Before you start your treatment there may be several tests and checks to have done first. You may be surprised that there are more tests at this late stage and you may feel that this is another hurdle that will slow things down, but it ensures the medical team have all the information they need before you start treatment.
You may have to have new tests done, or the clinic may want to repeat tests you’ve already had done if they were carried out a while ago. Let’s go through some of the tests you will have done.
If you are not immune, you will need a rubella vaccination before you start your fertility treatment. Rubella, or German measles, can be dangerous in early pregnancy, putting babies at risk of deafness, blindness and learning difficulties.
There are different types of hepatitis, which are caused by a virus and affect the liver. Symptoms are not always obvious and the clinic may want to carry out blood tests for hepatitis B or C for both partners.
The chances of passing the infection on to a baby during a normal pregnancy are not high, but hepatitis is infectious and staff and other patients could be at risk if proper procedures are not put in place.
Not all clinics will treat patients who test positive for hepatitis, and some will not freeze embryos in these circumstances. If this is the case, they should be able to refer you to another clinic where they are equipped to help patients who have had a positive hepatitis test result.
Most clinics will do their own semen analysis before starting IVF. Sometimes this can be done at home if you live close to the clinic. Sperm samples deteriorate if they don’t get to the laboratory quickly, but usually the male partner will be asked to produce a sample in the men’s room at the clinic. The clinic may do a sperm antibody test at this stage.
Ovarian reserve testing
You may also be tested to see how many immature eggs are in your ovaries (known as your ovarian reserve) before you start treatment. This is to find out how you might respond to the drugs given during IVF.
There is some debate among fertility specialists about how valid these tests are. There are a few ways to check ovarian reserve. Traditionally, doctors tended to look at levels of follicle-stimulating hormone (FSH) which helps the eggs grow in the ovaries. Now they may also look at levels of luteinising hormone (LH), oestradiol, inhibin B and AMH (or anti-Mullerian hormone), which can all give an indication of how many immature eggs there are.
Some clinics may also carry out an antral follicle count which involves looking at the numbers of the tiny follicles in the ovary in their early stages of development.
AMH is generally considered to be one of the most reliable as it can be done at any time during the cycle and doesn’t fluctuate much. AMH testing is becoming more popular in clinics as an indicator of how a woman is likely to respond to IVF. It is thought ovarian reserve testing probably gives a picture of the number of eggs left in the ovaries, whereas the quality of those eggs is more dependent on your age.
If tests indicate you have a very low ovarian reserve some clinics might suggest you consider egg donation but others prefer to see how your body responds to the drugs before going down this path. IVF can be successful when ovarian reserve tests are poor, but this is something you should discuss with your doctor.
Full Blood Count
The results of a full blood count give an indication of your general health, so this is sometimes carried out at the same time to alert the medical team to any other problems.
Sexually transmitted infection tests
Clinics may also want to test you both for chlamydia, gonorrhoea and syphilis as you can have these sexually transmitted infections without being aware of them, and they can have a terrible impact on your fertility.
If you are going to be using donated eggs or sperm, you will usually have a test for cytomegalovirus, or CMV. CMV is a very common infection and it is thought that at least half of us will have had it during our lifetime without knowing it. Once you have been infected, the antibodies remain in your body forever and will show up as positive in tests.
Doctors may prefer not to give eggs or sperm from a CMV-positive donor to a recipient who has never had the virus and therefore the test is done. This is just a precautionary measure, as CMV does not usually cause any problems.
You will usually have an ultrasound scan before you start treatment to make sure you don’t have any fibroids or polyps (lumps of tissue) in the womb that could prevent the egg implanting. The scan also gives a clear view of your ovaries. If the medical team want to check your ovarian reserve using an antral follicle count, this is done during the ultrasound scan.
Trial embryo transfer
In the final stage of treatment doctors are aiming to transfer one or two embryos that have been fertilised in the laboratory back into your womb. This is done by inserting a catheter into the vagina, which passes into the womb itself through the cervix.
The cervix is not actually a straight line from the vagina to the womb, and the path can be quite awkward, and the length of the cervix varies. Doctors often do a practice run either before you start treatment, or when you have your eggs collected to highlight any problems.
The trial embryo transfer is a straightforward procedure, like a pap/smear test and it avoids the risk of doctors suddenly discovering you have a particularly difficult cervix to negotiate when your embryos are ready and waiting to be put in the womb.
Understanding your treatment
Most clinics arrange a meeting where they will talk you through what happens during your treatment in order to give you an idea of what to expect.
This may be part of a large open day, a meeting attended by several patients, or an individual session. If you do attend an open day or large meeting, you will probably have a personal discussion with a doctor or nurse before you start treatment anyway.
Don’t be afraid to ask questions at these sessions, and don’t ever feel your questions are too silly or unimportant, or that it’s something you should already know. These introductory meetings are aimed at making sure you have all the information you need and helping you to understand as much as you can about the process.
You will probably be given some brochures or other documents about the treatment and it is worth taking the time to sit down and read through these.
Making sure that you are well informed can also help you feel more in control of what is happening and reading books or going online may also be useful. People who have had IVF often say that one of the most helpful things is talking to others who have been through fertility treatment about their experiences, and there are lots of online platforms where you can do this.
This is from my program ‘Everything you need to know before starting your IVF/ART’
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