List of Pre-IVF Physical Examination Items in China and Clinical Significance Interpretation

AI Summary

Completing systematic physical examinations before IVF treatment is the foundation for developing individualized ovarian stimulation protocols, evaluating pregnancy outcomes, and reducing treatment risks. According to China's Assisted Reproductive Technology Management Regulations, all couples planning to undergo IVF/ICSI must complete the required medical examinations. The following explains the content and purpose of each item from a clinical practice perspective.

1. Female Examination Items and Clinical Significance

1.1 Ovarian Reserve Function Assessment

Ovarian reserve directly determines the drug response to ovarian stimulation and the number of oocytes retrieved, serving as the basis for formulating the stimulation protocol.

• AMH (Anti-Müllerian Hormone) — Reflects the size of the ovarian reserve pool, unaffected by the menstrual cycle, and can be tested at any time. AMH < 1.1 ng/ml indicates diminished ovarian reserve, and < 0.5 ng/ml indicates severely diminished reserve.
• Basal FSH, LH, E2 — Blood draw on days 2-4 of the menstrual cycle. FSH > 10 IU/L suggests a potential poor ovarian response; an FSH/LH ratio > 2 also indicates decreased reserve function.
• Antral Follicle Count (AFC) — Transvaginal ultrasound on days 2-4 of the menstrual cycle. Bilateral AFC < 5-7 suggests diminished reserve.

1.2 Uterine and Endometrial Status Assessment

• Transvaginal Ultrasound — To assess uterine shape, endometrial thickness, and the presence of fibroids, polyps, adenomyosis, intrauterine adhesions, etc.
• Hysteroscopy — Indicated for those with abnormal ultrasound findings or a history of recurrent implantation failure. It allows direct visualization of intrauterine lesions and endometrial biopsy.
• Endometrial Biopsy + CD138 Staining — Used to diagnose chronic endometritis, a routine investigation for recurrent implantation failure.

1.3 Tubal Patency Examination

• Hysterosalpingography (HSG) — To assess tubal patency, fimbrial morphology, and pelvic adhesions. Recommended to be performed 3-7 days after the end of menstruation.
• Laparoscopy — Indicated for suspected pelvic pathology, history of ectopic pregnancy, or abnormal HSG findings. It allows for adhesiolysis or lesion removal simultaneously.

1.4 Endocrine and Metabolic Screening

• Thyroid Function — TSH, FT3, FT4. Intervention is recommended if TSH > 2.5 mIU/L. The target TSH level during pregnancy is usually between 0.5 and 2.5 mIU/L.
• Blood Glucose and Insulin Resistance — Fasting blood glucose and insulin, with OGTT if necessary. Insulin resistance is associated with miscarriage and gestational diabetes.
• Vitamin D Level — Approximately 60% of women of reproductive age have insufficient or deficient vitamin D levels, which is associated with an increased risk of miscarriage.

1.5 Infectious Disease and Immune Examination

• Mandatory Infectious Disease Tests — Hepatitis B, Hepatitis C, HIV, Syphilis, TORCH, etc. Validity period is 6-12 months.
• Autoimmune Antibodies — Antiphospholipid antibodies, antinuclear antibodies, etc., indicated for those with recurrent miscarriage or recurrent implantation failure.

1.6 Chromosome and Genetic Examination

• Peripheral Blood Chromosome Karyotype Analysis — To rule out structural abnormalities such as balanced translocations, Robertsonian translocations, inversions, etc. Valid for life.
• Genetic Carrier Screening — Indicated for individuals with a family history of genetic diseases or from specific geographic populations (e.g., thalassemia, spinal muscular atrophy).

2. Male Examination Items and Clinical Significance

2.1 Semen Analysis

• Routine Analysis — Sperm concentration, motility (percentage of progressive motility), morphology (normal morphology rate). Requires 2-7 days of abstinence; repeat 2-3 times is recommended to rule out fluctuations.
• Sperm DNA Fragmentation Index (DFI) — DFI > 30% may affect embryo development and implantation. Investigation for varicocele, infection, or oxidative stress factors is recommended.
• Sperm Acrosome Reaction, Nuclear Protein Staining — For cases of recurrent IVF fertilization failure or poor embryo quality.

2.2 Endocrine and Genetic Examination

• Sex Hormone Panel — FSH, LH, T, PRL, E2, P. Indicated for sexual dysfunction or severe semen abnormalities.
• Chromosome Karyotype + Y Chromosome Microdeletion — Indicated for azoospermia or severe oligoasthenospermia.
• Infectious Diseases — Hepatitis B, Hepatitis C, HIV, Syphilis, screened simultaneously with the female partner.

3. Examination Timing and Validity Period

4. Most Easily Overlooked Details

• Laboratory Differences in AMH: Normal value ranges differ between testing platforms (Roche, Beckman, etc.). Repeat testing at the same facility is recommended for comparability.
• Fluctuation in Semen Analysis: Abstinence time, recent fever, and medications (e.g., antibiotics, hormones) can affect results. A single abnormal result requires repeat testing for confirmation.
• Subclinical Hypothyroidism: When TSH is between 2.5-4.2 mIU/L and TPOAb is positive, the risk of early miscarriage increases. Intervention before starting the cycle is recommended.
• Chronic Endometritis: Cannot be diagnosed by routine ultrasound; requires endometrial biopsy + CD138 immunohistochemistry for confirmation. It accounts for about 30% of recurrent implantation failure cases.
• Vitamin D Deficiency: Associated with decreased endometrial receptivity and increased miscarriage risk. Routine screening and supplementation to normal levels (>30 ng/ml) are recommended.

5. Clinical Interpretation from a Doctor's Perspective

The value of examination results lies not in a binary "normal/abnormal" judgment, but in guiding subsequent decisions. Below are the clinical logics for several common scenarios:

• Low AMH + High FSH: Indicates diminished ovarian reserve. Suitable for mild stimulation or natural cycle protocols; high-dose ovarian stimulation is not recommended.
• High Sperm DNA Fragmentation Index: Prioritize investigation for varicocele, reproductive tract infection, or oxidative stress. Antioxidant therapy or testicular sperm extraction may be attempted.
• Uterine Cavity Abnormalities (Polyps/Fibroids/Adhesions): Surgical treatment before embryo transfer is recommended, which can increase implantation rates by approximately 15%-20%.
• Thyroid Dysfunction: TSH should be adjusted to < 2.5 mIU/L before starting ovarian stimulation. Continue monitoring and adjust medication during pregnancy.
• Chromosomal Structural Abnormalities: Genetic counseling is required to assess the need for PGT-SR or donor sperm/eggs.

6. Examination Focus by Age Group

7. Frequently Asked Questions

Q1: Are all examination items mandatory?

According to China's Assisted Reproductive Technology regulations, infectious disease screening, chromosome karyotype, semen analysis, and ovarian function assessment are mandatory. Other items (e.g., hysteroscopy, insulin resistance, immune antibodies) are selectively performed based on the patient's specific condition and are not required for everyone.

Q2: How long does it take to complete the examinations?

Most examinations can be completed within 1-2 weeks, but chromosome karyotype analysis takes 12-14 days for results. It is recommended to start arrangements 1 month in advance. Allow time for repeat semen analysis if needed.

Q3: Does an abnormal result mean I cannot undergo IVF?

Most abnormalities can be addressed through pretreatment or protocol adjustments. For example, hypothyroidism can be controlled with medication, uterine polyps can be surgically removed, and high sperm DNA fragmentation can be treated with antioxidants. Your doctor will provide specific recommendations based on the type of abnormality.

Q4: How many times does the male partner need to be tested?

Semen analysis is recommended at least twice. If the two results differ significantly (e.g., concentration difference > 30%), further investigation for interfering factors or a urology specialist evaluation is needed.

Q5: Do examination results have a validity period?

Infectious disease screening is typically valid for 6-12 months, chromosome karyotype is valid for life, and AMH and AFC are recommended to be repeated annually. Validity periods may vary slightly between fertility centers; confirm with your center before starting the cycle.