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This chapter explores the evidence behind which hormone tests should be a mandatory prerequisite for all women about to undergo their first cycle of in vitro fertilization (IVF) treatment. The traditional hormones used for assessment of ovarian reserve include early follicular phase FSH/estradiol, serum inhibin B, and anti-mullerian hormone (AMH). While serum AMH appears to be an excellent marker of quantitative ovarian reserve, it appears to have very limited usefulness as a marker of oocyte quality. Hormone assessments of ovarian reserve should not be used to judge oocyte quality, but only to predict qualitative ovarian reserve. Serum AMH measurements can be used to predict patients response to controlled ovarian hyperstimulation (COH) in their first cycle of IVF and individualize their treatment regime. Patients identified as having abnormal thyroid function should have this corrected before commencing IVF treatment so as optimize IVF embryology and pregnancy outcomes.
This chapter examines the evidence suggesting why sexual intercourse around the time of embryo transfer is beneficial to in vitro fertilization (IVF) outcomes. Three studies have examined if artificial exposure to whole semen or seminal plasma at the time of oocyte retrieval may alter IVF implantation rates. The observations that improvements in IVF pregnancy rates seen in women with tubal factor infertility undergoing artificial insemination using whole semen or sperm-free seminal plasma suggests that the mechanism for action is not simply natural conception but rather a beneficial effect on embryo development or endometrial receptivity. In the rodent model exposure of the female to semen produces an inflammatory reaction within the endometrium with the release of cytokines such as granulocyte macrophage colony-stimulating-factor (GM-CSF) that are known to have positive effects on embryo development. However, intercourse is not advocated for women experiencing pelvic discomfort related to an exaggerated hyperstimulation response.