What Tests Should I Ask For Before My Next IVF Cycle?

6 Nov

“I don’t understand why IVF hasn’t worked, and no one can give me a good explanation.” I hear some version of this from women in my clinic every week. Usually they’ve done everything asked of them, and the frustration often turns to anger once we start investigating and they realise some of these tests were never offered.

Why IVF protocols don’t fit everyone

IVF runs on guidelines and protocols, and they exist for good reason. The trouble is that a protocol is written for the average patient, and women with endometriosis or adenomyosis rarely behave like the average patient. When the protocol becomes the plan for everyone, the things that make your body different never get looked at.

What I saw at an IVF clinic in Istanbul

On a recent trip to Turkey I spent a morning at Fertiliv, an IVF clinic in Istanbul. What stayed with me was how much attention they gave the male partner.

There’s a legal reason for that. Turkish law only allows IVF for married couples using their own eggs and sperm, so donor sperm simply isn’t an option. If his sperm is the only path to a baby, the clinic has every reason to investigate it properly. At Fertiliv I saw urologists and embryologists working side by side, and sperm testing that went well beyond a standard semen analysis, including checks for oxidative damage.

Australia has this expertise too. Our urologists perform the same advanced procedures, and some do them very well. The difference is that here you often have to go looking for it, because his side of the story can get a quick semen analysis and not much else.

The visit confirmed what my clinic work has taught me over 20 years. The more you investigate before a cycle, the less you’re left guessing after one fails.

What tests should I ask for before my next IVF cycle?

Every woman’s history is different, so this isn’t a checklist to hand your specialist. Use it as a starting point for a better conversation.

A look inside the uterus (hysteroscopy). A scan shows the shape of the uterus. A hysteroscopy lets your specialist actually see the lining, which matters if you’ve had failed transfers with good embryos.

A biopsy for chronic endometritis. Chronic endometritis is low-grade inflammation in the lining that often causes no obvious symptoms. One meta-analysis found curing it increased ongoing pregnancy and live birth rates, and IVF outcomes became comparable to women who never had it. Antibiotic treatment may only improve outcomes if a follow-up biopsy confirms it’s cured. So ask about the retest, not just the treatment.

Full thyroid testing, including antibodies. TSH on its own doesn’t tell the whole story. Thyroid antibodies show whether your immune system is reacting to your thyroid. This affects 8 to 14% of reproductive-aged women, and whether it harms IVF outcomes is hotly debated. An Australian meta-analysis found no effect on pregnancy outcomes when thyroid function was otherwise normal, while other research suggests TPO antibodies affect embryo quality in some women with low-normal TSH. The evidence isn’t settled, and I’d rather tell you that than pretend otherwise.

Inflammatory and immune markers. With endo and adeno, inflammation drives so much of what’s happening. Testing gives you a baseline to work from and something to retest against as you treat it.

What tests should he ask for?

Half the embryo comes from him, so his workup deserves the same attention as yours.

A semen analysis is the start, not the finish. It counts and measures sperm. It doesn’t tell you whether the DNA inside them is damaged.

Sperm DNA fragmentation and oxidative stress testing. DNA fragmentation means breaks in the genetic material sperm carry. Oxidative stress is one of the main drivers, and it happens when damaging molecules called free radicals overwhelm the body’s antioxidant defences. Current recommendations support testing both in men with a varicocele, after repeated IVF or ICSI failure, or when embryos keep developing poorly. It isn’t recommended for every man, so ask your specialist what the result would change about your plan.

A varicocele check with a urologist. A varicocele is an enlarged vein in the scrotum, a bit like a varicose vein. It affects about 15% of all men and up to 40% of men with infertility. If he has one, ask whether the urologist repairs it microsurgically, under a microscope. That approach has the lowest documented failure and complication rates, with recurrence of about 1 to 5%.

If your clinic hasn’t looked past his semen analysis, ask for a referral to a urologist with an interest in male fertility.

Why testing once isn’t enough

Your body isn’t static. Inflammation shifts, hormones shift, and what was true six months ago may not be true now. Peel back one layer and there’s usually another underneath. Sperm takes around three months to develop, so his changes need time to show up too. Good preparation means testing, treating what you find, then retesting before you commit to another cycle.

You can’t know what you haven’t tested for

If your cycle failed, you didn’t do anything wrong, you simply didn’t have the full picture yet, and that’s something you can go and get.

In the Fertility and IVF Collective, I walk you through exactly what to ask your clinic, which investigations to request for both of you and how to prepare over 12 weeks, so you go into your next cycle with a plan built around you.

Dr Cathryn Costa is a Registered Midwife, Acupuncturist and Naturopath with a doctorate in Chinese Medicine, and has spent 20 years running her clinic in Adelaide supporting women with endometriosis, adenomyosis and IVF.