Preparing for IVF in the UK: a GP's checklist, from three months out to transfer day

As a GP, I see people arrive at their first IVF cycle having spent months on Google and hours on Instagram, still unsure what they are supposed to have done to get ready. As someone who has been through IVF myself, I remember the feeling exactly: a long list of things everyone says matter, and no clear order to do them in.

This is the checklist I wish I had been given. It runs from three months before treatment to the day of embryo transfer, and it is written for the UK system: NHS or private, England, Scotland, Wales or Northern Ireland.

One thing before we start. Preparation improves the odds and the experience. It does not guarantee an outcome, and nothing on this list is a test you can fail.

Why three months?

The egg that is collected during IVF has been maturing for roughly 90 days before it is released. Sperm take around 70 to 80 days to develop. Whatever you change in that window, from folic acid to alcohol to sleep, is what your eggs and sperm are developing alongside. Starting three months out is not a wellness slogan. It is biology.

If you have less than three months, do not panic. Start where you are. Most of the items below still help when started later.

Three months before: the medical basics

• Folic acid, 400 micrograms a day. The NHS advises this for anyone trying to conceive, ideally from before conception until 12 weeks of pregnancy. If your BMI is 30 or over, you have diabetes, you take epilepsy medication, or you or your partner have a family history of neural tube defects, you need the higher 5 milligram dose, which your GP prescribes. Ask.
• Vitamin D, 10 micrograms a day. Standard NHS advice for everyone in the UK from October to March, and for anyone pregnant or trying, all year.
• Check what you already take. Avoid supplements containing vitamin A (retinol) and cod liver oil. Tell your clinic about every medication, including over the counter and herbal products.
• Smoking and vaping. Stopping is the single biggest lifestyle change that improves IVF outcomes. The NHS Stop Smoking service is free and works better than willpower alone.
• Alcohol. The safest approach when trying to conceive is none. During a cycle, most clinics ask you to avoid it entirely.
• Weight. Many NHS funding rules ask for a BMI between 19 and 30, and clinics see better response to stimulation within that range. If you are outside it, ask your GP about support early, not at the referral stage.
• Both of you. Half of fertility problems involve a male factor. Everything in this section applies to your partner too, and a semen analysis should already be in hand before IVF is planned.

Notice what is not on this list: expensive supplement stacks, elimination diets, and anything sold with the word "boost". I cover what the evidence actually supports in supplements when trying to conceive: what the evidence says.

Six to eight weeks before: the practical layer

• Understand your protocol. Ask which protocol you are on (long, short, antagonist or a variant), which drugs, and when each starts. Write the dates down. Ask what happens if your response is too low or too high.
• Know the warning signs. Ovarian hyperstimulation syndrome (OHSS) is uncommon but serious. Your clinic will give you a list of symptoms and a number to call. Put the number in your phone now.
• Check the money, all of it. If you are paying, ask for the full cost of a cycle including drugs, scans, freezing, storage, and what you pay if the cycle is cancelled before egg collection. The HFEA clinic finder shows verified success rates and inspection reports for every UK clinic.
• Decide about add-ons in advance. You will be offered extras. Read IVF add-ons: which are worth paying for? before the conversation, not during it.
• Plan work now. Monitoring scans are often early morning, egg collection needs a full day plus recovery, and transfer needs a morning. There is no legal right to time off for fertility treatment in the UK, so this is a negotiation. IVF and work: your rights in the UK explains what you can ask for.
• Line up support. Every UK clinic must offer counselling. Take it. Fertility Network UK runs free support groups and a helpline.

The two weeks before egg collection: stimulation

This is the injection phase. A few things nobody told me:

• Bloating, tiredness and mood changes are normal. Sudden severe abdominal pain, vomiting, or breathlessness are not: call the clinic.
• Scans every two to three days are the norm. Book them into your diary as fixed appointments.
• Keep exercise gentle once your ovaries are enlarged. Walking is fine. High-impact exercise is usually advised against because of the small risk of ovarian torsion.
• The trigger injection is timed to the hour. Set two alarms.

Egg collection day

• You will usually be sedated. You cannot drive for 24 hours and you need someone to take you home.
• Plan the day off, and ideally the next. Cramping and spotting afterwards are common.
• Your partner or donor sample is collected the same day. Confirm the abstinence window the clinic wants (usually two to five days).

Transfer day and the two-week wait

• Most clinics ask for a comfortably full bladder for transfer. Ask yours.
• Ask about single embryo transfer. It is the UK standard for most people because twins carry higher risks for mother and babies.
• Progesterone support starts around transfer. Pessaries, gel or injections: know which, and how to store them.
• Testing early gives unreliable results because the trigger injection contains hCG, the same hormone the test detects. Wait for your clinic's date.
• Carry on as normal. Bed rest does not improve implantation rates, and the guilt of "doing it wrong" is not something you need on top of everything else.

What to skip

• Any supplement or test that promises to "boost egg quality" without evidence for people like you.
• Strict diets started in the middle of a cycle. Eat well, eat enough, and do not add food anxiety to hormone anxiety.
• Reading success rates without checking the age group and the measure. Live birth per embryo transferred, for your age, at that clinic, is the number that matters.

The checklist, in one place

1. Folic acid 400 micrograms (or 5 milligrams if higher risk) and vitamin D 10 micrograms, daily, both from now.
2. Stop smoking and vaping; stop alcohol.
3. Both partners: medication review, weight check, semen analysis done.
4. Protocol written down with dates; OHSS number saved.
5. Full cycle costs in writing, including cancellation and storage.
6. Add-on decisions made before the sales conversation.
7. Work plan agreed: scans, collection, transfer.
8. Counselling and support line saved.
9. Someone to drive you home from egg collection.
10. Test date fixed by the clinic, not by the box in the bathroom cupboard.

If you want the long version, the one that walks through protocols, NHS testing, private clinics and your rights at work in order, that is what Fertility Foundations is: twelve chapters, eight hours, written by a GP who has sat on both sides of the desk.

Sources: NHS: IVF; NHS: planning your pregnancy; HFEA: getting started with treatment; NICE guideline CG156, fertility problems: assessment and treatment.