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OvaFlow
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Stage 3 of 9

Stimulation & monitoring

During ovarian stimulation—typically 8 to 12 days of daily gonadotropin injections—morning ultrasounds measure growing follicles while blood tests track estradiol and progesterone. Results from in-house or satellite labs come back by midday so the physician can confirm or adjust evening medication doses and schedule the next scan.

6 prototype walkthroughs
Watch the walkthroughSee the whole journey
Expanded workspace My work queue (prototype walkthrough) at two points in the same day: before and after an explicit handoff acceptance. Fictional patient data.
  1. 16:45 PDT. Nora's queue: what needs action, what is waiting, and who owns each item.
  2. 20:28 PDT. Alex Kim, RN accepted the evening callback. The clinical decision stays with Dr. Lee.
16:45 PDT: an expected outside result is tracked as expected, not missing.Prototype walkthroughFictional patient dataOpen the walkthrough

Expected, not missing

A late result is tracked, not lost

In the daily-care walkthrough, Elena's estradiol result is due but hasn't arrived. A quiet inbox doesn't mean nothing is owed.

  1. 0116:45ExpectedThe result is tracked as expected, not missing. Nora Ruiz, RN owns the follow-up.
  2. 02OfferedNora Ruiz, RN offers the follow-up to Lee Park, RN. Until Lee Park accepts, Nora stays responsible.
  3. 0316:56AcceptedThe late result arrives and Lee Park, RN explicitly accepts the nursing follow-up.
  4. 0416:59Clinical reviewDr. Mira Lee accepts the clinical review. The decision is hers.

Times in PDT, from the daily-care walkthrough. Fictional patient data.

Handoffs and safeguards

Where work slips, and what holds instead

These are the moments the design is built around. Each safeguard stops or holds work; the decision stays with the clinician or the lab.

Where it slips today

  1. An outside morning estradiol or ultrasound result is expected by mid-afternoon but never arrives, and nobody notices because the inbox is quiet.
  2. A monitoring note is drafted in the EMR flowsheet but never actually saved before the afternoon callback.
  3. A dose change is messaged to the patient without going through the clinic's own e-prescribing and allergy controls.
  4. An antagonist or refill shipment runs short over a weekend because pharmacy fulfillment and patient receipt were never confirmed.

What holds in OvaFlow

  • Right next stepSave checkText placed in the EMR isn't treated as saved until the EMR shows it.
  • Right ownerPrescribing stays in the EMRDose changes are handed to the clinic's own e-prescribing workflow. OvaFlow never prescribes.
  • Right next stepClinical and financial readiness, side by sideAn unresolved authorization or clearance is visible before a cycle starts, without either one standing in for the other.
All safeguards

Both sides

One stage, seen from both sides

For the clinic team

What the team coordinates

OvaFlow tracks expected outside results, monitoring notes and their save check, dose changes handed to the clinic's own e-prescribing, and pharmacy fulfillment before stim.

  • Expected-result tracking from morning order through lab receipt to documented clinician review
  • Monitoring note placement and EMR save check before afternoon patient instructions go out
  • Dose changes routed to the clinic's own e-prescribing workflow rather than sent as unverified chat
  • Specialty pharmacy clarification, prior authorization, cold-chain delivery and the patient's own inventory check
Operational checks at this stage (3)
  • Track every morning ultrasound and satellite estradiol/progesterone order from requisition to lab receipt and physician sign-off.
  • Verify that dictated or drafted monitoring notes are committed and saved inside the clinic's own EMR flowsheet before messaging the patient.
  • Route any medication or dose change through the clinic's own e-prescribing workflow and confirm patient weekend supply.

People involved

For you and your family

What you experience

Daily injections help several follicles (fluid-filled sacs that may each contain an egg) grow at the same time, with regular scans and blood tests to check progress.

Questions you may ask here (3)
  • “What happens between my 7:30 AM ultrasound and blood draw and the 3:30 PM phone call or portal message with tonight's dose?”
  • “If I had my blood drawn at an outside satellite lab near work, how do I know my clinic received the result in time?”
  • “Why do I sometimes add a second injection mid-cycle, and what if I am running low on vials before Sunday?”
Words you may hear (4)
Ovarian stimulation
Daily injections that help several follicles (fluid-filled sacs that may each contain an egg) grow at the same time. Not every follicle yields an egg.
Estradiol
A hormone measured in blood tests during monitoring.
Monitoring
Ultrasounds and blood tests during stimulation that guide the clinician's decisions on doses and timing.
E-prescribing
Sending prescriptions electronically from the clinic's own system. Prescribing and dose changes happen there, by a clinician. OvaFlow never prescribes or sends doses.

Questions about your own treatment go to your care team. OvaFlow never gives medical advice. In an emergency, call 911.

Read the plain-language guide to IVF

Workflows here

Workflows at Stimulation & monitoring

Each row opens the capability. Point at, focus or scroll to a row to see it in a recording from this stage.

  1. My workOne role-scoped queue: what needs action, what is waiting, and what is done.Seen in: Daily care: a changed trigger, the wrong chart and an unknown outcome
  2. Checked in the EMRDone means the EMR shows it. Unknown stays unknown until someone checks.Seen in: nAbleIVF: allergy check, monitoring note, save check, specimen stop
  3. Visit capture & dictationOpt-in capture with consent first, a visible recording state, and a draft you review before it goes anywhere.Seen in: nAbleIVF: consult capture, pause, save check and a nursing task

See it

Walkthroughs from this stage

Recorded from an interactive design prototype. Every patient, clinician and clinic is fictional, and EMR screens are modeled reconstructions.

Prototype walkthrough · Fictional patient data

Stories

Stories that pass through here

Fictional people, told end to end.

Fictional patient data

Step-by-step timing & questions

How Stimulation & monitoring unfolds day by day

Daily hormone injections recruit a cohort of follicles while morning ultrasounds and estradiol blood draws guide same-afternoon dose adjustments and antagonist timing.

8–12 days typical · Scans & labs every 1–3 days

The daily stimulation & same-day monitoring loop

  1. 01Days 1–4

    Baseline & gonadotropin start

    Patient & family

    After a baseline scan and blood test confirm quiet ovaries, you begin nightly follicle-stimulating hormone injections at home.

    What holdsBaseline cleared & inventory checked
    Clinic, EMR & lab

    Coordinator confirms baseline clearance, saved flowsheet note, and that the patient has enough pens/vials through the weekend.

  2. 02Days 5–7

    Antagonist addition & mid-stim scan

    Patient & family

    You return for a morning ultrasound and estradiol blood draw; a second daily injection (antagonist) is often added to prevent early ovulation.

    What holdsExpected estradiol result received
    Clinic, EMR & lab

    Morning scan and outside estradiol lab are tracked as expected items so a late satellite result is flagged before afternoon rounds.

  3. 03Days 8–11

    Every-1-to-2-day monitoring

    Patient & family

    Scans measure leading follicles (typically 12–20 mm) and endometrial lining while you wait for the afternoon call with tonight's dose.

    What holdsNote saved in EMR · Dose in e-Rx
    Clinic, EMR & lab

    Physician reviews follicle counts and hormone trends; OvaFlow verifies the monitoring note actually saved in the EMR before instructions go out.

  4. 04Day 10–12

    Trigger readiness decision

    Patient & family

    When multiple lead follicles reach mature size, your clinic prepares your exact evening trigger instruction.

    What holdsSigned trigger order ready
    Clinic, EMR & lab

    Clinician evaluates estradiol level, follicle cohort and ovarian hyperstimulation syndrome (OHSS) risk to select trigger type and time.

Every monitoring day runs on a tight morning-to-afternoon clock: morning scan and blood draw, midday lab return, physician flowsheet review and EMR save check, and evening dose confirmation.
Worked example: Elena Rivera's Day 8 monitoring save check and Oct 30 expected estradiol result
Worked example · West ClinicFictional patient data

Elena Rivera's Day 8 monitoring save check and Oct 30 expected estradiol result

What the patient sees

Elena completes her morning monitoring scan and blood draw. She receives her updated evening instruction only after her ultrasound and hormone results are reviewed together.

What the clinic team sees

On Day 8, Elena's monitoring note counts as saved only when the EMR flowsheet confirms it. On Oct 30 at 16:45 PDT, her satellite estradiol result is flagged as 'Expected — not yet arrived', and Nora Ruiz, RN keeps ownership until Lee Park, RN accepts or the result lands.

Why it holds: A missing outside lab never hides in a quiet inbox, and an unsaved EMR draft never looks like a completed monitoring note.

Where OvaFlow fits

How OvaFlow works beside the clinic's own EMR and lab

Coordination companion

What OvaFlow coordinates

  • Expected-result watchlists for morning ultrasounds and outside satellite hormone labs
  • EMR save verification for monitoring notes and consultation summaries
  • Explicit handoff ownership between daytime and coverage nurses during afternoon callbacks
System of record

What stays with clinicians & the EMR

  • Follicle measurement, estradiol interpretation, and clinical dosing decisions
  • Entering and signing medication orders inside the clinic's own e-prescribing system
  • Direct nursing education on injection technique and symptom assessment
OvaFlow never prescribes medications, never triages symptoms, and never replaces the clinic's own EMR or electronic witnessing hardware.

Common questions at this stage

Questions from patients, families and clinic teams

View all 4 stage questions & answers
How many days does ovarian stimulation usually last, and how often are scans needed?

In SART and ESHRE patient guidelines, ovarian stimulation typically lasts 8 to 12 days of daily gonadotropin injections. After a baseline check, transvaginal ultrasounds and blood estradiol tests usually happen every 2 to 3 days early on and every 1 to 2 days as leading follicles approach 16 to 20 mm.

Sources: [5] ESHRE Guideline Group (2026) · [6] SART Patient Guide (2026)

Why does the clinic wait until the afternoon to confirm my evening medication dose?

Morning ultrasound measurements show how many follicles are growing and their sizes, while serum estradiol and progesterone assays take several hours to run in the endocrine lab. Your physician reviews both pieces of information together in the afternoon before confirming tonight's dose or scheduling your trigger.

Sources: [5] ESHRE Guideline Group (2026) · [6] SART Patient Guide (2026)

What if an outside lab result is delayed on a critical monitoring day?

Following ONC SAFER test-result tracking principles, OvaFlow treats every ordered morning lab as an expected item with a due window. If a result has not arrived by afternoon review, it surfaces on the nursing worklist as overdue rather than staying invisible in an empty inbox.

Sources: [18] ONC SAFER Guides (2025)

What is an EMR save check during monitoring?

When a nurse or physician prepares a monitoring note alongside the clinic's EMR, an interrupted session or browser tab change can leave the text in a draft state. OvaFlow checks the EMR's own saved record before marking the monitoring note complete.

Sources: [18] ONC SAFER Guides (2025)

Clinical & operational sources for Stimulation & monitoring (4 primary guidelines)
  1. [5]
    ESHRE Guideline Group (2026) — Guideline on Ovarian Stimulation for IVF/ICSI (v2.3 update)Individualized gonadotropin stimulation, ultrasound and estradiol monitoring cadence, trigger criteria and luteal phase support.
  2. [6]
    SART Patient Guide (2026) — ART Step-by-Step Guide: Oocyte Retrieval and Embryo Transfer8–12 day stimulation window, 35–36 hour trigger-to-retrieval interval, 15–30 minute sedated retrieval, Day 5–6 blastocyst culture and progesterone support.
  3. [7]
    HFEA Patient Guide (2026) — In vitro fertilisation (IVF) and Pre-implantation Genetic Testing (PGT-M / PGT-SR)Plain-language overview of IVF stages, embryo grading, single embryo transfer and genetic testing options.
  4. [18]
    ONC SAFER Guides (2025) — Test Results Reporting and Follow-Up & Contingency PlanningClosed-loop tracking of expected diagnostic results from order to clinician review and downtime reconciliation.

Along the spine

Keep walking the journey

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