How IVF clinics can speed up monitoring bloodwork turnaround
During ovarian stimulation, a fertility clinic's day has a familiar rhythm. Patients come in early for ultrasound and blood draws, the care team reviews results around midday, and nurses call patients in the afternoon with dosing instructions for that evening.
That rhythm only works if bloodwork comes back on time. When results arrive late, nurses chase the lab, physicians review in a rush and patients wait by the phone for instructions they need before their next injection.
This guide looks at where monitoring bloodwork loses time, what current evidence says about which hormone tests to run and practical steps clinics can take to get results back sooner. It's written for clinic operations and nursing leaders. It's educational only and isn't medical advice; monitoring protocols are clinical decisions for each practice.
What monitoring bloodwork is for
During stimulation, clinics track follicle growth with transvaginal ultrasound. Many also draw serum hormones, most often estradiol, along with LH and progesterone, and sometimes FSH or hCG at other points in treatment. Results help the team adjust medication, decide when to trigger final oocyte maturation and watch for over-response.
What the evidence says about hormone monitoring
Before optimizing turnaround, it helps to know which results really need to be fast.
The most recent Cochrane review of cycle monitoring in IVF and ICSI (2021) found no evidence that combining ultrasound with serum estradiol worked better than ultrasound alone for clinical pregnancy rates or the incidence of ovarian hyperstimulation syndrome (OHSS). The number of oocytes retrieved was similar with both approaches. The authors rated the evidence as low quality and said the choice may depend on convenience and cost.
The 2025 ESHRE guideline on ovarian stimulation says adding estradiol, or a combined estradiol, progesterone and LH panel, to ultrasound monitoring is probably not recommended. It also advises against timing the trigger on estradiol levels alone.
The same guideline says measuring serum progesterone on the day of final oocyte maturation is probably recommended in cycles aimed at a fresh embryo transfer. High progesterone is linked with lower ongoing pregnancy and live birth rates, which may inform the transfer plan.
Practice still varies, and many clinics rely on hormone results for dosing and trigger decisions, especially in patients at risk of over- or under-response. The practical lesson is to be deliberate. Know which values drive same-day decisions, and make sure those come back first.
Where the time goes
A monitoring result passes through many hands between the needle and the nurse's phone call:
Blood draw at the clinic or a draw site.
Clotting and centrifugation, if serum is processed on-site.
Holding until courier pickup.
Transport to the lab.
Receipt and accessioning.
Testing on the analyzer.
Result review and release.
Delivery to the clinic's EMR, portal or inbox.
Clinician review and dosing decision.
Patient call or message.
Testing itself is often only a small part of the total. Waiting for a courier, re-keying requisitions, missing STAT flags and hunting for results tend to cost more time than the analyzer.
Eight ways to shorten monitoring turnaround
1. Agree on the decision-driving tests
Review your monitoring orders with your physicians. If some hormones don't change same-day decisions for a given patient, consider leaving them off routine monitoring orders. That's a clinical decision, but fewer tubes usually mean faster processing and less to review.
2. Compress the draw window
Concentrating monitoring draws in a short early-morning window, for example 7 to 9 am, lets the lab batch STAT specimens predictably. It also keeps late arrivals from pushing the whole day back.
3. Match courier pickups to the draw window
Schedule a pickup soon after the draw window closes rather than at a fixed afternoon time. Ask your lab when specimens need to arrive to make the same-day cutoff, and work backward from there.
4. Flag STAT clearly and consistently
Mark monitoring specimens as STAT on every requisition and label, and follow your lab's process for calling them in. Specimens that look routine get handled as routine.
5. Get specimen handling right the first time
Recollections are the slowest result of all. Use the tube types and processing steps your lab requires, label at the bedside and train staff on common rejection reasons, such as hemolysis, mislabeling and an insufficient volume.
6. Use electronic orders and results
An EMR or API connection removes manual requisitions and faxed or emailed results. Results that land directly in the patient chart, flagged when out of range, can be reviewed as soon as they're released.
7. Keep each cycle at one lab
Hormone results from different labs and assays don't always line up, so trends within a cycle are easiest to read when every draw goes to the same lab. The same principle applies to ovarian reserve tests. For example, AMH results vary between assays.
8. Measure turnaround and share it
Track a few simple numbers each week:
Median time from draw to result.
Share of monitoring results back before your dosing-call cutoff.
Recollection rate.
Share them with your lab partner. It's hard to improve what nobody measures.
Questions to ask your lab partner
What time must STAT monitoring specimens arrive to get same-day results, and when will results be released?
Which hormones do you run in-house, and which are sent to another lab?
Is courier pickup available on your schedule, including weekends?
Can results flow directly into our EMR?
What are the specimen requirements and common rejection reasons for each test?
Can the same lab also handle donor eligibility testing, AMH and pre-cycle workups, so the team works with one partner?
How IHDLab supports IVF monitoring
IHDLab is a CLIA-certified lab (CLIA 05D2040304) that works with fertility clinics. For morning draws between 7 and 9 am, we run STAT estradiol, LH, FSH, progesterone and hCG, with results by 2 pm, so your team can make afternoon dosing calls. We offer courier pickup for California clinics, and we deliver results to your EMR, through our API or in a portal. See how it works on our fertility and IVF testing page, and review ordering steps and cutoffs for same-day hormone testing.
Clinics running donor cycles can also send egg and sperm donor panels to the same lab. See our FDA donor testing page.
Sources
Kwan I, Bhattacharya S, Woolner A. Monitoring of stimulated cycles in assisted reproduction (IVF and ICSI). Cochrane Database Syst Rev. 2021.
ESHRE Guideline Group on Ovarian Stimulation. ESHRE guideline: ovarian stimulation for IVF/ICSI, an update in 2025. Hum Reprod.
