Evaluation Cycle Overview

The Fertility Centers of New England offers monitoring at satellite offices for your convenience. Because each satellite office has specific hours of operation it is important to confirm times with your Care Team.  Please inform your Care Team of the satellite you intend to use when reporting day one of your cycle.

 

Reading Office:          20 Pond Meadow Drive, Suite 101, Reading, MA 01867

Monitoring MON-SUN 6:30AM-7:45AM

 

Boston Office:             Abbey Building, 575 Boylston Street, Boston, MA 02116

Elevator one (left side), Floor 4W,

Monitoring MON-FRI 7:15am – 7:45am

 

Bedford Office:           169 South River Road, Suite 11, Bedford, NH 03110

Monitoring MON-SAT 6:30am - 7:15am

 

Braintree Office:         30 Braintree Hill Office Park

1st Floor, Suite 107, Braintree, MA 02184

Monitoring MON-SAT 6:45am - 7:45am

           

Monitoring in BRAINTREE on SATURDAYS and Holidays

the only door that is unlocked for our patients to come in to have bloods/us in Braintree on SAT/Holidays is the backside of the office.

Please park on the left side of the building and the door that is unlocked is on the left.

 

Leominster Office:      80 Erdman Way, Suite 104, Leominster, MA 01453

Monitoring MON-FRI 6:30am - 7:15am

 

Portsmouth Office:     875 Greenland Road, Building C, Unit 1, Portsmouth, NH 03801

Monitoring hours MON-SAT 7:00AM-7:30AM only

 

Westborough Office:  33 Lyman Street, Suite 302, Westborough, MA 01581

Monitoring hours MON-FRI 6:30AM-7:15AM only

 

 

Falmouth ME:             Foreside Place 202 US Route 1 Falmouth ME 01405

Monitoring hours MON-FRI 6:30AM-7:00AM only

 

Providence RI:            134 Thurbers Ave, 2nd Floor Suite 209 Providence, RI 02905

Blood Draws: Mon- Sat 6:45AM-8:15 AM

ULTRASOUND: Mon-Sat 6:30AM - 7:15 AM

           

 

 

All appointments are on a first come, first served basis.

Please sign in upon arrival.

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Please be aware that depending on your email server (gmail especially) FCNE Patient Portal emails may get routed to your SPAM or TRASH folder. Please check those folders or your Patient Portal for instructions every time you are in for US and/or bloods. Please call us if you do not receive your expected instructions by 5 PM.

While all of your fertility care will happen through FCNE, please make sure that you stay up to date with your regular healthcare maintenance (including pap smears, mammograms when indicated, vaccinations, annual physicals etc.)  through your primary care provider or OB/GYN.

All of your test results will be reviewed at your follow up visit.  We do not call with your individual results unless it is medically necessary and needs to be addressed prior to the consult. You may download the MyQuest app to access your lab results once they are final.

Your evaluation blood work may consist of the following tests:

 

1. GENETIC CARRIER SCREENING

Genetic carrier screening provides information to you and your doctor about your reproductive risks prior to a pregnancy. With each pregnancy there is a small chance of having a baby with a genetic disorder. Carrier screening helps determine what that risk is for you. Carrier screening is a blood test.

 

A carrier is someone who has a change, called a mutation, in one of their genes that causes that copy of the gene to stop working properly. There are usually no health problems associated with carrying a mutation; however, as a carrier, there is a chance that your children could inherit that genetic disorder.

 

A positive test means that you are a carrier and the chance of having a child with that genetic disorder is increased. The next step is typically to test your partner and talk to a genetic counselor about your specific risks and concerns.

 

A negative test provides reassurance that the chance of you having a child with that disorder is greatly reduced. However, no test can detect all carriers so there is always a small chance, called a residual risk, of being a carrier.

Your provider may order a blood test which will be sent to Quest Diagnostics and tested for a panel of genetic disorders that are relatively common across all ethnic groups. These disorders include cystic fibrosis, spinal muscular atrophy and Fragile X syndrome.

 

If you would like to reach out to Quest for review of benefits for genetic carrier screening, you may do so.

PatientNavigators@Questdiagnostics.com

Phone: 888.445.5011

 

 

HORMONAL BLOOD WORK

This cycle day specific blood work is done to measure hormones that give us information about your ovarian function and ovarian reserve. These hormones include FSH, estradiol (E2), thyroid stimulating hormone (TSH), prolactin and AMH.  For your cycle day 3 blood work, you will be asked to fast with nothing to eat or drink after midnight. You may drink water.

 

 

VAGINAL ULTRASOUND

Ultrasound is used to visualize the development of an ovarian follicle, which produces an egg every month. The uterus endometrial lining and other potential ovarian pathology will also be examined.

 

□          Hemoglobin

The total amount of hemoglobin in the blood.         

 

□          RUBELLA and VARICELLA SCREENING

Rubella or German Measles is a self-limited viral infection that produces a characteristic skin rash.  However, if a Rubella infection occurs during pregnancy it can have significant effects on the fetus, which can result in severe damage to the developing organs.  While most of us are immunized against rubella during childhood, up to 10% of adults are not immune to this infection.  For this reason, the current recommendation is to undergo a blood test to determine if you are immune to Rubella.  If you are found to be non-immune, it is recommended that you receive the vaccine (MMR).  The arrangements for the vaccine should be arranged through your PCP. If you are non-immune, you will be unable to cycle for 1 month after your MMR immunization.  If you choose not to have the MMR vaccine, you may choose to sign a “Rubella Waiver” stating that you have been informed of your choices and the potential risks involved.

 

The CDC recommends that all women who are non-immune to Varicella or Chicken Pox be vaccinated before attempting pregnancy. For this reason, we will test to check your varicella immunity status. If you are non-immune, you should arrange to receive the vaccine through your PCP in 2 doses at least 28 days apart and avoid pregnancy from the first dose through one month after the second dose. If you choose not to be immunized, you may choose to sign a “Varicella Vaccine Waiver” stating that you have been advised of your choices and the potential risks involved.

 

□        HEPATITIS B & C/HUMAN IMMUNODEFICIENCY VIRUS (HIV)

Hepatitis and HIV screening is recommended prior to pregnancy for several reasons, including:  1) potential affect on infertility; 2) potential placental transmission to the fetus; 3) breast-feeding; and 4) laboratory storage issues should a couple have embryos frozen for cryopreservation.

 

 □           Hepatitis B virus (HBV) is a DNA virus that develops in 2 to 6% of adults. 

 Acute HBV is associated with a higher miscarriage rate as well as preterm labor in pregnancy.  In women with a positive HBV blood test, up to 90% will have placental transmission of the virus to the fetus.  Prior medical treatment is very effective in reducing this risk of transmission.

 

 □          Hepatitis C virus (HCV) is an RNA virus and present in 2 to 5% of prenatal patients.  Many patients with HCV are at risk for developing chronic liver disease.  The risk of transmission to the fetus is as high as 35%, dependent on titer levels.  Infants delivered to women with high HCV titers may develop chronic hepatitis.

 

□            Human immunodeficiency virus (HIV) is estimated to be present in approximately 200,000 patients in the U.S. who have not been screened   for the virus.  HIV screening is recommended to minimize transmission to both partner and child.  Medical treatment can markedly reduce transmission.  HIV screening is voluntary.  Any lab test is with limitations and if results are equivocal, further confirmatory testing will be recommended.  Additional information is also available at the Centers for Disease Control website (www.cdc.gov) and the Massachusetts State Dept of Public Health (www.mass.gov/dph)

 

There have been no reported cases of HBV, HCV, or HIV transmission among cryopreserved embryos or semen in storage.  However, in theory, it is possible to have viral cross contamination in liquid nitrogen storage.  For this reason, couples that have not received blood test screening will have their cryopreserved embryos placed in a separate tank apart from embryos with known negative screening.

 

 

□     CLOMID CHALLENGE TEST

The clomiphene citrate challenge test (CCCT) provides an additional assessment of ovarian reserve. It is performed by measuring the day 3 FSH and estradiol levels.  The patient takes two 50mg pills of Clomid on cycle days 5-9, and her FSH and progesterone levels are measured again on day 10.  The test is abnormal if either the day 3 or day 10 FSH values are elevated or if the day 3 estradiol is greater than 80 pg/ml. This test is often required by insurance companies on women 40 years old or greater.

 

 

□     COTININE TESTING

Cotinine is a chemical that is made by the body from nicotine, which is found in cigarette smoke. Since cotinine can be made only from nicotine and since nicotine enters the body with cigarette smoke, cotinine measurements can show how much cigarette smoke enters your body.

                   

 Studies show that babies born to women with high cotinine levels are more likely to be growth retarded. These smaller, weaker babies may need to spend more time in the hospital and may require special medical care. Women who smoke during pregnancy may also be higher risk for miscarriage and other pregnancy problems.

 

Most insurance companies require this testing if you are a smoker or smoked in the past. This is done by a simple blood test. If cotinine is found in your system most insurance companies may choose to postpone your treatment cycles.

 

□       RECURRENT PREGNANCY LOSS BLOODS

If these tests are ordered for you, you will be directed to go to the Quest Diagnostics Lab, closest to your area. Please let us know once you have had the testing done so we may document and look for the results. The results of these tests will be discussed with you at the time of your Follow-Up consult. The results can take up to 3 weeks to come back.

 

□      HYSTEROSALPINGOGRAM

The hysterosalpingogram (HSG) is an x-ray test that is performed in the radiology department at the following locations:

 

            LOCD Lahey Outpatient Ctr Danvers 480 Maple St. Danvers, MA

             

This appointment is made by calling the office receptionist at 781-942-7000 ext. 600, on day one of your menstrual period (if day one falls on Sat/Sun, please call on Mon.). The receptionist will make your appointment. You must abstain from intercourse from CYCLE DAY 1 until after this procedure. All patients are given a 3-day prescription for antibiotics, which is to be taken the day before, day of and day after your HSG.  If you have had a recent HSG, you may not be required to have this test performed.

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INDICATIONS

This test provides information about tubal patency and tubal obstructions, if present.  This test is useful in the diagnosis of uterine congenital malformations and/or intrauterine lesions such as endometrial polyps, submucosal fibroids and adhesions.

 

PROCEDURE

Preliminary x-ray of the pelvis is taken to assess that the pelvic area is normal.  Injection of a small amount of radio-opaque material (material that is seen under x-ray) is injected through a catheter into the cervical canal to reveal the outline of the cervix, uterus, and the fallopian tubes. As this material is being injected through the cervix and up into the fallopian tubes additional x-rays are taken to visualize the condition of these structures. This procedure usually takes 1-2 minutes, but allow 15-30 minutes in total, from your time of arrival to your time of departure.

 

We recommend that you take 800 mg (4 tablets) of Ibuprofen one hour prior to the procedure.  You may experience mild to moderate discomfort at the time of the procedure.  Some report cramping sensations for a few hours after the procedure. You will usually rest for 15-30 minutes after the procedure and then may return home or work without adverse effects.

In the event that you should experience any pain, fever or chills immediately after the procedure or in the first few days after the procedure, you should notify your Care Team 781-94-0052.

 

□      OFFICE HYSTEROSCOPY

You must abstain from intercourse from cycle day one until after this procedure.  The office hysteroscopy allows the physician to view the inside of the uterus using a hysteroscope, an instrument with a camera.  This may show polyps or other abnormalities that may interfere with pregnancy.  Most often the hysteroscope is inserted through the cervix and into the uterus.  The camera portion allows the physician to capture pictures of the interior of the uterus.

We recommend that you take 800 mg (4 tablets) of Ibuprofen one hour prior to the procedure. To schedule this appointment, please call 781-942-7000 ext. 600 with the first day of your menses.

 

□      SONOHYSTEROSALPINGOGRAM (SONO-HSG)

You must abstain from intercourse from CYCLE DAY 1 until after this procedure.

A sono-hsg is an ultrasound of the uterus with saline distension of the uterine cavity.  This may show scar tissue, polyps or other abnormalities that may interfere with pregnancy. Most often, a catheter is placed through the cervix and into the uterus and held in place with a small inflatable balloon, located at the tip of the catheter. Ultrasound is then used to visualize the uterus while (saline) is injected through the catheter.  We recommend that you take 800 mg (4 tablets) of Ibuprofen one hour prior to the procedure. To schedule this appointment, please call 781-942-7000 ext. 600 with the first day of your menses.

 

HYCOSY is a sonohysterogram where an additional assessment of tubal patency. During the sonohsg, bubbled saline is instilled and its progression through the uterus and through the fallopian tubes is monitored.

 

 

 

□     ENDOMETRIAL BIOPSY

An endometrial biopsy is a sampling of the uterine lining obtained to detect a possible infection. This is achieved by passing a small catheter through the cervix. To schedule this appointment, please call 781-942-7000 ext. 600 with the first day of your menses. This sampling is usually performed between days 5-12 of your cycle. You must abstain from intercourse from CYCLE DAY 1 until after this procedure. The procedure itself usually takes only 1-2 minutes, but please allow 10-20 minutes in total for this visit. You may experience slight to mild cramping during this procedure. We recommend that you take 800 mg (4 tablets) of Ibuprofen one hour prior to the procedure.

 

□      Counseling

We understand that this process can be emotionally difficult, and we want all of our patients to have access to these resources should they need them at any point during their time with us.  

 Please call to arrange an appointment with one directly and ask that they fax a consult letter to 1-781-942-0435.

 

Our clinician list will be sent as a separate document.

 

A great resource for navigating the path of infertility is Resolve. Please review their website for helpful information. https://www.resolvenewengland.org/

 

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□      FOLLOW-UP CONSULT

 

Please schedule a consult by calling 781-942-7000 ext. 600. Make sure this appointment falls after all evaluation testing has been completed. At this time the physician will review the results of all your evaluation testing and discuss a plan of treatment specific to your needs. Please make sure that you and your partner are present for this appointment. You will receive a follow up call from the clinical team after the consult to review the plan. If you are to be booked into a treatment cycle you will be sent consent forms electronically at this time. You will also go over what to expect from your cycle. Medication and injection information will be provided at this time via our patient portal.

 

At this time, we will submit your case for insurance approval. Please be aware that the approval process may take up to 4 weeks. This includes insurance approval, medication order, prior authorization of medications, and delivery of the medications.

 

We, at the Fertility Centers of New England are dedicated to providing guidance and support throughout this emotional time.  We look forward to working with you. Please reach out with any questions or concerns.