IVF Procedure Step by Step - Part 1
Summary
TLDRThis video script offers an in-depth look at the initial stages of the IVF process, highlighting the importance of a team approach with key players like doctors, patient care coordinators, nurses, and billing specialists. It emphasizes the necessity of understanding IVF risks, personalized protocols, medication education, and the significance of a suppression check. The script also addresses financial considerations and the streamlined experience for Progeny members, ensuring viewers are well-informed about what to expect before starting IVF treatment.
Takeaways
- 😀 The video is part one of a three-part education series on in vitro fertilization (IVF), focusing on pre-treatment expectations.
- 👩⚕️ The IVF care team typically includes a doctor, patient care coordinator, IVF nurse, and billing specialist, each playing a crucial role in the patient's journey.
- 🤝 The doctor emphasizes a team approach and partnership with the patient, ensuring a comprehensive understanding of the IVF process.
- 📝 Informed consent is vital, with the clinic providing forms for patients to review and ask questions about the risks and side effects of IVF.
- 🧬 A personalized IVF protocol is developed based on factors like body mass index, anti-mullerian hormone, ultrasound results, baseline hormones, and patient age.
- 💊 Medications used in IVF stimulate follicle growth and include follicle-stimulating hormone (FSH) and luteinizing hormone (LH), often combined in drugs like Menopure.
- 📅 The timing and preparation for medication start are customized, considering factors like cycle regulation, travel schedules, and patient convenience.
- 💼 Billing specialists discuss overall costs, financial expectations, and insurance coverage, including co-payments, coinsurance, deductibles, and out-of-pocket maximums.
- 💡 Progeny members have streamlined processes for authorizations and medication, reducing the burden of insurance negotiations and paperwork.
- 📚 An IVF orientation session, led by an IVF nurse, educates patients on the process, medication administration, and their specific protocol.
- 🩺 A suppression check, involving blood work and ultrasound, ensures the patient is ready to begin medication, with no dominant follicles present.
Q & A
What is the purpose of the three-part education video series by Progeny?
-The purpose of the series is to educate members about the in vitro fertilization (IVF) process, covering what to expect prior to treatment, during stimulation and monitoring, and through the egg retrieval process.
Who are the key team members involved in managing an IVF journey according to the script?
-The key team members include the doctor, the patient care coordinator, the IVF nurse, and the billing specialist or practice administrator.
What is the role of the patient care coordinator in the IVF process?
-The patient care coordinator is responsible for organizing the patient's care from the initial consultation through the start of the IVF cycle, ensuring the patient's expectations are clear and coordinating logistics.
Why is it important for patients to understand the risks of IVF before starting treatment?
-Understanding the risks is crucial for informed consent, allowing patients to make educated decisions about their treatment and to be aware of potential side effects and complications.
What is the significance of consent forms in the IVF process?
-Consent forms are not only for legal protection but also serve as an opportunity for patients to review the information they've been told verbally and understand the inherent risks of each step in the IVF process.
How are IVF protocols customized for each patient?
-Protocols are customized based on factors such as the patient's height, weight, anti-mullerian hormone levels, ultrasound results, baseline hormones, and age to determine the appropriate medication and dosage for ovarian stimulation.
What are the common fears patients have regarding hormone administration in IVF?
-Patients often fear being 'blasted' with hormones and drugs, but the clinic's approach is to administer an appropriate amount of medication to encourage a safe number of follicles to develop.
What is the role of the billing specialist in the IVF process?
-The billing specialist discusses the overall cost, authorizations, and financial expectations with the patient, ensuring they understand any co-payments, coinsurance, deductibles, or out-of-pocket maximums associated with their health plan.
Why is the suppression check important before starting the IVF medication?
-The suppression check, which includes blood work and an ultrasound, ensures that the patient's body is in the optimal state to respond to the medication, with no dominant follicles and low hormone levels.
What support does Progeny provide to patients during the IVF process?
-Progeny provides coverage that simplifies the process, including streamlined medication authorizations, financial support subject to the patient's primary health plan, and assistance from Patient Care Advocates.
What is the purpose of the IVF orientation run by an IVF nurse?
-The IVF orientation is meant to educate patients about the process, including the menstrual cycle, medication usage, potential side effects, and how to administer the self-injections at home.
Outlines
🤝 Introduction to IVF and Team Roles
In this introductory segment, Lissa Klein from Progeny's member care team welcomes viewers to the first part of a three-part educational video series on In Vitro Fertilization (IVF). The focus is on pre-treatment expectations, emphasizing that each clinic and patient's experience may vary. The video introduces the key team members involved in an IVF journey, including the doctor, patient care coordinator, IVF nurse, and billing specialist. The importance of a team approach and partnership between the patient and practitioner is highlighted. The video also outlines the initial steps post-decision to pursue IVF, such as understanding the risks and side effects, and the role of consent forms in educating patients about the process.
📅 Customizing IVF Protocols and Financial Considerations
This paragraph delves into the customization of IVF protocols based on individual patient needs, including the timing and preparation for medication. It discusses the various scenarios for starting medication, such as natural cycle tracking or the use of birth control pills for regulation. The paragraph also addresses the importance of working with the patient care coordinator to prepare for treatment, including logistics, medication ordering, and financial arrangements. Financial discussions with a billing specialist are highlighted, covering cost structures for self-pay patients, insurance coverage, and Progeny members. The paragraph underscores the streamlined process for Progeny members, including authorizations and financial expectations.
💊 Medication Authorizations and IVF Orientation
The third paragraph focuses on the authorization process for IVF medications, detailing the requirements for insurance companies and the streamlined process for Progeny RX members. It also emphasizes the importance of the IVF orientation, typically conducted by an IVF nurse, which covers the basics of the menstrual cycle, medication usage, potential side effects, and step-by-step instructions for self-administering injections. The orientation aims to alleviate patient anxiety and ensure they are well-prepared for the IVF process, including understanding their specific protocol and how it fits into their personal calendar.
🔍 Suppression Check and Upcoming Treatment Steps
The final paragraph of the video script discusses the suppression check, a crucial step before starting the IVF medication process. This check involves blood work and an ultrasound to confirm that the patient's body is in the appropriate state for treatment, with small follicles, a thin uterine lining, and low hormone levels. The paragraph explains the process of the suppression check, including meeting with medical staff and what to expect if everything is in order. It also previews part two of the video series, which will cover the stimulation and monitoring process, and encourages viewers to reach out to their patient care advocate with any questions.
Mindmap
Keywords
💡In Vitro Fertilization (IVF)
💡Patient Care Coordinator
💡IVF Nurse
💡Billing Specialist
💡Consent Forms
💡Protocol
💡Follicle Stimulating Hormone (FSH)
💡Menopure
💡Ovarian Hyperstimulation Syndrome (OHSS)
💡Baseline
💡Suppression Check
Highlights
Introduction to the three-part education video series on In Vitro Fertilization (IVF) by Lissa Klein from Progeny's member care team.
Emphasis on the importance of a team approach and partnership in managing an IVF journey with key team members including the doctor, patient care coordinator, IVF nurse, and billing specialist.
Explanation of the risks and side effects associated with IVF, including bleeding, pain, infection, and medication side effects like ovarian hyper stimulation syndrome.
The role of consent forms in the IVF process, not just for legal protection but as an opportunity for patients to understand and question what they are consenting to.
Customization of IVF protocols based on patient-specific factors such as body mass index, anti-mullerian hormone levels, ultrasound results, baseline hormones, and age.
Discussion on the types of hormones used in IVF, specifically follicle stimulating hormone (FSH) and luteinizing hormone (LH), and the practice of not overusing hormones.
The significance of timing and preparation for starting medication in an IVF cycle, including the use of birth control pills for regulation.
Coordination by the patient care coordinator to prepare for treatment, including logistics, medication ordering, and financial arrangements.
The importance of discussing the IVF cycle timeline with patients, especially in relation to their travel schedules and blackout dates.
Clarification of Progeny's role in simplifying the IVF process for patients, including coverage specifics and the support provided by patient care advocates.
Financial considerations for different patient scenarios: self-pay, insurance coverage, and Progeny coverage, including the average cost and reimbursement processes.
The challenges faced with traditional insurance coverage, such as the 'lesser before greater' policy and its impact on the IVF treatment process.
The streamlined process for Progeny patients, including pre-arranged authorizations, clear coverage understanding, and the absence of traditional insurance roadblocks.
The necessity of medication authorizations, detailing the specific requirements and the process of obtaining approval for the drugs used in IVF.
The role of the IVF nurse in conducting the IVF orientation, covering the basics of the menstrual cycle, medication usage, and potential side effects.
The importance of hands-on medication teaching to alleviate patient anxiety and ensure understanding of self-administered injections.
The significance of the suppression check, a crucial step to ensure the body is ready to start the stimulation process with low hormone levels.
The final steps before beginning the IVF stimulation process, including the suppression check and the patient's first meeting with the doctor and nurse.
Anticipation of part two of the video series, which will cover the stimulation and monitoring process, and the egg retrieval procedure.
Transcripts
[Music]
hi I'm Lissa Klein part of progeny's
member care team welcome to part one of
our three-part progeny member education
video on in vitro fertilization or IVF
in part one we will cover everything
that you can expect prior to treatment
starting it's important to note that all
clinics and all patients are different
so be sure to speak directly with your
physician about your protocol if you
have any questions
it truly takes a team to properly manage
an IVF journey and the care team you are
likely to work with includes four key
team members there's the doctor My
Philosophy about taking care of patients
is that as a team approach and a
partnership between the patient and the
practitioner the patient care
coordinator who is sometimes called the
Patient Liaison I coordinate the
patient's care from the new patient
Council all the way until the start of a
cycle any type of cycle that a patient
will be doing the IVF nurse
I was working with with the coordinator
to help organize the patient and make
sure they have an idea of expectations
and the billing Specialist or practice
administrator from beginning to end we
work with the patient throughout the
entire process from the moment they step
in the door and to the moment they
deliver their child even after if they
require any assistance especially with
their insurance we make sure we advocate
for them today we are going to take you
through everything you can expect to
happen from the moment you decide to
pursue IVF until the moment you've
reached an outcome the first thing that
usually happens after making that
decision is a conversation with your
doctor to make sure that you fully
understand the risks once the decision
has been made to proceed with IVF
patients need to be counseled carefully
about all the risks of IVF
bleeding from the retrieval pain from
the retrieval infection from the
retrieval those are the obvious ones but
the other ones are the side effects of
the medications things like ovarian
hyper stimulation syndrome infection at
the site of the injections so we have to
explain all these side effects and what
can happen and what can go through so I
typically do is I sit down with a
patient and I say let's go through the
whole process we start with an
orientation to IVF
some pictures egg and sperm meeting in
the laboratory and whatnot but then we
also go through the consent forms
explaining that each step of the process
has its own inherent risks making sure
the patient understands those risks
you see consent forms everyone thinks
are just to protect us in case we get
sued but actually consents have a really
important purpose in the IVF process
consents are the opportunity for a
patient to take what is being told to
them and now read it on a piece of paper
a good Clinic has consent forms for
patients ahead of time that they can
take home and read
a great clinic in my opinion is a clinic
that engages patients on their consent
forms and says to them do you have any
questions about what you're about to
sign not just hoping they sign their
forms to move on to the next process
after gaining a complete understanding
of all of the side effects and risks of
the IVF process one of the first and
most important conversations that needs
to happen with your doctor is a
conversation about your specific
protocol the patient and the partner if
there is one present and the physician
should sit down altogether to make a
plan and what we do is you typically
look at a patient's height and weight
that gives us their body mass index
their anti-mullerian hormone which is a
blood marker of how good their ovarian
reserve is or what their egg count
should be the ultrasound that we
performed upon the patient where we
counted their eggs on day two or three
of their cycle that's the Baseline skin
the Baseline hormones which we typically
assess on day two or three of their
menstrual cycle to help us understand
that is the brain yelling at the ovary
every month
or is the brain in the
over-communicating beautifully and then
of course the patient's age once we have
all these data points we can figure out
what medications the patient has to take
to stimulate their ovaries to grow a
robust number of follicles in a safe
manner
the hormones that we give patients are
follicle stimulating hormone or FSH and
luteinizing hormone or LH in the United
States we cannot give LH to a patient
alone so LH and FSH come together as one
single drug the drug is known as
menopure but the follicle stimulating
hormone can come to the patient in two
different forms one's called follow stem
and one's called gonowaf
regardless of the manufacturer they all
have the same function and the function
is turning the gas on to grow eggs in
our practice at ccrm and most other
practices around the country are not
fans of blasting away with hormones
and when you explain this to patients
that's actually their biggest fear
everyone's afraid that they're going to
be blasted with hormones and blasted
with drugs so what we believe is that we
give patients an appropriate amount of
medications to encourage a safe number
of follicles that develop that hopefully
have good quality where the follicles
are around the same size
in vitro fertilization Protocols are
customized on a patient-to-patient basis
and one of the first things that needs
to be customized is the timing and
preparation for when you will start your
medication
sometimes we tell a patient call us with
day one of your cycle when you start
bleeding and we'll start with medication
on day two or three sometimes we say to
patients you know what we need to
regulate you because maybe you don't get
periods or maybe you're a super
responder we need to suppress you so
we're going to use the birth control
pill
or maybe you live afar and we have to
schedule trip for you to come into our
clinic so in that case we can give you
the birth control pill for a couple days
or a couple weeks or a couple months and
typically you stop the pill and then two
days later you start these drugs
sometimes we have to have patients down
regulate that brain yelling at the ovary
right that brain is so used to yelling
at the ovary kind of like your mom
yelling at you to clean up your room
when you're a child that your mom can't
use a normal talking tone with you
and so to help calm down your body's
system we use an estrogen patch or
estrogen pills
right because the feedback mechanism to
the brain is estrogen
and so if the brain sees that there's
estrogen on board it'll calm down its
own FSH
so sometimes we have patients take the
patch or the pill
and then they come in on day two or
three of their cycle when they start
bleeding after you and your doctor set
the protocol the rest of the team starts
to get to work to help you prepare for
the treatment this part is often
spearheaded by the patient care
coordinator a lot of things happen the
month before it's not like you just come
in and say I'm ready to start and let's
just do this we always like to work with
the period beforehand to get all of the
logistics done
all of the medications ordered all the
finances in order and then we go from
there we discussed the timeline of an
IVF cycle and just make sure that the
patient is comfortable with how that's
going to work and if they have any
traveling schedules because a lot of
people come in here and they actually
have blackout dates is what we call it
so what it would look like is we
actually go in there with a physical
calendar and we write down every step of
the way everything that they need to
have scheduled by what time they need to
have their documents in we also put down
a week in which they are allotted to
have a nurse consult prior to injection
start we just like to explain to the
patient this is how it works is the
timing seem right for you this is what
the doctor has planned for you
if you're watching this video there's a
good chance that you are covered by
progeny when you get to the clinic you
should make it clear to the patient care
coordinator and to your physician that
you have progeny coverage you should
also communicate with your patient care
Advocate before you begin treatment it
makes a big difference from the very
beginning so the difference for me with
progeny patients is it just seems a lot
easier I feel like they have a sense of
they're already okay when they come in
here an important part of the process
prior to treatment beginning is a
conversation with a billing specialist
to go over the overall cost
authorizations and General Financial
expectations one thing that is important
for progeny members to understand is
that your coverage is subject to any
co-payment coinsurance deductible or
out-of-pocket maximum associated with
your primary health plan you can go over
these details with your patient care
advocate
in terms of finances there are three
different scenarios there's a selfie
patient no insurance coverage insurance
coverage and progeny so with the
self-pay patient they're 100 out of
pocket their typical cost is roughly
about thirty thousand dollars and that
consists of the IVF with the testing and
the medications in your anesthesia and
we break that process down for them
right so we tell them this is your cycle
this is what this is where you pay it
this is your medications this is where
it goes in the anesthesia no one seems
to think about the anesthesia and that's
a huge aspect the insurance aspect
um we still give them the self-pay price
and what the estimated reimbursement
could be for their insurance and the
timeline of when that reimbursement can
come into play for example a patient can
pay on November 29th but the insurance
companies typically has 45 days to pay
the patient and so we set that
expectation for them so they know when
to get the process started with
traditional coverage there are a lot of
roadblocks and mandates that get in the
way one of the standard roadblocks if
you don't have progeny is a policy
called lesser before greater most
insurance companies consist of lesser
before greater so basically what they
look for is to ensure that the patient
is in fact infertile and if any you know
less invasive procedures can be
performed before IVF but if a patient
comes to us and we know that she needs
IVF we automatically put it in for them
and we say this is what we recommend
insurance companies comes back and says
why don't you try to do this procedure
before this procedure the back and forth
requires that both you and the clinic
have to struggle with the insurance
company and it doesn't always result in
coverage for IVF often leaving patients
to pay out of pocket for the treatment
they need or deciding to begin with
lesser treatments that are not likely to
succeed wasting money and precious time
with progeny this is never an issue when
a patient comes to our practice and they
have progeny the process is amazing
they're already set up with their
Patient Care Advocates so they have
everything aligned from their
authorizations their IDs exactly what's
covered what's not covered
and actually what their smart cycles
look like so they know everything we
just go over it with them so we set that
expectation but the process is seamless
a crucial piece of the IVF puzzle is the
authorizations for the medications that
you will be taking for the 10 to 12 days
of stimulation
so the medication process especially for
authorization is very specific they
require the type of medication is it
name brand or non-name brand and the
dosaging so for example if a patient's
33 years old and on a high dosage they
may question why she's on that dosage so
same requirements they want all your
medical records They want to confirm why
you're doing the treatment and then they
tell you exactly where to fill the
medications so a patient may come in and
think oh I can just go to my local 24
CVS it actually has to be a specialty
pharmacy within the city or mail order
depending on your insurance
if you have your medication covered
through progeny RX again the process is
much more streamlined so project RX is
pretty similar to their authorization
process it's seamless they tell us
exactly where to fill the medications
they ask for the authorization for
what's been approved and we just submit
everything to them an important step of
any IVF protocol is the IVF orientation
which is usually run by an IVF nurse
so we usually schedule the nurse consult
which is a patient orientation when
everything has been completed in terms
of prerequisite checklists so they're I
in the Infectious Disease panel genetics
you know major things that would help
determine what their protocol was for
moving forward with the IVF process so
once all that is complete we would
schedule the orientation class or nurse
consult where they meet with the nurse
and we sit down to talk about IVF in
general so we start off with a slideshow
which usually entails the normal mensi
cycle and what we do during a stimulated
cycle
because I think that is important
important to start with the basics and
we talk about that medication and how
it's used potential side effects Etc we
also talk about how to use the
medication it's very overwhelming as a
patient when you get a box of medication
so we try to break that down as best as
possible possible and give as much
education as we can so we give
step-by-step instructions we give access
to videos online I know myself I sit
down with the patient and actually show
them what they're going to be using
because I prefer Hands-On approach I
think it's good to just touch everything
and and see what you're going to be
working with so when that night comes
when you have to start your first
injection you're not as intimidated so
medication teaching is probably one of
the biggest parts of of the nurse
console but then also talking about
their specific protocol we talk about
their cycle how their protocol works
with their cycle how it works with their
calendar you know we're always getting
questions about timeline and they're
going on vacation and how this affects
their treatment so that's definitely
something we would review at that point
as well
IVF medications are usually
self-administered injections that you do
at home
some of the medications are very
straightforward some are a little more
complex and many patients feel anxiety
about this part of the process
the doctors and nurses at your clinic
are important resources for you to lean
on but don't forget that you can also
rely on progeny and honor Patient Care
Advocates to help you ease the burden if
you have progeny RX you can schedule an
unpacket consult with every shipment of
medications you receive on that call you
will speak with the pharmacist or nurse
who will walk you through all your
medications how to store and administer
the drugs and answer any questions that
you may have
after your IVF orientation there is one
more important step before you can begin
the stimulation process the suppression
check sometimes called your Baseline
morning monitoring visit
so once you're set up for your cycle we
usually tell you a specific day to come
in for your suppression check so your
suppression check entails blood work and
ultrasound to make sure you are
suppressed we want your follicles to be
all very very small we want your lining
to be nice and thin and we want your
estrogen to be low your progesterone to
be negative your LH everything to be
nice and low prior to starting the
medication because we know that this is
the best way your body will actually
respond to the medication we do this
suppression check also to make sure you
don't have any dominant follicles should
you have a dominant follicle the
medication wouldn't work so that is the
session essentially what the suppression
check is probably the most important
check to begin with so you come in you
meet with the front desk you tell them
you're here the medical assistant then
pulls you back to draw your blood work
and then you meet with the Doctor Who to
your ultrasound that first day you also
meet with a nurse to again go over what
to expect so she'll say if everything
looks good today we'll send you your
instructions via the patient portal or
call if that's what we've set up for you
the has been part one of our three-part
education video on the IVF experience in
part two we will take you through
everything you can expect during the
stimulation and monitoring process
through the day you go in for the egg
retrieval please don't hesitate to reach
out directly to your patient care
Advocate if you have any questions or
concerns about your upcoming treatment
and remember you can always get more
information at progeny.com
education I'm Lissa Klein and on behalf
of your entire progeny family we look
forward to helping you along your
journey
[Music]
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