OviflowWhen Monitoring Falls Short
Dan
There’s a moment in every IVF cycle where everything depends on timing. The eggs are mature. They’re ready to be retrieved. And the window for retrieval is incredibly narrow.
If you miss that window, you lose the cycle. That’s what happened to us.
What happened
During one of our IVF cycles - at the second clinic this time - monitoring during the stimulation phase wasn’t frequent enough.
During ovarian stimulation, the doctor performs ultrasounds every few days to track follicle growth and decide the exact moment for the trigger shot (the injection that initiates final egg maturation, 36 hours before retrieval).
In that particular cycle, ultrasounds weren’t done often enough. My wife’s follicles grew faster than anticipated. The eggs were mature, ready to be retrieved - but nobody noticed in time.
By the time retrieval happened, with 90-95% certainty, my wife had already ovulated a day or even two earlier.
The result: one of her ovaries was completely empty. Not a single oocyte was retrieved from that side. The cycle was essentially compromised.
Why it happened
We don’t know the exact reason. Maybe the doctor didn’t think an extra check was necessary. Maybe the clinic’s schedule didn’t allow flexibility. Maybe it was simply an oversight.
What we know for certain is that it could have been avoided.
If an ultrasound had been done a day or two earlier, they would have seen that the follicles were already at maximum size. The trigger would have been decided sooner. Retrieval would have happened at the optimal time. And an entire ovary wouldn’t have been lost.
What this means in practice
A lost IVF cycle isn’t just a “failed attempt.” It’s:
- Weeks of daily stimulation injections
- Side effects from hormones - bloating, pain, mood swings
- The emotional stress of the entire period
- Thousands of euros for medication and the procedure
- And most importantly, time - the resource you can’t get back
When you’re 35, 38, 40 years old and every cycle counts, a cycle lost due to insufficient monitoring is unacceptable.
Our lessons about monitoring
1. Ask about ultrasound frequency
Before starting stimulation, ask the doctor: how many ultrasounds are planned and on which days? A standard protocol includes ultrasounds on days 2-3 (baseline), then on days 6-7, 8-9, and potentially daily as you approach retrieval.
If the doctor plans only 2-3 ultrasounds over the entire stimulation, ask why and whether more can be added.
2. Demand flexibility
Every woman responds differently to stimulation. Some need more days, some fewer. Follicles grow at different rates. A rigid protocol that doesn’t adapt in real time is a risk.
Ask: “If my follicles grow faster than expected, can you schedule an extra ultrasound? Can you adjust the trigger timing?”
3. Monitor hormones too
Ultrasounds show follicle size, but hormone levels (estradiol, LH, progesterone) complete the picture. A sudden LH surge can signal imminent ovulation - meaning retrieval needs to be expedited.
4. Be proactive, not passive
We learned the hard way that you can’t leave everything to the clinic. If you feel something isn’t right - if you have different sensations, if bloating increases suddenly, if something feels “different” from the previous ultrasound - call and ask for a check.
It’s your body. It’s your cycle. It’s your emotional and financial investment. You have the right to demand attention.
The thaw-on-the-table - another procedural failure
We’ve told this story in the article about the lab, but it’s worth emphasizing here too, because it’s also about monitoring and procedures:
In another cycle, my wife was on the table, ready for transfer. We’d traveled 200 kilometers. And only then did we learn the embryo didn’t survive the thaw.
At a clinic with rigorous procedures, the embryo is thawed ahead of time, observed for several hours, and only then is the decision made to proceed with transfer. We found out on the table. On the spot. After hours of driving.
It’s also a form of insufficient monitoring - this time, of the embryo, not the eggs.
What we wish had been different
We wish we’d been more vocal. Asked more questions. Requested additional ultrasounds. Insisted on closer monitoring.
But more than anything, we wish clinics would treat every cycle as if it were the only one. Because for the couple on the operating table, it truly is.
References
- ESHRE Guideline Group. “ESHRE guideline: ovarian stimulation for IVF/ICSI.” Human Reproduction Open, 2020. Recommends 2-4 ultrasound checks during stimulation.
- Kadoura S, et al. “Prevention of Premature Ovulation by Administration of GnRH Antagonist the Day After Ovulation Triggering.” Reproductive Sciences, 2022. Premature ovulation rate of 6.86% with post-trigger GnRH antagonist.
This is the sixth in a series of articles about our IVF journey. We’re sharing what we learned across 6 cycles, three clinics, and five years - not as medical advice, but as the honest account we wish we’d had when we started.
Dan