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Study question Are Australian fertility clinics adequately addressing unhealthy lifestyle in patients seeking fertility treatment? Summary answer This study has highlighted deficiencies in practices and education around managing patients with unhealthy lifestyle undergoing fertility treatment. What is known already The association between lifestyle and fertility is well documented, with obesity and smoking being of particular concern to fertility and pregnancy outcomes. Guidelines recommend that unhealthy lifestyle is addressed prior to conception, yet anecdotal experience suggests this is not being addressed. Lifestyle modification programmes can be effective in improving pregnancy rates and outcomes, however, recruitment to such programmes can be challenging. Study design size duration A cohort study of Australian fertility clinics' attitudes and practices regarding lifestyle modification to augment reproductive treatment outcomes was conducted between August and October 2015. Participants/materials setting method An online survey was administered to senior fertility nurses, from all registered fertility clinics in Australia. Data were collated and subjected to a univariate data analysis, where frequency tables were produced for each question. A separate qualitative analysis was undertaken of data from open ended questions. Main results and the role of chance Fifty-three out of 85 potential respondents (62.4%), all from different clincis, completed the survey, with almost all acknowledging the importance of addressing unhealthy lifestyle before offering ART treatment. However, most clinics did not offer internal resources to assist with lifestyle modification. Whilst the promotion of healthy lifestyle was recognised as a key component of the role of a fertility nurse, participants did not feel that nurses were best equipped to provide lifestyle modification programmes, owing to a lack of resources and specific skills in this area. Suggested areas for improved practice included prioritising general health prior to offering treatment, and further utilising and upskilling nurses to assist with lifestyle modification programmes. Limitations reasons for caution The survey was completed by only one nurse from each clinic and as such may not be entirely representative of all clinic practices. Wider implications of the findings Fertility clinics are likely to see an increasing number of patients with unhealthy lifestyle, resulting in health concerns such as obesity. The results of this study provide an insight into how unhealthy lifestyle is currently being addressed in fertility clinics and suggested areas that could be targeted for improving practice and outcomes. Study funding/competing interests No conflict of interest to declare. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Trial registration number NA.