Stims Week: What Happens, and What to Write Down

Stimulation is somewhere between seven and 15 days of daily injections, with a scan and bloodwork every few days, and a dose that will very likely change at least once while you are in it.

ASRM puts typical stimulation at seven to 12 days, extended if the ovaries respond slowly, from a usual starting dose of 75 to 150 IU daily. Cleveland Clinic's guidance on injecting at home gives eight to 15 days, and notes some medications need two or more injections a day.

People call it "stims week". It is often not a week, and that mismatch causes a surprising amount of scheduling grief.

The daily rhythm

You inject at roughly the same time each day, which Cleveland Clinic advises where your protocol allows it. Depending on your drugs that might be one injection or several, and some protocols add a second medication partway through to stop you ovulating early.

Between injections there is not much to do, which makes the first few days feel oddly anticlimactic. The work is the consistency rather than any single event.

Then the monitoring starts, and the rhythm becomes: inject in the evening, get scanned in the morning, wait for a phone call, possibly change the dose, repeat.

The monitoring appointments

These are short and frequent, and they are the reason stims week is logistically awkward.

ASRM describes follicle size being tracked by ultrasound with blood estradiol measured frequently through the stimulation phase. Your clinic is watching two things together: how many follicles are growing and how fast, and what your hormone levels say about that growth.

Appointments are usually early morning, because the lab needs to run bloods and get a decision back to you the same day. Several of those a week, at 7am, is a genuine problem if you have a job, and it is worth knowing before you plan the fortnight.

The output of each visit is a set of numbers and sometimes a new instruction. Both are worth capturing while you are still in the car park, because "they said the left one had a few good ones" is not something you can use later.

Your dose will probably change

This trips people up more than anything else in the cycle.

The plan you were given at the start is a starting point. ASRM's guidance describes dosing adjusted according to response, and that is exactly what the monitoring is for. A change is not a sign something has gone wrong. It is the system working as designed.

What it does mean is that your printed schedule goes out of date mid-cycle, sometimes more than once. If your tracking depends on that printout, it quietly stops being accurate, which is the core of why keeping track of IVF medications needs a system that can absorb a change rather than a fixed routine.

How you might feel

Variable, and not always in proportion to how the cycle is going.

ASRM's fact sheet on the side effects of injectable fertility drugs notes that some women experience breast tenderness, headaches or mood swings from gonadotropins, and that the injection itself may cause local skin irritation. An actual allergy to the medication, it says, is extremely rare.

Bloating tends to build through the second half as the follicles grow, and it can be substantial by the end. Clothes stop fitting for a week or two, which nobody warns you about and which is worth planning around rather than being annoyed by.

The emotional side is harder to attribute. You are on hormones, undersleeping, injecting yourself daily and waiting on results every 48 hours. Working out which part of a bad afternoon is the drugs is largely futile, and it does not need to be diagnosed to be real.

The line where you stop waiting and call

Most of stims is uncomfortable rather than concerning. There is one exception worth knowing in advance.

Ovarian hyperstimulation syndrome is the significant risk of this phase. ASRM reports a mild form in 10 to 20 percent of cycles and the severe form approximately 1 percent of the time, with severe symptoms including nausea, vomiting, rapid weight gain, dehydration, blood clots and kidney dysfunction. Close ultrasound monitoring, it says, is advised specifically to minimise these risks, which is part of what those frequent appointments are doing.

You are not expected to diagnose this yourself. The thing to watch is which way it is heading. Normal bloating and soreness levels off after a while and then starts to ease off. Anything that keeps building day after day is worth a phone call. So is putting on weight fast, getting breathless, pain that is genuinely severe, or noticing you are urinating far less than usual. Ring them rather than waiting for your next scan.

Call early and call about small things. Clinics would rather hear about day four than find out on day nine.

Cancellation, and why it happens

Worth knowing in advance, because hearing it for the first time mid-cycle is much worse.

Some cycles get stopped during stimulation. Broadly it happens in two opposite directions: too few follicles developing to make retrieval worthwhile, or so many, with hormone levels climbing so fast, that continuing would push your OHSS risk too high.

ASRM lists the strategies used in that second situation, including withholding further gonadotropin stimulation, delaying the trigger until hormone levels plateau or decline, or withholding the trigger altogether to prevent ovulation. A freeze-all cycle, banking embryos rather than transferring fresh, is another way clinics reduce that risk.

So a change of plan late in stims is usually a risk decision, not a verdict on you. It does not feel that way at the time, and it is reasonable to be devastated by it anyway.

If it happens, the questions worth asking are what specifically prompted it, what would be done differently next time, and what the financial position is, since a cancelled cycle is billed differently by different clinics.

What to write down

Five things, and they take under a minute a day:

• Each dose: the drug, the number of units, and the time you actually injected.
• Each dose change: as its own dated entry, including who told you.
• Each scan: follicle counts and measurements, and any hormone values they give you, in the clinic's own words.
• Each injection site, so rotation is a decision rather than a guess.
• How you feel, briefly. Useful for spotting a trend that is building rather than settling.

The scan numbers are the ones people most regret not recording. They come by phone, often while you are doing something else, and they get discussed at every subsequent appointment and again if there is ever a second cycle.

Holding all of that per phase is what Marigold is built for, with the doses, scan results and side effects sitting inside the stimulation stage rather than scattered. It records and organises. It does not give medical advice, and your clinic's instructions override anything the app shows.

Getting through the fortnight

Stims is the busiest stage and the one where the routine feels most relentless. It is also the one where consistency genuinely matters, since the whole monitoring loop assumes you took what you were told, when you were told.

Protect the mornings you need for appointments, tell work whatever you are comfortable telling them, and write things down at the time. It sits at stage three of seven, and the trigger arrives at the end of it, which is a short and very precisely timed relief.

If you want the doses and scan numbers in one place, Marigold is free to download on the App Store.