Pre-treatment hormone assessment to optimize IVF outcomes

There is considerable debate and substantial individual variation in clinical practice regarding what hormones should be assessed in all patients prior to commencing in vitro fertilization (IVF) treatment. While it would appear logical to measure multiple hormones such as gonadotropins (luteinizing hormone [LH]; follicle stimulating hormone [FSH]), steroids (testosterone, 17 hydroxy-progesterone), prolactin, and thyroid function (thyroid stimulating hormone [TSH]; thyroxine [FT4]) in all women with suspected anovulation (irregular menstrual cycle), the utility of such an extensive hormone analysis in the average ovular patient about to commence IVF for male or tubal factor infertility is less certain. In today's environment of escalating medical costs it is imperative that we only order tests that have potential clinical value. Furthermore, abnormal test results can produce anxiety in the patient, an undesirable outcome at a time when the patient is already under considerable psychological distress. The focus of this chapter is to explore the evidence behind which hormone tests should be a mandatory prerequisite for all women about to undergo their first cycle of IVF treatment.