Answers To Common Questions
We have listed the most frequent questions on this page by category. Please select the appropriate tab to get answers to our most asked questions. If the topic is not covered here, please contact us and someone from our staff should be able to get the information you need.
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.
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.
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.
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.
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.
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.
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.
Anywhere from 2-5. It depends on how fast the follicles are growing and how many there are.
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
• Scheduling appointments/lab tests
• Prior authorization of medications
• Insurance/financial issues/concerns
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 or concerns when you call.
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.
Many of the infertility diagnostic tests need to occur after menstruation stops and before ovulation. Patients are placed on OCPs to assist in scheduling their tests or treatments in a timely fashion.
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 and start with a brand new pack of OCPs. Do not stop taking OCPs until directed to do so. Refills are available at your pharmacy. Note: Never start OCPs until after your day 3 labs are drawn if they are ordered.
Spotting or bleeding is a frequent side effect of OCPs 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.
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 OCPs, the withdrawal bleed when the OCPs have stopped may be minimal.
Review these over-the-counter medications considered safe to use during pregnancy. As brand names and ingredients can change, please refer to the generic name in parentheses. Should you have questions or concerns, please call the clinic or your pharmacist.
No, medications must be obtained from an American or Canadian pharmacy. The use of medications from other countries will not be permitted.
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.
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.
• 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.
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.
The number of medications used in a fertility treatment cycle can seem overwhelming. Some of the medications used in fertility treatment are oral, but many require injection either under the skin’s surface (subcutaneous) or into the muscle (intramuscular). For your reference, we have provided these instructions via teaching videos.
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 (pen), Cetrotide (pen), 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.
• Subcutaneous (subq) – short needle should be used for: Follistim, Gonal-F, Bravelle, Lupron, Menopur, Ganirelex Acetate (pen), Cetrotide (pen), 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.
Please refer to the safe disposal of needles and syringes sheet.
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.
Contact the clinic for further instructions.
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.
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.
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.
For nausea before nine weeks of pregnancy, eat frequent high carb, low fat meals and drink lots of fluids. You may be prescribed Pyridoxine (B6) 10-25mg 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. Always check with your obstetrician first.
If you are undergoing pre-screening in preparation for IVF, you may need to begin taking OCPs. 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.
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.
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.
After 2:00pm, the day of the first blood draw.
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.
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 1.5 hours.
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.
The embryologist will discuss egg quality and number the morning of your scheduled embryo transfer.
On the day of your TVOR.
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.
Avoid activities that may increase your risk for ovarian torsion as your ovaries get heavier from developing follicles. This includes activities that may jostle or twist your ovaries, such as: running, yoga, bending forward or backward and intercourse. Refrain from these activities from the start of your IVF stimulation (start of injection medications) to two weeks after your egg retrieval (the total duration of time is approximately four weeks). Walking or going up and down the stairs is safe to do.
No. Due to the increased risk of ovarian torsion, patients should avoid intercourse during IVF treatment from the start of injection medications until two weeks following the egg retrieval.
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 is available upon request.
Counseling services are available for couples struggling with infertility. Ask a nurse for information.
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.
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.
Under ILSC, we are out of network for all andrology, IVF services and surgery/facility fees.
No, RMIA will submit a claim on your behalf.
RMIA has two separate companies with two separate tax IDs. For Reproductive Medicine & Infertility Associates 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 & Specialty Center, is out of network for all insurances with 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.
Any payment for IVF services are due in full at the time of your program start.
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.
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.
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.
Yes, RMIA has established a relationship with Lending Club Financing to provide affordable monthly payments for your treatments. In addition to accepting all major credit cards, we have established relationships with Lending Club and EggFund in an effort to provide patients affordable monthly payments for treatment.
