Tests before assisted reproduction (couple referred to a fertility centre)

Mandatory serologies (less than 6 months before the first gamete collection, the first insemination or the first transfer)

• HIV-1 and HIV-2 serology
• Hepatitis B serology: HBsAg, anti-HBc, anti-HBs (not needed if vaccinated with documented anti-HBs ≥ 10 IU/mL)
• Hepatitis C serology

Laboratory tests

• Anti-Müllerian hormone (AMH)
• TSH
• Anti-TPO antibodies (depending on the centre)if neededThe European Thyroid Association recommends TSH and anti-TPO in every woman before ART ^[2]; ESHRE advises against antithyroid antibodies in unexplained infertility ^[3]. NABM coverage in a woman who wishes to conceive ^[4].
• Rubella serology (unless two vaccinations documented)
• Toxoplasmosis serology (in the absence of written proof of immunity)
• Syphilis serology (according to risk factors)if neededThe 2023 order no longer requires it for the couple ^[5]; to offer according to risk factors (occupational, addictions, history of transfusion) ^[6].
• Serum prolactin (if ovulation disorder, galactorrhoea or pituitary adenoma)if needednon-French guidelineOnly in case of ovulation disorder, galactorrhoea or pituitary adenoma ^[7]; not routinely ^[3].
• ABO and RhD blood group (if no complete blood group card)if neededWoman without a complete blood group card (ABO, full rhesus phenotype and Kell; two determinations); if she is RhD negative, blood group of the future father ^[6].
• HTLV-1 serology (if linked to a high-prevalence region: residence or origin, partner or parents originating from there)if neededThe UK requires this test before processing the gametes of patients living in or coming from a high-prevalence region, or whose partner or parents come from one; Germany follows the same rule ^[8,9]. The French order cites it for third-party donors and allows additional tests in case of exposure to another pathogen that may affect the pregnancy ^[5]. The French recommendation on migrants proposes it for women of childbearing age from sub-Saharan Africa, Latin America, the Caribbean or Japan ^[10].

+ on self-collected vaginal sample or first-catch urine

• Chlamydia trachomatis and Neisseria gonorrhoeae NAAT (PCR) (before uterine instrumentation, if not done in the infertility work-up)if needednon-French guidelineBefore any intrauterine procedure (hysterosalpingography, insemination) ^[7], if the test was not done in the infertility work-up.

At the start of the cycle (day 2 to 4), only if cycles are irregular or at the centre's request

• FSHif neededIrregular cycles: FSH and LH ^[7,11]; not to predict the response to stimulation ^[7,12].
• LHif neededIrregular cycles: FSH and LH ^[7,11].
• Oestradiolif neededIrregular cycles, with FSH and LH ^[11]; baseline oestradiol does not predict the response to stimulation ^[12].
• Total testosterone (if cycles irregular or PCOS suspected, outside combined oestrogen-progestogen pill use)if needednon-French guidelineSuspected PCOS, especially without clinical signs of hyperandrogenism; uninterpretable on a combined oestrogen-progestogen pill ^[13].

In the middle of the luteal phase (day 21 of a 28-day cycle)

• Progesterone (if ovulation is not already documented)if needednon-French guidelineConfirms ovulation; NICE proposes it to all women in the mid-luteal phase, later if cycles are long ^[7]; ESHRE considers it optional if cycles are regular ^[3].

Cervico-uterine sample (if cervical screening is not up to date)

• HPV test (if 30 years or over and screening not up to date)if neededNICE asks to check the date and result of the last screening and to offer it according to the national programme, so as not to delay treatment ^[7]. HAS provides for a smear before pregnancy when the previous one is more than 2 to 3 years old ^[6]. Interval and conditions: see the page "Cervical cancer screening".
• Cervical cytology (if 25 to 29 years and screening not up to date)if neededSame reasons as the HPV test ^[6,7]: before 30 years, screening remains cytological. Interval and conditions: see the page "Cervical cancer screening".

Mandatory serologies (less than 6 months before the first gamete collection, the first insemination or the first transfer)

• HIV-1 and HIV-2 serology
• Hepatitis B serology: HBsAg, anti-HBc, anti-HBs (not needed if vaccinated with documented anti-HBs ≥ 10 IU/mL)
• Hepatitis C serology
• Syphilis serology (according to risk factors)if neededThe 2023 order no longer requires it for the couple ^[5]; to offer according to risk factors (occupational, addictions, history of transfusion) ^[6].
• HTLV-1 serology (if linked to a high-prevalence region: residence or origin, partner or parents originating from there)if needednon-French guidelineSame rules in the UK and Germany for the man as for his partner ^[8,9]. The French order cites it for third-party donors ^[5].

Semen examination

• Semen analysis and sperm morphology (spermocytogram)
• Semen culture

If at least two abnormal semen analyses, oligospermia < 10 million/mL or azoospermia

• Total testosteroneif neededAfter at least two abnormal semen analyses ^[7], or straight away if oligospermia < 10 million/mL or azoospermia ^[11].
• LHif neededSame indications as testosterone ^[7,11].
• FSHif neededSame indications as testosterone ^[7,11].
• Serum prolactin (if reduced libido, unexplained gynaecomastia or gonadotropic insufficiency)if neededDecreased libido with sexual dysfunction, unexplained gynaecomastia or hypogonadotropic hypogonadism ^[11].
• TSH (if ejaculation disorders, erectile dysfunction or abnormal semen analysis)if needednon-French guidelineNo routine thyroid screening in men; TSH in case of ejaculation disorders, erectile dysfunction or abnormal semen analysis ^[2].