PREG's Team Approach for Fertility Care

Tori Bishop MS, FNP-BC, Nurse Practitioner and Director of Nursing, discusses PREG’s team approach to fertility care.

As a patient, why do I talk to so many departments and people at PREG?

It can be a little overwhelming at first because so many people are involved in the patient’s care, and the physicians plan for them. But it doesn’t take long to see how it’s all working together for their benefit.

Initially, a patient may have gotten a generalized plan or advice from their OBGYN. Still, when they come to us, we treat them individually with a personalized plan tailored to their specific needs or situation based on data. And it takes a lot of professional people working together to pull that off.

How is it different from seeing your OGYGN or family physician?

When patients see a PREG provider, we look at significant factors regarding the causes of infertility. We like to think of it as pieces of a pie we are eating away. We test for those causes and begin a process of elimination, ruling out the major factors; some things require a more in-depth analysis and additional testing later on. For example, lab work can’t find everything; we may need an ultrasound or radiology procedure to look at to compare to your personalized lab results, or you may need a hands-on assessment to compare to those labs. Different people perform those functions- nurses, doctors, embryologists, phlebotomists, andrologists, nurse practitioners. If there are abnormal results, various departments will talk with you concerning those results. Each department (embryology, nursing, laboratory, andrology, radiology, etc.) has a specialty area and may contact you to discuss something in their purview; of course, your provider will always answer additional questions.

Can you be more specific about the different pieces of the pie?

A patient may have to see the nursing staff for an ultrasound. Then a phlebotomist to draw labs to correlate to that ultrasound, and then your provider to get a care plan for that specific issue seen on ultrasound. Then your provider could order more tests involving radiology, andrology, or embryology. There is an entire team striving for the same goal with every patient- to grow your family. Keep in mind that while patients are seeing and communicating with different faces throughout their treatment, their provider (doctor) guides the entire process of reading lab results, making new orders, signing off on additional labs, ultrasounds, etc. The provider is always pushing the final decisions regarding the patient treatment plan and care. We work together to keep the patient in the loop at every turn of their care. Multiple departments can contact a patient; however, every contact is within the overall direction and plan of their provider.

Do patients see their provider at every appointment?

No, unless it’s a scheduled appointment or something unscheduled that requires their presence. Many times they are seeing other people involved in their care who are reporting everything to their provider. It could be something as simple as lab work, an ultrasound, or meeting with their IVF nurse coordinator, a nurse practitioner, or someone else. But like I said, the provider is overseeing every turn of their care even if they are not with the patient at every appointment. A specific department may call for a quick update, but the next week it may be someone else from another department. We are not annoying the patient, but we strive to communicate as much as possible with them and answer their questions.

What’s going on behind the scenes?

When patients are in the office, they see us up and moving around a lot, but we have to coordinate all departments to ensure a full workup for the provider’s plan for that patient. Departments communicate via computer, phone, and in-person, not to mention scheduling that takes place behind the scenes that patients do not see. Everyone is pulling together toward the same goal of a successful outcome for each patient. Lab staff must work with embryology because timing is critical to get the right time for a transfer or retrieval.

How does it all come together?

We have a nurse who coordinates and organizes a weekly meeting that includes an embryologist, all of the doctors, nurse practitioners, sometimes the IVF coordinator, a lab person to discuss each patient’s treatment plan, updates, new orders, results of labs, or other tests. The nurse organizes the meeting based on summaries sent to them by the providers on specific patients’ treatment plans. The nurse will send an overview of each patient’s status of their treatment plan ahead of that meeting. This way, everyone involved is in the know before we meet.

How is IVF treatment different?

For example, an embryology team is a very specialized group of professionals who have successfully learned complex skills. If the embryology lab and staff weren’t there, we wouldn’t get embryos. Every team has a specific and integral role, but we are all working toward the ultimate goal for each patient.

You may have a 15-minute blood draw or lab appointment, but it’s just as crucial as an ultrasound or egg retrieval. Our financial team is trying to help patients find the most cost-effective options and plans for their treatment, medications, and authorizations. Our receptionists are the front line and the first face of PREG for patients. Our administrative team has to get the patients on the schedule and make sure they see the right person for the right thing, so it takes everyone working together, so patients aren’t wasting their time. Patients only see pieces of the pie, but we are working toward the whole pie. Many different faces are working together, but the ultimate goal is to help someone grow their family.