In Vitro Fertilization (IVF Procedure) - Process and Internal Controls

IVF procedure involves following medical and/or billing steps

?1. ?Pre-IVF recipient stimulation (Ovulation Induction):

?This stage involves stimulating the ovaries to produce multiple mature eggs using hormone medications. Monitoring of hormone levels and ultrasound scans are used to track follicle development.

Hormone medications (i.e. Stimulation injections) are generally administered on Out-patient basis. IVF injection administrations could be medically tracked though “Stimulation Chart”.? Pharmacy (i.e. Injection price) would be billed to patient.

?2. IVF Procedure:

This procedure could be performed in following steps

Egg Retrieval (Oocyte Retrieval): Once the eggs reach a suitable size, a minor surgical procedure called egg retrieval is performed under sedation or anaesthesia. A needle is guided through the vaginal wall to remove the eggs from the ovaries.

Sperm Collection and Preparation: On the day of egg retrieval, sperm is collected from the male partner or a sperm donor. The sperm is then processed and prepared in the laboratory to be used for fertilization.

?Fertilization: In this stage, the eggs retrieved from the ovaries are combined with sperm in the laboratory dish for fertilization to occur. This can be done through conventional insemination (placing sperm and eggs together in a culture dish) or intracytoplasmic sperm injection (ICSI), where a single sperm is injected directly into an egg.

?Embryo Culture: The fertilized eggs (embryos) are cultured in the laboratory for several days to allow them to develop and grow. During this time, they are monitored carefully to assess their quality and development potential.

Egg Retrieval (Oocyte Retrieval) procedure could be performed on inpatient or outpatient basis depending on patient’s response. This is governed by pre-decided IVF tariff by hospital.

?3. ?Embryo transfer:

After the embryos have been cultured for a few days (usually 3 to 5 days after fertilization), one or more embryos of the highest quality are selected for transfer into the woman's uterus. This procedure is typically perfhspormed without anaesthesia and involves passing a thin catheter through the cervix to place the embryos into the uterine cavity.

Procedure is performed mostly on Outpatient basis. This is governed by pre-decided tariff by hospital for embryo transfer.

Luteal Phase Support:

Following embryo transfer, hormone medications such as progesterone are often administered to support the uterine lining and improve the chances of embryo implantation.

Hormone medications are generally administered on Out-patient basis. Pharmacy (i.e. Injection cost) would be billed to patient.

4. ?Oocyte freezing:

As multiple eggs are generated, so couple can opt for oocyte freezing for some high-quality eggs

This is charged on outpatient basis, if recipient opts for oocyte freezing. This is governed by pre-decided tariff by hospital for oocyte freezing

In case of involvement of donor in IVF process, recipient has to connect with donor via donor bank. In such cases, donor registration charges and donor expenses have to be paid to donor bank by recipient.

Some hospitals can decide complete IVF process package, collect at same the time of IVF process start as deposit and adjust at the time of individual IVF steps as revenue. IVF package has to be decided by hospital tariff committee considering cost involved in each step to hospital and required minimum margin.

I hope this article will help in fixing internal controls on IVF process and audit/review of the same