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1524 East Morehead StreetCharlotte, North Carolina 28207Main # 704-343-3400Fax 704-370-0427800-500-2887

200 Medical Park PlazaSuite 220Concord, North Carolina 28025Ph 704-343-7020Fax 704-795-1779

www.reachdrs.com

New Patient Liaison: 704-343-4444

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Dear Patient:

Thank you for choosing Reproductive Endocrinology Associates of Charlotte (REACH).We are one of the leading practices in the country for the specialty of ReproductiveEndocrinology and Infertility. So that your first appointment with us is as productive aspossible, please help us by paying close attention to all of the details contained in thispacket. We must have all new patient paperwork, medical records and insurance verificationprior to your first appointment. Helping us to obtain this information will ensure that ourPhysicians and Staff can best serve you and your specific needs with the utmost of care.

NEW PATIENT INFORMATION:We ask that you and your partner take a few moments to fill out the enclosed packet ofinformation. YOU will need to request copies of your medical records from thephysician who has been treating you. Please forward all relevant medical records,insurance information, a copy of your insurance card and the entire New PatientPacket (minus the red consent form) one week prior to your appointment:

We look forward to meeting you and reviewing your medical records with you. Inaddition, at your first visit, please be prepared for a full exam with vaginal ultrasound andpossible rectal exam. If your partner is available, we encourage them to attend this firstappointment. If medical records are not received at our office, there is a possibility thatwe will have to reschedule your appointment. A medical release form is in this packetfor your convenience to submit to your previous doctor. Records are crucial in yourtreatment process evaluation, without them it will slow the process down and may result inunnecessary tests and procedures.INSURANCE:Due to the many different insurance companies and regulations, please note that it is yourresponsibility to contact your insurance carrier for the specifics of your plan. If we do notdirectly participate with your insurance company, you will be responsible for the fullconsultation fee at the time of the visit.

Please arrive 30 minutes before your appointment and if for any reason you are unableto keep your appointment, please call 704-343-4444 at least 24 hours in advance, or youmay be responsible for a cancellation fee up to the full amount of your first visit. Thank youfor taking the time to prepare for your appointment.

Sincerely,The Physicians and staff of REACH

For further information visit our website www.reachdrs.com

TO: REACHAttention: New Patient Liaison1524 East Morehead StreetCharlotte, NC 28207Ph: 704-343-4444Fax: 704-370-0427

REACHAttention: New Patient Liaison200 Medical Park Plaza Suite 220Concord, NC 28025Ph: 704-343-7020Fax: 704-795-1779

We look forward to meeting you and reviewing your medical records with you. Inaddition, at your first visit, please be prepared for a full exam with vaginal ultrasound andpossible rectal exam. If your partner is available, we encourage them to attend this firstappointment. If medical records are not received at our office, there is a possibility thatwe will have to reschedule your appointment. Records are crucial in your treatment process evaluation, without them it will slow the process down and may result in unnecessary tests and procedures.INSURANCE:Due to the many different insurance companies and regulations, please note that it is your responsibility to contact your insurance carrier for the specifics of your plan. If we do notdirectly participate with your insurance company, you will be responsible for the total charges incurred at each visit. Claim documentation will be provided for you.

Please arrive 20 minutes before your appointment and if for any reason you are unableto keep your appointment, please call 704-343-4444 at least 48 hours in advance, or youmay be responsible for a cancellation fee up to the full amount of your first visit. Thank youfor taking the time to prepare for your appointment.

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Section 1Please complete and return to

Reproductive Endocrinology Associates

along with a copy of your (and your partner’s) insurance card (front and back).

This will help ensure your registration is complete

and insurance is verified prior to your appointment.

Thank you.

4

Section 1Please complete and return to

Reproductive Endocrinology Associates

along with a copy of your (and your partner’s) insurance card (front and back).

This will help ensure your registration is complete

and insurance is verified prior to your appointment.

Thank you.

Please complete and return to

Reproductive Endocrinology Associates

along with a copy of your (and your partner’s)

insurance card (front and back)

bEfoRE yoUR APPoINtmENt.

It is necessary that we receive this information

in order to complete the registration process

and confirm your appointment.

Thank you

4

(Please print clearly)

Referring Physician Phone #

Address

Patient Name SS#

Address

City State Zip

Date of Birth: Marital Status

Home# Mobile# Work #

Employer

Employer Address

Spouse’s Name

Date of Birth SS#

Employer Work#

Employer Address

Person to contact in case of emergency

Phone# Relationship

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Patient Information Sheet

PATIENT INFORMATION

Partner/Spouse’s Name

OB/GYN

5

Patient’s Primary Insurance Co.

Address

Policy# Group# Plan#

Insurance Company’s Phone# (for precertification)

Policy Holder

Patient’s Secondary Insurance Co.

Address

Policy# Group# Plan#

Insurance Company’s Phone# (for precertification)

Policy Holder

Partner’s Primary Insurance Co.

Address

Policy# Group# Plan#

Insurance Company’s Phone# (for precertification)

Policy Holder

Partner’s Secondary Insurance Co.

Address

Policy# Group# Plan#

Insurance Company’s Phone# (for precertification)

Policy Holder

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INSURANCE INFORMATION

It is your responsibility to know and understand what type of coverage you have for infertility. We are happy to file claims on your behalf but we do not guarantee any type of payment from your insurance carrier.

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REACH Contracted Insurance Companies:

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• Blue Cross Blue Shield� Blue Advantage PPO� Federal� National� North Carolina State� Medpoint� South Carolina State� South Carolina� Personal Care Plan� Preferred Care Select

• Cigna (North Carolina Only)� HMO-Requires an authorization number from Primary Care Physician� POS� PPN� PPO� Healthsource

• Requires an authorization number from Primary Care Physician• All labs must go to LabCorp/ REACH’s lab is not a participating lab

****We are NOT contracted with Cigna of South Carolina****

• PHCS (Private Health Care Systems)

• United� HMO� POS� PPO

• Aetna – You are required to call 800-575-5999 to pre-register with their infertility program

Authorization for Filing Insurance:I hereby Authorize REACH to file my insurance and release all medical information necessary for theprocessing of insurance claims on my behalf.

Non-Authorization for Filing Insurance:I DO NOT authorize REACH to file my insurance. I take full responsibility of processing all insuranceclaims on my behalf and my spouse when applicable. Any insurance claims or release of medical recordsfor myself or my spouse to my insurance company will be allowed ONLY at my request.

Please sign only one:

Name Date

Name Date

I am aware that even though REACH is contracted with my insurance Company Iwill be responsible at the time of service for any fees not covered by my currentpolicy.SIGNATURE REQUIRED

-You are required to contact Medical for authorization of procedures 800-925-9724

****Not contracted with HMO Blue or SC State HMO****

Non-Authorization for Filing Insurance:I DO NOT authorize REACH to file my insurance. I take full responsibility of all office visits and proce-dures on my behalf and my spouse when applicable. Any insurance claims or release of medical records for myself or my spouse to my insurance company will be allowed ONLY at my request.

Some policies require you to use LabCorp as REACH’s lab is not a participant

I herby authorize REACH to file my insurance and release all medical information necessary for the processing of insurance claims on my behalf.

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PATIENT:Authorization forCommunication ofProtected Health Information

Patient Name (print) Date of Birth Chart Number

I hereby release, discharge and agree to hold harmless all parties to whom this consent is given from any liabilitythat may arise from the release of information authorized above. I understand that I may revoke this consent inwriting at any time. This consent is valid for one year from the date of signature unless otherwise revoked in writing.

Signature of Patient or Parent/Guardian Date

Relationship to Patient if Minor

A) Name @

B) Name @

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PARTNER:Authorization forCommunication ofProtected Health Information

Patient Name (print) Date of Birth Chart Number

I hereby release, discharge and agree to hold harmless all parties to whom this consent is given from any liabilitythat may arise from the release of information authorized above. I understand that I may revoke this consent inwriting at any time. This consent is valid for one year from the date of signature unless otherwise revoked in writing.

Signature of Patient or Parent/Guardian Date

Relationship to Patient if Minor

A) Name @

B) Name @

Partner/Spouse

Signature of Partner/Spouse/Parent/Guardian

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New Patient GynecologicHistory for Infertility

A. Identifying Date Date this form completed

C. Contraceptive Use

Type From when to when Reason discontinued

1.

2.

3.

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1116

Antichlamydial antibodies

What medications do you take for pain/cramps?

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Antichlamydial antibodies

What medications do you take for pain/cramps?

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Has anyone in your direct family ever been diagnosed with breast or ovarian cancer? ___________________________

____________________________________________________________________________________________

Was anyone in your family born with any birth defects/mental retardation? ____________________________________

____________________________________________________________________________________________

Do you or anyone in your family have bleeding / blood clot disorders? _________________________________________

___________________________________________________________________________________________

_______________________________________________________________________________________________

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Genital herpes

Genital warts/condyloma

Mycoplasm

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Karyotype genetic testing

(ovulation predictor kit)

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Section 2Complete and send to your referring

doctor’s office prior to your appointment with us.

This will help us evaluate your history and

develop a treatment plan for you.

We must have your records for first appointment.

Thank you.

Please complete the following release form and send it to your referring doctor’s office so that we receive

your medical records prior to your first appointment.

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I understand that I have the right to revoke this authorization at any time by notifying the Medical Records Departmentof the providing organization in writing. I understand that revocation will not apply to information that has alreadybeen released in response to this authorization. I understand that revocation will not apply to my insurance companywhen disclosure of the private health information is voluntary. I can refuse to sign this authorization. I understand that Imay inspect or obtain a copy of the information to be used or disclosed.

Printed Name:

Signature: Date:

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1813

Section 3Complete this section and

return to REACH at least one week

prior to your appointment.

Thank you.

• Telephone Communication• Driving Directions• Counseling Services• PGD Testing• Consent Form

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Telephone Communication

Main Office: 704-343-3400Concord Office: 704-343-7020

Toll Free 1-800-500-2887

Proper and Efficient telephone communication with our patients is a priority. We hope that the following information willenhance our service to you:

1) Follow up Appointments may be made by calling the medical secretary Monday through Friday from8:30 am until 5:00 pm.

2) During lunch each weekday (12:30 pm to 1:45 pm), a nurse is available for emergencies only.

3) Billing questions may be directed to our Billing Department located in the office at extension 193.

4) Direct your routine medical questions to the nurses line at extension 191. You will be asked to leave amessage. Be sure to give your name, date of birth, chart number or SS#, physician’s name and yourphone number including area code. Clearly state the reason for your call.

5) If you need to reach an IVF nurse you may direct your phone calls to their voice mail. Weekend phonecalls for IVF nurses will be received by the answering service. They will NOT check voice mail onweekends and holidays.

6) Messages left on the nurse’s line, ext. 191 are retrieved from 8:30 am to 4:00 pm Monday through Friday,Sat & Sun from 8:30-11:30. A nurse will respond to your call as soon as your question has been reviewedwith your physician. Non-emergency calls will be answered as soon as possible, and may sometimes bereturned the following business day.

7) Prescription refills should be called to your pharmacy. The pharmacist will contact our office for therefill. Please do not call on the weekend for refills unless it is an emergency.

8) Any lab results requiring immediate attention will be reported to you by phone. Other lab results may bereported by mail, or your physician may discuss the results with you during your course of therapy.

9) Urgent weekend calls are handled by an answering service through our 704-343-3400 number. Urgentcalls such as reporting your cycle day 1 menses. The answering service will contact the physician on calland they will call you back with instructions.

11) Anonymous Egg Donor line- 704-342-8235

12) If you have a real EMERGENCY please call 911

Thank you for your cooperation with our phone procedures. We hope that your understanding of the system willenable our staff to serve you in the most efficient manner.

Direct your routine medical questions to your nursing team. You will be asked to leave a

Messages on your nursing teamline are retrieved from 8:30 am to 4:00 pm Monday through Friday, Sat & Sun from 8:30 am to 1:00 pm. A nurse will respond to your call as soon as your question has been reviewed with your physician. Non-emergency calls will be answered as soon as possible, and may sometimes be returned the following business day.

2021For further information visit our website www.reachdrs.com

Driving Directions to REACH Charlotte:

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* Please note: In addition to our front parking lot we also have parking available behind ourbuilding next to the dental office on Morehead Street.

2122

REACH – Concord200 Medical Park Drive Suite 220

Concord, NC 28025704-343-7020

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REACH – Concord200 medical Park Drive Suite 220

Concord, NC 28025704-343-7020

fRom NoRtH:I-85 take Exit 58, follow South 29/601 Concord signs. Turn left at the 4th stoplight, onto Mall Drive, which is shared between Carolina Mall and NorthEast Medical Center. Immediately bear to the right at the first fork. Follow the road around to the large water fountain with the pineapple on top. Take advantage of our free valet parking and come in the revolving door of the 200 building next to valet stand. Take the first set of elevators to the second floor. We are in suite 220 at the end of the hall. fRom mooRESVILLE/StAtESVILLE:I-77 to Exit 36 turn left onto HWY 150. Follow 150 approximately 6-7 miles to HWY 152-bear right.. Follow HWY 152 to I-85 SOUTH. Take Exit 58 off I-85. Follow to South 29/601 to Concord. Turn left onto Mall Drive, which is shared between Carolina Mall and NorthEast Medical Center. Immediately bear to the right at the first fork. Follow the road around to the large water fountain with the pineapple on top. Take advantage of our free valet parking and come in the revolving door of the 200 building next to valet stand. Take the first set of elevators to the second floor. We are in suite 220 at the end of the hall.

fRom LAKE NoRmAN:I-77 to Exit 25 HWY 73 EAST (Davidson Highway) to HWY 29/601 intersection at stoplight in Concord. Turn left onto 29 NORTH. At 3rd stoplight turn right, onto Mall Drive, which is shared between Carolina Mall and NorthEast Medical Center. Immediately fork to the right. Follow the road around to the large water fountain with the pineapple on top. Take advantage of our free valet parking and come in the revolving door of the 200 building. Take the first set of elevators to the second floor. We are in suite 220 at the end of the hall.

fRom SoUtH/CHARLottE :I-77 to I-85 NORTH. Take Exit 58 toward concord off of I-85. Turn left at the 4th light, onto Mall Drive, which is a shared road with Carolina Mall and NorthEast Medical Center. Immediately bear to the right at the first fork. Follow the road around to the large water fountain with the pineapple on top. Take advantage of our free valet parking and come in the revolving door of the 200 building next to valet stand. Take the first set of elevators to the second floor. We are in suite 220 at the end of the hall.

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Have we discussed pre-conceptiongenetic screening with you?

If not, please ask your nurseor physician for more information.

Thank you!

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PLEASE READ THE FOLLOWING PAGES PRIOR TOYOUR FIRST APPOINTMENT.

REMEMBER TO BRING IT WITH YOUSO IT CAN BE SIGNED IN FRONT OF A REACH

STAFF MEMBER.

THANK YOU!

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General Information Consent Regarding Fertility Treatment, Monitoring and Intra-Uterine Insemination ProceduresReproductive Endocrinology Associates of Charlotte (REACH)

The physicians and staff welcome to you to REACH! Among our many services which are available toyou pertaining to gynecological reproductive endocrinology, our specialized services for fertility treatmentare offered to you to promote your chances of having a successful healthy pregnancy. Such treatmentrequires the use of medications, variable methods for monitoring ovarian function and the possibility ofusing a wide variety of technical procedures. While no medication or medical procedure is without risks,we believe that in the hands of careful, experienced professionals these risks are minimized to assure thehighest level of your safety at all times. Likewise, should any complication from your treatments occur webelieve that the chance of any harm possibly resulting from such complications is minimized due to yourcare being managed by subspecialty-trained physicians who are highly competent and knowledgableregarding the appropriate treatment of complications which may arise from fertility-related medications orprocedures.

There are many medications, monitoring techniques, and procedures which can be used for the purposeof fertility treatment. You should be aware that some medications commonly used for fertility purposesare not approved by the FDA for fertility purposes. The FDA typically reviews and approves a newmedication to be used for a specific purpose. Many times physicians later find that medications have agood alternative usefulness other than for the original use approved by the FDA. Such is the case formany medications used in the entire field of medicine. At REACH we strive to always be aware ofprogressive new treatments though you can be assured that the medications, monitoring methods andprocedures we use are considered to be within the 'standard of care' for the fertility industry. There aretypical medications and common procedures which will likely be necessary for your treatment while in ourcare here at REACH. The specific risks inherent in such medications and procedures, though rare, arelisted below so that you can be fully informed regarding the treatment you may choose to undertake. Yourphysician may recommend alternative medications, monitoring methods or procedures which are not list-ed here. In those cases, your physician will specifically review such treatment with you personally toinform you of any related risks. You are asked to sign the 'informed consent' document found at the backof this booklet to indicate that you acknowledge these risks and that you have had a chance to inquire toyour physician regarding any questions you may have about such risks. The informed consent document,with your signature, will need to be turned in to your physician to be filed in your chart prior to initiating fer-tility treatment at REACH.

Ovulation Induction Agents'Ovulation induction' agents are oral medications which serve as a relatively mild stimulation to theovaries to produce usually one, but sometimes several, eggs per treatment cycle. The most commonmedications in this category are clomiphene citrate, tamoxifen citrate, letrozole and anastrazole. The sideeffects of these medications in general are few and mostly mild if they occur at all. Such mild side effectsmay include: brief hot flushes in the face or chest area, visual disturbances with blurring or spots, fluidretention, headaches, dizziness, fatigue, mood swings, nausea, vomiting, diarrhea or constipation, irregu-lar uterine bleeding, bone or joint discomfort, skin changes, breast tenderness, increased vaginal fluidsecretions. Typically, you are only taking such medications for relatively brief periods of time and so sideeffects, if they occur, are only brief. Potentially severe side effects such as gallbladder disease, highblood pressure, pulmonary disease and/or blood clots, heart attacks or strokes have been reported asextremely rare (<1% chance) and are not conclusively known to be directly related to such medications. Ifyou think you may be having any bothersome side effects while using these medications, please alertyour treating doctor immediately. Please also review the list of 'potential complications common to allfertility drugs'.

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REACH Informed Consent for General Fertility Treatment

Injectable Gonadotropin Hormones (for 'Super-ovulation' or 'Controlled Ovarian Hyperstimulation')Gonadotropin hormones are injectable medications typically given for the purpose of stimulating yourovaries to produce and release several eggs per cycle. These medications typically include follicle-stimulating-hormone (FSH), luteinizing-hormone (LH), or human-chorionic-gonadotropin (hCG).Growth Hormone is another injectable hormone sometimes used to help stimulate ovaries to produceeggs. The side effects of these medications in general are few and mostly mild if they occur at all. Suchmild side effects may include: fluid retention, headaches, dizziness, fatigue, mood swings, nausea,vomiting, diarrhea or constipation, irregular uterine bleeding, bone or joint discomfort, skin changes,breast tenderness, increased vaginal fluid secretions, or irritation / allergic reaction at the injection site.Typically, you are only taking such medications for relatively brief periods of time and so side effects, ifthey occur, are only brief. Potentially severe side effects such as gallbladder disease, high bloodpressure, pulmonary disease and/or blood clots, heart attacks or strokes have been reported as extremely rare (<1% chance) and are not conclusively known to be directly related to such medications. Ifyou think you may be having any bothersome side effects while using these medications, please alertyour treating doctor immediately. Please also review the list of 'potential complications common to allfertility drugs'.

Medications to Help Control Ovarian Function and Pituitary FunctionYour treatment may involve the use of injectable medications which are necessary for controlling thehormonal communication which naturally occurs between your brain (the pituitary gland) and yourovaries. This is sometimes necessary in order to prevent your own natural hormones from interfering withthe medications we are using to stimulate your ovaries. The two medications commonly used to achievethis purpose are leuprolide acetate or ganirelix acetate. The side effects of these medications in generalare few and mostly mild if they occur at all. Such mild side effects may include: headache, hot flushes,mood swings, nausea or irregular vaginal bleeding. When taken in combination with ovarian stimulationmedications, these medications may cause your ovaries to become enlarged which may cause feelings ofbloating or abdominal pain. Side effects from prolonged (3-6 months of continuous use) treatment withleuprolide acetate may include skin rashes, acne, vaginal irritation, symptoms of menopause, or weaken-ing of bone mineralization - such types of adverse effects are more typical of larger and more prolongeddoses of leuprolide acetate than what you would typically be taking for fertility treatments. If you think youmay be having any bothersome side effects while using these medications, please alert your treatingdoctor immediately. Please also review the list of 'potential complications common to all fertility drugs'.

None of the above medications are meant to be taken if you are pregnant. Please assure yourselfthat you are not pregnant prior to using these medications by either checking a pregnancy test orconfirming that you have had a normal, recent menstrual flow prior to starting any of thesemedications, and please share this information with your treating physician.

ProgesteroneYour fertility treatment may also involve the use of the natural hormone progesterone. Supplementalprogesterone may be started after the time of ovulation (release of the egg) and may be continued intoyour pregnancy to help support the development of the pregnancy. Whether you will need progesteronetreatment and the duration of progesterone treatment will depend upon your specific case. Potential sideeffects from supplemental progesterone are rare but may include water retention, pelvic cramping,dizziness, headache, nausea, breast pain or vaginal discharge. Although references can be found in theinternet and lay press alleging a possible association between 'progestins' (progesterone-like substances)and birth defects, natural progesterone hormone has not been found to have any direct adverse effectupon developing babies in any peer reviewed medical study known at this time. It is important toremember that birth defects occur in 3 - 4% of babies in the general population - who are not takingfertility medications or progesterone supplements.

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REACH Informed Consent for General Fertility Treatment

Monitoring TechniquesWhile you are using fertility medications it will be necessary to monitor the response of your ovaries tosuch treatment. The purpose of this monitoring is to make sure your ovaries are responding appropriatelyto your treatment while also ensuring that you are not over-responding to your treatment. The twoprimary ways of performing this monitoring are ultrasound exams and blood tests. To date there are noknown risks to your health or to the health of an early pregnancy from ultrasound procedures.Venipuncture (drawing blood from a vein) is necessary for blood testing. This minor procedure includes the risk of possible infection, bleeding or bruising at the needle insertion site. Such events are rare andonly minor and temporary if they should occur. Please ask your physician if you have any concerns aboutvenipuncture or ultrasound monitoring.

The Intra-Uterine Insemination (IUI) Procedure (or 'Artificial Insemination')In this procedure a thin flexible catheter is inserted through the cervix to allow a concentrated amount ofhigh quality sperm to be injected into the uterine cavity, bypassing the vagina and cervix to facilitatesperm arrival in the fallopian tube where fertilization of the egg occurs. Complications as a result of thisprocedure are almost unheard of. Nevertheless, the catheterization of the cervix may result in milduterine cramping or a small amount of blood spotting which may result from irritation to the cervix oruterus. Care is taken at the time of the procedure to wipe away all cervical mucus from around theopening of the cervix to minimize the chance of vaginal bacteria being carried into the uterus along thecatheter. Despite this precaution, it could be possible for bacteria to be introduced into the uterus by thisprocedure. Symptoms of an infection would be progressive pelvic cramping and pain, temperature above100.5 F°, or an odorous vaginal discharge. In the very rare case that an infection occurs as a result of anIUI, these symptoms would not be expected to start until approximately 24 hours after the procedure. It ishelpful to keep in mind that IUI procedures are performed around the time of ovulation (release of theegg) and therefore you may experience some mild to moderate pelvic cramping on the day of the IUIprocedure. 'Ovulation cramping' should be resolved within 24 hours. If you experience any of thesesymptoms which you find worrisome following an IUI procedure, call your treating physician immediately.

Potential Complications Common to All Forms of Fertility TreatmentRegardless of which specific medications are involved in your individualized fertility treatment, there arealways risks of complications which may result, though uncommonly, from treatments which stimulate theovaries to produce eggs. You should be aware that regardless of your insurance coverage for fertilitytreatment, your health care insurance may not cover complications from fertility-related treatments. Suchcomplications are not common but may include:

Ovarian Cysts - A 'cyst' is simply a contained collection of fluid. Typically ovarian cysts arerelatively small and pose no significant threat to your general health as they typically resolvespontaneously within several weeks. Ovarian cysts that we consider problematic measure ~ 3centimeters or more in diameter as seen by ultrasound. These cysts may not cause any symptoms at allor they may be quite painful. Typically the ovarian cysts we see on pelvic ultrasound exams are 'left-over'areas of stimulation in the ovary remaining from a previous treatment cycle.

Cysts can also, rarely, represent ovarian tumors or an area of endometriosis within the ovaryand therefore they need to be watched carefully. If you are found to have a large cyst prior to starting afertility treatment cycle, then it may be advised that you give your ovaries a 'rest' and avoid ovarianstimulation treatment for a month or more. An ultrasound exam can be performed in several weeks tore-evaluate the cyst.

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REACH Informed Consent for General Fertility Treatment

Multiple Pregnancy - A fertility treatment cycle may result in the release of more than one egg inthe treatment cycle and if these eggs are all fertilized by sperm then there is a chance that you will havemultiple pregnancies develop. The occurrence of twin pregnancies in the general population is thought tobe approximately 1% of all pregnancies. The chance of having a multiple pregnancy from fertilitytreatment may be several times this risk but depends upon what type of fertility therapy you areundergoing. You should discuss the specific risks of multiple pregnancy with your treating physicianrelative to the particular fertility treatment you are undergoing. Compared to a pregnancy with a singlebaby, a multiple pregnancy carries higher risks for cesarean section, premature labor and prematuredelivery. Babies born prematurely may suffer long term health complications of prematurity. Pregnancieswith 3 or more babies are termed 'high order' multiple pregnancies and are at particularly high risk forthese complications. All multiple-pregnancies (including twins) are high risk pregnancies - for babies andfor mothers. We consider multiple-pregnancies to be a complication of fertility treatment, therefore it isnever our goal to cause a multiple-pregnancy. On the contrary, it is our goal to maximize your chance ofhaving a healthy single baby - one at a time. If you should become pregnant with a 'high order' multiplepregnancy (triplets, quadruplets, etc) then you should be aware of the availability of the procedure'selective fetal reduction'. This procedure is essentially an elective abortion of one or more of the multiplebabies, performed early in your pregnancy for the purpose of lowering the eventual risk of complicationslater in pregnancy that would be expected of a 'high order' multiple pregnancy. This procedure isavailable in the Charlotte area and should only be performed by a maternal-fetal medicine specialist - anOB-GYN doctor who specializes in high risk obstetrical problems. This is obviously a very upsetting ideato think about when planning a pregnancy, yet it should be given some consideration at least so that youand your spouse can discuss how you feel about this before starting on fertility medications. However youfeel about this issue, your feelings will be respected at the REACH program.

Future Risk of Breast or Ovarian Disease - There have been a very few studies which claim tohave found an association between fertility medications and future risk of breast or ovarian disease,including breast or ovarian tumors. These studies are typically flawed (the results can not be relied uponas truth) for two reasons: (1) These studies fail to account for the fact that women who never deliver ababy in their lifetime are at definite increased risk for ovarian cancer. So it may not be that fertilitymedications are a risk for causing breast or ovarian disease, but rather it may be that lifelong infertility isthe reason for an increased risk of breast or ovarian disease. (2) The studies which have alleged anassociation between fertility medications and breast or ovarian disease have typically studied women whohave used many more cycles of fertility medication than are typically recommended for reasonable pur-suit of pregnancy. This issue of risk association between fertility medications and breast or ovarian dis-ease will likely be clarified with better designed research studies in the future. It is reassuring at thecurrent time that the majority of the studies and reviews which have evaluated this issue havefound no significant direct correlation between fertility medications and breast or ovarian disease.In the meantime it is our goal to treat you with a reasonable number of appropriately selected fertilitytreatment cycles as long as these treatments are giving you a reasonable chance of pregnancy.

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REACH Informed Consent for General Fertility Treatment

Ovarian Hyperstimulation Syndrome - The ovarian hyperstimulation syndrome (OHSS) is thought tooccur in approximately 1 - 3% of all ovarian stimulation treatment cycles though it is more typically asso-ciated with gonadotropin hormones and extremely rare with oral ovulation induction agents. OHSSresults from an exaggerated response of the ovaries to the ovarian stimulation medicationsand is rather unpredictable in its occurrence. Initial symptoms of OHSS may include uncomfortableabdominal 'bloating' combined with decreased appetite, decreased urine output, and possibly diarrhea.If these problems occur they are self-limited with spontaneous resolution usually within 1 to 2 weeks.Severe OHSS is very rare and involves alteration of liver and kidney function and possibly results in fluiddevelopment ('ascites') within the abdomen. Severe cases of OHSS necessitate hospitalization to helpstabilize and improve a patient's condition. Development of large amounts of abdominal ascites cancause difficulty breathing which then necessitates removal of the ascites fluid by a procedure calledpericentesis. In the worldwide medical literature there have been isolated case reports of death due toOHSS though in the hands of responsible physicians the chance of such a catastrophe should beextremely remote.

Congenital Anomalies ('birth defects'), Fertility Medications, and Infertile Patients

The REACH medical staff is constantly reviewing current medical literature with regard to potentialimplications of infertility with congenital anomalies in human and animal studies. In treating infertility wewill always strive to use medications which are considered standard of care for use within the fertilityindustry and safe for patients and developing babies. It should be noted that some medications found tobe beneficial in treating infertility may have been originally approved by the FDA for medical conditionsother than infertility, and therefore use of such medicines would be considered 'off-label'. Such is thecase for many medications used throughout the field of medicine. We will prescribe medications for the'off-label' use in fertility treatment as long as credible, peer-reviewed, current literature in the fertilityindustry demonstrates such medicines are beneficial as a fertility treatment and are safe for patients anddeveloping babies. Occasionally media reports will claim association of congenital anomalies withcertain medications or medical treatments. To properly understand such risks it is important tounderstand that approximately 3-4% of all babies born in the human population have some form of acongenital anomaly. Furthermore, it has been found that when specifically studying people who have dif-ficulty in conceiving by natural means, the rate of congenital anomalies and medical complications foundin newborn babies is higher than background rates acknowledged for the human population in general.(*See references). Any report of a medication or treatment being associated with an increased risk ofactually causing a congenital anomaly would have to be properly controlled to account for the back-ground data of congenital anomalies in the general population as well as in the population of peopleneeding fertility treatment to conceive. The relative importance of this information is not typicallycontained in media reports claiming an association of medications or treatments with abnormalpregnancy outcomes.

*Fertility and Sterility Vol.84, No.5, 2005. Buckett, W et al.Lancet Vol. 353, 1999. Draper, E et al.J Med Genet Vol. 42, 2005. Ludwig, M et al.Human Reproduction Vol. 20, No.2, 2005. Clementini, E. et al.

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REACH Informed Consent for General Fertility Treatment

Informed Consent to Fertility Treatment, Monitoring, and Intra-Uterine Insemination ProceduresYour personal feelings regarding your fertility health are always respected at REACH, and we will workwith you to individualize your care to hopefully meet your expectations and goals. Your signature belowdoes not obligate you to any form of therapy. You may refuse any therapy or discontinue any therapywhich has already been initiated at any time. Please realize however that refusal or non-compliance withrecommended therapy may compromise the possibility for achieving an optimal outcome from yourtreatment. Please also be aware that the above information is time-sensitive - this information reflects thecurrent understanding of fertility medications, monitoring methods and procedures as of the date of yoursignature. Our informed consent document for general fertility treatment may be subject to modificationsin the future as new information and research becomes available. Expecting such, this consent will beperiodically revised as the standard of care in the fertility industry continues to mature.

Patient's verification of reading the informed consent document for general fertility treatment:I have read all the above information. I have been given a chance to discuss this information with myphysician and have my questions answered. If I disagree or object to any of this information I will sharethese feelings with my treating physician in order to appropriately individualize my treatment.I acknowledge the potential for risks to my health that may be associated with the use of fertility medica-tions, monitoring methods and procedures as described above. I acknowledge the availability ofselective fetal termination which may be recommended in the case of a high order multiple pregnancy,though the availability of this procedure does not obligate me to participate in this procedure. Iacknowledge that the above information is time-sensitive and reflects the standard of care as isconsidered current at this time. The consent may be modified as new information becomes available.

Patient Signature_____________________________________ Date _____________________

Witness _____________________________________

Document last revised 2-28-06

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