Morning Monitoring: Tracking Your Fertility Treatment Progress

When you are trying to conceive with the help of a fertility specialist, your doctor needs to closely track your body's response to any medications. Regular check-ins, often referred to as "morning monitoring" appointments, help track your progress. 

In this article:

• What is morning monitoring?
• What types of treatment require morning monitoring?
• What do we look for during morning monitoring?
• Preparing for Your Monitoring Appointment
• What to Expect During Morning Monitoring
• Getting Your Test Results
• Morning Monitoring FAQs
• You're On Your Way to Success

What is morning monitoring?

Morning monitoring refers to appointments performed at a fertility clinic (usually in the early morning) around every other day during a fertility treatment cycle. The term may also be used to refer to monitoring a fertility patient undergoes during the diagnostic process to help your doctor assess your "baseline" fertility prior to developing a treatment plan.

During a fertility treatment cycle, keeping a close watch on your hormone levels, follicle count, uterine lining, and other factors greatly increases your chances of success.

Test results from these regular appointments provide your doctor and Care Team with critical information they use to help fine-tune your medication protocol. Without such frequent monitoring, there is a greater chance that you could have an adverse reaction to the medications or have a poor response, leading to the cancellation of a treatment cycle.

What types of treatment require morning monitoring?

Whether you are trying to conceive with the help of timed intercourse, ovulation induction, intrauterine insemination (IUI), or in vitro fertilization (IVF) treatment, morning monitoring is an essential part of the process.

What do we look for during morning monitoring?

Here's a deeper dive on what we're monitoring and why:

• Estrogen (E2) levels - this hormone is produced inside the developing follicle (the structure that contains the egg), and correlates to the growth of the follicle. Monitoring this level helps track follicle growth progress and can alert your team to any irregularities or risk of ovarian hyperstimulation. 
• Luteinizing hormone (LH) levels - this indicates when you are about to ovulate, which can help with the timing of scheduled intercourse and IUI treatments.
• Uterine lining - this is critical to successful embryo implantation. Typically, around Days 6-8 of a cycle, the uterine lining (endometrium) begins to 'thicken up.' Your provider will be able to assess the thickness of your uterine lining during ultrasound. 

Reducing the Risk of Multiples

For those undergoing IUI treatment, it's important to achieve a low number of follicles, as a higher number of follicles greatly increases your chances of multiple pregnancy (i.e. twins, triplets, or higher order multiples). 

The Importance of Individualized Treatment Protocols

Every body responds to medications in different ways, which is why regular appointments are so critical during fertility treatment.

For example, monitoring might reveal that your uterine lining is too thin - this is sometimes related to medication. Clomid may be helping you ovulate, but also thinning out your uterine lining too much, necessitating a medication adjustment by your doctor.

Preparing for Your Monitoring Appointment

Here's everything you need to know before your first morning monitoring appointment at Illume Fertility (if you are a patient at another fertility clinic, please refer to their policies).

What to bring:

• Insurance cards and government-issued ID cards are only required at your first appointment and at the beginning of the year. 
• Make sure you drink plenty of water before your appointment, as you will sometimes need to provide a urine sample during morning monitoring. 

Note: If there has been a change to your insurance plan or current address, please inform a Front Desk Ambassador and they will be happy to update your file with the new information.

What to wear:

No special clothing is required, however, we do suggest wearing a loose-fitting top with sleeves you can easily roll up (if long-sleeved) as you will be getting your blood drawn.  

Morning Monitoring Hours & Locations

Morning monitoring is by appointment only, no walk-ins will be accepted. You may select the location closest to you for convenience, simply let your Patient Navigator know which office you prefer so the team knows to expect you.

Appointments are scheduled Monday through Friday each week:

• 7AM-9AM at our Norwalk, Trumbull, Danbury, and Harrison offices
• 6:45-8:30AM at our Stamford office
  

Note: If you require weekend monitoring, this appointment will be scheduled at our Norwalk, CT office.

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What to Expect During Morning Monitoring

Morning monitoring typically includes a blood draw and a transvaginal ultrasound (to visualize your ovaries and perform a follicle count).

Before performing any blood work, we will ask questions such as, "How do you do with blood work?" "Do you get nauseous or faint?" If the answer is yes, don't worry! We are always happy to lay you down in an exam room for your blood work to help you be more comfortable.  

Morning Monitoring: Step by Step

Let's walk through a full morning monitoring appointment together so you feel confident and prepared before your first visit. Here's what will happen when you arrive at our office:

1. You will check in with one of our Front Desk Ambassadors so the team knows you are present and ready for your appointment. 
2. A medical assistant (MA) will come to the waiting room and call your first name.
3. The MA will bring you to our phlebotomy (blood draw) room and sit you down while they confirm your full name and date of birth.
4. The MA will draw your blood, then walk you over to an exam room.
5. They will ask you to undress from the waist down and provide you with a cover up.
6. A nurse will enter the exam room with the provider (a doctor, physician assistant, or nurse practitioner, depending on location and scheduling) and introduce themselves.
7. The provider will perform a vaginal ultrasound to measure follicle size and count how many follicles there are in each ovary, as well as measure the thickness of your uterine lining.

Note: Vaginal ultrasounds are completely painless for most patients, with few patients experiencing only a slight sensation of pressure or very mild discomfort.

What happens after my exam?

After your ultrasound is complete, the provider will advise on specific next steps, for example, "You will remain on the same dose of medication and return to the office in two days!"

If there are any changes to your medication protocol or treatment plan, a nurse will always call later in the afternoon to explain further once blood work results are reviewed.

Can I ask the doctor questions during morning monitoring?

You are welcome to ask any questions you may have regarding today's monitoring appointment. If you have additional questions, or want to speak with your primary doctor to discuss anything else, please reach out to your nurse or patient navigator!

Since you may not always be seeing your primary doctor (who knows you best), morning monitoring is not the time to have a longer consult. However, if you have questions or concerns after your morning monitoring appointment, please reach out to your Care Team so they can ensure you receive adequate time with your primary doctor to talk through them.

We know it can be frustrating to not have more time with a provider when your head is swirling with questions. Please keep in mind that our goal is always to be able to see each patient on time and give them our full attention.

Getting Your Test Results

At the end of your morning monitoring appointment, the team will always advise you on whether or not to expect a follow-up call. Know that you will always receive a call if there is any change to your treatment plan.

At Illume Fertility, you can expect to receive a phone call about any blood work results from your nurse before the end of the day (typically, prior to 4PM). We know it can be nerve-wracking waiting to hear this news, especially when you are anxious about pregnancy test results or hormone levels.

Rest assured: Your Care Team is working diligently to communicate the day's results to each patient as efficiently as possible, and you have not been forgotten.

If your provider reviews your results and sees that you’re not responding well to a medication, they will call you as soon as possible to let you know and discuss next steps. 

What if I don't get a phone call?

If you do not receive a call, don't panic! Here's what it means:

• Your Care Team has reviewed your test results and determined that your levels are exactly where they need to be (based on the medication you are taking).
• If you don't get a call, simply continue with your current medication protocol as directed. 
• Feeling unsure or have additional questions? Email your nurse!

Morning Monitoring FAQs

Here are some other frequent questions and concerns we receive about morning monitoring:

Can I get morning monitoring done at an outside lab? 

If you live far away from your fertility clinic or have other extenuating circumstances, you may request to have outside monitoring appointments performed at a different lab. Please inform your Care Team (nurse, patient navigator, and doctor) so that they may email you a requisition form to give to the outside lab.

Keep in mind, outside monitoring may delay test results in some cases, and special coordination between your fertility clinic's team and the external lab is critical to maintain continuity of care. 

Why might my follicle count vary between providers? 

It is normal for follicle counts to vary a little bit from scan to scan. However, even if the follicle count you receive from one provider differs slightly from another, these numbers should still be close to each other.

Rest assured that each provider, whether they are a physician assistant, reproductive endocrinologist, or nurse practitioner, have been extensively trained in ultrasound monitoring and will provide the most accurate assessment possible. 

Will I always see my primary doctor during morning monitoring? 

At Illume Fertility, our physician team rotates through all five locations, so it is unlikely that you will see your primary doctor at each morning monitoring appointment.

However, all nine doctors (as well as our advanced practice providers) work collaboratively as partners, and always keep each other informed with regular discussions of patient protocols.

One of the benefits of having multiple providers involved in each patient's care? More expert eyes on your case! Whether you see your primary doctor or another Illume provider during morning monitoring, you can be confident that they all work as a team.

How does IVF work?

Get a step-by-step walkthrough of the entire IVF process from start to finish, learn about the cost of IVF, how to get started, and much more.

I'll be on my period for my appointment - is that okay?

Yes! Monitoring appointments may fall during your menses - particularly during the diagnostic stage. If you arrive wearing a tampon or menstrual cup, you can simply remove it prior to your vaginal ultrasound and replace it as soon as you're done (usually less than 5 minutes).

Note: Each exam room and bathroom will always be stocked with pads and tampons.

You're On Your Way to Success

Whether you only require minimal morning monitoring, or end up becoming best friends with the team at your office after countless visits, know that every person you encounter is cheering you on and wants to see you succeed.

No matter what it takes, we will be by your side until you achieve your goals!