FERTILITY TREATMENT
In Vitro Fertilisation
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What to ask your fertility specialist
Fertility test for women
The IVF Roadmap
01
Initial Consultation
The journey begins with an initial consultation with a fertility specialist. During this visit, the patient’s medical history is reviewed, and preliminary tests are conducted to assess fertility issues.
02
Pre-treatment Testing and Preparation
Patients undergo various tests, including blood tests, ultrasounds, and semen analysis for male partners. This phase also includes discussions about lifestyle changes and any necessary medications to optimize fertility.
03
Ovarian Stimulation
The patient starts taking hormonal medications to stimulate the ovaries to produce multiple eggs. Regular monitoring through blood tests and ultrasounds tracks the development of the eggs.
04
Suppressing your Natural Cycle
Depending on your treatment plan, you will start taking injections to suppress ovulation from either day 21 of your previous cycle or around day 6 of your IVF cycle
05
Monitoring
Up to every 3 to 5 days. Regular ultrasounds can be performed to monitor your growing eggs and adjust your medication if necessary
06
Trigger injection
You will administer the trigger shot to complete maturation and prepare your eggs for retrieval
07
Egg Retrieval
Once the eggs are mature, a minor surgical procedure called egg retrieval is performed under sedation. The eggs are collected from the ovaries using a fine needle.
08
Sperm Collection
On the day of egg retrieval, a sperm sample is collected from the male partner or a sperm donor. The sperm is then processed and prepared for fertilization.
09
Fertilization
The collected eggs and sperm are combined in a laboratory to facilitate fertilization. This can be done through conventional insemination or intracytoplasmic sperm injection (ICSI).
10
Embryo Culture
Fertilized eggs (embryos) are cultured in a controlled environment for several days. The embryologist monitors their development and selects the healthiest embryos for transfer.
11
Embryo Transfer
One or more healthy embryos are transferred into the patient’s uterus through a thin catheter. This procedure is usually painless and does not require anesthesia.
12
Luteal Phase Support
After the embryo transfer, the patient takes hormonal medications to support the uterine lining and enhance the chances of implantation.
13
Pregnancy Test
Approximately two weeks after the embryo transfer, a blood test is conducted to check for pregnancy. If the test is positive, the patient continues with early pregnancy monitoring and care.
14
Follow-up and Support
Regardless of the outcome, patients receive follow-up care and support from their fertility clinic. This includes emotional support, counseling, and further treatment planning if necessary.
2Fertility.com on IVF, https://www.fertility.com/en/fertility-treatment/ivf.html
What to ask your fertility specialist
You may encounter unfamiliar terms and complex medical procedures. Please refer to the IVF Road Map to better understand the fertility treatment journey.
Here are some questions you may want to consider asking your fertility specialist before starting any treatments.
What is the cost of fertility treatment? Is there any financial aid available?
How many embryos do you typically transfer per cycle?
What happens to the eggs once they are removed?
Can I freeze my eggs or sperm?
Can I transfer my frozen eggs/sperm to another clinic if needed?
What will you do with any remaining fertilised or unfertilised eggs?
If necessary, do you have a donor egg or sperm bank?
Do you perform genetic testing in your clinic?*
What support is available following embryo transfer?
What’s your process for determining a successful pregnancy?
Will another treatment cycle be successful?
What are the side effects and risks of this treatment?
*Subject to local regulations
There are several factors that influence fertility and it is important that couples understand these factors to kick start their fertility journey. Keep in mind that it is always best to consult your fertility expert as early on in your journey as possible.
Fertility Tests for Women
If you and your partner are having trouble conceiving and are seeking help to get pregnant, you’ll need to undergo a range of fertility tests. There can be many reasons why you and your partner may be struggling to conceive. Fertility testing helps your doctor to diagnose why you are finding it difficult to get pregnant, and to develop a personalised fertility treatment plan for you.
What fertility tests will be performed initially?
If you opt to visit your family doctor at the start of your fertility journey, they may conduct some simple and less invasive fertility tests on you or your partner. These may include:
General physical examination
Weight check
Pelvic and genital examination
Breast exam
Routine cervical screening (smear) test
Blood tests
Afterwards, you and/or your partner will be referred to a fertility specialist should there be a need for further or more invasive tests.
What Do Fertility Doctors Test For?
Your fertility doctor will check that you and/or your partner have:
The right balance of hormones to help eggs to mature
Regular ovulation
A healthy, functioning uterus and intact fallopian tubes
A thick uterus lining that could nourish an embryo
Should you have any concerns or require additional information, do not hesitate to ask your doctor or fertility team about their different roles and how they will be supporting you.
Preliminary Tests12
Personal History
You will be asked about your medical history and sex life in detail. If you feel uncomfortable discussing certain topics in front of your partner, ask to speak with your doctor in private.
Physical exam
You may have to undergo a pelvic examination to check the shape and size of your uterus. Your breasts may also be examined physically, with your weight and body mass index (BMI) measured.
Cervical screening (smear) test
You may be asked about the results from your most recent cervical screening test. If you have not gone for a cervical screening test recently, a new test may be performed. This procedure will help to rule out any infection or abnormal cells on your cervix.
Screening blood and urine tests
You will have some routine and some investigational blood and urine tests. For more information, please ask your fertility clinic about the tests that will be done.
General health tests
You may be tested for rubella (German measles), chlamydia, hepatitis B and C, and human immunodeficiency virus (HIV). Depending on your heritage, you may also be tested for diseases or disorders that are more common amongst certain ethnic groups, such as sickle cell anaemia or thalassaemia.
Fertility Tests
Hormone blood and urine tests
These tests will be taken on specific days of your menstrual cycle to measure different hormone levels3 and will help to determine if you are ovulating4,5 as well as the quality and quantity of the eggs produced (your ovarian reserve)6. Additionally, these tests will be able to help predict the ovary's response to IVF treatments. Depending on the couple, blood tests on either the female or the male may be necessary. These tests may include testing for day 3 follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), anti-mullerian hormone (AMH), prolactin, testosterone (T), and progesterone (P4)7.
Assessment of ovarian reserve
This assesses the remaining egg supply of a woman and is conducted via blood and ultrasound tests. Blood testing will show day 3 FSH, LH and estradiol hormone testing and AMH hormone levels, while the ultrasound checks for the ovarian volume and antral follicle counts.
Assessment of adequate ovulation
This assessment can be conducted in various ways. It has been discovered that about 25% of all infertility is caused by an ovulation disorder. One type of ovulation problem known as polycystic ovarian syndrome for example, can be effectively treated with medication.
Antral follicle count (AFC)
This test uses an internal ultrasound scan to show the number and size of follicles present in your ovaries8.
Anti-Mullerian Hormone (AMH)9
The anti-mullerian hormone (AMH) is a substance produced by granulosa cells in the ovarian follicles. Blood levels of this substance have been used in fertility tests to attempt to measure the size of the pool of growing ovarian follicles in women, since AMH is produced only in small ovarian follicles. AMH blood levels are thought to reflect the size of the remaining egg supply, also known as the “ovarian reserve”.
Temperature
Your temperature may also be taken throughout the menstrual cycle to identify when you are ovulating10.
Hysterosalpingogram (HSG)
This test applies a coloured dye inside the uterus to check the shape and size of the uterus and fallopian tubes. It will also show your doctor if there are any tubal blockages or cysts11.
Laparoscopy12
This test involves insertion of a small surgical telescope into the abdomen, under general anaesthetic. This allows your doctor to check for any blockages, growths or signs of endometriosis around the uterus and fallopian tubes.
If you require more information about a specific test, please do not hesitate to consult your fertility doctor.
2Dunson D, et al. Hum Reprod 2002;17(5):1399–1403.
3Harris I, et al. Rev Urol 2011;13(4):e184–e190
4The American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and The Practice Committee of the American Society for Reproductive Medicine. Fertil Steril 2014;101(3):633–634.
5The American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and The Practice Committee of the American Society for Reproductive Medicine. Fertil Steril 2014;101(3):633–634.
6American Society for Reproductive Medicine (ASRM). Age and fertility. A guide for patients. 2012. Available at http://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/Age_and_Fertility.pdf. Accessed: February 2018.
7The American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and The Practice Committee of the American Society for Reproductive Medicine. Fertil Steril 2014;101(3):633–634.
8American Society for Reproductive Medicine (ASRM). Age and fertility. A guide for patients. 2012. Available at http://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/Age_and_Fertility.pdf. Accessed: February 2018.
9The American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and The Practice Committee of the American Society for Reproductive Medicine. Fertil Steril 2014;101(3):633–634.
Fertility Tests for Men
What Do Fertility Doctors Test For?
Your fertility doctor will check that you have:
The right balance of hormones for
sperm to develop
Good quality and quantity of sperm
A healthy, functioning reproductive
tract
Unblocked sperm ducts
When first seeking fertility help, you will typically begin with your family doctor who can perform some basic examinations and blood or urine tests. You may then be referred to a male reproductive specialist (urologist or andrologist), or directly to a fertility clinic, for further tests or treatments.
Preliminary Tests
Personal history
You will be asked about your medical history and sex life in detail13. If you feel uncomfortable discussing certain subjects in front of your partner, you can speak with your doctor in private.
Physical exam
Your doctor will usually examine your penis, testicles and prostate gland (via your rectum) to check for any abnormalities14. They will also be looking for varicose veins around your scrotum (varicoceles) which can affect your fertility. They will also check that your sperm ducts (epididymis and vas deferens) are present and intact.
Blood and urine tests
You may be tested for rubella (German measles), hepatitis B and C and human immunodeficiency virus (HIV)15. Depending on your heritage, you may also be tested for diseases or disorders that are more common amongst certain ethnic groups, such as sickle cell anaemia or thalassaemia.
Semen analysis
You may be asked by your doctor to provide a semen sample. This sample can be collected either by masturbating at home or at your clinic. The quality and volume of semen will be tested, including sperm count, concentration, movement (motility), size and shape (morphology) of your sperm16.
Testicular biopsy
A testicular biopsy may be performed if no sperm have been seen in your semen sample17. You will be given an anaesthetic and your doctor will remove a small sample of tissue from one of your testicles. This sample will be tested to see if it contains any sperm that can be used in fertility treatment.
More Advanced Fertility Tests
Ultrasound scan (transscrotal ultrasound)
This scan will show any blockages or varicoceles around your testicles or sperm ducts that may be causing fertility issues18. Your doctor will pass a small device back and forth over your scrotum to pick up soundwaves, which are converted into an image. The transscrotal ultrasound is non-invasive and painless.
Transrectal ultrasound
This scan shows a more thorough overview of your prostate, the glands which produce your semen (seminal vesicles), and the sperm duct which carries sperm from your testicles to your urethra (vas deferens)19. Your doctor will insert a thin probe into your rectum while you lie on your side. Most men find this painless, although you may experience some mild discomfort.
Further semen analysis
If your initial semen analysis results are abnormal, you may need to provide another semen sample. Your doctor will check that enough sperm are alive, and that there are no antibodies or infections present in your semen20.
While it is natural to want answers as to what may be causing your fertility issues straight away, fertility testing can take some time. It can sometimes take months for you and your partner to perform all the necessary tests. In some cases, even after testing, some couples find that the reasons for their fertility difficulties remain unknown and they will be diagnosed with unexplained infertility.
It’s important to try to remain positive during this time. Getting a diagnosis is an important step forward in defining the right treatment to help you conceive.
2 American Society for Reproductive Medicine (ASRM). Fibroids and fertility. Fact sheet. 2015. Available at: http://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/fibroids_and_fertility_factsheet.pdf. Accessed: February 2018.
3American Society for Reproductive Medicine (ASRM). Endometriosis and infertility: A committee opinion. 2012. http://www.fertstert.org/article/S0015-0282(12)00585-7/pdf. Accessed: March 2018.
4American Society for Reproductive Medicine (ASRM). Medications for inducing ovulation. A guide for patients. 2016. Available at: http://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/booklet_medications_for_inducing_ovulation.pdf. 2014. Accessed: February 2018.
5Martyn F, et al. Human Reproduction 2014;29:2092–2098.
6American Society for Reproductive Medicine (ASRM). Endometriosis and infertility: A committee opinion. 2012. http://www.fertstert.org/article/S0015-0282(12)00585-7/pdf. Accessed: March 2018.
7American Society for Reproductive Medicine (ASRM). Age and fertility. A guide for patients. 2012. Available at: http://www.reproductivefacts.org/globalassets/rf/news-and-publications/bookletsfact-sheets/english-fact-sheets-and-info-booklets/Age_and_Fertility.pdf. Accessed: February 2018.
Disclaimer : The information provided by Merck is not a substitute for professional medical care or advice and intended for educational purposes only and should be used only as an aid in understanding the medical condition and treatment. A physician or another healthcare professional should always be consulted for any health problem or medical condition.
