Treatment Plan TREATMENT PLAN TREATMENT PLAN TYPE Management Review Committee TREATMENT PLANNED Diagnostic Cycle Natural Cycle Ovulation Induction Gonadotropins Letrozole Metformin Metformin plus Natural Cycles Gonadotropins COH Letrozole Metformin Metformin plus Donor Insemination Natural Cycles Gonadotropin COH Letrozole Metformin Metformin plus Conventional insemination Testicular biopsy Split ICSI/Conventional Insemination Aneuploidy Single Gene Defect Translocation Family Balancing with PGD & MicroSort X for female with PGD & MicroSort Y for male with PGD only for female with PGD only for male Donor Egg Family Balancing MicroSort X (desires female) Clinical Master® Treatment Plan Y (desires male) PGD and MicroSort X (desires female) Y (desires male) X (desires female) Y (desires male) Testicular biopsy Split ICSI/Conventional Insemination Donor Sperm Gestational Surrogacy Egg donor anonymous designated (known) Gestational surrogacy Conventional insemination Testicular biopsy Split ICSI/Conventional Insemination with Donor Egg Conventional insemination Testicular biopsy Split ICSI/Conventional Insemination True Surrogacy Conventional insemination Testicular biopsy Split ICSI/Conventional Insemination Expectant Management CYCLE DAY 2-5 LABS CCT (FSH, LH, E2, Baseline US) Baseline Ultrasound (AFC & Ovarian Volume) CYCLE DAY 7-12 LABS CCT (d10 FSH) Hx of PID or Hydrosalpinx Recommend Doxycycline prophylaxis Clinical Master® Treatment Plan beginning the day before HSG and for 5 days day of procedure Hx of PID or Hydrosalpinx Recommend Doxycycline prophylaxis beginning the day before SHG and for 5 days day of procedure CYCLE DAY 14-28 Trial Transfer Cervical Cultures Gonorrhea/Chlamydia General Genital LABS ANY DAY HIV 1&2 for female for both partners for female for both partners for female for both partners for female for both partners Prolactin BASELINE LABS ONLY ONCE Rubella titer Varicella titer Blood type and Rh MOCK CYCLE for donor egg recipient for gestational surrogate LABS (MALE) SA with strict morphology 24 hour motility test Semen Cultures Neisseria gonorrhea Chlamydia Aerobic bacteria Hormone Profile Testosterone Clinical Master® Treatment Plan Prolactin Karyotype Y-micro deletion assay LABS (REPRO ENDO) Prolactin TFT panel Testosterone ACTH Stim test CAH Stim Test LABS (AUTOIMMUNE) Thyroid Antibodies LABS (ID) HIV 1&2 Both partners Female partner Male partner Both partners Female partner Male partner Hep C Antibody Both partners Female partner Male partner Both partners Female partner Male partner Chlamydia IgG Chlamydia IgM Syphyllis (RPR) Female partner Male partner Clinical Master® Treatment Plan LABS (METABOLIC) Fasting Glucose and Insulin AM Cortisol Lipid Profile ACTH Stim Test CAH Stim Test LABS (RPL) MTHFR mutation Protein S Protein C Factor V Leiden Karotype Female Karyotype Male LABS (PG & PRENATAL) Serial HCG levels (every 3 days) Ectopic screen (serum HCG & pelvic US) Type and Screen Varicella LABS (GENETIC) Karyotype Female Karyotype Male Y-del Assay Tay Sachs Gauchers Canavans Hgb Electrophoresis LABS (PRE-OP) Blood Type & Screen Clinical Master® Treatment Plan DIAGNOSTIC PROCEDURES (FEMALE) Basic Ultrasound Baseline (CD 2-4) Antral Follicle Count Diagnostic pelvic scan Hx of PID or Hydrosalpinx Recommend Doxycycline prophylaxis beginning the day before SHG and for 5 days day of procedure Hx of PID or Hydrosalpinx Recommend Doxycycline prophylaxis beginning the day before SHG and for 5 days day of procedure Endometrial Biopsy call and schedule 7-8 days after LH surge (OPK) call and schedule on CD 21 with Integrin assay DEXA scan Mammogram SEMEN CRYOPRESERVATION LABS HIV 1&2 Semen Culture for GC & Chlamydia EXPECTANT MANAGEMENT Recommend expectant management for: Patient requests expectant managment for: PSYCHOLOGICAL EVAL & SERVICES Schedule psychological evaluation Obtain psych medical records SUPPORT SERVICES Refer for the Mind-Body Relaxation class Informed of 10 week class Separate fee charged by class instructor Refer for Acupuncture services ART CLASS & TRAINING Schedule orientation class with nursing staff Schedule injection training class with nursing staff SMOKING CESSATION RECOMMENDED Both partners CONSULTS Clinical Master® Treatment Plan Primary care Routine gynecology for annual exam and/or pap smear Andrology - Dr Opsahl Andrology - Urologist Andrology - Endocrinologist Maternal Fetal Medicine consult for High-Risk pregnancy Maternal Fetal Medicine consult for preconception counseling Genetics counseling before PGD for genetic diseases Gynecologic Oncology consult indication: Pelvic surgery consult indication: Other consult: indication: FOLLOW-UP APPOINTMENTS Complete recommended tests then return to discuss Fillin specific recommendations: Next cycle after andrology consultation after surgery to complete conversation (inadequate time to answer all questions) after psychological counseling Patient will return as needed Financial Counseling Medical Assistant/Nursing Consult Clinical Master® Treatment Plan Clinical Master® Treatment Plan Clinical Master® Treatment Plan Clinical Master® Treatment Plan Clinical Master® Treatment Plan Clinical Master® Treatment Plan Clinical Master® Treatment Plan Clinical Master®
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