Before you begin IVF you will go through a screening process to assess your
reproductive health. This process may take 2-3 weeks. During your telephone consultation
or office visit, you will meet your physician, a reproductive endocrinologist (RE), who
will take a detailed history and explain the process of in vitro fertilization and embryo
transfer. Your doctor will order various tests and arrange a visit or telephone consult
with the nurse coordinator and financial counselor. Testing might include:
Cycle day 3 blood tests:
A blood sample is drawn on the third day of your menstrual cycle (cycle day 3) to test
your pituitary gland, ovaries, blood type, and certain infectious diseases (such as
hepatitis and HIV). The results of these tests will help us plan your stimulation protocol
and general medical care. Your doctor may select other screening tests according to your
medical and fertility history. Please ask if the reason for any test is unclear to you.
Mid-Cycle Ultrasound:
An ultrasound is performed near the time of ovulation to measure the endometrium, which
is the inside lining of the uterus, the location of early embryo development. The uterus,
cervical canal, and ovaries are also studied. Critical measurements include the thickness
and pattern of the endometrial lining, the curvature of the cervical canal, and the
position of the uterus. A catheter may be passed through the cervix to measure the depth
of the uterus, a uterine measurement or mock embryo transfer. A brief physical exam may
also be performed if this is the first time you meet your doctor.
Hysterosalpingogram (HSG), Hysteroscopy or Hysterosonogram:
Hysterosalpingogram is a test done in the radiology department of the hospital
to test your fallopian tubes and the uterus. This test is a frequently performed fertility
test, but is not required prior to IVF. A small amount of fluid is injected into the
uterus and tubes and an X-ray picture is taken. The picture outlines the uterine cavity
and fallopian tubes and provides important information about the inside of your uterus.
Hysteroscopy is an examination of the interior of the uterus performed using a
narrow hysteroscope, a long thin telescope with a light and lens. Small lesions like
polyps and fibroids could prevent attachment of an embryo and act like an IUD inside your
uterus. These can be removed through the hysteroscope.
Hysterosonogram (Saline Sonogram): A hysterosonogram is another test
which can be performed to evaluate the uterine cavity for polyps or fibroids. A small
amount of fluid (sterile saline) is injected through a catheter placed through the cervix
and into the uterine cavity while a vaginal ultrasound is performed at the same time. This
provides important information about the inside of your uterus without surgery or exposure
to x-rays.
Semen analysis:
A semen analysis provides a measure of semen volume, sperm concentration or number,
sperm motility and sperm morphology. Although we accept evidence of normal sperm counts
from outside laboratories, if there is any history of sperm abnormalities, we may request
a semen analysis be performed in our laboratory before the planned IVF cycle. If
persistent abnormalities are detected, a more detailed evaluation including additional
tests and/or an exam by a urologist may be suggested. Fortunately, with the availability
of ICSI (Intracytoplasmic sperm injection) we now have a very effective method of
producing pregnancies even when sperm function is very poor.
Infectious Disease Tests:
California state law requires testing of all male partners in IVF treatment for agents
of viral hepatitis (B and C), HTLV-I, syphilis, and HIV I and II. State law also requires
us to screen female partners for the same diseases before their embryos are frozen. These
are legal requirements which cannot be waived.