Ways to Improve IVF Success: Evidence-Based Strategies
Key Takeaways
No single tip raises IVF success for everyone. Better odds usually come from matching care to age, egg reserve, sperm results, and how the last cycle went. A personal plan for stimulation and transfer matters more than piling on extras with weak evidence.
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 marketing around extras.
The main biological drivers — maternal age, ovarian response, embryo quality, sperm integrity, and uterine receptivity — are covered in our guide to what most influences IVF success. The IVF success rates by age page explains how to read success-rate figures. Neither is a guarantee.
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 state of the uterus and tubes, so the review starts there.
The review covers age and ovarian reserve (the AMH blood test and the antral follicle count, an ultrasound count of small follicles). It also covers tubal patency and any hydrosalpinx, the uterine cavity when symptoms or imaging raise concern, and endometriosis or adenomyosis when they matter clinically. A standard semen analysis comes first; further male-factor tests are added only when indicated. How the ovaries, fertilisation, and embryo development responded in earlier cycles completes the picture.
2. Individualise ovarian stimulation
One standard protocol cannot serve every patient; the right one depends on how the ovaries are expected to respond. Polycystic ovary syndrome (PCOS) calls for a plan that limits the risk of ovarian hyperstimulation syndrome (OHSS). Low reserve calls for realistic expectations about egg yield, and 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
Choosing to transfer a single embryo (elective single embryo transfer) is mainly a safety decision: 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. For younger patients with a favourable prognosis, ASRM strongly encourages single embryo transfer because it lowers the risk of multiple pregnancy without a significant reduction in live-birth rates across clinics (ASRM embryo-transfer guidance, 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 — a fluid-filled fallopian tube whose fluid can reach the uterine cavity — has clearer evidence than many other findings before IVF. A cavity-distorting fibroid is a different problem and needs a separate discussion. The “toxic fluid” concern belongs to hydrosalpinx, not to fibroids.
ASRM concludes that laparoscopic salpingectomy (keyhole removal of the tube) or proximal tubal occlusion (blocking the tube close to the uterus) should be considered before IVF. The reason is that untreated communicating hydrosalpinges are associated with poorer IVF outcomes (ASRM tubal-surgery opinion, 2021).
Cavity-distorting fibroids may justify myomectomy (surgical removal of the fibroid). The clearest evidence is for better clinical pregnancy rates — pregnancies confirmed on ultrasound — rather than live birth. Routine removal of silent fibroids that do not distort the cavity is generally not advised just to improve fertility (ASRM fibroid guideline, 2017). Polyps, adhesions, and suspected chronic endometritis each need their own assessment.
5. Do not ignore the male factor
A semen analysis is the starting point. Further testing should answer a specific clinical question; sperm DNA fragmentation testing is not recommended routinely in the initial male evaluation (AUA/ASRM male infertility guideline).
When previous attempts showed poor fertilisation or early arrest of embryo development, a male-fertility specialist may need to review the history and semen findings before the next cycle. Not every advanced sperm test will change treatment.
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.
Smoking is associated with poorer reproductive and assisted-reproduction outcomes, so stopping matters before treatment (ASRM tobacco opinion, 2024). Known thyroid disease, diabetes, and hyperprolactinaemia (raised prolactin) should be managed for their own clinical reasons.
The same applies to body mass index (BMI). 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 women with obesity who ovulate regularly (ASRM obesity opinion, 2021). Advice about lifestyle is there to support the person, not to blame them for a failed cycle.
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 (given without a proven immune cause), routine endometrial receptivity testing (ERA), platelet-rich plasma (PRP), and megadose supplements are often suggested after a failed cycle. A failed cycle alone is not a reason to add them. The same caution applies to advanced sperm-selection methods such as IMSI, PICSI, or MACS when they are offered as a general way to raise live birth in routine ICSI. Hyaluronan-enriched transfer medium, 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 decision turns on the likely egg yield, injection burden, cost, the fresh-versus-frozen plan, and the evidence for that ovarian-response group.
Evidence box: clomiphene continuation and POSEIDON protocol comparisons
A single-centre retrospective cohort (a study that looks back at past cases in one clinic) included women with diminished ovarian reserve. It found a similar mature-egg yield when clomiphene citrate was continued throughout stimulation, rather than given for five days with a GnRH antagonist (a drug that prevents early ovulation) added later. Mild-stimulation cycles were excluded, and the study did not establish a live-birth advantage (Mandelbaum et al., 2025).
A 2026 network meta-analysis (a method that compares several protocols through a web of studies) found that, in POSEIDON group 3, GnRH-agonist protocols gave higher live-birth rates at the first embryo transfer than mild stimulation. In POSEIDON group 4 there was no significant live-birth difference among protocols. Groups 3 and 4 are the two low-reserve subgroups of the POSEIDON classification. 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 Approach
Dr. Aksoy’s approach
“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, matches stimulation to how the ovaries respond, 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.
Related reading
- What Most Influences IVF Success?
- Chronic Endometritis Before IVF: Diagnosis and Treatment
- IVF Protocols and Medications Explained
- Repeated IVF Failure and the Immune System
- EmbryoGlue in IVF: Helpful or Overhyped?
Frequently Asked Questions for Dr. Aksoy
After a failed IVF cycle, should we add every extra treatment I’ve read about online?
I mostly tell patients that increasing the chance does not mean adding more to the treatment. Sometimes the most reliable way to improve the result is to remove what is not necessary.
After failed attempts, every untried option can start to look like a missed opportunity. We do not have to order the whole menu. First we work out where the previous attempt actually lost ground — too few eggs, too few mature eggs, failed fertilisation, failure to reach blastocyst, or a good embryo that did not implant. Adding methods without naming the problem makes treatment more expensive and more complicated, but not necessarily more successful.
I go through decisions in order: diagnosis and prior cycles, individualised stimulation, embryo development and transfer timing, the cavity and tubes when relevant, male factor, then modifiable health factors. Only after that do I discuss whether an add-on is meaningful for that person. Some extras can be reasonable in selected cases. None of them is the missing piece for everyone.
Is switching the medication brand after a failed cycle a useful next step?
Another mistake is switching medication or brand after a failed cycle without analysing why it failed. Changing the box the drug comes in is not the same as changing the treatment strategy. If we cannot say what went wrong or fell short in the previous protocol, we cannot explain why a new brand would do better.
Is less medication or mini-IVF better for improving IVF success?
Less medication is not automatically more natural or better, and a higher dose does not automatically mean more eggs. The goal is not to use the maximum amount of medication. It is to get the most appropriate response the ovaries can safely give.
Does losing weight to lower my BMI before IVF raise the chance of a live birth?
I always discuss weight with my patients before IVF, but I never present it as “Lose weight first, then you can get pregnant.” Excess weight, especially at obesity level, can be linked with ovulation problems, a lower ovarian response to treatment, and pregnancy complications such as diabetes and hypertension.
There is an important distinction, though. Improving metabolic health by losing weight does not automatically mean the live-birth rate in IVF will rise. Results from randomised trials have not shown that weight loss before IVF clearly increases live-birth rates.
In women with polycystic ovary syndrome and ovulation disorders, weight loss may help regulate ovulation and may even raise the chance of a spontaneous pregnancy. By contrast, I do not advise a woman of 39–40, or one with low ovarian reserve, to delay IVF for months only to lose weight, because in that time the reproductive potential lost with age may matter more than the possible benefit we hope for from weight loss.
In patients with marked obesity I assess anaesthetic safety, metabolic disease, and pregnancy risks together. My approach is to judge the whole health picture, not a number on the scale. Losing weight can be an important part of preparing for a healthier pregnancy. I do not promise patients that reaching a particular BMI will definitely improve IVF success or that they will have a healthy baby.
FAQ: more questions about IVF success strategies
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
- European Society of Human Reproduction and Embryology. Ovarian stimulation for IVF/ICSI guideline. ESHRE Guidelines. 2025.
- American Society for Reproductive Medicine. Guidance on the limits to the number of embryos to transfer: a committee opinion (2021). Fertil Steril. 2021;116(3):651-654.
- American Society for Reproductive Medicine. Role of tubal surgery in the era of assisted reproductive technology: a committee opinion (2021). Fertil Steril. 2021;115(5):1143-1150.
- American Society for Reproductive Medicine. Removal of myomas in asymptomatic patients to improve fertility and/or reduce miscarriage rate: a guideline (2017). Fertil Steril. 2017;108(3):416-425.
- American Society for Reproductive Medicine. Obesity and reproduction: a committee opinion (2021). Fertil Steril. 2021;116(5):1266-1285.
- American Society for Reproductive Medicine. Tobacco or marijuana use and infertility: a committee opinion (2024). Fertil Steril. 2024;121(4):589-603.
- ESHRE Add-ons working group. Good practice recommendations on add-ons in reproductive medicine. Hum Reprod. 2023;38(11):2062-2104.
- Mandelbaum RS, Melville S, Masjedi A, et al. Clomiphene citrate throughout the duration of ovarian stimulation in patients with diminished ovarian reserve. J Assist Reprod Genet 2025;42(3):791-797.
- Zhu T, Zhang J, Zhang X, et al. Optimal selection of ovarian stimulation protocol for infertile women with diminished ovarian reserve based on Bologna and POSEIDON criteria: a network meta-analysis. Reprod Biol Endocrinol 2026;24:76.
- Schlegel PN, Sigman M, Collura B, et al. Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I. Fertil Steril. 2021;115(1):54-61.
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The content has been created by Dr. Senai Aksoy and medically approved.