Top Fertility Tips and IVF Insights from Dr. Lora Shahine

In this Q&A, we dive into the hottest topics about IVF and fertility tips with Dr. Lora Shahine, a board-certified reproductive endocrinologist. 

This is not intended to provide medical advice. The interview has been edited for clarity and length. Please consult your doctor for any health-related concerns.

Dr. Shahine completed her fellowship in reproductive endocrinology and infertility at Stanford University, where she contributed to groundbreaking research on fertility and recurrent miscarriage. Dr. Shahine is a clinical assistant professor at the University of Washington and a published author of multiple books, including Not Broken: An Approachable Guide to Miscarriage and Recurrent Pregnancy Loss. She is deeply committed to advancing women's health through research, education, and patient advocacy.

Dr. Shahine answers common questions on infertility types, how age impacts fertility in men and women, the effects of microplastics, and what lifestyle changes can boost your chances of conceiving. 

She also covers important topics like environmental toxins, IVF vs. IUI, and tips to improve fertility naturally. Whether you're exploring fertility treatments or looking to optimize your reproductive health, this interview provides must-read expert advice that can guide your journey to parenthood.

What are the common types of infertility?

Dr. Shahine: "Infertility has a lot of different definitions, but I usually use the one from the World Health Organization stating that infertility is a disease in which someone's inability to get pregnant or carry a pregnancy to term after trying for about a year. It can impact as many as one in six people worldwide.

"Infertility is just really wanting to have a baby and struggling to get to your goal."

Primary infertility is never being pregnant before and suffering from the inability to get pregnant. Secondary infertility is when you've gotten pregnant before, and had a live birth before, but you're struggling to add to your family.

Some people will divide infertility into female factors and male factor infertility. I think that's important because there are a lot of misconceptions and societal assumptions that anything to do with having a baby or having a family is a woman's fault. And up to 50% of the time, there can be a contribution of male factor infertility. But in general, infertility is just really wanting to have a baby and struggling to get to your goal."

How does age affect fertility in both women and men?

Dr. Shahine: "Age and fertility are everywhere. You've heard about your biological clock ticking. You hear that if you have a pregnancy after the age of 35, it's labeled a geriatric pregnancy. Listen, people often wait to start or add to their family later. Age is a big part of fertility, but there are people having babies without assistance into their 30s and 40s.

"As we age, fewer and fewer of the eggs can do all of that genetic work that they need to ovulate, to fertilize with sperm, to turn into a healthy embryo that will turn into a healthy baby. "

It's important to learn more and see if you might need a little help. The whole link between age and fertility is not just eggs, it's sperm too, it's just more dramatic with eggs. Sperm are made every single day and some lots are made and there are lots of options, but male factor fertility starts to be impacted by age later in your 40s and certainly by 50. For women, we are born with all the eggs we are ever going to have.

As we age, fewer and fewer of the eggs can do all of that genetic work that they need to ovulate, to fertilize with sperm, to turn into a healthy embryo that will turn into a healthy baby. And so it's not that with age, all of the eggs are bad. It's just that with fewer good eggs that can do all that genetic work, it can take longer to conceive, miscarriage rate increases, and fertility can just be more challenging as we age."

IVF and Fertility Tips: What Lifestyle Changes Can Improve Your Chances of Conceiving?

Dr. Shahine: "Lifestyle factors affecting your fertility are such a common question because when you're trying to have a baby and it's not happening, you feel so out of control. You know, you want to take back control of your fertility. Think about what you can do in your everyday life to have better quality egg, sperm or get pregnant faster.

"Focusing on sleep, that helps with our circadian rhythm."

You can't reverse age, which we talk about impacting reproductive health, but maybe you could think about things you're doing in your everyday life. So nutrition is important. Moving your body is important. Think about having a healthy weight—not underweight, not too overweight. And listen, people can be fertile in all different sizes, but in general, think about a healthy weight that's right for your body. Sleep is essential.

Focusing on sleep helps with our circadian rhythms. It helps with resetting our cortisol levels. It helps with all of hormonal functions. Sleep is important to nutrition, exercise, sleep, and stress management. You cannot eliminate stress. We all have stress and just being infertile or not having a baby on your timeline is stressful in and of itself, but you can work hard on tools that manage stress so you can recover faster. Those are some things for lifestyle optimization."

How do environmental toxins impact fertility?

Dr. Shahine: "We are learning a lot about endocrine disruptors and endocrine-disrupting chemicals like in plastics, bisphenol or BPA, phthalates, parabens, a lot of these forever chemicals like PFAS that's in a lot of the, you know, like raincoats that are waterproof or a lot of the plastics in our kitchen. We are learning that we are absorbing a lot of these plastics and microplastics and that they can impact egg health, sperm health, risk of miscarriage, and fertility. Once you start to learn about this, it can be overwhelming.

"Plastics in the kitchen, plastic food containers to store food, or putting them in the microwave—heat and plastic should not mix."

If you make solid choices just in your everyday life, you can dramatically decrease your exposure, and that's exciting. I think about plastics in the kitchen, plastic food containers to store food, or putting them in the microwave—heat and plastic should not mix. Buy glass food containers to store leftovers. Heat up food in glass, not in your microwave or stove, not in those plastic containers. Think about glass or a stainless steel water bottle. Think about your cookware. Teflon and some of these non-stick pans are full of chemicals, especially the 'forever chemicals,' and it's getting right into those foods."

"The past is the past, and you can only control right now and what's moving forward."

What are some effective stress management tools for going through infertility?

Dr. Shahine: Stress management tools for fertility are really personal to each individual. Some people benefit greatly from one-on-one therapy, but access to this type of care isn't always easy. It can be difficult to find a provider who focuses on miscarriage or infertility, and sometimes insurance coverage is lacking. However, one-on-one therapy can be a wonderful option.

"It's essential to ensure that the fertility journey doesn't consume every aspect of life—remember to find joy in the little things. Schedule vacations."

There are also excellent group therapy opportunities. Resolve.org, a national organization run by patients, offers both online and in-person support groups. Fertility Out Loud is another fantastic website that provides information and support for those on a fertility journey. Even here in Seattle, there are classes like yoga for fertility, which often turn into support networks.

Additionally, personal reflection is important. Getting outdoors, journaling, and using mindfulness apps like Calm can really help manage stress. It's essential to ensure that the fertility journey doesn't consume every aspect of life—remember to find joy in the little things. Schedule vacations. People often hesitate, thinking, "What if I'm pregnant or in treatment?" But you can still plan. If you're concerned, get traveler's insurance and go when the time feels right.

Does lifestyle in your 20s affect fertility later in life?

Dr. Shahine: "People ask, 'I did not know anything about environmental toxins or products when I was growing up. This is all new.' Or, 'I had a lot of fun in college with different substances. Does that impact my fertility now?' Most importantly, you have to realize that the past is the past, and you can only control right now and what's moving forward. Honestly, people talk about sperm and eggs on a three-month cycle from an immature germ cell to ovulating if it's an egg or coming out of the body if it's a sperm. And so, yes, you can't worry about what you did before.

"Heavy regular alcohol use, heavy regular cannabis or marijuana use, and tobacco, absolutely can impact fertility."

"I don't have any evidence or I'm not aware of any research that says if you had a lot of substances and had a lot of fun in college it's going to impact your fertility later. Heavy regular alcohol use, heavy regular cannabis or marijuana use, and tobacco, absolutely can impact fertility. If you are using those things now and you're ready to start your family, maybe think about modifying and kind of talk to your doctor about what's right for you."

What is the difference between IUI and IVF?

Dr. Shahine: "The difference between IUI and IVF is vast. They are both fertility treatments, but they are controlling different variables, and it's different procedures for the people involved. IUI, intrauterine insemination, is a low-tech fertility treatment because everything is still happening in the woman's body. It could be combined with medications to help with ovulation.

"The egg and sperm have to like each other and fertilize."

It could be combined with ultrasounds or tests to know when we're ovulating. When ovulation is happening, you can get a sperm sample, wash and prep it to keep only the most active sperm, and place that sperm past the cervix in the uterine cavity to be closer to where the egg is. But after that, all the magic still has to happen. You don't know, but the egg needs to get into the fallopian tube. The egg and sperm have to like each other and fertilize. That embryo has to grow and come down the fallopian tube and implant. Intrauterine insemination is simple. It's less costly than IVF. It's less invasive, but it's also not as successful for most people because IVF, which is different from in-vitro fertilization, is just controlling for more variables.

In IVF, you're taking medication to get the ovaries to produce more than one egg. And around the time of ovulation, instead of those eggs ovulating into the body, we do a procedure to extract the eggs—an egg retrieval to get the eggs out of the ovaries. Then in the lab, we have eggs and we get a sperm sample, and we can help the eggs and sperm fertilize. Then, the embryos grow over the next five or six days so that when the embryo is ready. Sometimes we do it right away, but a lot of times we actually freeze the embryos or test the embryos and we're getting pregnant later. But when you're getting pregnant with IVF, you have an embryo. It's so much further along in the process, and then you're putting that embryo into the uterine cavity."

What are your top tips for improving fertility?

Dr. Shahine: "Number one is learning your body and cycle. If you are using some birth control that is not allowing you to ovulate regularly, like the birth control pill or maybe you have an IUD so you don't have periods anymore, if you're ready to start trying, you want to learn about your body, learn about your cycles, then stop using that type of contraception. Maybe use an alternative, something like condoms, if you aren't ready to get pregnant, but learn about your body about three months before you're ready to start trying or whatever is right for you.