The technique of in vitro fertilization involves the proper preparation of both partners. Before the treatments starts, the patient and her partner have to undergo a number of tests according to the doctor’s recommendations. Infertility diagnosis should always be conducted in both partners at the same time.
Before starting ovarian stimulation, doctors should endeavor to determine the cause of ovarian function disorders and to normalize the female patient’s body mass. It is necessary to verify the patency of fallopian tubes and to carry out the male partner’s semen analysis.
In the beginning, both partners are interviewed with special regard to the factors which may have impact on the safety of IVF procedure and on the determination of the likely prognosis as regards the success of the procedure. Both female and male patient, on their own or assisted by a nurse, a midwife or a patient assistant, complete the forms of the first-time questionnaire, which concern their medical and genetic history. The doctors need to get answers to the questions concerning, among others, the age at menarche, cycle duration, symptoms of ovulation, previous obstetric history, congenital diseases in the family, previous inflammations of the adnexa of uterus, existing or previous serious systemic diseases, sexually transmitted diseases, use of stimulants and the occurrence of addictions.
In the case of a male patient, it is important to determine, among others, the facts as regards his previous fertility, childhood diseases, developmental interview, previous and existing diseases including systemic diseases (e.g. diabetes), congenital diseases in the family, past surgeries and applied therapies, previous sexually transmitted diseases, gonad exposure to toxic factors, including increased temperature.
According to the applicable EU directives, prior to in vitro fertilization both partners should undergo tests for hepatitis B, hepatitis C and HIV.
In addition, tests for Chlamydia and syphilis are recommended.
Before the initiation of the treatment, the female patient should undergo physical examination as well as selected hormonal tests and imaging. It is necessary to carry out a gynecological examination, collect a sample for the cervical smear test (or obtain the normal results of the smear test performed not earlier than 12 months ago), vaginal pH, and, potentially, culture. The ultrasound examination of the reproductive tract is carried out with the assessment of antral follicle count (by means of a vaginal probe), hormone tests and basic tests related to the ovarian puncture and general anesthesia (including the obligatory blood group determination), as well as genetic tests including karyotype from lymphocytes, CFTR and other tests.
In order to assess the anatomy of the female reproductive organs, imaging tests have to be carried out, such as USG (ultrasonography) and hysterosalpingography (HSG) or hystero-salpingo contrast sonography (HyCoSy). When there are clinically suspected anomalies of fallopian tubes, the method of choice is laparoscopy with the examination of tubal patency (the so-called gold standard in the assessment of tubal patency), and when uterine changes are suspected – the hysteroscopy. In the case of suspected pathologies of fallopian tubes or uterine cavity (uterine fibroids, uterine septum) and endometriosis, a surgical treatment is considered.
The basis diagnostic test is semen analysis, and in the case of its abnormal result, potential additional tests should be carried out according to medical indications. Before initiating the treatment, a male partner should have andrological consultation with an andrologist, urologist or a doctor from the Fertility Clinic. During the consultation, the doctor examines the patient by palpation and assesses the structure of reproductive organs, size and location of testicles, location of the urethral orifice, presence and consistency of the vasa deferentia and epididymides, presence of varicocele. The doctor may also recommend the ultrasound examination and endocrine assessment of the patient (including the determination of the serum levels of gonadotropins, prolactin and testosterone), and also the determination of the karyotype from lymphocytes, analysis of Y chromosome deletions, genetic tests for the presence of CFTR gene mutations, AZF.