Introduction: Cycle Types - How Lab Notes Works With IVF vs. Third Party Parenting

This manual will provide an introduction to the different types of cycles that live within Artisan.  Some of the combinations consist of egg providers and recipients, PGT-m and PGT-a, delayed embryo transfer, banked donor eggs, and banked donor embryos - often all in the care of a single patient. 

The variations of a cycle are structured differently within lab notes, particularly as they relate to the medical practice's treatment plans and record keeping.  

Cycle Types: Egg Providers & Embryo Recipients

In the Calendar Wizard tool there are five options to create ART treatment plans:

For egg providers:

• IVF-this is also used for patient's banking their own eggs (egg freezing)

• Donor Egg Banking- this is used for any cycle that involves an egg donor cycling to donate her eggs fresh either to a designated recipient or to a donor egg bank

For embryo recipients:

• Frozen Embryo Transfer

• Donor Egg Recipient

• Surrogacy (GC) Recipient

• Egg Thaw 

Patients Attempting Pregnancy With Their Own Eggs

Cryopreserved embryos are documented in the patient's Embryo Cryo Log:

While we are beginning this introduction with the straightforward case of IVF with the transfer of the patient's own fresh embryos, it is important to note that you can document any combination of materials for transfer in a fresh IVF cycle.

For instance, you could add thawed patient embryos, thawed patient banked oocytes, or thawed donor oocytes and/or embryos to a "basic" IVF case.

 

IVF  

 

Patients in an IVF cycle may have either an immediate embryo transfer, what is known as a fresh transfer - or - created embryos for delayed embryo transfer in a Frozen Embryo Transfer (FET)cycle. This is all recorded in Lab Notes. 

 

Frozen Embryo Transfer

 

 

FET cycles will be most commonly be used to transfer a patient's embryos either via intentional delayed embryo transfer or for a secondary embryo transfer.

Just as noted above,  in the Lab Notes you may document any combination of materials such as combined transfer of fresh donor eggs, thawed banked patient or donor oocytes, or donor embryos. 

 

Oocyte Banking/Egg Freezing

 

 

Use the IVF lab notes to document egg retrieval and cryopreservation of oocytes.

Cryopreserved oocytes are listed in the Embryo Cryo Log (yes, we understand that it sounds a little odd to have eggs in the embryo cryo log, but we elected to do this to reduce the number of places where lab staff need to search to find cryopreserved material). 

Ovum Donation

 

Introducing the "Donor Egg Bank" 

 

 

We have created a virtual "Donor Egg Bank" within the EMR system.

The concept is simple: all frozen donor eggs must temporarily "reside" within the Donor Egg Bank before being distributed to a patient or being reserved for use as banked eggs available for future use by intended parents that purchase the eggs.

Eggs may be "routed" to one of three "destinations" at the time of donor oocyte retrieval:

• Fresh to an intended parent for immediate fertilization and transfer in a "Donor Egg Recipient" cycle or a "Surrogate Recipient" cycle.

• Cryopreserved and immediately transferred to the ownership of an intended parent for later thawing, insemination, and transfer.

• Cryopreserved for the purpose of oocyte banking to future intended parents.

We will review the concept of the Donor Egg Banking in another manual.  

 

 

Donor eggs and embryos are indicated in Lab Notes via displaying the egg or embryo grade in italics.

Internal record keeping informs the SART registry whether embryos are created from patient's eggs or a donor's oocytes.

 

Fresh Ovum Donation Cycle

 

 

In this instance we divide the records of the intended parent and their donor into two separate records.

• Ovum donor: we will create a Donor Egg Banking cycle record to document the donor's medical treatment and to enter her oocytes into the database.  For a fresh donor cycle going to a recipient, it will be designated fresh to the recipient's cycle from the donor banking cycle. The retrieved eggs are allocated fresh to the donor egg recipient's cycle directly from the donor banking cycle.  

 

• Intended Parent: we will create a Donor Egg Recipient cycle record to manage the IP's medical care. The donor's eggs will be shown as fresh eggs within the patient's laboratory record. These eggs will then be managed in the usual fashion for the steps of insemination, culture, embryo transfer and cryopreservation.

Banked Donor Egg Cycle

 

 

Cryopreserved donor eggs are recorded within the Intended Parents Embryo Cryo Log.

A Frozen Embryo Transfer cycle - using the same tools used for FET with a patient's own eggs or embryos - is created in Calendar Wizard.

 

 

 

Laboratory staff will select the frozen donor oocytes from the list of Oocytes in Storage in the Oocyte Thawing tab.

 

 

 After the oocyte is selected it will bring the selected egg/eggs into the Lab Notes to record fertilization information and embryo development.

 

FET of Embryos Created From Donor Oocytes

 

 

 

Calendar Wizard uses the same process, creating a Frozen Embryo Transfer cycle, to document an FET of embryos derived from donor oocytes.  The process of recording the thaw and transfer from these types of embryos is done exactly the same as an FET with embryos from a patient's own eggs.

 

FET of Banked Donor Embryos

 

 

More and more practices are adopting Donor Embryo programs. Artisan accommodates this by using an FET cycle type and the Donor Embryo Bank cryo log allocation features.  First, from the embryo cryo log allocate the embryos to the IP. After allocating the embryo you are now able to place the IP in an FET cycle. 

 

Gestational Surrogacy

 

Surrogacy is the most challenging cycle type from a record-keeping perspective since the genetic material may be any combination of fresh or frozen eggs or embryos from the intended parent or an ovum donor.

 

Artisan supports gestational surrogacy by using a combination of cycle types for the egg provider - either IVF for the fresh intended parent's eggs or Donor Banking for fresh donation cycles. 

 

 

 

 

 Please see the image above Test,Surrogate  is the surrogate for Test, Houston who is the Surrogate recipient (IP).  

 

 

Egg Thaw cycle

 

Egg thaw cycles will be used to thaw donor or the patients' autologous eggs to inseminate. This can include a transfer of the resulting embryos from the egg thaw or freezing of the embryos

Just as noted above,  in the Lab Notes you may document any combination of materials such as combined transfer of fresh donor eggs, thawed banked patient or donor oocytes, or donor embryos. 

 

 

**All manuals are compliant with HIPPA regulations.  No patient information has been released.  All screenshots above were taken from a test clinic with fake patient information.