Nutrition and Lifestyle During Active Treatment: What the Evidence Actually Supports

One of the most common experiences in active fertility treatment is the desire for something to do — some way of contributing to the outcome that is within your control when so much of what determines the outcome is not. Nutrition and lifestyle optimization are often presented as that something, and the evidence does support a genuine role for lifestyle factors in reproductive health. But the evidence varies considerably in quality and specificity across different recommendations, and it is worth being honest about what is well-supported, what is plausible but less certain, and what is more hope than evidence.

This article aims to give you an honest account of what the evidence supports, clearly flagged when the certainty is lower, so that the lifestyle choices you make during treatment are grounded in genuine information rather than anxiety-driven compliance with recommendations of uncertain value.

DIET: WHAT IS ACTUALLY SUPPORTED

The dietary pattern with the strongest evidence base for reproductive health is a broadly anti-inflammatory, nutrient-dense diet — one that emphasizes vegetables, fruits, whole grains, legumes, healthy fats (found in olive oil, nuts, avocados, and fatty fish), and adequate protein, while limiting processed foods, refined sugars, trans fats, and excessive alcohol. This dietary pattern is associated in multiple observational studies with better reproductive outcomes. Research published in journals including Human Reproduction Update and Fertility and Sterility has examined dietary patterns and reproductive health, though your reproductive endocrinologist or a registered dietitian can provide more specific guidance.

The Mediterranean dietary pattern is among the most studied in the context of fertility and has shown associations with better IVF outcomes in several studies. I want to be clear about the nature of this evidence: observational associations do not prove causation, and the specific effect size of dietary changes on IVF outcomes is not precisely known. What is reasonable to say is that a diet consistent with these patterns is genuinely good for overall health and reproductive health, and that making these changes during treatment is unlikely to cause harm and is plausible to be helpful.

For men, diet affects sperm quality through its effects on oxidative stress and inflammation. Diets higher in antioxidants — found in colorful vegetables and fruits — are associated with better sperm parameters in some research. Again, I cannot point to specific studies with confidence. Your reproductive endocrinologist can advise on what the current evidence supports for your specific situation.

SUPPLEMENTS: WHAT TO KNOW BEFORE TAKING THEM

The supplement landscape in reproductive health is large, frequently marketed, and variable in evidence quality. A few points worth knowing before making decisions about supplements.

First: always discuss supplements with your reproductive endocrinologist before taking them. Interactions with treatment medications are possible, and some supplements may affect treatment parameters in ways that are not obvious. This is not a general precaution — it is a specific recommendation given the complexity of hormonal medication protocols.

Second: targeted supplementation based on identified deficiencies — through bloodwork — is more evidence-based than generic supplementation without a clinical basis. If bloodwork identifies a vitamin D deficiency, supplementing vitamin D makes clinical sense. Taking vitamin D without a known deficiency because it appears on fertility supplement lists is different.

Commonly discussed supplements in the fertility context include: folic acid or folate (strongly recommended for women of reproductive age, with robust evidence for prevention of neural tube defects — this is one of the best-supported recommendations in reproductive health); CoQ10 (discussed in the context of egg and sperm quality, with some supportive evidence but less certainty about optimal dosing and effect size); omega-3 fatty acids (associated with general anti-inflammatory effects and some evidence of benefit in reproductive contexts); and antioxidants more broadly. Specific supplement protocols should be discussed with your doctor.

EXERCISE: WHAT HELPS AND WHAT TO AVOID

Moderate regular exercise is genuinely beneficial during fertility treatment — it supports cardiovascular health, improves mood, reduces anxiety, supports healthy weight management, and improves sleep quality. Walking, yoga, swimming, light cycling, and similar activities are generally appropriate throughout a treatment cycle.

The important caveat for IVF specifically: during the ovarian stimulation phase, the ovaries enlarge significantly. High-impact exercise, contact sports, and activities with significant twisting or jarring movements carry a risk of ovarian torsion — a rare but serious complication in which the enlarged ovary twists on its stalk, cutting off its blood supply. Your clinic should advise you specifically on what to avoid during stimulation. When in doubt, err toward lower-impact activity until the retrieval is complete.

Exercise should be a source of genuine benefit rather than another performance obligation. If the activity you're doing during treatment is causing stress rather than relieving it — because it feels like another thing you're doing to optimize outcomes rather than something you enjoy — that is worth noticing. The stress-relief value of exercise depends partly on it being something you're doing for yourself, not for the cycle.

SLEEP: UNDERRATED AND IMPORTANT

Sleep quality has genuine relevance to both hormonal regulation and emotional resilience during fertility treatment. Both are relevant to IVF. The relationship between sleep and fertility outcomes is not precisely established, and I cannot make strong causal claims. What is well-established is that sleep deprivation impairs emotional regulation, worsens anxiety, and reduces the cognitive resources available for managing a demanding situation.

Getting adequate sleep during treatment is important for wellbeing and functioning, regardless of its direct effect on cycle outcomes.

Hormonal medications during IVF can disrupt sleep directly — insomnia and vivid dreaming are commonly reported during stimulation phases. If this is affecting you, it is worth mentioning to your clinic rather than managing it as an expected nuisance.

ENVIRONMENTAL FACTORS

The evidence on environmental toxins and reproductive health is a legitimate area of ongoing research, and certain exposures are worth reducing on precautionary grounds. Endocrine-disrupting chemicals — found in some plastics (particularly BPA), certain pesticides, and some personal care and cleaning products — have been associated in research with effects on hormonal function and reproductive health. Reducing exposure where it is practical to do so — choosing glass or stainless steel containers over plastic where feasible, choosing organic produce for the items most heavily treated with pesticides, reviewing personal care product ingredients — is reasonable precautionary behavior.

I want to be appropriately cautious here: the evidence on specific environmental exposures and IVF outcomes is not definitive, and the effect sizes of individual lifestyle changes are not precisely known. Making these changes because you want to do what is reasonable and within your control is different from making them with confidence that they will significantly affect your outcome.

REFLECT TOGETHER:

Choose one or two lifestyle areas where you both feel genuinely motivated to make changes — not because the evidence is overwhelming, but because doing something together that feels purposeful is good for the relationship and may be good for the outcome. Then agree on one specific change you'll make this cycle, how you'll support each other in making it, and how you'll check in on it. Making this a shared project rather than a solo optimization effort changes its character significantly.

Verification note: Dietary and lifestyle recommendations in this article are based on the general direction of research in reproductive nutrition and medicine. I cannot cite specific studies with confidence. Please consult your reproductive endocrinologist and, where relevant, a registered dietitian experienced with fertility for guidance specific to your situation. Evidence quality and specific recommendations may have evolved since my knowledge cutoff of August 2025.