What Tests To Take Before Turning to IVF

If you’re trying to get pregnant, there can be a number of different treatments and pathways to try. Each patient has unique needs and challenges, so your doctor will want to create a treatment plan that’s right for your specific circumstances. Before starting IVF, there are several fertility tests that can provide insight into your reproductive health. These tests can help identify any potential barriers to conception and may even offer alternative solutions before taking the IVF route.

Here’s a breakdown of the key tests to consider, and how they can guide you on your fertility journey.

1. Hormone Testing

A blood test can evaluate a variety of hormones, each giving important clues about your menstrual cycle, ovulation and overall fertility.

• FSH (Follicle-Stimulating Hormone): This hormone helps regulate the growth of eggs in your ovaries. Testing your FSH levels on day 3 of your menstrual cycle can give your doctor an idea of your ovarian reserve, meaning the number of remaining eggs you have.
• AMH (Anti-Müllerian Hormone): AMH is another indicator of ovarian reserve. Higher levels suggest a greater number of eggs, while lower levels may indicate a diminished ovarian reserve. AMH levels don’t fluctuate with your menstrual cycle, so this test can be done at any time.
• LH (Luteinizing Hormone): Your LH level surges right before ovulation, and testing it can help determine whether you’re ovulating regularly. This hormone works closely with FSH to control your cycle.
• Estradiol: A form of estrogen, estradiol is important for preparing your body for pregnancy. Testing it along with FSH can give a more complete picture of your ovarian function.
• Progesterone: This hormone helps prepare the uterus for pregnancy after ovulation. Testing progesterone levels after ovulation confirms whether ovulation occurred, which is essential when trying to conceive without assistance.

2. Ovarian Reserve Testing

Ovarian reserve tests estimate the quantity of eggs left in your ovaries. As mentioned, AMH and FSH are commonly used for this, but your doctor may also recommend an antral follicle count (AFC).

Antral follicle count is performed via a transvaginal ultrasound, where the doctor counts the number of small follicles (egg-containing sacs) visible in the ovaries. This test is typically done at the beginning of your cycle and gives a direct estimate of your remaining egg supply. Combining AFC with hormone tests provides a clearer picture of your reproductive potential.

3. Hysterosalpingogram (HSG)

A hysterosalpingogram (HSG) is a specialized X-ray that checks whether your fallopian tubes are open and if the shape of your uterus is normal. The fallopian tubes are where the sperm meets the egg, so if either tube is blocked or damaged, conception without assistance can be difficult. During the test, a dye is injected into the uterus, and X-ray images are taken to see if the dye passes through the fallopian tubes without any obstruction. This test can help diagnose conditions like blocked tubes, scar tissue, or abnormalities in the uterine cavity that could affect your ability to conceive unassisted.

4. Semen Analysis

A semen analysis tests sperm count, motility (movement), and morphology (shape) to assess sperm health. Issues with sperm quality or quantity can be a contributing factor to difficulty in conceiving, and addressing them early on can sometimes lead to alternative treatment options that might be less invasive or expensive, such as IUI,  before turning to IVF.

If sperm issues are identified, lifestyle changes, medications, or other treatments may improve sperm quality and lead to successful conception without the need for IVF.

5. Ultrasound and Pelvic Exam

An ultrasound can give your doctor a visual of your reproductive organs, helping to identify any physical issues that might be preventing conception. A transvaginal ultrasound is typically used to examine your ovaries and uterus. This can help identify conditions like polycystic ovary syndrome (PCOS), endometriosis, or uterine fibroids—all of which can affect your fertility.

In some cases, your doctor may also perform a more detailed pelvic exam to check for signs of infection, scarring, or other abnormalities that could impact fertility.

6. Genetic Testing

For some couples, genetic testing may be recommended before trying IVF. This type of testing can help identify whether you or your partner are carriers of genetic conditions that could be passed on to your children. Genetic testing can also be used to determine the risk of certain chromosomal abnormalities that could lead to miscarriage or difficulty conceiving.

If you and your partner are both carriers of a genetic disorder, IVF with preimplantation genetic testing (PGT) can be used to screen embryos before they’re transferred, ensuring that only healthy embryos are selected for transfer.

7. Thyroid Function Test

The thyroid gland regulates many important functions in your body, including your metabolism and menstrual cycle. A thyroid function test checks your levels of thyroid-stimulating hormone (TSH). If your thyroid is underactive (hypothyroidism) or overactive (hyperthyroidism), it can disrupt your cycle and affect your ability to conceive. Treating thyroid issues may improve your chances of conceiving naturally.

8. Anti-Sperm Antibody Test

Although less common, some individuals develop antibodies that mistakenly attack sperm, making it more difficult for sperm to fertilize an egg. An anti-sperm antibody test can help determine whether these antibodies are present in either partner’s system. If antibodies are found, ICSI (intracytoplasmic sperm injection) may be recommended to bypass this issue.

Knowing When to Move Forward with IVF

After completing these tests, you’ll have a clearer understanding of the factors that might be affecting your chances of conceiving. Depending on the results, you may discover that lifestyle changes, medications, or less invasive treatments can help you get pregnant. But if the tests reveal challenges that can’t be resolved through these methods, your Reproductive Endocrinologist may recommend moving forward with IVF.