Pre IVF Evaluation of the Infertile Woman



Patients presenting for infertility have the advantage of receiving a complete preconception evaluation including recommended antenatal screening, appropriate referrals to specialists as necessary, and optimizing health for pregnancy. Testing to determine optimal treatment includes, at a minimum, ovarian reserve screening, uterine cavity evaluation, and semen analysis. Balancing psychological, emotional, and financial pressures with realistic expectations in a supportive physician–patient relationship is essential in guiding treatment. While not all infertile women require IVF to achieve pregnancy, the clinical algorithm remains the same as for those who ultimately proceed to IVF.


Celiac Disease Spinal Muscular Atrophy Ovarian Reserve Infertile Woman Recurrent Pregnancy Loss 
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  1. 1.
    Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. 2009 Assisted reproductive technology success rates: national summary and fertility clinic reports. Atlanta, GA: US Department of Health and Human Services; 2011. Accessed 2 Jan 2012.
  2. 2.
    Olive DL, Lindheim SR, Pritts EA. Endometriosis and infertility: what do we do for each stage? Curr Womens Health Rep. 2003;3(5):389–94.PubMedGoogle Scholar
  3. 3.
    Senapati S, Barnhart K. Managing endometriosis-associated infertility. Clin Obstet Gynecol. 2011;54(4):720–6.PubMedCrossRefGoogle Scholar
  4. 4.
    NIH Consensus Statement on Celiac Disease. NIH Consens State Sci Statements. 2004; 21(1):1–22. Accessed 16 Mar 2012.
  5. 5.
    American Academy of Pediatrics Committee on Fetus and Newborn and the American College of Obstetricians and Gynecologists Committee on Obstetric Practice. Antepartum care. Guidelines for perinatal care. 6th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2007.Google Scholar
  6. 6.
    American College of Obstetricians and Gynecologists. Obesity in pregnancy. ACOG Committee opinion no. 315. Obstet Gynecol. 2005;106:671–5 (reaffirmed 2008).CrossRefGoogle Scholar
  7. 7.
    Rittenberg V, Seshadri S, Sunkara SK, Sobaleva S, Oteng-Ntim E, El-Toukhy T. Effect of body mass index on IVF treatment outcome: an updated systematic review and meta-analysis. Reprod Biomed Online. 2011;23(4):421–39. Accessed 2 Jan 2012.PubMedCrossRefGoogle Scholar
  8. 8.
    Moragianni VA, Jones SML, Ryley DA. The effect of BMI on outcomes of first assisted reproductive technology cycles. Fertil Steril. 2012;98:102–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Shah DK, Missmer SA, Berry KF, Racowsky C, Ginsburg ES. Effect of obesity on oocyte and embryo quality in women undergoing in vitro fertilization. Obstet Gynecol. 2011;118(1):63–70.PubMedCrossRefGoogle Scholar
  10. 10.
    Depalo R, Garruti G, Totaro I, et al. Oocyte morphological abnormalities in overweight women undergoing in vitro fertilization cycles. Gynecol Endocrinol. 2011;27(11):880–4.PubMedCrossRefGoogle Scholar
  11. 11.
    American College of Obstetricians and Gynecologists. Preconception and prenatal carrier screening for genetic diseases in individuals of eastern European Jewish descent. ACOG Committee opinion no. 442. Obstet Gynecol. 2009;114(4):950–3.CrossRefGoogle Scholar
  12. 12.
    Pratt LA, Brody DJ, Gu Q. Antidepressant use in persons aged 12 and over: United States, 2005–2008. NCHS data brief, no 76. Hyattsville, MD: National Center for Health Statistics. 2011. Accessed 1 Feb 2012.
  13. 13.
    Coutifaris C, Mayers ER, Guzick DS, et al. Histological dating of timed endometrial biopsy tissue is not related to fertility status. Fertil Steril. 2004;82:1264–72.PubMedCrossRefGoogle Scholar
  14. 14.
    Grimes DA. Validity of the postcoital test. Am J Obstet Gynecol. 1995;172:1327.PubMedCrossRefGoogle Scholar
  15. 15.
    Bayer SR, Alper MM, Penzias AS, editors. Boston IVF handbook of infertility. 3rd ed. New York: Informa Healthcare; 2011.Google Scholar
  16. 16.
    Fritz MA, Speroff L, editors. Clinical gynecologic endocrinology and infertility. 8th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2011.Google Scholar
  17. 17.
    Verhagen TE, Hendriks DJ, Bancsi LF, Mol BW, Broekmans FJ. The accuracy of multivariate models predicting ovarian reserve and pregnancy after in vitro fertilization: a meta-analysis. Hum Reprod Update. 2008;14(2):95–100.PubMedCrossRefGoogle Scholar
  18. 18.
    van Rooij IA, Bancsi LF, Broekmans FJ, Looman CW, Habbema JD, te Velde ER. Women older than 40 years of age and those with elevated follicle-stimulating hormone levels differ in poor response rate and embryo quality in in vitro fertilization. Fertil Steril. 2003;79(3):482–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Abdalla H, Thum MY. An elevated basal FSH reflects a quantitative rather than qualitative decline of the ovarian reserve. Hum Reprod. 2004;19(4):893–8.PubMedCrossRefGoogle Scholar
  20. 20.
    Toner JP. Age  =  egg quality, FSH level  =  egg quantity. Fertil Steril. 2003;79(3):491.PubMedCrossRefGoogle Scholar
  21. 21.
    Yanushpolsky EH, Hurwitz S, Tikh E, Racowsky C. Predictive usefulness of cycle day 10 follicle-stimulating hormone level in a clomiphene citrate challenge test for in vitro fertilization outcome in women younger than 40 years of age. Fertil Steril. 2003;80(1):111–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Hofmann GE, Danforth DR, Seifer DB. Inhibin-B: the physiologic basis of the clomiphene citrate challenge test for ovarian reserve screening. Fertil Steril. 1998;69(3):474–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Urbancsek J, Hauzman E, Klinga K, Rabe T, Papp Z, Strowitzki T. Use of serum inhibin B levels at the start of ovarian stimulation and at oocyte pickup in the prediction of assisted reproduction treatment outcome. Fertil Steril. 2005;83(2):341–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Hall JE, Welt CK, Cramer DW. Inhibin A and inhibin B reflect ovarian function in assisted reproduction but are less useful at predicting outcome. Hum Reprod. 1999;14(2):409–15.PubMedCrossRefGoogle Scholar
  25. 25.
    Fanchin R, de Ziegler D, Olivennes F, et al. Exogeneous follicle stimulating hormone ovarian reserve test (EFORT): a simple and reliable screening test for detecting “poor responder” in in-vitro fertilization. Hum Reprod. 1994;9:1607–11.PubMedGoogle Scholar
  26. 26.
    Frattarelli JL, Levi AJ, Miller BT, Segars JH. A prospective assessment of the predictive value of basal antral follicles in in vitro fertilization cycles. Fertil Steril. 2003;80(2):350–5.PubMedCrossRefGoogle Scholar
  27. 27.
    Chang MY, Chiang CH, Hsieh TT, Soong YK, Hsu KH. Use of the antral follicle count to predict the outcome of assisted reproductive technologies. Fertil Steril. 1998;69(3):505–10.PubMedCrossRefGoogle Scholar
  28. 28.
    Erdem M, Erdem A, Guler I, Atmaca S. Role of antral follicle count in controlled ovarian hyperstimulation and intrauterine insemination cycles in patients with unexplained subfertility. Fertil Steril. 2008;90(2):360–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Visser JA, de Jong FH, Laven JS, Themmen AP. Anti-Müllerian hormone: a new marker for ovarian function. Reproduction. 2006;131(1):1–9.PubMedCrossRefGoogle Scholar
  30. 30.
    van Rooij IA, Broekmans FJ, te Velde ER, et al. Serum anti-Müllerian hormone levels: a novel measure of ovarian reserve. Hum Reprod. 2002;17(12):3065–71.PubMedCrossRefGoogle Scholar
  31. 31.
    Seifer DB, Baker VL, Leader B. Age-specific serum anti-Mullerian hormone values for 17,120 women presenting to fertility centers within the United States. Fertil Steril. 2011;95:747–50.PubMedCrossRefGoogle Scholar
  32. 32.
    Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update. 2006;12(6):685–718.PubMedCrossRefGoogle Scholar
  33. 33.
    Pittaway DE, Winfield AC, Maxson W, et al. Prevention of acute pelvic inflammatory disease after hysterosalpingography: efficacy of doxycycline prophylaxis. Am J Obstet Gynecol. 1983;147:623–6.PubMedGoogle Scholar
  34. 34.
    Practice Committee of the American Society for Reproductive Medicine in collaboration with The Society of Reproductive Surgeons. Salpingectomy for hydrosalpinges before in vitro fertilization increases the success rate. Fertil Steril. 2008;90:S66–8.Google Scholar
  35. 35.
    Alper MM, Garner PR, Spence JE, et al. Pregnancy rates after hysterosalpingography with oil- and water-soluble contrast media. Obstet Gynecol. 1986;68:6–9.PubMedGoogle Scholar
  36. 36.
    Galen DI, Khan N, Richter KS. Essure multicenter off-label treatment for hydrosalpinx before in vitro fertilization. J Minim Invasive Gynecol. 2011;18(3):338–42.PubMedCrossRefGoogle Scholar
  37. 37.
    Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril. 2004;81(1):19–25.CrossRefGoogle Scholar
  38. 38.
    Gharib H, Tuttle RM, Baskin HJ, Fish LH, Singer PA, McDermott MT. Subclinical thyroid dysfunction: a joint statement on management from the American Association of Clinical Endocrinologists, the American Thyroid Association, and the Endocrine Society. J Clin Endocrinol Metab. 2005;90(1):581–7.PubMedCrossRefGoogle Scholar
  39. 39.
    Klipstein S, Regan M, Ryley DA, Goldman MB, Alper MM, Reindollar RH. One last chance for pregnancy: a review of 2,705 in vitro fertilization cycles initiated in women age 40 years and above. Fertil Steril. 2005;84(2):435–45.PubMedCrossRefGoogle Scholar
  40. 40.
    Malizia BA, Hacker MR, Penzias AS. Cumulative live-birth rates after in vitro fertilization. N Engl J Med. 2009;360(3):236–43.PubMedCrossRefGoogle Scholar
  41. 41.
    The Practice Committee of the Society for Assisted Reproductive Technology and the Practice Committee of the American Society for Reproductive Medicine. Guidelines on the number of embryos transferred. Fertil Steril. 2008;90:S163–4.Google Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  1. 1.Department of Obstetrics & GynecologyBeth Israel Deaconess Medical CenterBostonUSA
  2. 2.Department of Obstetrics & GynecologyHarvard Medical SchoolWalthamUSA

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