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What are the first steps for IVF?

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7 fertility expert(s) answered this question

Answer from: Raúl Olivares, MD

Gynaecologist, Medical Director & Owner Barcelona IVF
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The first step, of course, is being sure that IVF is indicated for you. And that you are in this group of patients in which IVF is the best answer for your problem. Either because you have a problem with a tube, or there is a severe male factor, or you are in concern about your egg quality, or you have endometriosis.

The second step is being sure it is worth undergoing an IVF. That is why there is an initial setup of tests that usually are recommended to confirm that if you start this procedure, you are going to have at least good chances of ending up with a baby. One of the main things that I usually tell my patients is that we are not focused on having eggs or embryos. What we focus on is for you to have a baby. Whenever we start an IVF, we need to be sure that it is the right indication and that the chances of succeeding are high.

The final decision, though, is going to be up to the patients. They are going to decide if they accept the chances we are offering them, but in my opinion, IVF makes sense as long as it significantly increases the chances of success compared to those you may have in a natural cycle.

First, making the diagnosis, be sure that you have the proper indication. Second, be sure that IVF is going to increase your chances of success significantly compared to a natural pregnancy. Third, that depends on the protocol you use. In some protocols, you may need some preparations in some protocols, you start on the first day of your period.

Answer from: Guillermo Quea Campos

Gynaecologist, Specialist in Reproductive Medicine Pronatal Fertility Clinics
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The first step is to go to your doctor or your medical centre to receive the necessary information and carry out the basic studies to determine the cause of sterility. The study includes a general and hormonal analysis, an ultrasound, karyotype tests for both of them, a test to check the integrity of the fallopian tubes and the semen quality. With the results, we will decide the best treatment for the couple or the patient to comfort us.

Answer from: Tomas Frgala, PhD

Gynaecologist, Head Physician at UNICA Clinic - Brno
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Well, the first and most important step is the consult with the physician and with the couple and yes, emphasis on couple – both partners should be present, both partners need to be examined and the results of these exams have to be taken into account when we plan the treatment or the direction which we’re going to take. One of the crucial examinations is the spermiogram and the gentleman’s analysis of his sperm cells, it’s an ultrasound in the woman, of course the patient’s history is very important and eventually their previous treatment. Also blood tests of the woman or both partners are usually performed during the first consultation.

Answer from: Santiago Eduardo Novoa, MD

Gynaecologist, specialised in Reproductive Medicine Instituto iGin
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There are a couple of steps for male and female in the couple. In case of the female, tests that should be done and scans to check the anatomy (principally that there are no problems in ovaries and uterus itself), some blood tests to check general health of the patient, to rule out infections, check for hormone levels and we ask for basic genetic tests what is called karyotype. From the male point of view, in fact it is the same: blood tests checking general health, infections, genetics and of course we need a sample of sperm – just to check that everything is good in that aspect.

Answer from: Matthew Prior, PhD, MBBS

Gynaecologist, Reproductive Medical Consultant, Founder of The Big Fertility Project
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It’s important to have some tests done first of all to find out what the reason is for the fertility problem because there are some fertility treatments that are not IVF that can be used for some conditions. So, for example, women who aren’t ovulating might just take tablets to be able to try and ovulate but once the decisions have been made to go with IVF, there’s really sort of three important tests that are done. The first of the tests for the woman which should involve an ultrasound scan and that’s really just to check that the womb is all okay and that the ovaries look fine and there’s not any funny cysts or anything going on. Scan can also involve counting the number of little follicles on the ovary and that gives us an idea of how well the ovary is likely to respond to the stimulation medication – that’s what we call the natural follicle counts alongside that and the woman will have some blood tests done to check a marker called AMH which stands for Anti-Müllerian hormone which basically tells you the same as how many follicles there are (what the egg reserve is) and helps plan what type of protocol or recipe is used for the IVF stimulation medications. The man would also do a sperm test and that’s really important to check if there’s any issues with that because the last thing you want to happen is to go through all this process of IVF, collect eggs and then suddenly on the day of treatment, find out that there’s a problem with the sperm test and not able to do treatment at all. So to help with planning, man would normally do a sperm test. Also some clinics would do some other blood tests to check if you’re not anemic or the thyroid function is okay and then finally both partners would be advised to have some screening bloods done to check for hepatitis and HIV and the reason why is that’s a UK requirement that if you’re going to work with eggs and sperm in the lab and potentially freeze egg sperm or embryos, you need to have had screening done to make sure you don’t have those conditions or if you do, that can be discussed with your particular clinic about how that would affect your treatment.

Answer from: Delphine Dewandre, Embryologist

Embryologist, Senior Embryologist Beacon CARE Fertility
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If no natural pregnancy is achieved in one year, a good thing is of course to go to the fertility center and get a checkup done. The first thing they will do is to ask the male for a semen assessment because it’s easier for males than for females. As i said for a male  it’s just the semen assessments just because we can directly check the quality of the semen when for a woman it’s a bit more difficult as the eggs are inside and they can be taken out that easily so it’s very difficult to just assess the quality of the eggs right away. The first thing they will do for a woman is to take the blood and check the hormones that are important for fertilisation. There are hormones for example that can show what ovarian reserve is for example. There would also be a scan. With the scan they would check if the uterus aligning is fine, if they see any malformations or anything else.  Now you don’t have to wait a year for that. I do know that our culture is to always get checked if there’s already a problem but I think a good thing is to have a checkup when you’re younger. It is easy for a woman to take her blood and see if everything is fine and then scan if everything is fine and for a man as well it’s just the semen assessments. It can only last like 10 minutes so sometimes it could be worth it to not wait until you have a problem to do a checkup.

Answer from: Elias Tsakos, MD, FRCOG

Gynaecologist, Medical Director EmbryoClinic
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Firstly, you have to choose the best IVF unit for you. There’s a lot of good IVF units all over the world. Some of them are around the corner from where you live, some of them are abroad, some others are very far away. However, you have to identify, which is the best unit for you depending on your particular case, your circumstances, and of course, your wishes for treatment approaches and techniques.

Once you decide which is your chosen IVF unit, based on the investigations you have done, on testimonials you may have heard. And of course, based on the initial assessment that most of the IVF units are offering online, including our Embryoclinic, you should be able to start your journey. Generally, IVF is divided into two parts.

The first one is the pre-IVF stage, during which all the assessments are taking place, all the diagnostic tests, all the consultations, the counselling. You have to decide together with your specialist and your team to proceed with a specific IVF treatment and protocols. The pre-IVF stage is very important, in my opinion, this has to be condensed into a few weeks only. It doesn’t have to be very long because if it is long, then, of course, the impact and the possible consequences can be adverse. I would wish to have all the pre-IVF testings concluded within 3 to 5 weeks to decide how to go further. Once this is done, the protocols are designed and explained, then delivered to the patient, and then the IVF to process itself starts.

The IVF process usually lasts for about 2 weeks. There are some shorter programs or a little longer, but roughly this is 2 weeks of your life. During this time, it is very important to collaborate with the clinic. Also, optimize the stimulation and the egg collection if we’re talking about IVF with your own eggs and the endometrium preparation to ensure you have made your very best for a successful outcome from your side.

About this question:

What are the first steps patients who have indications for IVF should take? Diagnostic tests, visits, scans?

There are many aspects to consider and take into account before starting your IVF journey. You probably wonder: How long does it take to find a suitable fertility clinic? What do they do at your first appointment? What tests should be performed for IVF? What questions should I ask my fertility specialist? Below you can find out a bit more on those first steps from our fertility experts.

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