An in vitro fertilization program using satellite physicians.
In order to provide an in vitro fertilization (IVF) service for a large geographic region, we developed the concept of Satellite IVF Centers. The goals of this program were as follows: 1) to facilitate patient participation by decreasing travel expenditures, time for screening appointments, and IVF cycle cancellations, and 2) to involve community physicians in a regionalized program. We established centers in nine cities within the Washington, Alaska, Montana, and Idaho region serviced by the University of Washington, and in Alberta, Canada. A 2-day training session was held to provide participating physicians with a basic knowledge of IVF. We considered the roles of the satellite IVF physician to include identification of couples for IVF, initiation of ovulation induction cycles, and determination of appropriate induction cycles for oocyte recovery. The staff of the University Department of Laboratory Medicine standardized the methodologies for estradiol measurements and maintained a quality control analysis for all participating community laboratories. Satellite activity was coordinated through the IVF office at the University, which monitored physicians' decisions based on hormone and ultrasound data from days 7 and 8 of the stimulation cycle. Patients meeting specific ovarian response criteria arrived at the University on day 9 of the stimulation cycle and completed IVF. During 18 months, 72 patients were screened and initiated cycles at the nine participating centers. Forty-four of these patients were sent to the University for oocyte recovery, which resulted in 39 embryo transfers and eight pregnancies. This service has reached a large geographic community, dramatically reduced the cost of IVF for this community, and met with both patient and physician acceptance.