Starting an in vitro fertilization (IVF) cycle is a significant step—and one that requires careful preparation long before any injections or procedures begin. For many people on the fertility journey, the volume of appointments, tests, and terminology in the lead-up to treatment can feel overwhelming. That’s completely understandable.
Here’s the important thing to know: pre-IVF diagnostic testing isn’t just a formality. It’s the foundation upon which your entire treatment plan is built. Every test serves a specific purpose, whether it’s predicting how your body will respond to stimulation medications, ensuring your uterus is structurally ready to support an embryo, or ruling out conditions that could quietly undermine a successful pregnancy.
This guide walks you through what tests are done before IVF, why each one matters, and what your care team at ONE Fertility Kitchener Waterloo is looking for along the way.
Ovarian Reserve Testing: Predicting Your Response to Medication
The first phase of your IVF fertility workup focuses on ovarian reserve—a measure of egg quantity, not necessarily quality (which is primarily influenced by age). These results help your physician determine the most appropriate starting dose of gonadotropin medications, and they flag potential risks like a poor response or ovarian hyperstimulation syndrome (OHSS).
Three key assessments are used:
- Anti-Müllerian Hormone (AMH): A blood test that can be drawn on any cycle day. AMH is produced by small follicles in the ovaries and provides a reliable snapshot of egg supply. Low AMH may indicate a reduced response to stimulation; high AMH can signal an increased OHSS risk.
- Day 3 FSH & Estradiol: These hormones must be measured on days 2, 3, or 4 of a natural menstrual cycle. Follicle-stimulating hormone (FSH) reflects how hard the brain is signalling the ovaries to produce eggs. Notably, an elevated estradiol level on day 3 can artificially suppress FSH, masking a diminished ovarian reserve.
- Antral Follicle Count (AFC): This involves a transvaginal ultrasound that counts resting follicles measuring 2–10 mm. The AFC provides a visual baseline that typically correlates closely with AMH results.
Together, these three data points help personalize your stimulation protocol from the outset.
Uterine Cavity and Fallopian Tube Evaluation
A common patient question at this stage is: If IVF bypasses the fallopian tubes, why do they need to be evaluated?
It’s a fair question—and the answer matters. If a tube is blocked and filled with fluid (a condition called hydrosalpinx), this toxic fluid can flow backward into the uterine cavity and cut embryo implantation success rates by up to 50%. Having this information before transfer is critical.
Several tests are used to evaluate the uterine environment:
- Hysterosalpingogram (HSG): A fluoroscopic X-ray that uses iodinated contrast dye injected through the cervix to visualize the uterine cavity and fallopian tubes. It detects blockages, structural abnormalities, and hydrosalpinx.
- Saline Infusion Sonogram (SIS) / Sonohysterography: Sterile saline is used to gently expand the uterine walls during a transvaginal ultrasound, offering a detailed 3D view of the cavity. This is particularly effective for detecting endometrial polyps, submucosal fibroids, and uterine adhesions (Asherman’s syndrome).
- Diagnostic Hysteroscopy (if Indicated): When the HSG or SIS reveals ambiguous findings, a thin endoscopic camera is passed through the cervix to directly visualize the uterine interior—and, in some cases, to perform immediate corrective procedures such as polypectomy or septum resection.
- Endometrial Receptivity & Microbiome Testing: For patients with recurrent implantation failure, specialized biopsies can be sent for Endometrial Receptivity Analysis (ERA) testing, which identifies the precise transfer window for optimal implantation, as well as ALICE/EMMA testing to detect chronic endometrial inflammation or microbiome imbalances.
Male Fertility Assessment: Semen Analysis and Beyond
Male-factor infertility contributes to approximately 40–50% of all infertility cases—yet it often goes unaddressed until later in the diagnostic process. A thorough male fertility evaluation is a core component of the IVF preparation checklist, not an afterthought.
The male fertility semen analysis evaluates several parameters according to WHO criteria:
- Volume & pH: Whether the transport medium for sperm is adequate and non-acidic.
- Concentration: The number of sperm per millilitre (normal: >15 million/mL).
- Motility: The percentage of sperm demonstrating progressive forward movement.
- Morphology (Kruger Strict Criteria): The proportion of structurally normal sperm. The threshold for “normal” is just 4%—surprisingly low, but clinically meaningful.
In addition to the standard semen analysis, your physician may order a Sperm DNA Fragmentation Assay (SDFA). This test measures the degree of DNA damage within the sperm head. High fragmentation rates can lead to poor blastocyst development and recurrent early pregnancy loss, even when a routine semen analysis appears completely normal. It’s a test that adds an important layer of information for many couples.
Systemic Health, Hormones & Infectious Disease Screening
This portion of the IVF testing phase timeline ensures that the person carrying the pregnancy is in optimal health and that the embryology laboratory environment is protected. The following tests are standard:
- Infectious Disease Panel: Testing for HIV 1 & 2, hepatitis B, hepatitis C, syphilis (RPR), and chlamydia/gonorrhea PCR is required by regulatory and laboratory safety guidelines. These results are necessary to prevent cross-contamination of tissues stored in the embryology lab.
- Thyroid Panel (TSH & Free T4): Thyroid-stimulating hormone (TSH) levels are ideally kept below 2.5 mIU/L before and during early pregnancy, as thyroid imbalances can affect implantation and early fetal development.
- Prolactin: Elevated prolactin, a hormone produced by the pituitary gland, can disrupt ovulation and egg quality.
- Hemoglobin A1c: Assesses blood sugar control; unmanaged diabetes carries an increased risk of miscarriage and birth defects.
- Rubella & Varicella Immunity: If immunity is absent, vaccination is recommended before proceeding, as both viruses can cause severe birth defects if contracted during pregnancy.
- Blood Type and Rh Factor: This testing identifies potential Rhesus (Rh) incompatibility issues that may need to be managed during pregnancy. Rh factor is a type of protein found on red blood cells.
Expanded Carrier Screening: A Pre-Conception Consideration
It’s worth distinguishing between two types of genetic testing that often come up during this process. Expanded Carrier Screening (ECS) is performed on the biological parents before the IVF cycle begins. Preimplantation Genetic Testing (PGT), by contrast, is performed on embryos during the IVF cycle itself.
ECS uses next-generation sequencing (NGS) of parental DNA—via blood or saliva—to screen for more than 100 autosomal recessive or X-linked conditions, including cystic fibrosis, spinal muscular atrophy, and fragile X syndrome. If both biological parents are carriers of the same condition, there is a 25% chance of passing it to a child. Identifying this risk before the cycle begins allows the care team to recommend preimplantation genetic testing for monogenic disorders (PGT-M) as part of the IVF protocol, should you choose to pursue it.
From Results to Protocol: What Happens Next?
Once all test results are in—typically within three to four weeks—the ONE Fertility Kitchener Waterloo team conducts a thorough protocol review. This is where the stimulation calendar is built, the medication doses are tailored, and any structural or health concerns are addressed before the cycle begins.
Completing the pre-IVF diagnostic testing phase is an investment of time up front, but the payoff is significant. A well-informed protocol reduces unnecessary interventions, minimises the risk of complications, and gives each cycle the strongest possible foundation for success.
If you have questions about what to expect during your diagnostic phase, or if you’d like to book a consultation with one of our specialists, contact ONE Fertility Kitchener Waterloo today.
Frequently Asked Questions
What tests are done before IVF?
Pre-IVF testing typically includes ovarian reserve assessment (AMH, Day 3 FSH & Estradiol, Antral Follicle Count), uterine and fallopian tube imaging (HSG, SIS, and in some cases hysteroscopy), a male fertility semen analysis, systemic bloodwork, including infectious disease screening and hormone levels, and expanded carrier screening for hereditary conditions.
How long do pre-IVF test results take?
Most results are returned within one to three weeks, with some specialized tests—such as genetic carrier screening—taking slightly longer. In most cases, the full diagnostic picture is complete within three to four weeks, after which the medical team reviews the results and builds a personalized stimulation protocol.
Does IVF require fallopian tube testing if eggs are retrieved directly from the ovaries?
Yes. Even though IVF bypasses the fallopian tubes during fertilization, a blocked and fluid-filled tube (hydrosalpinx) can leak fluid back into the uterus and significantly reduce embryo implantation rates—by up to 50%. Identifying this issue before a cycle allows the team to address it in advance.
What is the IVF fertility workup for male partners?
Male partners undergo a semen analysis to assess sperm count, motility, and morphology. If results are abnormal—or if there is a history of recurrent miscarriage with normal semen results—a Sperm DNA Fragmentation Assay may also be recommended to evaluate DNA integrity within the sperm.
What is expanded carrier screening and who needs it?
Expanded carrier screening tests both biological parents for genetic mutations associated with hereditary conditions like cystic fibrosis and spinal muscular atrophy. If both parents are carriers of the same condition, there is a 25% chance of passing it to a child. Identifying this risk before the cycle allows for informed decisions about additional genetic testing of embryos (PGT-M).
