Making the decision to begin fertility treatment is a big step for any hopeful parent. Now that you’ve decided to move forward with in vitro fertilization (IVF), what happens next? Let’s walk through what to expect as you prepare for your IVF cycle, including which fertility tests and procedures you may undergo and why proper preparation for IVF is so essential. 

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As a nurse at Illume Fertility who also went through IVF to grow my own family, I know how overwhelming it can be to try and understand all the different pieces of the puzzle! 

While your doctor and Care Team will always be on hand to answer your questions and guide you through the process, it can be helpful to have a full guide to refer to as you prepare for your IVF cycle. Let’s explore what fertility tests or surgical procedures you may undergo before you begin fertility treatment.

Before you begin any type of fertility treatment, your reproductive endocrinologist will complete a full assessment of your current fertility, uncover potential underlying causes of your fertility issues, and perform any necessary therapeutic procedures to give you the best chance at successfully conceiving.

Here’s what you can expect:

Checklist Blood Work

One of the most important parts of your fertility assessment is evaluating your hormone levels via blood work. This is typically performed on two different days of your cycle.

Day 3 

This blood work (referred to as “Day 3” blood work) is typically performed between days 2-4 of your cycle. We will check your estradiol, follicle stimulating hormone (FSH), and luteinizing hormone (LH). Here’s why:

• Follicle stimulating hormone (FSH) is secreted by the pituitary gland and stimulates the production of estradiol (estrogen) and eggs (oocytes) during the first half of the menstrual cycle. It can be used to diagnose or evaluate polycystic ovarian syndrome, ovarian cysts, irregular vaginal bleeding, and infertility. 
• Leutinizing hormone (LH) is also secreted by the pituitary gland. LH levels rise mid-cycle; and within 24 to 36 hours, ovulation usually occurs. Higher than normal levels of LH can indicate several issues, including ovarian failure and polycystic ovarian syndrome.
• Estradiol (E2) is the most important form of estrogen. It is primarily made in and released from the ovaries, adrenal cortex, and the placenta, and it is responsible for the growth of the breasts, outer genitals, uterus, fallopian tubes, and vagina.

What does a high FSH level mean? High levels of FSH are an indication of poor ovarian reserve. In other words, the quality and quantity of eggs is likely low. This does not necessarily mean that pregnancy is impossible, but it may be more difficult to achieve.

Day 21 

We will perform a second set of blood work on “Day 21” of your cycle. These tests will include checking your estradiol and progesterone levels, which will help determine if you ovulated this cycle. In addition, your team will check your Anti-Mullerian hormone (AMH) to determine your ovarian reserve, as well as your thyroid levels.

The goal here is to make sure these hormones are within normal limits before starting any treatment, as well as help determine the best course of treatment for your specific diagnoses.

Genetic Carrier Testing

Your partner finally gets to join in on the fun for blood work!

You will both have the option to be screened for up to 500+ genetic conditions that you may pass on to your future children. Genetic carrier testing is especially important for patients with a known family history of serious inheritable medical conditions (i.e. cystic fibrosis, sickle cell anemia, and others).

As soon as we receive your genetic screening results, we will inform you and help you set up a meeting with one of our knowledgable genetic counselors to discuss your results.

Semen Analysis

If you have a male partner, they will also undergo some testing. A semen analysis (often referred to as an SA) is a simple test that analyzes sperm count, motility, and shape. This will help determine the best treatment plan and uncover any possible male factor fertility issues. 

Baseline Ultrasound

Once all the poking and prodding of your veins is done, you get to move on to your baseline ultrasound. This is an internal (transvaginal) ultrasound that measures both the lining of your uterus, as well as the number of follicles you have on each ovary during that particular cycle (known as a basal antral follicle count).

This number can vary depending on individual diagnoses, but we typically see between 10-15 follicles on average.

Note: You will receive a full instruction sheet from your Care Team prior to any procedures!

The SHG/SIS test discussed above will determine if you need a hysteroscopy or any other surgical procedures by identifying any uterine abnormalities that may hinder an IVF embryo transfer from being successful. We want to make sure the uterine cavity is nice and ready for your little embryo!

Note: Not every fertility patient will need a hysteroscopy in order to be successful growing their family! Your reproductive endocrinologist will discuss the findings of your SIS/SHG test with you and determine whether a hysteroscopy is necessary. 

A hysteroscopy is performed to find the cause of abnormal bleeding, remove uterine growths like polyps and small fibroids, and/or examine the uterus to see if there’s a problem with its shape or size that’s preventing you from becoming pregnant or causing recurrent pregnancy loss. A hysteroscopy is both a diagnostic and therapeutic procedure.

Here’s what you can expect on the day of your hysteroscopy procedure:

You will arrive at Illume’s Norwalk office an hour before the surgery start time given to you by your team. You will then be walked back to our surgical suite where you will sign a host of paperwork, have an IV inserted, and get your vital signs taken.

You will also meet with your surgeon to discuss exactly what he/she is looking for (polyp, fibroid, etc.) and then talk with your anesthesiologist to discuss the medications he will be giving you for your surgery.

Finally, you will walk with us into the operating room (OR) where your surgery will take place.

If you have a septate uterus (i.e. have a membrane separating your uterus into two different sections), your doctor may also be able to modify the septum during your hysteroscopy. 

Want to know what comes next? Read my guide to egg retrieval and embryo transfer!