While you take stimulation medicines, your clinic checks you with blood tests and ultrasounds, sometimes every day. What the team sees can change your medicine dose, your next visit or the day of your egg retrieval. So walk in with a few set questions, and write down every change you are given. Your clinic's instructions always come first.

If you feel unwell between visits, check the warning signs first.

What are IVF monitoring appointments?

While you take medicines to help your eggs grow, your IVF team watches you closely. This is called monitoring. It can include two kinds of tests:

  • A blood draw. It shows how much your hormone levels are rising.
  • A vaginal ultrasound. A small probe is placed in your vagina. It uses sound waves to make pictures of your ovaries and uterus, which show how your follicles are growing. A follicle is a small sac in the ovary where an egg grows.

Monitoring can happen daily or every few days, over about two weeks. Visits are not all the same. Some are blood work only, and what the team checks depends on where you are in the cycle. Our guide to stimulation explains this stage.

How you hear about changes

Each clinic has its own routine. The person who does your scan may not be the one who decides on your medicines. At NYU Langone's fertility center, for example, monitoring is in the morning, and a nurse sends instructions in the afternoon by portal message or phone. Your dose may change during the cycle, based on how your body responds.

So at each visit, ask:

  • Who will send my instructions, and by when?
  • Will they come by phone, text or portal?
  • Who do I contact if I have not heard by then?
  • Who do I contact if a portal message and a phone call disagree?

Baseline visit

Before you start stimulation medicines, an ultrasound checks that your ovaries are quiet, meaning they are not already growing eggs. A blood test measures your estradiol, a hormone. Sometimes the scan finds a cyst. If the visit is normal, you start your medicines, and your clinic tells you when.

Questions to ask:

  • What day of my cycle should I come in? Who do I call when my period starts?
  • What if my period starts at night or on a weekend?
  • How will I know I am cleared to start, and when do I take my first dose?
  • What happens if the scan finds a cyst?
  • When is my next visit?

Monitoring visits during stimulation

Questions to ask:

  • How many follicles are growing, and about what size are they?
  • How are my hormone levels?
  • Is my dose changing? Starting when?
  • Am I adding a new medicine?
  • When is my next visit?
  • When might I take my trigger medicine?

Your stimulation may be stopped if tests show too little or too much response. If that happens, your team will talk with you about next steps. See cycle cancellation.

Trigger and retrieval

When your follicles are ready, your doctor will tell you. Your clinic gives you a trigger medicine plan and an exact time to take it. The trigger helps your eggs finish maturing, and retrieval is done 34 to 36 hours later, which is why the time matters.

Questions to ask before retrieval:

  • What is my trigger plan, and at what exact time do I take it?
  • Which medicines do I stop, and when?
  • When do I stop eating and drinking?
  • What time should I arrive, and where?
  • Do I need someone to drive me home?
  • Who calls me with my egg and fertilization results, and when?

Our guide to egg retrieval walks you through the day.

Transfer visits

If you have a frozen embryo transfer with hormones, you will have blood tests and ultrasounds again. The ultrasound checks whether your uterine lining (the endometrium) is thick enough. The start time for progesterone matters, because it is linked to when your embryo is thawed and transferred.

Questions to ask:

  • Is my lining ready? What happens if it is not?
  • What day and time do I start progesterone?
  • What day is my transfer, and what time should I arrive?
  • Do I need a full bladder?
  • When is my pregnancy blood test?
  • Which medicines do I keep taking, and until when?

Read more in embryo transfer day.

Plan changes table

Changes can come by phone or portal on the same day as your visit. Writing each one down right away lets you check it later instead of relying on memory. Copy this table into a notebook or your phone's notes.

Received (date, time) From whom, and how Medicine Dose and units How you take it Starts (date, time) Replaces an old instruction?

Tips for using it:

  • Write the change in the clinic's own words, including units such as IU, mg or mL.
  • Note the route, such as under the skin, into the muscle or by mouth.
  • Read it back to the nurse before you hang up.
  • A table helps you compare instructions, but it cannot tell you which one is current. If two seem to clash, call and ask before your next dose.

When to get help

Call your clinic right away, day or night, if you have:

  • A fever of 100.4°F (38°C) or higher.
  • Bleeding your clinic did not tell you to expect, or a brown, watery discharge. After a transfer, call for any bleeding, even light spotting.
  • Belly or pelvic pain that is severe, gets worse, or isn't eased by the pain relief your clinic recommended.
  • Pain and bloating in your belly, or bloating that is getting worse.
  • Nausea and vomiting, nausea that won't go away, or you can't keep fluids down.
  • Peeing less than usual, even if you are not thirsty.
  • Fast weight gain. Your clinic will tell you its number, but do not wait to reach a weight threshold if you feel unwell.
  • Before a transfer: sudden belly pain, dizziness, lightheadedness, or feeling faint.
  • Pain, redness or warmth in an arm or leg.
  • Blood in your urine, or pain when you pee or poop.

OHSS (ovarian hyperstimulation syndrome) is when the ovaries overreact to the medicines.

Tell your clinic at your next contact about other milder symptoms that are new, don't go away or slowly get worse.

For any question about a dose, a missed shot or a missed visit, call your clinic before you do anything. Do not guess.

Key takeaway

At every visit, ask whether your dose is changing, when your next visit is and who will send your instructions. Write each change in your table. If instructions are late or two seem to clash, contact the clinic before your next dose.