In Vitro Fertilization (IVF) offers a pathway to parenthood for many. Before an IVF cycle, a thorough series of medical evaluations is performed. These preliminary tests are crucial for assessing reproductive health, identifying potential underlying issues, and tailoring the most effective treatment strategy for a successful pregnancy and healthy outcome.
Assessing Female Fertility
Evaluating the female partner’s fertility involves key assessments of ovarian function and uterine health. Ovarian reserve testing assesses the quantity and quality of a woman’s eggs. Common blood tests for ovarian reserve include Anti-Müllerian Hormone (AMH), Follicle-Stimulating Hormone (FSH), and estradiol levels.
AMH, produced by ovarian follicles, indicates egg supply and can be measured at any cycle point. FSH and estradiol levels are typically assessed on day 2-5 of the menstrual cycle, with elevated FSH suggesting diminished ovarian reserve.
An antral follicle count (AFC) uses transvaginal ultrasound to count small, fluid-filled sacs containing immature eggs. This estimates egg supply and predicts ovarian response to stimulation medications during IVF.
Uterine health is evaluated to ensure it is receptive for embryo implantation. Transvaginal ultrasound visualizes the uterus, identifying potential issues like fibroids or polyps.
For detailed assessment of the uterine cavity, a saline infusion sonogram (SIS) is performed. This procedure introduces sterile saline into the uterus during an ultrasound to outline the uterine lining and detect abnormalities like polyps, fibroids, or adhesions.
A hysteroscopy, using a thin, lighted telescope, allows direct visual inspection of the uterine cavity. It can also facilitate immediate removal of polyps or fibroids.
Fallopian tube patency may be assessed through a hysterosalpingogram (HSG). This X-ray procedure injects contrast dye into the uterus and fallopian tubes, monitoring its flow to determine if tubes are open or blocked.
Identifying conditions like hydrosalpinx (fluid-filled blocked tubes) is important, as the fluid can negatively impact embryo implantation, potentially requiring surgical intervention before IVF.
Evaluating Male Fertility
Male fertility assessment primarily involves a semen analysis, which provides detailed information about sperm quality. This analysis measures several key parameters:
Sperm count (total number).
Sperm motility (percentage moving and efficiency).
Sperm morphology (size and shape).
Semen volume and pH (affect sperm survival).
Normal parameters include over 15 million sperm per milliliter, at least 40% forward movement, and more than 4% normal morphology.
If initial semen analysis results are abnormal, additional tests may be conducted. Hormonal evaluations include blood tests for testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH). Imbalances in these hormones, which regulate sperm production, can indicate issues with testicular function or brain signaling.
A sperm DNA fragmentation test evaluates the genetic integrity of sperm by detecting DNA damage. High levels of fragmentation can be associated with reduced conception chances, lower IVF success rates, and increased miscarriage risk.
General Health and Genetic Screening
General health screening for both partners identifies conditions that could impact pregnancy. This includes infectious disease screening for HIV, Hepatitis B and C, and Syphilis, important for patient safety and preventing transmission.
Immunity to Rubella and Varicella is checked; vaccination may be recommended if immunity is absent.
Blood type and Rh factor determination are standard. The Rh factor is important: if the female partner is Rh-negative and the male is Rh-positive, Rh incompatibility can be managed to protect the baby.
Genetic carrier screening identifies risks of passing inherited conditions to a child. Common conditions screened for include Cystic Fibrosis, Spinal Muscular Atrophy, and Fragile X syndrome. This screening determines if either partner carries a gene mutation, allowing for informed decisions if both are carriers for the same condition.
Interpreting Results and Planning Treatment
After tests are completed, the medical team reviews the results. This analysis combines findings from female ovarian reserve, uterine health, male sperm quality, and general health and genetic screenings. It aims to create a holistic picture of fertility status and identify contributing factors, which is fundamental for developing a personalized IVF treatment plan.
During a consultation, the fertility specialist explains all test results, ensuring clarity and addressing questions. This discussion covers how findings, such as diminished ovarian reserve or male factor infertility, influence the treatment approach. Results guide decisions on medication protocols, fertilization techniques (e.g., conventional IVF or ICSI), and procedures to optimize uterine receptivity. The planning phase outlines the IVF cycle steps, from ovarian stimulation and egg retrieval to embryo transfer. This review and planning empower patients to proceed confidently.