Is IVF Really the Best Next Step for You? Questions to Ask Before You Say Yes [EP 56]
If you’ve been told IVF is your “best option” after a few labs and a short conversation, this episode is for you. I want to say this clearly: IVF is an incredible medical technology. It has helped millions of families build their babies. But it should almost never be the first step after an infertility—or “unexplained infertility”—diagnosis. It should be a tool of last resort, not a default.
What I care about most is your informed consent. You deserve to understand why pregnancy hasn’t happened yet. True infertility—absence of ovaries or uterus, bilateral tubal removal, complete azoospermia—is rare. Most couples are dealing with subfertility, meaning something is interfering: inflammation, nutrient depletion, insulin resistance, immune dysregulation, poor egg or sperm quality. IVF bypasses these issues. It does not fix them. In this episode, I walk you through what should be investigated before jumping into a cycle—so you can improve your biology, your outcomes, and your future baby’s long-term health.
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“IVF bypasses biology. It does not fix the terrain.”
What You’ll Learn:
Why IVF should be a last-resort tool—not the default recommendation
The critical difference between true infertility and subfertility
Why IVF does not improve egg quality, sperm quality, or inflammation
The labs most couples are missing before starting IVF
How sperm DNA fragmentation impacts embryo quality and miscarriage risk
Why AMH does not determine your ability to conceive naturally
The 90-day preconception window that can dramatically improve outcomes
When IVF truly makes sense—and how to prepare properly if it does
“AMH reflects quantity, not quality—and quality is something we can change.”
Labs & Markers Mentioned:
Comprehensive semen analysis (with morphology review)
Sperm DNA fragmentation
Fasting insulin
HOMA-IR calculation
Triglyceride to HDL ratio
Ferritin
Transferrin
Serum iron
C-reactive protein (CRP)
Mid-luteal progesterone
Links Mentioned:
Episode 4 — How to Increase AMH
Episode 6 — Is Your Sperm Analysis Really Normal?
Episode 7 — How to Improve Sperm DNA Fragmentation
Get my FREE Fertility Meal Plan
References:
Mutsaerts MAQ, van Oers AM, Groen H, et al. Randomized trial of a lifestyle program in obese infertile women. N Engl J Med. 2016;374(20):1942-1953. doi:10.1056/NEJMoa1505297
Temel S, van Voorst SF, Jack BW, Denktas S, Steegers EAP. Evidence-based preconceptional lifestyle interventions. Eur J Obstet Gynecol Reprod Biol. 2014;183:19-26. doi:10.1016/j.ejogrb.2014.09.016
Karayiannis D, Kontogianni MD, Mendorou C, Mastrominas M, Yiannakouris N. Adherence to the Mediterranean diet and IVF success rate among non-obese women attempting fertility. Hum Reprod. 2018;33(3):494-502. doi:10.1093/humrep/dey003
Gaskins AJ, Chiu YH, Williams PL, et al. Maternal diet before and during pregnancy and treatment outcomes among women undergoing assisted reproduction. Hum Reprod. 2014;29(11):2473-2480. doi:10.1093/humrep/deu194
Xu Y, Nisenblat V, Lu C, et al. Pretreatment with coenzyme Q10 improves ovarian response and embryo quality in low-prognosis young women with decreased ovarian reserve: a randomized controlled trial. Reprod Biol Endocrinol. 2018;16(1):29. doi:10.1186/s12958-018-0343-0
Showell MG, Mackenzie-Proctor R, Jordan V, Hodgson R, Farquhar C. Antioxidants for female subfertility. Cochrane Database Syst Rev. 2020;8(8):CD007807. doi:10.1002/14651858.CD007807.pub4
Showell MG, Mackenzie-Proctor R, Brown J, Yazdani A, Stankiewicz MT, Hart RJ. Antioxidants for male subfertility. Cochrane Database Syst Rev. 2014;(12):CD007411. doi:10.1002/14651858.CD007411.pub3
Practice Committee of the American Society for Reproductive Medicine. Obesity and reproduction: a committee opinion. Fertil Steril. 2021;116(5):1266-1285. doi:10.1016/j.fertnstert.2021.08.003
“Reproduction is optional from a biological perspective. Your body has to feel safe first.”
Transcript:
Introduction
Welcome back to The Fertility Dietitian Podcast. Today, we’re having a very real and very important conversation about IVF—specifically, how to know whether IVF is truly your best next step or if you’re being rushed into something before your body has been fully understood or investigated.
Let me say this clearly: this episode is not anti-IVF. IVF is an incredible medical technology and has helped millions of families build their babies. But IVF should almost never be the first step after an infertility or unexplained infertility diagnosis. It should be a tool of last resort, not a default recommendation.
What matters most is informed consent. You deserve to understand the barriers standing between you and pregnancy and how to support your body for the best possible outcomes—no matter how you end up conceiving.
Infertility vs. Subfertility
Infertility is often defined as not getting pregnant after 12 months of trying if you’re under 35, or six months if you’re over 35. But this definition doesn’t tell us why pregnancy hasn’t happened. It only tells us that it hasn’t happened yet.
True infertility—meaning biological impossibility—is rare. Examples include absence of ovaries or uterus, bilateral tubal removal, complete azoospermia, or certain genetic or structural conditions.
What most couples are dealing with is subfertility, meaning something is interfering. Something is dysregulated, missing, inflamed, or signaling that the body doesn’t feel safe supporting reproduction.
That distinction matters.
Why IVF Does Not Fix Root Causes
IVF does not improve egg quality.
It does not improve sperm quality.
It does not correct inflammation, immune dysfunction, insulin resistance, gut infections, or iron dysregulation.
IVF bypasses biology. It retrieves eggs, fertilizes them, and transfers embryos—but it does not upgrade the reproductive environment.
If the body is inflamed, metabolically unstable, or nutrient-depleted, IVF is working against the same terrain. This often leads to failed retrievals, poor embryo quality, failed transfers, or repeated cycles.
Preparation changes outcomes.
Feeling Rushed Into IVF
Many couples are pushed toward IVF after minimal testing. A low AMH, age over 35, or an unexplained diagnosis is often used to create urgency and fear.
If you feel rushed, pressured, or told IVF is your only option—pause.
Your intuition matters. That quiet feeling that something hasn’t been fully explored is worth listening to. You deserve deeper answers before committing to something this invasive, expensive, and emotionally demanding.
What Should Be Investigated First
If you’ve been labeled unexplained, that should be the beginning of the investigation—not the end.
Before IVF, these areas deserve a thorough evaluation.
Sperm Quality Matters
A basic semen analysis is not enough.
Sperm quality should be evaluated beyond count and motility. Morphology needs a critical review, and DNA fragmentation testing is essential.
High sperm DNA fragmentation increases the risk of poor embryo quality, failed implantation, and miscarriage—even with IVF. The good news is that sperm quality can improve dramatically in about 90 days.
Sperm health affects not only conception, but pregnancy outcomes and lifelong child health.
Blood Sugar and Metabolic Health
Blood sugar regulation must be assessed at a cellular level—not just fasting glucose.
Key markers include fasting insulin, HOMA-IR, triglyceride to HDL ratio, and signs of reactive hypoglycemia. Mineral status also plays a role in insulin signaling.
Insulin resistance disrupts ovulation quality, sperm health, hormone communication, and mitochondrial energy production—all essential for fertility.
Iron Regulation and Mitochondrial Function
Hemoglobin alone does not assess iron status.
Ferritin, transferrin, serum iron, and CRP are critical markers. Patterns of inflammatory iron sequestration are common and can severely impair egg maturation, implantation, and energy production.
Iron dysregulation is frequently missed—but highly correctable.
Inflammation and Immune Balance
Fertility is an immune-modulated process.
Chronic inflammation, infections, oral health issues, gut permeability, and uterine microbiome imbalances all divert resources away from reproduction.
When the immune system is constantly putting out fires, fertility is deprioritized.
Ovulation Quality vs. Just Ovulating
Ovulation is not binary.
You can ovulate every month and still have poor egg quality, weak progesterone production, or a compromised luteal phase.
Mid-luteal progesterone ideally exceeds 12 ng/mL, with closer to 20 being optimal. Symptoms like PMS, spotting, and cycle length offer important clues about ovulation quality and implantation readiness.
Gut and Uterine Environment
The microbiome influences estrogen metabolism, immune tolerance, implantation, and sperm health.
Conditions like bacterial overgrowth, endometritis, BV, H. pylori, and chronic low-grade inflammation are commonly overlooked—but small shifts here can have major fertility impacts.
Your microbiome is also passed to your baby, shaping their immune system and long-term health.
AMH, Time Pressure, and Preparation
AMH reflects egg quantity—not quality.
Natural conception is not determined by AMH. Egg quality is influenced by mitochondrial health, oxidative stress, nutrient sufficiency, metabolic stability, and inflammation—factors that can improve within 90–120 days.
Preparation is not wasted time. Even if IVF becomes necessary, going in metabolically supported dramatically improves outcomes.
When IVF Makes Sense
IVF may be appropriate in cases of:
Tubal blockage
Severe male factor infertility unresponsive to intervention
Genetic considerations requiring embryo selection
Advanced maternal age with a limited conception window
Even then, preparation still matters.
IVF performed on a depleted, inflamed body often leads to more rounds, more cost, and more heartbreak.
Questions to Ask Before IVF
Have we fully evaluated sperm quality, including DNA fragmentation?
Have inflammation markers been assessed?
Has insulin resistance been evaluated beyond fasting glucose?
Has iron regulation been properly assessed?
Have chronic infections been ruled out?
Has mitochondrial support been prioritized for at least 90 days?
Has ovulation quality truly been assessed?
If the answer is no, there is more to explore.
Final Thoughts
Your body is not broken.
It may be overwhelmed, inflamed, undernourished, or overcompensating—but that is not the same as incapable.
IVF should be a last-resort tool, not a default. When barriers are removed, and the body feels safe, reproduction becomes possible—naturally or with medical support.
The goal is not just pregnancy.
The goal is a healthy pregnancy, resilient motherhood, and a thriving baby.