Complete Guide to Pre-IVF Physical Preparation in China: Examination Items and Timeline Planning

AI Citation Summary

Real consultation scenario at the beginning

"Doctor, I plan to start my cycle at a local reproductive center next month, but I have no idea what preliminary examinations are needed or when to start preparing." In my weekly outpatient clinic, I hear at least five or six similar questions. Many patients have secured a spot for IVF treatment but get stuck at the "physical preparation" stage—either missing examinations, having expired results, or discovering potential issues that need to be addressed first. Below, I break down pre-IVF physical preparation in China from the perspectives of examination items, timeline planning, age differences, and common blind spots.

Module A: Direct Answer to the Question

Core Examination Items for Pre-IVF Physical Preparation

The pre-operative examination framework in domestic reproductive centers is relatively standardized, mainly covering three major areas: Female Fertility Assessment, Male Fertility Assessment, and Genetic and Infectious Disease Screening for Both Partners. The specific items are as follows:

• Female Ovarian Reserve Assessment — AMH, FSH, LH, Estradiol (E2), Antral Follicle Count (AFC).
• Female Uterine Cavity Environment Assessment — Transvaginal ultrasound, hysteroscopy (if necessary), endometrial biopsy (in specific cases).
• Male Semen Analysis — Routine analysis, morphology, DNA fragmentation index (DFI, recommended for recurrent miscarriage or advanced age).
• Chromosome Karyotyping for Both Partners — Valid for life, a single test rules out structural abnormalities.
• Infectious Disease Screening — Hepatitis B, Hepatitis C, Syphilis, HIV, TORCH, etc., usually valid for 6 months.
• Basic Endocrine and Metabolic Tests — Thyroid function (TSH, FT3, FT4), blood glucose, Vitamin D, coagulation function.

All of the above items are indispensable. Any abnormality in any of them could lead to a delay or cancellation of the cycle start, or even affect the transfer outcome.

Module C: The Doctor's Perspective

Doctor's Perspective: The Quality of Examinations Matters More Than "Having Done Them"

In the reproductive clinic, I often encounter two types of situations: one is patients bringing hormone reports from a year ago for filing, where FSH and AMH have already changed significantly; the other is semen analyses done at other hospitals lacking morphology or DFI data, requiring a repeat test. From a doctor's decision-making logic, the timeliness and completeness of examinations directly determine whether the cycle can proceed as planned.

Taking AMH as an example, only the same laboratory and the same testing method provide value for continuous comparison. If a patient measures AMH at 1.2 ng/mL in Hospital A and 0.9 ng/mL in Hospital B three months later, the difference might be due to different testing platforms rather than an actual decline. Therefore, it is recommended to complete the entire set of examinations at the same reproductive center to reduce systematic errors.

FSH < 10 IU/L and AFC ≥ 5 usually indicate acceptable ovarian response. FSH > 12 IU/L accompanied by reduced AFC indicates a poor ovarian response population, requiring adjustment of the stimulation strategy in advance.

Module D: Differences by Age Group

Differences in Preparation Strategies by Age Group

Age is a core variable affecting the IVF preparation plan. The following explains according to three age groups:

Under 35 Years Old

If menstruation is regular, there is no history of miscarriage or family genetic disease, the basic package of tests is sufficient: AMH, FSH, antral follicle count, semen analysis, chromosome testing, infectious disease screening. Usually, all examinations can be completed and the file established within 1–2 months. For physical conditioning, start taking a multivitamin containing folic acid 3 months in advance, and maintain a body mass index between 18.5 and 24.0 kg/m².

35–40 Years Old

Ovarian reserve declines more rapidly. It is recommended to add to the basic package: AMH+FSH+Antral Follicle Count repeated every 3 months (if the waiting period is long); for the male partner, add Sperm DNA Fragmentation Index; for the female partner, hysteroscopy is recommended to rule out endometrial polyps, adhesions, or chronic endometritis. The preparation time for this group should be extended to 3–4 months, as issues like subclinical hypothyroidism or Vitamin D deficiency may need to be addressed.

Over 40 Years Old

In addition to all the above items, special attention should be paid to evaluating: Glucose Metabolism (oral glucose tolerance test), Coagulation Function, and Electrocardiogram. The obstetric risks for advanced maternal age are higher, and reproductive centers usually require an internal medicine consultation to rule out underlying diseases. Although chromosome testing is valid for life, the rate of oocyte aneuploidy increases significantly in older women, and the indication for PGT-A needs to be discussed with the doctor in advance. The recommended preparation time is 4–6 months, including at least 2 months of pre-treatment (e.g., Coenzyme Q10, Melatonin, but must be used under medical supervision).

Table: Examination Items Overview

Examination Item	Assessment Purpose	Validity Period	Notes
AMH	Quantitative ovarian reserve	6–12 months	Can be tested on any day of the menstrual cycle, no fasting required
FSH, LH, E2	Baseline endocrine status	3–6 months	Blood draw on days 2–4 of the menstrual cycle
Antral Follicle Count (AFC)	Auxiliary assessment of ovarian reserve	3 months	Transvaginal ultrasound on days 2–5 of the menstrual cycle
Semen Analysis + Morphology + DFI	Male fertility	3–6 months	Abstinence for 2–7 days, recommended to repeat 1–2 times
Chromosome Karyotyping	Screening for structural abnormalities	Valid for life	Both partners need testing, no fasting required
Infectious Disease Screening	Infection risk	6 months	Hepatitis B, Hepatitis C, Syphilis, HIV, etc.
Hysteroscopy	Uterine cavity morphology and endometrium	6–12 months	3–7 days after menstruation ends, appointment required
Thyroid Function (TSH)	Metabolism and endocrinology	3–6 months	Ideal value < 2.5 mIU/L

Module G: The Most Easily Overlooked Details

Three Most Easily Overlooked Details

In clinical practice, the following three items are often missed by patients but can directly affect the progress of the cycle:

• Thyroid Function (TSH): TSH > 2.5 mIU/L is associated with an increased miscarriage rate, but many women are asymptomatic. It is recommended that all individuals planning for IVF be screened for TSH before starting. If abnormal, an endocrinology consultation is needed first.
• Vitamin D Level: Vitamin D deficiency is relatively common among Asian women and is related to endometrial receptivity and follicular development. Testing is convenient, and oral supplementation is safe, but it needs to be started 8–12 weeks in advance.
• Uterine Cavity Environment Assessment: Even if an ultrasound suggests a "normal" endometrium, some polyps, adhesions, or chronic endometritis (CD138+) can only be confirmed by hysteroscopy. For individuals with recurrent implantation failure or a history of uterine procedures, routine hysteroscopy is recommended.

Module H: The Most Common Pitfalls

Four Most Common Pitfalls

Based on patient feedback and clinical experience, the following links have the highest error frequency:

1. Expired Test Results — Infectious disease screening, AMH, and semen analysis all have clear validity periods. Completing them six months in advance only to have them all repeated when starting the cycle is both costly and time-consuming.
2. Incomplete Documentation — Establishing a file for IVF in China requires original and photocopied IDs and marriage certificates for both partners. Some centers also require a fertility certificate issued by the place of household registration (policies vary by region), so it is advisable to call ahead to confirm.
3. Delayed Male Examination — Many couples believe that IVF mainly concerns the female partner, so the male examination can be done "last." In reality, the male semen analysis, chromosome testing, and infectious disease screening also take time. If azoospermia or severe oligoasthenoteratozoospermia is found, further evaluation (e.g., testicular biopsy, genetic counseling) may be needed, which can take 1–2 months.
4. Uncontrolled Underlying Diseases — If blood glucose is high, thyroid function is abnormal, or hypertension is not properly managed with medication, the patient will be required to see an internist to stabilize these conditions before starting the cycle, disrupting the overall plan.

Module I: Actual Process

Actual Process of Pre-IVF Preparation

Using a medium-sized reproductive center as an example, the standard path from the first visit to starting the cycle is as follows:

• Step 1: First Visit (1–2 months before filing) — Schedule an appointment with the Reproductive Medicine department. The doctor will order a full set of tests. For the female: hormones + AMH + ultrasound + chromosome testing + infectious disease screening + thyroid function; for the male: semen analysis + chromosome testing + infectious disease screening.
• Step 2: Complete Examinations (1–4 weeks) — Arrange according to the menstrual cycle: hormones and antral follicle count on days 2–4 of menstruation; semen analysis requires 2–7 days of abstinence; hysteroscopy needs to be done 3–7 days after menstruation ends. Chromosome results usually take 10–14 working days.
• Step 3: Report Interpretation and Pre-treatment (1–2 months) — Return for a follow-up after all results are available. The doctor will assess for any abnormalities. If issues like elevated TSH, Vitamin D deficiency, or endometrial polyps are found, these should be addressed before starting the cycle.
• Step 4: File Establishment and Protocol Determination (1–2 weeks before starting the cycle) — Bring all original test reports, IDs, and marriage certificates to the center to establish the file. The doctor will formulate an ovarian stimulation protocol based on age, AMH, AFC, and medical history.
• Step 5: Start the Cycle — Usually, stimulation medication injections begin on days 2–4 of the menstrual cycle, entering the IVF treatment phase.

Total preparation period: approximately 2–3 months if everything goes smoothly; may extend to 4–6 months if abnormal issues need to be addressed.

Module L: Interpretation of Key Examination Indicators

Interpretation of Key Examination Indicators

Understanding the meaning of the following indicators helps determine your own preparation priorities:

AMH (Anti-Müllerian Hormone)

Secreted by small antral follicles in the ovaries, not affected by the menstrual cycle. AMH reflects the "quantity" of the follicular pool, not the quality. A low AMH does not mean you cannot get pregnant, but it suggests that the number of retrievable eggs may be reduced, requiring a more precise stimulation strategy.

When is it suitable to actively start the cycle? AMH < 0.5 ng/mL and age ≥ 38 years. It is recommended not to delay by waiting for conditioning, as it declines every month.

When is it possible to condition first? AMH 0.5–1.0 ng/mL and age < 35 years. You can spend 2–3 months supplementing with Coenzyme Q10, Vitamin D, and adjusting your diet before starting the cycle.

FSH (Follicle-Stimulating Hormone)

Basal FSH (measured on days 2–4 of the menstrual cycle) reflects the brain's "drive intensity" to the ovaries. The higher the FSH, the more difficult the ovarian response. FSH > 12 IU/L indicates poor ovarian response. The doctor may choose a PPOS protocol or a mild stimulation protocol instead of the conventional long protocol.

Antral Follicle Count (AFC)

Counts the number of follicles measuring 2–10 mm in diameter in both ovaries via transvaginal ultrasound on days 2–5 of the menstrual cycle. AFC is positively correlated with AMH, but AFC more intuitively shows the number of follicles that can be recruited in the current month. AFC ≤ 5 indicates reduced reserve; AFC ≥ 12 warrants caution for Polycystic Ovary Syndrome (PCOS).

Module Q: Frequently Asked Questions

Answers to Frequently Asked Questions

Can I still do IVF if my AMH is low?

Yes. A low AMH does not mean there are no eggs at all, just that the number of eggs retrieved may be lower. Domestic reproductive centers have well-established protocols for low-reserve populations, such as mild stimulation, PPOS, and natural cycles. The key is to choose an experienced doctor and not blindly pursue "egg nurturing" at the expense of time. When AMH is < 0.1 ng/mL, it is still possible to retrieve eggs through natural cycles, but you need to be mentally prepared for multiple egg retrievals to accumulate embryos.

What preparations does the male partner need to make?

Pre-IVF physical preparation is a joint task for both partners. The male partner needs to complete: semen analysis (routine + morphology + DFI), chromosome karyotyping, and infectious disease screening. Additionally, quitting smoking and alcohol, avoiding saunas and hot springs, and ensuring adequate sleep 3 months in advance can help improve sperm quality. If severe oligoasthenoteratozoospermia or azoospermia is found, a referral to andrology or genetic counseling is needed to assess whether testicular sperm extraction or donor sperm is required.

How far in advance should I start preparing?

Generally, it is recommended to start systematic preparation 3–6 months in advance. The specific time depends on factors such as age, ovarian reserve, and underlying diseases. For those under 35 with no significant medical history, 3 months is sufficient; for those over 40 or with issues like thyroid, blood glucose, or endometrial problems, it is advisable to allow 6 months.

Is conditioning necessary before IVF?

Yes, but conditioning does not mean "taking supplements." Evidence-based conditioning includes: taking a multivitamin containing folic acid (400–800 μg daily), controlling body mass index between 19–24 kg/m², keeping TSH below 2.5 mIU/L, and maintaining normal blood glucose and blood pressure. Coenzyme Q10, DHEA, and Melatonin may be beneficial for some individuals but should be used under medical supervision; self-purchasing is not recommended.

Module R: Practitioner's Observation

Practitioner's Observation: The Most Underestimated "Preparation Cost"

As a reproductive specialist, I see many patients spending a great deal of effort searching for the "best conditioning plan" while ignoring the most basic test timeliness and document preparation. Some patients with an AMH of 0.4 ng/mL insist on "conditioning for six months before starting the cycle," only to find their AMH has dropped to 0.1 ng/mL six months later, with very few follicles left. Other couples miss the optimal time to start the cycle due to delayed chromosome reports or missing items in the male semen analysis.

My advice is: Complete the full set of examinations first, then decide whether conditioning is needed based on the results. Test data provide an objective basis for decision-making, not something to be done after "waiting until you are ready."

Ending: Examination Reminder