06 May Fertility Tests Before IVF: What to Expect and Why Each One Matters
Before a single injection is given or a protocol is written, there is a quieter, more fundamental step in the IVF journey: understanding your body. The tests that come before treatment are not bureaucratic formalities or boxes to tick. They are the foundation of everything that follows. They are how your fertility team learns who you are – medically speaking – and how they tailor a plan that gives you the best possible chance.
If you have just been told you need to do “a series of tests” before starting IVF, you may be feeling a mixture of relief (finally, something is happening) and apprehension (what will they find?). Both are completely normal. This guide walks you through every test, explains why each one matters, and helps you understand how the results shape what comes next.
Tests for Women: Building a Complete Picture of Ovarian Health
For women, fertility testing is about understanding two things: the quantity of the eggs you have, and the condition of the uterus and hormonal environment that will support a pregnancy. These are assessed through a combination of blood tests and ultrasound.
AMH – Anti-Mullerian Hormone
If there is one test that has become synonymous with fertility assessment in recent years, it is AMH. Anti-Mullerian Hormone is produced by the small follicles in your ovaries, and its level in the blood gives a reliable indication of your ovarian reserve – roughly speaking, how many eggs you have remaining.
AMH does not tell you whether your eggs are good quality (that is assessed differently), but it is one of the most useful guides for predicting how your ovaries will respond to stimulation. A low AMH suggests a smaller reserve and a more cautious stimulation protocol may be needed. A very high AMH – common in women with polycystic ovary syndrome – signals a more abundant reserve but also raises the possibility of an exaggerated response, requiring careful management to avoid ovarian hyperstimulation.
The beauty of AMH is that it can be measured at any point in your cycle – there is no need to wait for a specific day.
FSH and LH – Reading the Hormonal Conversation
FSH (follicle-stimulating hormone) and LH (luteinising hormone) are the hormones your brain sends to your ovaries each cycle to prompt follicle development and trigger ovulation. These are measured on Day 2 or Day 3 of your menstrual cycle.
A high FSH level on Day 3 can indicate that the pituitary gland is working harder than usual to stimulate the ovaries – a sign that the ovarian reserve may be diminished. LH levels, taken in context, help to complete the picture. In women with PCOS, LH is often elevated relative to FSH, which is one of the diagnostic markers.
Prolactin and Thyroid Function
Prolactin is a hormone that, in high quantities, can suppress ovulation. Thyroid disorders – both underactive and overactive – can interfere with reproductive hormones and affect implantation. Both are straightforward blood tests, and any abnormalities found are usually very manageable with medication before treatment begins.
Oestradiol
Measured alongside FSH and LH on Day 2-3, oestradiol (E2) helps to contextualise the other results. An elevated E2 early in the cycle can sometimes mask an abnormal FSH reading, so it provides an important check.
Karyotype and Thrombophilia Screening (where indicated)
In some cases – particularly where there is a history of recurrent pregnancy loss or implantation failure – additional blood tests may be recommended, including a chromosomal karyotype and a screen for inherited clotting disorders (thrombophilias) such as Factor V Leiden or MTHFR mutations. These are not routine for everyone, but they can be important for tailoring the treatment approach in specific clinical scenarios. Chromosomal karyotyping is obligatory if someone wants to proceed with pre-implantation genetic selection (PGT-A).
Immunological testing – either through an endometrial biopsy or blood tests – including relevant tests for endometritis (chronic infection) and implantation window testing (ERA/ERMAP) may also be suggested in cases of recurrent implantation failure or recurrent miscarriages.
Tests for Men: The Semen Analysis
Male factors contribute to fertility difficulties in a significant proportion of couples – estimates consistently place this at around 40-50% of cases. Yet semen analysis remains one of the most underutilised tests, with many men either delaying it or feeling reluctant to undergo it. The reality is that it is one of the simplest investigations in the entire fertility workup, and its results are enormously informative.
A semen analysis (also called a spermogram) evaluates several key parameters: sperm concentration (how many sperm per millilitre), motility (what percentage are moving, and how well), morphology (what percentage have a normal shape), and total motile sperm count. The sample is produced by masturbation after an abstinence period of 2-3 days, and the analysis is performed in the laboratory.
If the first semen analysis shows abnormalities, it is standard practice to repeat it after 10-12 weeks, since sperm production is a continuous process and a single result can be affected by temporary factors such as recent illness, high fever, or stress.
Where sperm parameters are significantly impaired, ICSI (intracytoplasmic sperm injection) – a refined form of IVF in which a single sperm is injected directly into each egg – is often recommended. In some cases, additional sperm testing such as DNA fragmentation analysis or oxidation testing may also be suggested.
Infectious Disease Screening: Protecting Everyone Involved
Before any fertility treatment, both partners undergo a standard panel of infectious disease tests. This is not a reflection of anyone’s lifestyle or personal history – it is a universal, mandatory safeguard for the safety of patients, embryos, and laboratory staff.
The standard infectious screening panel typically includes:
HIV (human immunodeficiency virus) for both partners.
Hepatitis B (surface antigen and antibodies) for both partners.
Hepatitis C antibodies for both partners.
Rubella (German measles) immunity for women – if immunity is absent, vaccination is recommended before treatment.
Syphilis (VDRL/TPHA) for both partners.
CMV (cytomegalovirus) status may also be checked, particularly if donor gametes are involved.
These tests are generally valid for one year and need to be repeated if they expire before the treatment cycle. If any result comes back reactive, the medical team will advise on the appropriate steps – which, in most cases, do not prevent treatment but may require additional precautions or specialist input.
Ultrasound Timing: The Baseline Scan
Perhaps the most important single investigation before IVF is the transvaginal ultrasound – specifically the baseline scan performed early in the menstrual cycle, ideally on Day 2, 3 or 4.
This scan serves several purposes at once. It assesses the uterus – checking for fibroids, polyps, or any structural abnormalities that might affect embryo implantation. It evaluates the uterine lining at its thinnest, most baseline state. And crucially, it counts the antral follicles.
AFC – The Antral Follicle Count
The antral follicle count (AFC) is one of the most reliable predictors of how your ovaries will respond to stimulation. Small, resting follicles – called antral follicles – are visible on ultrasound, and their number directly corresponds to the follicles that will be available for recruitment during stimulation. Together with AMH, the AFC gives your fertility team the information they need to choose the right stimulation protocol and dosing strategy.
A low AFC (generally fewer than 5-7 follicles across both ovaries) suggests a diminished response may be expected. A high AFC (15 or more) suggests a strong response – and the need for careful management to avoid excessive stimulation.
The timing of this scan matters: it must be done at the right point in the cycle to capture an accurate baseline. Your coordinator will guide you on exactly when to come in.
The baseline scan is also an opportunity to check for any ovarian cysts that might interfere with the start of stimulation, and to confirm that the uterine cavity appears clear.
How Your Results Shape Your Protocol
Here is where everything comes together. Once all of your test results are in, your fertility specialist uses them to design a treatment plan that is tailored specifically to you – not to an average patient, not to a standard protocol, but to your particular hormonal profile, ovarian reserve, sperm parameters, and medical history.
A woman with a low AMH and AFC will typically be placed on a higher-dose, more aggressive stimulation protocol, with the aim of recruiting as many follicles as possible. Her monitoring during stimulation will be frequent and attentive. In women with very low AFC though, low-dose protocols might also be used (mini IVF) or even repeated natural or semi-natural cycles might be recommended.
A woman with PCOS and a high AFC will be placed on a low-dose, carefully controlled protocol to avoid overstimulation. She may well be advised to follow a freeze-all strategy – freezing all embryos for transfer in a subsequent cycle – to further minimise any risk, and an agonist trigger will be used. In resistant PCOS though, we may decide to proceed with a higher initial dose that can be stepped down later in stimulation, depending on progress and blood tests.
If the semen analysis reveals significant sperm abnormalities, ICSI will be planned rather than conventional insemination. If DNA fragmentation is high, the protocol may be adjusted accordingly, or additional interventions considered – e.g. Zymot or MACS sperm selection techniques.
If the ultrasound reveals a uterine polyp or significant fibroid, the recommendation may be to address this surgically before proceeding with IVF, so that the uterine environment is as receptive as possible for the embryo.
Every finding shapes a decision. Every decision is made with the goal of giving your embryo the best possible start.
At Pelargos IVF, all blood tests are reviewed in the context of your full history before a protocol is proposed. IVF is carried out in collaboration with our partner laboratory IOLife, which handles fertilisation, embryo culture, and cryopreservation to the highest standard. Pelargos operates as a fertility group, and the coordination between the clinical team and the laboratory is central to how care is delivered.
A Word on Timing
One question that comes up frequently is: when should I get these tests done? The short answer is: as early as possible, but do not let the perfect be the enemy of the good.
Some tests – particularly AMH – can be done at any time. Others need to align with your cycle. If you are planning IVF, the sooner you begin the testing phase, the more time your team has to review results, address anything that needs attention, and plan your cycle without unnecessary delays.
Of course, infectious blood tests need to be done in the last 6 months before IVF, and AMH and thyroid function are best checked within the last 6 months before IVF as well.
If you have had fertility tests done elsewhere, bring them with you – ideally with the original laboratory reports. Results that are less than 6 months old may in many cases be accepted without repeating them, though this depends on the specific test and your clinical situation.
If you have been told to book a first consultation and are not sure what to bring, a brief summary of any tests already done is always useful.
Frequently Asked Questions
What is AMH and why does it matter for IVF?
AMH (Anti-Mullerian Hormone) is a hormone produced by follicles in the ovaries. It gives a reliable indication of your ovarian reserve – the pool of eggs available for stimulation. A higher AMH generally means a better response to stimulation; a lower AMH suggests a more limited reserve. It is one of the most useful single tests for predicting how IVF will go, and it is used alongside the antral follicle count to plan your protocol.
When should I have my fertility tests done?
The earlier, the better. Some tests such as AMH can be done on any day of your cycle; others such as FSH, LH, and oestradiol need to be done on Days 2-4 of your period. The baseline ultrasound scan is also performed on Days 2-8. If you are considering IVF, booking an initial consultation first allows your doctor to advise on exactly which tests you need and when.
Does my partner need to be tested too?
Yes. A semen analysis is a standard part of the fertility workup and should be done before treatment begins. Male factors contribute to a significant proportion of fertility difficulties, and knowing the full picture for both partners is essential for designing the right treatment approach.
What happens if my AMH is very low?
A low AMH does not mean IVF is impossible, but it does mean the approach will be carefully tailored to maximise results. Your doctor may recommend a higher-dose stimulation protocol or a mini IVF approach, and will discuss realistic expectations with you. In some cases, where ovarian reserve is very significantly diminished, donor eggs may be considered as an option – but this is a conversation that happens with full information and at your own pace.
Are the infectious disease tests really necessary?
Yes, they are mandatory before any fertility treatment, for all patients regardless of background or history. They protect the safety of you, your embryo, and the laboratory environment. Results are treated with complete confidentiality.
How long does it take to get all the results back?
Most blood tests return results within a few days. The ultrasound results are available immediately. In most cases, all baseline testing can be completed within one menstrual cycle, and a treatment plan can be proposed shortly afterwards.
The tests before IVF are not something to fear. They are, in a real sense, the beginning of your team getting to know you – and the beginning of building the plan that gives you the best possible chance.
If you are ready to take that first step, you can book a free initial consultation with the Pelargos IVF team.
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