Support information

The morning

On the morning of your egg collection, you’ll arrive at Cambridge IVF and be admitted to our ward area ready for your trip to theatre.  While you are having your eggs collected we will be preparing the sperm sample from your partner or donor which will be used to inseminate your eggs later in the day. 

We use a microscope to identify the eggs, which are surrounded by a cloud of cells called cumulus, in the fluid the doctor collects from your follicles. We then wash the eggs and place them in the incubator in a culture medium which is designed to give them the nutrients they need until we are ready to inseminate the eggs the same afternoon.

After your egg collection

After your egg collection, a member of our laboratory team will come and see you and confirm with you the number of eggs we collected, the quality of the semen sample and the insemination method we intend to use (IVF, ICSI or MACS-ICSI) to fertilise your eggs.

Before your treatment starts, your semen will have been analysed. If you are using a donor, we will have the information we need from them too. Based on this, we will already have a good idea of what the best treatment option is. Sometimes things can change on the day, so we are always flexible in our approach. We want to ensure that you get the very best chance of a successful outcome from your treatment cycle.

We will also let you know the arrangements for the next few days and what contact we will be making with you and when.

The insemination

The next step is to inseminate your eggs. The way we do it will depend on the best treatment option chosen for you:

If you’re using standard IVF, we’ll mix the prepared sperm sample with the eggs in a petri dish.  This process is controlled using our electronic witnessing system which prevents errors occurring in the lab.  It won’t let us use any sperm with your eggs except the one we’ve prepared for you. The procedure is fast and within five minutes your eggs are back in the incubator and the fertilization process has begun to take place.

• ICSI takes the insemination process a little further. Here we inject a single sperm into each mature egg using a very fine pipette.  We carry out this procedure when we believe that there is a significant chance that the sperm and eggs may not fertilise well using the IVF technique. Following the injection procedure, we return your eggs back to the incubator.  Or into the EmbryoSccope if you have elected to deploy that technology as part of your treatment plan.
• Magnetic-activated cell sorting (MACS) is a variation from the ICSI technique used to select functional sperm in cases in which the spermatozoa have high DNA fragmentation. The sperm cells in the semen sample are separated using a suspension of magnetic nano-particles and a magnetic field. The sperm that are DNA fragmented bind to the magnetic nano-particles and when they are passed through the magnetic field they are retained, whilst the healthy functional sperm pass straight through and are collected. These healthy sperm are then used for the ICSI procedure as previously described and the eggs are returned to the incubator or EmbryoScope. MACS-ICSI improves embryo quality and reduces the change of miscarriage in patients with high DNA fragmentation. If we believe you are going to benefit from it, we will have discussed this with you.

What should I expect?

We can only perform ICSI on mature eggs. We can easily spot an egg which is mature using the microscope.  Immature eggs would not fertilize, and it is not legal for us to inject immature eggs.  It is not unusual for some of your eggs to be immature, so you need to be prepared for this when we call and let you know how the fertilisation procedure has gone.

On average we would expect approximately 65% of all injected eggs to fertilise normally from ICSI.  The average may be lower if you are using surgically recovered sperm or if we know your egg quality is variable.

You now face a wait of up to six days. For you, these are very tense days of waiting and not being able to do anything. For us they are full of activity, making sure that things are progressing as they should.

When do you check?

On the first day, we need to find out how many of your eggs have fertilized. No matter how we fertilised the eggs yesterday, with IVF, ICSI or MACS-ICSI, the procedure for fertilisation check is pretty much the same. It takes place around 18 hours after we inseminate your eggs or inject the sperm.

How do you do it?

We all hope that things have gone well overnight, but we will not know until we look closely at your eggs. We are looking for signs of ‘normal’ fertilisation and it is easy to spot this using the microscopes we have in the laboratory.

If your treatment involves the use of Embryoscope time-lapse technology, then we do things a little different. Visit our section on Embryoscope to see how it works and what we do with it.

What should I expect?

A normally fertilised egg should have two ‘pronuclei’ (the male and female genetic information which you can see as two small circles within the egg) and two ‘polar bodies´(by-products of cell division that need to be released in the process so that the resulting embryo has normal genetic content). If an egg has fertilized normally these are very clear to see.  If an egg is seen to have more or less than two pronuclei then this has fertilised abnormally and is separated from the normally fertilised eggs.

It may sound silly, but it is perfectly normal for some of your eggs to fertilize abnormally, its nothing at all to worry about. On average we would expect approximately 65% of all injected eggs to fertilise normally from IVF or ICSI treatment.  The average may be lower if you are using surgically recovered sperm or if we know your egg quality is variable.

We will call you on the morning of the Fertilisation Check, usually before 10:30 to let you know how things have gone. We probably do not need to say this, but it is important that you keep close to the telephone, as we know you will want to find out as soon as possible how your eggs have fertilised.

What is happening?

The fertilised eggs should by now have formed a four cell embryo.  We do not check the embryos routinely using a microscope on day two as we do not want to disturb your embryos unnecessarily. They are much better left alone in the incubator to develop as well as they can in most cases. 

If your treatment involves the use of Embryoscope time lapse technology, then we do things a little different. Visit our section on EmbryoScope to see how it works and what we do with it.

In some situations, there are reasons why we might need to check on day two.  We use the standardised national scheme to grade each embryo. This allows us to give you an indication of their quality. Each embryo is an individual and we don’t expect all of them to be top grade, it's normal to have a mixture of grades. 

What should I expect?

People routinely become pregnant using embryos we have not graded highly so do not be downhearted if we have not graded your embryos as top quality. The main thing is that they are healthy and continue to develop well over the next 4 days.

How do you do it?

The fertilised eggs should have continued their development and by now they should have formed eight-cell embryos. We will check this on the morning of day 3 using a microscope in the same way we may have done on day two. At this point, we will grade all your embryos according to the same nationally standardised scheme.  Again, remember each embryo is an individual and we don’t expect all of them to be top grade. It is normal to have a mixture of grades. 

If your treatment involves the use of Embryoscope time lapse technology, then we do things a little different. Visit our section on Embryoscope to see how it works and what we do with it.

What should I expect?

We will call you before 10:30 on day three. Depending on how things are going, we will either arrange for an embryo transfer for you the same afternoon or recommend we wait until day five.  Our preference is to wait until day 5 as success rates are higher when transferring day 5 embryos when compared to day 3.  It is now rare for us to recommend a day 3 transfer but if we do we will ensure we explain the rationale for that recommendation.

We base this decision on the number of good quality embryos we have available to you.  The decision is based on careful calculations, our experience, and our aim to ensure we give you the best possible chance of a positive outcome.

If we feel your embryo quality and number is good on day 3, we will recommend we continue with culture for another two days and transfer one or two blastocysts on day five or opt to electively freeze all of the suitable quality blastocysts on day 5 and or day 6.  This extension to culture allows us to track an embryo´s true potential for as long as we can and gives us the best possible chance of a successful treatment outcome.

If we do not think enough embryos are likely to give blastocysts, we will discuss with you the option of embryo transfer on day three. If you are using the Embryoscope incubator you may wish to consider the value that the additional information we will gain from extending culture for a further two days would bring.  There is no right or wrong answer and you are at liberty to decide if a day 3 or day 5 transfer is right for you.  We will take the time to ensure you have all of the information necessary to make an informed decision.  You should be mindful that in a small number of cases embryos do not thrive and there may be no embryos to transfer or freeze on day 5 because the embryos have not survived in culture.  In such cases, had the embryos been transferred on day 3 it is very likely that the outcome would be the same, it would just have happened inside your body and we would never have known.

What is happening?

The embryos are undergoing a very important transition process we call compaction and early blastulation so that they form blastocysts. Compaction commences when the embryo forms a ´morula´, a stage in which the embryo usually has 16 or more cells and they start to come very close to each other to form a mass resembling a raspberry.

Once the embryo has become a compacted morula, a cavity starts to form inside it, a process called blastulation. This cavity fills with liquid and as it grows the embryo will form a blastocyst on day 5 or day 6 of development.

What should I expect?

During day four we perform no checks as it is hard for us to grade them with so many changes going on at this point. We prefer to leave them undisturbed in the incubator. Therefore, we will not get in touch with you today.

If your treatment involves the use of Embryoscope time lapse technology, then we do things a little different. We can see the formation of the morula and the blastulation. Visit our section on Embryoscope to see how it works and what we do with it.

By day five some of your embryos should have developed into blastocysts.  They look very different to embryos; the cells are now starting to specialise into those which will form the baby (the inner cell mass) and those that will form the placenta (the trophectoderm, the outer layer).

The blastocyst will ultimately hatch from the protective ‘shell’ which has surrounded the embryo through its early development. This is called the Zona Pellucida. It is this mass of hatched cells which, once free from its shell, will implant into the lining of your womb and form the pregnancy. 

How do you choose the best embryo for transfer?

The blastocyst is a more advanced development stage, so we know that embryos which form good quality blastocysts have good potential to implant.  Your blastocysts will be graded using a microscope on the morning of day five using a nationally approved blastocyst grading scheme.. We will select the one or two strongest looking ones for transfer.

If your treatment involves the use of Embryoscope time lapse technology, then we do things a little different. Visit our section on EmbryoScope to see how it works and what we do with it.

What should I expect?

We will call you before 10:30 on day five to arrange your embryo transfer the same day. Again, you should make sure you are close to the phone at this time.

If there are any remaining good quality blastocysts after the transfer, we will freeze them so that you can use them in a frozen blastocyst transfer if you need to. 

The window of time where blastocyst formation can normally occur is day 5 and day 6 so we will review any embryos which were not suitable for transfer or freezing on day 5 again on day 6 and it may be that we freeze blastocysts on day 6 as well as day 5.

If you have any good quality blastocysts left after your embryo transfer, we can freeze these on day five. We use a process called vitrification to freeze your embryos very rapidly. We then store them in our Cryostore. They are then there for you to use at any time in the future within the time period you have consented to.

At the time of your embryo transfer we’ll look at all the remaining embryos and decide if any of them are strong enough to be frozen. We’ll let you know at the time of transfer how many are suitable.

Of course it's your choice – you don’t have to have them frozen if you don’t want to. We’ll carry out your wishes either way. But you should spend some time before your ET deciding what you would like to do if you do have embryos available to be vitrified.

If you have surplus embryos after an IVF or ICSI cycle, they are frozen for future use in case that your treatment is not successful or for trying for a second baby.

Having embryos frozen means that you can undergo future cycles of IVF without having t stimulate your ovaries, collect and fertilise your eggs.  Instead, we can warm the frozen embryo(s) and transfer them to your womb in a much more simplified frozen embryo warming cycle.  This is what is commonly known as frozen embryo transfer (FET).

The frozen embryos can be in one of these two stages of development: cleavage stage (Day 3) or blastocyst stage (Day 5), depending on how long they had been cultured for before they were frozen.  In our lab, we tend to culture them till blastocyst stage for transfer on Day 5, but this may vary case to case.

The embryology team will talk to you about how many embryos would be more convenient to transfer in your case.  Whenever possible, we aim for an elective single embryo transfer (eSET) to reduce the chances of a multiple pregnancy and its complications.  Read more about eSET in our section about embryo transfer.

Your chance of becoming pregnant following a transfer of frozen-warmed embryos is comparable to that following a transfer of fresh embryos.  There is no evidence that any babies resulting from warmed embryos have an increased risk of abnormality.

It is also possible to bring your cleavage stage embryos or blastocysts frozen in another clinic for transfer at Cambridge IVF.

Frozen Cleavage stage embryo transfer

Not all the embryos survive the process of freezing and warming, particularly those that are not of good quality, as these processes can cause damage to the cells of the embryo.  To maximize survival rates, we only select very good embryos.

When we warm cleavage stage embryos we assess them for cellular damage immediately after.  We will call you on the day of your transfer to let you know how many embryos survived the warming.  If we need to, we will warm an additional straw to ensure you have the agreed number of blastocysts for transfer.

Once the embryos are warmed, we place them in culture medium for approximately 2-3 hours to regain their shape and recover from the warming process.  After this time, we can perform the transfer.

Frozen blastocyst transfer (FBT)

Freezing and warming can cause damage to the cells of a blastocysts (advanced 5 to 6-day embryos), particularly those which are not good quality; for this reason, we only select very good quality blastocysts for freezing.

When we warm blastocysts we assess them for cellular damage immediately post warm. Our data from warming procedures performed at Cambridge IVF on vitrified blastocysts tells us that over 90% of all warmed blastocysts survive the procedure and are suitable for transfer.

We will call you on the day of your blastocyst transfer to let you know how many blastocysts survived the warming.  If we need to, we will warm an additional straw to ensure you have the agreed number of blastocysts for transfer.

Once the blastocysts are warmed, we place them in culture medium for approximately 2-3 hours to re-expand.  After this time, we can perform the transfer.

What should I expect on the day?

You should bring your partner or a friend with you as we would prefer you to have a chaperone and someone to take you home after the procedure.

We will confirm with you the number of embryos we are transferring and let you know the quality.  We will then ask you to sign the consent prior to the embryo transfer taking place.  You also have the option of seeing the embryos on the screen before we transfer them if you like.

Then you will lay down and one of our Embryologists will bring the catheter containing the embryo(s) to be transferred.  The consultant will introduce the catheter through your cervix and place the embryo(s) at the fundus of the uterus using an ultrasound to guide him/her.

Finally, the Embryologist will take the catheter back to the lab to check that the catheter is clean, meaning that the embryos have been correctly introduced into your uterus and are not in the catheter. 

What should I do after?

You do not need to rest after the transfer.  Lying on your back for days afterwards will not help the embryo(s) implant and in truth may do more harm than good.  We recommend you take things easy, so no parachute jumps or horse riding, but just try to carry on with your life as normal otherwise.

You can have your pregnancy test on the date established by your consultant.  This is usually done 15 days after your transfer.

If you would like more information, please contact us.

A

Abstinence

Abstinence involves refraining from any sexual activity, including masturbation.

Agonist

This is an IVF treatment used to control ovulation. During the agonist cycle, there is an initial surge in hormone production, followed by a reduction, which prevents ovulation

Antagonist

This is an IVF treatment used to control ovulation. During the antagonist cycle, hormone production is suppressed, preventing ovulation.

Assisted conception

Treatments which help people conceive by controlling the way that the sperm and the egg are brought together.

B

Blastocyst

An embryo that has developed for five to six days after fertilisation.

Body mass index

The ratio of your weight in kilograms to the square of your height in metres. Your BMI is an indicator of whether your weight is healthy. A healthy weight increases the chance of successful IVF treatment.

C

Catheter

A tube that can be inserted into a body cavity, duct or vessel - a catheter may be used either to introduce something into the body, or to drain something from it.

CCG

Clinical Commissioning Group

Cervix

The cervix is the lower portion or 'neck' of the womb which opens into the vagina.

Chlamdydia

A common sexually transmitted disease (STD), chlamydia can damage a woman's reproductive organs and affect her fertility.

Chromosonal defect

Errors in the number or structure of chromosomes, which are found within human cells can cause abnormalities eg Down's syndrome.

CIVF

Stands for Cambridge IVF

Clinical pregnancy

A confirmed pregnancy, shown by both high levels of hCG (hormone) in the blood and ultrasound confirmation of a fetal heartbeat.

Compaction

During compaction, the cells of an embryo bind tightly together into a sphere. This is an important step in the formation of a blastocyst (five/six day old embryo).

Crystorage

The preservation of blastocysts, unfertilised eggs, or sperm, at very low temperatures for use in future treatment cycles.

Culture medium

A liquid or gel designed to support the growth of embryos in the lab.

Cycle

The IVF treatment cycle describes the complete round of treatment, incorporating all stages of IVF

D

Data Protection Act

The Data Protection Act (DPA) is the 1998 law designed to protect your personal data, whether this is stored in paper files or on a computer. Your IVF treatment notes, other health records and any other information you choose to share with us, eg by filling in forms on this website, are covered by the DPA.

Diabetes

Diabetes is a long-term condition caused by too much glucose, a type of sugar, in the blood. It happens when the body is not able to produce insulin to control the breakdown of sugar in the blood (Type 1). It may also happen if the body does not produce enough insulin or if the insulin does not work properly (Type 2). Type 2 diabetes is more common and usually occurs in older people. It is linked to obesity in many cases. Diabetes may also occur during pregnancy in women who do not otherwise have the condition. This happens when pregnant women produce so much sugar that their insulin cannot control it.

Donor insemination

Using the sperm of a donor, usually not known to you, to fertilise the eggs during fertility treatment.

Down regulation

"Switching off" the reproductive hormone production before the woman can receive drugs to stimulate egg production during fertility treatment. This describes the antagonist IVF cycle.

E

Egg collection

The process of collecting eggs from the follicles in your ovaries during IVF treatment.

Embryo

A fertilised egg where the cells have begun to divide. After five or six days, the embryo becomes a blastocyst.

Embryo transfer

The process of transferring embryos from the culture in which they have been developing in the lab, into the womb.

Embryologist

Clinical scientist working in the field of fertility. The embryologist is responsible for checking fertility levels, collecting eggs and sperm and processes of bringing them together during fertility treatment. Embryologists are also involved in research, supporting IVF and other fertility treatments.

Endometriosis

Condition in which tissue similar to the lining of the womb (endometrium) grows in other parts of the body, most commonly on the ovaries. It can contribute to infertility.

Endometrium

The lining of the womb. This grows and sheds during a normal menstrual cycle. For pregnancy to take place, the blastocyst must implant into the endometrium.

Epididymis

A long tube forming part of the male reproductive system. The epididymis carries the sperm from the testicles. The sperm are then stored in the lower part of the tube until the man comes.

eSET

Elective single embryo transfer refers to transferring a one embryo as part of IVF treatment. There are strong arguments, in some cases, for transferring a single embryo (rather than two or three), to prevent multiple pregnancies.

F

Fallopian tubes

Two long, thin tubes that connect to a woman's ovaries to her womb. The fallopian tubes allow sperm to travel to the eggs after they leave the ovaries and fertilised eggs to move to the womb and implant.

Fibroids

Benign (non-cancerous) tumours that grow in or around the womb. Fibroids can contribute to infertility.

Folic acid

Also known as vitamin B9 [3], vitamin Bc[4] or folacin. Having enough folic acid before you are pregnant and during the early weeks of pregnancy, can significantly reduce the chance of a baby being born with a neural tube defect such as spina bifida.

Follicle

The follicles are small, fluid-filled sacs in the ovaries in which the eggs develop.

Follicle-Stimulating Hormone

FSH is a hormone which stimulates the production of follicles by the ovaries. It is used during fertility treatment to stimulate the growth of multiple follicles, producing several eggs for use during treatment.

Frozen embryo transfer

The process of transferring embryos into your womb, using embryos which have been frozen after previous IVF treatments. The embryos will have been carefully thawed for use in the current treatment.

G

GnRH agonists

GnRH is a hormone released by the body which stimulates the production of lutenising hormone and follicle-stimulating hormone. During IVF, GnRH is used to control the fertility cycle. See also 'down regulation' in the jargon buster.

H

Hormone replacement therapy

HRT is used to replace the female hormones that a woman’s body no longer produces because of the menopause or fertility treatment.

Human Chorionic Gonadatrophin

hCG is a naturally occuring hormone, usually found in the placenta. Artificial hCG is used during IVF to help the eggs mature before they are collected.

Hysterosalpingogram

An X ray process, showing whether the fallopian tubes are open and womb cavity is a normal shape. During an HSG a special dye is injected into the womb, showing clearly where there are abnormalities. How the dye travels through and out of the fallopian tubes can show up defects and blockages.

L

Laparoscopy

This is a surgical examination of the pelvis/abdomen, through a small incision. The surgeon uses a narrow telescopic tool with a small camera attached. This is inserted just below the belly button and allows images to be projected onto a screen. Also sometimes called 'keyhole surgery'.

Lutenising Hormone

A hormone which is essential for the development of eggs and sperm.

M

Menstrual cycle

This describes the changes which normally take place in a more or less monthly cycle in the ovaries and the lining of the womb. During a normal menstrual cycle, the ovary will release an egg and the womb lining will thicken so that the embryo can implant if the egg is fertilised. If this happens, the cycle ends in pregnancy. If the egg is not fertilised, the thickened lining is shed through the vagina - this is what causes menstruation / periods. See also 'menstruation'.

Menstruation

Menstruation is the formal word for a woman's period. During the normal menstrual cycle, the womb builds up a thick lining. This allows the embryo to implant if the egg released at the start of the menstrual cycle is fertilised. If the egg is not fertilised, the thickened lining is shed through the vagina - this is what causes menstruation / periods.

Miscarriage

Loss of a pregnancy in the first 23 weeks.

Morphology

Size and shape - in the case of fertility treatment this refers to the size and shape of sperm.

Motility

The ability to move - in the case of fertility treatment, this refers to the movement of sperm.

Multiple birth

The birth of more than one baby from a single pregnancy, usually twins or triplets.

N

Natural cycle

A fertility treatment cycle in which no drugs are given to stimulate egg production.

O

Oestrogen

A hormone produced in the ovaries, oestrogen controls sexual development and the reproductive cycle in women.

Ovarian Hyperstimulation Syndrome

OHSS is a potentially serious complication of some treatments, which occurs when the ovaries respond excessively to fertility drugs

Ovaries

Part of the female reproductive system, the two ovaries are attached to the womb by the fallopian tubes. When functioning normally, they produce and release eggs as part of the menstrual cycle. They also produce hormones which are essential for reproduction. Problems with the ovaries may be a cause of fertility problems in women.

Ovary stimulation

The use of drugs to stimulate the ovaries to develop follicles and thus produce more eggs.

Ovulation

Ovulation takes place when an ovary releases one or more eggs. In the normal menstrual cycle, the ovaries alternate in releasing a single egg a month.

Ovum

'Ovum' is the Latin word for egg. It is used to describe the eggs produced by a woman's ovaries.

P

Penis

The penis is the male sex organ.

Pessary

A solid, often bullet shaped 'pill' made to be inserted into the vagina or rectum. Pessaries hold drugs which are gradually released as the pessary dissolves at body temperature.

Polyscystic ovaries

Polycystic ovary syndrome is a condition in which small cysts develop aaround the ovaries. This can affect hormone production and hence fertility, as it can result in no ovulation taking place.

Premature menopause

The early onset of menopause, before the age of 40.

Progesterone

One of the female hormones, progesterone is produced after ovulation and encourages the growth of the lining of the womb.

Prostate

The prostate gland is located just below the bladder. It produces most of the liquid which makes up 20 - 30% of the semen.

R

Retrograde Ejaculation

Retrograde ejaculation occurs when semen squirts backwards into the bladder instead of out of the penis when a man comes.

S

Sedation

Sedatives are drugs which produce a calming effect. You may be given a sedative to relax you before a treatment, rather than having to undergo a general anaesthetic.

Semen

Semen is the liquid which emerges from the penis when a man comes. Its purpose is to carry the sperm into and through the vagina, cervix and womb, to the eggs.

Specimen

A sample collected for testing.

Sperm

Sperm are reproductive cells produced by men. The word comes from the Greek word for seed. When a man comes, millions of sperm cells are carried into the woman's reproductive system in the semen.

Sperm Preparation Test

The method by which sperm are separated from seminal liquid so that they can be used for IVF.

T

Testicles

The testicles, testes or 'balls' are the two, oval male organs which hang below the penis. Sperm and testosterone are produced in the testicles which are the main organs in the male reproductive system.

Testosterone

Testosterone is the main male sex hormone and is necessary for normal sperm development.

Transvaginal Ultrasound

Transvaginal ultrasound is a type of ultrasound scan of eg the womb and its lining and/or the ovaries. During this scan a wand-like probe is placed into the vagina, enabling the clinician to get a good view of the pelvic organs.

Tubal blockage

If the fallopian tubes are blocked, this can cause infertility as the sperm cannot reach the eggs. The eggs also cannot travel from the ovaries to the womb. Tubal blockage may be caused by disease eg pelvic infection or endometriosis. It can also be used intentionally during sterilisation.

U

Ultrasound

Ultrasound is a method of scanning which uses high frequency sound waves to produce images of internal organs, eg the womb and ovaries.

Uterus

The uterus or womb is the female reproductive organ in which the embryo develops. At one end, the cervix opens into the vagina, at the other, the fallopian tubes link to the ovaries.

V

Vagina

The vagina is the tube leading from the womb to the outside of the body.

Vas Deferens

The vas deferens is a pair of tubes which carry the sperm into the penis.

Vasectomy

This is a surgical method of sterilisation for men. The tubes carrying the sperm to the penis are cut and sealed to prevent sperm from entering the semen.

Z

Zona Pellucida

A clear membrane which surrounds the egg and the developing embryo for the first few days after fertilisation. After five days the blastocyst 'hatches' through the zona.

Zygote

The zygote is the initial cell which forms when the sperm fertilises the egg.

Although the scientific community is still working hard to define clear and effective dietary guidelines for men seeking fertility treatment, wide-scale research suggests that following a more balanced diet, such as the Mediterranean diet, can go a long way in improving your semen quality. Even more so, the Western-style diet has been consistently shown to have a negative effect on men's fertility. As such, high intakes of seafood, poultry, whole grains, nuts, skimmed milk, fruits, and vegetables are highly recommended. On the contrary, fatty and fried foods, red and processed meat, refined grains, heavily processed convenience foods, sweets and sweetened beverages are best to be avoided.

Dietary supplements marketed as fertility boosters to men mostly contain antioxidants which have been previously linked to improved sperm parameters and pregnancy rates by a cohort of low-quality studies. More recently, evidence derived from two large-scale, well-designed clinical trials failed to support antioxidant supplementation as an effective treatment for male subfertility. As such, although the use of these supplements is not prohibited, they should not be used as a replacement for a healthy diet, or as the only means of dealing with any fertility issues you may be currently experiencing.

Although alcohol consumption and cigarette smoking are suspected risk factors for male subfertility, clear evidence is still lacking to support these habits as critical for your reproductive health. Nevertheless, most studies investigating the relationship between smoking and semen quality have concluded that, particularly among men with poor semen quality, moderate to heavy smoking can lead to even more pronounced semen abnormalities. Likewise, only chronic and/or excessive drinking has been clearly associated with adverse effects on semen quality. As such, you are advised to limit your alcohol consumption to no more than the government advised limit of 14 units of alcohol per week and to quit or abstain from smoking.

Although several studies have investigated whether men who wear tighter underwear have a poorer semen quality compared to those who wear looser underwear, results have been inconclusive. Nevertheless, choice of clothing along with other modifiable lifestyle factors, e.g. hot showers, use of saunas and prolonged time in sedentary positions, have all been long suspected to cause elevated testicular temperature which is in turn widely known to reduce sperm production. As such, you are advised to limit any behaviour that might result in prolonged pressure or heat to your genital region as a cautionary step before and during your fertility treatment.

Although exercise is undoubtedly beneficial for your general health, its relationship with male fertility remains controversial. More specifically, recreational exercise of moderate intensity was suggested to improve reproductive health, particularly in men with poor semen quality, sedentary lifestyle and/or high BMI. On the contrary, highly strenuous exercise of extreme duration is suggested to increase the risk of poor semen quality and sexual dysfunction, with elite athletes being the most affected. It should be stressed here that image- and performance-enhancing use of anabolic steroids can have a detrimental effect on your sexual health, even leading to irreversible loss of sperm production. Instead, regular exercise in moderation and without any drug intervention is the scientific proven way to virility and reproductive success.

Stress is widespread in modern society and has taken its toll on people's well-being more than ever before. As a result, scientists have long suspected a link between psychological stress and reduced parameters of semen quality. Increasing evidence has particularly highlighted chronic and acute stress due to major life events as detrimental for male fertility. Most importantly, several studies have shown that high stress levels associated with infertility diagnosis and treatment can negatively affect semen quality and sabotage your best efforts to conceive. As such, please do not underestimate the importance of your emotional and psychological well-being in achieving your goal of having a baby. Taking measures to limit your stress levels as much as possible using techniques that work best for you can make a difference for your treatment.

The process of spermatogenesis (sperm production) is cyclical and takes around 3 months to complete. Any positive changes you make will therefore not be seen immediately. You should therefore see this as a ‘long game’ and only make changes you feel are realistic and you can sustain for a long period of time. Fad dieting and short term changes will not be effective in improving your semen quality. Even with the best of intentions the improvements we see (if any) are not likely to be dramatic but by taking the time to make positive changes well in advance of your treatment process you are giving that treatment the very best chance of success.