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The basic diagnosis tests before considering IVF are, in our opinion, general blood tests to confirm that you are healthy, including a mammogram, coagulation test, and all the biochemical studies that are usually requested.
The Complete hormonal profile, specifically, should include Anti-Müllerian hormone (AMH), which will help us first confirm that it is worth trying an IVF with your own eggs. Second, it is going to help us decide which is a protocol that we are going to use. The lower the AMH, the stronger the protocol should be. We know that these ovaries are not going to many eggs. It is also important to have a scan just to confirm that there is nothing wrong with the uterus because if there is anything wrong with it, it should be fixed before we start the stimulation. Those could be polyps, fibroids, cysts. We also need to do a spermogram sometimes, more than one. If the first one is normal and there are no other risk factors on the male side, we don’t need to repeat it. In cases where there is an abnormal spermogram, we usually recommend repeating it at least once just to confirm that it was not an exceptional circumstance. Sometimes there is huge variability in the quality of the spermogram, and then we proceed with a second one.
To sum up, you need to check your hormones, do general blood tests including AMH to decide the protocol, and confirm that it is worth starting the IVF, and then do a scan and spermogram, that’s the basic set-up.
In some other cases, if there is something in the medical history that could be a problem, like having sexually transmitted diseases, it would make sense to carry out other tests, just focus on these risk factors.
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Yes, of course we have some special tests. We have tests for our end result like AMH levels. In some cases FSH level. Antral follicle count; is the number of small follicles that we can see at the beginning of the menstrual cycle, the age of the patient, and her body weight. Regarding all these points, we can choose different types of protocol stimulation. Usually, we discuss which types we can choose in her personal case, and then we will decide which way will be better.
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The basic study to determine the cause of sterility includes general and hormonal analysis. Ultrasound and Karyotype test for both of them as well as an integrity test to check the fallopian tubes and semen quality. All of them are important because they give us information about the cause of sterility and help decide the treatment needed for the couple or the patient who comes to us.
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Perhaps surprisingly for some one of the crucial examinations at the very beginning is the spermiogram analysis in the gentleman. The result frequently actually dictates the direction which we’re going to take and we’ll see if conservative treatment is an option, insemination or indeed the In Vitro Fertilization – the stimulation of the ovaries and the woman the fertilization of the obtained eggs with the selected sperm cells and the cultivation of the embryos. In the woman, we need to individualize the response to this question: it depends on the patient’s age, patient history, definitely an ultrasound it’s a must, usually there are hormonal levels examined – AMH (Anti-Müllerian hormone) is a very valuable examination at the very beginning because it represents the ovarian reserved in the woman, the strength of the reserve of the eggs. There might be other hormonal examinations, there might be a blood test and a genetic consult in both partners if need be and the other examinations are usually specified based on the patient history or their family history, eventually their previous treatment.
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The test that the couple should go for before an IVF treatment, we call the “five most important one” are: from the male point of view, the sperm check ( just to be sure that everything is fine there), from the female point of view, of course, an internal scan to check how all the anatomy is there (ovaries, tubes and uterus), for both of them (male and female): blood tests – just to check for general health issues, how hormones are working – in case of the female, rule out infections in both of them. Sometimes, we advise always to go for a basic genetic test what we call karyotyping and only we have some doubt about the tubes if they are healthy or not or we cannot exclude absolutely from the scan point of view if there are some liquid inside of the tube, so we ask for a special x-ray just to check the patency or not of those tubes.
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The chances of success in IVF are getting higher if we work on a personalized basis. Each case is different, and when we treat each case as a unique one, we increased the chances of success. This is why every single couple going ahead with IVF needs to have some initial baseline test. Sometimes, other tests may be needed depending on the history and, of course, records of any previous attempts as well. The baseline blood test that the couple needs to have to create a protocol for them is an Anti-Müllerian hormone for the female partner that shows the number of eggs that she has in comparison to other women at her age. A hormonal check on day 2 to 4 of the cycle including thyroid hormones like prolactin.
Sometimes an HSG might be needed or previews laparoscopic with a dye test to see if there are any problems with the tubes. Patency of the tubes is not always needed in IVF cycles, but we need to see if there is a mild hydrosalpinx, for example, or if there is any suspicion from the ultrasound regarding that, then we need to clarify that before the IVF because hydrosalpinx needs to be operated before to increase the chances. On all the occasions, we need another follicular count and the baseline ultrasound in which we check the endometrium, if there are any cysts in the ovaries or if there is any evidence of endometriosis, and we need an antral follicle count as well because the combination of the antral follicle count is counted together with AMH, these are the basic things that help us adjust the dose of the medication in IVF.
Sperm analysis is very important as well. We definitely need to have infection tests for both of the partners HIV, Hepatitis B, C and syphilis test are needed, and they need to be recent tests as well. Now depending on the medical history, we may need the extra tests, for example, if there is suspicion of endometriosis, sometimes a laparoscopy may be advised. If there is suspicion of polyps, the endometrium is not getting thicker, or for example, there is a bicornuate uterus. Then we always suggest a hysteroscopy, which is always suggested after unexplained IVF failures, which means no implantation with a good quality embryo.
Sometimes we ask for more specific tests, for example, in couples that have a history of recurrent miscarriages or recurrent failures of implantation, we may ask for a thrombophilia check, we may ask about natural killer tests, immunological tests, karyotypes. There are a lot of tests that depending on the case, may be needed. Nowadays, we have some genetic tests as well as ERA, EMMA, ALICE, which actually can be suggested in cases of recurrent implantation failures or unexplained infertility.
