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OvaFlow
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Study where coordination breaks, before drawing more screens.

Before designing more screens, we studied where IVF coordination actually breaks. Three specialist reviews (clinical care, lab and material operations, and administration and patient support) were consolidated into 33 workflow gaps. They are product hypotheses to test with clinics, not findings about any EMR vendor or any clinic's care.

See the gap mapReadiness

Main finding

Main finding

The biggest opportunity is following a treatment episode through time, including changed plans and unsuccessful outcomes: which event makes the next action possible, which decision changes several tasks at once, who has accepted responsibility, and what is still open when a cycle stops.

Audit taxonomy & worked traces

Three reviews, 33 gaps, seven views

Rather than treating each gap as an isolated screen, the audit maps how clinical, laboratory and administrative workflows share seven core episode views.

How the audit fits together

Three domain reviews, 33 workflow gaps, and seven shared episode views

October 2026 gap audit

Clinical & Nursing Care

Workup, stimulation, trigger, OHSS, PUL, and OB handoff

Embryology, Andrology & Cryo

ICSI, PGT-M, reagent lot trace, donor eligibility (21 CFR 1271), and warming

Front Office, Access & Continuity

Prior authorization, cost drift, multi-party consent, and downtime recovery

33 consolidated gaps
  • 15 newly surfaced workflows often tracked outside the main chart
  • 13 deeper workflow extensions across daily clinical handoffs
  • 5 relationship & data models for multi-person episodes and lineage
7 shared episode views
  1. Episode Header & Contributors
  2. Parallel Clinical & Financial Readiness
  3. Versioned Plan-vs-Actual Timeline
  4. Explicit Offer → Accept Handoff Queue
  5. Specimen, Biopsy & Reagent Lot Trace
  6. Multi-Party Disposition & Consent View
  7. Outcome & Sensitivity Stop Banner
Worked examples

Four worked traces connecting published sources to our fictional walkthroughs

Fictional patient data

Trigger-to-retrieval timing & discrepancy follow-up

Walkthrough cast: Elena Rivera, Dr. Mira Lee, Nora Ruiz, RN & Alex Kim, RN

Published basis: ESHRE Ovarian Stimulation Guideline (v2.3, Sept 2026) and NICE NG257 (March 2026) on 35–36h trigger intervals.

Product hypothesis: Preserve both planned (20:00 PDT, version 3) and patient-reported (20:20 PDT, received at 20:22 PDT) times with explicit UTC offsets across daylight saving time for the Nov 1, 07:00 PST retrieval, retire superseded version 2 (20:30 PDT), and require explicit on-call nurse acceptance.

OHSS freeze-all pivot, anesthesia readiness & discharge ownership

Walkthrough cast: Elena Rivera, Dr. Mira Lee & Nora Ruiz, RN

Published basis: ASRM OHSS Guideline (2023/2024) and ASA Multi-Society GLP-1 Perioperative Guidance (Oct 2024).

Product hypothesis: Surface preoperative medication hold checks on the retrieval readiness gate, cancel fresh-transfer tasks immediately upon a freeze-all decision, and require a named post-op discharge owner.

Reciprocal IVF separate roles, embryo warming & OB graduation

Walkthrough cast: Avery & Sam, Dr. Priya Shah & Embryology team

Published basis: ASRM Ethics/Practice guidance on LGBTQ+ family building (2026) and SMFM Consult Series #60 on ART pregnancies.

Product hypothesis: Keep egg-source and gestational-carrier charts separate under Role × Relationship × Task access rules, verify multi-party warming consent, and keep OB graduation open until the receiving team accepts.

Early PGT-M preparation, lot traceability & downtime recovery

Walkthrough cast: Jordan Patel & Embryology / Nursing team

Published basis: ASRM PGT-M Opinion (2023), US medical-device culture-media recall records (2024), and ONC SAFER Contingency Guide (2024/2025).

Product hypothesis: Track familial probe build before cycle day one, link reagent lots across cases for rapid exposure review, and enforce line-by-line paper-to-chart reconciliation after EMR outages.

Gap map

33 gaps, grouped by where they happen

Each one is a product hypothesis to test with clinics. None is a finding about a specific clinic or EMR vendor.

8

Before treatment starts

Getting the right path, people and prerequisites in place.

  1. Accepting a referral with its reason for care and urgency
  2. Each person's workup, run in parallel
  3. Fertility preservation with a competing treatment deadline
  4. Separate roles for everyone involved, and private information kept private
  5. PGT-M preparation started early enough
  6. A plan for when the expected sperm source isn't available
  7. Decisions that evolve as options and preferences change
  8. Benefits and the complete expected cost
8

During a treatment cycle

Keeping the plan, the people and the actual events lined up.

  1. A versioned timeline of planned and actual events, with time zones
  2. Room, staff, lab and anesthesia commitments that are actually accepted
  3. Expected outside results, including ones that never arrive
  4. Medication use after delivery, including what the patient reports
  5. Trigger-to-retrieval coordination and discrepancy follow-up
  6. Anesthesia, retrieval and discharge with a named follow-up owner
  7. Follow-up after retrieval, including outside emergency care
  8. Cancellation, conversion and pause as complete paths
7

In the lab and in storage

Exact material, exact decisions, across people and facilities.

  1. Fertilization and development, including no-embryo endings
  2. Reagent and equipment exposure traced across cases
  3. Receiving-lab acceptance before anything ships
  4. Donor eligibility specific to each action
  5. Warming and transfer of exactly the authorized embryo
  6. Long-term storage and disposition decisions
  7. Donor and family health updates that reach every clinic involved
5

After transfer

Staying with patients through every outcome.

  1. Frozen embryo transfer as its own pathway
  2. Early pregnancy, including pregnancy of unknown location
  3. A transfer to obstetric care that the receiving team accepts
  4. Unsuccessful treatment and loss, with incompatible prompts stopped
  5. Gestational-carrier arrangements tied to the right attempt
5

Continuity, access and evidence

What keeps a clinic working, and keeps it honest.

  1. Language, access and support needs, and a chosen pause
  2. EMR downtime, lab emergencies and staff departures
  3. Measures that count every transfer and keep unknown outcomes unknown
  4. Exact versions of clinical references and models
  5. Clear relationships between people, episodes, materials and events

External evidence

What we read, and what it changed

Each source is cited with its exact scope and denominator. The right-hand column is how it shapes the product, not advice about care.

ScopeExternal studies are cited with their exact scope as inputs to product design. They are not clinical guidance, and no OvaFlow clinical study exists.

  1. Source

    ASRM fertility-evaluation committee opinion, 2026 (replaces the 2021 version)

    What it says

    Supports tailored and parallel evaluation.

    Product input

    Intake should start from the reason for care and everyone involved, not a single infertility questionnaire for every path.

  2. Source

    NICE guideline NG257, published March 31, 2026 (replaces CG156)

    What it says

    Individual recommendations keep their own original dates.

    Product input

    Record the exact source and jurisdiction. UK funding or treatment recommendations don't automatically become US clinic rules.

  3. Source

    ESHRE guideline publication surfaces, checked October 2026

    What it says

    The landing page still shows a removal notice, while the current PDF records a section reintroduced on September 22, 2026 (version 2.3) under a cover still labeled 2025.

    Product input

    A year label or banner isn't enough. Reconcile the exact document and change log before updating linked templates.

  4. Source

    Randomized frozen embryo transfer trial, 2026 (primary abstract): 4,376 ovulatory women aged 20–40 planning a single frozen blastocyst transfer at 24 centres in China

    What it says

    Healthy live birth was 41.6% with natural-ovulation preparation and 40.6% with programmed preparation (RR 1.03, 95% CI 0.96–1.10), with randomized participants as the denominator. Among clinical pregnancies, pre-eclampsia was 2.9% versus 4.6% (RR 0.63, 0.43–0.94). Cycle cancellation was 16.2% versus 11.5% of randomized participants.

    Product input

    Frozen transfer planning should record the clinician's rationale and the trade-offs, not a single convenience or success score. The trial does not establish universal superiority or an individual prediction.

  5. Source

    ASRM committee opinion on ICSI for non-male-factor infertility, 2026

    What it says

    Does not support routine ICSI in all such cycles, and identifies selected circumstances separately.

    Product input

    Keep the authorized fertilization method and its indication; never install a silent universal default.

  6. Source

    Historical IVF culture-media recall notices

    What it says

    Recalls required stock action and acknowledgment, but a stock-only view can't identify earlier uses across patients.

    Product input

    Support a reviewed exposure investigation across lots, uses, cases and facilities, without assuming any clinic or patient is affected.

  7. Source

    Current US federal donor-eligibility text

    What it says

    Distinguishes quarantine, shipment and clinical use.

    Product input

    Readiness must be specific to the item, action, recipient and purpose, not a single eligibility badge.

  8. Source

    World Health Organization guideline for the prevention, diagnosis and treatment of infertility, November 2025

    What it says

    Emphasizes structured parallel evaluation of both contributors, continuity across care settings, and integrated psychosocial support.

    Product input

    Track each contributor's diagnostic workup in parallel and keep emotional-support and pause requests first-class workflow states.

  9. Source

    ASRM Practice Committee guideline on prevention and treatment of moderate and severe ovarian hyperstimulation syndrome (2023/2024)

    What it says

    Supports GnRH agonist triggers, dopamine agonist prophylaxis, planned freeze-all pivots and structured outpatient symptom surveillance for high responders.

    Product input

    When a cycle pivots to freeze-all for OHSS risk, immediately retire fresh-transfer tasks and assign a named post-retrieval discharge owner.

  10. Source

    American Society of Anesthesiologists multi-society perioperative GLP-1 receptor agonist guidance, October 2024

    What it says

    Highlights delayed gastric emptying and pulmonary aspiration risk during procedural sedation, requiring preoperative medication review, liquid-diet timing or hold coordination.

    Product input

    Include GLP-1 medication screening and anesthesia-specific pre-procedure hold instructions on the retrieval readiness gate.

  11. Source

    Society for Maternal-Fetal Medicine Consult Series #60 on pregnancies achieved through assisted reproductive technology (2022, reaffirmed 2024)

    What it says

    Identifies placenta accreta spectrum, fetal growth, multifetal gestation and hypertensive risk factors that obstetricians need documented at transfer of care.

    Product input

    Build the OB graduation summary with cycle protocol type (such as programmed versus ovulatory FET), embryo biopsy status and explicit receiving-team acceptance.

  12. Source

    NICE guideline NG126 on ectopic pregnancy and miscarriage diagnosis and initial management (updated June 2026)

    What it says

    Defines serial beta-hCG intervals, transvaginal ultrasound thresholds and safety-netting for pregnancy of unknown location and early pregnancy loss.

    Product input

    Treat pregnancy of unknown location as a high-priority tracked follow-up loop, and halt routine congratulatory prompts when loss is recorded.

  13. Source

    American Society of Clinical Oncology guideline update on fertility preservation in people with cancer, 2025 (PMID 40106739)

    What it says

    Recommends rapid reproductive specialist referral and parallel coordination so cryopreservation does not delay urgent oncology treatment start dates.

    Product input

    Support an expedited medical fertility-preservation intake track that surfaces competing oncology treatment deadlines alongside stimulation readiness.

  14. Source

    US Office of the National Coordinator for Health IT (ONC) SAFER Guides for Test Results Reporting and Contingency Planning (2024/2025)

    What it says

    Identifies unacknowledged abnormal test results, ambiguous order states and post-downtime paper-to-EHR reconciliation as major preventable safety hazards.

    Product input

    Track expected results so silence is never mistaken for normal, hold automatic retries on unknown outcomes, and enforce structured downtime reconciliation.

  15. Source

    The International Glossary on Infertility and Fertility Care (ASRM / ESHRE / ICMArt, 2025)

    What it says

    Standardizes denominators for initiated cycles, aspirations, transfers and cumulative deliveries, requiring unknown outcomes to be accounted for explicitly.

    Product input

    Keep cancelled cycles, no-embryo retrievals and unconfirmed transfers in their true denominator categories rather than dropping them from views.

Still open

Questions only a pilot can answer

We will not claim any of these until they are measured with a clinic, on real work.

  • Which records and confirmations each clinic's EMR actually exposes, operation by operation
  • Whether checking and verification add more effort than they save, measured on real work
  • How the desktop companion fits real workstations and remote sessions
  • Whether a patient channel reduces or adds burden compared with the clinic's existing portal
  • Whether family and proxy access rules are precise enough
  • How easily staff notice source or model mistakes in review

Methodology questions

How to read and evaluate our workflow research

Answers on how the 33 gaps were compiled, why exact denominators matter, and what remains open for clinic testing.

How were the 33 workflow gaps identified and consolidated?

We conducted three independent domain reviews—covering (1) clinical REI and nursing care, (2) embryology, andrology and cryostorage operations, and (3) front-office administration, financial readiness and patient support—cross-referenced against 2020–2026 clinical guidelines and health-IT safety standards. Overlapping findings were consolidated into 33 distinct episode-level workflow gaps.

How do the 33 gaps break down structurally?

Across the 33 gaps, 15 represent workflows that are often tracked outside the main chart on spreadsheets or sticky notes (such as PGT-M probe prep, reagent lot exposure tracing, or post-loss sensitivity stops), 13 deepen existing daily workflows (such as trigger-to-retrieval variance tracking and accepted handoffs), and 5 define foundational data and relationship models (such as multi-person episodes and guideline version lineage).

Are these 33 gaps a critique of any specific fertility clinic or EMR vendor?

No. Fertility EMRs handle complex regulatory reporting, billing and charting. Our gap audit studies the coordination seams between roles, shifts, external labs, pharmacies and patients. Every gap is framed as a product hypothesis for OvaFlow to test alongside clinics.

Why does the evidence table quote exact denominators and revision dates?

In reproductive medicine, a statistic changes meaning depending on whether the denominator is randomized participants, initiated cycles, egg retrievals or embryo transfers (as emphasized in the 2025 International Glossary on Infertility and Fertility Care). Similarly, clinical guidelines update individual sections on different dates (such as NICE NG257 and ESHRE v2.3). Recording exact scope prevents oversimplified software rules.

Does OvaFlow claim any clinical trial results or time-saved metrics of its own?

No. Every external study cited on this page is published literature used as a design input. No clinical study of OvaFlow exists today, and we make zero claims of clinical outcome improvement or measured staff time savings.

Research

Help us test a hypothesis.

If your clinic sees one of these gaps every week, we would like to hear how you handle it today.

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