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. The patient and her partner will also be
tested for hepatitis B and C, HIV and syphilis. Other genetic tests may be
requested depending on the patient’s genetic background, such as cystic
fibrosis and sickle cell trait.
Ovarian Reserve Testing
As women age they have a decreased ability to conceive and
an increased risk of miscarriage. Ovarian reserve testing tries to measure egg
quality, quantity and reproductive potential.
The following tests may be used to measure ovarian reserve:
- Day 3 Levels of FSH, LH, and Estradiol. The determination follicle stimulating hormone (FSH), luteinizing (LH) and estradiol levels on menstrual cycle day 3 has been used to estimate fertility potential. Women with elevated levels of FSH and/or estradiol measurements may have reduced pregnancy rates with IVF or may require more medications during IVF.
- Clomiphene Citrate Challenge Test. This test requires patient to take 100 mg of clomiphene citrate on menstrual cycle days 5-9. Blood levels of FSH are measured on cycle day 3 and again on cycle day 10. Elevated blood levels of FSH on cycle day 3 or cycle day 10 are associated with reduced pregnancy rates.
- Anti-Mullerian Hormone Test (AMH). Anti-Mullerian hormone levels are thought to reflect the remaining number of eggs. This test can be performed on any day of the cycle.
A semen analysis should be reviewed. Changes in sperm
quality may occur over time that could affect IVF success.
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