GENERAL GUIDELINES FOR REFERRAL OF INFERTILITY/ENDOCRINOLOGY SERVICES AT WAMC

To: All Providers

RE: Requirements prior to initial appointment with the REI/ART program at WAMC

Purpose: To improve the referral process to the infertility clinic and expedite the initiation of the basic work up on patients prior to their initial appointment to specialty Reprodcutive Endocrinology and infertility care.   

• Immediate referral: all female patients 35 years of age interested in fertility, or any age with previous failure of in vitro fertilization at an outside clinic or hospital.        
• Immediate referral :Reproductive Endocrinology Referral
  
• Refer any patient with reproductive endocrinology conditions (per provider's judgment)
  
• Immediate referral: Reproductive anatomic abnormality
                               1.  Intersex conditions
                               2.  Abnormalities of sexual  differentiation
  
• Immediate referral: Developmental reproductive issues.
                               1.  Reproductive developmental delay
                               2.  Precocious reproductive development
  
• Immediate referral: All female patients with over 2 miscarriages.
  
• Infertility Referral (1 year unprotected intercourse <35 years old or 6 months for patients >35). Detailed referral to the GYN/Infertility Clinic in CHCS. Referring providers outside of the military charting system may fax referrals to 910-907-7825.
             
• Basic Infertility Work up current within 12 months
• Female Order Set: (Local) CHCS ORDER SET “ Infertility Referral” has all the required labs. At MINIMUM, patient is to have cycle day 3 FSH,LH, Estradiol, and AMH labwork and TSH and Prolactin levels,
• AND HSG (Once ordered patient calls radiology on CD 1 to book appointment) OR other proof of fallopian tube status such as laproscopic chromopertubation.
  
• Basic Male Order Set: CHCS ORDER SET “InfertM Referral” has all the required labs, to include lab work and semen analysis.
• Recurrent Pregnancy Loss (>2 losses): CHCS ORDER SET “Infertility-SAB” -ANTI-CARDIOLIPIN PANEL, PROTEIN C AG, PROTEIN S ANTIGEN, FACTOR V LEIDEN, THROM/ANTITHROMBIN 3 COMPLEX , PTT-LA W/REFLEX , and CHROMOSOME ANALYSIS for both female and male
    
• Nutrition Consultation for BMI>30 for weight loss prior to referral. Patients with a BMI > 35 will not be accepted into program.
• Referral to specialty services for specific medical, social, psychological, or surgical condition requiring consideration prior to implementing infertility treatments or subsequent pregnancy (includes genetic counseling).  Patients with recent history (6 months or under ongoing treatment) that is contraindicated in child bearing or family building MUST be cleared by treating provider prior to acceptance into program.                
• Prenatal Vitamins/Folic Acid supplementation

          Fertility diagnosis and treatment and treatment for recurrent pregnancy loss are available through Womack Army Medical Center including all advanced reproductive technologies. Patients are financially responsible for services not covered by Tricare. Infertility services are dedicated to support the families within the military health care system, surrogacy services and tubal reversals are not available at this time. Patients who desire tubal reversal should be referred to Bethesda. 

          Womack Army Medical Center is committed to the long term health of all patients and require any patients with a BMI in excess of 30 to participate in a weight reduction program prior to initiation of infertility treatment.  We strongly encourage all patients (BMI 25 -29) to actively engage in a weight reduction/health maintenance program during or prior to infertility treatment.

          Also, patients who smoke or use tobacco are strongly encouraged to quit smoking prior to starting fertility treatment. Smokers much be actively enrolled in smoking cessation class prior to receiving ovarian hyperstimulation medications for infertility treatment.

          Patients may choose to self refer to a civilian infertility specialist, however they assume all financial responsibility related to fertility care not covered by Tricare.

Please contact one of our Nurse Coordinators at 910-907-0753 for any questions or concerns.

**Please click here to view or print the official memo