how the ovaries are expected to respond. PCOS calls for careful control of ovarian hyperstimulation risk. Low reserve calls for realistic expectations about egg yield.

One standard protocol cannot serve every patient. Women with polycystic ovary syndrome (PCOS) need a plan that limits the risk of ovarian hyperstimulation syndrome (OHSS). Those with diminished ovarian reserve may need a different protocol, but more medication does not automatically produce more eggs.

ESHRE’s 2025 guideline uses markers such as AMH and antral follicle count to predict ovarian response and plan treatment safely (ESHRE ovarian stimulation guideline). Ultrasound and hormone monitoring then show whether the ovaries are responding as expected. For more detail, see how IVF protocols and medications are chosen.

3. Use embryo transfer strategy carefully

Elective single embryo transfer is mainly a safety choice: it reduces the risk of twins. Fresh versus frozen transfer should follow the clinical details of the cycle, not a clinic habit.

Transfer decisions affect both the chance of pregnancy and medical safety. ASRM strongly encourages single embryo transfer for younger patients with a favourable prognosis because it lowers multiple-pregnancy risk without a significant clinic-level reduction in live birth rates (ASRM, 2021).

Whether the next transfer is fresh or frozen should follow progesterone levels, ovarian response, and endometrial readiness. The trade-offs are set out in our guide to fresh versus frozen embryo transfer.

4. Treat major uterine or tubal problems before transfer

A communicating hydrosalpinx has clearer evidence than many other findings before IVF. A cavity-distorting fibroid is a different problem and needs a separate discussion.

A communicating hydrosalpinx is the clearest example. ASRM concludes that laparoscopic salpingectomy or proximal tubal occlusion should be considered before IVF because untreated communicating hydrosalpinges are associated with poorer IVF outcomes (ASRM tubal-surgery opinion, 2021).

Cavity-distorting fibroids may justify myomectomy, although the clearest evidence is for improved clinical pregnancy rather than live birth. Routine removal of asymptomatic fibroids that do not distort the cavity is generally not advised solely to improve fertility outcomes (ASRM fibroid guideline, 2017). Polyps, adhesions, and suspected chronic endometritis need their own assessment rather than the same rule.

5. Do not ignore the male factor

A semen analysis is a starting point, not a formality. Further testing should answer a specific clinical question; sperm DNA fragmentation is not recommended routinely in the initial male evaluation.

When previous attempts showed poor fertilisation or early arrest in embryo development, a male-fertility specialist may need to review the history and semen findings before the next cycle. That does not mean every advanced sperm test will change treatment (AUA/ASRM male infertility guideline).

6. Support general health — without treating it as the treatment

Better metabolic health, a treated thyroid problem, and stopping smoking make pregnancy safer. They do not bypass maternal age or laboratory technique.

General health supports procedural safety and pregnancy health. It cannot replace embryology. Smoking is associated with poorer reproductive and assisted-reproduction outcomes, so stopping matters before treatment (ASRM, 2024). Known thyroid disease, diabetes, and hyperprolactinaemia should be managed for their own clinical reasons.

Body mass index needs the same honesty. Obesity can affect ovarian response, anaesthetic safety, and pregnancy risk. Pre-IVF weight-loss programmes have not been shown to raise live-birth rates in ovulatory women with obesity (ASRM, 2021). Lifestyle advice should support the person, not recast a failed cycle as personal failure.

7. Be careful with add-ons

Add-ons do not all carry the same evidence. A few may have a role in selected situations, but many have not shown a reliable live-birth benefit in routine use.

Endometrial scratching, empirical immune therapies, routine ERA testing, PRP, and megadose supplements should not be added simply because a cycle failed. Hyaluronan-containing transfer media, often marketed as EmbryoGlue, has a different evidence profile and still needs an individual discussion.

ESHRE’s 2023 recommendations assess each add-on separately; many are not recommended for routine clinical use, while a small number have narrower indications (ESHRE Good Practice Recommendations on Add-ons, 2023). The useful question is not whether an extra might help, but which problem it is meant to solve and whether the evidence fits that situation. For immune protocols after repeated failure, see repeated IVF failure and the immune system.

8. Consider reduced-medication protocols only when they fit

A lower-burden protocol may suit some patients with diminished ovarian reserve. That is not the same as saying that mild stimulation is better for everyone.

The likely egg yield, injection burden, cost, fresh-versus-frozen plan, and evidence for that ovarian-response group all matter.

A single-centre retrospective cohort found a similar mature-egg yield when clomiphene citrate was continued throughout stimulation without a GnRH antagonist. Importantly, this was not a mild-stimulation study and it did not establish a live-birth advantage (Mandelbaum et al., 2025).

A 2026 network meta-analysis found higher live-birth rates with GnRH-agonist protocols than with mild stimulation in POSEIDON group 3, but no significant live-birth difference among protocols in group 4. The analysis included non-randomised studies and clinically varied protocols, so it supports individualisation rather than a universal winner (Zhu et al., 2026).

Dr. Aksoy’s clinical perspective

Dr Aksoy’s clinical perspective

“I mostly tell my patients this: increasing your chances doesn’t mean adding more to the treatment. Sometimes the most reliable way to improve success is to remove what isn’t necessary.

“When a patient says, ‘I want to try everything I’ve read about online — let’s not leave anything out,’ I first try to understand the anxiety behind that request. After a few failed attempts, couples can start seeing every untried option as a missed opportunity. What I tell them is this: we don’t have to order the whole menu. Let’s first work out at which stage the previous attempt actually lost ground — did too few eggs develop, were too few mature, did fertilisation fail, did the embryo not reach blastocyst, or was a good embryo transferred without implantation? Every method added without identifying the problem makes treatment more expensive and more complicated — but not necessarily more successful.

“My approach isn’t to apply eight methods at once — it’s to go through them in the right order. I start by re-reviewing the diagnosis and prior cycles. Then I individualise stimulation based on age and ovarian reserve, and assess embryo development and transfer timing. The uterine cavity — and the tubes, when relevant — get reviewed; the male factor isn’t waved off with a standard semen count alone. Genuinely modifiable general-health factors — thyroid, metabolic status, weight, smoking, current medications — get addressed. Only after that do I discuss whether an add-on is actually meaningful for that particular patient.

“What bothers me most is adding a new ‘add-on’ after every failed attempt without a scientific rationale — EmbryoGlue, time-lapse, assisted hatching, endometrial scratching, ERA, immune therapies, PRP, or a different lab test each time. Some of these can be reasonable for selected patients, but none of them is the missing magic piece for everyone.

“Another mistake is switching medication or brand after a failed cycle without analysing why it failed in the first place. Changing the box the drug comes in is not the same as changing the treatment strategy — if we can’t say what went wrong or fell short in the previous protocol, we can’t explain why the new brand would do any better.

“My approach to reduced-medication or mini-IVF protocols is the same: less medication isn’t automatically more natural or better, and a higher dose doesn’t automatically mean more eggs. The goal isn’t to use the maximum amount of medication — it’s to get the most appropriate response your ovaries can safely give.

“What I offer the patient in the end is this framework: I can’t promise you success, but I can explain why each recommendation is being made, what problem it’s meant to solve, and how strong the evidence behind it is. If a method doesn’t have a good answer to those three questions, I don’t think it’s right to add it just because ‘it might help.’”

Conclusion

A sound IVF plan is not simply a longer one. It starts with an accurate diagnosis, uses stimulation that fits that ovary, keeps maternal safety in view, and treats commercial add-ons with scientific caution.

Request a case review

If you want to see which of these decisions apply to your history — rather than a generic internet list — a review of prior stimulation logs, embryology reports, and cavity evaluations is the useful next step. You can request a confidential case review with the clinical team.

Frequently Asked Questions

What improves IVF success most reliably?

The most reliable improvements come from an accurate diagnosis, stimulation that fits that ovary, a careful transfer strategy (often elective single embryo transfer), and treating problems such as hydrosalpinx before transfer when they are present.

Are IVF add-ons always helpful?

No. A few add-ons may help narrow subgroups. Most lack high-quality evidence of a live-birth gain. Invasiveness, cost, and side effects should be weighed before optional extras are added.

Can lifestyle changes replace clinical IVF technique?

No. A healthier lifestyle, stopping smoking, and treating thyroid or metabolic disease support safety. They cannot overcome maternal age, very low ovarian reserve, or severe sperm defects.

Is single embryo transfer less effective than transferring multiple embryos?

For younger patients with a good prognosis, often not. ASRM guidance supports elective single embryo transfer because it sharply reduces twin-related risk without a significant clinic-level reduction in live-birth rates. The right embryo number still depends on age, embryo history, and prognosis.

Sources

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Dr. Senai Aksoy

Dr. Senai Aksoy studied and trained in France before returning to Turkey, where he was a founding member of the ICSI team at Sevgi Hospital, Ankara — the country's first ICSI centre (1994-95) — and a co-author on the first Turkish ICSI publications produced in collaboration with the Brussels Van Steirteghem group (Human Reproduction, 1996; PMID 8671323). He helped build the IVF programme at the American Hospital Istanbul and has been running his own fertility practice since 1998.

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The content has been created by Dr. Senai Aksoy and medically approved.

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