Preliminary tests for IVF

Note the obligatory disclaimer: The below is from my personal knowledge and experience of IVF.  The exact advice and processes from your IVF clinic may differ.

What tests do you need before IVF?

There are tests that take place prior to the initial consultation, in order to give your IVF consultant the best understanding of your situation. These tests are booked through the IVF clinic and are:

Baseline pelvic scan - A transvaginal scan between days 2 and 6 of the cycle and a first meeting with your new best friend, the transvaginal ultrasound machine (AKA the twat wand). The test is seeing what your ovaries do when they think nobody is watching, checking whether everything is ‘normal’ in there, for example the number of follicles, any cysts, fibroids, other surprises.

Sperm analysis test – Your partner’s first visit to the wank room. The sperm is being checked for the usual parameters (volume, morphology, motility etc) to understand whether there is likely to be an issue with fertilisation of the collected eggs. If so, ICSI⁠ may be required, which is when the embryologists select a sperm and insert it into the egg.  

Blood test for AMH levels – Checking for ovarian reserve and an indicator of how your body will respond to the IVF stimulation drugs. Low AMH may show that stronger drugs are required and potentially fewer eggs collected. High AMH may point to PCOS and potential overstimulation of the ovaries. The results help the consultant to determine the appropriate drugs doses (known as your drugs protocol).

Do you need a smear test before IVF?

You must have a smear test within 3 years of starting IVF treatment. Cervical screening aims to check the health of the cervix and help prevent cervical cancer by detecting and treating abnormal changes in the neck of the womb. A smear test cannot be done once you are pregnant, so it needs to be up to date (which means within 3 years) before starting IVF treatment. This is commonly booked through your GP practice, rather than the IVF clinic.

What STDs do they test for before IVF?

All IVF patients are required to complete screening tests including HIV, Hepatitis B and Hepatitis C. The female partner having treatment is also required to have tests for Chlamydia and Rubella. These checks must be within three months of your first IVF treatment cycle, so it may be that the tests take place at a later appointment (such as the IVF drugs appointment) once your IVF schedule is known.

Complete a forest of preparatory paperwork 

Not a test, other than of your patience, but before the first IVF consultation you will need to complete forms, upon forms, upon forms. These forms ask for personal details, your status as a couple, your basic health history, etc. It feels similar to applying for a credit card, but with requests for results of medical tests and body max index thrown in.

It turns out not to be an urban myth. They do indeed ask if you are a paedophile, which makes me question what else is true. Did the pet snake really eat its owner and did the girl dry the cat in the microwave?

You will also be faced with some emotionally heavy questions in your pre-IVF forms, which may take time to ponder in advance. Examples include: what happens to any embryos if either partner dies? Or if you separate? Would you wish for the other partner to still use them? Would you give permission for your embryos that are not able to be used in treatment (because they are of insufficient quality) to be used in training by the clinic?

Being poked and prodded - my preliminary tests for IVF

Off we head to the IVF clinic for my preliminary tests. By some scheduling disaster, 'we' means me and my parents. They are visiting from abroad for a few days and do not consider a group trip to the fertility clinic to be as unreservedly weird as it most definitely is.

I need to have a baseline pelvic scan, between cycle days 2 and 6. When booking the appointment, the nurse reassured me on the phone ‘not to worry’ if I am still bleeding, as that is ‘normal'. But I can’t help but worry, as it feels a long way from my normal. The aim of the scan is to check what is going on in there before IVF begins, for example the number of follicles, any cysts, fibroids or other surprises, undoubtedly negative ones.  The surprise is never a tiny three month old foetus happily bouncing off the walls, always a gigantic three month old cyst, ready to burst.

We bundle into the car and drive to the IVF clinic, a small brick building on the outskirts of town that makes its title of ‘hospital’ appear ambitious. As I go for my scan, my parents sit in the waiting room thumbing through magazines and sipping tea. Which, to be fair, is probably what we would have been doing at home.

In the scan room for my baseline pelvic scan

My poshest pants hide under my trousers, which are folded neatly on the blue plastic chair next to the examination bed. From my belly button up, I look normal. A smart jumper, make-up, hair brushed. Presentable. But from the belly button down, a different tale is being told. The sonographer hands me a giant blue paper towel, which I wear in the style of a sarong, covering cold bare legs which are capped off with woolly socks. I’m not sure of the purpose of the sheet of blue paper. Or how best to wear it. I suppose it is to maintain my dignity, I conclude to myself, as I hop onto the bed and spread my legs.

The scan is enlightening. The sonographer’s squinting at the screen and frowning at my notes, is interspersed with ’ah! Look at that’ and 'you do know that you have a polycystic ovary, right?'. She tells me that my right ovary represents a clearer example than the one in her textbook. I flush with misplaced pride. And a little confusion as to where my ovary managed to hide its cysts for its previous scans.

15 minutes and it’s all done. I have a normal left ovary, but a polycystic right. During my fertility visualisation exercises, I would always imagine my left ovary releasing the egg. Always the left, like the right one decided it is all too much effort and closed its doors to business. It turns out that it had. When I later remarked on this oddity to my husband, he responded that it was indeed odd that I visualised my ovaries, somewhat missing my point.

The findings from the scan will be given to the consultant to plan my drugs protocol and I am released back into the wild, to continue my relaxing weekend with my now traumatised parents. On spotting my retired folks in the waiting area, it occurs to me that they have unwittingly performed an important public service. Every couple entering the clinic that morning would feel a confidence boost on observing my parents. No matter their medical history or how many failed IVF rounds they carry on their score sheet, they would still all conclude that they have a better chance of success than the mature couple in the corner.

Up to date Smear test

One needs to have had a smear test within three years of beginning IVF treatment and, of course, mine had just run out. To get an up to date test, I book an appointment with the nurse at my GP practise. As part of the NHS cervical screening programme, women my age are offered, even encouraged to attend, a smear every three years. It is a standard service and mine is overdue.

It is a mistake to mention IVF, I realise too late. The nurse says, snippily in my view, "well, we don't do additional smears just to help you with your IVF". What a sensitive soul, dealing delicately with my troubling situation. She spends a moment scowling at her computer records and I dare not sit down, in case I’m not invited to stay. The nurse delivers an unnecessary tut, just for me, then concedes that "we will do it if it is overdue. Which it is, so....fine" rendering her judgmental comment on my IVF obsolete. What an absolute sweetie, thank you.

My days of being embarrassed or coy about a smear test have long departed. Since infertility I'm all come on lady, roll up your sleeves and get stuck in. No pussy footing around (pun intended). If more than a month or two has passed since a medical professional last fiddled with my privates, I feel neglected. Is it something I said? Are you seeing someone else? Still, on this occasion I consider it prudent to brace myself, as intuition tells me this nurse is not a gentle soul.