Still no results trying to conceive? A large-sample study suggests these 6 things may be what truly set fertility apart.

When it comes to female fertility, many people’s first thoughts are age, AMH, ovarian reserve, and inherent factors. Especially for those who have been trying to conceive for some time, or who have already begun learning about IVF and Thailand third-generation IVF, it is easy to feel a sense of powerlessness: age is what it is, and ovarian conditions seem impossible to change. So do diet, sleep, and exercise in daily life really still matter?

A large reproductive health study published in Frontiers in Nutrition in 2025 offers an answer worth noting. The study first analyzed data from more than 2,000 women of reproductive age in the U.S. NHANES 2013–2020, and then conducted external validation using samples from more than 30,000 women at a large reproductive center in China. The study found that, compared with people who met fewer healthy lifestyle criteria, women who consistently maintained 5–6 healthy lifestyle factors had an approximately 70% lower relative risk of infertility. It also showed a cumulative trend: with each additional healthy habit, infertility risk decreased further.

What deserves the most attention here is not the number “70%” itself, but the fact that the study broke down the previously vague idea of “healthy preconception preparation” into several lifestyle variables that ordinary people can actually act on: not smoking, reducing alcohol exposure, maintaining regular exercise, improving dietary patterns, managing waist circumference, and ensuring adequate sleep.

In other words, age, genetics, and the natural aging of the ovaries cannot truly be reversed through lifestyle. But beyond these uncontrollable factors, there is still some room that we can actively manage. This applies to those trying to conceive naturally, and it is equally worth attention for those preparing for overseas fertility care, cross-border childbirth, or even those who have already entered an assisted reproductive cycle.

The first step is not “what to eat to nourish eggs,” but reducing clear adverse factors such as smoking and alcohol

After deciding to prepare for pregnancy, many women first search for “what to eat to nourish eggs,” while easily overlooking more fundamental issues such as tobacco and alcohol.

Among the healthy lifestyle factors examined in the original study, smoking is one that deserves particular attention. Multiple harmful substances in tobacco may increase oxidative stress and adversely affect the reproductive environment, including the ovaries, fallopian tubes, and endometrium. A previous meta-analysis cited in the article showed that smokers had about 1.6 times the risk of infertility compared with nonsmokers. It is even more important to note that tobacco exposure does not only mean a woman smoking herself; secondhand smoke from a partner’s smoking, as well as thirdhand smoke lingering on clothing, furniture, and in cars, also means that a woman preparing for pregnancy remains in a tobacco-exposed environment.

So what really needs to change during preconception preparation is not only “the woman quitting smoking,” but striving to create a smoke-free home environment. If you are already preparing to enter an IVF cycle, it is not advisable to wait until the day of ovarian stimulation to start changing lifestyle habits; adjustments should be made as early as possible.

Alcohol follows a similar principle. In the lifestyle score, the original study focused on reducing drinking and avoiding excessive drinking. From a preconception management perspective, however, the simpler approach remains: if you can avoid drinking, do so as much as possible, and especially avoid frequent, heavy drinking.

Long-term or heavy alcohol intake may interfere with the normal regulation of the hypothalamic-pituitary-ovarian axis, while also increasing oxidative stress and affecting normal ovulation rhythm and overall metabolic status. The original article also noted that frequent heavy drinking may affect follicular maturation and the endometrial environment.

Therefore, whether preparing for natural conception or Thailand third-generation IVF, rather than seeking so-called “egg-nourishing alcohol” or “fertility-boosting alcohol,” it is better to first reduce these unnecessary exposures. What preconception preparation truly requires is not constantly adding things to the body, but first removing some clearly adverse factors.

More important than “frantic weight loss” is managing exercise, diet, and waist circumference together

A second very common preconception misconception is suddenly forcing oneself into a state of extreme self-discipline. Some run every day to lose weight, some suddenly cut out all carbohydrates, and others lift weights at high intensity, hoping to quickly adjust their body to a so-called “optimal conception state.”

But from a reproductive health perspective, exercise is not better simply because it is more intense.

The exercise standard used in the original study was a cumulative total of about 150 minutes of moderate-intensity exercise per week, which translates in daily life to roughly 30 minutes a day, 5 days a week. Brisk walking, swimming, yoga, and gentle aerobic exercise are all forms of activity that are relatively easy to maintain long term. Regular moderate exercise can help improve insulin sensitivity, control visceral fat, and maintain a relatively stable metabolic environment. Conversely, if you suddenly undertake high-intensity exercise, excessive fat loss, or strict calorie restriction, keeping the body in a long-term energy-deficient state may instead interfere with menstruation and ovulation.

So what preconception exercise really needs to pursue can be summed up in one word: stability. Exercising 30 minutes a day for several months is usually more consistent with sound health management than training frantically for a week and then giving up completely.

The same is true for diet. Before preparing for IVF, many people become especially focused on black beans, soy milk, protein powder, bird’s nest, and various so-called “egg-nourishing foods.” But the original study focused on overall dietary patterns, not any single “fertility food.” Long-term, high intake of sugary, oily, and highly processed foods can easily cause blood sugar fluctuations and increase metabolic burden, while insulin resistance is closely associated with issues such as polycystic ovary syndrome and abnormal follicular development.

The dietary approach truly worth maintaining is not that mysterious: ensure reasonable intake of high-quality protein, fresh vegetables and fruits, and whole grains, while reducing milk tea, desserts, fried foods, and highly processed snacks. For those preparing for Thailand third-generation IVF, there is also no need to suddenly buy large amounts of so-called “egg-nourishing products” just because ovarian stimulation is approaching. What diet can truly provide is help in maintaining a relatively stable nutritional and metabolic environment, not in reversing the biological age of eggs within a few days or weeks.

Beyond exercise and diet, there is another often overlooked indicator—waist circumference.

Many women focus only on weight and BMI, assuming that as long as their weight is normal, their metabolic status is fine. But the original study found that the relationship between waist circumference and fertility cannot be fully explained by BMI. That is, some women may not be overweight overall and may have a BMI within the normal range, but if they have more abdominal and visceral fat, they may still have metabolic issues worth attention.

This is because visceral fat is not simply an energy-storage “warehouse”; it is also active endocrine tissue. Excessive visceral fat is closely associated with chronic inflammation, insulin resistance, and some hormonal abnormalities, and these changes may further affect the metabolic environment in which follicular development takes place.

The study also further examined an indicator that many women preparing for pregnancy would not normally think of—serum uric acid. The study’s mediation analysis suggested that part of the association between lifestyle and infertility risk may occur through the serum uric acid pathway. Elevated uric acid is not only associated with gout; it may also accompany oxidative stress, chronic inflammation, and other metabolic abnormalities.

Therefore, scientific preconception preparation should not simply mean stepping on the scale every day to look at a number. Instead, weight, waist circumference, diet, exercise, and overall metabolic status should be managed together. What truly needs improvement is not “whether you look overweight,” but whether the body’s internal environment is relatively stable metabolically.

The most easily underestimated preconception practice may be simply sleeping well every day

Compared with quitting smoking, controlling diet, and exercising, sleep may not sound as “professional,” but it is in fact closely related to the body’s endocrine rhythms.

Melatonin, cortisol, and multiple reproductive-related hormones all have clear circadian rhythms. Long-term late nights, insufficient sleep, or constantly changing sleep schedules may interfere with normal endocrine regulation and further affect the menstrual cycle, ovulation, and the environment for follicular development. The healthy sleep standard proposed in the original article is to maintain about 7–9 hours of regular sleep per day, and it noted that long-term late nights and insufficient sleep may interfere with the normal secretion rhythm of gonadotropins.

Of course, this does not mean that if you stay up late one night, your egg quality will suddenly decline the next day. What truly deserves caution is long-term, ongoing sleep deprivation—for example, falling asleep after 1 or 2 a.m. every day, chronically insufficient sleep time, or frequent reversal of circadian rhythms due to work.

For people planning overseas fertility care or cross-border childbirth, sleep management is even more easily overlooked. Flight times, hotel environments, hospital examinations, tension during ovarian stimulation, and daily trips to and from the hospital can all disrupt an originally regular rhythm of life. Therefore, when Huanqiu Xinsheng provides overseas patient accompaniment and cycle coordination, it also arranges hospital appointments, transfers, accommodation, and visit times in advance as much as possible to reduce unnecessary travel. For those who have already entered an assisted reproductive cycle, arranging the rhythm of life in a more orderly way is itself part of full-cycle fertility management.

Do not interpret “about 70% lower infertility risk” as meaning that doing these six things will definitely lead to pregnancy

The most easily misinterpreted part of this study is precisely the most attention-grabbing phrase in the headline: “about 70%.”

What the study found was that there is a clear association between maintaining more healthy lifestyle factors and a lower risk of infertility—not proof that “completing these six things will directly make infertility risk disappear by 70%.” The original study is observational. It can help us identify associations between lifestyle and reproductive health, but it cannot equate these healthy habits directly with infertility treatment. The original article also clearly emphasized this: tubal disease, uterine cavity problems, male factors, natural decline in ovarian reserve, and age-related issues cannot be reversed by lifestyle adjustment alone.

This point is especially important for those preparing for IVF. If clear infertility factors already exist, medical evaluation should not be delayed indefinitely because of a desire to “first spend half a year regulating the body.” Especially for women who are older, have declining AMH, or have already experienced a significant reduction in ovarian reserve, time itself is a very important variable in fertility management.

Healthy lifestyle and medical treatment are never an either-or choice.

A more reasonable approach should be: undergo examinations promptly when needed, receive standardized treatment when treatment is needed, and at the same time do as well as possible with the factors that can be actively managed, such as smoking and alcohol, exercise, diet, waist circumference, and sleep.

The same applies to families planning Thailand third-generation IVF. From preliminary examinations and doctor evaluations to ovarian stimulation, egg retrieval, fertilization, embryo culture, and then preimplantation genetic testing when medically indicated and subsequent embryo transfer, each stage has its own medical significance. Lifestyle management is better positioned as foundational support throughout the treatment process, rather than being packaged as a certain “secret to improving success rates.”

Therefore, among the overseas fertility care families that Huanqiu Xinsheng works with, we recommend dividing preparation into two parallel directions. On one hand, follow the doctor’s requirements to complete the woman’s AMH, baseline hormones, ultrasound, and the man’s related examinations, so that both partners’ real fertility conditions can be understood as early as possible. On the other hand, start with what can be changed in daily life, gradually adjusting smoking and alcohol, exercise, diet, weight, and sleep toward a more stable state. In this way, whether the final choice is natural conception, conventional assisted reproduction, or Thailand third-generation IVF, less time will be wasted on so-called “folk remedies” or “secret egg-nourishing formulas.”

Real preconception preparation is not suddenly turning life into an exam

This study also offers information that ordinary families preparing for pregnancy can readily understand: a healthy lifestyle does not require achieving a perfect score all at once.

The original article ultimately proposed a very vivid “addition logic.” The study observed that as the number of healthy habits increased, infertility risk showed an overall downward trend. This means preconception preparation does not require perfectionism, and even less does it mean that after reading one popular science article today, you must completely change your entire lifestyle tomorrow.

If you currently smoke, you can start by quitting smoking. If you rarely exercise, start by walking an extra half hour each day. If you habitually drink milk tea every day, gradually reduce the frequency. If your waist circumference is high, combine diet and exercise to improve it slowly. If you only fall asleep after 1 a.m. every day, you do not need to force yourself to suddenly go to bed at 9 p.m.; instead, gradually move your sleep time earlier.

Changing one thing is one thing; a change you can truly sustain is more meaningful.

Fertility itself is a complex process, affected by multiple variables including age, ovarian reserve, sperm quality, fallopian tubes, uterine cavity environment, genetic factors, and lifestyle. We cannot use lifestyle to turn back age, nor can we rely only on early sleep and exercise to solve all infertility problems. But this does not mean health management is meaningless.

Its true value is that, beyond the physiological patterns we cannot control, it allows us to do as well as possible with the parts we can manage.

For families planning IVF, Thailand third-generation IVF, overseas fertility care, or cross-border childbirth, early scientific evaluation, standardized treatment, and lifestyle management throughout the entire cycle are equally important. Huanqiu Xinsheng provides one-stop services ranging from initial consultation, hospital and doctor appointments, and itinerary coordination to translation accompaniment after arrival in Thailand, transfers, accommodation assistance, hospital communication, and overseas patient accompaniment. Through full-cycle fertility management, it helps make the complex cross-border medical process as clear and orderly as possible.