Evalutation before IVF
Before starting ART, each patient is evaluated to help maximize her chances for success and a healthy pregnancy. Good preconception health is essential to achieving pregnancy with IVF. Chronic medical conditions such as diabetes, hypertension and asthma should be well controlled before attempting to conceive. In addition, women planning an IVF cycle should optimize their weight. Obesity has been associated with infertility, a reduced chance of success with IVF, and an increase in the risk of miscarriage and preterm birth. Your physician can help you determine your ideal weight and refer you to appropriate resources for weight management.
Prior to starting IVF, the woman's blood type should be verified, and she should be screened for conditions that could affect the health of a pregnancy. Documentation of immunity to rubella (German measles) and varicella (chicken pox) may also require a blood test. Vaccination can be offered before pregnancy if immunity is not present. The patient and her partner will also be tested for hepatitis B and C, HIV and syphilis. An option for couples to consider is Universal Genetic Carrier Screening. This testing offers the additional advantages of identifying before pregnancy couples at risk of having children with genetic diseases. They can then be offered appropriate testing to optimize patient education, counseling, and options for achieving pregnancy. Couples at risk of having children with specific genetic diseases can be counseled about the disease inheritance and course and offered referral for potential interventions, such as preimplantation genetic testing.
Ovarian Reserve Testing
As women age they have a decreased ability to conceive and an increased risk of miscarriage. The reproductive potential of the ovaries, termed ovarian reserve, represents the number of oocytes available for potential fertilization at that point in time and may be assessed by serum tests or ultrasonography. The presence of decreased ovarian reserve predicts future response to ovarian stimulation. The results of ovarian reserve tests should be considered in the context of the patient’s age. Ovarian reserve tests are good predictors of response to ovarian stimulation, but poor results do not necessarily predict inability to achieve a live birth.
- Anti-Mullerian Hormone Test (AMH): AMH levels remain relatively stable throughout the menstrual cycle and can be assessed on any day of the menstrual cycle. An AMH value less than 1.0 can predict a low response to stimulation.
- Day 2-5 Levels of FSH, and Estradiol: Follicle stimulating hormone values greater than 10 IU/L are associated with a less robust response to ovarian stimulation. Estradiol serves as an aid for interpreting FSH results. Basal estradiol levels typically should be less than 60–80 pg/mL; elevated estradiol levels may have a suppressive effect on FSH levels and may be indicative of decreased ovarian reserve.
- Ultrasonographic assessment of the antral follicle count: determines the number of follicles that measure 2–10 mm in both ovaries. Low antral follicle count may be defined as fewer than 5–7 follicles and is associated with poor response to ovarian stimulation. However, antral follicle count is a relatively poor predictor of future ability to become pregnant.
A semen analysis should be reviewed. Changes in sperm quality may occur over time that could affect IVF success. Semen parameters can help determine whether standard insemination of eggs or intracytoplasmic sperm injection (ICSI) may be advised.
The uterus is usually evaluated prior to an IVF. Three methods can be used: a hysterosalpingogram, a saline infusion sonohysterography or a hysteroscopy.
Prior to IVF, a trial or “mock” transfer may be done. The purpose of this procedure is to determine the length and direction of the uterus. This enables the physician to anticipate any difficulties with the embryo transfer.
For more information, see these fact sheets:
LINKS: ASRM FACT SHEETS
- Weight and Fertility
- Smoking and Infertility
- Reproductive Aging in Women
- Diagnostic Testing for Female Infertility
- Diagnostic Testing for Male Factor Infertility
- Hysterosalpingogram (HSG)
- Evaluation of the Uterus
- Saline Infusion Sonohysterography