Complete Guide to Pre-IVF Examination Items in Hong Kong with Detailed Index Interpretation and Precautions

Opening: Timeline approach

A woman planning to start an IVF cycle in Hong Kong typically begins arranging systematic pre-cycle examinations 1 to 3 months before the cycle starts. These tests not only determine eligibility for the cycle but also directly influence the ovarian stimulation protocol, embryo culture strategy, and pregnancy success rate. The following is a detailed breakdown by examination category, index significance, timing, and common blind spots.

1. Female Examination Checklist and Core Indicators

1.1 Basic Fertility Assessment (Ovarian Reserve & Endocrine)

• AMH (Anti-Müllerian Hormone) — Can be tested at any time via blood draw, unaffected by menstrual cycle. The value reflects the size of the ovarian reserve pool. AMH > 1.0 ng/mL indicates normal reserve, 0.5–1.0 ng/mL indicates diminished reserve, and < 0.5 ng/mL indicates severely diminished reserve.
• Sex Hormone Panel (FSH, LH, E2, P, T, PRL) — Fasting blood draw on days 2–4 of the menstrual cycle. FSH < 10 IU/L suggests normal ovarian function, while FSH > 12 IU/L warrants caution for diminished reserve. An LH/FSH ratio > 2 may indicate a tendency toward polycystic ovaries.
• Antral Follicle Count (AFC) — Transvaginal ultrasound on days 2–4 of the menstrual cycle, counting the total number of follicles measuring 2–9 mm in both ovaries. AFC > 10 is normal, 5–10 is reduced, and < 5 is significantly reduced.
• Thyroid Function (TSH, FT3, FT4) — Maintaining TSH below 2.5 mIU/L is more favorable for embryo implantation and early development. Some centers require TSH < 4.0 mIU/L to start a cycle, but < 2.5 is the preferred target.
• Prolactin (PRL) — Elevated levels can inhibit ovulation, requiring investigation for pituitary microadenoma or medication effects.

1.2 Chromosomal and Genetic Screening

• Peripheral Blood Chromosome Karyotype Analysis — Valid for life; results take 14–21 days. Screens for structural abnormalities such as balanced translocations, Robertsonian translocations, inversions, and sex chromosome aneuploidies. It is recommended to complete this early to avoid missing a cycle due to report delays.
• Genetic Counseling — If there is a family history of genetic disorders, recurrent miscarriage, or previous abnormal pregnancy, genetic counseling should be completed before starting the cycle. Additional carrier screening or PGT (Preimplantation Genetic Testing) may be necessary.

1.3 Infectious Disease and Basic Health Screening

• Infectious Disease Panel (Four Items) — Hepatitis B surface antigen (HBsAg), Hepatitis C antibody (anti-HCV), HIV antibody (anti-HIV), and syphilis serology (TPPA/RPR). Validity is typically 6–12 months, with slight variations between fertility centers.
• Complete Blood Count, Coagulation Profile, Liver and Kidney Function, Fasting Blood Glucose — Assesses basic health status, screening for anemia, coagulation disorders, liver/kidney damage, and diabetes.
• TORCH Panel — Toxoplasma, Rubella virus, Cytomegalovirus, Herpes simplex virus, etc. Positive IgM indicates recent infection and may require postponing the cycle.

1.4 Uterine Cavity Evaluation

• Hysteroscopy — Recommended before starting the cycle, especially for those with a history of uterine surgery, thin endometrium, recurrent implantation failure, or abnormal ultrasound findings. Rules out endometrial polyps, submucosal fibroids, intrauterine adhesions, and chronic endometritis.
• Transvaginal Ultrasound (Baseline Antral Follicles + Endometrium) — Performed 3–7 days after the end of menstruation to observe endometrial morphology, presence of uterine fluid, ovarian cysts, etc.

2. Male Examination Items and Key Indicators

2.1 Semen Analysis

• Routine Semen Analysis — Abstain from ejaculation for 2–7 days, collect sample via masturbation. Reference standards (WHO 6th edition): Sperm concentration ≥ 16×10⁶/mL, total motility (PR+NP) ≥ 42%, progressive motility (PR) ≥ 30%, normal morphology ≥ 4%.
• Sperm DNA Fragmentation Index (DFI) — DFI > 30% may affect fertilization rate, embryo development, and pregnancy outcome. High fragmentation is common in conditions like varicocele, smoking, sleep deprivation, and advanced age.

2.2 Chromosomal and Genetic Testing

• Chromosome Karyotype Analysis — Same as for women, valid for life, results take approximately 2–3 weeks.
• Y Chromosome Microdeletion (AZF Factors) — Essential for azoospermia or severe oligozoospermia to determine if it is obstructive azoospermia or spermatogenic failure, guiding sperm retrieval method (testicular biopsy/micro-TESE).

2.3 Infectious Disease and Basic Health

• Infectious disease panel (four items), complete blood count, liver and kidney function, etc., same items and validity as for women.

3. Examination Timeline: When is the Most Appropriate Time

Timeline Planning Advice: Complete chromosome testing first (slowest report), then schedule menstrual phase tests (hormones + AFC), and complete hysteroscopy and male semen analysis during the non-menstrual period. Infectious disease screening and basic health checks can be done within 1–2 months before starting the cycle.

4. Most Easily Overlooked Details

• Differences in Report Validity — Chromosome results are valid for life, but semen analysis and hormone panels have short validity (3–6 months). If the cycle is delayed for any reason, these need to be rechecked. Some centers require infectious disease reports within 6 months; beyond that, repeat testing is needed.
• Hysteroscopy Appointment Lead Time — Some Hong Kong fertility centers require 2–4 weeks to schedule a hysteroscopy, and it must avoid menstrual and ovulation periods. It is recommended to book 1.5–2 months in advance.
• Male Abstinence Period — Abstaining for less than 2 days before semen analysis can result in low sperm concentration, while more than 7 days can decrease motility and increase fragmentation, directly affecting the value of the results.
• Differences in AMH Testing Platforms — Different laboratories use different reagent platforms (e.g., Beckman, Roche, Kangning) with slightly different reference ranges. It is best to have repeat tests at the same center to avoid misinterpretation due to numerical fluctuations.

5. Interpretation of Examination Indicators: When Extra Attention is Needed

Low AMH (< 0.8 ng/mL)

Indicates diminished ovarian reserve but does not preclude IVF. These individuals require a more individualized ovarian stimulation protocol (e.g., mild stimulation, natural cycle, or luteal phase stimulation) and realistic expectation management—the number of eggs retrieved may be lower, but there is still a chance of obtaining transferable embryos. For extremely low AMH (< 0.3 ng/mL), it is advisable to combine AFC and FSH for a comprehensive assessment and consider egg or embryo donation if necessary.

Elevated FSH (> 12 IU/L)

Suggests reduced ovarian response to stimulation medications. Doctors typically use higher doses of gonadotropins or add LH preparations while closely monitoring follicle development. When FSH > 15 IU/L and AMH < 0.5 ng/mL, the number of eggs retrieved is usually ≤ 3.

High Sperm DNA Fragmentation Index (DFI > 30%)

Commonly associated with varicocele, smoking, infection, or oxidative stress. Fragmentation can be reduced through antioxidant therapy (Coenzyme Q10, Vitamin E, L-carnitine) and lifestyle modifications (smoking cessation, regular sleep, avoiding prolonged sitting), typically requiring over 3 months of adjustment. For persistently high DFI, ICSI (Intracytoplasmic Sperm Injection) or TESA (Testicular Sperm Aspiration) may be considered to obtain better quality sperm.

Hysteroscopy Findings of Endometrial Polyps or Adhesions

After hysteroscopic polypectomy or adhesiolysis, it is generally recommended to rest for 1–2 months before starting the IVF cycle to allow adequate endometrial recovery. Some centers schedule a follow-up hysteroscopy the next month to confirm endometrial morphology before proceeding.

6. Frequently Asked Questions

• Q: Can I still do IVF in Hong Kong with low AMH?
  A: Yes. Low AMH only means the number of eggs retrieved may be lower, but as long as follicles grow and eggs are obtained, embryo formation is possible. It is advisable to choose an experienced fertility center, use mild stimulation or natural cycle protocols, and be mentally prepared for multiple egg retrieval cycles to accumulate embryos.
• Q: What additional tests are needed for advanced maternal age IVF?
  A: For women over 38, it is recommended to add an ECG, chest X-ray, blood glucose and HbA1c, Vitamin D level, and pre-thrombotic state screening (e.g., anticardiolipin antibodies, lupus anticoagulant). For men, adding sperm DNA fragmentation index is advised. Both partners should have a cardiovascular function assessment before starting the cycle.
• Q: How long are the examination reports valid?
  A: Chromosome karyotype analysis is valid for life; infectious disease screening for 6–12 months; semen analysis for 3–6 months; sex hormone panel + AMH for 3–6 months; hysteroscopy results for 6–12 months. Validity periods may vary between fertility centers, so confirm with the center before starting the cycle.
• Q: Does the male partner have to undergo chromosome testing?
  A: Fertility centers in Hong Kong typically require both partners to complete chromosome karyotype analysis. The main purpose is to screen for structural chromosomal abnormalities (e.g., balanced translocations), which are carried by about 1 in 500 infertile individuals and are directly linked to recurrent miscarriage and embryo developmental arrest.

7. Management of Special Situations

Recurrent Miscarriage or Implantation Failure

In addition to routine tests, it is recommended to add:
• For women: Antiphospholipid antibody panel, Protein S/C activity, MTHFR gene mutation, uterine microbiome testing (for chronic endometritis).
• For men: Sperm DFI, Y chromosome microdeletion, sperm nuclear protein transition.
PGT-A (Preimplantation Genetic Testing for Aneuploidy) for embryos is also recommended to reduce the risk of miscarriage due to chromosomal abnormalities.

Azoospermia or Severe Oligozoospermia

The male partner must complete chromosome karyotype, Y chromosome microdeletion, sex hormones (FSH, LH, T), and reproductive system ultrasound (to check for varicocele, cryptorchidism, vas deferens absence). For obstructive azoospermia, sperm can be retrieved via testicular biopsy; for non-obstructive azoospermia, micro-TESE is required. Testicular volume and serum AMH levels should be assessed before surgery.

8. Preparations Before the Examinations

• Required Documents: Valid passports for both partners (validity should cover the entire cycle and subsequent transfer arrangements, recommended > 6 months), marriage certificate (some centers require notarization or translation), visa (choose the appropriate type based on length of stay).
• Documentation for File Creation: Original copies of all previous examination reports (including those from other hospitals), surgical records (if any hysteroscopy/laparoscopy history), genetic counseling reports (if any).
• Lifestyle Adjustments: Women should start taking folic acid (0.4–0.8 mg/day) 3 months in advance. Both partners should quit smoking, limit alcohol, maintain a regular sleep schedule, and avoid staying up late and high-temperature environments (saunas, hot springs).

Content Note: This article is compiled based on standard practices in Hong Kong assisted reproductive medicine. The listed examination items and reference ranges apply to most fertility centers. The specific checklist should be based on the requirements of the patient's chosen center for starting a cycle. Interpretation of results must consider individual age, medical history, and the center's laboratory reference intervals; do not self-apply thresholds for decision-making.