Fertility assessment: the checklist I give to every patient before their first appointment

The scenario I see most often is this: a patient books an appointment with a clinic abroad, the doctor asks for a medical file, and half the documents are missing. Three weeks go by, then another three, and the cycle is lost. Here is the complete list, in the order in which I ask patients to complete it.

For the woman: hormone tests

• AMH — any day of the cycle. Please state if you’re currently using hormonal contraception. How to interpret the result.
• FSH, LH, oestradiol — on the second or third day of the cycle, without fail.
• TSH and, if abnormal, free T4 and anti-thyroid antibodies. Even mild hypothyroidism can be treated and improves outcomes.
• Prolactin — in the morning, on an empty stomach, whilst at rest.
• Vitamin D, which is often low and easy to correct.
• In the event of irregular cycles or signs of hyperandrogenism: testosterone, SDHEA, 17-OH-progesterone, and a fasting blood glucose test with insulin levels.

For women: imaging

• Pelvic ultrasound with antral follicle count, between the second and fifth day of the cycle. This is an essential complement to the AMH test.
• Hysterosalpingography or HyFoSy to check fallopian tube patency, in the first part of the cycle following menstruation. Not necessary if proceeding directly to IVF with donor eggs, but essential before any insemination.
• Diagnostic hysteroscopy — the test most often overlooked. It checks for polyps, septa, adhesions and chronic endometritis. Many clinics request this before a first embryo transfer, and all do so following a failed attempt. See the article on recurrent failure.
• Pelvic MRI if endometriosis or adenomyosis is suspected. Details here.

For the male partner

• Semen analysis including a sperm cytogram, following two to five days of abstinence. If abnormalities are found, a repeat test should be carried out after a three-month interval.
• Sperm DNA fragmentation test in cases of miscarriages, repeated failures, or advanced paternal age. Often not covered by insurance, often decisive. See the dedicated article.
• Sperm culture if the semen analysis shows white blood cells.
• Hormone profile (FSH, LH, testosterone) and scrotal ultrasound if the parameters are significantly abnormal.
• Karyotype and Y-chromosome microdeletions if the concentration is very low.

For both: what the clinic will require

No licensed clinic will schedule a transfer without these documents, and they have an expiry date:

• Serological tests: HIV 1 and 2, hepatitis B and C, syphilis, and, depending on the clinic, HTLV, CMV, toxoplasmosis and rubella. Generally valid for six months, sometimes three. Do not have them done too early.
• Blood group and Rhesus factor for both partners.
• Cervical smear taken within the last three years, sometimes within the last year.
• Karyotypes for both partners in cases of recurrent miscarriages or abnormal sperm.
• Identity documents and, for a single woman or a donor, notarised consents. The administrative details for single women are available here.

The procedure and timetable

A full assessment is carried out over one or two cycles, no more, provided it is planned in advance:

1. Days 2 to 5 of the cycle: full blood test (FSH, LH, oestradiol, AMH, TSH, prolactin, vitamin D) and ultrasound scan with follicle count. Everything is carried out on the same morning.
2. Days 6 to 12: hysterosalpingography or HyFoSy if necessary.
3. In parallel: semen analysis, serological tests for both partners, cervical smear if the last one is out of date.
4. Depending on the results: hysteroscopy, MRI, karyotyping, DNA fragmentation analysis.

Almost all costs are covered by the French health insurance system as part of an infertility assessment prescribed by your gynaecologist or GP. The usual exceptions are sperm DNA fragmentation, certain genetic tests and vitamin D, depending on the circumstances.

The tip that saves the most time

Compile everything into a single PDF, in chronological order, including the full reports rather than screenshots. Add the reports from your previous attempts, if any: treatment protocols used, doses, number of eggs, embryo quality, and transfer dates. This is the file the doctor reads before the video consultation, and it makes all the difference between an appointment where a strategy is proposed and one where you’re asked to have further tests.

Frequently asked questions

Source: https://fertilitegrece.com/en/blog/fertility-workup-tests/ — Triada Baloukoudis, IVF patient coordination in Greece. General information, not medical or legal advice. Printed on

Triada Baloukoudis
Independent IVF patient coordinator in Thessaloniki, with 24 years of experience supporting patients travelling from abroad. More · Contact · Facebook