Introduction to cycle monitoring

1. What is cycle monitoring?

Cycle monitoring is the process we use to track development of ovarian follicles during your menstrual cycle. It involves regular ultrasound and blood work to understand the timing of ovulation, assess the health of your ovaries and optimize chances of conception.

2. First things first: report your day 1

We consider day 1 of your period to be full flow and bright red bleeding, not spotting. This is when you should report your day 1.

You can do this through your app once you have accepted, paid and checked out of your treatment plan. Go to My Journey, then Upcoming Milestones, then Report day 1.

Shortly after reporting your day 1, within 24–48 hours, you will be booked in for your baseline ultrasound and blood work. The admin team will contact you to advise you of this appointment within 24–48 hours.

3. Blood work: female reproductive hormones

4. Ultrasound

• Antral follicle count (AFC): the follicles that are seen in each ovary. At the start of your cycle, you can anticipate them to be less than 1.0 cm each or non-measurable. Your AFC can fluctuate in a minor fashion throughout your cycle.
• Lead follicle: these are the follicles that are growing. They may dissipate throughout your cycle, or continue growing to become dominant. We use the term “lead” as these follicles take the lead in size. Usually larger than 1.0 cm, however they can be smaller.
• Dominant follicle: a lead follicle that has continued to grow in size, approximately larger than 1.5 cm. Typically when we see a dominant follicle together with elevated estrogen levels, it indicates a mature egg inside the dominant follicle. We cannot see eggs on ultrasound.
• Endometrial thickness: as you have your period, your lining will shed and be thin at the start of the cycle. As your cycle progresses, it will gradually thicken. We do not look for a specific measurement; the pattern and progression of the thickening lining is what matters.

5. Your results

Following your testing, you will be advised to check in at the front desk for any further action (for example, to see a nurse, pick up medications, or go home after testing). You are welcome to speak with a nurse after your appointment to review ultrasound results and ask any questions. If you wish to speak with a nurse, let the technician or front desk know before your appointment so we can accommodate your request.

If you do request to see a nurse after testing, please note that we can review your ultrasound results only in the morning.

Later that morning, when your blood work results are ready, the nursing team will review them with your physician. The nursing team will then release your blood and ultrasound results from your visit, with your instructions and medication instructions, in the release notes in your patient app. You will also be booked in for your next cycle monitoring appointment, if applicable.

6. Booking cycle monitoring appointments

Your appointments will be displayed under milestones in your patient app. For your first cycle monitoring appointment (cycle day 2–5) you will be booked in for:

• Baseline ultrasound (full bladder, pelvic and transvaginal), about 20–30 minutes
• Cycle monitoring blood work
• Medication pickup (if applicable)

For all other cycle monitoring appointments, you will be booked in for:

• Cycle monitoring ultrasound (empty bladder, transvaginal), a shorter appointment
• Cycle monitoring blood work
• Medication pickup (if applicable)

Each appointment shows as a separate milestone: blood, ultrasound and medication pickup. If you need to rebook a time, please contact your clinic’s cycle monitoring team.

7. Medications

Most medications involved are taken orally. At times, there may be injections involved. If so, the nurse will ensure you receive appropriate instructions on how to self-administer. If your plan includes luteal support, these medications are taken vaginally. The nurse will always provide you with accurate information about your medications.

8. Picking up medications

If your plan includes medications, they will appear in your app. A red alert will prompt you to pay for your medications through the app.

A milestone titled Medication Pickup will allow you to book a time to pick up medications. You will pick up your medications at the front desk after your ultrasound and blood work.