Cycle Plan Page1 CYCLE PLAN TYPE CYCLE TYPE: Initial Plan Updated Plan Management Team Review Monitoring Review

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1 Cycle Plan Page1 CYCLE PLAN TYPE Initial Plan Updated Plan Management Team Review Monitoring Review CYCLE TYPE: Undecided - diagnostic testing only Natural Cycle Coitus with IUI Ovulation Induction CC plus Metformin Gonadotropins plus Metformin Letrozole plus Metformin CCT + IUI IUI CC Letrozole Gonadotropin Sperm source Partner sperm Anonymous donor sperm Directed donor sperm Mixed specimen sperm IVF ICSI all eggs split eggs PGD Aneuploidy Single Gene Defect Translocation Donor Egg ICSI all eggs 50% PGD Aneuploidy Single Gene Defect Translocation Egg Donor Frozen Embryo Transfer using CED preparation using natural cycle preparation Donor Embryo Gestational Surrogacy with intended parents own eggs with donor eggs & intended parents sperm Family Balancing MicroSort

2 Cycle Plan Page2 X (desires female) Y (desires male) PGD & MicroSort X (desires female) Y (desires male) PGD for female for male OI MONITORING PLAN OPK Monitor with Blood & US Baseline B&S Monitoring B&S begin monitoring on CD: BBT Timed Coitus QOD beginning CD: STIMULATION PLAN: Follow all stimulation and adjunct medications and dosages in standard protocols unless as altered Long-term Lupron, protocol for women less than 35 yrs Long-term Lupron, protocol for women greater than 35 yrs Microdose Lupron with Estrogen pre-treatment for standard duration for extended duration of Antagonist, good prognosis patient match to gonadotropin Ganarelix Cetrotide with Estrogen pre-treatment for standard duration for extended duration of Antagonist, poor prognosis patient match to gonadotropin Ganarelix Cetrotide with Estrogen pre-treatment for standard duration for extended duration of Controlled Endometrial Development Transdermal Patch Vivelle Dot Estrace Estradiol valerate IM Combination therapy using: Natural Cycle Development Supplement with progesterone No supplements CC 100 mg days 5-9 for CCT Other: STIMULATION MED: Medication and dosage according to protocol

3 Cycle Plan Page3 OCP: Limit OCP days to: Extend OCP days to: Reason for protocol deviation: rfsh AM Dose: PM Dose: Reason for protocol deviation: Gonal-f AM Dose: PM Dose: Reason for protocol deviation: Follistim AM Dose: PM Dose: Reason for protocol deviation: Repronex AM Dose: PM Dose: Reason for protocol deviation: Menopur AM Dose: PM Dose: Reason for protocol deviation: Bravelle AM Dose: PM Dose: Reason for protocol deviation: Transdermal Patch plus vaginal estrace plus IM estradiol valerate Vivelle Dot standard doses start with: plus vaginal estrace plus oral estrace plus IM estradiol valerate Estrace (2mg tablets) Oral Dose: Vaginal Dose: CC CC 100 mg days 5-9 Dose: Stim days 5-9 Stim days 3-7 Other: TRIGGER: hcg 10,000 U 5,000 U titrate to E2 schedule IUI 36 hr later

4 Cycle Plan Page4 Ovidrel Lupron (12 units x 2) None LUTEAL SUPPORT MEDS: Progestrone in Oil 50mg/1cc Dosing QD BID Switch to vaginal P4 after ET Crinone 8% BID Crinione 8% QD Prometrium Tablets 200mg 1 tablet TID PV Progesterone Capsules 200mg 1 BID PV Other Begin Progesterone 3 days after LH surge 7 days after LH surge as directed when endometrium developed OTHER MEDS Metformin Advance dose each week by 500mg daily beginning with Baby Asprin (81mg QD) Predinsone Dose: Heparin (5,000 units BID) Parlodel 2.5mg QD Synthroid Dose: Estrace 2mg QHS PV Viagra 50mg PV QHS IVIg Other: INSEMINATION TECHNIQUE To Be Determined pending review of Conventional IVF insemination pending review of pending repeat 24 hour motility test ICSI Indication for ICSI: Poor semen quality Poor morphology but normal AR test Failed AR test Poor 24hr motility test Prior poor or failed IVF fertilization Testicular sperm use Unexplained infertility MicroSorted sperm Other: All eggs Split Conventional/ICSI: Percent Conventional

5 Cycle Plan Page5 ART ADJUNCTS PGD Percent ICSI Assisted Hatching Indication Advanced reproductive age Prior failed IVF implantation Embryologist recommendation Other: Percent hatching: as indicated by embryologist Fragment removal, as indicated by embryologist Freeze all embryos Donor Sperm Primary sperm source Back up Split Partner/Donor sperm Percentage Partner sperm Percentage Donor sperm Cryopreserve excess partner's sperm NSA & PESA (includes ICSI all eggs) Back-up only Required Testicular Biopsy (includes ICSI all eggs) Back-up only Required - urology consult pre-op Other: Aneuploidy Single Gene Disorder CF SMA Fragile X Huntingtons Other probes already built probes require building Translocation Parental Karyotype: Parental Translocation Include Aneuploidy testing Family Balancing MicroSort X (desires female) Y (desires male) Couple must contact MicroSort and meet study criteria Obtain and freeze adequate sperm before cycle PGD & MicroSort X (desires female) Y (desires male) Couple must contact MicroSort and meet study criteria Obtain and freeze adequate sperm before cycle PGD Only

6 Cycle Plan Page6 for female for male EMBRYO CRYOPRESERVATION Freeze all viable excess embryos Patients understand that to donate embryos to other couples later requires costs borne by the Patients want long-term option for donation Dispose of excess embryos Counseled regarding potential for viable pregnancies with frozen-thawed embryos Donate embryos for science Donate embryos for other couples Counseled regarding potential for viable pregnancies with frozen-thawed embryos FDA requires screening history and tests of male and female donors Costs for preparation and shipping borne by patient Unlikely to recover embryos for personal use NCRS does not guarantee outcome of embryos when they leave our lab ADJUNCTIVE & SUPPORT THERAPY Mind-Body Class requested by patient recommended by NCRS Acupuncture requested by patient recommended by NCRS TRANSFER ORDERS Day 3 only Reason for Day 3 Only ET: decreased ovarian reserve past IVF cycle outcome No. of embryos patient wants to transfer No. of embryos recommended for transfer Day 5/6 if adequate Day 3 embryos No. of D3 embryos patient wants to transfer No. of D3 embryos recommended for transfer No. of D5 embryos patient wants to transfer No. of D5 embryos recommended for transfer Day 5/6 only Reasons for Blastocyst only ET: No. of Blast to Transfer Single embryo transfer desired by patient will consider additional blasts will ONLY TRANSFER SINGLE EMBRYO Single embryo transfer recommended by NCRS FET THAW ORDERS Frozen Embryo Serial Thaw No of embryos desired for transfer Max. number of embryos to thaw Thaw all remaining embryos Indication Limited embryos Unknown number in available straws Patient does not want to continue embryo storage and wants best available embry Other:

7 Cycle Plan Page7 Transfer best embryos up to: Transfer all embryos up to: DISPOSITION OF NON-TRANSFERRED EMBRYOS refreeze viable blastocysts discard donate for research donate for other couples if feasible

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9 Cycle Plan Page9 ered

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13 Cycle Plan Page13 borne by them ilable embryos for transfer

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