FU Consultation Note Page1 FU CONSULTATION CHIEF COMPLAINTS Need to review test Need to review possible surgery Need to plan treatment CC: DISCUSSION Tests Reviewed: FSH / CCT: Reviewed implications of normal results (<10mlU/ml) Reviewed implications of borderline results (<10-14 mlu/ml) Reviewed implications of abnormal results (>14mlU/ml) Endocrine tests HSG Presence of hydrosalpinx and their implications for success rates Role of surgery to remove or occlude tubes Presence of filling defects and need for other tests or surgery HYS Presence of polyps and their role in infertility Presence of myomas and role of surgery Selective Tubal Catheterization Role to open prozimal tubal occlusion SA AR Test Implications of normal results Implications of abnormal results and need for more tests or IVF/ SCSA Implications of the test Controversial nature of results Diagnostic NSA How this test may help us determine feasibility of using partner sperm Limitation of the test Anti-sperm anibodies Y-deletion test Discussion of genetics and inplications of transferring deletion to male offspring Kayotype APA Lupus anti-coagulant EMB Pregnancy ultrasound Missed abortion and option of expectant management or D&C Possible ectopic pregnancy and option of surgery or MTX Treatment Reviewed: OI IUI COH/IUI Expectant management Cycle management for RPL Adoption Counseling Hysteroscopy Laparoscopy
FU Consultation Note Page2 Diagnostic role Treatment role with long-term expectations Risk and complications Compared surgery to ART Tubal Occlusion Role of tubal occlusion for hydrosalpinx before ART treatment Implication for "tubal sterilization" and requirement for IVF in future Possible unilateral occlusion with some retained fertility potential Salpingectomy Role of salpingectomy for hydrosapinx before ART treatment Implication for "tubal sterilization" and requirement for IVF in future Possible unilateral sapligectomy with some retained fertility potentials Neosalpingostomy Role of neosalpingostomy for hydrosalpinx before ART treatment Potential retained fertility after neosalpingostomy is quite low D&C Role in normalization uterine cavity Risks and complications IVF Role in treating infertility Technique and process Risks and complications: Multiple births and number of embryos to transfer Meds and Ovarian Cancer Anesthesia and retieval/transfer Controversies regarding ART treatments Adjuntive procedures AH. Fragment removal Role in improving fertilization when sperm are abnoraml Discussed fertilization rates equivalent to standard IVF w NSA May require donor sperm back-up Donor Sperm back-up Genetic Diseases Family Balancing MicroSort Entry requirements Clinical Trial Sort purities Requires IVF/ Embryo Cryopreservation Some embryos are not freezable Success rates lower but important Probably only save for 8-10 years
FU Consultation Note Page3 Some embryos do not survive thaw Success rates Discussed variables affecting success Discussed number of embryos transferred Discussed SART statistics Donor Egg IVF Role in treating infertility Donors Anonymous verses known donors Selection process Variability in response Technique and process Donor Recipient Risks and complications Multiple births and number of embryos to transfer Anesthesia and retrieval/transfer Adjuctive procedures AH, Fragment removal Role in improving embryo quality Best used for women >38 and/or thick zonas Role in improving fertilization when sperm are abnoraml or failed fer Discussed fertilization rates equivalent to standard IVF with non-mal NSA May require donor sperm back-up Donor sperm back-up MicroSort Entry requirements Clinical Trial Sort purities Requires IVF/ Embryo Cryopreservation Some embryos are not freezable Success rates lower but important Probably only save for 8-10 years Some embryos do not survive thaw Success Rates Discussed variables affecting success Discussed number of embryos transferred Discussed SART statistics Role in improving fertilization when sperm are abnormal or failed fertilization
FU Consultation Note Page4 IMPRESSION Discussed fertilization rates equivalent to standard IVF with non-male factor sperm Option for women >35 years Indicated to reduce chromosomally abnormal pregnancies and miscarriages Indicated to improve pregnancy rates in selected women who produce larger nu Imperfect test because only 8-10 of the 23 chromosomes tested, some false pos Requires at least 5 embryos to proceed to biopsy May decrease implantation rates No evidence of abnormal birth above baseline risk Genetic Diseases Not all genetic abnormalities testable Cannot identify all genetic defect of testable abnomalities Family Balancing Only used to balance sex ratio in family Requires for essentially 100% assurance of desired sex Works best with combination of MicroSort and Must be decided on fate of embryos of undesired sex Does not test for other genetic defects Recurrent PG Loss Indicated to reduce chromosomally abnormal pregnancies and misc Imperfect test because only 8-10 of the 23 chromosomes tested, som Requires at least 5 embryos to proceed to biopsy May decrease implantation rates No evidence of abnormal birth above baseline risk Translocation screening Indicated to reduce chromosomally abnormal pregnancies and misc Identifies unbalanced translocations in embryos Probes not available for all translocations Some increase risks for other birth defects when carries of certain t Genetic counseling recommended Surrogacy Must have medical indication for using a surrogate Requires IVF and ET into gestational surrogate Requires legal contract with surrogate (obtained through attorney) Requires legal contract with surrogate (obtained through attorney) Usually both parties meet each other Ideal surrogate has previous successful pregnancies Mind-Body Class Stress and infertility issues Controversies regarding effect of stress on outcomes Discussed mind-body class No new problems New problems: Discussed tests and treatments as described More testing needed before treatment plan Ready to begin treatment RECOMMENDATIONS General:
FU Consultation Note Page5 Complete tests and return for FU Begin treatment cycle Schedule surgery Return for additional FU discussion with partner Other: Follow Treatment Plan