- Why do I need an OB/GYN physician?
- What is a program start?
- What is monitoring?
- My menses started on Friday night. I need to schedule day 3 labs or my baseline ultrasound. What do I do?
- I forgot what my next step is before my next appointment.
- I’m supposed to have a laparoscopy/D&C/HSG/etc., done before I am seen again. Do I need to do anything else?
- I was told to call and schedule an appointment for my first day of “normal menstrual flow.” What does this mean?
- What do you mean by day 1, day 3?
- How many ultrasounds will I need?
- Do you provide on-call services?
- Can I stop in to the clinic to get a quick question answered?
- I need a “landmark” drawn for an injection. Can I stop in to have this done?
Oral Contraceptive Pills (OCP’s)
- Why am I on OCP’s if I am trying to conceive?
- When do I start my OCP’s?
- Is it okay if I am spotting while taking OCP’s? What about nausea?
- I have stopped taking OCP’s and have not begun bleeding. Is this normal?
- I need a refill on my medication, what should I do?
- I received a package insert from the pharmacy that says progesterone-in-oil should not be used if I am pregnant. What does that mean?
- I forgot how to mix my medication. What do I do?
- What needle do I use?
- How long should we take the doxycycline?
- I forgot to take a dose of my medication. What do I do?
- I am currently undergoing treatment and was diagnosed with a viral infection, disease, etc. The family physician wants to prescribe an antibiotic. Is this okay?
- I have a cold. What can I take?
- I think that I may have a bladder infection. Does RMIA offer testing and treatment?
- I am pregnant and feel nauseous. What should I take?
- What is an estradiol?
- I just had my day 3 blood tests drawn, what is my next step?
- When will I get the results of my lab tests?
- Why do I need two pregnancy blood tests if the first test is positive?
- When will I get the results of my pregnancy test?
- I took a urine pregnancy test and the results were negative. Could I still be pregnant?
- How long will I be there for a TVOR (transvaginal oocyte retrieval)?
- How long will I be there for an ET (embryo transfer)?
- I had a TVOR done. When will we know how good the eggs are or how many we got?
- When do the eggs get fertilized? (When is the sperm and egg put together?)
- Does each follicle give you an egg?
- Am I able to exercise during ovarian stimulation?
- May my partner and I have intercourse?
- Can I have a massage or acupuncture before or after TVOR/ET?
- I am finding this process very stressful. What can I do?
- Where should I obtain my referral?
- Why am I also receiving a bill from Quest or other reference labs?
- Why do I have to pre-pay for my semen analysis / sperm prep?
- Do I have to submit a claim to my insurance company?
- How does RMIA bill in-network vs. out-of-network?
- When and how much do I need to pay for my IVF program?
- What is the difference between Regular IVF and FCWP (Warranty Program)?
- What is included/excluded in the FCWP Program?
- Is financing available?
Why do I need an OB/GYN physician?
Prior to starting treatment, RMIA will ask that you establish care with an Ob/Gyn physician. This is necessary for correspondence relating to your care at RMIA and any follow up care that may be necessary.
What is a program start?
This is the final step in the pre-screening process before moving on to your IVF program. This visit may include a Sonohysterogram, trial of transfer, and consent signing with your physician. The program start is still considered part of the pre-screening process.
What is monitoring?
Monitoring begins at your baseline ultrasounds and leads up to the point of retrieval. This includes all vaginal ultrasound and blood work needed to determine how your ovaries are responding to stimulation.
My menses started on Friday night. I need to schedule day 3 labs or my baseline ultrasound. What do I do?
Call the main RMIA phone number (651-222-6050). You will be given the option of paging the on-call nurse or leaving a voice mail. Since this is not an emergency, choose the voice mail option. Leave your name, phone number and reason for your call. Although we do not answer the phones on weekends, a staff member will still retrieve messages and contact you to schedule your appointment.
I forgot what my next step is before my next appointment.
Refer to your “Follow-Up Appointment” checklist. You received this at your Phase I appointment. All requested labs/records needed for your next appointment are listed on this form. Your next appointment cannot be scheduled until every item requested is received/completed.
I’m supposed to have a laparoscopy/D&C/HSG/etc., done before I am seen again. Do I need to do anything else?
You will be scheduled for your next appointment once we have received the actual operative report, film or pathology report. You need to sign a record release form at the time of the procedure to authorize your physician to send these records to RMIA. HSG films are stored at the facility/hospital in which the procedure was performed. You must request the films from this facility.
I was told to call and schedule an appointment for my first day of “normal menstrual flow.” What does this mean?
This refers to the first day you are menstruating at what is considered a normal red blood flow based on your regular cycles. The level of blood flow varies greatly from person to person. If you are only spotting sporadically on a given day, please wait until you have consistent flow before counting it as the first day. If spotting occurs early in the day, but it progresses to red flow before you go to bed, this is considered “day 1”.
What do you mean by day 1, day 3?
Day 1 refers to the first day you are menstruating, that which is considered a normal red flow based on your regular cycles. If you are only spotting sporadically, please wait until you have a consistent flow before counting it as the first day. If spotting occurs early in the day but it progresses to red flow before you go to bed, this is considered to be “day 1”.
How many ultrasounds will I need?
Anywhere from 2-5. It depends on how fast the follicles are growing and how many there are.
Do you provide on-call services?
We do have medical emergency on-call services after normal clinic hours. Our answering service number is 952-930-5258. The answering service will page our on-call staff for you. We ask that you reserve this service for medical emergencies only. For life threatening emergencies, either call 9-1-1, or go directly to the emergency room. Contact your OB/GYN if you are pregnant and have vaginal bleeding or pelvic cramping. If you have a question that can be answered the following morning or during normal business hours, please leave a voice mail and your call will be returned. Please be aware that the on-call staff cannot assist you with:
• Scheduling appointments/lab tests
• Prior authorization of medications
• Insurance/financial issues/concerns
Can I stop in to the clinic to get a quick question answered?
No. Our nursing staff is scheduled with patient appointments all day. We do not offer walk-in services. We are happy to assist you with your questions/concerns when you call.
I need a “landmark” drawn for an injection. Can I stop in to have this done?
Please call to schedule this. Our nursing staff is happy to accommodate this request with advance notice only. Please refer to the Medication section of the handbook.
Why am I on OCP’s if I am trying to conceive?
Many of the infertility diagnostic tests need to occur after menstruation stops and before ovulation. Patients are placed on OCP’s to assist in scheduling their tests/treatment in a timely fashion.
When do I start my OCP’s?
Most people will start on day 3 of their menses and continue on active pills until their next appointment. If you have a 4-week pill pack, you will omit the last week of pills (these are a different color) and start with a brand new pack of OCP’s. Do not stop taking OCP’s until directed to do so. Refills are available at your pharmacy. Note: Never start OCP’s until after your day 3 labs are drawn if they are ordered.
Is it okay if I am spotting while taking OCP’s? What about nausea?
Spotting or bleeding is a frequent side effect of OCP’s and will not interfere with the pills effectiveness. Continue to take the pill daily until your official stop date. Nausea is also quite common, especially during the first week. You may minimize this problem by taking your pill nightly with food.
I have stopped taking OCP’s and have not begun bleeding. Is this normal?
Yes, bleeding (or spotting) is the desired condition prior to IVF stimulation. Absence of bleeding may occur and should be brought to the attention of the medical staff prior to your baseline ultrasound. Keep in mind, however, if bleeding occurred while taking the OCP’s, the withdrawal bleed when the OCP’s have stopped may be minimal.
I need a refill on my medication, what should I do?
First, check with your pharmacy for refill availability as most prescriptions are written to include refills.
• Always check your medication supply prior to the weekend so as to avoid refill problems over the weekend. After hours, it can be difficult to find a pharmacy that carries infertility drugs.
• If you are out of a particular medication, please call a member of our nursing staff. You will need to provide a pharmacy phone number at the time of your request.
I received a package insert from the pharmacy that says progesterone-in-oil should not be used if I am pregnant. What does that mean?
We have used progesterone for over 20 years to support early pregnancy without problems or increased instances of birth defects. Progesterone-in-oil is chemically identical to what your own body produces.
I forgot how to mix my medication. What do I do?
Please refer to the injection teaching video or the medication section of the patient handbook. Detailed teaching sheets are located there.
What needle do I use?
This depends on which medication you are injecting. Please refer to the injection teaching video or the medication section of the patient handbook for further details regarding these medications.
• Subcutaneous (subq) – short needle should be used for: Follistim, Gonal-F, Bravelle, Lupron, Menopur, Ganirelex Acetate (has own syringe), Cetrotide (has own syringe), Heparin, Ovidrel
• Intramuscular (IM) – long needle should be used for: Progesterone-in-oil and Estradiol Valerate. Pregnyl/Novarel/HCG can be given IM but only if instructed to do so.
How long should we take the doxycycline?
Doxycycline, an oral antibiotic, will be taken twice daily when your IVF stimulation begins if combined with Flagyl. If taken alone it will begin the night of egg retrieval for 3 nights and for a frozen cycle it will begin the night progesterone begins until the night of the embryo transfer. You should take doxycycline with a large glass of water and food in your stomach.
I forgot to take a dose of my medication. What do I do?
Contact the clinic for further instructions.
I am currently undergoing treatment and was diagnosed with a viral infection, disease, etc. The family physician wants to prescribe an antibiotic. Is this okay?
If you need to be treated for a condition by another physician while you are undergoing fertility treatment, please inform the attending physician you are currently attempting pregnancy through infertility treatment. If the medication is considered safe during pregnancy, it is also safe for you to take during your infertility treatment.
I have a cold. What can I take?
Tylenol, Sudafed, and Robitussin cough syrup are acceptable medications while undergoing infertility treatment or in pregnancy. Do not take anything containing alcohol or a decongestant such as Mucinex “D.” Most cough drops are ok as long as they don’t contain these either.
I think that I may have a bladder infection. Does RMIA offer testing and treatment?
RMIA is a subspecialty clinic, therefore, we see patients strictly for infertility treatment. Please contact your primary health care provider or obstetrician for routine health care and treatment of illnesses.
I am pregnant and feel nauseous. What should I take?
For nausea before nine weeks of pregnancy, eat frequent meals (high carb, low fat) and drink lots of fluids. You may be prescribed Pyridoxine (B6) 10-25 mg 3 times a day. If no response in 2 days, take Unisom Sleep tablets (doxylamine), not the Unisom Sleepgels (diphenhydramine): half tablet 3 times a day, and a full tablet at bedtime (may cause drowsiness). Always check with your obstetrician first.
What is an estradiol?
Estradiol is an estrogen hormone produced by the ovaries. When undergoing ovarian stimulation, the result of the estradiol blood tests and ultrasounds provide your physician with information regarding the maturity of the eggs.
I just had my day 3 blood tests drawn, what is my next step?
If you are undergoing pre-screening in preparation for IVF, you may need to begin taking OCP’s. (Please call one of the nurses to confirm). Since there are several IVF pre-screening tests, call your nurse to inquire as to what additional tests may be needed if you are uncertain. If you are not undergoing IVF pre-screening, review the “Follow-Up Appointment” checklist given to you at your Phase I visit.
When will I get the results of my lab tests?
If you are a Phase I patient and have currently undergone the required diagnostic testing, your results will be reviewed with you by the Physician at your Phase II appointment. The nurses do not review these tests with you over the telephone.
Why do I need two pregnancy tests if my first test is positive?
The blood tests are drawn just as the pregnancy hormone is becoming detectable in your system. Comparing the value of your two tests allows your physician to accurately determine if there is an appropriate rise in pregnancy hormone.
When will I get the results of my pregnancy test?
After 2:00 p.m., the day of the first blood draw.
I took a urine pregnancy test and the results were negative. Could I still be pregnant?
Urine pregnancy tests are not as sensitive as blood pregnancy tests. If you are in the very early stages of pregnancy, the urine test may not detect low levels of pregnancy hormone in your system.
How long will I be there for a TVOR (transvaginal oocyte retrieval)?
You will be asked to arrive 1 hour before your scheduled retrieval. Following the actual retrieval which takes approximately 15-20 minutes, you will be in recovery an additional 1 to 1-1/2 hours.
How long will I be there for an ET (embryo transfer)?
You will be asked to arrive 1 hour prior to the scheduled embryo transfer time. Following the embryo transfer which takes approximately 15 minutes, you will be asked to remain in the treatment room for an additional 6 minutes.
I had a TVOR done. When will we know how good the eggs are or how many we got?
The embryologist will discuss egg quality and number the morning of your scheduled embryo transfer.
When are the eggs fertilized?
On the day of your TVOR.
Does each follicle give you an egg?
The number of ovulatory sized follicles will usually not correlate with the number of eggs retrieved. Some eggs may be too mature and others may be too immature.
Am I able to exercise during ovarian stimulation?
Yes, but only during the early stages. As your ovaries become enlarged, exercise may become uncomfortable and should, therefore, be discontinued. Walking is fine at any time.
May my partner and I have intercourse?
Yes. We desire only 2-5 days of sexual abstinence prior to the collection of the semen sample the day of the egg retrieval or IUI. We will remind you of this when we advise you on the timing of your HCG/Ovidrel administration.
Can I have a massage or acupuncture before or after TVOR/ET?
Massage is OK provided they don’t perform any deep muscle massage of the lower abdomen. The use of acupuncture is supported by RMIA. However, do not take any herbs recommended by an acupuncturist during treatment. Please discuss this with your physician if using an acupuncturist during your treatment. A list of recommended acupuncturists can be found in the General Information section of the patient handbook.
I am finding this process very stressful. What can I do?
Counseling services are available for couples struggling with infertility. Ask a nurse for information.
Where should I obtain my referral?
Your referral should come from your primary physician and go to your insurance (not RMIA). With some insurance carriers, a patient can self-refer to an OB/GYN, but that OB/GYN cannot then refer the patient to a sub-specialist.
Why am I also receiving a bill from Quest or other reference labs?
RMIA performs in-house testing for Day 3 labs, Estradiol, Progesterone, FSH, LH, HCG, Rubella, Prolactin, and Hemoglobin. All other lab tests are sent to outside labs for analysis.
Why do I have to pre-pay for my semen analysis / sperm prep?
Under ILSCA, we are out of network for all andrology, IVF services, and surgeries/facility fees.
Do I have to submit a claim to my insurance company?
No, RMIA will submit a claim on your behalf.
How does RMIA bill in-network vs. out-of-network?
RMIA has two separate companies with two separate tax ID#’s. For Reproductive Medicine and Infertility Associates (tax id 41-192-4195) we are in-network for most insurances. Physician consults, ultrasounds, labs, and other procedure are billed to insurance and then you are billed for your portion. A separate company, Infertility Lab and Surgery Center (41-1939941), is out of network for all insurances (IVF procedures, Andrology and surgeries are billed through this company). IVF is always a prepaid service in full. Once you’ve had your procedure we submit the claims to your insurance for possible reimbursement back to you at the out-of-network level.
When and how much do I need to pay for my IVF program?
Any payment for IVF services are due in full at the time of your Program Start.
What is the difference between Fee for Service IVF and the Warranty Program (FCWP)?
Fee for Service is based on one cycle of IVF. Fertility Cost Warranty Program (FCWP) is a program based on up to three cycles of IVF for a predetermined cost with a refundable portion due back if the patient does not achieve a live birth.
What is included/excluded in the FCWP Program?
Included services: Three complete cycles of IVF including retrieval, anesthesia, transfer, fertilization, ICSI, Assisted Hatching, extended culture, cryopreservation, one year of embryo storage, and frozen transfers off unsuccessful fresh cycles, and cycle monitoring for couples monitoring through RMIA.
Excluded services: Physician consult, lab testing, psychological consult, MMPI (if required), program start, surgeries, monitoring (if done outside of RMIA at an approved satellite/monitoring clinic), hyperstimulation checks and aspirations (if necessary), pregnancy testing, medications and ultrasounds.
Is financing available?
Yes, RMIA has established a relationship with Lending Club Financing to provide affordable monthly payments for your treatments.