By Hilary Metcalfe
When I first began IVF, I thought the most important decisions were which clinic, which protocol, and how to survive the many-week wait. What I didn’t realise? Some of the most important work happens before you even start injections.
IVF doesn’t begin the day you start hormone stimulation, it begins with the state of your body walking in. If your hormones, nutrients, and systems aren’t supported first, you’re asking your body to perform under strain. I learned this the hard way. And if I could give every woman one piece of advice before she steps into her first consultation, it would be: pause, and check your foundations first.
Here are the checks I wish I’d done earlier, to save you time, money and potentially heartache and that I now recommend to anyone about to start IVF for a better outcome.
1. Check your hormones, beyond the basics
Most clinics will run standard fertility labs: AMH (ovarian reserve), FSH, LH, oestradiol, and sometimes thyroid. These are important, but they’re not the whole picture.
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Thyroid function (TSH, Free T3, Free T4, antibodies): Subclinical thyroid issues are common in women with infertility. A meta-analysis found that thyroid autoimmunity is associated with higher miscarriage rates in women undergoing ART.
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Cortisol and DHEA: Stress hormones can impact ovulation and implantation. Elevated cortisol has been associated with lower chances of conception in observational studies.
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Progesterone: Ensuring luteal adequacy matters for implantation. Even if supplementation is planned, knowing your baseline helps.
Tip: Ask your doctor for a more comprehensive endocrine panel, or work with a functional medicine practitioner who understands the hormonal interplay beyond fertility drugs.
2. Test for nutrient deficiencies
Egg and sperm quality are influenced by mitochondrial health, oxidative stress, and nutrient status. IVF protocols can’t fix deficiencies, but you can.
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Vitamin D: Essential for implantation and immune modulation. Multiple studies show higher pregnancy and live birth rates in IVF cycles when vitamin D levels are sufficient. Most of us are deficient, and standard labs will tell you above blood level 30 is good, below isn’t. But if you are, say, 38 is that enough? I wanted OPTIMAL and according to functional medicine, that means getting levels into the 60’s. For this, I used vitamin D3 + K2, which is the vehicle that gets the D where it needs to be (pun intended). I found this in raw dairy cheeses, naturally richer in K2.
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Iron & ferritin: Iron deficiency is common in women, especially with heavy periods. Low ferritin is linked to poor ovulatory function. I added grass fed liver into my diet for the most bioavailable, natural multi-vitamin there is. Add vitamin C which helps your body absorb Iron better!
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B12 & Folate: Needed for DNA synthesis and methylation. Opt for methylated forms (methylcobalamin, methylfolate). Same re: GF liver here.
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Omega-3 index: Higher omega-3 status is associated with better embryo quality and reduced inflammation. Think small school fish like sardines and anchovies, mackerel and herring, less mercury load, more sustainable, and richest in the good fats.
Tip: Don’t just “take a prenatal.” Get tested. Knowing your starting point allows for targeted support.
3. Look at your gut health
It may not be the first thing you think of before IVF, but gut function influences hormone metabolism, nutrient absorption, and immune tolerance. Dysbiosis or undiagnosed celiac disease can undermine fertility.
Research shows that gut microbiota imbalances can affect oestrogen recycling through the “estrobolome,” potentially impacting endometrial receptivity. I also started taking a high-quality probiotic and eating naturally fermented foods daily, think kefir, sauerkraut, kimchi, and yoghurt made from raw or grass-fed milk.
Tip: If you experience chronic bloating, IBS-type symptoms, or food intolerances, consider functional stool or breath testing before IVF.
Herbal support matters too:
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The Digestive Infusion: formulated with holy basil, cardamom, and vervain, can help soothe bloating, calm cramping, and support smoother digestion, as well as support gut lining rebuild with essential prebiotics, making it easier for your body to absorb nutrients.
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The Gentle Period: rich in red clover, raspberry leaf, and hibiscus, can help balance hormones naturally and support both gut lining and cycle comfort before stimulation begins.
4. See a functional medicine or integrative practitioner
IVF clinics are brilliant at protocols and egg retrievals. But they’re not designed to look at your whole system or to deal with these deficiencies or nurture your hormonal health overall, which is paradoxically essential for a positive IVF outcome and your journey to parenthood. Functional and integrative medicine practitioners can fill that gap.
They can help you:
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Identify root causes (e.g., PCOS, endometriosis, thyroid disease, insulin resistance).
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Personalise your supplement stack.
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Support your liver detox pathways, which process the surge of synthetic hormones in IVF.
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Guide nutrition and stress management.
5. Check for inflammation and hidden conditions
Silent inflammation can sabotage IVF outcomes. Consider testing:
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hs-CRP (C-reactive protein): Marker of systemic inflammation.
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Autoimmune panels: Especially if you have family history of autoimmune disease.
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Blood sugar & insulin resistance: Elevated fasting insulin is linked to poorer IVF outcomes.
Addressing inflammation with diet (anti-inflammatory foods, omega-3s, antioxidants), gentle movement, and stress care may improve implantation odds.
6. Don’t forget the emotional prep
IVF is as much emotional as it is medical. Rates of anxiety and depression in IVF patients are significantly higher than the general population. It’s stressful, you may feel a lot is riding on each cycle, and your hope and the investment is worth the exercise of preparing yourself mentally and emotionally for what can be a bumpy ride.
Pre-IVF therapy, journaling, or mindfulness can help create resilience before you’re in the middle of injections and waiting games.
I know the urge is to start fast. Time feels urgent, the clock feels loud. But if I’ve learned anything, it’s this: slowing down before IVF may save you heartache later.
Checking your hormones, correcting deficiencies, supporting your gut, and preparing emotionally isn’t wasted time, it’s creating fertile ground for the science of IVF to work better.
So before you start the meds and the monitoring, give yourself this gift: a full-body check-in. It might change everything.
Rooting for you,
Hilary
ABOUT HILARY
Hilary is the Co-Founder of the SABI, a Holistic Nutritionist, natural, whole foods Chef, product developer and advocate for women getting to know their bodies, cycles and selves better. Born in Los Angeles, California and raised in Baja California, Mexico, she now lives in Los Cabos with her partner Kees, a curly-tailed rescue dog from Curacao, Flint and her rainbow babies Paloma and Bea.
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HORMONAL & PROUD
Created as a brand to help women navigate the toughest moments in pregnancy, childbirth, postpartum — and practically every stage of life, the SABI aims to change the narrative around our hormones from one of taboo, embarrassment and loneliness, to awareness and even pride. Much more than a wellness brand, SABI offers a carefully crafted line of products to carry you through your hormonal journey; a set of rituals, supportive tools, and ancient herbal remedies that have been tested time and again by women and now, backed by medicine. SABI is a blend of science and nature conceived by women who have experienced the joys and deep implications of bringing a child into the world, the pains of a heavy and difficult period, miscarriage and difficulty conceiving
Here is an invitation to get to know your body and its cycles better and to really understand what is going on inside. Learn to use your hormonal cycle to your advantage no matter your stage of life, and know that you can always support and balance your hormone levels. Look for the right sources of information, know that there is help, and know that you’re supported.
DISCLAIMER
The SABI blog and articles are not meant to instruct or advise on medical or health conditions, but to inform. The information and opinions presented here do not substitute professional medical advice or consultations with healthcare professionals for your unique situation.
