No test can determine if the embryo is going to result in a successful pregnancy; the real test is when the embryo is transferred into the mother's womb. — Filepic
Some traditional fertility tests are of no use in the current era.
For example, a Day 2 Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH) to assess egg reserve is redundant.
Anti-Mullerian Hormone (AMH) is the current gold standard test, along with a fertility ultrasound scan for egg reserve.
Assessing a regularly-menstruating woman for ovulation with Day 21 serum progesterone level is also unnecessary.
I have seen patients with irregular period cycles, in whom this test was done to check for ovulation.
This is a waste of time and money because the Day 21 serum progesterone level test was initially designed for a woman with a regular 28-30 days menstrual cycle.
This test, if done at the wrong time of the period cycle, will naturally show a low level.
This leads to unnecessary progesterone supplementation.
Necessary tests
So, what are the important basic and advanced tests that should be considered?
A basic fertility test should include a semen analysis, female egg reserve tests as mentioned above, and hysterosalpingography (HSG).
Preferably, the semen analysis should be done in a fertility centre because the assessment of the semen by a trained embryologist or andrologist is far more accurate.
Further blood tests are done based on the couple’s medical history.
These can include thyroid hormone tests and diabetes screening, among others.
Advanced tests are not done routinely for all patients.
They are done for a selected group of patients, such as those with recurrent miscarriages, repeated implantation failure in in-vitro fertilisation (IVF), advanced age and unexplained infertility.
Let me summarise the advanced tests that you should be considering.
First of all is a hysteroscopy.
This is a procedure where a telescope is introduced into the womb to assess the internal structures.
This is done because an ultrasound scan does not see the actual structural issues inside the womb.
For a woman with recurrent miscarriages, blood tests for anti-phospholipid syndrome and inherited thrombophilia can be done.
Recently in Japan, a blood test for Beta 2 Glycoprotein-1 antibody was approved as a recommended test for a couple with recurrent miscarriages and recurrent implantation failures, as well as for all couples starting an IVF treatment.
This test is currently available in Malaysia.
Parental chromosomal study (genetic study) can be considered in couples with recurrent miscarriages as some of them may have chromosomal rearrangements that can be passed on to their embryo.
Endometrial receptivity test is also at times done for women with recurrent implantation failure.
However, this is not a routine test worldwide, and in Malaysia, the cost of the test can be a hindrance.
Other emerging or controversial tests are endometrial microbiome testing and Natural Killer (NK) cells testing.
More research is needed before these tests can be recommended for routine use.
Some of the equipment required for one cycle of IVF, seen here as part of a 2018 exhibition titled ‘IVF: 6 Million Babies Later’ at the Science Museum in London. IVF can now be done with less injections and more oral medications. — AFP
Analysing the embryo’s genes
Many couples going through an IVF treatment often face this dilemma of whether or not they should perform a genetic analysis on their embryo(s).
This is not an easy decision to make as it comes with financial implications.
Previously known as Preimplantation Genetic Screening (PGS), this test is now known as Preimplantation Genetic Testing for Aneuplodies (PGT-A).
PGT-A testing might be useful and enables the IVF laboratory to choose an embryo with higher likelihood of implantation.
However, PGT-A testing does not guarantee a pregnancy.
There are several issues with this test.
First of all, there is the possible loss of a viable embryo(s) due to misclassification.
This can happen because only a very small area of the embryo is biopsied and we assume that it represents the entire embryo.
The issue of mosaicism (a mixture of normal and abnormal cells in the biopsy) can also lead to misclassification.
In some patients, an “A” grade embryo could be genetically abnormal, while the “B” grade embryo is normal.
The other issue with PGT-A testing is the cost of the test.
The cost-effectiveness of PGT-A in your own fertility circumstances needs to be thoroughly discussed with your fertility specialist.
Remember, PGT-A is not a routine test in an IVF treatment, and many couples do not need this as an add-on test.
PGT-A might be useful for couples with recurrent miscarriage or recurrent IVF failures.
It is not useful for couples with a good prognosis with IVF or when you have a very low number of embryos.
I always tell my patients, no test can determine if the embryo is going to result in a successful pregnancy.
You will only know when the embryo is transferred into your womb.
So, give your embryo a fighting chance as long as the embryo is of a reasonable quality.
Changes in IVF
It’s been more than four decades since IVF gave the world its first baby.
Since then, this technique has gone through many scientific advancements.
What to expect in 2026?
Your IVF stimulation regime is changing.
Now you can do IVF with less injections and with more oral medications.
This protocol is not new, but I notice that the uptake of this type of stimulation protocols is increasing.
For example, I use only about one-third of the total injections that are normally used in a “conventional” IVF protocol.
This makes the protocol more patient- friendly, and ultimately, saves cost for the patient.
Please do discuss the IVF stimulation protocols with your fertility specialist and find the one that is efficient, easier to follow and cost-effective.
Another emerging IVF protocol is In-Vitro Maturation (IVM).
This is when immature eggs are collected and matured in the IVF laboratory.
In this protocol, you need only very minimal medications and eggs are collected earlier than the conventional IVF protocol.
In one of the IVM protocols, you may not need any medication at all.
You need to visit the fertility clinic only once for the egg collection.
Your next procedure is embryo transfer.
This saves you multiple clinic visits.
In my opinion, IVM might emerge as a new standard in IVF technology very soon.
I hope you can start your fertility journey in 2026 with clarity, confidence and full of hope.
Good luck to you all and happy new year!
Dr Agilan Arjunan is an obstetrician and gynaecologist, and fertility specialist. For more information, email starhealth@thestar.com.my. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
