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Meta-Analysis
. 2021 Apr 29;4(4):CD008189.
doi: 10.1002/14651858.CD008189.pub3.

Preconception lifestyle advice for people with infertility

Tessy Boedt  1 , Anne-Catherine Vanhove  2   3 , Melissa A Vercoe  4 , Christophe Matthys  1 , Eline Dancet  5 , Sharon Lie Fong  5   6
Affiliations
Meta-Analysis

Preconception lifestyle advice for people with infertility

Tessy Boedt et al. Cochrane Database Syst Rev. .

Abstract

Background: Infertility is a prevalent problem that has significant consequences for individuals, families, and the community. Modifiable lifestyle factors may affect the chance of people with infertility having a baby. However, no guideline is available about what preconception advice should be offered. It is important to determine what preconception advice should be given to people with infertility and to evaluate whether this advice helps them make positive behavioural changes to improve their lifestyle and their chances of conceiving.

Objectives: To assess the safety and effectiveness of preconception lifestyle advice on fertility outcomes and lifestyle behavioural changes for people with infertility.

Search methods: We searched the Cochrane Gynaecology and Fertility Group Specialised Register of controlled trials, CENTRAL, MEDLINE, Embase, PsycINFO, AMED, CINAHL, trial registers, Google Scholar, and Epistemonikos in January 2021; we checked references and contacted field experts to identify additional studies.

Selection criteria: We included randomised controlled trials (RCTs), randomised cross-over studies, and cluster-randomised studies that compared at least one form of preconception lifestyle advice with routine care or attention control for people with infertility.

Data collection and analysis: We used standard methodological procedures recommended by Cochrane. Primary effectiveness outcomes were live birth and ongoing pregnancy. Primary safety outcomes were adverse events and miscarriage. Secondary outcomes included reported behavioural changes in lifestyle, birth weight, gestational age, clinical pregnancy, time to pregnancy, quality of life, and male factor infertility outcomes. We assessed the overall quality of evidence using GRADE criteria.

Main results: We included in the review seven RCTs involving 2130 participants. Only one RCT included male partners. Three studies compared preconception lifestyle advice on a combination of topics with routine care or attention control. Four studies compared preconception lifestyle advice on one topic (weight, alcohol intake, or smoking) with routine care for women with infertility and specific lifestyle characteristics. The evidence was of low to very low-quality. The main limitations of the included studies were serious risk of bias due to lack of blinding, serious imprecision, and poor reporting of outcome measures. Preconception lifestyle advice on a combination of topics versus routine care or attention control Preconception lifestyle advice on a combination of topics may result in little to no difference in the number of live births (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.79 to 1.10; 1 RCT, 626 participants), but the quality of evidence was low. No studies reported on adverse events or miscarriage. Due to very low-quality evidence, we are uncertain whether preconception lifestyle advice on a combination of topics affects lifestyle behavioural changes: body mass index (BMI) (mean difference (MD) -1.06 kg/m², 95% CI -2.33 to 0.21; 1 RCT, 180 participants), vegetable intake (MD 12.50 grams/d, 95% CI -8.43 to 33.43; 1 RCT, 264 participants), alcohol abstinence in men (RR 1.08, 95% CI 0.74 to 1.58; 1 RCT, 210 participants), or smoking cessation in men (RR 1.01, 95% CI 0.91 to 1.12; 1 RCT, 212 participants). Preconception lifestyle advice on a combination of topics may result in little to no difference in the number of women with adequate folic acid supplement use (RR 0.98, 95% CI 0.95 to 1.01; 2 RCTs, 850 participants; I² = 4%), alcohol abstinence (RR 1.07, 95% CI 0.99 to 1.17; 1 RCT, 607 participants), and smoking cessation (RR 1.01, 95% CI 0.98 to 1.04; 1 RCT, 606 participants), on low quality evidence. No studies reported on other behavioural changes. Preconception lifestyle advice on weight versus routine care Studies on preconception lifestyle advice on weight were identified only in women with infertility and obesity. Compared to routine care, we are uncertain whether preconception lifestyle advice on weight affects the number of live births (RR 0.94, 95% CI 0.62 to 1.43; 2 RCTs, 707 participants; I² = 68%; very low-quality evidence), adverse events including gestational diabetes (RR 0.78, 95% CI 0.48 to 1.26; 1 RCT, 317 participants; very low-quality evidence), hypertension (RR 1.07, 95% CI 0.66 to 1.75; 1 RCT, 317 participants; very low-quality evidence), or miscarriage (RR 1.50, 95% CI 0.95 to 2.37; 1 RCT, 577 participants; very low-quality evidence). Regarding lifestyle behavioural changes for women with infertility and obesity, preconception lifestyle advice on weight may slightly reduce BMI (MD -1.30 kg/m², 95% CI -1.58 to -1.02; 1 RCT, 574 participants; low-quality evidence). Due to very low-quality evidence, we are uncertain whether preconception lifestyle advice affects the percentage of weight loss, vegetable and fruit intake, alcohol abstinence, or physical activity. No studies reported on other behavioural changes. Preconception lifestyle advice on alcohol intake versus routine care Studies on preconception lifestyle advice on alcohol intake were identified only in at-risk drinking women with infertility. We are uncertain whether preconception lifestyle advice on alcohol intake affects the number of live births (RR 1.15, 95% CI 0.53 to 2.50; 1 RCT, 37 participants; very low-quality evidence) or miscarriages (RR 1.31, 95% CI 0.21 to 8.34; 1 RCT, 37 participants; very low-quality evidence). One study reported on behavioural changes for alcohol consumption but not as defined in the review methods. No studies reported on adverse events or other behavioural changes. Preconception lifestyle advice on smoking versus routine care Studies on preconception lifestyle advice on smoking were identified only in smoking women with infertility. No studies reported on live birth, ongoing pregnancy, adverse events, or miscarriage. One study reported on behavioural changes for smoking but not as defined in the review methods.

Authors' conclusions: Low-quality evidence suggests that preconception lifestyle advice on a combination of topics may result in little to no difference in the number of live births. Evidence was insufficient to allow conclusions on the effects of preconception lifestyle advice on adverse events and miscarriage and on safety, as no studies were found that looked at these outcomes, or the studies were of very low quality. This review does not provide clear guidance for clinical practice in this area. However, it does highlight the need for high-quality RCTs to investigate preconception lifestyle advice on a combination of topics and to assess relevant effectiveness and safety outcomes in men and women with infertility.

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Conflict of interest statement

TB, ACV, MV, CM, ED, and SLF declare that they do not have any conflicts of interest.

Figures

1
1
Study flow diagram.
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Preconception lifestyle advice on a combination of any of the following topics: weight, diet, vitamin and mineral intake, alcohol intake, caffeine intake, physical activity, smoking, and/or other substance abuse vs routine care or attention control, Outcome 1: Live birth
1.2
1.2. Analysis
Comparison 1: Preconception lifestyle advice on a combination of any of the following topics: weight, diet, vitamin and mineral intake, alcohol intake, caffeine intake, physical activity, smoking, and/or other substance abuse vs routine care or attention control, Outcome 2: Reported behavioural changes in weight: BMI
1.3
1.3. Analysis
Comparison 1: Preconception lifestyle advice on a combination of any of the following topics: weight, diet, vitamin and mineral intake, alcohol intake, caffeine intake, physical activity, smoking, and/or other substance abuse vs routine care or attention control, Outcome 3: Reported behavioural changes in diet: vegetable intake
1.4
1.4. Analysis
Comparison 1: Preconception lifestyle advice on a combination of any of the following topics: weight, diet, vitamin and mineral intake, alcohol intake, caffeine intake, physical activity, smoking, and/or other substance abuse vs routine care or attention control, Outcome 4: Reported behavioural changes in vitamin and mineral supplement intake: use of folic acid supplement
1.5
1.5. Analysis
Comparison 1: Preconception lifestyle advice on a combination of any of the following topics: weight, diet, vitamin and mineral intake, alcohol intake, caffeine intake, physical activity, smoking, and/or other substance abuse vs routine care or attention control, Outcome 5: Reported behavioural changes in alcohol intake: numbers of women and men abstaining from alcohol
1.6
1.6. Analysis
Comparison 1: Preconception lifestyle advice on a combination of any of the following topics: weight, diet, vitamin and mineral intake, alcohol intake, caffeine intake, physical activity, smoking, and/or other substance abuse vs routine care or attention control, Outcome 6: Reported behavioural changes in smoking: numbers of women and men not smoking
1.7
1.7. Analysis
Comparison 1: Preconception lifestyle advice on a combination of any of the following topics: weight, diet, vitamin and mineral intake, alcohol intake, caffeine intake, physical activity, smoking, and/or other substance abuse vs routine care or attention control, Outcome 7: Clinical pregnancy
2.1
2.1. Analysis
Comparison 2: Preconception lifestyle advice on weight vs routine care or attention control, Outcome 1: Live birth
2.2
2.2. Analysis
Comparison 2: Preconception lifestyle advice on weight vs routine care or attention control, Outcome 2: Adverse events
2.3
2.3. Analysis
Comparison 2: Preconception lifestyle advice on weight vs routine care or attention control, Outcome 3: Miscarriage
2.4
2.4. Analysis
Comparison 2: Preconception lifestyle advice on weight vs routine care or attention control, Outcome 4: Reported behavioural changes in weight: BMI
2.5
2.5. Analysis
Comparison 2: Preconception lifestyle advice on weight vs routine care or attention control, Outcome 5: Reported behavioural changes in weight: percentage of weight loss
2.6
2.6. Analysis
Comparison 2: Preconception lifestyle advice on weight vs routine care or attention control, Outcome 6: Reported behavioural changes in diet: vegetable intake
2.7
2.7. Analysis
Comparison 2: Preconception lifestyle advice on weight vs routine care or attention control, Outcome 7: Reported behavioural changes in diet: fruit intake
2.8
2.8. Analysis
Comparison 2: Preconception lifestyle advice on weight vs routine care or attention control, Outcome 8: Reported behavioural changes in alcohol intake
2.9
2.9. Analysis
Comparison 2: Preconception lifestyle advice on weight vs routine care or attention control, Outcome 9: Reported behavioural changes in physical activity
2.10
2.10. Analysis
Comparison 2: Preconception lifestyle advice on weight vs routine care or attention control, Outcome 10: Birth weight
2.11
2.11. Analysis
Comparison 2: Preconception lifestyle advice on weight vs routine care or attention control, Outcome 11: Gestational age
2.12
2.12. Analysis
Comparison 2: Preconception lifestyle advice on weight vs routine care or attention control, Outcome 12: Clinical pregnancy
2.13
2.13. Analysis
Comparison 2: Preconception lifestyle advice on weight vs routine care or attention control, Outcome 13: Time to pregnancy
2.14
2.14. Analysis
Comparison 2: Preconception lifestyle advice on weight vs routine care or attention control, Outcome 14: Quality of life
3.1
3.1. Analysis
Comparison 3: Preconception lifestyle advice on alcohol intake vs routine care or attention control, Outcome 1: Live birth
3.2
3.2. Analysis
Comparison 3: Preconception lifestyle advice on alcohol intake vs routine care or attention control, Outcome 2: Miscarriage
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    1. Dortaj A, Mehdizadeh A, Dortaj H, Bahari H. Effectiveness of mindfulness-based cognitive therapy on improvement of stress and infertility in infertile women undergoing IVF. Journal of Reproduction and Infertility 2016;17(2):264.
DRKS00017554 2019 {published data only}
    1. DRKS00017554. The effect of counselling on preconceptional care knowledge, attitude and lifestyle behaviors in Turkish women: a randomized controlled trial. http://www.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00017554 (first received 2019).
Einarsson 2017a {published data only}
    1. Einarsson S, Bergh C, Friberg B, Pinborg A, Klajnbard A, Karlstrom PO, et al. Weight reduction intervention for obese infertile women prior to In vitro fertilisation: a randomised controlled trial. Human Reproduction 2017;32:i29. - PubMed
Einarsson 2017b {published data only}
    1. Einarsson S, Bergh C, Friberg B, Pinborg A, Klajnbard A, Karlstrom PO, et al. Weight reduction intervention for obese infertile women prior to IVF: a randomized controlled trial. Human Reproduction 2017;32(8):1621-30. - PubMed
Einarsson 2018 {published data only}
    1. Einarsson S, Christina B, Kluge L, Thurin-Kjellberg A. The effect of weight intervention on obstetric and neonatal outcome in obese women scheduled for IVF treatment. Human Reproduction 2018;33:320. [DOI: ]
Einarsson 2019 {published data only}
    1. Einarsson S, Bergh C, Kluge L, Thurin-Kjellberg A. No effect of weight intervention on perinatal outcomes in obese women scheduled for in vitro fertilization treatment. Acta Obstetricia et Gynecologica Scandinavica 2019;98(6):708-14. [DOI: ] - PubMed
Elsinga 2008 {published data only}
    1. Elsinga J, Jong-Potjer LC, Pal-de Bruin KM, le Cessie S, Assendelft WJJ, Buitendijk SE. The effect of preconception counselling on lifestyle and other behaviour before and during pregnancy. Women's Health Issues 2008;18(6):S117-25. [DOI: ] - PubMed
Emery 2001 {published data only}
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Emery 2002 {published data only}
    1. Emery M, Beran M, Darwiche J, Oppizzi L, Joris V, Capel R, et al. What do couples expect and what do the receive through systematic pre-IVF counselling? Results from a randomized controlled study. Human Reproduction 2002;17(1):192.
Emery 2003 {published data only}
    1. Emery M, Beran M, Darwiche J, Oppizzi L, Joris V, Capel R, et al. Results from a prospective, randomized, controlled study evaluating the acceptability and effects of routine pre-IVF counselling. Human Reproduction 2003;18(12):2647-53. - PubMed
Emery 2004 {published data only}
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Emery 2006 {published data only}
    1. Emery M, Joris V, Beran M, Darwiche J, Capel R, Guex P, et al. Prospective study of pre-IVF counselling; one year study follow-up. Journal of Reproductive Medicine and Endocrinology 2006;1:77-8.
Espinos 2017 {published data only}
    1. Espinos JJ, Polo A, Sanchez-Hernandez J, Bordas R, Pares P, Martinez O, et al. Weight decrease improves live birth rates in obese women undergoing IVF: a pilot study. Reproductive BioMedicine Online 2017;35(4):417-24. - PubMed
Fauque 2007 {published data only}
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Galhardo 2013 {published data only}
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Garruti 2017 {published data only}
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Gaskins 2018 {published data only}
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Gautam 2019a {published data only}
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Gautam 2019b {published data only}
    1. Gautam S, Kumar M, Chaurasia P, Rana D, Dada R. Impact of yoga based lifestyle intervention on quality of life, depression and sperm oxidative DNA damage: a randomized controlled trial on infertile men with rheumatoid arthritis. Fertility and Sterility 2019;112(3):e409. [DOI: 10.1016/j.fertnstert.2019.07.1161] - DOI
Goswami 2015 {published data only}
    1. Goswami SK, Yasmin S, Chakraborty P, Chattopadhyay R, Ghosh S, Goswami M, et al. Role of dietary antioxidant supplementation in treatment of idiopathic male infertility: promising evidence from a sub-continental study. Fertility and Sterility 2015;104:e288.
Guzick 1994 {published data only}
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Hamzehgardeshi 2019 {published data only}
    1. Hamzehgardeshi Z, Yazdani F, Elyasi F, Moosazadeh M, Peyvandi S, Gelehkolaee KS, et al. The efficacy of group counselling on perceived stress among infertile women undergoing in vitro fertilization treatment: an RCT. International Journal of Reproductive Biomedicine 2019;17(1):57-66. - PMC - PubMed
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HuMl 2016 {published data only}
    1. Hu Ml, Chang MY, Chu MC, Wang HS, Huang HY. The effectiveness of brief mindfulness-based stress reduction program on stress, mindful awareness attention, sleep quality in infertile women: a quasi-experimental study. Human Reproduction 2016;31(Suppl 1):i343. [DOI: 10.1093/humrep/31.Supplement_1.1] - DOI
IRCT201110267915N1 2014 {published data only}
    1. IRCT201110267915N1. The effect of collaborative counseling on psychological subsequent in infertile women. http://en.irct.ir/trial/8359 (first received 25 July 2014).
IRCT201301189463N 2017 {published data only}
    1. IRCT201301189463N12. The effect of an educational program based on BASNEF model on sexual health promotion in infertile women. http://www.who.int/trialsearch/Trial2.aspx?TrialID=IRCT201301189463N12 (first received 3 February 2017).
IRCT20150119020719N6 2018 {published data only}
    1. IRCT20150119020719N6. The effect of counseling on stress and female behaviors of infertile women. http://en.irct.ir/trial/29348 (first received 14 April 2018).
IRCT2016012610324N 2016 {published data only}
    1. IRCT2016012610324N28. The effect of preconception counseling on women lifestyle. http://www.who.int/trialsearch/Trial2.aspx?TrialID=IRCT2016012610324N28 (first received 10 April 2016).
IRCT20160605028270N2 2020 {published data only (unpublished sought but not used)}
    1. IRCT20160605028270N2. The effects of different exercise training modalities as a treatment and prevention strategies on body composition measures in association with semen parameters in married middle age fertile and at-risk infertile patients. http://www.who.int/trialsearch/Trial2.aspx?TrialID=IRCT20160605028270N2 (first received 7 August 2020).
ISRCTN03259732 2014 {published data only}
    1. ISRCTN03259732. Start at the beginning: a nutrition and lifestyle digital intervention for women planning a pregnancy. http://www.who.int/trialsearch/Trial2.aspx?TrialID=ISRCTN03259732 (first received 31 July 2014).
ISRCTN11081163 2016 {published data only}
    1. ISRCTN11081163. A Swedish population-based reproductive life plan intervention. https://doi.org/10.1186/ISRCTN11081163 (first received 1 November 2016).
ISRCTN17222161 2017 {published data only}
    1. ISRCTN17222161. Changes in male fertility during chronic illness. https://doi.org/10.1186/ISRCTN17222161 (first received 24 February 2017).
Jaffar 2018 {published data only}
    1. Jaffar M, Andrabi SW, Prakash Babu SML, Subramani SA. Impact of weight loss on reproductive hormones in obese men. International Journal of Infertility and Fetal Medicine 2018;9(3):32-6. [DOI: ]
Jamali 2016 {published data only}
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Jiménez Tuñón 2017 {published data only}
    1. Jiménez Tuñón JM, Trilles PP, Molina MG, Duvison MH, Pastor BM, Martín PS, et al. A double-blind, randomized prospective study to evaluate the efficacy of previous therapy with melatonin, myo-inositol, folic acid, and selenium in improving the results of an assisted reproductive treatment. Clinical Medicine Insights: Therapeutics 2017;9:1-6. [DOI: 10.1177/1179559X17742902] - DOI
Kaya 2016 {published data only}
    1. Kaya Y, Beji NK, Aydin Y, Hassa H. The effect of health-promoting lifestyle education on the treatment of unexplained female infertility. European Journal of Obstetrics & Gynecology and Reproductive Biology 2016;207:109-14. - PubMed
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Kersten 2015 {published data only}
    1. Kersten FAM, Nelen WLDM, den Boogaard NM, Braat DDM, Koks CA, Spinder T, et al. Improving the implementation of tailored expectant management in couples with unexplained infertility: results from a cluster randomized controlled trial. Human Reproduction 2015;30(Suppl 1):57-8.
Kiel 2018 {published data only}
    1. Kiel IA, Lundgren KM, Mørkved S, Kjøtrød SB, Salvesen Ø, Romundstad LB, et al. Women undergoing assisted fertilisation and high-intensity interval training: a pilot randomised controlled trial. BMJ Open Sport & Exercise Medicine 2018;4(1):e000387. [DOI: ] - PMC - PubMed
Kirca 2019 {published data only}
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Li 2017 {published data only}
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Lundgren 2016 {published data only}
    1. Lundgren KM, Romundstad LB, During V, Morkved S, Kjotrod S, Moholdt T. Exercise prior to assisted fertilization in overweight and obese women (FertilEX): study protocol for a randomized controlled trial. Trials 2016;17(1):268. - PMC - PubMed
Maleki 2017a {published data only}
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Mirghafourvand 2020 {published data only (unpublished sought but not used)}
    1. Mirghafourvand M, Babapour J, Mohammad-Alizadeh-Charandabi S, Ghasemi Yngyknd S. The effect of preconception counselling on health locus of control and stress in Iranian women: a randomized control trial. Women & Health 2020;60(3):314-29. - PubMed
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Naab 2019 {published data only (unpublished sought but not used)}
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Nayar 2018 {published data only}
    1. Nayar P, Nayar KD, Singh M, Aggarwal N, Gupta M, Gupta RA, et al. Yoga as an adjuvant to enhance the outcome of IVF treatment. Human Reproduction 2018;33(Suppl 1):393-4.
NCT01509066 2012 {published data only}
    1. NCT01509066. Healthy eating for reproductive health (HERHealth). https://clinicaltrials.gov/show/NCT01509066 (first received 12 January 2012).
NCT01566929 2012 {published data only}
    1. NCT01566929. Weight management interventions for obese women and the live birth outcome of in vitro fertilization (IVF): a randomized controlled trial. https://clinicaltrials.gov/show/NCT01566929 (first received 30 March 2012).
NCT01716429 2012 {published data only}
    1. NCT01716429. Healthy eating for reproductive health: Greenville. https://clinicaltrials.gov/show/NCT01716429 (first received 29 October 2012).
NCT01892111 2013 {published data only}
    1. NCT01892111. Structured exercise training in infertile obese patients treated with assisted reproductive techniques: a randomized controlled trial. https://clinicaltrials.gov/show/NCT01892111 (first received 3 July 2013).
NCT01933633 2013 {published data only}
    1. NCT01933633. Improved fertility after exercise in overweight/obese women. https://clinicaltrials.gov/show/NCT01933633 (first received 2 September 2013).
NCT01952795 2013 {published data only}
    1. NCT01952795. Effect of hypocaloric diet and exercise in obese women who are subjected to IVF cycle. https://clinicaltrials.gov/show/NCT01952795 (first received 30 September 2013).
NCT01954498 2013 {published data only}
    1. NCT01954498. Effect of walnuts on sperm parameters and male fertility. https://clinicaltrials.gov/show/NCT01954498 (first received 1 October 2013).
NCT02063256 2014 {published data only}
    1. NCT02063256. 7 NUTS Study. A randomized dietary intervention trial on the influence of diet on human sperm quality in subfertile men. https://clinicaltrials.gov/show/NCT02063256 (first received 14 February 2014).
NCT02432209 2015 {published data only}
    1. NCT02432209. Improving reproductive fitness through pretreatment with lifestyle modification in obese women with unexplained infertility. https://clinicaltrials.gov/show/NCT02432209 (first received 4 May 2015).
NCT02541487 2015 {published data only}
    1. NCT02541487. Fetal effects of pre-pregnancy lifestyle interventions in unexplained infertility patients. https://clinicaltrials.gov/ct2/show/NCT02541487 (first received 4 September 2015).
NCT02648555 2016 {published data only}
    1. NCT02648555. A lifestyle intervention to improve in vitro fertilization results. https://clinicaltrials.gov/show/NCT02648555 (first received 7 January 2016).
NCT02746601 2016 {published data only}
    1. NCT02746601. My Health eSnapshot - a preconception health research study. https://clinicaltrials.gov/ct2/show/NCT02746601 (first received 21 April 2016).
NCT02752555 2016 {published data only}
    1. NCT02752555. Investigating the effect of modifiable lifestyle factors in severe oligoasthenotertozoospermic men combined with antioxidant treatment prior ICSI. https://clinicaltrials.gov/ct2/show/NCT02752555 (first received 27 April 2016).
NCT03050944 2017 {published data only}
    1. NCT03050944. Association of the Mediterranean diet with fertility outcomes: a study among couples undergoing in vitro fertilization treatment. https://clinicaltrials.gov/ct2/show/NCT03050944 (first received 13 February 2017).
NCT03343405 2017 {published data only}
    1. NCT03343405. Fertility & well-being: mind/body protocol. https://clinicaltrials.gov/show/NCT03343405 (first received 17 November 2017).
NCT03348865 2017 {published data only}
    1. NCT03348865. Fertility Life Counselling Aid (FeLiCiA). https://clinicaltrials.gov/ct2/show/NCT03348865 (first received 21 November 2017).
NCT03475199 2018 {published data only}
    1. NCT03475199. Evaluation of personalised support program effectiveness in sperm quality improvement. https://clinicaltrials.gov/show/NCT03475199 (first received 23 March 2018).
NCT03553927 2018 {published data only}
    1. NCT03553927. Investigating the physiological effects of weight loss on male fertility. https://clinicaltrials.gov/show/NCT03553927 (first received 12 June 2018).
NCT03898037 2019 {published data only}
    1. NCT03898037. Effect of lifestyle and/or metformin intervention on pregnancy outcome: a pilot randomized controlled trial. https://clinicaltrials.gov/show/NCT03898037 (first received 1 April 2019).
NCT04002414 2019 {published data only}
    1. NCT04002414. Physical activity and fertility care study. https://clinicaltrials.gov/show/NCT04002414 (first received 26 June 2019).
NCT04273048 2020 {published data only (unpublished sought but not used)}
    1. NCT04273048. The MOM TO BE Study. https://clinicaltrials.gov/show/NCT04273048 (first received 17 February 2020).
NCT04585581 2020 {published data only (unpublished sought but not used)}
    1. NCT04585581. Preconception lifestyle interventions to improve future metabolic health (before the beginning). https://clinicaltrials.gov/show/NCT04585581 (first received 14 October 2020).
Nieschlag 1998 {published data only}
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PACTR201611001683280 2016 {published data only}
    1. PACTR201611001683280. Personalized IVF to maximize success rate [Individualized controlled ovarian stimulation for IVF to maximize success rate]. http://www.who.int/trialsearch/Trial2.aspx?TrialID=PACTR201611001683280 (first received 14 June 2016).
Pedro 2019 {published data only}
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Poehl 1999 {published data only}
    1. Poehl M, Bichler K, Wicke V, Dorner V, Feichtinger W. Psychotherapeutic counseling and pregnancy rates in in vitro fertilization. Journal of Assisted Reproduction and Genetics 1999;16(6):302-5. - PMC - PubMed
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Rasoulzadeh 2013 {published data only}
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Rasoulzadeh 2018 {published data only}
    1. Rasoulzadeh BM, Latifnejad RR. The effect of the collaborative infertility counseling model on coping strategies in infertile women undergoing in vitro fertilization: a randomized controlled trial. International Journal of Women's Health and Reproduction Sciences 2018;6(1):47-54.
RBR‐7by76r 2016 {published data only}
    1. RBR‐7by76r. Effects of "anti-stress therapy" on behavior and stress hormones in infertile women and also on weight loss after diet and exercise guidance in those overweight. http://www.who.int/trialsearch/Trial2.aspx?TrialID=RBR-7by76r (first received 2016).
Rothberg 2016 {published data only}
    1. Rothberg A, Lanham M, Randolph J, Fowler C, Miller N, Smith Y. Feasibility of a brief, intensive weight loss intervention to improve reproductive outcomes in obese, subfertile women: a pilot study. Fertility and Sterility 2016;106(5):1212-20. - PMC - PubMed
Sant'Anna 2017 {published data only}
    1. Sant'Anna EM, Paiva SPC, Santos RP, Rodrigues AM, Nery SF, Maia FP, et al. Mindfulness-based intervention for lifestyle modification and weight loss in infertile women: randomized controlled trial. Human Reproduction 2017;32(Suppl 1):i398-9.
Schick 2019 {published data only}
    1. Schick M, Roesner S, Germeyer A, Moessner M, Bauer S, Ditzen B, et al. Smartphone-supported positive adjustment coping intervention (PACI) for couples undergoing fertility treatment: a randomised controlled trial protocol. BMJ Open 2019;9(7):e025288. - PMC - PubMed
Shahrestani 2012 {published data only}
    1. Shahrestani M, Qanbari BA, Nemati SH, Rahbardar H. The effectiveness of mindfulness based cognitive group therapy (MBCT) on improving perceived infertility-related stress and irrational parenthood cognitions among infertile women undergoing IVF treatment. Iranian Journal of Obstetrics, Gynecology and Infertility 2012;15(19):28-38.
Sim 2012 {published data only}
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    1. Sim KA, Dezarnaulds GM, Denyer GS, Skilton MR, Caterson ID. Weight loss improves reproductive outcomes in obese women undergoing fertility treatment: a randomized controlled trial.. Clinical Obesity 2014;4(2):61-8. [DOI: 10.1111/cob.12048] - DOI - PubMed
Skogsdal 2019 {published data only}
    1. Skogsdal Y, Fadl H, Cao Y, Karlsson J, Tydén T. An intervention in contraceptive counseling increased the knowledge about fertility and awareness of preconception health - a randomized controlled trial. Upsala Journal of Medical Sciences 2019;124(3):203-12. [DOI: 10.1080/03009734.2019.1653407] - DOI - PMC - PubMed
Tolahunase 2017 {published data only}
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Tolahunase 2018 {published data only}
    1. Tolahunase MR, Sagar R, Chaurasia P, Dada R. Impact of yoga- and meditation-based lifestyle intervention on depression, quality of life, and cellular aging in infertile couples. Fertility and Sterility 2018;110(4):e67.
Tolahunase 2018a {published data only}
    1. Tolahunase M, Sagar R, Chaurasia P, Dada R. Yoga optimized neuroplasticity and regulatory feedback improve semenogram and sperm quality in infertile men with major depressive disorder: a randomized controlled trial. Andrology 2018;6(Suppl 1):80.
Tolahunase 2018b {published data only}
    1. Tolahunase M, Kumar R, Sagar R, Dada R. Impact of yoga- and meditation-based lifestyle intervention on depression and quality of life in infertile couples: a randomized controlled trial. Human Reproduction 2018;33(Suppl 1):308-9. [DOI: ]
Tsagareli 2006 {published data only}
    1. Tsagareli V, Noakes M, Norman RJ. Effect of a very-low-calorie diet on in vitro fertilization outcomes. Fertility and Sterility 2006;86(1):227-9. [DOI: 10.1016/j.fertnstert.2005.12.041] - DOI - PubMed
Twigt 2012 {published data only}
    1. Twigt J, Bolhuis M, Steegers E, Hammiche F, Inzen W, Laven J, et al. The preconception diet influences the chance of ongoing pregnancy even after IVF/ICSI treatment. Reproductive Sciences 2012;19(3):245A. [DOI: 10.1177/1933719112442493] - DOI
UMIN000009034 2012 {published data only}
    1. UMIN000009034. The influence of physical constitution, life-style and environmental factors on sex hormones and anti-mullerian hormone. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R00001... (first received 1 November 2012).
UMIN000016168 2015 {published data only}
    1. UMIN000016168. Effects of fertility information on people's knowledge, life-planning, and psychology. http://www.who.int/trialsearch/Trial2.aspx?TrialID=JPRN-UMIN000016168 (first received 13 January 2015).
UMIN000027424 2017 {published data only}
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References to other published versions of this review

Anderson 2010
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