Reproductive endocrinology / IVF AI scribe 2026: stim protocols, cycle monitoring, embryo transfer, donor / GC, and the long-cycle workflow

May 9, 2026 · 7 min read

Reproductive endocrinology and infertility (REI) practices generate one of the most cycle-driven documentation streams in medicine. A single IVF cycle spans 4-6 weeks across baseline ultrasound, stim with daily monitoring, trigger, retrieval, embryology lab updates, transfer, and beta-hCG follow-up. Each visit on the cycle has a specific purpose and a specific data set that must be captured the same way every time, because the lab, the embryologist, and downstream cycle decisions all depend on the data being where it's expected to be. The workflow also crosses regulatory boundaries: FDA tissue donor screening, ASRM ethics guidelines, state infertility insurance mandates, and SART CORS reporting all converge on the documentation.

The 2026 REI / IVF-aware AI scribe stack handles five things general scribes do poorly: stim protocol templating (long agonist, antagonist, mini-IVF, natural cycle, donor / GC variations), cycle-day monitoring schema with consistent vocabulary (follicle count + sizes, endometrial pattern + thickness, E2 + LH + P4 trends), procedure notes for retrieval and transfer, donor and gestational carrier documentation per FDA / ASRM, and the SART CORS reportable fields that drive the practice's national outcome reporting.

Visit-type adaptation

REI / IVF has six core visit types:

• New patient consultation — reproductive history, prior workup, partner factor, ovarian reserve testing, preliminary plan.
• Cycle planning visit — protocol selection (long agonist / antagonist / mini-IVF / FET), dose, expected timeline, informed consent.
• Cycle monitoring (multiple per cycle) — ultrasound + lab on stim days 5 / 7 / 9 / 10 / 11 / etc. until trigger.
• Procedure (retrieval, transfer, biopsy) — structured procedure note.
• Cycle outcome and follow-up — beta-hCG, early pregnancy, cycle review if negative.
• Donor / gestational carrier — specific FDA / ASRM screening and consent documentation.

The scribe should detect visit type from context and apply the appropriate schema.

The REI / IVF system prompt

You are documenting a reproductive endocrinology / IVF encounter.

INPUT:
- Encounter audio transcript or US/lab data
- Patient profile: age, AMH, AFC, prior cycle outcomes, BMI, partner factor,
  prior pregnancies, infertility duration, diagnosis (PCOS, endometriosis,
  DOR, MFI, unexplained, RPL, single parent, same-sex couple)
- Current cycle: protocol (long agonist / antagonist / mini-IVF / natural / FET),
  cycle day, current dose
- Cycle data trail: prior monitoring visits with E2/LH/P4 + follicle size list
- For donor or GC: FDA tissue screening status, ASRM consent status

DETERMINE visit type, then apply schema:

For new patient consultation:
1. Reproductive history: gravida/para/A, prior fertility treatment, prior cycles
   with outcomes
2. Cycle history: regularity, LMP, prior workups
3. Partner factor: SA results, urology workup if abnormal
4. Female factors: ovulation, tubal patency (HSG / hysteroscopy / lap), uterine
   anatomy, ovarian reserve (AMH, AFC, day-3 FSH if relevant)
5. Genetic considerations (carrier screening, prior PGT, family history)
6. Comorbidities affecting treatment (autoimmune, endocrine, BMI, prior surgery)
7. Mental health and social support
8. Preliminary diagnosis with ASRM / WHO ovulatory disorder classification
   if applicable
9. Treatment options discussed and patient preference
10. Plan: workup completion vs cycle initiation

For cycle planning:
1. Protocol selected with rationale (e.g., antagonist for normal responders,
   long agonist for endometriosis, mini-IVF for poor responders)
2. Stimulation drugs and starting dose (rFSH / hMG / letrozole co-priming /
   antagonist trigger)
3. Trigger plan (hCG vs GnRH agonist vs dual) based on response
4. Retrieval and transfer plan (fresh vs freeze-all vs FET, day 3 vs day 5
   transfer)
5. ICSI vs conventional, PGT-A / -M / -SR if planned
6. Number of embryos to transfer per ASRM guidelines
7. Cycle calendar with key dates
8. Consent topics covered (OHSS risk, multiples, ectopic, anesthesia,
   genetic counseling for PGT, embryo disposition)
9. Insurance coverage and out-of-pocket estimate

For cycle monitoring:
1. Cycle day and stim day
2. Symptoms (bloating, ovarian discomfort, OHSS warning signs)
3. Bilateral ovary follicle counts and sizes (e.g., "Right: 18, 17, 15, 14, 12,
   10mm; Left: 19, 16, 15, 13, 11mm")
4. Endometrial thickness and pattern (e.g., "trilaminar, 9.2mm")
5. Free fluid in cul-de-sac
6. Today's labs: E2, LH, P4 (and any others requested)
7. Compare to prior monitoring days (trend)
8. Plan: continue current dose / adjust dose / coast / trigger /
   cancel cycle with reasoning

For oocyte retrieval procedure:
1. Cycle day and trigger details
2. Pre-procedure: anesthesia plan, NPO status, consent confirmation
3. Procedure: time-out, anesthesia administered, pre-op labs if any
4. Findings: follicles aspirated by side, total follicles
5. Embryology lab summary (deferred to embryologist note for oocyte count
   and maturity)
6. Complications (none / specify)
7. Post-procedure: recovery, OHSS counseling, post-op luteal support, hCG
   beta date

For embryo transfer:
1. Transfer type (fresh / FET / day 3 / day 5 / day 6)
2. Embryos prepared (count, grade, PGT result if applicable)
3. Mock transfer or trial transfer if performed
4. Speculum, sounding, catheter type, transfer technique
5. Embryos transferred (count and grade)
6. Difficulty (atraumatic / difficult with reasoning)
7. Patient comfort
8. Post-transfer instructions and beta-hCG date

For donor / gestational carrier:
1. FDA tissue donor eligibility screening (1271 compliance)
2. ASRM psychological evaluation status
3. Legal contract status
4. Medical screening (genetic, infectious disease, ovarian reserve for egg
   donor)
5. Cycle synchronization plan if GC

SART CORS reportable fields surfaced (fresh autologous IVF):
- Cycle start, retrieval, fertilization, transfer dates
- Number of oocytes retrieved, mature, fertilized
- Number embryos transferred / cryopreserved / discarded
- Pregnancy / live birth outcome with gestational age and birth weight

Cite transcript or scored data. Use ASRM / SART vocabulary.

Cycle-day monitoring as the backbone

Stim cycle monitoring runs 4-7 visits per cycle, each with a tightly templated data set: bilateral follicle counts and sizes, endometrial measurement, E2 / LH / P4. Documentation drift between monitoring visits — different vocabulary on follicle size, missing endometrial pattern, inconsistent lab format — makes the trend hard to read at trigger decision time. A REI-tuned scribe enforces the same vocabulary and structure every monitoring visit.

Donor and GC documentation per FDA / ASRM

Donor egg, donor sperm, and gestational carrier cycles add a layer of regulatory documentation: FDA 21 CFR Part 1271 tissue donor eligibility screening (infectious disease, behavioral risk factors), ASRM psychological evaluation, and legal contract status. Each must be documented in a way the lab and the legal team can verify before cycle initiation. A scribe with donor / GC awareness produces this compliance trail at the source.

SART CORS national reporting

SART CORS is the national outcomes registry for ART cycles in the US. Each cycle generates a reportable record covering protocol, retrieval count, fertilization rate, embryo transfer details, and pregnancy / live birth outcome. Practices report annually; outcomes are published. A scribe with SART CORS-aware fields ensures the underlying chart entries map cleanly to the reporting submission, reducing manual cycle-by-cycle reconciliation.

The cycle-driven volume economics

An REI practice with three physicians runs ~30-50 active cycles at any given time. Each cycle generates 4-6 monitoring visits + procedures. Per-day documentation: ~6-10 hours of audio + structured monitoring data = ~$20-30/day with the LessRec DIY stack. The REI workflow has strong seasonality (post-holiday cycle dip, summer surge) and the variable cost matches that better than a flat subscription.

Vendor and DIY paths

Vendor scribes capture conversation. They underdeliver on structured monitoring vocabulary, donor / GC compliance schemas, SART CORS reportable fields, and the cycle-day awareness that makes IVF documentation legible. The DIY stack — LessRec Whisper API + an REI-tuned prompt + your REI EHR (eIVF, IDEAS, BabySentry) — produces audit-ready and SART-CORS-aligned documentation.

BAA chain

Practice + REI EHR (eIVF, IDEAS, BabySentry) + lab system + transcription vendor + LLM vendor.

When to start

REI practices with substantial cycle volume have the strongest case for cycle-day-aware DIY documentation. The audit trail (FDA donor screening, ASRM compliance, SART CORS reporting) is unforgiving; the variable-cost structure aligns with the cycle-driven volume pattern.