Female fertility evaluation

You have to do a female fertility evaluation before you can do IVF. The evaluation is needed to discover possible causes of infertility. Here we describe everything you need to know about how the fertility evaluation works.

Step 1: Infertility History Form

Prior to your first fertility evaluation visit, you usually need to fill out an (infertility) history form. This document helps the clinic quickly assess if there are any obvious reasons for infertility such as illness, medication or surgery. Once you have decided where you want to do your fertility evaluation, you can search the clinic’s website for information on the type of history form required. It is often possible to download the form online and fill out in advance and then bring it to the clinic for the next step of the fertility evaluation. Also beware that you might have to fill out some additional forms before your first visit. It can be good to bring your medical records to the clinic as well. Check the homepage to see if it’s mandatory.

Step 2: Consultation, examination and ultrasound

• Consultation
  At the first visit you will meet a physician to discuss your history form and your medical history to assess your health and lifestyle, your sexual life and your period. This may include discussing any long-term conditions or surgeries, medicines you take, if you have been pregnant before or have children from previous relationships, or if you have had any miscarriages. After the consultation a gynecological examination and a vaginal ultrasound is carried out.
• Gynecological examination and vaginal ultrasound
  A basic gynecological examination and a vagial ultrasound is carried out to look for polycystic ovaries, larger ovarian cysts and fibroids. It is also sometimes done to confirm that ovulation is taking place. Sometimes you may be asked to check your ovulation yourself with ovulation tests.

Step 3: Blood tests

You will most likely need to take different blood tests. Sometimes these tests can be taken during the first visit, while others will be taken during the next appointment. Your clinic will inform you about which tests are relevant for you.

The most common blood tests are:

• AMH (anti-müllerian hormone) shows how many eggs you have and therefore measures the capacity of your ovarian reserve.
• TSH (thyroid-stimulating hormone, free T4) to analyze your thyroid function and metabolism (since metabolism is controlled by the thyroid gland). The TSH value can indicate if you have any deviations in metabolism that can in itself affect the ovulation and the risk of miscarriage.
• PRL (prolactin, also known as luteotropic hormone or luteotropin, a hormone that enables females to produce milk) is measured in some cases. For example, if you have menstrual disorders affecting fertility.
• Progesterone (blood test) can be taken approximately a week after you have ovulated. Therefore, if you are going to do a progesterone test, you also need to take ovulation tests yourself to know when ovulation occurs. The clinic will inform you when to start with the tests. It’s usually done on day 9 of your menstrual cycle.

(Step 4: Examination of the uterus and fallopian tubes)

Some women may need to examine the condition of the uterus and see whether there are any blockages in the fallopian tubes. This is done through a so-called hysterosalpingography (HSG). It’s most often done if you have not found any explanation for infertility in the earlier steps of the fertility evaluation and / or if you consider, for example, fertility treatments other than IVF. Some IVF clinics will always do an HSG.

(Step 5: More rarely performed examinations)

Depending on your situation you may have to do a hysteroscopy to look for uterine disease and a laparoscopy to identify endometriosis, scarring, blockages or irregularities of the fallopian tubes, and problems with the ovaries and uterus. These are, however, more rare examinations.

What happens next?

When the clinic has analyzed the results of the evaluation, the underlying cause of infertility can be determined. This then forms the basis for which fertility treatment is most suitable to do.

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