ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
LABS/ULTRASOUNDSER Round 1 (Month/Year) ER Round 2 (Month/Year)ER Round 3 (Month/Year)ER Round 4 (Month/Year)ER Round 5 (Month/Year)
2
Total STIMS days
3
BaselineDate: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
4
Appointment 1Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
5
Appointment 2Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
6
Appointment 3Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
7
Appointment 4Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
Date: AFC = XX
Estradiol= XXXX pg/mL
LH = XXX mIU/mL
Progesterone = XX ng/mL
8
STIMSBaseline Date: Baseline Date: Baseline Date: Baseline Date: Baseline Date:
9
Estrogen priming?
10
Menopur75 units150 units
11
Follestim350 units300 units
12
ANTAGONISTStartStartStart: Start: Start:
13
Ganirelix250 mcg250 mcg250 mcg250 mcg250 mcg
14
TRIGGER SHOTDate: Date: Date: Date: Date:
15
Lupron
16
Ovidrel
17
EGG RETRIEVAL
18
Retrieved
19
Matured (usually ~80% of total are mature)
20
Fertilized (usually ~70-80% of mature eggs)
21
Blastocysts (usually ~30-50% of fertilized eggs)
22
PGT-A
23
Euploid (statistically 1 in 3 or 1 in 4 at age 40)
24
Aneuploid
25
26
ROUND 1 (Biopsy sent on DATE)DAY & GRADEGENETIC TESTINGSEX1st # = Stage1st letter: Inner cell mass2nd letter = Outer (trophectoderm)
27
Embryo 11: Early blastocystA: Large group of tightly packed cellsA: Many cells forming cohesive layer
28
Embryo 22: Early, cavity formingB: Loosely grouped but identifiableB: Fewer cells, somewhat irregular
29
Embryo 33: Full blastocystC: Few cells/less organizedC: Sparsely dispersed cells
30
Embryo 44: Expanded
31
Embryo 55: Hatching
32
Embryo 66: Fully hatched (out of zona pellucida)
33
ROUND 2 (Biopsy sent on DATE)DAY & GRADEGENETIC TESTINGSEX
34
Embryo 1
35
Embryo 2
36
Embryo 3
37
Embryo 4
38
Embryo 5
39
Embryo 6
40
Embryo 7
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100