IVF is a complex medical procedure designed to help individuals and couples achieve pregnancy. Because IVF involves significant physical, emotional, and financial investment, a rigorous series of diagnostic tests is required before starting treatment. These evaluations are fundamental to assessing the chance of success, ensuring patient safety, and customizing the medication protocol for the best possible outcome. Comprehensive testing allows specialists to identify and address any underlying medical or anatomical conditions that could interfere with the IVF cycle.
Assessing Ovarian Health and Hormonal Status
Assessing the female partner’s ovarian reserve—the remaining quantity and quality of the egg supply—is a primary component of the pre-IVF workup. The Anti-Müllerian Hormone (AMH) blood test is the most reliable marker for this assessment. A higher AMH level correlates with a better response to stimulation medications, while a lower level suggests diminished ovarian reserve.
Further hormonal evaluation is performed through “Day 3” testing, conducted on the third day of the menstrual cycle. This blood draw measures Follicle-Stimulating Hormone (FSH) and Estradiol (E2) levels. An elevated Day 3 FSH level indicates the body is working harder than normal to mature an egg, suggesting a lower egg supply. E2 is measured alongside FSH because a high E2 level can artificially suppress FSH readings.
These hormonal results are combined with a transvaginal ultrasound to determine the Antral Follicle Count (AFC). The AFC involves counting the number of small, fluid-filled sacs (antral follicles) visible on the ovaries. Since each antral follicle potentially contains an egg, the total count serves as a direct measure of the ovarian reserve. This comprehensive profile allows the physician to predict the number of eggs likely to be retrieved and tailor the ovarian stimulation drugs.
Evaluating Uterine and Structural Readiness
Before an embryo transfer, the specialist must confirm the uterus is structurally sound and prepared to support a pregnancy. The initial assessment involves a standard transvaginal ultrasound, which checks the overall shape and size of the uterus and ovaries. This imaging screens for visible abnormalities such as uterine fibroids or endometrial polyps.
To gain a more detailed view of the uterine cavity, a Saline Infusion Sonohysterography (SIS) is often performed. This procedure involves introducing sterile saline solution into the cavity via a small catheter while performing an ultrasound. The saline distends the cavity, allowing the specialist to visualize the lining more clearly and identify subtle irregularities like small polyps, scar tissue, or septa.
If the SIS or standard ultrasound detects significant structural issues, a hysteroscopy may be required. Hysteroscopy is an outpatient surgical procedure where a thin, lighted telescope is inserted into the uterus for direct visualization. It serves as both a diagnostic and corrective tool, enabling the surgeon to remove polyps or correct a septum immediately. Ensuring a clear uterine environment is important, as abnormalities can interfere with embryo implantation.
Screening for Male Factor and Infectious Risks
The pre-IVF evaluation includes a thorough assessment of the male partner’s contribution. The foundational test is the semen analysis, which measures sperm quantity and quality. This analysis examines three main parameters: the total number of sperm, motility (progressive movement), and morphology (normal shape).
If the semen analysis reveals severe issues, such as extremely low count or poor motility, specialized testing may be recommended. For instance, a sperm DNA fragmentation test assesses the level of genetic damage within the sperm. Identifying high fragmentation levels can help guide the decision to use specialized techniques like Intracytoplasmic Sperm Injection (ICSI) during fertilization.
Mandatory infectious disease screening is required for both partners before gametes can be handled in the laboratory. This screening is a health safety requirement necessary to prevent cross-contamination of samples and ensure the safety of the pregnancy. Screening often includes testing for:
- Human Immunodeficiency Virus (HIV)
- Hepatitis B (HBsAg and core antibody)
- Hepatitis C
- Syphilis (RPR)
Genetic and Comprehensive Health Screening
Pre-IVF testing incorporates screening for inherited conditions and a general health check to ensure the female partner is physically prepared for pregnancy. Carrier screening is a genetic test that determines if either partner carries a gene for certain recessive conditions, such as Cystic Fibrosis. Expanded carrier screening panels are widely offered, allowing couples to understand the risk of passing on a condition to their child.
Karyotyping may be indicated if a couple has a history of recurrent miscarriage, multiple failed IVF cycles, or severe male infertility. This test maps a person’s chromosomes to identify structural rearrangements, such as balanced translocations, which can lead to genetically abnormal embryos. Identifying these issues allows the clinical team to potentially recommend Preimplantation Genetic Testing (PGT) of the embryos.
The female partner also undergoes general health screening to confirm medical fitness for pregnancy and the egg retrieval procedure. These tests include a basic metabolic panel, complete blood count, and checks for immunity to diseases like Rubella and Varicella. Blood typing and Rh factor determination are standard procedures to identify potential risks, such as Rh incompatibility, that require monitoring during pregnancy.