January 7, 2025

A 38-year-old nulliparous woman presents to discuss IVF

By Med-Challenger · 2 minute read

A 38-year-old nulliparous woman presents with her husband to discuss in vitro fertilization (IVF). The couple has tried to become pregnant for more than 12 months and wishes to proceed with IVF rather than trying other infertility treatments due to the woman’s age.

At a minimum, what testing should be completed as part of the couple's evaluation prior to starting IVF?

Pap smear and pelvic examination, semen analysis, and HIV testing
uterine cavity evaluation, thyroid hormones and prolactin levels on the woman, and testosterone level on the man
ovarian reserve testing, screening for sexually transmitted infections, and urine culture
genetic testing (if indicated), ovarian reserve testing, uterine cavity evaluation, and semen analysis
semen analysis, endometrial biopsy, and screening both partners for sexually transmitted infections

The correct answer is:

genetic testing (if indicated), ovarian reserve testing, uterine cavity evaluation, and semen analysis

Before beginning IVF treatment, the couple must undergo a basic evaluation that includes ovarian reserve testing, appropriate genetic testing, semen analysis, and a uterine cavity evaluation. Determining the cause of infertility in this couple may pave the way for appropriate counseling about the success rate of IVF as well as other options beyond IVF.

Ovarian reserve is important when determining the likelihood of a successful embryo, and an evaluation of the uterine cavity may reveal abnormalities that could pose difficulties during implantation. Semen analysis may help determine the method required for fertilization. Genetic testing should be performed if either partner has a family history of genetic defect. The other tests listed above may also be needed following a history and physical examination findings. Specifically, HIV testing, screening for sexually transmitted infections, and other testing, such as rubella titers and testing to rule out hepatitis B and C virus infection, are recommended--and, in some cases, required--prior to conception or may be considered part of prenatal testing.

References:

Jayaprakasan K, Hopkisson J. Assisted reproduction treatments. In: Shaw RW, et al. Gynaecology. 4th ed., 2011:312-334.

Strauss JF III, Barbieri RL. Assisted reproduction. Strauss JF III, Barbieri RL. In: Yen & Jaffe's Reproductive Endocrinology. 7th ed., 2014: 734-773.e12.

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