If you need IVF treatment in order to get pregnant, we have to do certain tests to determine: 1. If we do IVF for you 2. What type of IVF treatment would be best for you (IVF: ICSI ZIFT Donor Egg) 3. What chances of success are many clinics to a huge pile of evidence routinely before starting IVF treatment. They use a checklist approach can senseless drain some blood and money! Many of these tests are meaningless, since they provide little useful information. However, this seems the norm, especially in major IVF centers (that run as mills and employ a large number of physicians) as well as in the U.S., where the test is often done for nonmedical reasons. We prefer to adopt a simplified, patient friendly approach, focusing on what is important medially. We customize these tests, depending on the patient. In order to do IVF, we just have to remember to check the following: eggs, sperm, uterus and fallopian tubes. In general, not just the following simple medical tests before starting an IVF cycle. If the tests were done in the past year, there is no need to repeat them. For the husband, all we need is a simple analysis of semen (www.drmalpani.com / semen analysis.htm), to check the sperm count, motility and morphology. a. If your normal, then we do IVF. b. If your abnormal, then we do ICSI. If there is an element of doubt (for example, counts vary widely), then ICSI is a safer option, as fertilization is guaranteed c. If its zero, then we must consider the sperm retrieval by TESE or PESA Women need more extensive testing. 1. blood tests for the following reproductive hormones: FSH (follicle stimulating hormone), LH (luteinizing hormone), PRL (prolactin) and TSH (thyroid stimulating hormone), the cycle day 3, (to check the quality of eggs). This must be done from a reliable lab such as Specialty Ranbaxy (www.srl.in). If these tests are normal, then the standard superovulation regimen can be followed. However, if there is a problem, then this must be corrected. a. A high prolactin (www.drmalpani.com / prolactin.htm) can be corrected by treatment with bromocriptine or cabergoline B. Abnormal levels of thyroid (www.drmalpani.com / thyroid.htm) can be treated with medications c. An abnormal LH: FSH suggests PCOS. This must be corrected before starting metformin IVF. Furthermore, superovulation must be softer d. High levels of FSH and high FSH: LH level suggests poor ovarian reserve. This means that the response to superovulation can be poor and reduces the success rate. Poor ovarian reserve (www.drmalpani.com / oopause.htm). Additional testing may be necessary, as a stimulation test clomid; tests AMH (antihormone levels M�ller) and antral follicle count. The options may include treating ovarian reserve improve with empirical treatment and more aggressive use of superovulation for IVF. An alternative would be to consider donor eggs or donor embryos 2. a (Hysterosalpingography HSG, Xray of the uterus and tubes) on Day 8 of the cycle (to confirm normal uterine cavity and fallopian tubes are open. You can read about it in www.drmalpani.com / hsg . htm. The HSG can be painful and not always essential prior to IVF. However, it is a great way to document that the uterus is anatomically normal (especially in cities with poor medical services). Alternatives HSG include vaginal ultrasound scan, but the quality should be high. If the HSG is normal and the fallopian tubes are normal, then an additional treatment option that can offer is TET (www.drmalpani.com / zift.htm) where embryos can be transferred directly into the fallopian tubes instead of the uterine cavity, to improve chances of implantation. 3. ultrasound vaginal ultrasound on day 10 or 11, you should check the following. AB ovarian volume account antral follicle d. c. uterus endometrial thickness and texture morphology Since the interpretation of ultrasound is so subjective, it is important to do this at a good quality. The best centers have digital ultrasound machines, which enable them to give a scanner into a JPEG file you can save on a DVD or flash drive. If there is an anomaly, then the latest ultrasound techniques, such as 3D ultrasound vaginal provide more information. If a polyp, then it will have to be removed to do a hysteroscopy. intramural fibroids (uterine wall) need not be removed prior to IVF because it does not affect embryo implantation. You can read more about this in www.drmalpani.com / fibroidsandinfertility.htm. submucosal fibroids (found in the uterine cavity) must be eliminated. can be removed with better surgical hysteroscopy (www.drmalpani.com / hysteroscopy.htm). Always insist on a copy of your medical record. What are the other tests needed All clinics also will be tested for infectious diseases such as HIV, hepatitis B and VDRL. Other tests include checking of rubella immunity, if have not been vaccinated against rubella. If the test shows that there is a problem, then this can be treated before starting IVF! Other clinical tests are much more extensive. these include tests for esoteric conditions such as: immunity testing, testing for tuberculosis (including blood tests for antibodies against tuberculosis and PCR in an endometrial biopsy), routine hysteroscopy to check the uterine cavity, and evidence of TORCH. Many patients are very impressed by proof doctors for so many people. They feel these doctors are very careful and thorough! However, the truth is that most of these tests are useless and just waste time and money. Before doing all these tests, ask doctor for a simple question: do the results of this test change my IVF treatment Remember, if the test result will not change their treatment, theres no point in doing the test! br br
