What Tests Should Be Done Before IVF?

Before starting IVF treatment, most patients undergo a fertility and medical assessment to understand the factors that may affect treatment and to help the fertility specialist choose an appropriate protocol.

There is no single set of tests that every IVF patient needs. The exact evaluation depends on age, medical history, fertility diagnosis, previous treatment, ovarian reserve, sperm factors and whether there are known problems involving the uterus, fallopian tubes or other reproductive organs.

Common pre-IVF assessments may include:

• Medical and reproductive history
• Ovarian reserve assessment
• Pelvic ultrasound
• Assessment of the uterus and, when indicated, the fallopian tubes
• Semen analysis
• Selected hormone or ovulation tests
• Infectious disease screening required before treatment
• Genetic testing in selected patients
• Additional investigations when the medical history or previous test results indicate a need

The purpose of these tests is not simply to collect laboratory results. Pre-IVF testing helps identify relevant fertility factors, assess ovarian response, evaluate sperm and reproductive anatomy, and identify medical issues that may need attention before treatment begins.

Dr. Emad Darwish’s fertility services include pre-IVF assessment and fertility testing, with evaluation of hormonal factors, semen, ultrasound findings and the uterus and ovaries.

 

Why Are Tests Needed Before IVF?

IVF involves ovarian stimulation, egg retrieval, fertilization in the laboratory and embryo transfer. The treatment protocol therefore needs to be adapted to the individual patient.

Pre-IVF assessment can help answer important questions such as:

• How many follicles are likely to respond to ovarian stimulation?
• Is there evidence of diminished ovarian reserve?
• Is ovulation occurring normally?
• Are there abnormalities involving the uterus or ovaries?
• Are the fallopian tubes relevant to the treatment plan?
• Is there a male-factor fertility problem?
• Is ICSI potentially relevant because of sperm-related or previous fertilization factors?
• Are there medical conditions that need to be addressed before treatment?
• Are infectious disease screening tests required?
• Is genetic testing appropriate because of the patient’s or family’s medical history?

A complete assessment can therefore help the fertility specialist develop a treatment plan based on the patient’s individual circumstances rather than applying the same IVF protocol to everyone.

 

What Tests Are Usually Done Before IVF?

1. Medical and Fertility History

The first part of a pre-IVF assessment is not necessarily a blood test. It is a detailed review of your medical and reproductive history.

Your fertility specialist may ask about:

• Age
• Menstrual cycle pattern
• Previous pregnancies and their outcomes
• How long you have been trying to conceive
• Previous fertility treatments
• Previous IVF or ICSI cycles
• Previous miscarriages
• Previous pelvic or abdominal surgery
• Endometriosis
• PCOS
• Previous pelvic infections
• Medical conditions
• Current medications
• Previous chemotherapy or radiation
• Family history of reproductive or genetic conditions

Previous test results are also useful. If you have already had an ultrasound, AMH test, HSG, semen analysis or other fertility investigation, bring the reports to your consultation.

This information helps determine which investigations are actually necessary.

 

2. Ovarian Reserve Testing

Ovarian reserve refers broadly to the remaining quantity of eggs in the ovaries.

Before IVF, ovarian reserve assessment can help the specialist anticipate how the ovaries may respond to ovarian stimulation and support treatment planning.

Common markers include:

• AMH, or anti-Müllerian hormone
• Antral follicle count, or AFC, measured by ultrasound
• In selected circumstances, other hormonal measurements

AMH and AFC can provide useful information about expected ovarian response, but they should not be interpreted as a simple test of whether someone can or cannot become pregnant.

ASRM states that ovarian reserve markers are useful for predicting ovarian response to stimulation but are poor independent predictors of reproductive potential, particularly when separated from factors such as age and diagnosis.

The 2026 NICE fertility guideline similarly recommends AMH or AFC to help predict ovarian response and inform counselling about assisted conception, while not using AMH as a predictor of spontaneous pregnancy.

 

Does Everyone Need an AMH Test Before IVF?

AMH is commonly useful in IVF planning, but the result should be interpreted in context.

A low AMH level does not automatically mean that IVF will fail, and it does not by itself determine whether IVF is appropriate.

Similarly, a higher AMH level does not guarantee a successful IVF outcome.

Age, ovarian reserve, diagnosis, sperm factors, embryo development and other clinical factors all contribute to treatment planning.

 

3. Pelvic Ultrasound

A pelvic ultrasound, usually performed transvaginally when appropriate, is an important part of many fertility assessments.

It can help evaluate:

• The uterus
• The ovaries
• Antral follicles
• Ovarian cysts
• Fibroids
• Endometrial appearance
• Other pelvic findings

Ultrasound may also provide the antral follicle count, which can contribute to ovarian reserve assessment and stimulation planning.

ACOG lists ultrasound among the imaging investigations that may be used during infertility evaluation.

The ultrasound findings may also help determine whether additional uterine or pelvic investigations are necessary.

 

4. Semen Analysis

A semen analysis is one of the most important tests when sperm will be used for IVF.

The test can assess characteristics including:

• Sperm concentration
• Sperm motility
• Sperm morphology
• Semen volume

The results can help identify male-factor infertility and may influence the laboratory fertilization strategy.

A semen analysis is particularly important because fertility difficulties can involve male factors, female factors, both partners, or sometimes no clearly identifiable cause.

ACOG includes semen analysis as a basic component of male infertility evaluation, while NICE recommends semen analysis as part of the assessment of male-factor fertility problems.

What If the Semen Analysis Is Abnormal?

An abnormal result does not necessarily provide the complete picture from one test.

Depending on the findings, a repeat semen analysis or additional male reproductive assessment may be appropriate.

For significant sperm abnormalities, the fertility team may also consider whether ICSI is appropriate as part of IVF.

Additional male-factor tests, including certain genetic investigations, are generally reserved for selected clinical situations rather than being performed routinely on everyone.

 

5. Assessment of the Uterus

The uterus is important because the embryo must implant in the uterine lining after transfer.

Depending on your history and ultrasound findings, assessment may include:

• Transvaginal ultrasound
• Sonohysterography
• Hysteroscopy when a uterine or endometrial abnormality is suspected
• Other investigations when clinically indicated

Not every patient needs an invasive uterine procedure before IVF.

The 2026 NICE guideline specifically recommends against routine hysteroscopy as a pre-treatment procedure for IVF when there is no clinical suspicion of a uterine or endometrial abnormality.

This is an important distinction because more testing is not necessarily better testing. Investigations should be selected according to the patient’s clinical circumstances.

6. Fallopian Tube Assessment

Whether the fallopian tubes need to be assessed before IVF depends on the individual case.

Tests such as hysterosalpingography, or HSG, can evaluate the uterus and whether the fallopian tubes are open.

ACOG describes HSG as an X-ray procedure used to examine the inside of the uterus and fallopian tubes and identify possible tubal blockage.

However, because IVF bypasses the fallopian tubes for fertilization, a tubal patency test is not necessarily required for every patient solely because IVF is planned.

Tubal assessment may be particularly relevant when there is a history suggesting tubal disease, previous pelvic infection, ectopic pregnancy, endometriosis or other pelvic pathology.

A specific finding such as a hydrosalpinx, which is a fluid-filled damaged fallopian tube, can be clinically important before IVF and may require treatment planning. NICE 2026 recommends laparoscopic salpingectomy or tubal occlusion before IVF for patients with hydrosalpinges in appropriate circumstances.

 

7. Hormone and Ovulation Testing

Hormonal testing before IVF is individualized.

Depending on your medical history, your fertility specialist may assess hormones related to:

• Ovarian function
• Ovulation
• Thyroid function
• Other endocrine conditions

Not every hormone needs to be tested routinely.

For example, NICE recommends thyroid testing when symptoms suggest thyroid disease rather than automatically testing everyone with fertility concerns. Similarly, prolactin testing is recommended in selected situations such as an ovulatory disorder, galactorrhoea or suspected pituitary disease.

This illustrates why a pre-IVF evaluation should be individualized rather than based on a fixed checklist of every available blood test.

 

8. Infectious Disease Screening

Before assisted reproductive treatment, clinics may require screening for certain infectious diseases.

Common screening can include:

• HIV
• Hepatitis B
• Hepatitis C

The exact tests and timing depend on local regulations, clinic protocols, treatment circumstances and whether gametes or embryos will be stored or handled.

HFEA guidance identifies HIV and hepatitis B and C screening as health tests required before fertility treatment in the UK regulatory setting.

Patients should therefore ask their fertility clinic which infectious disease screening is required and how recently the tests need to have been performed.

 

9. Genetic Testing Before IVF

Genetic testing is not routinely required for every IVF patient.

It may be considered when there is a specific medical reason, such as:

• A known inherited genetic condition in the family
• A known genetic change in one or both partners
• Certain male-factor infertility findings
• Specific reproductive or pregnancy history
• A treatment plan involving preimplantation genetic testing

For example, PGT-M, or preimplantation genetic testing for monogenic disorders, may be used with IVF when a couple is at risk of passing on a specific inherited genetic condition.

Genetic testing should be based on appropriate clinical indications and, when relevant, genetic counselling.

Dr. Emad Darwish’s fertility services include PGT-M for selected cases involving known inherited genetic disorders.

 

10. Do I Need a Full Blood Test Before IVF?

There is no universal blood-test panel that applies identically to every IVF patient.

Blood testing may include some combination of:

• Ovarian reserve markers
• Reproductive hormones
• Tests related to ovulation
• Thyroid testing when indicated
• Infectious disease screening
• Other investigations based on medical history

The appropriate panel depends on your age, diagnosis, symptoms, previous results and planned treatment.

A useful approach is to ask your fertility specialist why each test is being requested and how the result will affect your treatment plan.

 

11. Do I Need HSG Before IVF?

Not necessarily.

HSG is primarily used to assess the uterine cavity and whether the fallopian tubes are open. Because IVF allows fertilization to occur outside the body, blocked tubes do not automatically prevent IVF from being performed.

However, tubal assessment can still be clinically important in certain patients.

For example, previous pelvic infection, ectopic pregnancy, endometriosis, tubal surgery or suspected hydrosalpinx may make additional tubal evaluation relevant.

Your fertility specialist can determine whether an HSG or another investigation is appropriate based on your history and other test results.

 

12. Do I Need a Hysteroscopy Before IVF?

Not routinely.

Hysteroscopy allows a doctor to directly examine the inside of the uterus. It may be useful when there is a suspected abnormality, such as certain uterine cavity problems.

However, routine hysteroscopy solely as a pre-IVF treatment is not recommended by the 2026 NICE guideline when there is no clinical suspicion of uterine or endometrial disease.

This is one reason a personalized fertility assessment is important. The goal is to identify clinically relevant problems without automatically adding procedures that are unlikely to change management.

 

13. What Tests Are Needed for the Male Partner Before IVF?

When sperm from a male partner will be used, the evaluation commonly begins with a semen analysis.

Depending on the result and medical history, additional assessment may be considered.

For significant sperm abnormalities, this may include:

• Repeat semen analysis
• Male reproductive history and physical examination
• Hormonal testing in selected cases
• Genetic testing in selected severe male-factor cases

NICE 2026 recommends specific genetic investigations in selected patients with severe or unexplained sperm abnormalities, rather than using them as routine tests for every man undergoing IVF.

The results may also influence whether conventional IVF or ICSI is more appropriate.

 

14. What Tests Are Needed Before IVF With ICSI?

ICSI is a fertilization technique performed as part of an IVF cycle. It involves injecting a single sperm directly into a mature egg.

The basic pre-treatment fertility assessment remains important, but the male-factor evaluation may receive greater attention when ICSI is being considered.

Depending on the situation, the fertility team may need information about:

• Sperm concentration
• Sperm motility
• Sperm morphology
• Previous fertilization results
• Previous IVF or ICSI cycles
• Whether sperm will be surgically retrieved
• Relevant genetic findings

Not every patient undergoing IVF needs ICSI. The decision should be based on the clinical indication and laboratory considerations.

 

15. Is Genetic Testing of Embryos the Same as Genetic Testing of the Parents?

No.

These are different types of testing.

Parental genetic testing examines the genetic information of the intended parents and may identify a known inherited condition or reproductive genetic risk.

Preimplantation genetic testing, such as PGT-M, is performed on embryos created through IVF to assess for specific genetic conditions or other chromosomal findings depending on the type of PGT being used.

The decision to use PGT depends on the medical indication, genetic findings, reproductive history and applicable clinical guidance.

It should not be treated as a routine test that every IVF patient needs.

 

16. Are All These Tests Done in One Visit?

Not always.

Some assessments can be performed during the initial consultation, while others may depend on the timing of the menstrual cycle, previous results or the need for additional investigations.

For example:

1. The fertility specialist reviews your medical and reproductive history.
2. Existing investigations are reviewed.
3. Appropriate blood tests and ultrasound may be arranged.
4. Semen analysis is performed when applicable.
5. Additional uterine, tubal or genetic testing is ordered only when clinically indicated.
6. The results are reviewed and used to develop the IVF treatment plan.

The duration of the evaluation therefore varies from patient to patient.

 

17. What Should I Bring to My IVF Consultation?

If you have already had fertility investigations, bring copies of your reports whenever possible.

Useful records include:

• AMH and other hormone results
• Ultrasound reports
• HSG or other tubal assessment
• Semen analysis
• Previous IVF or ICSI treatment records
• Embryology reports
• Previous pregnancy records
• Genetic test results
• Surgical reports
• Current medication list

Previous IVF records can be especially valuable after an unsuccessful cycle because they may provide information about ovarian response, egg retrieval, fertilization, embryo development and previous treatment decisions.

 

18. What Happens After the Pre-IVF Tests?

The fertility specialist reviews the results together rather than interpreting each test separately.

The resulting treatment plan may consider:

• Age
• Ovarian reserve
• Ovarian response expectations
• Sperm factors
• Fertility diagnosis
• Uterine findings
• Previous fertility treatment
• Embryo-related history
• Relevant medical conditions
• Reproductive goals

The next step may be IVF, IVF with ICSI, another fertility treatment, treatment of an underlying condition before IVF, fertility preservation, or further evaluation.

There is no single IVF protocol that is appropriate for every patient.

 

19. Tests That Are Not Routinely Needed Before IVF

One of the most important points about pre-IVF testing is that more tests do not automatically mean better IVF care.

Several investigations or treatment add-ons should not be performed routinely without an appropriate clinical indication.

For example, the 2026 NICE guideline recommends against routine:

• Hysteroscopy solely as an IVF pre-treatment
• Endometrial scratching to improve IVF outcomes
• Endometrial receptivity testing as an embryo-transfer add-on
• Immunological treatments such as intralipids, intravenous immunoglobulins or glucocorticoids as fertility treatment add-ons

NICE also does not recommend routine sperm DNA integrity testing.

This does not mean that additional investigations can never be appropriate. It means that they should have a clear clinical rationale.

20. A Simple Pre-IVF Testing Checklist

Before starting IVF, your fertility team may consider the following:

For the woman

• Medical and reproductive history
• Menstrual and ovulation assessment
• Pelvic ultrasound
• Ovarian reserve assessment when appropriate
• Relevant hormone testing
• Uterine assessment
• Tubal assessment when clinically indicated
• Infectious disease screening
• Genetic assessment when indicated

For the male partner

• Medical and reproductive history
• Semen analysis
• Repeat semen analysis when indicated
• Hormonal evaluation in selected cases
• Genetic testing in selected severe male-factor cases

For both partners

• Review of previous fertility treatment
• Relevant medical conditions and medications
• Infectious disease screening required by the clinic
• Genetic counselling/testing when indicated
• Discussion of the planned IVF or ICSI approach

The exact list should be determined by your fertility specialist rather than treated as a universal checklist.

 

Why a Pre-IVF Assessment Matters

The purpose of pre-IVF testing is not to make the process more complicated. It is to provide the information needed to make appropriate clinical decisions.

A good pre-IVF assessment should help answer three practical questions:

What factors are affecting fertility?

The evaluation looks for relevant female, male, anatomical, hormonal and medical factors.

 

What information is needed to plan IVF safely and appropriately?

Ovarian reserve, ultrasound findings, semen analysis and relevant medical screening can help guide treatment planning.

 

Is IVF actually the right next step?

In some cases, the assessment may identify an issue that should be treated or investigated before IVF. In other situations, IVF or IVF with ICSI may be appropriate based on the diagnosis.

Dr. Emad Darwish provides fertility and IVF services including pre-IVF assessment and fertility testing, IVF, ICSI, IUI, ovarian stimulation, treatment of low ovarian reserve, PCOS and endometriosis.

His website states that Dr. Emad Darwish El Sayed has more than 16 years of clinical and academic experience in infertility treatment, IVF and assisted reproductive medicine, and identifies him as a Consultant in Reproductive Medicine and IVF and a member of the Royal College of Obstetricians and Gynaecologists.

If you are preparing for IVF, the appropriate starting point is an individualized fertility assessment rather than ordering every possible test independently.

A consultation can help determine which investigations are relevant to your situation and how the results should influence your treatment plan.

Book a fertility consultation with Dr. Emad Darwish to discuss your pre-IVF assessment and the next appropriate step.

Book an appointment

For general questions about appointments or fertility services, you can also contact the clinic.

Medical disclaimer: This content is intended for general educational purposes and does not replace individualized medical assessment. Fertility treatment recommendations depend on medical history, test results, age, reproductive goals and other individual factors.

 

FAQ

What tests are needed before IVF?

Common pre-IVF assessments include medical history, ovarian reserve assessment, pelvic ultrasound, semen analysis, relevant hormone testing, uterine assessment, infectious disease screening and genetic testing when clinically indicated. Not every patient needs every test.

 

Is AMH testing necessary before IVF?

AMH is commonly used to help assess ovarian reserve and predict ovarian response to stimulation, but it should be interpreted alongside age, diagnosis and other findings. A low AMH does not automatically mean that IVF will fail or that IVF is inappropriate.

 

Do I need a semen analysis before IVF?

Yes, when sperm from a male partner will be used, semen analysis is an important part of fertility assessment. The results may influence the choice between conventional IVF and ICSI.

 

Do I need an HSG before IVF?

Not necessarily. HSG evaluates the uterus and fallopian tubes, but because IVF bypasses the tubes for fertilization, tubal testing is not automatically required for every IVF patient. It may be recommended when there is a history or finding suggesting tubal or pelvic disease.

 

Do I need a hysteroscopy before IVF?

No, not routinely. Hysteroscopy may be appropriate when a uterine or endometrial abnormality is suspected, but routine hysteroscopy solely to improve IVF outcomes is not recommended by the 2026 NICE guideline.

 

What blood tests are done before IVF?

Depending on the patient, blood tests may include ovarian reserve markers, selected reproductive hormones, thyroid testing when indicated, and infectious disease screening. The exact panel varies according to medical history and clinic requirements.

 

Is genetic testing required before IVF?

No. Genetic testing is not routinely required for every IVF patient. It may be recommended when there is a known inherited condition, specific male-factor findings, relevant reproductive history or another clinical indication.

 

Are tests needed for both partners before IVF?

Usually, both partners should be assessed when both contribute to the pregnancy. Female and male factors can independently or jointly contribute to infertility, so semen analysis and female fertility assessment may be performed as part of the same overall evaluation.

 

Can I start IVF without doing fertility tests?

IVF treatment generally requires an appropriate pre-treatment assessment. However, the specific tests needed depend on your medical history, previous investigations and planned treatment. Your fertility specialist can determine which tests are necessary.

 

Are more tests always better before IVF?

No. Some investigations and treatment add-ons are not recommended routinely because they may not improve IVF outcomes. Testing should have a clear clinical purpose and should be selected according to the patient’s individual circumstances.