IVF Procedure Step by Step - Part 1

Summary

This 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

00:00

🤝 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.

05:00

📅 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.

10:02

💊 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.

15:02

🔍 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.

Keywords

💡In Vitro Fertilization (IVF)

IVF is a medical procedure where eggs and sperm are combined outside the body in a laboratory setting to facilitate fertilization. It is a common treatment for infertility. In the video, IVF is the central theme, with the entire script focused on educating patients about what to expect before, during, and after the procedure.

💡Patient Care Coordinator

A Patient Care Coordinator is a professional who organizes and coordinates the patient's care from the initial consultation to the start of treatment. In the script, the coordinator's role is highlighted as they help manage the logistics, medications, and financial aspects of the IVF process.

💡IVF Nurse

An IVF Nurse works closely with the Patient Care Coordinator to ensure the patient is well-informed and prepared for the IVF process. The script mentions that the IVF nurse is involved in educating patients about the treatment, including medication administration and potential side effects.

💡Billing Specialist

A Billing Specialist or Practice Administrator is responsible for managing the financial aspects of a patient's care, including costs, insurance, and billing. The script emphasizes the importance of discussing financial expectations and understanding the costs associated with IVF treatment.

💡Consent Forms

Consent forms are legal documents that patients must sign to indicate their understanding and agreement to the treatment's risks and procedures. The script explains that these forms are not just for legal protection but also serve as an opportunity for patients to review and question the information they've been given about the IVF process.

💡Protocol

In the context of IVF, a protocol refers to a specific treatment plan tailored to an individual patient's needs. The script discusses how protocols are developed based on factors such as body mass index, anti-mullerian hormone levels, and patient age, to determine the appropriate medication and dosage.

💡Follicle Stimulating Hormone (FSH)

FSH is a hormone used in IVF to stimulate the growth of follicles in the ovaries. The script mentions that FSH is administered to patients to encourage the development of a safe number of follicles, which is crucial for the IVF process.

💡Menopure

Menopure is a medication that contains both follicle stimulating hormone (FSH) and luteinizing hormone (LH), used in IVF to stimulate egg development. The script specifies that in the United States, LH and FSH are not given separately, and Menopure is an example of a combined drug used in treatment.

💡Ovarian Hyperstimulation Syndrome (OHSS)

OHSS is a potential side effect of IVF treatment where the ovaries become enlarged due to an excessive response to stimulation medications. The script warns patients about this and other side effects, emphasizing the importance of understanding the risks associated with IVF medications.

💡Baseline

In the script, 'Baseline' refers to the initial state or measurements taken at the beginning of the IVF process, including hormone levels and the count of eggs on day two or three of the patient's cycle. These measurements help in determining the appropriate treatment protocol.

💡Suppression Check

A suppression check is a test conducted to ensure that the patient's body is in the correct state to begin IVF medication. The script describes this check as involving blood work and an ultrasound to confirm that hormone levels are low and that there are no dominant follicles present.

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]