Editing In vitro fertilisation (section)

==Medical uses==

===Indications===
{{Further|Infertility}}

IVF may be used to overcome [[female infertility]] when it is due to problems with the [[fallopian tube]]s, making in vivo fertilisation difficult. It can also assist in [[male infertility]], in those cases where there is a defect in [[sperm quality]]; in such situations [[intracytoplasmic sperm injection]] (ICSI) may be used, where a sperm cell is injected directly into the egg cell. This is used when sperm has difficulty penetrating the egg. ICSI is also used when sperm numbers are very low. When indicated, the use of ICSI has been found to increase the success rates of IVF.

According to UK's [[National Institute for Health and Care Excellence]] (NICE) guidelines, IVF treatment is appropriate in cases of unexplained infertility for people who have not conceived after 2 years of regular unprotected sexual intercourse.<ref name=NICE2013>{{cite web | url = http://guidance.nice.org.uk/CG156 | title = Fertility: assessment and treatment for people with fertility problems | work = [[NICE guidelines|NICE clinical guideline]] | date = February 2013 }}</ref>

In people with [[anovulation]], it may be an alternative after 7–12 attempted cycles of [[ovulation induction]], since the latter is expensive and more easy to control.<ref name="WeissBraam2014">{{cite journal | vauthors = Weiss NS, Braam S, König TE, Hendriks ML, Hamilton CJ, Smeenk JM, Koks CA, Kaaijk EM, Hompes PG, Lambalk CB, van der Veen F, Mol BW, van Wely M | display-authors = 6 | title = How long should we continue clomiphene citrate in anovulatory women? | journal = Human Reproduction | volume = 29 | issue = 11 | pages = 2482–2486 | date = November 2014 | pmid = 25164024 | doi = 10.1093/humrep/deu215 | doi-access = free }}</ref>

===Success rates===
IVF success rates are the percentage of all IVF procedures that result in favourable outcomes. Depending on the type of calculation used, this outcome may represent the number of confirmed pregnancies, called the [[pregnancy rate]], or the number of live births, called the [[live birth rate]]. Due to advances in reproductive technology, live birth rates by cycle five of IVF have increased from 76% in 2005 to 80% in 2010, despite a reduction in the number of embryos being transferred (which decreased the multiple birth rate from 25% to 8%).<ref>{{cite journal |vauthors=Wade JJ, MacLachlan V, Kovacs G |date=October 2015 |title=The success rate of IVF has significantly improved over the last decade |journal=The Australian & New Zealand Journal of Obstetrics & Gynaecology |volume=55 |issue=5 |pages=473–476 |doi=10.1111/ajo.12356 |pmid=26174052 |s2cid=22535393}}</ref>

The success rate depends on variable factors such as age of the woman, cause of infertility, embryo status, reproductive history, and lifestyle factors. Younger candidates of IVF are more likely to get pregnant. People older than 41 are more likely to get pregnant with a donor egg.<ref name="mayoclinic.org">{{Cite web|title = In vitro fertilization (IVF) Results – Mayo Clinic|url = http://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/basics/results/prc-20018905|website = www.mayoclinic.org|access-date = 5 November 2015}}</ref> People who have been previously pregnant are in many cases more successful with IVF treatments than those who have never been pregnant.<ref name="mayoclinic.org" />

====Live birth rate====
The live birth rate is the percentage of all IVF cycles that lead to a live birth. This rate does not include [[miscarriage]] or [[stillbirth]];  multiple-order births, such as twins and triplets, are counted as one pregnancy.

A 2021 summary compiled by the Society for Assisted Reproductive Technology (SART) which reports the average IVF success rates in the United States per age group using non-donor eggs compiled the following data:<ref>{{cite web |title=Final National Summary Report for 2021 |url=https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0#donor-fresh-egg |website=National Summary Report |access-date=28 April 2024}}</ref>

{| class="wikitable"
|-
! !! <&nbsp;35 !! 35–37 !! 38–40 !! 41–42 !! >&nbsp;42
|-
| Live birth rate (%)|| 54 || 40.5 || 26 || 13.3 || 4
|}

In 2006, Canadian clinics reported a live birth rate of 27%.<ref name=canadians/> Birth rates in younger patients were slightly higher, with a success rate of 35.3% for those 21 and younger, the youngest group evaluated. Success rates for older patients were also lower and decrease with age, with 37-year-olds at 27.4% and no live births for those older than 48, the oldest group evaluated.<ref name=r1>{{cite web|url=https://www.cdc.gov/art/ART2006/section1.htm|archive-url=https://web.archive.org/web/20090331150713/http://www.cdc.gov/art/ART2006/section1.htm|archive-date=31 March 2009|publisher=[[Centers for Disease Control and Prevention]]|title=2006 Assisted Reproductive Technology (ART) Report: Section 2|access-date=25 March 2009}}</ref> Some clinics exceeded these rates, but it is impossible to determine if that is due to superior technique or patient selection, since it is possible to artificially increase success rates by refusing to accept the most difficult patients or by steering them into [[oocyte]] donation cycles (which are compiled separately). Further, pregnancy rates can be increased by the placement of several embryos at the risk of increasing the chance for multiples.

Because not each IVF cycle that is started will lead to oocyte retrieval or embryo transfer, reports of live birth rates need to specify the denominator, namely IVF cycles started, IVF retrievals, or embryo transfers. The SART summarised 2008–9 success rates for US clinics for fresh embryo cycles that did not involve donor eggs and gave live birth rates by the age of the prospective mother, with a peak at 41.3% per cycle started and 47.3% per embryo transfer for patients under 35 years of age.

IVF attempts in multiple cycles result in increased cumulative live birth rates. Depending on the demographic group, one study reported 45% to 53% for three attempts, and 51% to 71% to 80% for six attempts.<ref>{{cite web | url = https://www.npr.org/templates/story/story.php?storyId=99654924 | title = Study: Sixth Time May Be Charm For In Vitro | vauthors = Neighmond P | work = Day to Day | publisher = National Public Radio | date = 21 January 2009 }}</ref>

According to the 2021 National Summary Report compiled by the Society for Assisted Reproductive Technology (SART), the mean number of embryos transfers for patients achieving live birth go as follows:<ref>{{cite web |title=Final National Summary Report for 2021 |url=https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0#donor-fresh-egg |website=National Summary Report |access-date=28 April 2024}}</ref>

{| class="wikitable"
|-
! !! <&nbsp;35 !! 35–37 !! 38–40 !! 41–42 !! >&nbsp;42
|-
| Mean # of transfers|| 1.33 || 1.28 || 1.19 || 1.11 || 1.10
|}

Effective from 15 February 2021 the majority of Australian IVF clinics publish their individual success rate online via YourIVFSuccess.com.au. This site also contains a predictor tool.<ref>{{Cite web|title=YourIVFSuccess|url=https://yourivfsuccess.com.au/|access-date=1 March 2021|website=YourIVFSuccess|language=en}}</ref>

====Pregnancy rate====
Pregnancy rate may be defined in various ways. In the United States, SART and the [[Centers for Disease Control]] (and appearing in the table in the Success Rates section above) include statistics on positive pregnancy test and clinical pregnancy rate.

The 2019 summary compiled by the SART the following data for non-donor eggs (first embryo transfer) in the United States:<ref name="2019 Clinic Summary Report">{{cite web|url=https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0|title=2019 Clinic Summary Report|work=Society for Assisted Reproductive Technology|url-status=dead|archive-url=https://web.archive.org/web/20200204120048/https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0|archive-date=4 February 2020|access-date=21 April 2022}}</ref>

{| class="wikitable"
|-
! !! <35 !! 35-37 !! 38-40 !! 41–42
!>42
|-
| Positive pregnancy test rate (%)|| 55.1 || 44.8 || 32.9 || 19.1
|8.5
|-
| Clinical pregnancy rate (%)|| 47.5 || 38.3 || 27.5 || 15.5
|6.3
|}

In 2006, Canadian clinics reported an average pregnancy rate of 35%.<ref name=canadians>{{cite web | vauthors = Branswell H | date = 15 December 2008 | url = http://www.theglobeandmail.com/servlet/story/RTGAM.20081215.wivf1215/BNStory/National/?page=rss&id=RTGAM.20081215.wivf1215 | title = Success rate climbs for in vitro fertilisation | work = The Canadian Press | archive-url = https://web.archive.org/web/20090318062752/http://www.theglobeandmail.com/servlet/story/RTGAM.20081215.wivf1215/BNStory/National/?page=rss&id=RTGAM.20081215.wivf1215 | archive-date = 18 March 2009 }}</ref> A French study estimated that 66% of patients starting IVF treatment finally succeed in having a child (40% during the IVF treatment at the centre and 26% after IVF discontinuation). Achievement of having a child after IVF discontinuation was mainly due to [[adoption]] (46%) or [[spontaneous pregnancy]] (42%).<ref>{{cite journal | vauthors = de La Rochebrochard E, Quelen C, Peikrishvili R, Guibert J, Bouyer J | title = Long-term outcome of parenthood project during in vitro fertilization and after discontinuation of unsuccessful in vitro fertilization | journal = Fertility and Sterility | volume = 92 | issue = 1 | pages = 149–156 | date = July 2009 | pmid = 18706550 | doi = 10.1016/j.fertnstert.2008.05.067 | s2cid = 207633738 | doi-access = free }}</ref>

====Miscarriage rate====
According to a study done by the [[Mayo Clinic]], [[miscarriage]] rates for IVF are somewhere between 15 and 25% for those under the age of 35.<ref name="mayoclinic">{{Cite web |title=In vitro fertilization (IVF) – Mayo Clinic |url=https://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/about/pac-20384716 |access-date=29 October 2022 |website=www.mayoclinic.org}}</ref> In naturally conceived pregnancies, the rate of miscarriage is between 10 and 20% for those under the age of 35.<ref>{{Cite web |title=Miscarriage |url=https://www.marchofdimes.org/find-support/topics/miscarriage-loss-grief/miscarriage |access-date=2024-03-18 |website=www.marchofdimes.org |language=en}}</ref> Risk of miscarriage, regardless of the method of conception, does increase with age.<ref name="mayoclinic" />

====Predictors of success====
The main potential factors that influence pregnancy (and live birth) rates in IVF have been suggested to be [[maternal age]], duration of infertility or subfertility, [[basal FSH|bFSH]] and number of oocytes, all reflecting [[Ovary#Function|ovarian function]].<ref>{{cite journal | vauthors = van Loendersloot LL, van Wely M, Limpens J, Bossuyt PM, Repping S, van der Veen F | title = Predictive factors in in vitro fertilization (IVF): a systematic review and meta-analysis | journal = Human Reproduction Update | volume = 16 | issue = 6 | pages = 577–589 | year = 2010 | pmid = 20581128 | doi = 10.1093/humupd/dmq015 | doi-access = free }}</ref> Optimal age is 23–39 years at time of treatment.<ref name=nice/>

[[File:Triple-line endometrium.jpg|thumb|A [[triple-line endometrium]] is associated with better IVF outcomes.<ref name="ZhaoZhang2012">{{cite journal | vauthors = Zhao J, Zhang Q, Li Y | title = The effect of endometrial thickness and pattern measured by ultrasonography on pregnancy outcomes during IVF-ET cycles | journal = Reproductive Biology and Endocrinology | volume = 10 | issue = 1 | pages = 100 | date = November 2012 | pmid = 23190428 | pmc = 3551825 | doi = 10.1186/1477-7827-10-100 | doi-access = free }}</ref>]]
[[Biomarker (medicine)|Biomarkers]] that affect the pregnancy chances of IVF include:
* [[Antral follicle count]], with higher count giving higher success rates.<ref name=Broer2012>{{cite journal | vauthors = Broer SL, van Disseldorp J, Broeze KA, Dolleman M, Opmeer BC, Bossuyt P, Eijkemans MJ, Mol BW, Broekmans FJ | display-authors = 6 | title = Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach | journal = Human Reproduction Update | volume = 19 | issue = 1 | pages = 26–36 | year = 2012 | pmid = 23188168 | doi = 10.1093/humupd/dms041 | doi-access = free }}</ref>
* [[Anti-Müllerian hormone]] levels, with higher levels indicating higher chances of pregnancy,<ref name=Broer2012/> as well as of live birth after IVF, even after adjusting for age.<ref name="IliodromitiKelsey2014">{{cite journal | vauthors = Iliodromiti S, Kelsey TW, Wu O, Anderson RA, Nelson SM | title = The predictive accuracy of anti-Müllerian hormone for live birth after assisted conception: a systematic review and meta-analysis of the literature | journal = Human Reproduction Update | volume = 20 | issue = 4 | pages = 560–570 | year = 2014 | pmid = 24532220 | doi = 10.1093/humupd/dmu003 | doi-access = free }}</ref>
* Level of [[DNA fragmentation]]<ref>{{cite journal | vauthors = Simon L, Brunborg G, Stevenson M, Lutton D, McManus J, Lewis SE | title = Clinical significance of sperm DNA damage in assisted reproduction outcome | journal = Human Reproduction | volume = 25 | issue = 7 | pages = 1594–1608 | date = July 2010 | pmid = 20447937 | doi = 10.1093/humrep/deq103 | doi-access = free }}</ref> as measured, e.g. by [[Comet assay]], [[advanced maternal age]] and [[semen quality]].
* People with ovary-specific [[FMR1]] genotypes including ''het-norm/low'' have significantly decreased pregnancy chances in IVF.<ref name="Gleicher 2010">{{cite journal | vauthors = Gleicher N, Weghofer A, Lee IH, Barad DH | title = FMR1 genotype with autoimmunity-associated polycystic ovary-like phenotype and decreased pregnancy chance | journal = PLOS ONE | volume = 5 | issue = 12 | pages = e15303 | date = December 2010 | pmid = 21179569 | pmc = 3002956 | doi = 10.1371/journal.pone.0015303 | doi-access = free | bibcode = 2010PLoSO...515303G | author-link1 = Norbert Gleicher }}</ref>
*[[Progesterone]] elevation on the day of [[final maturation (IVF)|induction of final maturation]] is associated with lower pregnancy rates in IVF cycles in women undergoing [[Ovulation induction|ovarian stimulation]] using GnRH analogues and gonadotrophins.<ref name=Venetis>{{cite journal | vauthors = Venetis CA, Kolibianakis EM, Bosdou JK, Tarlatzis BC | title = Progesterone elevation and probability of pregnancy after IVF: a systematic review and meta-analysis of over 60 000 cycles | journal = Human Reproduction Update | volume = 19 | issue = 5 | pages = 433–457 | year = 2013 | pmid = 23827986 | doi = 10.1093/humupd/dmt014 | doi-access = free }}</ref> At this time, compared to a progesterone level below 0.8&nbsp;ng/ml, a level between 0.8 and 1.1&nbsp;ng/ml confers an [[odds ratio]] of pregnancy of approximately 0.8, and a level between 1.2 and 3.0&nbsp;ng/ml confers an odds ratio of pregnancy of between 0.6 and 0.7.<ref name=Venetis/> On the other hand, progesterone elevation does not seem to confer a decreased chance of pregnancy in frozen–thawed cycles and cycles with egg donation.<ref name=Venetis/>
* Characteristics of cells from the [[cumulus oophorus]] and the [[membrana granulosa]], which are easily aspirated during [[oocyte retrieval]]. These cells are closely associated with the oocyte and share the same microenvironment, and the rate of expression of certain genes in such cells are associated with higher or lower pregnancy rate.<ref>{{cite journal | vauthors = Fragouli E, Lalioti MD, Wells D | title = The transcriptome of follicular cells: biological insights and clinical implications for the treatment of infertility | journal = Human Reproduction Update | volume = 20 | issue = 1 | pages = 1–11 | year = 2013 | pmid = 24082041 | pmc = 3845680 | doi = 10.1093/humupd/dmt044 }}</ref>
* An endometrial thickness (EMT) of less than 7&nbsp;mm decreases the pregnancy rate by an odds ratio of approximately 0.4 compared to an EMT of over 7&nbsp;mm. However, such low thickness rarely occurs, and any routine use of this parameter is regarded as not justified.<ref name="KasiusSmit2014">{{cite journal | vauthors = Kasius A, Smit JG, Torrance HL, Eijkemans MJ, Mol BW, Opmeer BC, Broekmans FJ | title = Endometrial thickness and pregnancy rates after IVF: a systematic review and meta-analysis | journal = Human Reproduction Update | volume = 20 | issue = 4 | pages = 530–541 | year = 2014 | pmid = 24664156 | doi = 10.1093/humupd/dmu011 | doi-access = free }}</ref>

Other [[Risk factor (epidemiology)|determinants]] of outcome of IVF include:
* As maternal age increases, the likelihood of conception decreases<ref>{{cite journal | vauthors = Baker VL, Luke B, Brown MB, Alvero R, Frattarelli JL, Usadi R, Grainger DA, Armstrong AY | display-authors = 6 | title = Multivariate analysis of factors affecting probability of pregnancy and live birth with in vitro fertilization: an analysis of the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System | journal = Fertility and Sterility | volume = 94 | issue = 4 | pages = 1410–1416 | date = September 2010 | pmid = 19740463 | doi = 10.1016/j.fertnstert.2009.07.986 | doi-access = free }}</ref> and the chance of miscarriage increases.<ref name="CDC-2015">{{Cite report|author1 = Centers for Disease Control and Prevention | author2 = American Society for Reproductive Medicine | author3 = Society for Assisted Reproductive Technology|title=2015 Assisted Reproductive Technology National Summary Report | date=2017|publisher=US Dept of Health and Human Services|url=https://www.cdc.gov/art/pdf/2015-report/ART-2015-National-Summary-Report.pdf}}</ref>
*With increasing paternal age, especially 50 years and older, the rate of [[blastocyst]] formation decreases.<ref>{{cite journal | vauthors = Frattarelli JL, Miller KA, Miller BT, Elkind-Hirsch K, Scott RT | title = Male age negatively impacts embryo development and reproductive outcome in donor oocyte assisted reproductive technology cycles | journal = Fertility and Sterility | volume = 90 | issue = 1 | pages = 97–103 | date = July 2008 | pmid = 17765235 | doi = 10.1016/j.fertnstert.2007.06.009 | doi-access = free }}</ref>
* [[Tobacco smoking]] reduces the chances of IVF producing a live birth by 34% and increases the risk of an IVF pregnancy miscarrying by 30%.<ref name=dh2009>{{cite web | url = http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_101070 | title =  Regulated fertility services: a commissioning aid | work = Department of Health UK | date = 18 June 2009 | archive-url = https://web.archive.org/web/20110103051232/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_101070 | archive-date = 3 January 2011 }}</ref>
* A [[body mass index]] (BMI) over 27 causes a 33% decrease in likelihood to have a live birth after the first cycle of IVF, compared to those with a BMI between 20 and 27.<ref name=dh2009/> Also, pregnant people who are obese have higher rates of [[miscarriage]], [[gestational diabetes]], [[hypertension]], [[thromboembolism]] and problems during [[childbirth|delivery]], as well as leading to an increased risk of fetal [[congenital abnormality]].<ref name=dh2009/> Ideal body mass index is 19–30,<ref name=nice/> and many clinics restrict this BMI range as a criterion for initiation of the IVF process.<ref name="pmid30963351">{{cite journal | vauthors = Kelley AS, Badon SE, Lanham MS, Fisseha S, Moravek MB | title = Body mass index restrictions in fertility treatment: a national survey of OB/GYN subspecialists | journal = J Assist Reprod Genet | volume = 36 | issue = 6 | pages = 1117–1125 | date = June 2019 | pmid = 30963351 | pmc = 6603101 | doi = 10.1007/s10815-019-01448-3 }}</ref>
* [[Salpingectomy]] or [[laparoscopic]] tubal occlusion before IVF treatment increases chances for people with [[hydrosalpinges]].<ref name=nice>{{Cite book|title=Fertility: Assessment and Treatment for People with Fertility Problems |publisher=RCOG Press |location=London |year=2004 |isbn=978-1-900364-97-3 | url = http://www.nice.org.uk/nicemedia/pdf/CG011publicinfoenglish.pdf |archive-url=https://web.archive.org/web/20101115121046/http://www.nice.org.uk/nicemedia/pdf/CG011publicinfoenglish.pdf |archive-date=15 November 2010 }}</ref><ref name=":0">{{cite journal | vauthors = Farquhar C, Marjoribanks J | title = Assisted reproductive technology: an overview of Cochrane Reviews | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 8 | pages = CD010537 | date = August 2018 | pmid = 30117155 | pmc = 6953328 | doi = 10.1002/14651858.CD010537.pub5 }}</ref>
* Success with previous pregnancy and/or live birth increases chances<ref name=nice/>
* Low alcohol/caffeine intake increases success rate<ref name=nice/>
* The number of embryos transferred in the treatment cycle<ref name=ii2011>{{cite web | url = http://www.ivf-infertility.com/ivf/standard/factors/couples.php | title = Factors affecting IVF success | date = February 2011 | work = IVF-infertility.com }}</ref>
* [[Embryo quality]]
* Some studies also suggest that [[autoimmune disease]] may also play a role in decreasing IVF success rates by interfering with the proper [[Implantation (embryology)|implantation]] of the embryo after transfer.<ref name="Gleicher 2010"/>

Aspirin is sometimes prescribed to people for the purpose of increasing the chances of conception by IVF, but {{as of|2016|lc=y}} there was no evidence to show that it is safe and effective.<ref name=CochraneIVF>{{cite journal | vauthors = Siristatidis CS, Basios G, Pergialiotis V, Vogiatzi P | title = Aspirin for in vitro fertilisation | journal = The Cochrane Database of Systematic Reviews | volume = 11 | issue = 11 | pages = CD004832 | date = November 2016 | pmid = 27807847 | pmc = 6463901 | doi = 10.1002/14651858.CD004832.pub4 }}</ref><ref>{{cite journal | vauthors = Groeneveld E, Broeze KA, Lambers MJ, Haapsamo M, Dirckx K, Schoot BC, Salle B, Duvan CI, Schats R, Mol BW, Hompes PG | display-authors = 6 | title = Is aspirin effective in women undergoing in vitro fertilization (IVF)? Results from an individual patient data meta-analysis (IPD MA) | journal = Human Reproduction Update | volume = 17 | issue = 4 | pages = 501–509 | year = 2011 | pmid = 21422062 | doi = 10.1093/humupd/dmr007 | doi-access = free }}</ref>

A 2013 [[systematic review|review]] and [[metaanalysis|meta analysis]] of [[randomised controlled trial]]s of [[acupuncture]] as an [[adjuvant therapy]] in IVF found no overall benefit, and concluded that an apparent benefit detected in a subset of published trials where the control group (those not using acupuncture) experienced a lower than average rate of pregnancy requires further study, due to the possibility of [[publication bias]] and other factors.<ref>{{cite journal | vauthors = Manheimer E, van der Windt D, Cheng K, Stafford K, Liu J, Tierney J, Lao L, Berman BM, Langenberg P, Bouter LM | display-authors = 6 | title = The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis | journal = Human Reproduction Update | volume = 19 | issue = 6 | pages = 696–713 | year = 2013 | pmid = 23814102 | pmc = 3796945 | doi = 10.1093/humupd/dmt026 }}</ref>

A [[Cochrane review]] came to the result that [[Endometrium|endometrial]] injury performed in the month prior to ovarian induction appeared to increase both the live birth rate and clinical pregnancy rate in IVF compared with no endometrial injury. There was no evidence of a difference between the groups in miscarriage, multiple pregnancy or bleeding rates. Evidence suggested that endometrial injury on the day of oocyte retrieval was associated with a lower live birth or ongoing pregnancy rate.<ref name=":0" />

Intake of [[antioxidant]]s (such as [[N-acetyl-cysteine]], [[melatonin]], [[vitamin A]], [[vitamin C]], [[vitamin E]], [[folic acid]], [[myo-inositol]], [[zinc]] or [[selenium]]) has not been associated with a significantly increased [[live birth rate]] or clinical [[pregnancy rate]] in IVF according to [[Cochrane review]]s.<ref name=":0" /> The review found that oral antioxidants given to the sperm donor with male factor or unexplained subfertility may improve live birth rates, but more evidence is needed.<ref name=":0" />

A [[Cochrane review]] in 2015 came to the result that there is no evidence identified regarding the effect of preconception lifestyle advice on the chance of a live birth outcome.<ref name=":0" />