In Vitro Fertilization (IVF) offers a pathway for individuals and couples pursuing parenthood. Before treatment begins, a comprehensive diagnostic phase is undertaken to ensure a safe and successful outcome. This initial assessment involves specialized tests for both partners, providing the medical team with data to formulate an individualized treatment protocol. This fundamental step optimizes the treatment trajectory and manages potential risks associated with the procedure.
Assessing Ovarian Reserve and Hormonal Function
The foundation of a successful IVF cycle is the quantity and predicted response of the eggs, which is determined by assessing the ovarian reserve. Assessing the ovarian reserve helps predict how a woman’s ovaries will react to the stimulation medications used to produce multiple mature eggs for retrieval. This prediction is crucial for selecting the appropriate medication type and dosage for the cycle.
One of the most informative tools is the Anti-Müllerian Hormone (AMH) blood test, which can be measured at any point in the menstrual cycle. AMH is produced by the small follicles within the ovaries, and its level reflects the size of the remaining egg supply. A low AMH level suggests a diminished ovarian reserve, indicating that the ovaries may respond poorly to stimulation, while higher levels often predict a more robust response.
Another set of hormone levels, Follicle-Stimulating Hormone (FSH) and Estradiol (E2), are typically measured on the second or third day of the menstrual cycle. FSH stimulates follicle growth, and a high Day 3 FSH level suggests that the ovaries are requiring a stronger signal from the pituitary gland, which is a sign of reduced ovarian function. E2 is measured alongside FSH because a high E2 level can artificially suppress the FSH reading, masking a potential ovarian reserve issue.
The final component of this assessment is the Antral Follicle Count (AFC), which is performed via a transvaginal ultrasound at the beginning of the cycle. The AFC involves counting the number of small, fluid-filled sacs, or antral follicles, visible in both ovaries. These follicles contain the immature eggs, and the total count serves as a direct visual estimate of the accessible egg pool. Together, the AMH, FSH/E2, and AFC provide a comprehensive picture, enabling the physician to tailor the ovarian stimulation regimen for optimal egg yield.
Evaluating Reproductive Anatomy and Uterine Health
Ensuring the uterus is a receptive environment for an embryo is important. Structural assessments identify any physical obstacles that could impede implantation or compromise a pregnancy following the embryo transfer. The primary diagnostic tool for the uterine cavity is the Saline Infusion Sonogram (SIS), also known as a sonohysterogram.
During an SIS, a sterile saline solution is introduced into the uterine cavity via a small catheter while a transvaginal ultrasound is performed. The fluid distends the cavity, allowing for a detailed, high-contrast visualization of the endometrial lining. This procedure effectively screens for intrauterine pathologies such as endometrial polyps, submucosal fibroids, or scar tissue (adhesions).
If the SIS reveals suspicious findings, a hysteroscopy may be necessary as a follow-up procedure. Hysteroscopy involves inserting a thin, lighted telescope through the cervix to allow for direct visual inspection of the uterine cavity. This technique can confirm the diagnosis and often allows for the immediate surgical removal of polyps or fibroids in the same setting, thereby preparing the uterus for the embryo transfer.
A structural check also includes an assessment of the fallopian tubes, particularly for the presence of hydrosalpinx, which is a blockage and swelling of the tube with fluid. Hydrosalpinx fluid can leak back into the uterus, creating a toxic environment for the implanting embryo and significantly reducing the success rate of IVF. The patency of the tubes is assessed using a Hysterosalpingogram (HSG) or a specialized ultrasound technique. If a hydrosalpinx is identified, its surgical removal or blockage may be recommended before treatment proceeds.
Semen Analysis and Male Factor Screening
The male partner’s contribution is assessed through a comprehensive Semen Analysis, a foundational test for all couples undergoing IVF. This analysis evaluates three primary characteristics of the sperm: count, motility, and morphology. The sperm count determines the concentration of sperm per milliliter of semen, while motility measures the percentage of sperm that are actively moving.
Morphology refers to the percentage of sperm that have a normal shape, which is a factor in the sperm’s ability to fertilize an egg. Abnormal results in any of these parameters can indicate a male factor contributing to infertility. The results of the semen analysis directly influence the method of fertilization in the laboratory.
If the sperm count, motility, or morphology is severely compromised, the treatment plan will likely incorporate Intracytoplasmic Sperm Injection (ICSI). ICSI involves injecting a single, carefully selected sperm directly into the center of each egg, bypassing the need for the sperm to penetrate the egg on its own. For cases of severe male factor infertility or previous fertilization failure, additional specialized testing, such as a sperm DNA fragmentation test, may be considered to refine the treatment approach.
Required Infectious Disease and Genetic Screening
Before gametes or embryos can be handled or cryopreserved, both partners must undergo mandatory infectious disease screening. This requirement is established by regulatory bodies to prevent disease transmission and protect the health of the patients, future offspring, and laboratory staff. The standard panel includes screening for:
- Human Immunodeficiency Virus (HIV)
- Hepatitis B (HBV)
- Hepatitis C (HCV)
- Syphilis (RPR)
Testing for other communicable diseases like Human T-cell Lymphotropic Virus (HTLV) may be required based on individual risk factors or clinic protocols. Positive results for certain infections do not prevent treatment but require specific protocols, such as using dedicated storage tanks and specialized laboratory procedures, to ensure the isolation and safety of the gametes and embryos.
Genetic carrier screening is also widely recommended for both partners to assess the risk of passing on serious inherited conditions. The most common panel screens for Cystic Fibrosis (CF), Spinal Muscular Atrophy (SMA), and Fragile X Syndrome (FXS). Many individuals are unaware they are carriers of these conditions, as they often have no family history of the disease.
Identifying carrier status before conception allows the couple to consider preimplantation genetic testing (PGT) of the embryos, which can prevent the transmission of the genetic condition to the child. This screening provides couples with information to make informed decisions about their family planning.