All couples undergoing a cycle of IVF or ART (Advanced Reproductive Technology) are required to undergo some preliminary testing prior to beginning. Once the testing is completed and results are obtained, appropriate therapy may begin.
Day 3 Labs: Estradiol, FSH and LH Blood Levels:
These levels are required on all patients preparing for an ART procedure. Blood is drawn on day 2 or 3 of your menstrual cycle. Baseline estradiol, FSH and LH levels help the physician determine your ovarian reserve, how well you will stimulate and assist in determining the correct medication dosage for you. Elevated levels can indicate a diminished ovarian reserve and a possible decrease in success rate. We require that these labs be performed at our facility for more accurate and timely results.
Clomiphene Citrate Challenge Test:
There are many ways to try and predict how individual patients will respond to gonadotropin (fertility drug) injections. Currently we use information such as patient age, previous fertility, day 3 labs and ultrasound results. The clomiphene citrate challenge test is another way for our staff to determine the appropriate medication and dose of the gonadotropins to stimulate our patients appropriately and minimize the risk of ovarian hyperstimulation. There are, however, a number of patients who respond poorly to gonadotropin stimulation resulting in a suboptimal cycle, a canceled cycle or disappointing pregnancy rates. The clomiphene citrate challenge test is the most sensitive predictive test that can unmask patients with diminished ovarian reserve, which may not be detected by a day 3 FSH (follicle stimulating hormone) measurement. Clomiphene citrate works by occupying estrogen receptor sites in the brain to prevent estrogen from binding to these sites. This fools the body into thinking that estrogen levels are lower than they really are. The brain then instructs the pituitary gland to release even greater amounts of FSH and LH (luteinizing hormone) which in turn accelerate the growth of an ovarian follicle. By checking a patient’s day 3 hormone levels then administering clomiphene citrate and rechecking the hormone levels on day 10, we can see how the body should respond to the gonadotropins.
This test is simple to perform. FSH, estradiol and LH are checked on day 3 of a menstrual cycle. Clomiphene citrate 100 mg is given on days 5 through 9 and a repeat FSH level is drawn on day 10. This test is considered abnormal if either day 3 or day 10 FSH levels are greater than 14 IU per liter (>14 IU/L on our IMX assay). Data from programs utilizing the clomiphene citrate challenge test are quite convincing. In one program patients with abnormal clomiphene citrate challenge test results have a 6% chance of conceiving through IVF, as compared to a 42% pregnancy rate in patients with a normal clomiphene citrate challenge test. Abnormal clomiphene citrate challenge tests are found in approximately 3% of patients under 30 years of age, 7% in patients 30 to 34 years of age, 10% in patients 35 to 39 years of age and 26% in patients over 40 years of age. An abnormal test result should be an indication to recommend weight reduction or smoking cessation where appropriate. In view of the dismal pregnancy rates noted in women with diminished reserve, it is an appropriate time to recommend oocyte donation or adoption.
HIV, Hepatitis Panel and Rubella:
Both husband and wife are required to have current testing (within the past year for HIV and hepatitis. These tests must be completed prior to beginning a cycle. You may have these tests drawn on the day of your consultation or your coordinator can write orders to have them drawn elsewhere. If you have had these tests performed elsewhere within the past year, written documentation will be needed for our records. A Rubella screening will also be drawn on the wife. If she is non-immune, she will be given the opportunity to be vaccinated. She must wait at least three months after vaccination to try and conceive.
This test is done for the female. It is required that all women have a diagnostic hysteroscopy performed prior to their IVF cycle. Diagnostic hysteroscopy is used to examine the inside of the uterus. This procedure will assist in diagnosing any abnormal uterine conditions, such as intramural fibroids, fibroid tumors, scarring, polyps and congenital malformations which could interfere with implantation. If this test has not been done, it will be a requirement prior to starting a cycle. All hysteroscopies must be current, within the past two years. If is generally performed in the office. Anesthesia is not necessary, however, we do recommend taking a nonsteroidal anti-inflammatory agent one hour prior to the procedure. If an abnormality is found, it may be taken care of at the office, or it may be necessary to perform further corrections in the hospital. This will be discussed at the time of the diagnostic hysteroscopy.
This test is for the male. All couples are required to have an extensive semen analysis completed at our Center prior to starting ART. This test gives our embryologist an opportunity to look at the sperm and anticipate any problems it may have in fertilizing the egg. The embryologist will be specifically looking at the sperm motility and count, as well as any abnormalities in the sperm itself. He will also look for antibodies on the sperm, which can cause decreased fertilization and lead to decreased pregnancy rates. In addition, a portion of the sperm will be frozen as a backup if an unavoidable situation occurs at retrieval and the husband is not available. This sperm workup must be completed prior to beginning a cycle.