Fertility Evaluation - Patient Overview

FERTILITY EVALUATION OVERVIEW:\n\nOLD RECORDS: Arrange to have prior fertility records sent in advance (Pap results, pathology, operative reports, labs, radiology, office visits, husband's seminal fluid results).\n\nCHARTING: CrMS recommended. Helps with NaProTECHNOLOGY approach. Tests timed based on charting. Disease-based approach - find what's wrong and correct it.\n\nSEMINAL FLUID ANALYSIS: Recommended if not done in past year or if prior abnormality. Collect during natural intercourse using perforated collection device. Must reach lab within 1 hour at body temperature.\n\nHORMONE SERIES: Pattern of estradiol and progesterone levels. May take 1 month to draw, another month for results. Must be run at National Hormone Lab in Omaha or other specified labs for proper calibration.\n\nULTRASOUND SERIES (OCE/FMS): Best technique to determine if ovulation is normal. Daily scans as ovulation approaches until follicle ruptures. Must be done at specially trained facility. Alternative: P+4 screening ultrasound.\n\nFOLLOW-UP APPOINTMENTS: Recommended every 2 months during evaluation/treatment. Results reviewed, treatment plan presented. Medication adjustments made at these appointments.\n\nMEDICATIONS: Take as ordered on specific days/times. Call pharmacy for refills.\n\nPREGNANCY TESTS: If not taking post-peak HCG, test as early as P+10, recommended by P+16. If taking post-peak HCG, wait until P+16 (can cause false positive). Notify provider immediately if positive - may need progesterone support.\n\nINSURANCE: Pre-authorization attempted for surgery but not guaranteed. Contact office if difficulties with insurance.\n\nQUESTIONS: Direct to nurse. Messages reviewed throughout day, answered within 2 business days with prioritization for urgent/time-sensitive issues. Use secure patient portal for non-urgent messages.\n\nOUT OF STATE SURGERY: Stay 4-14 days depending on tests. Includes ultrasound series (if ordered), surgeon meeting, pre-op testing, surgery, 1 night minimum post-op stay, possible follow-up appointment.\n\nNAPROTECHNOLOGY SURGICAL EVALUATION: Diagnose/treat organic causes like endometriosis and adhesions. Done under general anesthesia, outpatient. Recovery ~4 days. Includes:\n- Endocervical/endometrial cultures and biopsies (can do in office but uncomfortable)\n- Selective hysterosalpingogram (different from simple HSG - catheter directly into each tube opening with pressure measurement)\n- Hysteroscopy (view inside uterus for abnormalities)\n- Laparoscopy (view ovaries, tubes, outside of uterus)\n\nMild/moderate endometriosis and adhesions may be laser treated at time of diagnostic surgery. Extensive disease may require major surgery (laparotomy with 2-3 day hospital stay and 6 week recovery, or robotic laparoscopy with overnight stay and 2 week recovery).\n\nPOST-OP VISIT: ~2 weeks after laparoscopy for exam. Out of state

contact provider at 2 weeks with update and photos of incisions. Receive pictures and video of surgery.